Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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This invention relates to hand support and po~itioning
device for medical purposes. It is an object of the invention to
provide a hand support stand ~uitable for surgical use including
operative and post operative applications, in particular it is an
object of this invention to provide an adjustable hand support
and positioning device whereby the hand-wrist-forearm angular
relationship may be varied.
With these objects in view a wrist and hand posi~ioning
device i~ provided for maintaining wrist and fingers in different
degrees of flexion and extension in relation to the forearm as
reguired during surgery, for pre- and post-surgical management of
hand injury patients.
DESCRIPTION OF PRIOR ART
U.S. Patent 1,789, 060, to Weisenbach, shows an adjustable
articulated bone splint.
U.8. Patent 2,091,643, to Longfellow, shows a device for
permanently fixing an arm surgically in splinting position, and
is thereafter left in place on the patient, this device includes
an adju~table arm support of the brace type.
U.S. Patent 2,767.708, to Reropian, shows an orthopaedic
hand brace, which is designed to remain on the hand during
movement. It provides support me~bers for forearm, palm,
proximal and medial finger portions, and is a splint rather than
a support device.
U.S. patent 3,087,489, to Gilbert, shows a traction device
with brace like features. It is portable, and adjustable and
includes a stand element.
U.S. Patent 3,526,006, to Beardmore, teaches a two part
articulated splint having arm and hand engaging members, and a
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support to enable the splint to be put on or off. ;
U.S. Patent 3,877,424, to Murray, shows a unitary external
bridge for b~ne fix~tion, similar to that of Weisenbach.
U.S. Patent 4,258,708, to Gentile, shows an articulated
external bridge for bone fixation, joined by inter engaging
means.
U.S. Patent 4,273,116, to Chiquet, shows a unitary external
bridge for bone fixation, having adjustable pin clamps.
U.S. Patent 4,730,801, to Cloward, shows a surgical arm rest
having upper and lower arm support channels which are relatively
angular adjustable, and a hand cushion.
Leftwich teaches a hand or arm rest having a wooden base
hingedly attached at one end to a wooden arm support, an
adjustable metal support allows angular variation between base
and arm support. A hand position support is provided adjustable
lengthwise of the arm support.
U.S. Patent 4,858,903 to ~abor and Laszio shows a hand
surgery operating table consisting of a forearm support, a hand
support; and upto seven flexible and tensionable arms secured at
one end to the base plate and carrying finger-fixing thimbles at
the other end. The tension of the arms can be adjusted to any
desired extent so that they can either maintain their tensioned
fixed position or they can be readily displaced therefrom without
having to manipulate their tensioning mechanism.
BACKGROUND OF INVENTION
An astounding number and proportion of industrial and other
accidents are hand injuries of one kind or another, nearly all of
which require medical treatment of some kind, generally surgical
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in nature.
In operative and post-operative treatment of the hand, it is
often necessary to maintain the wrist and fingers in various
degrees of flexion and or extension dependent on the type of
injury and the repair of tissues at surgery. This angular
position is essential to facilitate healing of the repaired
tissues and is called as the "protective" position. The angular
position of the wrist and the hand is established immediately
after surgery in the operating room by means of Plaster of Paris
and bandages, which is also termed as "bulky dressings".
The patient is required to maintain the wrist and hand in a
"protective" position for a period of three to eight weeks until
the completion of healing of the repaired tissues dependent on
the nature of traumatized tissue. The patient attends for
therapy anywhere from forty-eight hours to three weeks post
surgery depending on the type of injury and the surgery involved.
In the early phases, post-operative therapy, constitutes removal
and replacement of bulky dressings with a light weight splint
(made from heat mouldable material), wound care, reducing the
post-operative swelling, while maintaining the wrist and hand in
the "protective" position through out the time period. A typical
scenario is presented below herein to illustrate the problems
with current procedures. The patient is commonly asked to "hold"
the hand in the desired positions, which are achieved using a
goniometer, while the splint is fitted. The patient has
difficulty in maintaining the hand in the required position
without moving during the fabrication process of the splint.
During this time, patient often has unpleasant and or painful
experience. Therapist clinical experience confirms the need to
re-heat and re-shape the wrist and or hand portion of the splint
due to movement of the patient and or quick hardening of the
material. Generally time is lost as it is not a one stage
procedure.
During measurement of the joints, patient is asked to "hold"
the proximal joint(s), in a full passive stretch of angular
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position, through out the length of the time, while therapist
measures the Range of Motion at the distal joints, of each
finger, one at a time.
The shape and the size of the hand being small as it is,
maintaining the "protective" position of the wrist and hand into
flexion creates difficulty to gain access into the palm of the
hand for wound care and removal of sutures, without altering the
position to the point of damaging the repair.
The danger of an uncautioned movement of the wrist and hand,
may elicit a startle reflex ie., active wrist extension and
active fist closure, which is a contraindicated movement for
several types of surgical procedures, with the propensity to undo
surgery.
During therapy sessions patient experiences fear of re-
injury and or damage to the site of repair, while the patient is
asked to "hold" the hand in the angular position and also during
other functions of therapy. The physiological response to fear
is described by Dr. Paul Brand in his book entitled Clinical
Mechanics of the Hand - "in some patients, can make the hand go
cold and stiff, which may in turn result into difficulty in
achieving movements in the hand. Such patients need to gain
confidence and gentle approach during the treatment sessions. It
is good to be unhurried and the focus of treatment needs to be
removal of fear, to facilitate good results of surgery in these
hands. This in turn will make the hand warmer and will relax,
and early stages of confidence and hope will appear".
If the hand support and positioning device was present then
in theory the patient's arm, hand and fingers could be supported
in the required angular position. This would have several
advantages, the hand will be secured in the correct "protective~
position as required by the injury, the patient's discomfort,
fear and frustrations are substantially reduced, and as a result
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the hand itself is relaxed allowing better and easier treatment.
The device will provide support allowing applications of internal
fixators, splints, etc. It offers a pre-positioned support
system and thus reduce the treatment procedural time.
On first consideration it seemed that separate support means
would be necessary for forearm, hand (palm or back), fingers and
elbow. Experimental and practical considerations have shown that
a separate finger support pan is not an essential element, and
that neither is an elbow support.
A so-called "Hand Surgery Table" has been invented as shown
in U.S. Patent Number 4,858,903, for the rapid and quick
securing, as well as accurate positioning of a hand for surgery.
Another object of the invention is to reduce the number of
assistants and therefore, the site of the operation is rendered
significantly more accessible.
In the above invention, finger fixing elements are formed as
flexible thimbles and or instrument supporting elements. The
thimbles are connected to the flexible and tensionable arms
secured at the other end to the base plate. The tension in the
flexible arms, can be altered by tightening or releasing of the
clamp, which in turn places the flexible arm fully rigid and
maintains the required position or it can be fully slackened.
This movement alters the hand-finger angle. It is claimed that
by utilizing the flexible thimbles in the apparatus securing the
finger may be achieved without damage to tissue material and also
the cuticles are automatically covered up, thereby significantly
reducing the risk of infection.
Manifestly this solution does not assure the conditions
re~uired for management of the hand post surgery. The thimbles
as shown in the invention, fits around the finger, at its distal
end. The thimble can cause pain from pressure over the finger,
which is generally swollen secondary to surgery. The pain can
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contribute to a post operative complication termed as Reflex
Sympathetic Dystrophy. A reflex dystrophy is a disease process
marked by pallor, rubor, pain, sweating, edema or skin atrophy,
probably a disturbance of the sympathetic nervous system
following a sprain, fracture or injury to nervous or blood
vessels. The pain in this disease process is out of proportion
to injury and extends beyond the region of the initial injury.
Associated with it, is joint tenderness, stiffness and fibrosis.
The resultant of this complication is a significant delay in
recovery of movements or no recovery of movements despite a good
surgical procedure by surgeon or a need of second surgery. In
addition, the flexible arms will obstruct and reduce access for
clinician, when applying splints, casts and other treatment
procedures. The flexible arms also pose a potential hazard of
entanglement of the splint material and bandages required after
surgery, as can be visualised by those involved in the management
of hand injuries.
Other complications of hand injuries are contracture of the
wrist and fingers in flexion or extension. Currently, these
contracture are reduced by manual passive extension or flexion
force and maintaining the stretched position by use of splints or
plaster of paris casts or traction offered by rubber bands and
finger cuffs. Reduction of contracture often require two people,
one person applies the passive stretch to the contracted joint
and the second person applies the splint to maintain the passive
stretch. It also requires to hold the splint material or the
plaster of paris until the material hardens. Furthermore, the
force applied to reduce the contracture, is applied based on the
tolerance of the patient as opposed to what is required by the
contracted tissue. Thus, the procedure lacks objectivity and the
force cannot be reproduced. There is a need for a device and a
method to provide accurate force to reduce the contracture, be
able to reproduce the results. The present invention will also
solve the problem outlined above.
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DESCRIPTION OF THE INVENTION
In broad aspect the invention is directed to hand support
and positioning device means comprising in combination base means
adapted to rest on a substrate, trough support means attached to
the base means, longitudinal trough means of generally concave
cross section, mounted on said support means, said trough means
being adapted to receive a forearm, and hand support means having
at least one surface adapted to receive a hand, said hand support
means being connected by lockable angularly adjustable means to a
member of the group consisting of said trough means and said
trough support means, whereby the angular position of said hand
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support means, whereby the angular position of said hand support
means with respect to said trough means is adjusted.
The lockable angularly adjustable means may be connected to
the trough means, and may comprise lockable hinge means, which
comprise leaf means attached to the hand support means, and leaf
means attached to the trough means, these leaf means are
pivotally mounted on pin bolt means lockable by nut means, which
can be wing nut means.
Alternatively the lockable angularly adjustable means is
connected to the trough support means. In this case,
conventionally the hand support means has spaced apart first and
second bottom pivot means mounted on the hand support means, the
first pivot means is mounted adjacent the trough means, the
second pivot means is mounted remote from the trough means, first
spar means pivotally attached to the first pivot means, second
spar means being pivotally attached to the second pivot means,
the first spar means being slidable and lockably secured to first
slot means to the trough support means by first nut and bolt
means passing through the slot and the first spar, the second
spar means being slidably and lockably secured to second slot
means by second nut and bolt means, whereby the position of the
first and second pivot means, and thus the angle between hand
support surface and trough means, can be independently varied by
adjusting the position of the respective nut and bolt in the
respective slot.
The second spar means may instead be pivotally attached to
third spar means, the third spar means being slidably and
lockably secured in third slot means in the trough support means
by second nut and bolt means, whereby the position of the first
and second pivot means, and thus the angle between hand support
surface and trough means, can be independently varied by
adjusting the position of the respective nut and bolt in the
respective slot.
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Alternatively in a preferred form, the hand support and
positioning device means comprises in combination base means
adapted to rest on a substrate, trough support means attached to
the base means, longitudinal trough means of generally concave
cross section, mounted on the support means, the trough means
being adapted to receive a forearm, and hand support means having
first and second surfaces adapted to receive a hand, the first
surface of the hand support means being connected by lockable
angularly adjustable means to a member of the group consisting of
the trough means and the trough support means, whereby the
angular position of the hand support means with respect to the
trough means is adjusted. Although one surface is sufficient, in
some cases a second surface is advisable, one surface supports
the palmar or dorsal surface of the hand proper, while the other
supports the fingers.
The first and second surfaces may be pivotally connected.
Alternatively they may be integrally connected.
The pivotally connected first and second surfaces may be
connected by lockable angularly adjustable means to the trough
means. These lockable angularly adjustable means may comprise
lockable hinge means, which include leaf means attached to the
hand support means and leaf means attached to the trough means,
these leaf means may be pivotally mounted on a pin bolt means
lockable by nut means. When the second surface of the hand
support means is pivotally connected to the first surface of the
hand support means by lockable hinge means, this hinge means
comprises leaf means attached to the first surface, leaf means
attached to the second surface, both leaf means being pivotally
mounted on pin bolt means lockable by nut means, which may be
wing nut means.
When the two surfaces are pivotally connected, the lockable
angularly adjustable means may be connected to the trough support
means. In this case, the first surface of the hand support means
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has spaced apart first and second pivot means mounted beneath the
hand support, the first pivot means being mounted adjacent the
trough means, the second pivot means being mounted remote from
the trough means, the second surface of the hand support means
being pivotally attached to the second pivot means, first spar
means pivotally attached to the first pivot means, second spar
means pivotally attached to the second pivot means, the first
spar means being slidably and lockably secured to first slot
means in the trough support means b~ first nut and bolt means
passing through the slot and the first spar, the second spar
means being slidably and lockably secured to second slot means by
second nut and bolt means, whereby the position of the first and
second pivot means, and thus the angle between hand support
surface and trough means, can be independently varied by
adjusting the position of the respective nut and bolt in the
respective slot, third pivot means being mounted beneath the
second surface re~ote from the first surface, third spar means,
pivotally attached to the third pivot means, the third spar means
having slot means through which, the third spar means is slidably
and lockably attached to the trough support by the second nut and
bolt means, whereby the angle between the first and second
surfaces can be varied by adjusting the position of the third
spar slot means with respect to the second nut and bolt means.
Alternatively the second spar means is pivotally attached to
third spar means, which are slidably and lockably secured to
third slot means in the trough support by second nut and bolt
means, whereby the position of the first and second pivot means,
and thus the angle between hand support surface and trough means,
can be independently varied by adjusting the position of the
respective nut and bolt in the respective slot, third pivot means
being mounted beneath the second surface remote from the first
surface, fourth spar means pivotally attached to the third pivot
means, the fourth spar means having slot means through which, the
fourth spar means is slidably and lockably secured to second spar
means by third nut and bolt means passing through the fourth spar
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slot means, whereby the angle between the first and second
surfaces can be varied by adjusting the position of the fourth
spar slot means with respect to the third nut and bolt means.
Desirably the trough means has first bottom pivot means
mounted adjacent the hand support means, the first pivot means
having first spar means pi~otally attached, first slot means in
the first spar means, first nut and bolt means passing through
the first slot means slidably and lockably securing the first
spar means to the trough means, the trough means additionally
having second bottom pivot means remote from the hand support,
the second pivot means having pivotally attached second spar
means, the second spar means having second slot means therein,
second nut and bolt means slidably and lockably securing the
second spar means to vertical plate means transverse of the
trough means, the plate means having horizontal extension means
ha~ing third slot means transverse of the trough means, third nut
and bolt means lockably and slidably securing the plate means to
the base means, whereby the relative heights above the base of
the first and second pivot means can be independently varied, and
second pivot means can be moved transversely with respect to the
base. This allows minor changes to forearm angle and wrist
alignment.
Desirably goniometer stand means, are provided comprising
means to attach the goniometer to the base, adjustable height
upright means, and first goniometer means mounted adjacent the
top of the upright, positioned between the hand support surface
and the trough means, whereby the angle between the hand support
surface and the trough means i.e. the wrist angle, can be
measured. Preferably the goniometer stand means includes besides
second goniometer means mounted adjacent the top of the upright,
positioned between the first and second hand support surfaces,
when these are present, whereby the angle between the first and
second hand support surfaces, i.e. the metacarpophalangeal
(M.C.P.) angle, be measured. Measurement of both such angles is
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usually desirable in post operative treatment.
The hand support and positioning device can also be used to
reduce contracture of the wrist and fingers. With the help of
transducers and sensors fixed internally, controlled externally
by means of two separate knobs, which can be located anywhere on
the hand support and positioning device, a quantifiable force can
be applied to the hand pan and or finger pan or individual finger
control system. The reduced position can be maintained by means
of straps around the hand pan and or the finger pan. The force
applied to the wrist joint or the finger joints can be displayed
on the screen located external to the device.
The materials used in the manufacture of the stand, and
components, are not critical, other than they should be
reasonably rigid and stand up to use. Desirably the trough and
hand support are made of suitable plastic or similar material of
a like nature, which can be shaped as desired, and then sets or
cures to a fairly rigid form.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Preferred embodiments are indicated in the drawings where:
Figure 1 shows a side view of an embodiment of the
invention;
Figure 2 shows a side view of another embodiment of the
invention;
Figure 3 shows a sectional view of embodiments of Figures 1
and 2;
Figure 4 shows a sectional view of alternative embodiments
of Figures 1 and 2;
Figure 5 shows a side view of an alternative embodiment of
that of Figure 1;
Figure 6 shows a bottom view of a hinge embodiment of Figure
5;
Figure 7 shows a bottom view of an alternative embodiment of
Figure 5;
Figure 8 shows a side view of an alternative embodiment of
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that of Figure 2;
Figure 9 to 11 show configurations of an alternative
embodiment to those of Figures 1 and 5, Figure 9 shows a side
view of a first configuration of this alternative embodiment,
Figure 10 shows a sectional view of the embodiment of Figure 9,
Figure 11 shows a side view of a second configuration of this
alternative embodiment;
Figures 12 and 13 show configurations of an alternative
embodiment of those of Figures 2 and 8, Figures 12 shows a side
view of a first configuration of this embodiment, Figure 13 shows
a side view of a second configuration of this embodiment;
Figure 14 shows a side view of a configuration of an
alternative embodiment of those of Figures 2, 8, 12 and 13;
Figures 15 shows a typical plan view of the embodiments of
Figures 13 and 14;
Figures 16 and 17 show details of alternative support
systems to those shown in Figures 1 to 15, Figure 16 shows a side
view of such a support system, Figure 17 shows a partially
elevational, partially sectional end view of an alternative
embodiment of that Figure 16;
Figures 18 to 22 show plan views of alternative embodiments
of hand support pans;
Figure 23 shows an embodiment of a pan combining hand and
finger support;
Figure 24 and 25 show alternative embodiments for finger
support pans;
Figure 26 to 28 show details of a goniometer stand
embodiment, Figure 26 shows a side view of this embodiment,
Figure 27 shows an end view of this embodiment, Figure 28 shows a
sectional view of this embodiment.
Figures 29, 30, and 31 show another embodiment of the
invention.
In broadest illustrated aspect the hand support stand
indicated by numeral 10, has three basic elements a forearm
trough 12, a support element 14 and a base element 16, adjustably
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attached to the stand 10, is an angular adjustable hand support
pan 18, as shown in Figure 1. In Figure 2 is shown an embodiment
incorporating a finger support pan 20 is shown. In general the
patient's forearm is laid in forearm trough 12, and the palm or
the back of the hand is supported by hand support pan 18.
In Figure 3 is shown a sectional view of one embodiment of
the forearm trough, support and base of Figs. 1 and 2, in this
embodiment support 14 is a single wall 24. In Fig. 4 is shown a
similar sectional view of an alternative support embodiment to
that of Fig. 3, support 14 has double walls 26 and 28. In both
Figs. 3 and 4, the concave cross section of forearm trough 12 is
shown, forming forearm receiving hollow 22.
Fig. 5 shows an alternative embodiment of that of Fig. 1,
where hand pan 18 is connected to forearm trough 12, by lockable
hinge 30, hinge leaf 32 attached to trough 12, and hinge leaf 36
attached to hand pan 18 are connected by pin bolt 34. Fig. 6
shows an embodiment of the underside of hinge 30, pop rivet 38
attaches leaf 32 to underside of trough 12, pop rivet 40 attaches
leaf 36 to underside of pan 18, barrel 42 of hinge is threaded by
pin bolt 34, with head 46, locked by nut 48. As appreciated by
those skilled in the art, pop rivets 38 and 40 may be replaced
with screws, studs or other conventional fasteners, nut 48 may be
replaced with a screw knob or wing nut or similar arrangement.
Fig. 7 shows one such alternative embodiment, wherein screws 50
and 52 replace pop rivets 38 and 40, and wing nut 54 replaces nut
48.
Fig. 8 shows an alternative embodiment of that of Fig. 2,
where finger pan 20 is connected to pan 18 by hinge 56,
(similarly constructed to hinge 30) where leaf 58 attached to pan
18, and leaf 62 attached to pan 20, are connected by pin bolt 60.
Figs. 9 to 11 show configurations of an alternative
embodiment of those of Figs. 1 and 5, including a single hand pan
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device supported by alternative means. In Figs. 9 and 11 hand
pan 18 is supported by tabs 64 and 66, pop stud 68 passes through
tab 66 and spar 72, pop stud 70 passes through tab 64 and spar
74, allowing angular movement of hand pan 18 with respect to the
spars. Slots 76 and 78 of support 14 have bolts passing through
them into holes in spars 72 and 74 respectively enabling these to
be adjustable secured, controlling the position of hand pan 18.
Fig. 10 shows a sectional view of the embodiment of Fig. 9, bolt
80 passes through support wall 26 through spar 74 and support
wall 28 to screw-on knob 82. In Fig. 11 the embodiment of Fig. 9
is shown in an alternative configuration, hand pan 18 is shown at
an angle above the horiæontal, this is achieved by removing
screw-on knob 84 and its associated securing bolt from hole 80,
and drawing out spar 72 and articulated spar 94, which are
pivotally connected by pop stud 96. Spar 94 is then secured by
screw-on knobs 88 and 9o to support 14, slot 86 allows vertical
movement of spar 94 and pivot stud 96, and angular adjustment of
pan 18.
Figs. 12 to 13 show configurations of alternative
embodiments to those of Figs. 2 and 8, having separate hand and
finger support pans. In Fig. 12 is shown a finger pan 20
attached by link 98 to pan 18 via pivot pop stud 68 in tab 66,
tab 100 carries pivot pop stud 102 which allows pivotal movement
of spar 104, which has slot 106 to allow longitudinal movement of
spar 104 relative to screw-on knob 84 and associated securing
bolt mounted in slot 76, allowing angular adjustment of pan 20
relative to pan 18, an attachment for a goniometer stand is
present having pin bolt 108 and nut 110. In Fig. 13 is shown an
alternative configuration of finger pan 20, in this case
articulated spar 94 is in play and screw-on knob 84 and
associated securing bolt are mounted in spar 72, an alternative
attachment for a goniometer stand is shown with wing nut 112 on
pin bolt 108. In Fig. 14 is shown an alternative embodiment to
those of Figs. 2, 8, 12 and 13, wherein finger pan 20 is replaced
by knuckle pan 114 adapted to receive the dorsal (back) portion
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of the hand, again spar 104 is adjustably secured to spar 72 by
screw-on knob 84 and associated securing bolt. In Fig. 15 is
shown a typical plan view of the embodiments of Fig. 13 and 14,
with forearm trough 12 attached by pop rivets 116 and 118 to
support 14 (not shown), hand pan 18 is secured by screws 120 and
122 to bases of tabs 64 and 66 (not shown). Finger pan 20 is
similarly secured by screws 124 and 126 to the bases of link 98
and tab 100, the position of goniometer attachment pin 108 and
wing nut 112 is also shown. Alternatively hand pans 18 and 20
can be removably installed by simple locking and unlocking
mechanisms as would be understood by those skilled in the art.
Figs 16 and 17 show an alternative mode of attaching forearm
trough 12, to those of Figs. 1 to 15. In Fig. 16, forearm trough
12 has attached paired tabs 128 and 130, which have paired pivot
pop studs 132 and 134 respectively pivotally engaging stub spars
136 and 138. Stub spar 136 has slot 137 allowing ad,ustable
securement of stub spar 136 by screw-on knob 140 and associated
securing bolt to enable relative vertical movement forearm trough
12 with respect to support 14, stub spar 138 is secured to plate
142 by bolt 146 and wing nut 152, plate 144 a horizontal
extension of plate 142, is secured by bolt 148 and wing nut 150
to base 16. In Fig, 17 is shown stub spar 138 with slot 139
which is adjustably secured to plate 142 by bolt 146 and nut 154.
Bolt 58 passes through slot 139 of spar 138 and slot 158 of late
142, to allow relative vertical movement of trough 12 and base
16. Bolt 148 passes through slot 160 of plate 144 into base 16
adjustably secured by nut 156. Plate 144 can be moved in a
limited arc about an axis passing through paired tabs 132,
allowing limited rotation of the trough relative hand pan 18.
Wing nuts 150 and 152 of Fig. 16 can be replaced by nuts 154 and
156 of Fig. 17, screw-on knobs and the like without departing
from the invention.
Figs. 18 to 22 depict alternative embodiments of the pan
element providing palmar support, viewed from above with the
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forearm trough to the right of the drawing . In Fig. 18 is hand
pan 162 having transverse arms 164 and 166, and lobe 168 toward
the forearm trough. In Fig. 19 is hand pan 170 having a base
portion 172 and inclined side portions 174 and 176, this pan can
be used for dorsal (back of the hand) support as well as palmar
support. In Fig. 20 is hand pan 178 having large lobe 180 and
smaller lobe 182. In Fig. 21 is pan 184 designed for right hand
use, bight or recess 186 is adapted to allow for the right thumb.
In Fig. 22 is shown pan 188 designed for less common left hand
use, with bight or recess 190 to allow for the left thumb.
Fig. 23 shows hand pan 192 for dorsal (back of hand support)
having attached integral finger pan, base portion 194 and
inclined side portions 196 and 198 receive the back of the hand,
while upward inclined base portion 200 with inclined side
portions 202 and 204 receives knuckles and fingers.
Figs. 24 and 25 show alternative embodiment of finger pan
elements as viewed from above with the hand pan to the right. In
Fig. 24 is finger pan 206 for palmar (front of hand) support
having base portion 208 and side inclined portions 210 and 212.
In Fig. 25 is finger pan 214 for dorsal (back of hand) support
base portion 216 joins upward inclined base portion 218 while
inclined side portions 220 and 222 adjoin both 216 and 218.
Figs. 26, 27 and 28 show a goniometer arrangement to measure
angular relation of pans and trough and thus pateints' fingers
palm and arm. Support 224 is attache to base 16, spar 226 fits
slidably into support 224, where it can be adjustably secured by
wing nut 228 and associated securing bolt 230, to allow raising
and lowering of goniometer 232 which is attached to spar 226 by
bolt 234 and wing nut 236, allowing pivotal motion of goniometer
232. Goniometer 232 has two sub goniometers 238 and 240 having
pointers 242 and 244 respectively pivotally attached by pop studs
246 and 248 respectively. Spar 226 has slot 250 to enable
vertical movement with respect to support 224, which has flanges
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252 which slidably engages spar 226. Support 224 has horizontal
extension 254 which is detachably secured to base 16 by bolt 256
and wing nut 258.
Figs. 29, 30, and 31 show another embodiment of the
invention where support structure 260 has base 262, extendible
arm 264 and securing knob 266, to allow adjustable tilting of
forearm support 12, which has adjustable elbow support 268. Hand
pan 18 is connected to forearm trough 12, by lockable hinge 30,
hinge leaf 32 attached to trough 12, and hinge leaf 36 attached
to hand pan 18 are connected by pin bolt 34, similarly finger pan
20 is connected to pan 18 by hinge 56, where leaf 58 is attached
to pan 18, and leaf 62 is attached to pan 20, are connected by
pin bolt 60. Goniometers 270 and 272 are mounted on the ends of
bolts 34 and 60 respectively. Hand pan 18 has two mutually
movable parts 274 and 276, connected by lockable slide 278, which
has two intermeshing leafs 280 and 282, attached respectively to
parts 274 and 276, which are securable in relative position by
bolt 284. Adjustable elbow rest 268 is slidably mounted in slit
286 of forearm support 12.
Various systems of height adjustable support may be employed
to control the relationship between forearm trough 12 and base
element 16, other than those described, as would be understood by
those skilled in the art.
A modified two lever or spar system could be employed to
control hand pan 18 and finger pan 20, one lever controlling hand
pan 18 sliding in slot 76, the other controlling finger pan 20
sliding in slot 78. These slots may be graduated to denote
angular position of the fingers at the metacarpophalangeal joints
and of the wrist joint, which could render goniometers
unnecessary. The goniometers could also be replaced by
electronic sensors measuring the angular positions at these
joints. The spars or levers could be mechanically controlled or
by an electronic system, the controls of which can be suitably
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207~3~3
located on support element 14, or base element 16, allowing
direct electronic control of the angular positions of hand pan 18
and finger pan ~0.
Although this invention is described in terms of specific
embodiments, it is not limited thereto, as would be understood by
those skilled in the art, numerous variations ar~ possible within
the scope of the invention, without departing from the scope and
nature thereof.
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207~32~
TORQUE RI~NGE OF MOTION DEVICE
There is a further need for accurate measurement of torque
range of motion curves of the various finger joints, proximal
interphalangeal (PIP), metacarpophalangeal (MCP), distal
interphalangeal (DIP) and the wrist joint. These curves may be
used to diagnose the cause of joint stiffness, by distinguishing
between stiffness caused by tendon adhesions, or by the joint
capsule, skin or scar, and whether the restraints are elastic or
viscous in nature.
These measurements allow initial planning for treatment
applied, monitoring of the results of treatment, evaluation of
the effectiveness of a given treatment, and evaluation of the
rebalancing of muscle power and indication of surgical
intervention.
At present two general variables affect accuracy of
measurement, the twisting moment of the torque applied to the
joint, the posture of the adjacent joints during measurement
particularly when tendons have been cut (injured), giving
inconsistent results, while goniometric measurements vary
depending on the technique used.
During range of motion measurements should be objective and
reproducible.
Attempts to do this have not been very successful, joint
position(s), goniometer stabilization, and torque traction must
be standardized. The current process is cumbersome, time-
consuming and inaccurate.
Typically the examiner uses one hand to hold the strain
gauge and the other to hold the goniometer, and cannot
simultaneously control the patient's hand position. Further
stabilizing the goniometer with one hand is difficult, as both
mobile limbs of the goniometer must be aligned with proximal and
distal ends of the bone and the axis of the goniometer must
coincide with the axis of the stiff joint which is under
assessment. It is also difficult to maintain torque traction at
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2~7~323
right angles to the length of the bone distal to the stiff joint
axis. Finally details often have to be recorded verbally into a
tape recorder or noted on the paper with a pen, each time the
measurement is completed.
Range of motion measurements are consequently neither
standardized, accurate nor reproducible
There is a need for a device and method to provide accurate
range of motion measurements.
DESCRIPTION OF THE INVENTION
In a further aspect the invention is directed to an improved
hand support and positioning device having a hand support pan,
and a base member. The improvement provides strain gauge means
mounted above said hand support pan, and a slidable plate means
conventionally mounted under said hand pan, allowing said plate
means to be slid longitudinally to said hand support pan and
stabilize the bone proximal to the stiff joint (PIP or DIP). This
prepares the stiff joint for assessment, in other words it
prepares the joint to be subjected to a quantifiable force. This
also requires the removal of the finger pan from the hand support
and positioning device so as to free the finger joints for
assessment. In addition, the strain gauge means mounted above
the said distal end of the forearm trough, of the hand support
and positioning device will facilitate the measurement of the
stiffness of the wrist joint. This requires the removal of the
said hand support pan and the said finger pan from the said hand
support and positioning device.
Preferably the strain gauge means is mounted on strain gauge
support means fixed to said base member. Preferably the strain
gauge means are calibrated. Preferably the slide has transverse
lip means.
The device meets several of the current requirements for
range of motion measurement. It provides consistent and
standardized measurement, which are reproducible. It is simple
and efficient to use, only goniometric measurement is required by
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the examiner. A tape recorder is not required for taking down
details, the results can be hand written down, or stored in the
memory of this device and reproduced in a sequence at a later
time on the display screen, or input into a data base in a
computer.
DESCRIPTION OF THE PREFERRED EMBODINENTS
Preferred embodiments are indicated in the drawings where:
Figure 32 shows a side view of a further embodiment of the
invention.
Figure 33 shows a top view of the embodiment of Figure 32.
In Figs. 32 and 33 is shown retractable slide 290, with
transverse lip 291, conventionally mounted under the hand support
pan 18, mounted on base element 16 is upright support member 292,
atop which is strain gauge 294, the force applied by strain gauge
294 is optionally controlled by control knob 295. The strain
gauge may be calibrated, that is the force applied may be set to
exact force levels. Optionally a digital readout 296 may be
present on the gauge. Wire 297 carrying loop 298, depends from
gauge 294. Finger 300 is placed so as to measure torque
(angular) range of motion of proximal interphalangeal joint (PIP)
304. As would be understood by those skilled in the art, the
finger can be placed to measure torque (angular) range of motion
of distal interphalangeal joint (DIP) 306, or metacarpophalangeal
joint (MP) 302. Typically the strain gauge is set at 100 to 800
grams (force), the maximum safe force applied varied as would be
understood by those skilled in the art, and depending on the hand
size, structure and condition may be as little as 100 grams
(force). The angular position of the joint is measured using a
goniometer at each force level giving a torque range of motion
curve, which may be used to measure therapeutic progress or to
diagnose causes of joint stiffness.
CLAIMS
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