||||||||||||||||||||ll|||||||||I||||||||||||||||||||||||||||||l||||||||||||
`
`US0071 12179B2
`
`(10) Patent No.:
`(45) Date of Patent:
`
`US 7,112,179 B2
`Sep. 26, 2006
`
`5.376.091 A “‘
`5.503.619 A *
`
`.......... .. 60655
`1291994 Hotchkiss et al.
`4/1996 Bonutti
`..................... .. 60216
`
`30997 Cf"? ------------------------- ~~ 503:“
`1C3°rb°r:i
`‘
`6(()(2)'l1:
`._.
`U onurea.
`a
`3/1999 Belkin .......... ..
`602.21
`92000 B
`rt‘
`602.20
`‘ (I.
`11//2000 G(i)lIl11l1]01iI"'
`60220
`7/2003 Bonulli el :11.
`.............. .. 602 20
`
`
`
`5-553-530 A
`‘Z I,
`. 1
`‘
`5.882.323 A =*=
`(.llI‘.5(2 A *
`6.142.964 A 2*‘
`6.599.263 B1"‘
`
`Cited by examiner
`
`1’riInar_i.' E.\‘mniI7er—i lenry Bennett
`
`(12)
`
`United States Patent
`
`Bonutti et al.
`
`(54) ORTHOSIS
`
`(75)
`
`Inventors: Boris P. Bonutti. Eflingham. IL (US);
`Peter M. Bonutti. Eiiingham. IL (US):
`.
`s»
`Km" R’ R"h°"‘ E’fi‘“gh‘m1‘ IL (US)
`.
`.
`(73) Asslgnee‘ Ma“ T°°’ Lu" Etfi“gh‘““* Imus)
`.
`T
`.
`,
`,
`,
`,
`( “ ) Notice:
`Subject to any disclaimer. the term oi tlns
`patent is extended or adjusted under 35
`U.S.(‘. 154(b) by 19 days.
`
`(21) App1_ No‘; 10/795,392
`
`(22)
`
`Filed:
`
`Mar. 8. 2004
`
`_
`.
`Assistant Examiner Amanda Wicker
`(74) Atluriiey. Agent, or Finn-—Fleit Kain Gibbons Gutmzm
`Bongini & Bianco: Paul D. Bianeo: Martin Fleit
`
`(65)
`
`Prior Publication Data
`
`(57)
`
`ABSTRACT
`
`(<1)
`7
`
`Sap’ 8‘ 2005
`
`US 2005/0197605 A1
`Int Cl
`'
`'
`(2006.01)
`A6IF5/00
`(52) U.S. CI.
`.......................... .. 602/16 602/21; 602/26;
`‘
`602/27: 602/32
`
`"""""" " 602/16‘
`(58) Field of Classificatmn Search
`602/21‘ 26127‘ 32‘ 36
`‘
`.
`.
`_
`566 apphcmlon file tor Complete Search h15I°ry'
`References Cited
`U.S. PATENT DOCUMENTS
`
`(56)
`
`4.809.688 A
`
`3/I989 Aymcrica
`del Valle et al.
`
`............ .. 602/2|
`
`An orthosis for stretching tissue around 0 joint of a patient
`between first and second relatively pivotable body portions.
`The orthosis includes at first aim member ziflixable to the first
`b d
`‘.
`I d. _1d. Y‘
`I, 1) P ‘.
`) b_ ‘ pd
`.° y P°r.‘°“"“ m“ " "15 “ 1“ ‘X "‘“3°”m"m “X ““ ‘
`mg theretrom. A second arm member afiixable to the second
`.
`.
`.
`.
`body portion 1s also included and has a second extension
`member having an areuate shape extending therefrom. The
`second extension member is operatively connected to the
`first extension member and travels trough the first extension
`member along an arcuate pat when the second arm member
`is moved from 21 tirst position to :1 second position relative
`to the first arm member.
`
`28 Claims. 9 Drawing Sheets
`
`

`
`U.S. Patent
`
`Sep. 26,2006
`
`Sheet 1 of 9
`
`US 7,112,179 B2
`
`LANTZ 1001.2
`
`

`
`U.S. Patent
`
`Sep. 26, 2006
`
`Sheet 2 of 9
`
`Us 7,112,179 B2
`
`FIG. 5
`
`LANTZ 1001.3
`
`

`
`U.S. Patent
`
`Sep. 26,2006
`
`Sheet 3 of 9
`
`US 7,112,179 B2
`
`FIG. 7
`
`LANTZ 1001.4
`
`

`
`U.S. Patent
`
`Sep. 26, 2006
`
`Sheet 4 of 9
`
`US 7,112,179 B2
`
`FIG.8
`
`LANTZ 1001.5
`
`

`
`U.S. Patent
`
`Sep. 26, 2006
`
`Sheet 5 of 9
`
`US 7,112,179 B2
`
`LANTZ 1001.6
`
`

`
`U.S. Patent
`
`Sep. 26,2006
`
`Sheet 6 of 9
`
`Us 7,112,179 B2
`
`FIG.10
`
`LANTZ 1001.7
`
`

`
`U.S. Patent
`
`Sep. 26, 2006
`
`Sheet 7 of 9
`
`US 7,112,179 B2
`
`
`
`FIG. 11
`
`/4
`
`LANTZ 1001.8
`
`

`
`U.S. Patent
`
`Sep. 26, 2006
`
`Sheet 8 of9
`
`US 7,112,179 B2
`
`FIG.13
`
`LANTZ 1001.9
`
`

`
`U.S. Patent
`
`Sep. 26,2006
`
`Sheet 9 of 9
`
`Us 7,112,179 B2
`
`
`
`
`
`
`
`
`.
`I
`‘
`N
`, H _
`§mV.1'7‘.51\'Uw11§5ff'él3l'E"a'f6"11!LUfl {-11%
`1at u:41.1111 11.1‘.a way:u-ananu1«tutor»/z.vrarr;pop;n-pan 'a11lz4atl
`
`
`
`Vllzrtlanwtlwa-Jw4rI15r.lp:r.lIIA
`
`
`
`LANTZ 1001.10
`
`

`
`US 7,112,179 B2
`
`1
`ORTHOSIS
`
`FIELD OF 'l‘HE INVENTION
`
`The present invention relates to an adjustable orthosis for
`stretching tissue in the human body. In particular. the present
`invention relates to an adjustable orthosis which can be used
`for stretching tissue such as ligaments. tendons or muscles
`around a joint during flexion or extension of the joint.
`
`BACKGROUND OF THE INVENTION
`
`In a joint. the range of motion depends upon the anatomy
`ofthat joint and on the particular genetics of each individual.
`Typically. joints move in two directions. flexion and exten-
`sion.
`l’lexion is
`to bend the joint and extension is to
`straighten the joint: however. in the orthopedic convention
`some joints only flex. For example. the ankle has dorsiflex-
`ion and plantarflexion. Other joints not only flex and extend.
`they rotate. For example, the elbow joint has supination and
`pronation. which is rotation of the hand about the longitu-
`dinal axis of the forearm placing the palm up or t11e palm
`down.
`
`1 0
`
`20
`
`2
`member extending at an angle or therefrom. A second arm
`member afiixable to the second body portion is also
`included. The second arm member has a second extension
`
`member having an arcuate shape extending therefrom. The
`second and first extension members are operatively con-
`nected. such that
`the second extension member travels
`through the flrst extension member along an arcuate path
`when the second arm member is moved from a first position
`to a second position relative to the first arm member.
`The orthosis further includes a drive assembly for selec-
`tively moving the second extension member relative to the
`first extension member. The drive assembly is mounted onto
`the first extension member. engaging the second extension
`member. The drive assembly can be manually or automati-
`cally actuated to selectively move the second extension
`member relative to the Iirst extension member.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`A more complete understanding of the present invention.
`and the attendant advantages and features thereof. will be
`more readily understood by reference to the following
`detailed description when considered in conjunction with the
`accompanying drawings wherein:
`FIG.
`1
`is a schematic diagram of the orthosis of the
`present invention in a flexed position;
`FIG. 2 is a schematic diagram of the orthosis of the
`present invention in an extended position:
`FIG. 3 is a second schematic diagram of the orthosis of the
`present invention in a flexed position;
`FIG. 4 shows an adjustable first extension member of the
`orthosis of the present invention:
`FIG. 5 shows the adjustable first extension member of
`FIG. 4 in a second position:
`FIG. 6 shows a segmented first extension member of the
`present invention‘.
`FIG. 7 shows an arcuate first extension member of the
`present invention:
`FIG. 8 shows an orthosis of the present invention:
`FIG. 9 shows an orthosis of the present invention for
`flexing and extending a wrist joint in a patient’.
`FIG. 10 shows a non-circular arcuate shaped second
`extension member of the present invention:
`FIG. 11 shows an alternative arcuate shaped second
`extension member of the present invention:
`FIG. 12 shows a linear shaped second extension member
`of the present invention;
`FIG. 13 shows an exemplary drive assembly of the
`present invention;
`FIG. 14 is a top plan view of portions of an articulating
`hand pad support of the present invention: and
`FIG. 15 is a schematic sectional view of the articulating
`hand pad support of FIG. 14.
`
`DETAILED DESCRIPTION OF THE
`INVENTION
`
`When a joint is injured either by trauma or by surgery.
`scar tissue can form. often resulting in flexion or extension
`contractures. Such conditions can limit the range of motion
`of the joint.
`limiting llexion (in the case of an extension
`contracturc) or extension (in the case of a Iiexion contrac-
`ture) of the injured joint. It is often possible to correct this
`condition by use of a range-of-motion (ROM) orthosis.
`ROM orthoses are devices commonly used during physi-
`cal rehabilitative therapy to increase the range-of-motion
`over which the patient can flex or extend the joint. Com-
`mercially available ROM orthoses are typically attached on
`opposite members of the joint and apply a torque to rotate
`the joint
`in opposition to the contraction. The force is
`gradually increased to increase the working range or angle
`of joint motion. Exemplary orthoses include US Pat. No.:
`6.599.263. entitled “Shoulder Orthosis;” U.S. Pat. No.
`6.113.562. entitled “Shoulder Ortl1osis;” U.S. Pat. No.
`5.848.979. entitled “Orthosisg” US. Pat. No. 5.685.830.
`entitled “Adjustable Orthosis Having One-Piece Connector
`Section for Flexingf’ U.S. Pat. No. 5.611.764. entitled
`“Method of Increasing Range of Motion.” U.S. Pat. No.
`5.503.619. entitled “Orthosis for Bending Wristsz” 5,456.
`268. entitled “Adjustable Orthosis;” U.S. Pat. No. 5.453.
`075. entitled “Orthosis with Distraction through Range of
`Motion:” US. Pat. No. 5.395.303, entitled “Orthosis with
`Distraction through Range of Motion;” 5.365.947, entitled
`“Adjustable Orthosis;" U.S. Pat. No. 5.285.773. entitled 7
`“Orthosis with Distraction through Range of Motion;” US.
`Pat. No. 5.213.095. entitled “Orthosis with Joint Distrac-
`tion;” and U.S. Pat. No. 5.167.612. entitled “Adjustable
`Orthosis.” all to Bonutti and herein are expressly incorpo-
`rated by reference in their entirety.
`
`35
`
`40
`
`at m
`
`SUMMARY OF THE INVENTION
`
`The present invention provides an orthosis for stretching
`tissue around a joint of a patient between first and second
`relatively pivotable body portions. Thejoint and the first and
`second body portions defining on one side of the joint an
`inner sector which decreases in angle as the joint is flexed
`and defining on the opposite side of the joint an outer sector
`which decreases in angle as the joint is extended.
`
`60
`
`The present invention relates to an orthosis for moving a
`joint between first and second relatively pivotable body
`portions. The joint and the first and second body portions
`define on one side (the flexor side) of the joint an inner sector
`which decreases in angle as the joint is flexed (bent) and on
`the opposite side (the extensor side) of the joint an outer
`sector which decreases in angle as the joint is extended
`(straightened). The ortl1osis of the present
`invention is
`
`LANTZ 1001.11
`
`

`
`US 7,112,179 B2
`
`3
`Referring now to the drawing figures in which like
`reference designators refer to like elements. there is shown
`in FIG. 1. a schematic of the orthosis 10 of the prese11t
`invention. The orthosis 10 includes a first arm member 12
`attachable to the first body portion and a second arm member
`14 attachable to the second body portion. wherein a joint
`axis of rotation 16 is interposed between and offset from the
`first and second arm members 12 and 14. The first and
`second arm members 12 and 14 are operatively eoimected to
`each other offset from the joint axis 16.
`The first arm member 12 of the orthosis 10 includes a first
`extension member 18. which extends at angle oz from the
`first arm member 12. The second arm member 14 of the
`orthosis 10 includes a second extension member 20 extend-
`ing thereform and having an arcuate shape. The first and
`second extension members 18 and 20 are operatively con-
`nected at point
`such that
`in operation the second
`extension member 20 travels along an arcuate path about
`and substantially through point “P.” The arcuate shape of the
`second extension member 20 results in the second body
`portion rotating about the joint axis 16. when the second arm
`member 14 is moved from a first position to a second
`position relative to the first aim member 12. T11e angle 0.
`between the first extension member 18 and the first ann
`member 12 and the radius of curvature of the second
`extension member 20 are a function of the joint to be treated
`and the degree of llexion or extension contractures.
`The orthosis further includes a drive assembly 22 at point
`The drive assembly connects the first and second
`extension members 18 and 20 for applying force to the first
`and second arm members 12 and 14 to pivot the first and
`second body portions relative to each other about the joint.
`The orthosis 10 of the present invention is shown having
`an angle 0. such that the operative connection. at point
`of tlie first and second extensions 18 and 20 is located in a
`plane “A” passing through the joint axis 16. wherein plane
`“A” is substantially orthogonal to a longitudinal axis of the
`first arm member 12. This position of point “P” provides an
`angle [31 between the second arm member 14 and the joint
`axis 16. wherein [31 is the maximum angle of fiexion. As
`shown in FIG. 2. the second extension member includes a
`stop 24. The stop 24 acts to limit the angle of maximum
`extension y between the second arm member 14 and the joint
`axis 16. An increase in the length of the stop 24 will decrease
`the angle of maximum extension y. A decrease in the length
`ofthe stop 24 will increase the angle of maximum extension
`
`Referring to FIG. 3. the maximum flexion angle can be
`increased by increasing the angle on. An increase in the angle
`on will move the point “P” to a location “in front of" the plane
`“A.” This position of point “P” provides an angle fig between
`the second arm member 14 and the joint axis 1 6 in maximum
`llexion. wherein [32 is greater than B 1. The greater the angle
`(1 the greater the angle of maximum flexion.
`Alternatively. (not shown) a decrease in the angle 0. will
`move the point “P” to a location “behind” the plane “A.”
`This position of point “P" provides an angle [33 between the
`second arm member 14 and the joint axis 16 in maximum
`flexion. wherein [33 is less than (31. The smaller the angle on,
`the smaller the angle (3 of maximum flexion.
`Referring to FIG. 4. the first extension member 18 is
`selectively. pivotally connected at location 26 to the first arm
`member 12. The pivotal connection 26 of the first extension
`member 18 permits the angle on between the first extension
`member 18 and the first arm member 12 to be selectively
`
`10
`
`._t
`
`t_/1
`
`30
`
`40
`
`4
`member 18 is positioned at an angle (11. wherein the
`operative connection. at point
`of the first and second
`extension members 18 and 20 is located in a plane “A”
`passing through the joint axis 16. wherein plane “A” is
`substantially orthogonal to a longitudinal axis of the first
`ann member 12. The first position 28 of point “P” provides
`a maximum angle of flexion of B1. The second extension
`member stop 24 acts to limit the angle of maximum exten-
`sion Y1 between the second arm member 14 and the joint axis
`16.
`
`Referring to FIG. 5. in a second position 30 the angle on
`is increased to an angle CL2. positioning the point “P” to a
`location “in front of’ the plane
`The second position 30
`of point “P” provides a maximum angle of flexion of (33.
`wherein B3 is greater than B1. The second extension member
`stop 24 acts to lin1it the angle of maximtnn extension Y2
`between the second arm member 14 and the joint axis.
`wherein Y3 is less the y 1.
`The selective pivotal connection 26 of the first extension
`member 18 to the first arm member 12 can have a plurality
`of selectable positions. The angle or between the first arm
`member 12 and the first extension 18 can be selectively
`increased to move the point “P”. on. “in front ol" or
`“behind” the plane
`It is also envisioned that a posi-
`tioned can be selected to increase the angle on between the
`first arm member 12 and the first extension 18 sufliciently to
`move the point “P” “in front of" plane “A” and “above” the
`longitudinal axis of the first arm member 12. maximizing the
`maximum angle of flexion B.
`The orthosis 10 of the present invention can be connected
`to the flexor side of the first and second body portions ofthe
`joint. which results in a decrease in angle as the joint is
`flexed (bent) and an increase in angle and the joint is
`extended (straightened). Alternatively. orthosis 10 of the
`present invention can be connected to the extensor side of
`the joint, which results in a decrease in angle as the joint is
`extended straightened and an increase in angle as the joint is
`flexed (bent).
`The previous description of the first arm member 12
`depicts a first extension 18 having a substantially linear
`shape. extending at an angle (1. from the first ann member 12.
`However. it is within the scope ofthe present invention that
`the first extension member 18 can be any shape extending
`from the first arm member 12 which positions the point “P”
`in the desired relationship to the plane
`Referring to
`FIG. 6. a segmented fist extension member is shown. includ-
`ing a first extension member segment 18a and a second
`extension member segment 18b. The first and second exten-
`sion member segments 18a and 1817 extend from the first
`ann member 12. positioning the point
`at an angle (‘L from
`the first arm member 12. Referring to FIG. 7. an arcuate first
`extension member 18c is shown. The arcuate extension
`member 180 extends from the first arm member 12. posi-
`tioning the point “P” at an angle (1 from the first arm member
`12.
`
`60
`
`Referring to FIG. 8. the orthosis 10 of the present inven-
`tion includes a first arm member 12 attachable to the first
`body portion and a second arm member 14 attachable to the
`second body portion. wherein the joint axis 16 is interposed
`between and ofliset from the first and second arm members
`12 and 14. The first and second arm members 12 and 14 are
`connected with each other offset from the joint axis 16.
`The first arm member 12 ofthe orthosis 10 includes a first
`extension member 18. which extends at angle ot from the
`first arm member 12. The second arm member 14 of the
`
`LANTZ 1001.12
`
`

`
`US 7,112,179 B2
`
`1 0
`
`ruUx
`
`30
`
`5
`such that in
`and 20 are operatively connected a point
`operation the second extension member 20 travels along an
`arcuate path about and substantially through point “P.” The
`arcuate shape of the second extension member 20 results in
`the second body portion rotating about the joint axis 16.
`when the second arm member 14 is moved from a first
`position to a second position relative to the first arn1 member
`12. The angle 0. between the first extension member 18 and
`the first arm member 12 and the radius of curvature of the
`second extension member 20 are a function of the joint to be
`treated and the degree of flexion or extension contractures.
`A first cuff 32 is attached to the first arm member 12.
`wherein the first cuff 32 is positionable about the first body
`portion. The first cufi‘32 is attached to the first body portion
`by cuff straps. The first cuff 32 secures the first body portion
`to the first arm member 12. A second cul]‘34 is attached to
`the second arm member 14. wherein the second cuff 34 is
`positionable about the second body portion. The second cuff
`34 is attached to the second body portion by cuffstraps. The
`second cufl‘34 secures the second body portion to the second
`arm member 14. (The term “cufl” as used herein means any
`suitable structure for transmitting the force ofthe orthosis 10
`to the limb portion it engages.)
`In an exemplary use. the orthosis 10 is operated to extend
`a joint in the following manner. The first cuff 32 is fastened
`about the first body portion tightly enough that the first arm
`member 12 may apply torque to the first body portion
`without having the first cufi‘ 32 slide along the first body
`portion. Similarly. the second cuff 34 is fastened securely
`around the second body portion so that
`the second arm
`member 14 may apply torque to the second body portion
`without the second cufl" 34 sliding along the second body
`portion. The orthosis 10 is attached to the first and second
`body portions in a first position. The second arm member 14
`is rotated from the first position to a second position, relative
`to the first arm member 12. rotating the second body portion
`about thejoint axis 16 stretching thejoint. As the second arm
`member 14 is rotated to the second position. the second
`extension member 20 travels along an arcuate path about
`and substantially through point
`The orthosis 10 is
`maintained in the second position for a predetermined
`treatment time providing a constant stretch to the joint. After
`the expiration of the treatment time. the second arm member
`14 is moved back to the first position. relieving the joint.
`Optionally. the second arm member 14 can be rotated to a
`third position. increasing the stretch on the joint. The second
`arm member 14 can be rotated at discrete time intervals to
`incrementally increase the stretch of the joint through the
`treatment cycle. After completion of the treatment cycle, the
`second arm member is returned to the first position for ,
`removal of the orthosis 10.
`The first and second arm members 12 and 14 are rigid
`members made of. for example. aluminum. stainless steel.
`polymeric. or composite materials. The arms are rigid so as
`to be able to transmit the necessary forces. It should be
`understood that any material of sufficient rigidity can be
`used.
`
`9»‘J1
`
`40
`
`U»’.I\
`
`In an embodiment. the components of the orthosis 10 of
`the present invention are made by injection molding. Gen-
`erally for injection molding. tool and die metal molds olithe
`orthosis 10 components are prepared. Hot. melted plastic
`material is injected into the molds. The plastic is allowed to
`cool. forming components. The components are removed
`from the molds and assembled. The cuff portions 32 or 34
`can be individual molded and attached to the arm members
`
`61‘:
`
`65
`
`6
`ln use. the orthosis 10 can be connected to the flexor side
`of the first and second body portions of the joint. which
`results in a decrease in angle as the joint is flexed (bent) and
`an increase in angle as the joint is extended (straightened).
`Alternatively. orthosis 10 of the present invention can be
`comiected to the extensor side of the joint. which results in
`a decrease in angle as the joint is extended straightened and
`an increase in angle as the joint is liexed (bent).
`In an embodiment. the orthosis 10 includes a first cuff 32
`for attachment to a first body portion. and a second cufi‘ 34
`for attachment to a second body portion. The first body
`portion is joined to the second body portion at ajoint. around
`which is located. as is well known. soft tissue. Each of the
`first and second cuffs 32 and 34 includes loop connectors for
`receiving straps extending around the body portions to
`clamp the cuffs 32 and 34 to the body portions.
`The first cuff32 is mounted for sliding movement on the
`first arm member 12 and is slidable along the first arm
`member 12 in a manner as described below. The second cuff
`
`34 is mounted for sliding movement on a second arm
`member 14 and is slidable along the second arm member 12
`in a manner as described below.
`
`Bending a Joint in Extension:
`In operation of the orthosis 10 to extend the joint. the
`orthosis 10 starts at a more flexed position. The first and
`second cuffs 32 and 34 are clamped onto the first and second
`body portions. respectively. by straps. tightly enough so that
`the cuffs 32 and 34 can apply torque to the body portions to
`extend the joint. The second arm member 14 is rotated from
`the first position to a second position. relative to the first ann
`member 12. rotating the second body portion about the joint
`axis 16 stretching the joint. As the second arm member 14
`is
`rotated to the second position the second extension
`member 20 travels along an arcuate path about and substan-
`tially through point
`The orthosis I0 is maintained in the
`second position for a predetermined treatment time provid-
`ing a constant stretch to the joint.
`As the orthosis 10 is rotated from the first position to the
`second position. extending the joint, the first and second
`cuffs 32 and 34 move along the first and second arm
`members 12 a11d 14. The first cul]‘32 moves inwardly along
`the first arm member 12. Similarly. the second cuff 34 moves
`inwardly along the second arm member 14. Because the
`cuffs 32 and 34 are clamped onto the first and second body
`portions as described above. the outward pivoting move-
`ment of the first and second arm members 12 and 14 and the
`cuffs 32 and 34 causes the joint to be extended as desired.
`However. this extension of the joint can place strong dis-
`tractive forces on the soft
`tissues around the joint. The
`sliding movement of the cufls 32 and 34. inwardly along the
`first and second arm members 12 and 14. helps to limit these
`distractive forces by counteracting the outward movement of
`the first and second arm members 12 and 14. The cuffs 32
`and 34 slide inwardly along the first and second arm
`members 12 and 14 a distance liar enough so that the joint is
`only slightly distracted during extension. Thus. the detri-
`mental effects of strong distractive forces normally gener-
`ated in forced extension of a joint are avoided. being
`replaced with the beneficial effects of limited and controlled
`distraction.
`
`Bending a Joint Flexion:
`ln operation ofthe orthosis 10 to flex thejoint. the orthosis
`10 starts at a more extended position. The first and second
`
`LANTZ 1001.13
`
`

`
`US 7,112,179 B2
`
`7
`extend the joint. The second arm member 14 is rotated from
`the first position to a second position. relative to the first arm
`member 12. rotating the second body portion about tl1e joint
`axis 16 stretching the joint. As the second arm member 14
`is
`rotated to the second position the second extension
`member 20 travels about and substantially though point
`along an arcuate path. The orthosis 10 is maintained in the
`second position for a predetermined treatment time provid-
`ing a constant stretch to the joint.
`As the orthosis 10 is rotated from the first position to the
`second position. flexing the joint. the first and second cuffs
`32 and 34 move along the first a11d second arm members 12
`and 14. The first cuff 32 moves outwardly along the first arm
`member 12. Similarly. the second cuff 34 moves outwardly
`along the second arm member 14. Because the cuffs 32 and
`34 are clamped onto the first and second body portions the
`inward pivoting movement of the first and second arm
`members 12 and 14 and the cuffs 32 and 34 causes the joint
`to be flexed as desired. However. this flexion of the joint can
`place strong compressive forces on the soft tissues around
`the joint. The sliding movement of the cuffs 32 and 34,
`outwardly along tl1e first and second arm members 12 and
`14. helps to limit these compressive forces by counteracting
`the inward movement of the first and second arm members
`12 and 14. The cuffs 32 and 34 slide outwardly along the first
`and second arm members 12 a11d 14 a distance far enough so
`that the joint is only slightly compressed during flexion.
`Thus. the detrimental effects of strong compressive forces
`normally generated in forced flexion of a joint are avoided.
`being replaced with the beneficial effects of limited and
`controlled compression.
`Referring now to FIG. 9. the orthosis 12 can be used to
`bend a wrist in flexion or extension. The orthosis 10 includes
`a first arm member 12 attachable to the forearm ofa patient.
`The first cuff'32 is clamped onto the forearm by straps. A
`second arm member 14. operatively connected to the first
`arm member 12.
`is attachable to the hand of the patient.
`wherein the axis of the wrist joint is interposed between and
`oflset from the first and second arm members 12 and 14. The
`second arm member 14 includes a base member 36 attach
`thereto. A hand pad 38 is attached to the base member 36.
`The hand pad 38 is clamped onto the hand by straps. tightly
`enough so that the second arm member 14 can apply torque
`to the joint. The hand pad 38 can be shaped to conform to
`the palm or the back surface of the hand.
`
`Bending Wrist in Flexion:
`When a wrist is to be bent in flexion. the first cuff 32 is
`connected with the forearm and the hand pad 38 is connected
`with the palm of the hand. The first cuff 32 and hand pad 38
`are clamped onto the forearm and hand. respectively. by
`straps. tightly enough so that they can apply torque to flex
`the joint. The second arm member 14 is rotated from the first
`position to a second position. relative to the first arm
`member 12. rotating the hand about the wrist joint axis 16
`stretching the joint. As the second arm member 14 is rotated
`to the second position the second extension member 20
`travels along an arcuate path about and substantially through
`point “P." The orthosis 10 is maintained in the second
`position for a predetermined treatment
`time providing a
`constant stretch to the wrist joint.
`
`Bending Wrist in Extension:
`When a wrist is to be bent in extension. the first cuff 32
`is connected with the forearm and the hand pad 38 is
`connected with the back surface of the hand. The first cuff
`
`8
`that they can apply torque to flex the joint. The second arm
`member 14 is rotated from the first position to a second
`position. relative to the first arm member 12, rotating the
`hand about the wrist joint axis 16 stretching the joint. As the
`second arm member 14 is rotated to the second position the
`second extension member 20 travels along an arcuate path
`about and substantially through point “P.” The orthosis 10 is
`maintained in the second position for a predetermined
`treatment time providing a constant stretch to the wrist joint.
`In an embodiment. the hand pad 38 is removable attached
`to the base member 36. The hand pad 38 includes a first
`surface. which has a substzmtially convex shape. to conform
`to the palm ofthe hand. A second surface. opposite the first
`surface.
`is also included. having a substantially concave
`shape. to conform to the back surface ofthe hand. 'll1e hand
`pad 38 can be removable attached to the base member 36
`such that the first or second surfaces engages the hand of the
`patient.
`For example. the hand pad 38 is removably secured to
`base member 36 by detent pin 40. The removable securing
`of the hand pad 38 allows the orthosis 10 to be used for both
`flexion and extension of the wrist. In flexion. the hand pad
`38 is connected to the base member 36 with the first surface
`facing “up” to conform to the palm of the hand. In extension.
`the hand pad 38 is connected to the base member 36 with the
`second surface facing “up" to conform to the back surface of
`the hand.
`
`‘JI
`
`,_ um
`
`‘Q
`
`toat
`
`The base member 38 can be mounted for sliding move-
`ment on the second arm member 14 and is slidable along the
`second ann member 14 in a manner as described below.
`
`30
`
`Bending Wrist in Extension:
`In operation of the orthosis 10 to extend the wrist joint. the
`orthosis 10 starts at a more flexed position. The first cuff 32
`is connected with the forearm and the hand pad 38 is
`connected with the palm of the hand. The first cuii‘32 and
`hand pad 38 are clamped onto the forearm and palm of the
`hand so as to apply torque to extend the wrist joint. The
`second arm member 14 is rotated from the first position to
`a second position. relative to the first arm member 12.
`rotating the hand about the wrist joint axis 16 stretching the
`wrist joint. As the second arm member 14 is rotated to the
`second position the second extension member 20 travels
`along an arcuate path about and substantially through point
`The orthosis 10 is maintained in the second position for
`a predetermined treatment time providing a constant stretch
`to the joint.
`As the orthosis 10 is rotated from the first position to the
`second position. extending the joint. the base member 36
`and hand pad 38 move along the second arm member 14.
`The base member 36 and hand pad 38 move inwardly along
`the second arm member 14. Because the cuff 32 and hand
`pad 38 are clamped onto the forearm and hand the outward
`pivoting movement of the first and second arm members 12
`and 14 causes thejoint to be extended as desired. However.
`this extension ofthe joint can place strong distractive forces
`on the soft tissues around the joint. The sliding movement of
`the base member 36 and hand pad 38. inwardly along the
`second arm member 14. helps to limit
`these distractive
`forces by counteracting the outward movement of the sec-
`ond arm members 12 and 14. The base member 36 and hand
`pad 38 slide inwardly along the second arm member 14 a
`distance far enough so that the joint is only slightly dis-
`tracted dttring extension. Thus. the detrimental effects of
`strong distractive forces normally generated in forced exten-
`
`40
`
`‘ITIn
`
`60
`
`65
`
`LANTZ 1001.14
`
`

`
`US 7,112,179 B2
`
`9
`
`Bending Wrist in Flexion:
`In operation of the orthosis 10 to flex the wrist joint. tl1e
`orthosis 10 starts at a more extended position. The first cuff
`32 is connected with the forearm and the hand pad 38 is
`connected with the back surface of the hand. The first cuff
`32 and hand pad 38 are clamped onto the forearm and back
`surface of the hand so as to apply torque to flex the wrist
`joint. The second arm member 14 is rotated from the first
`position to a second position.
`relative to the first arn1
`member 12. rotating the hand about the wrist joint axis 16
`stretching the wrist joint. As the second arm member 14 is
`rotated to the second position the second extension member
`20 travels along an arcuate path about and substantially
`through point
`Tl1e orthosis 10 is maintained iii the
`second position for a predefined treatment time providing a
`constant stretch to the joint.
`As the orthosis 10 is rotated from the first position to the
`second position. flexing the joint. the base member 36 and
`hand pad 38 move along the second arm member 14. The
`base member 36 and hand pad 38 move outwardly along th