WO2019020960A1

WO2019020960A1 - Device for holding the arm of a patient

Info

Publication number: WO2019020960A1
Application number: PCT/FR2018/051936
Authority: WO
Inventors: Johannes Barth; Philippe DELSOL
Original assignee: Johannes Barth; Delsol Philippe
Priority date: 2017-07-28
Filing date: 2018-07-27
Publication date: 2019-01-31
Also published as: FR3069431B1; FR3069431A1

Abstract

Device for holding the arm of a patient in the abducted position or in an anatomically low resting position, comprising: - a cushion (1) intended to be placed between the torso and the forearm of the patient, the cushion (1) being formed of a proximal member (1b) and a distal member (1a), the angle between the proximal member (1b) and the distal member (1a) being adjustable, at least from one anatomically low resting position to a position for holding the arm in the abducted position, - a removable spacer (2), configured to be positioned between the distal member (1a) and the proximal member (1b) of the cushion (1), - means for attaching the forearm and the arm to the distal member (1a) of the cushion, - means for attaching the torso of the patient to the proximal member (1b) of the cushion, - the particles moveable relative to each other arranged in the cushion (1).

Description

Device for holding the arm of a patient

Technical field of the invention

The invention relates to a device for holding the arm of a user. State of the art

The holding or immobilization devices are used to achieve post-traumatic immobilization without shoulder surgery or postoperative immobilization of the shoulder (rotator cuff, shoulder prosthesis, osteosynthesis on fracture, instability. .). The immobilization of the arm in abduction, that is to say in a position away from the axis of the body, allows the release position of the upper anatomical structures of the shoulder (deltoid, rotator cuff, etc.). ) as well as the reduction of deltoid pressure on the underlying anatomical elements (sub-acromial bursa in particular). This position promotes healing and has antalgic benefits.

French patent FR2898040 describes a flexible holding device for immobilizing the arm in an abduction position. The cushion on which the arm rests is a cover made of flexible material containing filling elements made of flexible material. These include a cushion filled with polyester fibers.

The flexible immobilization devices adapt well to the anatomy of each upper limb as well as to the morphological variations of each individual and make it possible to better distribute the support zones. However, this type of immobilization device has the disadvantage of offering a little firm support to the patient. It appears that this type of immobilization device can contribute to increase inflammatory and painful phenomena.

Document US 2014/0358052 discloses another embodiment of an immobilizer. It turns out that this immobilizer is rarely adapted to the morphology of the user which makes its acceptance difficult.

US patent application 2005/0171460 discloses a rigid holding device of the arm. Two elements are positioned under the arm to maintain it. The relative position of the two elements can be adjusted in height. The angle between the two elements can also be adjusted, which allows different abduction positions. The elements are made of memory foam. This type of device is quite rigid.

Rigid immobilization devices provide firm support, on which patients feel confident. However, such immobilization devices offer standardized supports, by definition less adapted to the morphological variations of the patients. These supports can sometimes be too limited and create areas of cutaneous compressions or nervous. The device proposed in document US 2005/0171460 has an imposing shape mainly rigid so as to install an axially movable corner in the direction of the height and a fixed spacer.

Object of the invention

The invention aims to overcome the drawbacks of the prior art and, in particular, to provide a firm holding device, while being adaptable to different morphologies, and to easily position the arm in different abduction positions.

This object is achieved by a device for holding the arm of a user in abduction or in an anatomical low rest position comprising:

a cushion intended to be placed between the trunk and the forearm of the user, the cushion being formed of a proximal element and a distal element, the angle between the proximal element and the distal element can be adjusted, at least from a low anatomical rest position to a high arm holding position,

a spacer configured to be positioned between the proximal member and the distal member of the cushion,

means for fixing the forearm and the arm to the distal element of the cushion,

- Means for fixing the cushion with the trunk of the user at the proximal element.

The holding device is remarkable in that the proximal member and the distal member are partially filled with moving particles with respect to each other. The proximal element and the distal element each form a closed envelope preventing transfer of moving particles between the proximal element and the distal element. The filling rates of the proximal member and the distal movable particle member are configured so that the moving particles can move in the proximal member and the distal member when the holder is attached to the trunk, to the forearm and the user's arm. The spacer is removable relative to the proximal member and the distal member to define two different positions of the distal member relative to the proximal member.

In one development, the distal member is fixed to the proximal member immovably. Alternatively, the proximal member is removably attached to the distal member.

Advantageously, the particles have a Young's modulus of between 0.2GPa and 30GPa. It is interesting to predict spherical particles. Preferably, the particles are spheres of expanded polystyrene. In a particular embodiment, the particles have dimensions of between 0.2 mm and 3 mm.

It is also advantageous to provide that the filling of the cushion by the particles is between 50% and 90% by volume.

In another development, the spacer is configured to define an angle of at least 45 ° between an outer face of the proximal member and an outer face of the distal member.

In a particular embodiment, the means for fixing the forearm and the arm on the distal element of the cushion and / or the means for fixing the cushion with the trunk of the user at the level of the proximal element are mounted removable.

Brief description of the drawings

Other advantages and features will emerge more clearly from the following description of particular embodiments of the invention given by way of non-limiting example and represented in the accompanying drawings, in which: - Figures 1 and 2 show, schematically, in front view, a holding device on a patient in the upper position of abduction and low anatomical position, respectively,

FIGS. 3 and 4 show schematically, and in section, a cushion comprising a distal element and a proximal element according to different embodiments,

FIG. 5 schematically represents the arm and the forearm of a patient held with a holding device according to the invention,

- Figure 6 schematically shows the trunk of a patient held with a holding device according to the invention.

Description of a preferred embodiment of the invention

As illustrated in FIGS. 1 to 4, the device for holding the shoulder of a patient in a high holding position or in an anatomically low resting position comprises a cushion 1 intended to be placed between the trunk and the forearm. of the patient.

The cushion 1 is formed of a distal element 1a and a proximal element 1b. The distal element 1a is the one intended to be in contact with the forearm and the arm. The proximal element 1b is the one intended to be in contact with the trunk. The distal member 1a and the proximal member 1b are configured to separate the trunk and the forearm.

According to a first embodiment, and as shown in FIG. 3, the cushion 1 may be a double cushion, that is to say that the distal element 1a is fixed irremovably to the proximal element 1b. . These two elements form a one-piece cushion.

According to a second embodiment, and as shown in Figure 4, the cushion 1 may also be formed by two separate cushions, that is, the proximal member 1b is removably attached to the distal member 1a. It is advantageous to provide two separate elements which are interconnected by a fixing means 3. The skilled person may choose any type of means of suitable fastening, for example clip fasteners, hook tape or hook and loop fasteners. Advantageously, the fixing means 3 form a flexible hinge, for example a fabric that allows the proximal element 1b to rotate relative to the distal member 1a while allowing another movement of these two elements, for example vertical translation of the proximal element 1b relative to the distal member 1a or a rotation about an axis perpendicular to the sagittal plane of the user. This displacement of the distal member 1 with respect to the proximal element 1b allows a better adaptation to the user by allowing a small movement of the arm relative to the trunk throughout the day. The displacement of the distal member 1a relative to the proximal member 1b may be enabled by the deformation of the upper portion of the distal member 1a and / or the proximal member 1b. It is particularly advantageous to have a holding device devoid of rigid areas because it allows to use the holding device for sleeping.

As shown in FIG. 1, the holding device also comprises a removable spacer 2, configured to be positioned between the distal element 1a and the proximal element 1b of the cushion 1. The spacer 2 can be fixed to the distal member 1a and / or to the proximal element 1b by any suitable means, for example by means of clips, a zipper, a hook or hook-and-loop tape , of a magnetized system. The spacer 2 is installed in the holding device so as not to come into direct contact with the body of the user. The spacer 2 is separated from the user's body by the distal member 1a on one side and the proximal member 1b on the other side.

Advantageously, the proximal element 1b is rotatably mounted relative to the distal member 1a so as to be able to modulate the total volume occupied by the holding device which forms a splint and thus modulate the angle formed by the arm of the user in relation to the trunk. The angle formed by the user's arm relative to the trunk is called angle a. When the holding device is used, the angle α is measured between the two outer surfaces of the holding device, that is to say the two opposite external surfaces of the distal member and the proximal member intended to come in contact with the user. The spacer 2 is separated from the user on the one hand by the proximal element 1b and on the other by the distal element 1a, which makes it possible to avoid rigid contact between the spacer 2 and the user can generate, over a significant period, painful discomfort.

When the spacer 2 is not used, the arm of the user realizes a first value of the angle with the trunk. This first value of the angle α is defined by the volume of the distal element 1a and by the volume of the proximal element 1b. The distal member 1a comes into contact with the proximal member 1b as shown in FIG.

When the spacer 2 is used, the arm of the user realizes a second value of the angle a with the trunk according to the desired position. This second value of the angle a is greater than the first value. The positioning of the spacer 2 makes it possible to maintain a non-zero angle between the distal element 1a and the proximal element 1b and thus to increase the volume occupied by the holding device. This angle can be adjusted by judiciously choosing the dimensions of the spacer 2 to the corpulence of the user and the desired position for his arm. The spacer 2 is installed between the distal member 1a and the proximal member 1b. Advantageously, the spacer 2 is made of a more rigid material than the distal element 1a and the proximal element 1b. This configuration makes it possible to have a very flexible holding device when the spacer 2 is removed, for example to sleep. The device presented in US 2005/0171460 does not allow such a configuration because it uses a rigid frame that cooperates with a system for adjusting the angle between the distal member and the proximal member.

The angle that exists between the arm and the trunk can be adjusted at least from a low anatomical rest position to a high arm holding position also called abduction hold. The low anatomical position is advantageously obtained by removing the spacer 2 while the holding position of the arm in abduction is obtained by means of the spacer 2. By abduction means that the arm is spaced relative to the body.

The holding device is advantageously configured so that the angle α which exists between the arm and the trunk in the anatomical low rest position is at least equal to 20 °. Preferably, the angle α in the anatomical low rest position is less than 40 °. Particularly advantageously, the angle has is between 20 ° and 30 ° which allows a better relaxation of the shoulder and thus a better comfort.

The holding device is advantageously configured so that the angle α which exists between the arm and the trunk in the high holding position in abduction is less than 90 °. Preferably, the angle a is greater than 45 °. Particularly advantageously, the angle α is between 45 ° and 60 ° which allows better relaxation of the upper anatomical elements.

The spacer 2 may be configured to offset the distal member 1a of the proximal member 1b by an angle of at least 10 °, preferably at least 20 °, preferably at least 45 °. The angle defined by the spacer 2 is smaller than the angle α which exists between the trunk and the arm.

Preferably, in the presence of the spacer 2, the angle α between the outer faces of the distal member 1a and the proximal element 1b of the cushion varies from 45 ° to 90 °. Even more preferably, the value of the angle α may vary from 45 ° to 60 °.

The high abduction holding position can be achieved, for example, initially, with an angle between the distal member 1a and the proximal member 1b ranging from 45 ° to 60 ° by means of the spacer 2 Advantageously, the spacer 2 is configured to define an angle of at least 30 ° between the inner faces of the proximal element 1b and the distal member 1a.

The holding device is an evolutionary system for easily adapting to different stages of evolution of healing and / or pain. The evolution can be done by removing the spacer 2 or by replacing the spacer 2 defining a first angle by another spacer defining a second angle different from the first angle. The second spacer defines a lower angle than the first spacer.

When the spacer 2 is not interposed, that is to say, when it is removed (Figure 2), the arm returns to a low anatomical rest position close to the body. The internal angle between the distal element 1a and the proximal element 1b is advantageously zero. It is particularly advantageous to provide that the distal element 1a is in contact with the proximal element 1b and preferably the distal element 1a is in continuous contact with the proximal element 1b. The distal element 1a is in contact with the proximal element 1b at means of two flexible walls and the two sets of moving particles cooperate. The displacement of the moving particles in the distal element 1a has an influence on the displacement of the moving particles of the proximal element 1b and vice versa, which allows a general better adaptation of the shape of the holding device to the morphology of the user. .

The distal member 1a and the proximal member 1b are mounted movable relative to each other to allow movement in the frontal plane of the user to allow movement of the arm in abduction. The holding device is configured to allow movement of the arm when the device is worn by the user because it is detrimental to immobilize the arm.

Advantageously, the spacer 2 is produced in a firm and light material. It is particularly advantageous to use a foam, and preferably a foam of a polymer material which allows to define a spacer 2 light so as not to inconvenience the user by overweight. The spacer2 can be made of polymer foam. By way of example, the spacer 2 may be formed of a foam whose density is greater than or equal to 24 kg / m ³ and preferably less than 100 kg / m ³ . It is possible to make the spacer 2 in a polyether foam whose density is equal to 24kg / m ³ or 28kg / m ³ . It is also possible to use polyurethane foams whose density is equal to 26kg / m ³ , 30kg / m ³ , 36kg / m ³ or 38kg / m ³ . It is still possible to use a polyurethane foam shape memory whose density is equal to 86kg / m ³ .

Alternatively or in addition, a spacer 2 formed by an inflatable element is also conceivable. This configuration is more advantageous than a holding device defining the same angle of abduction and devoid of spacer because the latter can be heavier and the large volume of the distal member 1a and the proximal element 1b prevents its use over a long period.

The spacer 2 is advantageously a wedge of triangular or trapezoidal section that can be easily interposed between the distal portion 1a and the proximal portion 1b of the cushion 1. However more complex shapes are possible insofar as one end can insert between the distal element 1a and the proximal element 1b and under the armpit of the user. Alternatively, the spacer 2 may be formed by a telescopic rod or other suitable device. However, it is particularly advantageous to provide that the spacer 2 is a solid element in order to increase the contact surface with the distal element 1a and the proximal element 1b, which makes it possible to reduce as much as possible the formation of a hard point formed by the spacer 2 through the distal member and the proximal member against the trunk and / or the arm of the user. Such a hard point is particularly unpleasant or dangerous for a long time. The use of a spacer 2 made in a solid element also allows a better distribution of the filling elements and in particular of the balls contained in the cushion 1. It is particularly advantageous to provide that the surface of the spacer 2 intended to come into contact with the distal element 1a and / or the proximal element 1b is a flat, concave or biconcave surface or defined by means of a generator.

The spacer 2 is removably mounted to remove the weight of the spacer 2 when the arm is installed in the low position and avoid constraining the opposite shoulder that must support the arm associated with the holding device and the holding device.

When weaning, the arm is repositioned along the body through the complete withdrawal of the holding device. Advantageously, such a device allows an intermediate step through the low anatomical position with an angle of the order of 20 ° to 30 °. This intermediate step allows progressive weaning, less painful and less painful, while avoiding the additional cost of purchasing another device for maintenance, and waiting times. This intermediate step can be obtained by removing the spacer 2 or replacing it with another spacer 2 defining a lower angle than the first spacer 2.

In some cases, the spacer is not necessary and the splint can be used directly in its intermediate position. It is therefore particularly advantageous to provide such a configuration that makes it easy to adapt to changes in the state of the user over time. This configuration also allows greater freedom of use because it can meet differentiated needs between high abduction positions and low abduction positions. The use of such a holding device also simplifies the choice of the surgeon as to its mode of maintenance. The preoperative imaging examinations give a good indication of the type of surgery to be considered, but sometimes the quality of a tendon or a bone can lead the surgeon to modify the surgical procedure, and consequently the delay or the position of the surgery. maintenance. The modulation of the angle defined by the holding device is rapid by inserting or removing the spacer 2.

Such a holding device makes it possible to choose the height of the support according to the lesions found during the surgery. Such a configuration also allows to choose the spacer 2 most suitable for the user if necessary.

As shown in FIGS. 5 and 6, the holding device also comprises fixing means configured to fix the device to the body of the patient. It comprises means for fixing the forearm and the arm on the cushion and means for fixing the cushion with the trunk.

These fixing means are removable so that they can be put in place and easily removed and adapt to the physiological variations of the user.

More particularly, as shown in Figure 5, the fixing means are configured to maintain the forearm and the arm on the distal portion 1a of the cushion 1. This attachment avoids unwanted movements active or passive arm. This improves the quality of maintenance regardless of the user's position by contributing to muscle relaxation.

In a particular embodiment, the attachment means of the arm with the cushion 1 comprise at least one circular band 4, 5. Preferably, for a better maintenance, the attachment means of the arm and the forearm comprises two bands. circular 4 and 5 to be positioned around the arm and the forearm respectively and respectively surround the forearm and the arm of the patient.

Particularly advantageously, the circular band 4 and / or the circular band 5 have a hook system which cooperates with the outer surface of the bag 1 in order to fix the arm and the forearm of the user on the outer face of the bag. cushion which comprises for example a scraped mesh. This embodiment is particularly advantageous because it allows a better attachment of the cushion 1 with the arm and the forearm and especially a better adaptation of the shape of the cushion 1 to the position of the user. Advantageously, at least the majority of the outer surface of the cushion comprises a material that can cooperate with the hooks of the circular strips 4 and 5 to facilitate the placement of the arm and the forearm in various positions.

Advantageously, a part of the outer surface of the circular band 4 and / or 5 is made with a system of hooks which cooperates with the scraped mesh of the circular band to close the circular band and surround the arm or the front- arms. The hook system can also be used to attach the circular band to the outer face of the cushion 1.

Advantageously, the circular strips 4, 5 advantageously have at one of their ends a system of hooks and at the other end a mesh system scraped to form a self-gripping system. In this way, the circular bands are easily closed around the arm and the forearm. Preferably, the system of hooks is formed on an inner face and the system of scraped mesh is formed on an outer face.

Advantageously, the circular strips 4, 5 are in mesh fabric scraped and the hook system is a hook tab, intended to cooperate with the scraped mesh.

In a preferred embodiment, each of the circular strips 4 and 5 is fixed on the cushion 1 and, more particularly, on the distal element 1a of the cushion by the system of hooks located on the outer face of the circular strips 4 and 5. It is then advantageous to use additional support strips which are preferably pivoting strips 6 and 7. The additional support strips make it possible to reinforce the mechanical strength between the cushion 1 and the circular strips 4 and 5. The holding strips additional 6, 7 are advantageously configured to form an additional support that stabilizes the arm or forearm. In this way, when the patient is lying down, the band 6, 7 makes it possible to avoid or reduce the movements of the arm or the forearm, which results in a better general support of the arm. Advantageously, a pivoting band 6, 7 is fixed on each circular band 4, 5, at the level of the arm or the forearm. The pivoting strip 6, 7 is for example fixed on the median part of the circular band 4, 5. The pivoting strip 6, 7 is fixed to the circular band 4, 5 by means of an axial system or axis 8 of to allow rotation of the swivel band with respect to the circular band. Preferably, the pivoting strip 6 is fixed close to one end of the circular strip 4. It may be the same for the pivoting strip 7 and the circular strip 5.

The axial system 8 secures the circular strips 4, 5 and pivoting 6, 7 between them while allowing rotation of the pivoting strips 6 and 7 around the axial system 8. The axial system 8 is, for example, a rivet.

The pivoting strips 6 and 7 preferably comprise a system of hooks on the opposite end to that fixed to the axial system. The hook system is intended to be attached to the cushion 1. Thanks to the axial system 8 and the hook system, the swivel band 6, 7 can be fixed at the most favorable place of the cushion 1 to better stabilize the body segment (arm or forearm). It is then possible to close the circular band around the arm and then to fix the closed circular band on the cushion. Then, the swivel band is oriented in the desired direction and attached to the cushion to form a second attachment point.

At least a portion of the outer surface of the cushion 1 is advantageously made of mesh fabric scraped to allow attachment of the circular fastening strips 4 and 5 and the swivel band at any point of the cushion 1 on which rests the upper limb. If the cushion 1 has a cover, at least a portion of the cover will be mesh fabric scraped.

These pivoting circular strips 6, 7 advantageously make it possible to support the arm or the forearm in many positions and also make it possible to secure the circular strips 4, 5. The pivoting strips 6, 7 may be made of fabric. In an advantageous embodiment, the fastening system comprises a first set of one or more hook-and-loop strips which are arranged to fix the circular strips on the distal member 1a. Advantageously, a second set of hook-and-loop strips is arranged so as to block the circular strips between the first set of hook-and-loop strips and the second set of hook-and-loop strips. The use of the two sets of hook-and-loop strips makes it possible to reinforce the fastening by means of the circular strips and in particular the holding in the supine position of the user. The holding device also comprises means for fixing the cushion 1 with the trunk of the patient.

These fixing means comprise at least one fixation band trunk 9, 10. Preferably, these attachment means comprise a scapular band 9 passing on the shoulder opposite the upper limb maintained and a dorsal band 10 passing around the trunk of the patient. The strips 9 and 10 are advantageously made of fabric and, more particularly, of meshed fabric.

Each end of the strips 9 and 10 is preferably provided with a system of hooks intended to be fixed on the cushion 1. Each band 9, 10 is held in position by a removable ring January 1. Advantageously, the band 9, 10 can move on the ring 1 1, which allows to adapt it as well to the left or right arm of the patient.

The scapular band 9 passes over the opposite shoulder to the maintained upper limb. The band 9 passes forward through the ring 1 1 disposed in front of the splint, and back through another ring attached to the back of the splint (not shown). Each of the ends of this band 9 makes a return on itself to be fixed by the hooks on the fabric itself of the band 9. The setting of this return on itself will adapt the holding device to the size and to the corpulence of each patient. The dorsal band 10 passes around the trunk of the patient. The fastening system is, as for the first band 9, at each end, formed by the return of the strip 10 on itself after passing through the ring January 1.

This holding device is a system that secures the support while allowing access to the upper limb for rehabilitation and care. The fixation system ensures a good stability of the arm and the forearm on the cushion 1 whatever the position of the patient (sitting, standing, lying on the back or sideways). Advantageously, a prior adjustment makes it possible to arrange the fastening systems according to the size of the user and his corpulence. The fastening means are removable fastening means, which can easily be undone and recover. This removable assembly allows the use of the cushion 1, for example in a sitting or lying position, to rest the arm on the body of the user when the maintenance is low position is no longer necessary. The cushion 1 can then be used in isolation so as to offer different comfort positions to achieve relief of the shoulder.

The holding device further comprises particles movable relative to each other arranged in the cushion 1. The distal member 1a and the proximal member 1b each define a closed envelope that includes the moving particles. In a particularly advantageous manner illustrated in Figure 3, the distal member 1a and the proximal element 1b are configured so that the moving particles can not move from one element to another. This precaution makes it possible to fix the volume of the distal element 1a and the volume of the proximal element 1b in time. This makes it possible to avoid the appearance of a hard point generated by the spacer 2 if the mobile particles were mainly leaving an element for another element. The moving particles are movable within the proximal element 1b and the distal member 1a at any time so as to continuously adapt to the trunk and the arm as well as to the movement of the arm relative to the trunk. The moving particles fill the proximal member 1b and the distal member 1a from the face in contact with the body of the user to the opposite face in contact with the spacer or with the other cushion. The mobility of these particles relative to each other, inside the distal element 1a and within the proximal element 1b, allows a good distribution of these particles within the cushion 1 and also a very good morphological adaptation of the cushion 1 on the body of the user. By choosing the moving particles, the contact with the arm, the forearm and the trunk is uniformly distributed, continuous and flexible. This configuration avoids the formation of hard spots and especially to increase as much as possible the contact surface. The mobility of the particles is particularly advantageous because it makes it possible to adapt to the differences in morphology that exist between the users and especially between the users. It appears that this splint configuration allows a better adaptation to the chest of women in high abduction position. This configuration avoids the formation of hard spots that generate significant pressure against the body and the appearance of painful areas and especially on the chest of women. The pain is sufficiently troublesome to impose the displacement of the rigid splint in a less uncomfortable position but also less effective. It is known from the prior art to use envelopes filled with moving particles that adapt to the morphology of the user and are then locked against each other to immobilize a limb. Such teaching is presented in the documents FR2902644 and US 5,618,263 which disclose a compression device with balls compressed against each other to immobilize a member.

This feeling of maintenance reassures the user which is translated unconsciously by a better muscle relaxation of the entire upper limb. The reduction of muscle contractions promotes good bone healing, and good tendon or ligament healing. In addition, muscle relaxation also contributes to analgesia. Preferably, the filling of the cushion 1 by the semi-rigid particles is between 50% and 90% by volume. Such a filling level makes it possible to adapt the morphology of the cushion to that of the user and avoids the formation of a hard point. Advantageously, the distal element 1a and the proximal element 1b each have a filling of between 50% and 90% by volume to avoid hard contact between the body and the spacer 2. With such a level of filling, the distal element 1a and the proximal element 1b allow an adaptation of the shape of the distal member 1a and the proximal element 1b relative to the trunk and the arm without immobilization. This configuration differs from traumatic maintenance devices which aim to immobilize a limb. The immobilization is obtained by modifying the volume of a bag which has balls so that the balls occupy the entire volume of the bag. In narrowing, the bag blocks the balls in the position defined by the trunk and the arm. The bag generates a constraint on the member to immobilize which forms a hard surface ensuring the immobilization.

On the contrary, according to the invention, so that the holding device is well accepted by the user, it is important that some mobility is possible at the arm and shoulder without this mobility allows movement. arm and / or shoulder beyond a threshold position. The position threshold may represent a too large movement of the arm downwards, for example the elbow reaches a minimum threshold height which represents an elongation of the deltoid muscles or the rotator cuff.

It is known from the prior art to use a shape memory foam. However such a configuration is generally not accepted by the user because it does not provide a feeling of reassuring support. It has been noted that the use of a memory foam too dense causes the appearance of hard spots at the trunk or on the arm. It has also been observed that the use of a memory foam too low density is not able to relieve the shoulder so that the user has a shoulder too little maintained. It also appears that the mass of an upper limb and the volume occupied by the same member does not correctly deform a shape memory pad using a dense foam. It is then advantageous to use a mouse whose density is lower but the feeling of maintenance is then degraded which can cause a twitching of the upper limb.

There is then a meticulous work to be done in the choice of the density of the foam or in the use of several foams having different densities to simultaneously provide good mechanical strength without the appearance of hard point. This configuration is very close to a tailor-made job.

With a filling of between 50% and 90% by volume, the holding device ensures good adaptability to the morphology of the trunk and the morphology of the arm while forming an obstacle to the descent of the arm below a threshold position. The distal element 1a and the proximal element 1b form an obstacle to support the arm and ensure the rest of the shoulder. This obstacle makes it possible to neutralize mobility sectors of the arm below the lower horizontal plane of the distal element 1a and the proximal element 1b. It is then forbidden for the arm to descend into a position that can tension the rotator cuffs and it is forbidden to stress the deltoids, for example after suturing without ensuring its complete immobilization.

The filling rate makes it possible to define the anatomical adaptability provided by the holding device. The lower the filling rate and the lower the Anatomical fit is important with less blockage to lower arm positions. There is a compromise to be found in the filling volume of the holding device. Once the upper limb is installed, the maintenance comes in part from the density of the particles. It is particularly advantageous to promote support and maintenance and not immobilization to promote the recovery of the shoulder. The holding device prevents the arm from reaching a low position which may be detrimental to good recovery. The lower limit position is defined by the degree of filling in the proximal element 1b and in the distal element 1a as well as by the use of the spacer if necessary.

Unlike the devices of the prior art, the filling rate of the proximal element 1b and the distal element 1a are configured to maintain the arm without complete immobilization of the arm and the forearm. In other words, the arm and the forearm can move slightly with respect to the trunk while being maintained. When the holding device is attached to the trunk, forearm and arm, the pressure exerted by the arm and forearm does not block the moving particles that can still move in order to continuously adapt to the position of the arm and forearm in relation to the trunk. The moving particles are always movable so as not to form an immobilizing device which completely blocks the arm in a particular position and which is a brake on good healing.

Preferably, the upper portions of the distal member 1a and / or the proximal member 1b are devoid of moving particles so as not to have a significant stress in the cushions when the holding device is compressed between the trunk and arm. In other words, the filling levels of the distal element 1a and / or the proximal element 1b are chosen so that the mobile particles can move in the cushions after the installation of the device. maintenance between the trunk and the arm because it is not sought a complete immobilization of the arm. This configuration is different from the teaching of DE 20 2013 104 479 which proposes an immobilizer. The device comprises an envelope filled with moving particles and the stress applied by the chin on the immobilizing device has the effect of completely immobilizing all the particles filling the envelope and immobilizing the chin laterally as well as vertically downwards. . The effect of gravity, trunk and arm once wedged, stabilize the movement of moving particles and then offer a good firmness on the cushion 1 in the upper limb to maintain. The relative firmness of these filling elements will increase the firmness of the system thus stabilized while distributing the supports perfectly to avoid the formation of punctual hard spots.

It is particularly advantageous to provide spherical particles. Preferably, the particles have dimensions of between 0.2 mm and 3 mm, and even more preferentially, between 0.2 mm and 1 mm. The particles are advantageously of polymer material and more preferably of polystyrene.

The small size of the filling elements increases the anatomical adaptability of the cushion 1 by reducing the support stresses. This also allows to incorporate a large amount of air which reduces the total mass of the holding device. Advantageously, the filling elements are chosen so that the density is between 10g / L and 50g / L to ensure good mechanical strength with a low weight.

In a particular embodiment, it is advantageous to use filling elements which are in the form of beads of a porous material containing at least 50% by volume of air. In this configuration, the volume of the beads makes it possible to form a breathable material.

It is more advantageous to use balls of material than fibers because the balls circulate more easily relative to each other which allows a better shaping of the cushion.

The cushion 1 can equally be used for a left arm or a right arm, because of its adaptability.

Moreover, the relative malleability of such a splint allows a very rapid adaptation according to the changes of positions. Indeed, during a change of position, the effect of gravity may vary (supine position), or another reaction force may apply (armrest, seat back, bed ...). In these cases, the holding device allows movement of moving parts within the cushion. Their new distribution will allow the cushion to adapt to these new constraints by holding the arm. Once the new position is obtained, the system instantly regains its firmness. The holding device will remain adapted to the morphology of the user while adapting to the possible support area: bed, seat with armrest, chair ...

The particles are, preferably, microbeads. By microbeads, it is meant that the particles are predominantly in a spherical shape whose diameter is less than 3 mm and greater than 1 μΐη, preferably between 1 μΐη and 1 mm.

The particles are advantageously semi-rigid. By semi-rigid means materials having a Young's modulus of between 0.2GPa and 30GPa, and preferably between 1 GPa and 5GPa.

Preferably, the particles are expanded polystyrene microbeads and / or expanded polystyrene beads whose maximum dimension is between 0.2 mm and 3 mm.

The low density of these filling elements provides an additional advantage: the stresses on the non-maintained shoulder are reduced.

Indeed, the weight of the arm maintained must be completely carried by the holding device. This force is transmitted to the cushion / trunk attachment system which often passes over the opposite shoulder by means of the strap 9. The unsupported shoulder must therefore not only support the weight of the arm maintained but also the weight of the device. maintenance.

Advantageously, the material forming the semi-rigid particles in the cushion is a low density material, the weight of the holding device is then reduced. The stresses applied to the non-maintained shoulder as well as to the cervical region decrease. The evolution of the mass of the cushion changes little according to its filling rate which facilitates the work upstream because it is a constraint of less for the adaptation to the user. The proximal member 1b and the distal member 1a of the pad 1 are both filled with the moving particles. In a particular embodiment, the proximal element 1b and the distal element 1a are each formed by a cushion filled with moving particles so that one face of each cushion is in contact with the spacer 2 and the other face of each cushion is in contact with the user.

The outer surface of the cushion 1 is advantageously of flexible material. If the cushion has a cover, it will also be flexible material. The envelope of the cushion can be made of fabric, for example cotton, polyester, in a cotton-polyester blend. Other materials are possible.

The holding device is comfortable and lightweight, even for extended periods of use. It is an evolutionary system allowing to adapt easily to the different stages of the evolution of a cicatrization and / or of the painful state.

Advantageously, it is possible to use the cushion freely, for example as a night comfort element without necessarily using the cushion during the day.

Claims

claims

A device for holding the arm of a user in abduction or in an anatomical low rest position comprising:

a cushion (1) intended to be placed between the trunk and the forearm of the user, the cushion (1) being formed of a proximal element (1 b) and a distal element (1 a) the angle between the proximal member (1b) and the distal member (1a) being adjustable, at least from a low anatomical rest position to a high arm holding position,

a spacer (2) configured to be positioned between the proximal member (1b) and the distal member (1a) of the cushion,

means for fixing the forearm and the arm on the distal element (1 a) of the cushion (1),

means for fastening the cushion (1) with the trunk of the user at the level of the proximal element (1b),

characterized in that the proximal member (1b) and the distal member (1a) are partially filled with moving particles with respect to each other, the proximal member (1b) and the distal member (1b). a) each forming a closed envelope preventing transfer of the moving particles between the proximal member (1b) and the distal member (1a), the filling rates of the proximal member (1b) and the member distal portion (1a) being configured so that the moving particles can move in the proximal member (1b) and in the distal member (1a) when the holder is attached to the trunk, the forearm and arm of the user and that the spacer (2) is removable relative to the proximal member (1b) and the distal member (1a) to define two different positions of the distal element (1 a) relative to the proximal element (1 b).

2. Device according to claim 1, characterized in that the distal element (1 a) is fixed to the proximal element (1 b) irremovably.

3. Device according to claim 1, characterized in that the proximal element (1b) is removably attached to the distal member (1a).

4. Device according to any one of claims 1 to 3, characterized in that the moving particles have a Young's modulus between 0.2GPa and 30GPa.

5. Device according to any one of claims 1 to 4, characterized in that the moving particles are spherical particles.

6. Device according to any one of the preceding claims, characterized in that the moving particles are expanded polystyrene beads.

7. Device according to any one of the preceding claims, characterized in that the moving particles have dimensions between 0.2mm and 3mm.

8. Device according to any one of the preceding claims, characterized in that the filling of the cushion (1) by the moving particles is between 50% and 90% by volume.

9. Device according to any one of the preceding claims, characterized in that the spacer (2) is configured to define an angle at least equal to 45 ° between an outer face of the proximal element (1b) and a face external part of the distal element (1 a).

10. Device according to any one of the preceding claims, characterized in that the means for fixing the forearm and the arm on the distal member (1a) of the cushion (1) and / or the fixing means cushion (1) with the trunk of the user at the proximal element (1b) are mounted removable.