Orthosis with shoulder and arm area

Abstract

Orthosis (1) with - a shoulder area (4) for application to a shoulder, - at least one sleeve (6) to put on an arm and - at least one elastic strap element (12), wherein the sleeve (6) has a hand area (10) which is arranged on one hand when the orthosis (1) is worn, and wherein the at least one strap element (12) is or can be placed around the sleeve (6) in at least one turn in the form of a helix and is attached or can be attached to the shoulder area (4) and to the hand area (10), characterized in that the strap element (12) is or can be attached to the sleeve (6) at at least one point (22) between the hand area (10) and the shoulder area (4), so that the at least one strap element can be functionally divided into two elements arranged in series, wherein different tensions and tensile forces are selected and can be applied to the arm and / or the shoulder in the areas in front of and behind this point (22).

Description

[0001] The invention relates to an orthosis with a shoulder region for application to a shoulder and at least one sleeve for application to an arm and at least one elastic strap element. The sleeve has a hand region that, when the orthosis is applied, is arranged on a hand. The at least one strap element is wrapped or can be wrapped around the sleeve in at least one helix-shaped turn and is or can be fastened to the shoulder region and the hand region. Such orthoses are known from US 2004 / 0 193 086 A1 and the subsequently published WO 2016 / 055 938 A1.

[0002] Shoulder orthoses are available in many different forms and are used, for example, to support and relieve pressure on a shoulder joint after surgery or an injury. This requires retracting the arm upward into the shoulder joint while restricting the shoulder joint's freedom of movement only to the extent necessary for therapy or rehabilitation. However, shoulder orthoses are not only used when the shoulder joint itself is affected. The shoulder, and especially the arm attached to it, also requires support after a stroke, for example. The affected arm is often in a spastic, forced position, which should be counteracted.This forced posture can include internal shoulder rotation / adduction, elbow flexion, forearm pronation (i.e., an inward rotation of the forearm), wrist flexion, a fisted hand, or a thumb held inward. Of course, several of these symptoms can also occur simultaneously, possibly with varying degrees of severity.

[0003] Various orthoses are known from the state of the art that can be used to alleviate some or all of the symptoms mentioned. For example, a forearm orthosis is known which consists of a band or strap wrapped around the forearm, at the lower end of which, facing the hand, is a hand element similar to a partial glove. Two or more fingers are passed through separate openings like a glove, ensuring that the lower part of the strap cannot detach from the wrist. The upper end of the strap is fixed to the arm above the elbow. The disadvantage is that this type of orthosis only counteracts forearm pronation and is difficult or impossible to put on alone, particularly for stroke patients who exhibit hemiplegia.

[0004] Other orthoses simply serve to pull the upper arm toward the shoulder joint, thus relieving pressure on the shoulder joint. These orthoses are also difficult or impossible to apply with one hand and offer no support in the patient's forearm or hand area.

[0005] The invention is therefore based on the object of further developing an orthosis in such a way that comprehensive support of the arm and shoulder is possible and at the same time the orthosis can also be applied by stroke patients with one hand.

[0006] The invention solves the stated problem by an orthosis according to the preamble of claim 1, which is characterized in that the belt element is fastened or can be fastened to the sleeve at least at one point between the hand area and the shoulder area.

[0007] The at least one elastic strap element thus runs in a helix shape around the sleeve from the shoulder area to the hand area. This does not necessarily mean that the strap element is guided along the outside of the sleeve, although this is a preferred embodiment. The strap element is simply guided in such a way that it runs around one arm of the wearer of the orthosis, which is surrounded by the sleeve when the orthosis is worn.

[0008] This applies a force to the sleeve and thus to the arm contained within it, which, for example, rotates the shoulder, forearm and palm outwards and thus counteracts forearm pronation and wrist inward rotation. Since at least one strap element is also arranged in the shoulder area, the entire arm is pulled into the shoulder, i.e. towards the shoulder joint, so that the shoulder is stabilized in the desired position. At the same time, internal rotation of the shoulder, i.e. shoulder adduction, is counteracted. The at least one elastic strap element advantageously runs on the outside of the sleeve so that it can be easily put on even by stroke patients or patients with other physical and motor limitations.Particularly in the case where at least one strap element is attached to the sleeve and remains wrapped around it, reproducibility in the arrangement of the strap element is achieved, so that the orthosis can be removed, for example, at night or during personal hygiene and then put back on in the same position. The orthosis can be designed, for example, in the form of a jacket or bolero jacket and can be closed, open, or closable. The strong similarity to a conventional item of clothing ensures that the orthosis is particularly easy to put on. In addition, the risk of the orthosis being applied incorrectly is reduced, so that any straps present exert a force in an undesirable and therefore potentially harmful direction.

[0009] In the shoulder area, at least one strap element is arranged, for example, between the shoulder blades on the back. It is possible to guide additional stabilizing straps, for example, through one or both armpits of the wearer of the orthosis and thus achieve optimal positioning so that the shoulder to be supported is subjected to as little strain as possible.

[0010] The hand area of ​​the sleeve can be designed in a wide variety of ways. The important thing is that the hand area allows for as fixed an attachment as possible to the hand of the wearer of the orthosis. The hand area can, for example, partially or completely cover the palm of the hand, or be designed as a mere thumb grip, and thus only be located in the ball of the hand. Alternatively or additionally, an attachment option in the area of ​​the fingers is also possible. The hand area can, for example, be designed in the form of a fingerless glove and thus completely cover the palm of the hand. The hand area can also or alternatively have at least one loop that can be placed around one or more of the fingers of the hand of the wearer of the orthosis, thus enabling attachment.

[0011] Alternatively or in addition to the previously mentioned designs of the hand area, which are achieved by, among other things, grasping the thumb, fingers or palm, it is also possible to coat a "sleeve extension", i.e. an extension of the sleeve. In some cases, such a coating enables sufficient spatial stability of the hand area, for example if it is located at the lower ball area of ​​the metacarpophalangeal joint of the thumb. In this case, grasping one of the fingers or thumb is not necessary. Such a coating may only prevent the sleeve and its hand area from twisting relative to the arm of the wearer of the orthosis and / or the hand area of ​​the sleeve from slipping "upwards". However, such limited spatial stability is sufficient in some situations.Slipping of the hand area “upwards” means that the hand area of ​​the sleeve moves away from the hand towards the shoulder, i.e. proximally.

[0012] In a preferred embodiment of the orthosis, the at least one strap element is detachably fastened to the hand area and / or the shoulder area. This ensures that different levels of tensile stress can be applied, whereby the force applied to the arm and / or shoulder can be adjusted and individually adapted. A preferred fastening means is a hook and loop fastener. A hook and loop fastener element is arranged on the hand area and / or the shoulder area of ​​the orthosis, while the hook and loop fastener counter element is located at the respective end of the at least one strap element. If the individual elements are designed with a relatively large surface area, a position at which the strap element is attached to the hand area and / or the shoulder area can also be adjusted across the area covered by the surface of the individual hook and loop fastener elements.This also allows, at least to a limited extent, the position and thus the point of application of the force applied by at least one elastic strap element to be changed and individually adjusted. Of course, other positioning options are also possible, for example, in the form of snap fasteners or other elements.

[0013] Advantageously, the at least one strap element does not run over the shoulder joint when the orthosis is worn. It has proven particularly advantageous if the strap element runs backwards over the wearer's upper arm, i.e. into the dorsal region, and from there is guided onto the back into the shoulder area, where it is fastened. Additionally or alternatively, a so-called "delta" strap can be used, which is placed around the shoulder joint in such a way that the actual joint is not stressed. It can, for example, be triangular or almost triangular. Such a positioning is known, for example, from DE 10 2011 119 397 A1, whereby the orthosis described therein does not exert any rotational force on the shoulder and / or the arm.

[0014] According to the invention, the at least one strap element is fastened or can be fastened to the sleeve at at least one point between the hand area and the shoulder area. Naturally, such fastening or fastenability can also be provided or prepared at multiple positions between the hand area and the shoulder area, i.e., along the longitudinal extent of the elastic strap element. Such fastening or fastenability allows the at least one strap element to be functionally divided into two elements arranged in a row, wherein different tensions and tensile forces can be selected and applied to the arm and / or shoulder in the areas in front of and behind this one fastening point.

[0015] It is equally possible for the at least one strap element to be formed by two separate straps fastened to at least one point on the sleeve, which straps are connected in series, i.e. arranged one behind the other in the longitudinal direction. In this way, it is possible, for example, to apply a first tensile force in the area of ​​the upper arm of the wearer of the orthosis and a second tensile force, which may be different from the first tensile force, in the area of ​​the forearm of the wearer of the orthosis. Here, too, the attachment is advantageously carried out using hook-and-loop fasteners, which enable particularly simple attachment. A hook-and-loop fastener element is arranged on the outside of the sleeve or incorporated into the material of the sleeve. This hook-and-loop fastener element can be relatively large and, for example, extend over the entire circumference of the sleeve.In this way, the position at which the belt elements are attached to the Velcro fastener can be individually adjusted, so that the applied forces can also be adapted to the respective patient.

[0016] The counter element is arranged on the inside of the strap element, which comes into contact with the sleeve material. Several of these counter elements can be arranged along the length of the sleeve. In this way, it is possible to bring different or different points of the individual counter elements into contact with the hook-and-loop fastener element arranged on the sleeve by applying different tensile forces, thus fastening the at least one elastic strap element to the sleeve. This simultaneously adjusts and adapts the tensile and rotational forces applied above and below, i.e., proximal or distal, the respective fastening point.

[0017] Of course, it is also possible to use multiple elastic strap elements, some of which, or all of which are attached or can be attached to the sleeve at different or identical locations. A combination of multiple elastic strap elements with different degrees of elasticity and thus capable of transmitting different tensile forces is also conceivable.

[0018] Advantageously, the pitch of the helix is ​​not constant over the length of at least one strap element. This also allows the applied rotational force to be adjusted. Particularly advantageously, the pitch is smaller in a distal region of the sleeve than in a proximal region. The proximal region is closer to the shoulder area than the distal region, which is closer to the hand area of ​​the sleeve.

[0019] Preferably, the at least one strap element is or can be wrapped around the sleeve in several turns. Particularly preferably, the at least one strap element is guided through at least one loop and / or a guide tunnel of the sleeve. Of course, several loops and / or several guide tunnels can also be provided. In this way, it is ensured that the elastic strap element, which may otherwise not be connected to the sleeve or is only connected at a few selected points, runs in the desired position and at the desired point on the arm and / or shoulder each time the orthosis is applied. Slipping of the strap element when putting on or taking off the orthosis, which leads to incorrect and possibly harmful forces being exerted on the patient's arm and / or shoulder, in particular when applying the orthosis, is avoided.The loops and guide tunnels can be sewn onto the sleeve material or incorporated into the sleeve material.

[0020] It has proven particularly advantageous if the orthosis or sleeve is made at least partially of a compression material. This ensures a secure hold and a firm fit of the sleeve on the patient's arm, while also achieving a compression effect that is beneficial for many applications. Of course, the orthosis can also be based on the aforementioned garment, such as a jacket, top, or bolero jacket, which is also partially or, advantageously, entirely made of a compression material. The compression material preferably exerts a pressure on the wearer of the orthosis that is below 20 mmHg, preferably below 18 mmHg.

[0021] In a particularly simple embodiment of the orthosis not according to the invention, the at least one belt element is incorporated into the material of the sleeve, in particular woven or knitted in, or applied to the material of the sleeve, in particular printed, glued or sprayed on.

[0022] An anti-slip coating can be applied to the inside of the sleeve, particularly where the elastic strap element is located on the outside. This further prevents the sleeve and / or the remaining portion of the orthosis from slipping and shifting relative to the patient's skin. Additionally, skin stimulation in a variety of forms can be integrated if necessary or advantageous.

[0023] The present design therefore creates an orthosis that lifts the arm, stabilizes the shoulder and shoulder blade, and simultaneously rotates the shoulder joint outward. This does not impair the natural back-and-forth swinging of the arm, which is used and required in particular for running and walking training. Furthermore, the handpiece covers at least a large part, but advantageously the entire palm, thus preventing the formation of edema and bruising. The use of a piece of clothing also makes putting on and taking off the orthosis particularly easy, and it can be worn under normal clothing because it is minimal and does not otherwise cause any discomfort. The coatings on the inside, which can be anti-slip, can be made of silicone, for example.

[0024] Markings are advantageously arranged on the outside of the sleeve and / or on the outside of the shoulder area, by means of which the course of the at least one strap element on the outside of the sleeve can be defined and adjusted. These can be formed by elements incorporated into the material of the sleeve, for example, woven or knitted, or by colored elements printed, embroidered, or applied in some other way.

[0025] The locations where the at least one strap element is or can be attached to the sleeve between the hand area and the shoulder area are advantageously located in the elbow and wrist areas. This allows the areas to be supported and influenced by the orthosis—namely, the shoulder and upper arm, forearm, and hand of the wearer of the orthosis—to be clearly separated and subjected to different forces separately.

[0026] Of course, it is also possible to wrap at least one strap element around the sleeve in at least one helix-shaped coil, achieving and supporting internal rotation rather than external rotation. To do so, simply change the direction of rotation of the helix in which the at least one strap element is wrapped around the sleeve. In a particularly advantageous embodiment, the orthosis is designed to allow both options, so that the strap element can be wrapped around the sleeve in either direction and secured accordingly to the hand area of ​​the sleeve.

[0027] If the strap is placed in a tunnel or channel, it is advantageously closable. This also means that it can be opened, which can be achieved, for example, using a zipper or a hook-and-loop fastener. To put on the orthosis, in particular to put it on for the first time, the orthosis is first put on while the at least one channel is open. The at least one strap element can then be inserted into the channel and attached to the sleeve in a way that best suits the respective therapy or support. The at least one tunnel is then closed, for example, using the existing zipper element.

[0028] The next time the orthosis is put on, at least one strap element automatically moves in the desired direction and along the desired path, so that malfunctions and incorrect use of the orthosis can be safely avoided.

[0029] An embodiment of the present invention is explained in more detail below with the aid of the following drawings. It shows: Fig. 1 - an orthosis according to a first embodiment of the present invention in the applied state in a back view, Fig. 2a and Fig. 2b - the applied orthosis from Fig. 1 in two further views, Fig. 3 - an orthosis according to another embodiment of the present invention, Fig. 4a and Fig. 4b - Details of an orthosis according to an embodiment of the present invention, Fig. 5a and Fig. 5b - further details of an orthosis according to an embodiment of the present invention and Fig. 6 to 9 - further details according to further embodiments.

[0030] Fig. 1 shows an orthosis 1 according to a first embodiment of the present invention. It is designed as a jacket 2 and can be worn like a conventional jacket. The jacket can preferably be made of a compression material or at least partially consist of such a material. The orthosis has a shoulder region 4 and a sleeve 6, which are arranged on the body of the wearer 8 of the orthosis like a sleeve and shoulder region of a jacket. In particular, the sleeve 6 and the shoulder region 4 are preferably made of a compression material. The sleeve 6 has a hand region 10 that at least partially covers a palm. An elastic belt element 12 can be seen, which is wrapped helically around the sleeve 6. Since the elastic belt element 12 is made of an elastic material, a tensile force is applied, which leads to a rotation of the sleeve 6 and thus of the arm of the wearer 8.The force is applied, among other things, along the arrows 14.

[0031] As in Fig. 1, the elastic strap element 12 does not extend over a shoulder joint of the wearer 8 of the orthosis 1. Rather, in the illustrated embodiment, it is fastened in the back region 16, i.e., the part of the orthosis 2 that covers part of the back of the wearer 8, with a cross-shaped fastening element 18. Extending from the ends of the fastening element 18 are further straps 20, which ensure optimal positioning of the orthosis 1 and thus also of the jacket 2 and the elastic strap element 12.

[0032] The elastic belt element 12 is attached to the sleeve 6 of the orthosis 1 at least at one point 22.

[0033] In the Fig. 2a and Fig. 2b is the Fig. 1 shows the orthosis 1 in its applied state from different perspectives. In Fig. 2a shows the jacket 2, which can be closed in the chest area of ​​the wearer 8, for example, with a zipper 24. This makes the orthosis 1 easy to put on, and the elastic strap element 12 can be reproducibly applied in the correct position and with the correct stretch. The straps 20 run under the wearer's armpits and are connected to the Fig. 2a are connected to a cross-shaped fastening element 18, not shown. They thus ensure a firm hold and a good fit of the orthosis 1 on the wearer 8.

[0034] In Fig. 2b shows that the elastic belt element 12 is wrapped around the sleeve 6 and fastened to this sleeve at point 22. The elastic belt element 12 is also secured to the fastening element 18. By fastening the elastic belt element 12 at point 22 to the jacket 2 and the sleeve 6, the applied force can be divided into two areas. The part of the elastic belt element 12 that extends between point 22 and the fastening element 18 applies a rotational force to the upper arm and thus the shoulder joint, which leads to an external rotation, i.e., a rotation outwards, in the illustrated embodiment to the left. Fig. 2b shown other part of the elastic belt element 12, which is located between the point 22 and the Fig. 2b, is arranged in the hand area 10 of the sleeve 6, not shown, exerts a rotational force on the arm and also ensures an external rotation here.

[0035] A loop 23 is arranged on the sleeve 6, through which the elastic belt element 12 is guided. Several such loops 23 can also be arranged on the sleeve 6 in order to hold the elastic belt element 12 in the desired position and along the desired path. Of course, these loops 23 can also be arranged on the inside of the sleeve or be designed in the form of one or more tunnels.

[0036] Fig. Figure 3 shows an orthosis 1 according to a further embodiment of the present invention. In addition to the elastic strap element 12 and the additional straps 20, which are connected to the fastening element 18 in the back region 16, it has a further tension strap 26, which in the illustrated embodiment is arranged between the elastic strap element 12 and the strap 20. This exerts a tensile force on the forearm or upper arm of the wearer 8, resulting in a slight lifting of the arm.

[0037] It can be seen that the elastic belt element 12 is arranged in the hand area 10 of the sleeve 6.

[0038] Fig. 4a again shows a section of an orthosis 1. The sleeve 6 can be seen, around which the elastic belt element 12 has been wound in the shape of a helix. In the exemplary embodiment shown, there are three windings, but this is not absolutely necessary. Depending on the desired force applied, more or fewer windings can be used. Of course, it is also possible to wrap the elastic belt element 12 around the sleeve 6 in a different direction, so that the force applied by the elastic belt element 12 does not lead to an external rotation but to an internal rotation. In the exemplary embodiment shown, however, a force is applied in the direction of an external rotation according to the arrow 14.

[0039] In Fig. 4b shows the hand area 10 of the sleeve 6 and the end of the elastic belt element 12 attached to this hand area 10. It has a Fig. 4b shows a hook-and-loop fastener element 28, which interacts with a counter-element 30 arranged in the palm of the hand area 10. It can be seen that the counter-element 30 is larger than the hook-and-loop fastener element 28, so that the exact position at which the hook-and-loop fastener element 28 is attached to the counter-element 30 can be varied. In this way, the applied tensile force, which is applied along arrow 14 to the hand area 10 and thus to the hand, can also be adjusted.

[0040] In the Fig. 5a and Fig. Figure 5b shows an enlarged view of the hand area 10. The elastic strap element 12 is again attached to the hand area 10 of the sleeve 6 via the Velcro fastener element 28 and the counter element 30. This again applies the force symbolized by the arrow 14. Fig. 5a, the elastic belt element 12 is shown as several parts that are not connected to each other. The upper part also has a hook-and-loop fastener element 28, which interacts with another counter element 30, so that the two parts of the elastic belt element 12 can be connected to each other. This situation is shown in Fig. 5b, in which the second hook-and-loop fastener element 28 is also arranged on its intended counter-element 30. Here, too, it can be seen that the counter-element 30 is larger than the hook-and-loop fastener element 28, so that the exact position and thus the applied force can be adjusted. Alternatively or additionally, it is possible to fix the counter-element 30 made of the elastic strap element 12 to the sleeve 6 of the orthosis 1, thus also separating the applied forces.

[0041] Fig. 5a and Fig. The lower part of the elastic belt element shown in Fig. 5b, which lies between the counter element 30 and the hand area 10, then applies a force to the wrist and forearm of the wearer, while the remaining part of the elastic belt element 12, which lies between the counter element 30 and the Fig. 5a and Fig. 5b, exerts a force on the arm and in particular the elbow of the wearer.

[0042] Fig. Figure 6 shows the sleeve 6 of an orthosis according to another embodiment of the present invention. As shown in the Fig. 5a and Fig. In the embodiment shown in Fig. 5b, the elastic belt element 12 consists of several parts that can be connected to one another via a hook-and-loop fastener element 28 and a corresponding counter-element 30. The hand area 10 is in the Fig. In the embodiment shown in Figure 6, the hand area 10 is designed merely as a thumb encirclement 32, and thus only covers the palm area of ​​the wearer's hand. However, in this embodiment, the hand area 10 also has a hook-and-loop fastener element 28 that can be arranged on the counter element 30 provided for this purpose.

[0043] Fig. Figure 7 shows the sleeve 6 of the orthosis, in which the hand area 10 is in the position already shown in the Fig. 5a and Fig. 5b. The elastic belt element 12 again consists of several parts, whereby in the case of Fig. In the embodiment shown in Figure 7, both components of the elastic belt element 12 each have a hook-and-loop fastener element 28, which can each be fastened to a common counter-element 30 arranged on the sleeve 6. Of course, embodiments are also conceivable in which, for connection, one of the two components of the elastic base element 12 is first fastened to the counter-element 30 and then the other component of the elastic belt element 12 is arranged on this already fastened component.

[0044] A similar design of the sleeve 6 shows Fig. 8. Here too, the elastic belt element 12 has two components, each with a Velcro fastener element 28. However, the counter element 30 is designed with a much larger surface area than in the Fig. This is the case in the embodiment shown in Figure 7. It runs around the entire circumference of the sleeve 6, so that a large area is available for positioning the hook-and-loop fastener elements 28 on the counter element 30, so that the applied forces can be individually adjusted by the elastic belt element 12.

[0045] Fig.Figure 9 shows the sleeve 6, in which the hand area 10 almost completely covers the palm of the hand, and the end of the elastic strap element 12 attached to the hand area 10 has a hook-and-loop fastener element 28 that can be attached to the counter element 30. However, this element is designed with a significantly larger surface area than is the case in other embodiments shown, so that here too, the fastening options are diverse and a large area is available.

[0046] Of course, the individual designs can be combined with each other and the orthosis can be adapted to the desired individual requirements and needs. List of reference symbols 1 orthosis 2 jacket 4 Shoulder area 6 sleeves 8 carriers 10 Hand area 12 elastic belt element 14 Arrow 16 back area 18 Fastening element 20 belt 22 positions 23 Loop 24 zipper 26 tension belt 28 Velcro fastener 30 Counter element 32 Thumb encirclement

Claims

[1] Orthosis (1) with - a shoulder area (4) for application to one shoulder, - at least one sleeve (6) for application to an arm and - at least one elastic belt element (12), wherein the sleeve (6) has a hand region (10) which, when the orthosis (1) is worn, is arranged on a hand, and wherein the at least one belt element (12) is or can be placed around the sleeve (6) in at least one winding in the form of a helix and is or can be fastened to the shoulder region (4) and to the hand region (10) characterized bythat the belt element (12) is fastened or can be fastened to the sleeve (6) at at least one point (22) between the hand area (10) and the shoulder area (4), so that the at least one belt element can be functionally divided into two elements arranged in a row, wherein different tensions and tensile forces can be selected in the areas in front of and behind this point (22) and can be applied to the arm and / or the shoulder. [2] Orthosis (1) according to claim 1, characterized by that the at least one belt element (12) is releasably fastened to the hand area (10) and / or to the shoulder area (4). [3] Orthosis (1) according to claim 1 or 2, characterized by that the at least one belt element (12) does not run over the shoulder joint when the orthosis (1) is in the applied state. [4] Orthosis (1) according to one of the preceding claims, characterized by that a pitch of the helix is not constant over the length of the at least one belt element (12). [5] Orthosis (1) according to claim 4, characterized by that the gradient in a distal region of the sleeve (6) is smaller than in a proximal region. [6] Orthosis (1) according to one of the preceding claims, characterized by that the at least one belt element (12) is or can be laid around the sleeve (6) in several turns. [7] Orthosis (1) according to one of the preceding claims, characterized by that the at least one belt element (12) is guided through at least one loop and / or at least one guide tunnel of the sleeve (6). [8] Orthosis (1) according to one of the preceding claims, characterized by that the sleeve (6) consists at least partially of a compression material.

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