With the addition of a shoulder joint, this level incorporates all the parts of a Transhumeral level. Body or externally powered (including myoelectric), oppositional and activity based devices can be fit under certain patient characteristics. External powered controls or a hybrid of controls tend to provide better functional results at these high amputation levels. Experience and expertise in fitting as well as attainment of appropriate function are key elements for positive results. Suspension is achieved using a harness system.