The disclosure relates to orthopedic devices and particularly to hand supports for treating various hand complications. The hand support may be arranged to employ traction for an extended period to remedy complications of the hand and associated joints.
In orthopedic medicine, traction refers to various mechanisms for straightening or aligning bones in a desired manner. An approach to knee osteoarthritis (OA) management involves invasive joint distraction. Experience with invasive joint distraction indicates that distracting the OA afflicted joint for an extended period may halt or reverse the disease.
Initially, joint distraction was used in the treatment of joint malalignment and joint contracture. An external fixation frame was used to actively reposition the joint and to increase the range of motion. Distraction was performed to prevent damage (compression) of the joint cartilage during the forced repositioning. In some of these patients OA was present in the treated joint and an unexpected clinical improvement of the OA was observed. These clinical observations led to a proof-of-concept study examining the benefit of joint distraction, by treating young patients with severe ankle OA. Two-thirds of patients treated for 3 months with joint distraction experienced significant clinical benefits for a period of up to 10 years. Based on preliminary radiographic outcomes in a few patients, joint distraction may lead to tissue structure modification.
Osteoarthritis can be found in other joints and there is reason to believe that distraction will have the same effect in other joints as described for the knee above. One major joint for OA is the first CMC joint (first carpal-metacarpal joint, also known as the trapeziometacarpal joint or the basal thumb joint) and OA of this joint is commonly considered thumb arthritis.
As shown in
Thumb arthritis occurs when the cartilage breaks down and wears away from adjoining ends of the metacarpal and trapezium bones at the first CMC joint. In early stages of thumb arthritis, there may be inflammation about the joint and isolated breakdown of cartilage around one or a few areas of the cartilage surface. As the arthritis progresses, bone spurs may develop and the thumb may contract into the palm, with pain and mobility of the hand worsening.
Treatment of arthritis in the early stages may involve joint protection, such as through hand supports arranged to reduce thumb movement or completely immobilize the thumb. Known hand supports may be soft or hard varieties, with soft hand supports providing better freedom of movement but less immobilization, whereas hard hand supports provide superior immobilization but better pain relief. Other options for treatment of hand arthritis include conservative treatments such as joint protection, physical therapy, massage, and cold and hot therapy. For moderate to severe hand arthritis, treatment options include medicines, injections, and invasive surgical treatment including ligament reconstruction, joint replacement, and joint fusion.
Medicines may cause side effects and diminishing returns over time, merely masking the pain but failing to treat the cause of the arthritis. Injections are effective however they may lead to a weakening of the joint and result in further breakdown of cartilage since they, like medicine, do not treat the source of the arthritis. The surgical treatments, while effective in treating the source of the arthritis, are invasive and recovery from surgical treatment for a return to normal activities is time-consuming.
The CMC joint may become inflamed due to excessive motion of the joint. While immobilization of the joint can reduce pain and inflammation, it does not allow for the functional use of the joint. A dynamic stability split may be used to reduce excessive motion of the joint while serving to provide traction to the joint to treat osteoarthritis.
Therefore, there is a desire for a solution to treat moderate to severe hand arthritis in a non-invasive manner that concentrates on the source of the arthritis rather than just the pain.
Noninvasively treating hand arthritis may be achieved by creating traction of the thumb joints and applying a force on the thumb or hand in opposition to an anchor located at a position on the hand or wrist. Adjustment means may be provided to enable incremental adjustment of the force according to a treatment protocol adapted for an individual suffering from arthritis.
Embodiments of hand supports and methods for using the same are described and are intended to function by creating traction to treat thumb arthritis. Embodiments are also provided for a versatile hand support for treating earlier complications of thumb arthritis and other complications of the hand.
Embodiments described herein generally relate to a hand support having a base component for securing to at least a portion of a hand. The base component can be supplemented with rigid, non-rigid, flexible or resilient features, such as a joint stabilizer for reinforcing a hand. The hand support generally includes an anchor element adjustably connected to the base component for grasping a thumb. The hand support also generally includes a counterforce device connecting to the base component and the anchor element. The counterforce device is arranged to generate a counterforce in combination with or against the base component and the anchor element. The embodiments are employed for providing traction by straightening or aligning bones in a desired manner, particularly by distraction or applying a counterforce to pull a CMC joint apart while the hand support is anchored on the hand or wrist.
These and other features, aspects, and advantages of the present disclosure will become better understood regarding the following description, appended claims, and accompanying drawings.
The drawing figures are not drawn to scale, but instead are drawn to provide a better understanding of the components, and are not intended to be limiting in scope, but rather to provide exemplary illustrations.
A. Overview
A better understanding of different embodiments of the disclosure may be had from the following description read with the accompanying drawings in which like reference characters refer to like elements.
While the disclosure is susceptible to various modifications and alternative constructions, certain illustrative embodiments are in the drawings and are described below. It should be understood, however, there is no intention to limit the disclosure to the embodiments disclosed, but on the contrary, the intention covers all modifications, alternative constructions, combinations, and equivalents falling within the spirit and scope of the disclosure.
It will be understood that, unless a term is defined in this disclosure to possess a described meaning, there is no intent to limit the meaning of such term, either expressly or indirectly, beyond its plain or ordinary meaning.
B. Hand Support Embodiments
The embodiments of the hand support are generally arranged to grab a digit of the hand, such as a thumb or finger, or portion of the hand, and pull and maintain a joint apart, such as the CMC joint. A distraction or counterforce is used to pull the joint apart while the hand support is anchored on the hand or wrist. The terms “hand support” and “thumb support” may be used interchangeably in the following discussion. Various means may be used to incrementally adjust the distraction force over a period of treatment. Additionally, or alternately, the hand support may provide dynamic stability which may focus on preventing excessive motion of a joint while also providing a force on the joint that may vary according to movement.
In the embodiment of
The anchor element 14 may comprise a strap 18 having a first end 22 securing to the base component 12 and a second end 24 arranged to secure to a thumb. The second end 24 of the strap 18 defines a grip 26 arranged to hold onto a thumb.
The counterforce device 16 may comprise a bolster 28 connected to the base component 12 and arranged to be received by a palm and leveraged over a first carpal-metacarpal joint to translate into traction in the thumb. The bolster 28 tethers to the base component 12 by a second strap 20. The bolster 28 may be compressible or rigid.
Referring to the hand support 100 embodiment of
The wrist portion 132 defines a clearance 136 and a wrist strap 120 extends from opposed first and second sides 138, 140 of the wrist portion 132 to tension over the wrist and maintain the wrist portion 132 on the wrist. The wrist strap 120 releasably and adjustably secures to the first side 138 and pivotally attaches to the second side 140.
The counterforce device 116 includes a tensioning device 124 connected to an elongate element 118 securing to the anchor element 114, and secured to the base component 112. The dial tensioning element 124 secures to a wrist portion 132 of the base component 112. The tensioning device 124 is arranged to incrementally tension the elongate element 118 and draw the anchor element 114 toward the base component 112. The elongate element 118 includes first and second portions 118A, 118B extending over dorsal and palmar portions of the hand and securing to the anchor element 114.
The anchor element 114 has an opening 142 arranged to extend over a finger and retain therewith. The anchor element 114 is arranged to extend between an index finger and the thumb. The anchor element 114 defines first and second sections 144, 146 compliantly extending over dorsal and palmar aspects of the hand.
A counterforce device 117 includes a tensioning device 125 connected to an elongate element 119 securing to an anchor element 115 arranged at an area between an index finger and thumb. The anchor element 115 is preferably sized and configured to generally span the distance between the base of the thumb and the base of the index finger. The dial tensioning element 125 preferably secures to a wrist portion 133 of the base component 113. The tensioning device 125 is arranged to incrementally tension the elongate element 119 and draw the anchor element 115 toward the base component 113. The elongate element 119 includes first and second portions 119A, 119B extending over dorsal and palmar portions of the hand and securing to the anchor element 115.
As illustrated in
A bar 168 connects to the base component 112 and the hand support 162. The bar 168 may extend from the base component 112 and proximally to the proximal portion 166 of the hand support 162 generally along the same side of the hand support 160.
The tensioning device 116 is slidably mounted on the bar 168 and mounted to the base component 112 by a mounting part 176. The elongate element 118 couples to the tensioning device 116 and a diverter 178 located at a proximal portion of the bar 168, such that by adjustment of the tensioning device 116, the bar 168 slides relative to the base component 112 to distract the CMC joint. The mounting part 176 may include a channel (not shown) through which the bar 168 slides.
A thumb strap 122 secures about the thumb portion 130 and a wrist strap 120 is arranged to secure about the wrist portion 132 and the hand support 162 and bridges the clearance 172. A proximal strap 170 extends proximally relative to the wrist strap 120 and over a proximal clearance 174 defined between opposed sides of the proximal portion 166 of the hand support 162.
A digit retainer 232 is secured to the anchor element 224 and is adapted to secure about a thumb. The anchor element 224 defines a saddle 238 extending between the thumb and the index finger. The anchor element 224 is substantially rigid and maintains the saddle profile 238 anatomically contouring to the space. The saddle profile 238 has a dorsal portion 240, a palmar portion 242 and a bridging portion 244 between the dorsal and palmar portions 240, 242.
The bar 228 pivotally attaches to the anchor element 224 by a pin 234. The counterforce device may be a tensioning device 226 and may be operatively engaged with the bar 228 in a manner similar to the embodiment of
The counterforce device 256 includes a bar 258 connected to the anchor element 254 by a pin 260 at a first end 268 such that the bar 258 has a second end 270 opposite the first end 268 and rotatable relative to the pin 260 such that rotation of the bar 258 is arranged to pull a metacarpal joint apart.
A retainer 266 may be mounted on the base component 252 and adapted to retain the second end 270 of the bar 258. A digit retainer 262 connects to the anchor element 254 to retain the thumb. A joining strap 264 is arranged to extend over dorsal and palmar portions of the hand and over or along the anchor element 254 and secure to the base component 252.
The bar 308 is secured to the anchor element 304, such that adjustment of the counterforce device 306 adjusts suspension of the digit retainer 324 relative to the base component 302.
The counterforce device 306 is arranged to incrementally tension an elongate element 310 connected to the anchor element 304 and draws the anchor element 304 toward the base component 302. The counterforce device 306 includes a tensioning device 318 secured to the base component 302. A tube 328 extends over or along the anchor element 304.
The anchor element 304 includes a saddle 312 extending between a space formed between the thumb and the index finger. The saddle 312 may be rigid or substantially rigid.
A joining strap 314 has first and second ends connecting to the base component 302 and extends over or along the anchor element 304. The first end of the joining strap 314 has a tab 316 removably securing to a surface 326 of the base component 302.
Referring to the hand support of
The counterforce device 306 includes a bar 352 connected to the base component 302. A strap 356 has a first portion 358 cantilevered at a first section 376 of the bar 352. A digit retainer 354 connects to the first portion 358 of the strap 356. The strap 356 is adjustable to modify a length of the tethering portion 358 between the first section 376 of the bar 352 and the digit retainer 354. The bar 352 may be substantially rigid and resilient to generally maintain a configuration depending on adjustment of the strap 356.
A buckle 362 is provided through which a second portion 360 of the strap 356 extends. The second portion 360 is arranged to secure to itself according to length adjustment of the first portion 358. The buckle 362 is pivotally attached to the bar 352 by a tab 372 carrying the buckle 362 and a pin 364 attached to the bar 352. The bar 352 may have a second section 366 adapted for being received by the base component 302 and securing therewith.
In a variation of the hand support 350 in
The hand support 400 has a main body 402 arranged to extend about a hand. The main body defines a hand section 406 and a thumb section 408 bordered by a bridging section 410. A flap 412 extends from the main body 402 and is adapted to wrap and secure to the main body 402. A first end 424 of the flap 412 secures to the hand section 406 and extends to a second end 426 carrying a tab 414 arranged to secure to a surface 428 of the hand section 406. An auxiliary strap 404 is arranged to secure over the surface of the main body 402 in a plurality of locations and orientations.
The hand section 406 forms a sleeve through which palmar and dorsal sides of a hand extend. The thumb section 408 forms a tube through which a thumb extends, and the bridging section 410 separates the thumb section 408 from the hand section 406. The thumb section 408 is arranged to extend obliquely relative to the hand section 406.
The material forming the main body 402 may be elastic to gently conform to the anatomy of the hand. The main body 402 preferably includes a body tab 422 on a palmar portion 432 of the hand section 406 arranged to secure to the flap 412.
The material forming the flap 412 may be elastic so as to tension over the main body 402 and conform to the hand. The flap 412 preferably has a length arranged to encircle at least once an entirety of the main body 402 by extending over both dorsal and palmar portions 430, 432.
At least a substantial entirety of the surface 428 of the main body 402 has hook receivable material and is substantially elastic.
The auxiliary strap 404 preferably defines an elongate segment 416 bordered at opposed ends 418, 420 by fasteners. The elongate segment 416 of the auxiliary strap 404 is substantially inelastic, and the fasteners 438 are arranged to engage the hook receivable material of the main body 402 entirely between top and bottom portions 434, 436 of the main body 402.
Referring to
The auxiliary strap 404 is detachable from the hand support 400 and advantageously allows for placement over the entirety of the surface of the main body 402 and the flap 412. Because of this versatility, the hand support 400 is capable of being adapted to orient the hand in manner orientations for supporting and treating the hand.
Referring to
The hand support 500 includes a base component 502 arranged to secure to a wrist and defining at least one opening 512 formed along a portion of the length of the base component 502 and extending from a periphery 558 into a width of the base component 502. An anchor element 504 is arranged to extend between or at an index finger and a thumb. A counterforce device 506 is secured to the base component 502 and comprises at least one elongate element 508 linked to the counterforce device 506 and cooperating with the base component 502 to adjust the length thereof by actuation of the counterforce device 506.
The base component may be constructed in an accordion manner, similar to the buttress described and illustrated in U.S. provisional application No. 62/058,306, filed Oct. 1, 2014, and incorporated herein by reference. The counterforce mechanism can be similar to the tensioning device in U.S. provisional application No. 62/058,306.
At least one elongate element 508 travels through a thickness 560 of the base component 502 and extends to a strap clip 518 located at a first portion of the base component 502. The base component 502 defines a strap segment 514 between at least the counterforce mechanism 506 and the strap clip 518. The strap clip 518 releasably secures to a strap coupler 520 located at a second portion of the base component 502.
The anchor element 504 is a preferably a strap extending between palmar and dorsal portions 524, 526 of the base component 502 such that a first portion of the anchor element releasably secures to a fastener 522 located on the base component 502. The anchor element 504 may be releasably secured at opposed first and second portions of the base component 502, or secured and tensionable by other known methods such as rings and buckles.
As illustrated in
The sizes and pad configurations of the bolsters 528, 530, 532 may vary among each bolster. For example, the configuration of the bolster 528 includes larger pads 536, 538 that are adapted to embrace the joint and lift it upwardly for traction. The main layer 534 is preferably relatively long and broad to enable the embracing function, along with wider and larger points 544 on each pad 536, 538.
Referring to the bolster 530, this arrangement includes pads 548 having sharper points 550. The pads 548 are configured as being steeper and may rise to generally the same height as the pads 544 in the bolster 528. The bolster 530 is arranged to press more into each side of the joint and lift it upwardly. The bolster 532 is arranged with a single pad 554 having a single point 556 raising a height that may be similar to the height of the pads of the bolsters 528, 530. The bolster 532 is arranged to press into the joint and lift it upwardly. The main layers 546, 552 are configured and dimensioned according to the arrangement of the pads of the individual bolsters 530, 532, respectively.
Referring to
The outer and inner layers 515, 516 may be separate from one another except at end portions like at the strap clip 518 and strap buckle 520, such that tensioning of the elongate element 508 causes the outer layer 515 to tension and compress over the inner layer 516 without substantially increasing tension in the inner layer 516. Alternatively, the outer and inner layers 515, 516 may be secured to one another along their length.
In use, as shown in
Referring to the embodiments of
The base component 602 preferably includes a strap 603 enabling tightening about the wrist and hand of the wearer. The base component 602 includes an opening 605 adapted for insertion of a thumb. A reinforcement component 616 is secured to the strap and formed of a more rigid material than the base component 602. The reinforcement component 616 preferably has a bridging portion 618 extending over the thumb web of the hand to maintain spacing of the base component 602. The reinforcement component 616 may be a flexible plastic, such as a thermoplastic enabling rigidity when the strap 603 is tightly secured to the hand yet some flexibility to enable adjustment about the hand when the strap 603 is loosened for setting of the hand support 603 for an individual user.
The joint stabilizer 604 is preferably more rigid than the reinforcement component but rather than merely being flexible, it may be malleable for pinching or securing about the thumb at a location preferably about the CMC joint to create a tight fit over the thumb. When muscles contract under the joint stabilizer 604, they become larger in circumference and an expansion force is directed inwardly, increasing pressure to stabilize the bone within the contained space of the support 600.
The joint stabilizer 604 has first and second ends 609, 611 extending from a base portion 607. The base portion 607 is preferably thicker or includes more material to provide a substantially more dimensionally stable portion of the joint stabilizer, whereas the first and second ends 609, 611 may be thinner so they can be more malleable. Despite taking advantage of the malleability of the joint stabilizer, once adjusted manually, the joint stabilizer maintains its shape on the hand or about the thumb of the user. Substantial force is required for adjusting the shape of the joint stabilizer beyond normal use of the joint stabilizer on the hand of a user.
While a preferred material for the joint stabilizer 604 is aluminum, other materials may be used. The joint stabilizer 604 may be configured as a solid structure, as depicted, or alternatively may be formed as bands or a mesh-like configuration to better contour to the anatomy of a hand and reduce the weight and profile of the hand support.
The joint stabilizer 620 defines a generally J-shape, with a first end 624 having a taper for mounting about a dorsal aspect of a hand, and a second end 626 adapted for wrapping about at least part of a palmar aspect of a hand. The first and second ends 624, 626 extend from a base portion 622 extending about a base of a thumb between the dorsal and palmar aspects of the hand. As noted above, the joint stabilizer 620 is adapted so the first and second ends 624, 626 are moveable relative to the base portion 622 for embracing the CMC joint, and remaining in position when secured to the hand of the user.
The first end 610 of the elastic element 606 secures to either the joint stabilizer 604 or reinforcement component 616, and encircles the thumb at a location preferably below the knuckle of a user whereat the retainer 608 encircles or grasps the thumb. In the illustrated example, the elastic element 606 is a spring arranged to bias between the joint stabilizer 604 and the retainer 608. The elastic element 606 provides traction of the thumb according to other embodiments described herein. The joint stabilizer 604 may be detachable from the joint stabilizer or reinforcement component 616 to enable positioning about the thumb of the user, or may be permanently secured to the joint stabilizer or reinforcement component 616.
The retainer 608 is arranged to encircle or at least securely grasp the thumb, preferably below the knuckle of the user. The retainer 608 may include interior padding or a wedge 614 that secures the retainer at a desired location on the thumb. The retainer 608 may be a ring or may be split for opening and closing like a clamshell or clamp about the thumb for donning the hand support on the hand of a user.
In the example shown in
As shown in
Referring to
The elastic element may comprise a variety of configurations beyond the spiral configuration depicted in the drawings. For example, the elastic element may be a “wave” spring that comprises a plurality of spring elements stacked on top of each other and forms a generally mesh appearance. Such a variation is useful in that it is generally cylindrical and may allow for the addition or removal of springs to modify the spring force and length of the elastic element. Another example is a ribbon or helical shaped spring that has a wider height, and may cover more of the thumb. The ribbon or helical shaped spring may have multiple helixes connected to one another. Yet another example may be a Belleville type spring comprising a plurality of washer disks stacked upon one another. Yet another example is a ribbon shaped loop spring whereby the spring of the elastic element comprises multiple loops formed from ribbons of springs placed between one another. Yet another example are magnetic springs whereby the at least two evenly loaded magnetic rings repel one another and therefore may provide the same effect as a spring. Yet another example is a helical or coil spring.
Referring to
The wedges may be formed from rigid, semi-rigid or compressible materials. For example, the wedges may be formed from silicone that is adhered against the inner surface of the rings. The silicone may be sufficiently firm to prohibit movement of the retainer on the thumb, yet supple enough to enable gentle application or rotation of the retainer when the retainer is being placed or removed from the thumb.
According to a method, the retainer is in an open configuration so a tip of the thumb is inserted between at least two wedges of the retainer, with the wedges sufficiently spaced to permit the thumb tip to slide past them without significant resistance. The retainer may be rotatable relative to the elastic element for permitting the retainer to be in open and closed configurations. The retainer, as it may be biased by the elastic element, may then be pulled toward and past the thumb knuckle, and rotated relative to the thumb and the elastic element so the wedges are essentially turned in a generally perpendicular direction relative to the direction they were in when slipped over the tip of the thumb to place the retainer in a closed configuration. The wedges are sufficiently rigid, semi-rigid or compressible to maintain the retainer in place below and wedged (at the least the top portion of the wedges) against the knuckle between thumb saddle or web and relative to the thumb tip despite biasing by the elastic element. When it is desired to remove the retainer, the retainer may be rotated so it no longer wedges against the knuckle and is essentially in the open configuration for slipping past the knuckle and thumb tip.
Variations of retainers are provided to customize the size of the retainer. One variation includes a metal ring, such as one made from aluminum, that is overmolded with a soft material, such as silicone, that may likewise have portions formed into wedges. The metal ring may be cold formable to customize the shape to the user's thumb whereas the wedges and soft material accommodate the adjustment of ring size. In another variation, the retainer includes a ring that can be adjusted by pulling apart or pushing together a slot in the ring to adjust the diameter of the ring. In yet another variation, the retainer includes an outer ring having an oval configuration and an inner ring located within the outer ring. The inner ring can be rotated inside the outer ring to adjust the inner shape, with the inner ring having wedges as discussed above. In yet another embodiment, an outer ring has a threaded surface under an angle and the inner ring can be rotated inside the outer ring to adjust the size.
Referring to a preferred embodiment in
The elastic element 906 is generally spiral in configuration between first and second ends 911, 912. The first end 911 preferably has a larger radius near the base component 902 and a smaller radius near the retainer 908. As shown in
The retainer 908 is configured for secure attachment to the thumb by rotation, similar to the retainer embodiment of
Dorsal and palmar portions 910, 904 of the base component 902 define an opening 905 adapted for insertion of a thumb, and extend across the dorsal and palmar portions, respectively, of the hand of the user. The portions 910, 904 extend and connect about the base of the thumb, both at or near the CMC joint and the thumb web, for creating a tight fit over the thumb. The base component 902 is preferably formed from a material or materials which are resilient enough to retain their shape during use but may be adjustable when fitted to a patient. The base component 902 may be thinner or more malleable as the distance from the opening 905 increases.
The dorsal portion 910 may terminate with a buckle 962 or other attachment means for securing the strap 903 and a fastener 960, such as hook and loop, latches, or interlocking components, for securing to the buckle 962 or similar elements and tightening around the wrist of the user.
The traction system 703 is secured to the base component 702. A tensioning device 704 secures to a bar 708 having a first end mounted to the base component 702. The tensioning device 704 includes an elongate element 706 routed about the bar 708 and tethered at a second end of the bar 708. A coupler 712 connects the second end of the bar 708 to a second end of the thumb arrest 710, to thereby cantilever the bar, particularly by tensioning the elongate element 706 and the bar 708 may serve as a spring for effectively pulling the thumb which is secured therewith by insertion of the thumb with the seal element 716 located within the thumb arrest 710.
The thumb arrest 710 defines an opening 714 at a first end through which the thumb is inserted with the seal element 716. According to a preferred embodiment, the seal element 716 defines a sleeve 718 arranged for being disposed over the thumb. A seal 720 radially extends from the sleeve 718 for engaging an inner surface (not shown) of the thumb arrest 710.
A vacuum is effectively formed within the thumb arrest 710 to maintain a connection between the thumb arrest 710 and the thumb in a gentle manner that does not restrict blood flow. From the connection, an increase in the CMC joint gap in the thumb is enabled by gradual tensioning of the tensioning device 704 and flexure of the bar 708.
In a closed or contracted configuration in
While the foregoing embodiments have been described and shown, alternatives and modifications of these embodiments, such as those suggested by others may be made to fall within the scope of the invention. While the hand support has been described in combination with or without traction means, it will be understood that the principles described may be extended to other types of orthopedic and prosthetic devices.
Reference characters are provided in the claims for explanatory purposes only and are not intended to limit the scope of the claims or restrict each claim limitation to the specific element shown in the drawings and identified by the reference character.
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Child | 16295442 | US |