CA2074323A1 - Hand support device - Google Patents
Hand support deviceInfo
- Publication number
- CA2074323A1 CA2074323A1 CA 2074323 CA2074323A CA2074323A1 CA 2074323 A1 CA2074323 A1 CA 2074323A1 CA 2074323 CA2074323 CA 2074323 CA 2074323 A CA2074323 A CA 2074323A CA 2074323 A1 CA2074323 A1 CA 2074323A1
- Authority
- CA
- Canada
- Prior art keywords
- trough
- spar
- hand support
- support
- hand
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
Classifications
-
- 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
- A61F5/04—Devices for stretching or reducing fractured limbs; Devices for distractions; Splints
- A61F5/05—Devices for stretching or reducing fractured limbs; Devices for distractions; Splints for immobilising
- A61F5/058—Splints
- A61F5/05841—Splints for the limbs
- A61F5/05858—Splints for the limbs for the arms
- A61F5/05866—Splints for the limbs for the arms for wrists, hands, fingers or thumbs
Landscapes
- Health & Medical Sciences (AREA)
- Nursing (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Orthopedics, Nursing, And Contraception (AREA)
Abstract
ABSTRACT
This invention is directed to hand support and positioning device for surgical and post surgical purposes. It comprises a base, trough support, arm trough and attached adjustable hand support. The hand support is adjustable so that the forearm-wrist angle can be varied according to need, and also the metacarpophalangeal joint of the fingers can be placed in flexion or extension. These required position aids treatment by reliably fixing the patient's hand in position, and thus relaxing the patient. The hand support may be directly attached to the trough or to the trough support. Advantageously, the hand support has two pivotally connected surfaces, so that the finger-hand angle can be varied according to need. A goniometer arrangement is preferably included to allow accurate measurement of the angles.
This invention is directed to hand support and positioning device for surgical and post surgical purposes. It comprises a base, trough support, arm trough and attached adjustable hand support. The hand support is adjustable so that the forearm-wrist angle can be varied according to need, and also the metacarpophalangeal joint of the fingers can be placed in flexion or extension. These required position aids treatment by reliably fixing the patient's hand in position, and thus relaxing the patient. The hand support may be directly attached to the trough or to the trough support. Advantageously, the hand support has two pivotally connected surfaces, so that the finger-hand angle can be varied according to need. A goniometer arrangement is preferably included to allow accurate measurement of the angles.
Description
2 207~3~
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 .
- ~ : ",, ~., .
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 .
- ~ : ",, ~., .
3 2~32~
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 .~ :
2~7~32~
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 . : ~
; , . - , - ::
:, . . .
2~7~32~
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 - . ~ ::
.: .. :.. . . .- : .
- ,, ' :
.
.
' . : - : :
6 2~7~3,~
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 ., . .. . ~
: : : ~ : , . .. . ~ :
.: ,. .:- ~ :.. : ,.
207~32~ ~
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.
:- - .: .. ':...... ' 8 2~7~2~ ;
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 .
. . . .
.
.
9 ~0~32~
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.
~, .: :
lo ~7~23 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 .- : ~ . . , . :.
- : : : - .~..
'-.
~. ~:: ~ . , , 11 2~3~
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 : `; .
'`.
2~7~32~
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 -;
:: ~
2~7~3~
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 , , , ;
. ., . ........... .. : :-; . , . i . .. . . .
- - - . - : . . ,;, ,, ,. -. ,. :
:. . . : ; ~. :. .. : : :
2~7~323 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 ., . - -:. : -~: , , ,.: .. : -: . ~ -.. . . ~ ;: . .. . -2~7~3 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 ' ' -, ' - .
: : .
- :. . ~
16 2 ~ 32~
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 :.,, .,.:
~, : . . . -:
. .. ~
~:
~: :
17 20~ ~3 2~
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 :: : ~..
, ::
18 2~ ~ 323 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 : - .
:: :
: . : . . :
; . ~
,.
19 2~323 252 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 :. : , . :
. : , : ~ :
- , ,. ., : ,. : . .
:.: . , ~
-: : ~.: , ::
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.
- ~ . . ;, - ~ :
:~' .. ' '` ; , 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 .: , :: : - : .
. : .: ~ :: ~ : , :,. : ~: : . .: ., ~-. , : : -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 , - :
. . , :."
~, ., ~ ,, :;
- ~7~3~
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.
:: . . : , ,
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 .~ :
2~7~32~
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 . : ~
; , . - , - ::
:, . . .
2~7~32~
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 - . ~ ::
.: .. :.. . . .- : .
- ,, ' :
.
.
' . : - : :
6 2~7~3,~
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 ., . .. . ~
: : : ~ : , . .. . ~ :
.: ,. .:- ~ :.. : ,.
207~32~ ~
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.
:- - .: .. ':...... ' 8 2~7~2~ ;
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 .
. . . .
.
.
9 ~0~32~
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.
~, .: :
lo ~7~23 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 .- : ~ . . , . :.
- : : : - .~..
'-.
~. ~:: ~ . , , 11 2~3~
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 : `; .
'`.
2~7~32~
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 -;
:: ~
2~7~3~
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 , , , ;
. ., . ........... .. : :-; . , . i . .. . . .
- - - . - : . . ,;, ,, ,. -. ,. :
:. . . : ; ~. :. .. : : :
2~7~323 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 ., . - -:. : -~: , , ,.: .. : -: . ~ -.. . . ~ ;: . .. . -2~7~3 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 ' ' -, ' - .
: : .
- :. . ~
16 2 ~ 32~
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 :.,, .,.:
~, : . . . -:
. .. ~
~:
~: :
17 20~ ~3 2~
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 :: : ~..
, ::
18 2~ ~ 323 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 : - .
:: :
: . : . . :
; . ~
,.
19 2~323 252 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 :. : , . :
. : , : ~ :
- , ,. ., : ,. : . .
:.: . , ~
-: : ~.: , ::
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.
- ~ . . ;, - ~ :
:~' .. ' '` ; , 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 .: , :: : - : .
. : .: ~ :: ~ : , :,. : ~: : . .: ., ~-. , : : -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 , - :
. . , :."
~, ., ~ ,, :;
- ~7~3~
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 (28)
1. Hand support stand means comprising in combination base means adapted to rest on a substrate, trough support means attached to said 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 support means with respect to said trough means is adjusted.
2. The stand of claim 1, wherein said lockable angularly adjustable means is connected to said trough means.
3. The stand of claim 2, wherein said lockable angularly adjustable mens comprises lockable hinge means, said hinge means comprising leaf means attached to said hand support mens, leaf means attached to said trough means, said leaf means being pivotally mounted on pin bolt means lockable by nut means.
4. The stand of claim 3, wherein said nut means comprises wing nut means.
5. The stand of claim 1, wherein said lockable angularly adjustable means is connected to said trough support means.
6. The stand of claim 5, wherein said hand support means has spaced apart first and second pivots means mounted beneath said hand support, said first pivot means being mounted adjacent said trough means, said second pivot means being mounted remote from said trough means, first spar means pivotally attached to said first pivot means, second spar means being pivotally attached to said second pivot means, said first spar means being slidably and lockably secured to first slot means to said trough support mens by first nut and bolt mens passing through said slot and said first spar, said second spar means being slidably and lockably secured to second slot means by second nut and bolt means, whereby the position of said 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.
7. The stand of claim 5, wherein said hand support means has spaced apart first and second pivots means mounted beneath said hand support, said first pivot means being mounted adjacent said trough means, said second pivot means being mounted remote from said trough means, first spar means pivotally attached to said first pivot means, second spar means being pivotally attached to said second pivot means, said first spar means being slidably and lockably secured to first slot means in said trough support means by first nut and bolt means passing through said slot and said first spar, said second spar means being pivotally attached to third spar means, said third spar means being slidably and lockably secured in third slot means in said trough support means by second nut and bolt means, whereby the position of said 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.
8. Hand support stand means comprising in combination base means adapted to rest on a substrate, trough support means attached to said 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 first and second surfaces adapted to receive a hand, said first surface of 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 support means with respect to said trough means is adjusted.
9. The stand of claim 8, wherein said first and second surfaces are pivotally connected.
10. The stand of claim 9, wherein said lockable angularly adjustable means is connected to said trough means.
11. The stand of claim 10, wherein said lockable angularly adjustable means comprises lockable hinge means, said hinge means comprising leaf means attached to said hand support means, leaf means attached to said trough means, said leaf means being pivotally mounted on pin bolt means lockable by nut means.
12. The stand of claim 11, wherein said second surface of said hand support means is pivotally connected to said first surface of said hand support means by lockable hinge means, said hinge means comprising leaf means attached to said first surface, leaf means attached to said second surface, said leaf means being pivotally mounted on pin bolt means lockable by nut means.
13. The stand of claim 12, wherein said nut means comprises wing nut means.
14. The stand of claim 9, wherein said lockable angularly adjustable means is connected to said support means for said trough.
15. The stand of claim 14, wherein said first surface of said hand support means has spaced apart first and second pivot means mounted beneath said hand support, said first pivot means being mounted adjacent said trough means, said second pivot means being mounted remote from said trough means, said second surface of said hand support means being pivotally attached to said second pivot means, first spar means pivotally attached to said first pivot means, second spar means pivotally attached to said second pivot means, said first spar means being slidably and lockably secured to first slot means in said trough support means by first nut and bolt means passing through said slot and said first spar, said 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 said second surface remote from said first surface, third spar means pivotally attached to said third pivot means, said third spar means having slot means through which, said third spar means is slidably and lockably attached to said trough support by said second nut and bolt means, whereby the angle between said first and second surfaces can be varied by adjusting the position of the third spar slot means with respect to said second nut and bolt means.
16. The stand of claim 14, wherein said hand support means has spaced apart first and second pivots means mounted beneath said hand support, said first pivot means being mounted adjacent said trough means, said second pivot means being mounted remote from said trough means, first spar means being pivotally attached to said first pivot means, second spar means being pivotally attached to said second pivot means, said first spar means being slidably and lockably secured to first slot means in said trough support means by first nut and bolt means passing through said slot and said first spar, said second spar means being pivotally attached to third spar means, said third spar means being slidably and lockably secured to third slot means in said 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 said second surface remote from said first surface, fourth spar means pivotally attached to said third pivot means, said fourth spar means having slot means through which, said fourth spar means is slidably and lockably secured to second spar means by third nut and bolt means passing through said fourth spar slot means, whereby the angle between said first and second surfaces can be varied by adjusting the position of the fourth spar slot means with respect to said third nut and bolt means.
17. The stand of claim 8, wherein said first and second surfaces are integrally connected.
18. The stand of claim 1, wherein said trough means has first bottom pivot means mounted adjacent said hand support means, said first pivot means having first spar means pivotally attached, first slot means in said first spar means, first nut and bolt means passing through said first slot means slidably and lockably securing said first spar means to said trough means, said trough means additionally having second bottom pivot means remote from said hand support, said second pivot means having pivotally attached second spar means, said second spar means having second slot means therein, second nut and bolt means slidably and lockably securing said second spar means to vertical plate means transverse of said trough means, said plate means having horizontal extension means having third slot means transverse of said trough means, third nut and bolt means lockably and slidably securing said plate means to said base means, whereby the relative heights above said base of said first and second pivot means can be independently varied, and second pivot means can be moved transversely with respect to base.
19. The stand of claim 1, additionally including goniometer stand means, said goniometer stand means, comprising means to attach said goniometer to said base, adjustable height upright means, and first goniometer means mounted adjacent the top of said upright, positioned between said first hand support surface and said trough means, whereby the angle between said first hand support surface and said trough means can be measured.
20. The stand of claim 9, additionally including goniometer stand means, said goniometer stand means, comprising means to attach said goniometer to said base, adjustable height upright means, first goniometer means mounted adjacent the top of said upright, positioned between said first hand support surface and said trough means, whereby the angle between said first hand support surface and said trough means can be measured, second goniometer means mounted adjacent the top of said upright, positioned between said first and second hand support surfaces whereby the angle between said first and second hand support surfaces can be measured.
21. In a hand support and positioning device, the transducer and sensors are placed internally, controlled by said knobs placed externally on the said hand support and positioning device. The knobs control the force applied to said hand support pan or said finger pan or individual finger system.
22. The transducer described in claim 21, offers calibrated force to the hand support pan or the finger pan.
23. The calibrated force means described in claim 22, wherein the transducer means includes the display readout screen mounted externally to the hand support and positioning device.
24. In a hand support stand having a hand support pan, and a base member, the improvement comprising strain gauge means mounted above said hand support pan, and slidable plate means conventionally mounted under the said hand support pan, allowing said plate means to be slid longitudinally to said hand support pan.
25. The hand support stand of claim 24, wherein said strain gauge means is mounted on strain gauge support means fixed to said base member 16.
26. The hand support stand of claim 24, wherein said strain gauge means is calibrated.
27. The hand support stand of claim 25, wherein said strain gauge means includes a digital force readout.
28. The hand support pan may be provided with a retractable longitudinal slide and strain gauge means mounted above the hand support pan, allowing measurement of torque range of motion of hand joints (DIP, PIP, MCP).
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA 2074323 CA2074323A1 (en) | 1992-07-21 | 1992-07-21 | Hand support device |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA 2074323 CA2074323A1 (en) | 1992-07-21 | 1992-07-21 | Hand support device |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2074323A1 true CA2074323A1 (en) | 1994-01-22 |
Family
ID=4150185
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA 2074323 Abandoned CA2074323A1 (en) | 1992-07-21 | 1992-07-21 | Hand support device |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA2074323A1 (en) |
-
1992
- 1992-07-21 CA CA 2074323 patent/CA2074323A1/en not_active Abandoned
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| JP3330381B2 (en) | Dynamic elbow support | |
| US5376091A (en) | Dynamic finger support | |
| US4443005A (en) | Foot support device | |
| US4643177A (en) | Dynamic traction wrist cast brace | |
| US5102411A (en) | Dynamic elbow support | |
| JP3093269B2 (en) | Knee brace | |
| US4766892A (en) | Limb restraint | |
| EP1890618B1 (en) | Fixator or splint | |
| Mah et al. | Percutaneous Kirschner wire stabilisation following closed reduction of Colles’ fractures | |
| US5020525A (en) | Ankle distraction apparatus | |
| US9757267B1 (en) | Forearm and wrist fracture table | |
| JPH0751307A (en) | Device for treating spinator/pronator contracture in joint between radius and ulna | |
| JPS60500847A (en) | external brace device | |
| JP2005512731A (en) | Gypsum member used as a splint to fix fractures | |
| JP2003526470A (en) | Pronation / supination / flexion therapy exercise device | |
| JPH06511169A (en) | Joint flexion characteristic measuring device and method | |
| JPS62286455A (en) | Dynamic bone fixing external apparatus | |
| JPH01121048A (en) | Regio lumbalis hinge device for orthopaedic surgery which can control muscle abduction | |
| Weber | A rational approach for the recognition and treatment of Colles’ fracture | |
| Opgrande et al. | Fractures of the hand | |
| US20210386577A1 (en) | Dynamic adjustable shoulder orthosis with rehabilitation by adduction | |
| AU660309B2 (en) | Dynamic joint support | |
| CA2074323A1 (en) | Hand support device | |
| CN107928851B (en) | Scalable brace of prevention tendon repair postoperative tendon fracture | |
| Moir et al. | Intracast pressure measurements in Colles' fractures |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| FZDC | Correction of dead application (reinstatement) | ||
| EEER | Examination request | ||
| FZDE | Dead |