ISO 8548-3:2025

Prosthetics and orthotics - Limb deficiencies - Part 3: Method of describing the residual limb after upper limb amputation

This document specifies a method of describing and measuring the residual limb after upper limb amputation. It also defines the measurements required for the provision of a prosthesis.

Prothèses et orthèses — Malformations des membres — Partie 3: Méthode de description du membre résiduel après amputation du membre supérieur

General Information

• Status: Published
• Publication Date: 21-Jan-2025
• ICS: 11.040.40 - Implants for surgery, prosthetics and orthotics
• Technical Committee: ISO/TC 168 - Prosthetics and orthotics
• Drafting Committee: ISO/TC 168 - Prosthetics and orthotics
• Current Stage: 6060 - International Standard published
• Start Date: 22-Jan-2025
• Due Date: 12-Apr-2025
• Completion Date: 22-Jan-2025

Relations

• Revises: ISO 8548-3:1993 - Prosthetics and orthotics - Limb deficiencies - Part 3: Method of describing upper limb amputation stumps
• Effective Date: 06-Jun-2022

Overview

ISO 8548-3:2025 - "Prosthetics and orthotics - Limb deficiencies - Part 3: Method of describing the residual limb after upper limb amputation" specifies a standardized method to describe and measure the residual limb (residuum) following upper limb amputation. The second edition updates terminology (preferring “residual limb”), refines descriptors, and sets out the measurements required for the clinical record and for prosthesis provision. The standard supports consistent documentation across the interprofessional team and enables outcome comparisons, research and epidemiology.

Key Topics and Requirements

• Scope and purpose: Defines what to record about a residual limb and which measurements are required to provide a prosthesis.
• Descriptive categories: Residuum shape (conical, bulbous, cylindrical), soft-tissue amount and consistency, muscle attachment, bony prominences, implants, and contact tolerance.
• Skin and circulation: Skin integrity, sensation, scars and grafts, colour, temperature and oedema descriptors.
• Pain and phantom phenomena: Recording of significant pain, tenderness, phantom sensation and phantom pain with location, intensity (using pain scales), frequency and triggers.
• Joint and muscle function: Range of motion (neutral zero method), muscle strength (manual muscle testing 0–5), selective muscle activation, EMG options, joint stability and proximal joint pain.
• Reference levels and planes: Defined anatomical reference levels (e.g., axilla, medial epicondyle, residual limb end, ulnar/radial styloid) and planes (posterior ulnar plane, cubital fold plane) for consistent measurement locations.
• Measurements: Specifies which length, circumference and width measurements to record for each amputation level and that the contralateral limb should have minimal dimensional description. The document does not mandate the measurement technique itself.
• Team responsibilities: Differentiates measurements for the interprofessional rehabilitation team (doctors, prosthetists, physical/occupational therapists, nurses) and additional prosthetist-only measurements.

Applications and Users

Who uses ISO 8548-3:2025:

• Prosthetists - for socket design and prosthesis fitting by using standardized residual limb measurements.
• Surgeons and clinicians - to document post-amputation limb status and guide rehabilitation.
• Physical and occupational therapists - to assess joint/muscle function and plan therapy.
• Nurses and wound-care specialists - to monitor skin, scars and circulation.
• Researchers, epidemiologists and health authorities - for comparable outcome reporting and surveillance data.

Practical benefits:

• Improves consistency in clinical records and prosthesis fabrication.
• Facilitates interprofessional communication and longitudinal tracking.
• Supports research and quality assurance in upper limb amputation care.

Related Standards

• ISO 8549-1: Vocabulary - General terms for external limb prostheses and orthoses
• ISO 8549-2: Vocabulary - Terms relating to external limb prostheses
• ISO 8549-4: Vocabulary - Terms relating to limb amputation

Keywords: ISO 8548-3:2025, prosthetics and orthotics, residual limb measurement, upper limb amputation, prosthesis provision, residual limb descriptors, interprofessional team.

Standards Content (Sample)

International
Standard
ISO 8548-3
Second edition
Prosthetics and orthotics — Limb
2025-01
deficiencies —
Part 3:
Method of describing the residual
limb after upper limb amputation
Prothèses et orthèses — Malformations des membres —
Partie 3: Méthode de description du membre résiduel après
amputation du membre supérieur
Reference number
© ISO 2025
All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may
be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting on
the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address below
or ISO’s member body in the country of the requester.
ISO copyright office
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CH-1214 Vernier, Geneva
Phone: [phone]
Email: [e-mail]
Website: www.iso.org
Published in Switzerland
ii
Contents Page
Foreword .iv
Introduction .v
1 Scope . 1
2 Normative references . 1
3  Terms and definitions . 1
4 Description . . 1
4.1 General .1
4.2 Characteristics.1
4.3 Skin .2
4.4 Circulation .2
4.5 Pain .2
4.6 Phantom sensation and phantom pain .2
4.7 Joint and muscle function.2
4.7.1 Measurement of the range of joint movement .2
4.7.2 Assessment of the residual limb muscle strength .3
4.7.3 Assessment of residual limb muscle activity .3
4.7.4 Assessment of joint stability .3
4.7.5 Assessment of joint pain .3
4.7.6 Assessment of hand function .3
5 Measurements of the residual limb . 3
5.1 Reference levels and reference planes.3
5.2 Measurements . .4

iii
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards
bodies (ISO member bodies). The work of preparing International Standards is normally carried out through
ISO technical committees. Each member body interested in a subject for which a technical committee
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with the International Electrotechnical Commission (IEC) on all matters of electrotechnical standardization.
The procedures used to develop this document and those intended for its further maintenance are described
in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the different types
of ISO document should be noted. This document was drafted in accordance with the editorial rules of the
ISO/IEC Directives, Part 2 (see www.iso.org/directives).
ISO draws attention to the possibility that the implementation of this document may involve the use of (a)
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rights in respect thereof. As of the date of publication of this document, ISO had not received notice of (a)
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Any trade name used in this document is information given for the convenience of users and does not
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For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and expressions
related to conformity assessment, as well as information about ISO's adherence to the World Trade
Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www.iso.org/iso/foreword.html.
This document was prepared by Technical Committee ISO/TC 168, Prosthetics and orthotics.
This second edition cancels and replaces the first edition (ISO 8548-3:1993), which has been technically
revised.
The main changes are as follows:
— in line with changes in ISO 8549-4, the remaining part of the limb is referred to using the preferred term
“residual limb”, or residuum, as opposed to “stump”;
— the residual limb descriptors have been revised;
— the lists of measurements to be taken by all members of the interprofessional team (doctors, prosthetist,
physical, and occupational therapists, nurses) and the additional measurements to be taken only by the
prosthetist have been revised;
— the use of hyphens in anatomical terms, such as transradial, has been removed in line with other parts
of the ISO 8549 series.
A list of all parts in the ISO 8548 series can be found on the ISO website.
Any feedback or questions on this document should be directed to the user’s national standards body. A
complete listing of these bodies can be found at www.iso.org/members.html.

iv
Introduction
This document provides all members of the interprofessional team (doctors, prosthetists, physical and
occupational therapists, nurses) treating the person with a method for describing and measuring the
residual limb after upper limb amputation.
A standardized method allows comparisons of the outcomes of amputation surgery and rehabilitation.
Such a method is also of value to epidemiologists, government health officials, and for those researching and
reporting on prosthetic use.
v
International Standard ISO 8548-3:2025(en)
Prosthetics and orthotics — Limb deficiencies —
Part 3:
Method of describing the residual limb after upper limb
amputation
1 Scope
This document specifies a method of describing and measuring the residual limb after upper limb
amputation. It also defines the measurements required for the provision of a prosthesis.
2 Normative references
The following documents are referred to in the text in such a way that some or all of their content constitutes
requirements of this document. For dated references, only the edition cited applies. For undated references,
the latest edition of the referenced document (including any amendments) applies.
ISO 8549-1, Prosthetics and orthotics — Vocabulary — Part 1: General terms for external limb prostheses and
external orthoses
ISO 8549-2, Prosthetics and orthotics — Vocabulary — Part 2: Terms relating to external limb prostheses
ISO 8549-4, Prosthetics and orthotics — Vocabulary — Part 4: Terms relating to limb amputation
3  Terms and definitions
For the purposes of this document, the terms and definitions given in ISO 8549-1, ISO 8549-2 and
ISO 8549-4 apply.
ISO and IEC maintain terminology databases for use in standardization at the following addresses:
— ISO Online browsing platform: available at https:// www .iso .org/ obp
— IEC Electropedia: available at https:// www .electropedia .org/
4 Description
4.1 General
Specify the amputation side and describe the residual limb using the relevant descriptors listed in Tables 1
to 7 and in 4.2 to 4.6.
4.2 Characteristics
The shape of the residual limb shall be described as either conical, bulbous or cylindrical.
The soft tissues of the residual limb shall be described by reference to their amount and consistency.
The amount shall be described as sufficient, insufficient or excessive and the consistency described as
normal, firm or flaccid.
It should be recorded whether the residual limb musculature is attached, detached or displaced.
Relevant bony features such as prominences, remnants, length or position shall be described.
The presence of any prominent foreign bodies, e.g. implants, shrapnel, shall be noted. The ability of the
residual limb-end to tolerate contact shall be recorded.
For partial hand amputations, record the level of amputation as specified in ISO 8549-4. The complete
description shall include the identification of the amputated bones and their level of amputation.
4.3 Skin
It should be noted whether the skin barrier is intact or not and whether the skin has normal sensation.
The position/orientation of the incisional scar and whether it is healed or not and mobile or adherent shall
be recorded. Additionally, the presence and condition of other scarring or skin grafting shall be noted.
Any history of skin pathology e.g. dermatitis, skin allergy and/or hyperhidrosis that can affect the residual
limb and prosthetic fitting shall be noted.
4.4 Circulation
The factors concerning the circulation which shall be described are colour, temperature and oedema.
The skin shall be described as either normal in colour, cyanotic or otherwise discoloured.
The skin shall be described as either normal in temperature or hot or cold to examination.
The presence of excessive oedema shall be noted. Excessive oedema is considered as that which would
adversely affect healing of the residual limb or prosthetic fitting and use.
4.5 Pain
Significant pain is regarded as that which is greater than expected at the stage of treatment.
The presence of significant pain or tenderness from whatever source, (e.g. painful neuroma, pain after
exercise or from prosthetic use) shall be recorded using an appropriate pain scale.
The location of pain and what modulates and elicits the pain shall be recorded.
4.6 Phantom sensation and phantom pain
Phantom sensation and phantom pain are felt as if in the amputated part of the limb. Phantom sensation is
common after amputation.
The capacity to perceive movement of the phantom limb shall be noted as well as the perceived resting
position of the phantom limb.
Phantom pain varies in intensity and shall be recorded using an appropriate pain scale.
The location of pain and what modulates and elicits the pain shall be recorded.
4.7 Joint and muscle function
4.7.1 Measurement of the range of joint movement
Abnormalities of the range of joint movement in the proximal joint(s) of the residual limb shall be recorded
using the neutral zero method in which zero is the anatomical position.

4.7.2 Assessment of the residual limb muscle strength
Reduced strength of the muscle groups responsible for producing movements at the proximal joint(s) of the
residual limb shall be recorded using the manual muscle testing 0 to 5 scale.
Surface electromyography (EMG) testing of the muscles may be conducted.
4.7.3 Assessment of residual limb muscle activity
The ability to selectively activate the muscles of the residual limb shall be recorded.
Surface EMG testing of the muscles of the residual limb may be conducted.
4.7.4 Assessment of joint stability
Instability of the proximal joint(s) of the amputated limb that is a consequence of bony or ligamentous
impairments should be recorded.
4.7.5 Assessment of joint pain
Pain in the proximal joint(s) including the cervical spine shall be recorded.
4.7.6 Assessment of hand function
In partial hand amputation, the grasp and pinch patterns present and functional use of the hand shall be
recorded.
5 Measurements of the residual limb
5.1 Reference levels and reference planes
Identify the reference levels and planes relevant to the level of amputation as described in 5.1.1 and 5.1.2
preferably with the patient standing erect and with the residual limb hanging unconstrained.
5.1.1 Reference levels.
5.1.1.1 Axilla level — the most proximal level at which a circumferential measurement, perpendicular to
the centre line of the upper arm, can be obtained.
5.1.1.2 Medial epicondylar level — the level of the medial epicondyle of the humerus.
5.1.1.3 Residual limb end level — the level of the end of the remining limb.
5.1.1.4 Ulnar styloid level — in wrist disarticulation only, the level of the tip of the ulnar styloid.
5.1.1.5 Radial styloid level – in wrist disarticulation and partial hand amputations, the level of the tip of
the radial styloid.
5.1.1.6 Thumb tip level – the level of the tip of the thumb.
5.1.1.7 Bone end level — the level of the bone end in transhumeral and transradial amputations.
5.1.1.8 Minimum circumferential level — in disarticulation only, the level of the minimum
circumferential measurement.
5.1.1.9  Inflection level – In transhumeral and transradial amputations only, the level on the residuum at
which the shape changes as it curves in towards the end.
5.1.2 Reference planes.
5.1.2.1 Posterior ulnar plane — the plane of the posterior aspect of the shaft of the ulna, parallel with
the centre line of the forearm when the elbow is flexed at 90°.
5.1.2.2 Cubital fold plane — the plane perpendicular to the centre line of the forearm at the level of the
anterior elbow crease with the elbow flexed at 90°.
5.2 Measurements
This document does not specify the method to be used to obtain the measurements.
It specifies both the measurements taken by the team responsible for the rehabilitation of the person and
those taken by the prosthetist responsible for the provision of a prosthesis.
To relate the description of the residual limb to the person as a whole, the contralateral upper limb shall
have some minimal measurement dimensional description.
Measure and record the length, circumference and width measurements as specified in Table 8 and
illustrated in Figures 1 to 4 for the level of amputation.
If the contralateral arm is the site of an amputation, state the level.
The posture of the person in which the measurements are taken shall be recorded.
Tables 1 to 7 list the descriptors for documentation for each upper limb amputation level.
Table 1 — Descriptors for recording scapula-thoracic amputation (see Table 8 a)
Descriptor Statements to be recorded
Residuum characteristics
Scapular remnant Present/absent
Position normal/abnormal
Clavicular remnant Present/absent
Position normal/abnormal
Soft tissues of the residuum
Amount Sufficient/insufficient/excessive
Consistency Normal/firm/flaccid
Skin
General Skin barrier intact/not intact
Sensation normal/impaired
Incisional scar Healed/unhealed
Mobile/adherent
Normal/excessive soft tissue
Additional scarring or grafting Mobile/adherent
Pathology Inflammatory conditions (specify)
Circulation
Colour of skin Normal/cyanotic/other discolouration
Skin temperature Normal/hot/cold
Oedema None/present/excessive
TTabablele 1 1 ((ccoonnttiinnueuedd))
Descriptor Statements to be recorded
Pain and phantom sensation/pain
Pain Absent/present
Location, intensity (pain scale score), frequency and
duration
Tenderness Absent/present
Location
Phantom pain Absent/present
Location, intensity (pain scale score), frequency and
duration
Condition which elicits pain (specify)
Phantom sensation Absent/present
Location
Perception of movement No/yes
Specify perceived resting position
Table 2 — Descriptors for disarticulation (see Table 8 a)
Descriptor Statements to be recorded
Residuum characteristics
Upper humeral remnant Present but not prominent/present and prominent/absent
Soft tissues of the residuum
Amount Sufficient/insufficient/excessive
Consistency Normal/firm/flaccid
Skin
General Skin barrier intact/skin barrier not intact
Sensation normal/sensation impaired
Incisional scar Healed/unhealed
Additional scarring or grafting Mobile/adherent
Pathology Inflammatory conditions (specify)
Circulation
Colour of skin Normal/cyanotic/other discolouration
Skin temperature Normal/hot/cold
Oedema None/present/excessive
Pain and phantom pain/sensation
Pain Absent/present
Location, intensity (pain scale score), frequency and duration
Tenderness Absent/present
Location
Phantom pain Absent/present
Location, intensity (pain scale score), frequency and duration
Condition which elicits pain (specify)
Phantom sensation Absent/present
Location
Perception of movement No/yes
Perceived resting position (specify)
Joint and muscle function
Residuum muscle selective Yes/no
activation
Table 3 — Descriptors for transhumeral amputation (see Figure 1 and Table 8 b)
Descriptor Statements to be recorded
Residuum characteristics
Shape Cylindrical/conical/bulbous/irregular
Humerus:
Length Short (proximal third)/medium (middle third)/long (distal third)
Prominence Not prominent/prominent
End shape Describe
Foreign bodies (e.g. implants) Absent/present (specify)
Distal end contact tolerance Yes/no
Soft tissue coverage Sufficient/insufficient/excessive
Consistency Normal/firm/flaccid
Muscle attachment Attached/detached/displaced
Skin
General Skin barrier intact/skin barrier not intact
Sensation normal/sensation impaired
Incisional scar Healed/unhealed
Additional scarring or grafting Mobile/adherent
Pathology Inflammatory conditions (specify)
Circulation
Colour of skin Normal/cyanotic/other discolouration
Skin temperature Normal/hot/cold
Oedema None/present/excessive
Pain and phantom pain/sensation
Pain Absent/present
Location, intensity (pain scale score), frequency and duration
Tenderness Absent/present
Location
Phantom pain Absent/present
Location, intensity (pain scale score), frequency
...