Note: Descriptions are shown in the official language in which they were submitted.
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SHOULDER STRETCHER AND METHOD OF USE
FIELD OF INVENTION
[0001] The invention relates generally to a device for use in rehabilitation
of the shoulder
of a human, in particular to address tightness of the posterior capsule of the
glenohumeral
joint, i. e. , the human shoulder.
BACKGROUND OF INVENTION
[0002] Tightness of the posterior capsule of the glenohumeral joint is a
common problem
that occurs secondary to a minor shoulder problem. It is a significant problem
to athletes
who throw, to post-operative patients having had shoulder surgery and to
people who suffer
from impingement syndrome of the shoulder, the most common source of shoulder
pain.
[0003] Devices and methods for shoulder stretching are known. For example,
United
States Patent 5,520,615 ("the `615 patent") describes a pulley system included
in a self-
assertive shoulder stretching and rotation machine wherein a supine person's
forearm is
secured to a forearm support that is attached to a horizontal support movable
by the supine
person's pulling on a rope. United States Patent 6,007,500 ("the `500 patent")
describes a
belt and pulley system included in a rotator cuff stretching machine with
pivoting members
that provide for simultaneously stretching of the rotator cuff, shoulder and
elbow in selective
upper arm positions of yaw and pitch angles and selective elbow positions of
flexion or
extension. The `500 patent machine includes upper and forearm assemblies that
are pivotably
joined through a bearing assembly and requires the patient to sit upright. The
assembly has a
rotational capacity of 360 degrees and is attached to a vertical support that
rotates in
horizontal yaw on a vertical yaw pivot pin. United States Patent 6,569,067
("the `067
patent") describes a device that elevates the elbow off of the torso and
abducts the arm for
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rehabilitating the shoulder. It includes a first C-shaped member for
supporting the extremity
of the patient and a second C-shaped member for engaging the torso of the
patient.
SUMMARY OF INVENTION
[0004] The shoulder stretcher and methods of use described herein provide the
first
known device that functions to permit, without a physical therapist or other
assistant,
posterior capsular stretching of the human shoulder through use of a
mechanical ratcheting
device. The device includes a base or rigid support, an arm strap, and a lever
arm that is
rotatably fastened to the base, and preferably includes a ratcheting mechanism
that prevents
reverse rotation except upon operation of a ratchet release. The mechanical
stretching device
functions to stretch human shoulders and is preferably for use in shoulder
rehabilitation and
prevention of posterior capsular tightness and capsulitis. It can be used for
self-stretching by
a patient, and preferably incorporates a dial type ratcheting mechanism for
staged stretching
of the shoulder. It can be used for posterior capsule stretching and in its
reverse position or
orientation can be used for external rotation stretching. The shoulder
stretching apparatuses
and methods described herein function to provide for progressive stretching of
the shoulder
joint in both internal and external rotation. The apparatus provides a person
with the
capability to maximally stretch the shoulder without an assistant or therapist
while slowly
advancing range of motion in a desired plane. It allows the person to
gradually advance the
rotation of his or her shoulder capsule through a home therapy program. These
functions and
capabilities are accomplished by a strap system that stabilizes the arm and
elbow to a firm
platform while the forearm is progressively advanced in the desired direction
of shoulder
rotation by means of a lever arm. In one embodiment the ratcheting mechanism
allows for
forward stretching of the forearm without the ability to reverse or go
backwards unless a
release mechanism is activated. The structure of this embodiment provides the
user with the
ability to stretch his or her shoulder joint over an extended period and at
his or her own pace.
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[0005] During use in stretching the injured shoulder's forearm is positioned
adjacent to,
or rested against the lever arm, and the user's forearm is strapped to or
otherwise stabilized to
the lever arm. The user's upper arm is strapped or otherwise stabilized to the
base. Then the
device's lever arm and the user's forearm are preferably advanced, or rotated
preferably by
the patient's other arm. As the forearm of the injured shoulder is advanced,
the ratchet
mechanism clicks and holds its place with each advancing increment of rotation
to prevent
backward or reverse motion of the forearm. The patient can stop the rotation
at any
increment or increments of rotation to rest the shoulder at a desired degree
or increment of
rotation and stretching. After each rest period, the patient can then continue
the sequence of
rotation, rest; rotation, rest, etc., until a desired degree of stretching is
reached for a given
exercise or therapy session. During this sequential series of motions and
rests the arm strap
holds or stabilizes the patient's upper arm to the base, so that that shoulder
does not lift off of
the base. Thus, during use the arm strap secures the patient's arm to the base
in order to
prevent the upper arm from lifting off of the base, as the forearm strap is
advanced toward the
base. Once the shoulder has been stretched adequately, or at any other time
during the
therapy session, a ratchet release actuator can be pressed or otherwise
activated to release the
ratchet. Releasing the ratchet mechanism permits reverse rotation, or
backwards movement
of the lever arm. The ratchet mechanism and lever arm preferably permit 180
of rotation of
the lever arm/forearm rest. Thus, the device may be used for right and left
shoulder
rehabilitation, and for progressive, staged stretching of the shoulder at a
pace and to the
extent desired by the patient.
[0006] These and other embodiments, features, aspects, and advantages of the
invention
will become better understood with regard to the following description,
appended claims and
accompanying drawings.
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BRIEF DESCRIPTION OF THE DRAWINGS
[0007] The foregoing aspects and the attendant advantages of the present
invention will
become more readily appreciated by reference to the following detailed
description, when
taken in conjunction with the accompanying drawings, wherein:
[0008] Figure 1 is a perspective view of a preferred embodiment shoulder
stretcher;
[0009] Figure 2 is a perspective view of the Figure 1 embodiment in reverse
orientation;
[0010] Figure 3 is a top view of the stretcher as shown in Figure 2;
[0011] Figure 4 is a front view of the stretcher as shown in Figure 2;
[0012] Figure 5 is a side view of the stretcher as shown in Figure 2;
[0013] Figure 6 is a view of the ratchet mechanism of the Figure 1 embodiment
with the
housing shown in dashed lines to expose the interior ratchet mechanism;
[0014] Figure 7 is a view of the Figure 1 embodiment including a drawing of a
user as
would be orientated during a shoulder stretching operation; and,
[0015] Figure 8 is a view of an alternate embodiment showing a lever arm that
includes a
forearm rest.
[0016] Reference symbols or names are used in the Figures to indicate certain
components, aspects or features shown therein. Reference symbols common to
more than
one Figure indicate like components, aspects or features shown therein.
DETAILED DESCRIPTION
With reference to Figures 1-8 preferred embodiments of the mechanical shoulder
stretcher device and methods of their use will be described. Shoulder
stretcher 20 includes a
base or rigid support 22, arm strap 24, elbow strap 26, lever arm 30, ratchet
mechanism 32
and ratchet release actuator 34. Shoulder stretcher 20 functions to stretch
the posterior
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capsule without need for a physical therapist or other assistant. In other
words, the person
with the injured shoulder, i.e., the patient, can operate the device by
himself or herself. The
attendant advantages to such a self-use device include more flexibility in
scheduling therapy
sessions, reduced costs, and increased number of therapy sessions because no
appointment
with a physical therapist is needed. The shoulder stretcher 20 is intended to
be used for
shoulder rehabilitation and prevention of posterior capsular tightness or
capsulitis, i.e.,
inflammation of the shoulder capsule.
[0017] Base 22 is preferably a padded board and functions to provide a stable
platform
for the user's torso. The board need not be padded. While the board shown in
the Figure 1
embodiment is generally rectangular, having a longitudinal centerline 21, it
may be of
virtually any shape, and be made of virtually any material so long as it
provides a platform
sufficiently stable to facilitate stretching of the shoulder in accordance
with the methods of
stretching described herein. Also, the size of the board may vary, in
accordance with the size
of the user, i.e., a relatively small board for a small user such as a child,
and a relatively large
board for a larger user, such as a professional basketball, football or
baseball player.
The arm strap or belt 24 is preferably a conventional strap that may be made
of
leather, natural fibers or synthetic material. The arm strap 24 preferably
extends from two
slots in the base that are preferably equidistant from the centerline 21 and
functions to
provide a firm, stable securing of the patient's upper arm to the base 22 with
sufficient
restraining force to prevent the upper arm from lifting off of the patient's
proximal shoulder
during use of the device. By the term upper arm is meant that part of the arm
surrounding the
humerus bone. Preferably a single strap is used, and the strap is of a
sufficient width and
placed in a position on the base so that during use it functions to hold the
upper arm, from the
distal end of the humerus bone to the proximal end of the humerus bone in a
fixed position on
or near to the base. Preferably the arm strap and the slots are constructed
and adapted to be
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capable of movement long the centerline 21 to accommodate arms of different
lengths. This
allows for variations in size of the patients' arm length between the elbow
and the shoulder.
During use it is important that this strap be tightened enough to hold down
the shoulder/upper
arm so that the shoulder touches the base during use of the device, or
alternatively, holds the
shoulder/upper arm close to the base during use of the device. When patient's
the arm is
stretched in this device it has a tendency to rise superiorly, and thus the
arm strap functions to
prevent this rise. As will be apparent to those skilled in this art, one or
more arm straps may
be used. Also, various materials of construction may be used, such as for
example, leather,
natural fiber cloth, and synthetic materials.
[0018] The arm strap preferably has Velcro brand or some other brand of loop
and hook
type fastener to maintain the strap in a tightened position. Alternatively,
other conventional
belt- fastening devices may be used. The arm strap 24 may be made of virtually
any material
and may be fastened in a tight position with virtually any type of fastener,
including a
conventional knot, so long as the strap is capable of functioning for its
intended purpose.
Optionally, the device may be made to have the arm strap positionable at
various locations
along centerline 21, as shown in Figure 3. Such a construction is believed to
be within the
skill of a person of ordinary skill in this field, and could include,
optionally, for example
relatively long slots 44, 46 that would extend in the same direction as line
21, but of course
be longer than the slots 44, 46 illustrated in Figure 3. Use of such a
positionable arm strap
would of course enable a single device to be used by patients of a wide range
of sizes.
[0019] As shown in Figures 1-5 and 7-8, a second strap 26 also provides for
holding the
upper arm down on or near to the base during operation. As shown here the
second strap 26
operates primarily on the distal end of the upper arm for the injured
shoulder. Second arm
strap 26 is preferably a conventional strap, much like the first arm strap 24,
and is used to
secure the elbow and lower part of the upper arm to the base during use. In
one embodiment
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the second arm strap 26 is preferably provided with a reinforcing frame 28
having opposed
sides that are equidistant from the centerline 21, and that function to
provide additional
structure to secure the patient's elbow to the base so that the elbow does not
lift off the base
during use. As described above, use of two arm straps is optional. In one
embodiment, a
single arm strap may be used so long as it functions to restrain movement of
the shoulder
away from the base during operation of the device.
[0020] Telescoping lever arm 30 includes at one end a handle and at its other
end a
connection to the axle of ratchet mechanism 32. The axle extends along the
centerline 21, at
a relatively short distance above the centerline 21, and provides an axis of
rotation for the
ratchet mechanism 32 and lever arm through planes that are perpendicular to
the axis of
rotation. In Figures 1, 3 and 4 a plane through which the lever arm rotates is
shown as plane
A, and the plane through which the ratchet wheel or gear rotates is shown as
plane B. Planes
A and B are generally perpendicular to the plane in which the base 22 lies and
they are also
generally perpendicular to the axis of rotation of the ratchet mechanism. As
may be
appreciated, the plane in which the ratchet mechanism rotates, plane B, is
parallel to the plane
in which the lever arm rotates, i.e., plane A. The conventional telescoping
arm provides for
and accommodates a range of arm lengths. The handle extends back toward the
patient and
during use of the device may be gripped by the patient's hand or used as a
support for the
patient's hand, either front side or back side. With reference to Figures 6
and 8, the ratchet
mechanism includes a gear or toothed wheel positioned inside of a housing and
fastened
about the axle for rotation in either the clockwise direction or
counterclockwise direction. A
U-shaped brake 44 is rotatingly attached to one side of the housing, and
extends exterior to
the housing in the form of a release and reverse lever 34. As shown in Figure
6, the lever 34
operates as a brake against rotation in a clockwise direction. By rotating the
lever 34 in a
clockwise direction the brake 44 is also rotated clockwise to a position
against the whee142
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at which it operates as a brake against counterclockwise direction. The
housing is fastened to
the base via conventional fasteners 36, such as screws, rivets, staples,
nails, glue or any other
means so long as they function to keep the housing fastened to the base.
Figure 7 illustrates
the positioning of a user's body, particularly the shoulder, upper arm,
forearm and hand in
relation to the various parts of the shoulder stretcher mechanism.
[0021] As shown in Figure 8, the device may be provided with an optional
forearm rest
48 positioned on the lever arm 30. The forearm rest functions to provide a
stable support for
the forearm. The end of the lever arm 30 distal from the ratchet mechanism 32
is formed into
a "U" shape, with the closed end of the "U" forming a handgrip 50. The
handgrip may be
made of any of a variety of materials, such as cloth, a rubber or elastomeric
material, or an
absorbent material. A sling 52 is positioned on the legs of the "U" and
extends between the
"U" to form and function as a forearm rest. A strap 54 is preferably fastened
to one of the
legs of the "U" and extends across, and is attachable at the opposite let of
the "U". The strap
54 functions to provide a restraint for the forearm in one direction of
rotation, and as the
forearm rest in the opposite direction of rotation. The strap 54 is preferably
fastened to one
leg with a hook and loop type fastener. Various types of materials may be used
for, and
various techniques may be used to fasten the forearm sling and forearm strap
to the lever arm
30. In yet another alternate embodiment, the lever arm may be in the form of a
horseshoe
with elongated legs of the same length, the distal ends of which are fastened
to the axle of the
ratchet mechanism. In this alternate embodiment webbing, a solid surface or
some other
material extends between the elongated legs and then along the length of the
lever arm to
function as a forearm rest or support. The elongated horseshoe lever arm may
also be of a
telescoping design capable of adjustment to accommodate arms of different
length.
[0022] The shoulder stretcher is designed to address tightness of the
posterior capsule of
the glenohumeral joint (shoulder) that is an extremely common problem that
occurs
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secondary to a minor shoulder problem. It is a real problem in throwing
athletes, post-
operative patients, and patients with a diagnosis of impingement syndrome of
the shoulder,
the most common source of shoulder pain. The shoulder stretcher is designed
primarily for
posterior capsule stretching, although it also could be used for internal
stretching simply by
reversing the orientation of the user with respect to the device during use.
During use the
patient lies on the side of the pathology, and then straps the arm into the
device. Next, using
the ratchet mechanism, the arm is bent towards the floor in the vicinity of
the hip on the same
side of the shoulder problem. This bending is in general a rotation with the
upper arm as the
axis of rotation, and with the upper arm extending in general along the base
centerline 21.
Thus, in general the axis of rotation of the upper arm and the axis of
rotation of the ratchet
mechanism are parallel, and as shown in Figure 1 preferably would also be
parallel to the
centerline 21. The device is designed primarily for rotation in one direction
that stretches the
posterior capsule. The reason for 180 degrees of motion is to allow for right
or left use with
the same unit. Thus, for each arm the device can be rotated in the clockwise
direction as well
as in the counterclockwise direction. For example, as shown in Figure 7 the
user's right arm
is positioned for rotation in the counter-clockwise direction, so that
posterior capsule
stretching takes place during the rotation. When the device is used on the
left arm, the
direction of rotation is clockwise for posterior capsule stretching. When
during use the right
arm is rotated in the clockwise direction the interior stretching takes place.
[0023] When stretching the shoulder with this devise, the patient lies on the
platform or
base, preferably padded and made of a plastic material, then turns on the side
of the injured
shoulder. The strap (or straps if more than one strap is used) is placed
across the arm
between the elbow and the shoulder is tightened sufficiently to prevent the
upper arm from
lifting up or rising during rotation of the arm of the user and lever arm of
the device. The
optional forearm rest, if used, provides a surface on which the forearm rests
while the hand
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grips the handgrip of the lever arm for support. The patient then uses the
other arm to pull or
rotate the lever arm and arm towards the floor adjacent to the hip. As the
forearm rest
advances or rotates incrementally toward the floor, as each increment of
rotation is
accomplished, the ratchet mechanism prevents reverse rotation of the forearm
rest back
toward its starting position. With this ratcheting capability, the patient can
sequentially rotate
the arm to a first desired rotational position, then stop and rest the
shoulder with the lever arm
locked in that position. After resting a desired period, the patient can
resume rotation until a
second desired rotational position is achieved, and again stop rotation to
rest the shoulder.
The patent can then continue the sequence of rotation, rest, rotation, rest,
rotation, etc., until a
final desired position of stretching is achieved for a given therapy session.
Then the patent
can release the ratchet, so that the lever arm and patient's arm can be
reverse rotated back to
the starting position.
[0024] By this sequential action and motion, the patient sequentially
stretches the
posterior capsule and holds it in a stretched position. The user rotates the
lever arm to a
position that can be tolerated, and then waits for the shoulder to stretch.
After a while, the
shoulder is stretched and the user can advance, or further rotate the level
arm, and the
attached forearm of the user to further stretch the shoulder. This cycle or
sequence of
rotation, rest; further rotation, rest; further rotation, etc., takes place
for a desired number of
times at the choice of the user during each session. The user also chooses the
number of
sessions, preferably under the direction of his or her treating physician. The
sessions and
stretching operations are continued until the shoulder capsule has been
stretched sufficient to
return the shoulder to normal ranges of motion, or otherwise to a position of
acceptable
stretching for that particular patient. During each stretching session, once
the shoulder has
been stretched adequately, or to some desired position of rotation for that
session, the release
button is pressed to release the ratchet brake, and to permit reverse rotation
of the forearm
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rest and the ratchet mechanism to their original, starting positions. Thus,
the patient may
gradually and progressively stretch his or her shoulder joint in both internal
and external
rotation.
[0025] Although specific embodiments of the invention have been described,
various
modifications, alterations, alternative constructions, and equivalents are
also encompassed
within the scope of the invention.
[0026] The specification and drawings are, accordingly, to be regarded in an
illustrative
rather than a restrictive sense. It will, however, be evident that additions,
subtractions,
deletions, and other modifications and changes may be made thereunto without
departing
from the broader spirit and scope of the invention as set forth in the claims.
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