Guide to the Americans with Disabilities Act for Hand and Upper Extremity Surgeons: Understanding Patient Experiences and Legal Challenges Associated with Upper Extremity Prosthetics

Background: The Americans with Disabilities Act (ADA) safeguards individuals with disabilities, including those related to upper extremity mobility, from discrimination. This study investigates the nature of ADA complaints initiated by individuals with upper extremity prosthetic devices. Objectives: The purpose of this study is to provide hand and upper extremity surgeons with valuable insights into the ADA and its relationship with patient care. Study Design: Retrospective descriptive legal database review. Methods: The Westlaw Campus Research legal database was searched for all cases involving clients with finger, hand, and arm prostheses. Cases were included if at least one plaintiff with an upper extremity prosthesis initiated an ADA complaint related to their prosthesis. No limitation was placed on whether the prosthesis was functional or for cosmetic purposes. Characteristics of each case were collected, including the location where the case was initiated, the type of ADA complaint, plaintiff and defendant demographics, and case outcomes. Descriptive statistics were calculated. Results: After removal of duplicates, 557 cases were identified, of which 16 cases met inclusion criteria. Most prosthesis-wearers were male (N = 13, 81.3%), and only one case involved a pediatric client. The alleged discrimination most commonly took place in the workplace (N = 12, 75%), followed by correctional facilities (N = 2, 12.5%), an amusement park (N = 1, 6.3%), and a housing authority (N = 1, 6.3%). Defense-favorable outcomes occurred in 66.7% of cases with a physician’s opinion versus 28.6% of those without. Conclusions: Hand and upper extremity surgeons should strengthen their understanding of ADA protections to better counsel patients using prostheses and support advocacy for workplace rights. Clinical Relevance Statement: An understanding of the ADA as it applies to individuals with upper extremity prostheses may help clinicians provide more effective functional documentation, support workplace accommodations, and counsel patients regarding disability-related discrimination and advocacy resources. ( J Prosthet Orthot . 2026;X:XX–XX)