WO2017017815A1 - 単振り子運動可能な肩装具 - Google Patents
単振り子運動可能な肩装具 Download PDFInfo
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- WO2017017815A1 WO2017017815A1 PCT/JP2015/071537 JP2015071537W WO2017017815A1 WO 2017017815 A1 WO2017017815 A1 WO 2017017815A1 JP 2015071537 W JP2015071537 W JP 2015071537W WO 2017017815 A1 WO2017017815 A1 WO 2017017815A1
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- Prior art keywords
- shoulder
- layer
- forearm
- brace
- sling
- Prior art date
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- 230000033001 locomotion Effects 0.000 title claims abstract description 64
- 210000000245 forearm Anatomy 0.000 claims abstract description 42
- 210000003414 extremity Anatomy 0.000 claims abstract description 16
- 210000002310 elbow joint Anatomy 0.000 claims abstract description 11
- 230000000472 traumatic effect Effects 0.000 claims 1
- 208000018286 Shoulder injury Diseases 0.000 abstract 2
- 210000003205 muscle Anatomy 0.000 description 15
- 210000001364 upper extremity Anatomy 0.000 description 15
- 208000014674 injury Diseases 0.000 description 12
- 208000010392 Bone Fractures Diseases 0.000 description 9
- 230000006378 damage Effects 0.000 description 9
- 206010017076 Fracture Diseases 0.000 description 8
- 208000027418 Wounds and injury Diseases 0.000 description 8
- 238000001356 surgical procedure Methods 0.000 description 8
- 210000001513 elbow Anatomy 0.000 description 7
- 230000004048 modification Effects 0.000 description 6
- 238000012986 modification Methods 0.000 description 6
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- 210000000513 rotator cuff Anatomy 0.000 description 5
- 210000001991 scapula Anatomy 0.000 description 4
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- 206010062575 Muscle contracture Diseases 0.000 description 2
- 208000002103 Shoulder Fractures Diseases 0.000 description 2
- 238000005452 bending Methods 0.000 description 2
- 208000006111 contracture Diseases 0.000 description 2
- 239000013013 elastic material Substances 0.000 description 2
- 230000005484 gravity Effects 0.000 description 2
- 210000000707 wrist Anatomy 0.000 description 2
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- 208000024288 Rotator Cuff injury Diseases 0.000 description 1
- 208000008877 Shoulder Dislocation Diseases 0.000 description 1
- 208000007613 Shoulder Pain Diseases 0.000 description 1
- 210000000142 acromioclavicular joint Anatomy 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
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- 238000006073 displacement reaction Methods 0.000 description 1
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- 230000012447 hatching Effects 0.000 description 1
- 210000002758 humerus Anatomy 0.000 description 1
- 230000004054 inflammatory process Effects 0.000 description 1
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- 230000020763 muscle atrophy Effects 0.000 description 1
- 230000003387 muscular Effects 0.000 description 1
- 201000000585 muscular atrophy Diseases 0.000 description 1
- 230000000399 orthopedic effect Effects 0.000 description 1
- 210000000062 pectoralis major Anatomy 0.000 description 1
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Images
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/37—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts
- A61F5/3715—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts for attaching the limbs to other parts of the body
- A61F5/3723—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts for attaching the limbs to other parts of the body for the arms
- A61F5/3753—Abduction support
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
- A61H1/02—Stretching or bending or torsioning apparatus for exercising
- A61H1/0274—Stretching or bending or torsioning apparatus for exercising for the upper limbs
- A61H1/0277—Elbow
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/37—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts
- A61F5/3715—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts for attaching the limbs to other parts of the body
- A61F5/3723—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts for attaching the limbs to other parts of the body for the arms
- A61F5/373—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts for attaching the limbs to other parts of the body for the arms for restricting the movement of the arm at the elbow
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/37—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts
- A61F5/3715—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts for attaching the limbs to other parts of the body
- A61F5/3723—Restraining devices for the body or for body parts, e.g. slings; Restraining shirts for attaching the limbs to other parts of the body for the arms
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/40—Suspensory bandages
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- A—HUMAN NECESSITIES
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- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H1/00—Apparatus for passive exercising; Vibrating apparatus; Chiropractic devices, e.g. body impacting devices, external devices for briefly extending or aligning unbroken bones
- A61H1/02—Stretching or bending or torsioning apparatus for exercising
- A61H1/0274—Stretching or bending or torsioning apparatus for exercising for the upper limbs
- A61H1/0281—Shoulder
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/01—Orthopaedic devices, e.g. splints, casts or braces
- A61F5/0102—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations
- A61F5/013—Orthopaedic devices, e.g. splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations for the arms, hands or fingers
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
- A61H2201/12—Driving means
- A61H2201/1253—Driving means driven by a human being, e.g. hand driven
- A61H2201/1261—Driving means driven by a human being, e.g. hand driven combined with active exercising of the patient
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- A—HUMAN NECESSITIES
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- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
- A61H2201/16—Physical interface with patient
- A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
- A61H2201/1614—Shoulder, e.g. for neck stretching
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
- A61H2201/16—Physical interface with patient
- A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
- A61H2201/1635—Hand or arm, e.g. handle
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
- A61H2201/16—Physical interface with patient
- A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
- A61H2201/165—Wearable interfaces
Definitions
- the present invention relates to a shoulder brace worn by a shoulder trauma patient such as a proximal brachial fracture, and more particularly to a shoulder brace that has both a fixing function immediately after an injury or immediately after surgery and a function of early rehabilitation.
- the shoulder is a part composed of the proximal end of the humerus, the scapula, and the distal end of the clavicle.
- the scapulohumeral joint includes a rotator cuff as an intrinsic muscle, a joint capsule, and an inguinal humeral ligament.
- the surrounding external muscles include a large number of muscles such as the deltoid muscle, the biceps brachii muscle, the triceps brachii, the pectoralis major and the trapezius. These muscles act on the shoulder and upper arm by acting on the scapulohumeral joint, the acromioclavicular joint, and the scapulothoracic joint.
- the present invention relates to a device related to post-traumatic fixation and post-treatment such as proximal humeral fracture, rotator cuff tear, acromioclavicular dislocation, shoulder dislocation, and distal clavicular fracture.
- the shoulder joint is a multi-axis joint called a ball socket joint and has a wide range of motion.
- a large number of muscles are attached to the periphery, and various movements are likely to occur due to the action. Therefore, conventionally, in the initial stage of treatment immediately after injury or immediately after surgery, not only the shoulder but also the elbow, forearm and wrist are fixed widely, and the neck and the shoulder on the healthy side are connected with a strap. Many braces have been used.
- Patent Document 1 discloses an appliance in which a shoulder pad and a forearm holder are connected by two straps.
- Patent Document 2 discloses a brace having support portions for supporting a wrist and a forearm at both ends of one stop that is put on a shoulder.
- Patent Document 3 discloses a brace for fixing the shoulder and forearm to the trunk with the elbow joint bent by 90 °.
- most of the appliances position the forearm bent at the elbow joint in the left-right direction in front of the trunk.
- a shoulder with many bones and muscles has a problem that contracture tends to occur if the holding and fixing period continues. Therefore, it is important to start rehabilitation at an early stage while ensuring the stability of the affected area.
- Ordinary rehabilitation is performed by removing the braces for fixation, and progresses step by step to passive movement, automatic assistance movement, automatic movement, and resistance movement.
- a CPM (continuous passive motion) device is known.
- the CPM device has a mechanical drive mechanism. This is used only for rehabilitation and is not always worn by the patient.
- FIG. 7 is a diagram showing the state of the Codman pendulum movement performed as early rehabilitation. This is done at an early stage of treatment. Usually, it is necessary to consider pain, avoidance of bone fracture and soft tissue invasion, and safety of the affected area.
- the patient bends the trunk, places the healthy hand on a desk or the like to support the body, and freely hangs the upper limb on the affected side.
- the suspended upper limb continues to perform a passive movement like a pendulum triggered by the trunk movement.
- the pendulum motion is a complex pendulum motion that can swing in various directions such as front and rear, left and right, and turn as indicated by arrows.
- FIG. 8 shows the notation of the movement of the shoulder joint in the three-dimensional space. This notation is established by the Japanese Orthopedic Association and the Japanese Association of Rehabilitation. Terms in this notation may be used in the description of the present invention and are collectively shown here.
- FIG. 8 (a) shows a rotational movement in a plane parallel to the sagittal plane.
- the front elevation indicated by FF is referred to as “flexion” and the rear elevation indicated by BE is “extension”. (Backward extension) ".
- FIG. 8 (b) shows a rotational movement in a plane parallel to the frontal plane, and the rotation away from the trunk indicated by the symbol AB is referred to as “abduction” and the opposite direction indicated by the symbol AD. This rotation is called “adduction”.
- FIG. 8 (c) shows the rotational motion in the horizontal plane with the elbow joint bent at 90 ° forward, and the outward turning indicated by the symbol ER is referred to as “external rotation” and is denoted by the symbol IR. The turning in the opposite direction shown is referred to as “internal rotation”.
- the physiological reference limb position is 0 ° flexion, 0 ° abduction, and 30 ° internal rotation.
- the physiological reference limb position is a limb position when the upper limb (upper arm) is dropped along the trunk with the force dropped. This is due to the fact that the human scapula plane is not parallel to the frontal plane and is inclined by 30 ° (the outside of the scapula protrudes forward from the inside). This 30 ° inclination angle slightly changes when the chest is stretched or the back is rolled up, because the scapula moves.
- the conventional shoulder orthoses described above have the following problems. ⁇ Because it is exclusively intended to fix the affected area, it is not expected to be applied to early rehabilitation in which the upper limb or upper arm is moved while wearing. ⁇ If worn for a long time, there is a risk of contraction of the affected area, muscle atrophy, or functional impairment. -When the forearm is in the left-right direction with the front of the trunk in contact, the upper limb is easy to move in the left-right direction, but difficult to move in the front-back direction. -In the case of a device that hangs a sling on the forearm and shoulder, if the user tries to exercise while wearing the sling, the sling is likely to slip or fall off the shoulder. In the orthosis that hangs the sling around the neck, it is easy to cause neck pain.
- the Codman pendulum exercise performed by removing the shoulder brace in the initial stage of treatment has the following problems. ⁇ Because the upper limb hangs down without support, the force of pulling the fracture site by gravity acts, which may cause dislocation (displacement) of the fracture site. ⁇ Because the pendulum movement is omnidirectional with the upper limb suspended, there is a risk of causing inflammation and pain in various muscles of the shoulder invaded by the operation. -Since the omnidirectional pendulum movement is performed, if the muscles of the shoulders are swung in such a direction that the muscles are tensed, there is a risk of dislocation of the fracture due to the upward pulling force due to the muscular tension.
- the present invention is a shoulder brace to be worn at an early stage of treatment of a patient with shoulder trauma, which can be exercised in an appropriate direction while being worn for early rehabilitation.
- the purpose is to provide.
- a first aspect of the present invention is a shoulder brace that is worn by a patient with a shoulder trauma in a physiological reference limb position in which an elbow joint is bent forward 90 ° and oriented in the direction of internal rotation 30 °.
- a shoulder pad (11a, 11b) placed in the front-rear direction with a predetermined width on both shoulders and a back extending in the left-right direction so as to connect the rear ends of the left and right shoulder pads (11a, 11b).
- a first layer (1) comprising at least a side connecting part (13); From the front end of the shoulder portion (21a) which has at least a ring-shaped sling (21) having a predetermined width and is placed on the affected shoulder pad (11a) of the first layer (1) It descends to the side of the elbow near the forearm, passes through the lower side of the forearm from the side of the forearm to the heel side, crosses the front of the upper arm from the side of the forearm, passes through the armpit, and connects to the rear end of the shoulder portion (21a).
- a second layer (2) hung so that The mounted patient can perform a simple pendulum motion in the front-rear direction while maintaining the internal rotation angle of the physiological reference limb position.
- the second layer (2) includes a forearm receiving portion (22) for supporting the forearm, and the sling (21) is provided on a lower surface side of the forearm receiving portion (22). Pass through.
- the shoulder brace capable of single pendulum movement of the present invention it is possible to perform single pendulum movement in the front-rear direction while wearing from the initial stage of treatment.
- the simple pendulum motion in the front-rear direction is to perform only bending and extension while maintaining the internal rotation angle of the physiological reference limb position.
- the direction of this simple pendulum movement is a safe direction that is unlikely to cause dislocation at the fracture site. Therefore, it is possible to perform the single pendulum exercise by wearing the shoulder brace of the present invention even before, for example, one or two days after injury or surgery, before the time when the Codman pendulum exercise is possible.
- the shoulder brace of the present invention the time required for complete holding and fixing immediately after injury or surgery can be shortened.
- the shoulder brace of the present invention can be exercised while standing or sitting, the burden on the patient is small. Furthermore, since the elbow joint is bent 90 ° forward, the forearm is facing forward, so that the hand can be used, and there are few problems in daily life.
- the sling provided in the second layer of the shoulder orthosis of the present invention has a function of holding the physiological reference limb position and performing a simple pendulum movement. Since this sling is hung with a predetermined path on the shoulder, upper arm, and forearm, the sling has a predetermined twist as a whole. Thereby, the force which restrict
- the rotator cuff which is the main intrinsic muscle responsible for abduction, is often damaged by injury or surgery, and for this reason, the rotator cuff should not be contracted.
- the sling of the second layer can only allow muscle movement in a safe direction and suppress muscle movement in a direction that should not be moved.
- a healthy rotator cuff usually plays a role of keeping the humeral head in a centripetal position.
- the sling of the second layer is also responsible for holding the humeral head in a centripetal position instead of a rotator cuff that is restrained from moving. With this function, the humeral head can be held in a centripetal position to perform stable exercise.
- the first layer plays a role as a base appliance for stably maintaining the functional form of the sling of the second layer.
- the shoulder portion of the sling of the second layer is placed on the shoulder pad of the first layer. Therefore, the shoulder rest portion of the first layer is configured to prevent the sling of the second layer from shifting in the left-right direction and to be slippery in the front-rear direction.
- the shoulder pad of the first layer is relatively wide and is provided on both shoulders, thereby preventing a burden from being concentrated on one part of the affected shoulder when performing a simple pendulum motion. Thereby, shoulder pain can be reduced.
- FIG.1 (a) is a perspective view which shows the state with which the patient mounted
- (B) is a perspective view which shows the form of the sling which the 2nd layer of the shoulder orthosis of (a) comprises.
- FIG. 2A is a perspective view showing a state in which the same shoulder brace as in FIG. 1 is used and the sling of the second layer is mounted in a manner different from that in FIG.
- FIG.2 (b) is a perspective view which shows the form of the sling contained in the 2nd layer of the shoulder brace of (a).
- FIG. 3 is a rear view of the state shown in FIG.
- FIG. 4 is a top view of the state shown in FIG. FIGS.
- FIGS. 5A to 5C are side views of the shoulder brace shown in FIG. 2 and are diagrams for explaining the effect of the present invention.
- FIGS. 6A to 6D are diagrams showing various modifications of the first layer of the shoulder brace.
- FIG. 7 is a diagram showing the state of the Codman pendulum movement performed as an early physical therapy prior to the passive movement.
- FIG. 8 shows a notation of the motion of the shoulder joint in the three-dimensional space.
- FIG.1 (a) is a perspective view which shows the state with which the patient mounted
- FIG.1 (b) is a perspective view which shows the form of the sling contained in the 2nd layer of the shoulder brace of (a).
- FIG. 2 (a) is a perspective view showing a state in which the same shoulder brace as in FIG. 1 is used and the sling of the second layer is mounted in a manner different from that in FIG.
- FIG.2 (b) is a perspective view which shows the form of the sling contained in the 2nd layer of the shoulder brace of (a).
- FIG. 3 is a top view of the mounted state shown in FIG.
- FIG. 4 is a rear view of the mounted state shown in FIG.
- the shoulder brace of the present invention is composed of at least two parts that are worn on top of the patient's body. Although the entire two parts do not necessarily overlap in layers, the two parts are referred to as a first layer and a second layer from the lower layer side.
- the first layer denoted by reference numeral 1 and the second layer denoted by reference numeral 2 in FIGS. 1 to 4 are main components to be worn for substantial treatment.
- the patient's right shoulder is the affected area (ie, the right is the affected side) and the left shoulder is healthy (ie, the left is the healthy side).
- the shoulder orthosis of the present invention can also be applied when both shoulders are the affected area.
- the second layer is arranged on each of the left and right sides.
- the physiological reference limb position is a limb position in which the upper limb is 0 ° bent, 0 ° abduction, and 30 ° internal rotation.
- the upper arm is naturally lowered along the side of the trunk.
- the forearm is directed in a direction that is 30 ° inwardly rotated from the direction perpendicular to the frontal plane FP (for convenience of explanation, this inwardly rotated direction is also referred to as “front”).
- the numerical values of these angles are not strict and have a certain range (for example, about plus or minus 10%).
- the first layer 1 connects the left and right shoulder rests 11a and 11b placed on both shoulders in the front-rear direction and the rear ends of the left and right shoulder rests 11a and 11b, respectively.
- it has at least the back side connection part 13 which extends a back in the left-right direction.
- the shoulder pads 11a and 11b have a predetermined width. In particular, with respect to the shoulder pad 11a on the affected side, the wider the width, the better the load is distributed.
- At least the shoulder pad 11b on the healthy side is connected by a side string portion 12b whose front end and rear end pass under the armpit.
- the sling 21 of the second layer 2 is placed on the shoulder pad 11a and is connected to the other shoulder pad 11b via the back connecting part 13, so that The position can be fixed. Therefore, it is not necessary to provide the side strap portion 12a on the shoulder pad 11a on the affected side.
- the side string portion is preferable in that it does not hinder the simple pendulum movement.
- the shoulder pad portions 11a and 11b on both the left and right sides may be connected by side string portions 12a and 12b, respectively. With such a configuration, the first layer 1 is stably attached to the patient.
- the second layer 2 includes at least a ring-shaped sling 21 having a predetermined width.
- the sling 21 is a single band-shaped ring that is connected without being twisted when not attached to the patient.
- the sling 21 is attached to the affected side.
- the uppermost portion of the sling 21 (this uppermost portion is referred to as a shoulder portion 21a of the sling 21) is placed on the shoulder rest portion 11a of the first layer 1 in the front-rear direction.
- the width of the sling 21 is narrower than the width of the shoulder pad 11a, and the sling 21 is preferably placed at the center in the width direction of the shoulder pad 11a.
- the sling 21 is hung as follows. From the front end of the shoulder portion 21a, it descends in a substantially vertical direction from the front end of the forearm to the elbow proximate portion, passes through the lower surface side of the forearm from the shank side to the heel side (the portion denoted by reference numeral 21b), Is further connected to the rear end of the shoulder portion 21a through the armpit.
- a constriction is formed at the center of the ring, and the entire sling 21 is twisted around the constriction.
- the overall twist of the sling 21 also appears in the top view of FIG.
- the two white arrows shown in FIG. 4 indicate the direction of the shoulder portion 21a of the sling 21 (substantially front-rear direction) and the direction of the portion 21b on the lower surface side of the forearm (substantially left-right direction) in plan view. These are almost perpendicular to each other.
- the sling 21 of the second layer 2 By wrapping the sling 21 of the second layer 2 in such a form, a force for controlling the positions of the forearm and the upper arm on the affected side works, and as a result, the affected upper limb can be held at the physiological reference limb position. . Further, the sling 21 allows only movement in the direction of extension and flexion of the upper limb while maintaining the internal rotation 30 ° of the physiological reference limb with the elbow joint bent 90 ° forward, and in the other direction. Exercise can be suppressed.
- the sling 21 descends from the front end of the shoulder portion 21a in a substantially vertical direction and is in contact with the forearm and its elbow proximity portion. Since the contact portion with the forearm is the elbow proximity portion, even if the elbow joint angle changes around 90 °, the influence on the length of the sling 21 is small. Thereby, the sling 21 can always be maintained in a state without loosening.
- FIGS. 1B and 2B the back surface of the sling 21 is indicated by hatching.
- FIG.1 (b) the surface is exposed by the shoulder part 21a, and the back surface is exposed in the forearm lower surface side part 21b.
- FIG. 2B the surface is exposed in both the shoulder portion 21 and the forearm lower surface portion 21b. This difference is due to a difference in the position of local twist in the sling 21.
- the effect of the present invention can be obtained regardless of which method is used.
- FIG. 5 is a side view of the shoulder brace shown in FIG. 2 and is a view for explaining the effect of the present invention.
- FIG. 5B corresponds to a side view of the state of FIG.
- the upper limb is held at a position where the elbow joint is 90 ° forward and the inner rotation is 30 °. That is, it is held at the physiological reference limb position.
- various movements of the trunk trigger the passive movement in the front-rear direction while maintaining the internal rotation angle.
- This back-and-forth movement is a pendulum motion that is repeated between the backward extension shown in FIG. 5A and the forward bending shown in FIG. 5C.
- This pendulum motion occurs only in a vertical plane including a vector with an internal rotation of 30 °, and is suppressed in other directions. This is therefore a simple pendulum motion.
- the point P of the shoulder portion of the sling 21 of the second layer 2 shown in FIGS. 5A to 5C corresponds to the shoulder pad of the first layer 1 during this simple pendulum movement. It turns out that it slides back and forth on the part 11a. It is preferable to make the surface of the first-layer first shoulder rest 11a slip easily in the front-rear direction in order to promote the single pendulum movement. Moreover, it is preferable that the surface of the shoulder pad 11a is difficult to slide in the left-right direction so that the sling 21 does not slip off from the shoulder.
- This single pendulum movement is limited to a safe direction. In this case, there is no movement in the direction to be prohibited, which may cause fracture dislocation or damage the muscle. Therefore, if this shoulder brace is worn immediately after injury or surgery, this simple pendulum motion can be performed from that point. This means that very early rehabilitation can be started. Moreover, since this simple pendulum motion is a passive motion that occurs spontaneously due to various movements of the patient's trunk, there is no need for the patient to perform it consciously. Further, this simple pendulum movement does not require the patient to take a heavy posture, and can be performed in a standing position or a sitting position. In addition, by wearing the shoulder brace of the present invention immediately after injury or surgery, there is no time to completely fix the patient's upper limb, so the risk of contracture can be eliminated.
- FIG. 6 is a diagram showing various modifications of the first layer of the shoulder brace of the present invention.
- FIG. 6A is a rear view of Modification 1A of the first layer.
- Projections 11a2 and 11a3 projecting at a predetermined height are formed on both edges in the width direction of the shoulder pad 11a. These ridges 11a2 and 11a3 serve as walls that prevent the sling from shifting in the left-right direction.
- the outer protrusion 11a2 is effective for preventing the sling from falling from the shoulder. Only the outer ridge 11a2 may be provided.
- a large number of thin grooves extending in the front-rear direction may be formed on the front surface 11a1 in contact with the back surface of the sling so that the sling can easily slide in the front-rear direction.
- protrusions and grooves are also provided on the shoulder-side support portion 11b on the unaffected side, but this is because the shoulder brace is used for both left and right. Basically, it is not necessary on the healthy side.
- FIG. 6B is a rear view of another modified example 1B of the first layer.
- An adjusting tool 14 for adjusting the length is provided on the back side connecting portion 13.
- FIG. 6C is a schematic cross-sectional view taken along the line II of FIG. 6B, and shows still another modification.
- the skin member 11d of the shoulder pad 11a has a bag shape and is filled with an elastic material 11e such as polyurethane.
- an elastic material 11e such as polyurethane.
- a core material having an appropriate hardness may be inserted into the central portion of the elastic material 11e.
- FIG. 6D is a front view of still another modified example 1C of the first layer.
- a front connection portion 15 is provided that extends in front of the chest in the left-right direction so as to connect the front ends of the left and right shoulder rest portions 11a, 11b.
- the first layer can be mounted sufficiently stably without providing the side string part 12b on the healthy side and the side string part on the affected side.
- the simple pendulum movement is not interfered by the side string part, and a smooth single pendulum movement is ensured.
- the third layer may be mounted as an additional component to be mounted in addition to the first layer and the second layer during the time when treatment is suspended.
- the third layer may have any form as long as it has a function of suppressing the simple pendulum movement by the second layer and fixing the patient's upper limb while wearing the second layer.
- the third layer takes the form of a wide transverse belt.
- the wide lateral belt is wound around the trunk and the affected upper arm in a horizontal direction with the affected upper arm along the side of the trunk.
- a second belt may be used in addition to the wide lateral belt.
- the second belt is an oblique belt for supporting the affected forearm.
- one end of the diagonal belt is fixed to the front end of the shoulder rest portion 11b on the healthy side of the first layer.
- the oblique belt crosses the front surface of the trunk diagonally from the front end of the shoulder pad 11b toward the heel side of the affected forearm, from the heel side of the forearm through the lower surface of the forearm to the vicinity of the elbow on the side of the forearm, It is fixed to a part of the back side of the lateral belt.
- the shoulder brace capable of single pendulum movement according to the present invention has been described with reference to some embodiments and modifications, but various modifications other than these can be made as long as the gist of the present invention is met. Moreover, although it does not specifically limit about the material of each component, In order to exhibit the function of this invention, a suitable thing shall be selected.
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Abstract
Description
・専ら患部の固定を目的としているため、装着したまま上肢又は上腕を動かすという早期リハビリテーションへの適用は想定されていない。
・長期に亘って装着したままであると、患部の拘縮、筋萎縮、機能障害を起こすおそれがある。
・前腕が体幹の前面に接した状態で左右方向に位置する場合、上肢を左右方向には動かし易いが、前後方向には動かし難い。
・スリングを前腕と肩に掛けるタイプの装具の場合、装着したまま運動しようとすると、スリングが肩からずれたり落ちたりし易い。スリングを首に掛ける装具では、首の疼痛を起こし易い。
・上肢を支持無しで下垂するため、重力により骨折箇所を引き離す力が作用し、骨折箇所の転位(ずれ)のおそれがある。
・上肢を下垂した状態で全方位的な振り子運動を行うため、手術で浸襲された肩の種々の筋肉に炎症や疼痛を引き起こすおそれがある。
・全方位的な振り子運動を行うため、肩の種々の筋肉が緊張するような方向に振れると、筋肉の緊張による上方への引っ張り力により骨折箇所の転位のおそれがある。
・初期段階で行うものではあるが、最低限の患部の修復を待って行うので、受傷又は手術の直後から行うことはできない。
・年齢や体調により、前傾姿勢を保てない患者もいる。
・装具を着脱する必要がある。
両肩にそれぞれ所定の幅で前後方向に置かれる肩当て部(11a、11b)と、左右の前記肩当て部(11a、11b)の後端同士を連結するように左右方向に延在する背側連結部(13)とを少なくとも具備する第一層(1)と、
所定の幅をもつリング状のスリング(21)を少なくとも具備しかつ前記スリング(21)が前記第一層(1)の患側の肩当て部(11a)に置かれる肩部分(21a)の前端から前腕の肘近接部の尺側に下降し、前腕の下面側を尺側から橈側に通り、前腕の橈側から上腕の前面を横切り、さらに脇の下を通って前記肩部分(21a)の後端に繋がるように掛けられる第二層(2)と、を有し、
装着した患者が生理的基準肢位の内旋角度を保持したまま前後方向に単振り子運動を行うことが可能であることを特徴とする。
左右の前記肩当て部(11)の前端同士を連結するように左右方向に延在する前側連結部(15)と、を具備する。
図1(a)は、患者が本発明の肩装具の一例を装着した状態を示す斜視図である。図1(b)は(a)の肩装具の第二層に含まれるスリングの形態を示す斜視図である。
・75歳女性
・左右の上腕骨近位端骨折(AO分類の11-B1.1)
<肩装具の装着>
手術翌日より肩装具を装着した。両肩が患部であるので、第2層は左右両方に適用した。手の使用は自由とした。肩装具を装着した状態で、座位又は立位にて単振り子運動を行わせた。
<結果>
術後8週で、疼痛無く肩のほぼ全可動域を獲得した。術後のリハビリテーションは良好であったといえる。
11a、11b 肩当て部
12a、12b 脇紐部
13 背側連結部
14 調節具
15 前側連結部
2 第二層
21 スリング
22 前腕受け部
23 調節具
FP 前額面
Claims (4)
- 肩の外傷患者が肘関節を前方90°に曲げかつ内旋30°方向に向けた生理的基準肢位にて装着する肩装具であって、
両肩にそれぞれ所定の幅で前後方向に置かれる肩当て部(11a、11b)と、左右の前記肩当て部(11a、11b)の後端同士を連結するように左右方向に延在する背側連結部(13)とを少なくとも具備する第一層(1)と、
所定の幅をもつリング状のスリング(21)を少なくとも具備しかつ前記スリング(21)が前記第一層(1)の患側の肩当て部(11a)に置かれる肩部分(21a)の前端から前腕の肘近接部の尺側に下降し、前腕の下面側を尺側から橈側に通り、前腕の橈側から上腕の前面を横切り、さらに脇の下を通って前記肩部分(21a)の後端に繋がるように掛けられる第二層(2)と、を有し、
装着した患者が生理的基準肢位の内旋角度を保持したまま前後方向に単振り子運動を行うことが可能であることを特徴とする
単振り子運動可能な肩装具。 - 前記第二層(2)が前腕を支持するための前腕受け部(22)を具備し、前記スリング(21)は該前腕受け部(22)の下面側を通ることを特徴とする請求項1に記載の単振り子運動可能な肩装具。
- 前記第一層(1)の左右両方の前記肩当て部(11a、11b)の各々における前端と後端を脇の下を通って連結する脇紐部(12a、12b)を具備することを特徴とする請求項1又は2に記載の単振り子運動可能な肩装具。
- 前記第一層(1)の健側のみの前記肩当て部(11b)の前端と後端を脇の下を通って連結する脇紐部(12b)と、
左右の前記肩当て部(11)の前端同士を連結するように左右方向に延在する前側連結部(15)と、を具備することを特徴とする請求項1又は2に記載の単振り子運動可能な肩装具。
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DE112015004654.2T DE112015004654T5 (de) | 2015-07-29 | 2015-07-29 | Schultergelenkorthese für einfache Pendelbewegungen |
PCT/JP2015/071537 WO2017017815A1 (ja) | 2015-07-29 | 2015-07-29 | 単振り子運動可能な肩装具 |
US15/518,903 US10786384B2 (en) | 2015-07-29 | 2015-07-29 | Shoulder brace for simple-pendulum motion |
JP2016563495A JP6539287B2 (ja) | 2015-07-29 | 2015-07-29 | 単振り子運動可能な肩装具 |
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USD966529S1 (en) * | 2019-09-30 | 2022-10-11 | L&M Innovations LLC | Compression apparatus |
US11696845B2 (en) | 2021-04-27 | 2023-07-11 | Burton Braces, LLC | Shoulder brace device |
USD954976S1 (en) * | 2021-07-22 | 2022-06-14 | Xing Li | Back support brace |
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- 2015-07-29 JP JP2016563495A patent/JP6539287B2/ja active Active
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JP2003010219A (ja) * | 2001-06-28 | 2003-01-14 | Emi Tonozuka | 腕吊り用具 |
US20030135141A1 (en) * | 2001-12-11 | 2003-07-17 | Gunther Berhorst | Orthesis for treatment of injuries to the acromioclavicula shoulder joint |
JP2004261531A (ja) * | 2003-01-08 | 2004-09-24 | At Lab:Kk | 肩関節脱臼急性期固定用装具 |
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US10786384B2 (en) | 2020-09-29 |
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