METHOD FOR ATTACHING AN ORTHOSE AND ORTHOSE

Description

[0001] The invention relates to a method for attaching a shoulder orthosis to an upper arm, wherein the orthosis has a dimensionally stable shell with a ventral flap and a dorsal flap, the ventral flap and the dorsal flap being connected or connectable by means of a clamping element. The invention further relates to a shoulder orthosis for carrying out such a method.

[0002] Orthoses are orthotic devices designed to protect, support, and / or strengthen a part of the wearer's body. The present invention relates to orthoses for the upper extremity, positioned in the proximal region of the upper arm and at the wearer's shoulder. They are used, for example, in stroke patients or in cases of brachial plexus palsy. Such orthoses are particularly advantageous when the wearer's upper arm muscles are not strong enough to hold the arm at the shoulder joint. The orthoses are intended to reduce subluxation in the shoulder joint and absorb the force, especially the weight, of the respective arm, transferring it to the shoulder and the opposite, contralateral side.Such orthoses can be called shoulder orthoses and are used, for example, to stabilize the shoulder after an injury or shoulder surgery, while still allowing and, if necessary, supporting at least some limited shoulder movement. The aim is to protect the weakened shoulder in an optimal position while simultaneously permitting or facilitating at least some restricted movement.

[0003] Conventional shoulder orthoses consist of a base made of an elastic material. This base typically includes a shoulder section that rests against the wearer's shoulder when the orthosis is applied. Attached to this shoulder section is a conventionally tubular arm section that wraps around the upper arm. Because the base is made of elastic material, the shoulder orthosis can be easily pulled over the arm, similar to a shirt sleeve, until it rests against the shoulder. At least one strap, which is placed around the wearer's torso, holds the base in this position and, in many designs, simultaneously exerts a pulling force on at least the shoulder area of ​​the base.It is possible to connect at least one strap to the base body in a detachable way at at least one point, in order to allow for easier application of the orthosis.

[0004] US Patent 4,862,878 A describes a shoulder orthosis designed to provide support to the shoulder, particularly when the corresponding arm is raised. This orthosis incorporates an elastic band guided over pulleys. In contrast, EP 2 356 957 A2 describes an orthosis intended to immobilize the shoulder and prevent movement.

[0005] US 7,320,669 B2 discloses a shoulder orthosis that has a pneumatic cushion which can be filled or emptied to adjust the pressure to be exerted on a shoulder. DE 201 14 446 U1, on the other hand, deals with a shoulder orthosis that exerts external rotation on the upper arm.

[0006] When a shoulder orthosis is applied according to the prior art, the wearer's arm is first inserted into the arm section of the base unit, and the base unit is then pulled upwards along the arm until it reaches its final position at the shoulder. A tensile force can then be applied to the base unit via a strap, which, for example, is permanently attached to the base unit at one end. This force is then exerted by the base unit on the shoulder against which it rests. Advantageously, the free end of the at least one strap has a fastening element, which could, for example, be part of a hook-and-loop fastener.

[0007] The corresponding counterpart is located on the main body of the shoulder orthosis, specifically on the shoulder portion of this main body. This allows the effective length of the strap, and therefore the tensile force exerted by the strap, to be individually adjusted to the wearer of the shoulder orthosis. The wearer of the shoulder orthosis, or a person assisting them, consequently exerts a pull on at least one strap before connecting the free end of the strap to the main body of the shoulder orthosis. In this way, a tensile force is exerted on the main body of the shoulder orthosis, and in particular on the shoulder portion. However, since this portion is made of an elastic material, it yields to these tensile forces, at least over a certain range.

[0008] The main body of the shoulder brace is conventionally placed directly on the wearer's skin. The inside of the main body may be coated to ensure optimal adhesion to the skin. This prevents or at least hinders slippage of the brace during shoulder movement. A disadvantage is that when the strap is attached to the main body, a tensile force is exerted on it, causing it to deform. Due to the increased friction between the wearer's skin and the main body, this deformation is transmitted to the patient's skin and thus to the shoulder support element. Consequently, when such a brace is closed, the shoulder moves, typically being pulled forward.In this position, the shoulder is supported and fixed by the shoulder brace. However, this is not the desired optimal, healthy posture, but rather a modified one. Therefore, supporting and fixing the shoulder in this position is detrimental.

[0009] The same problem arises if the strap is not detachably attached to the main body of the shoulder brace at one end, but is permanently attached at both ends, for example, by sewing. The strap can also be formed as a single piece with the main body, meaning it is also made of an elastic material. However, when such a shoulder brace is applied, the main body still deforms and distorts. This, combined with the high friction between the main body and the wearer's skin, leads to movement and displacement of the shoulder joint, so that even in this case, it is not guaranteed that the shoulder is supported in an optimal position.

[0010] From DE 10 2011 119 397 A1, a shoulder orthosis is known in which the straps that transmit the force to the base body of the orthosis are made of an elastic material. While this prevents deformation of the straps and also of the base body, at least in the area connected to the straps, the force applied when tightening the orthosis will nevertheless lead to deformation and displacement of the upper arm relative to the wearer's shoulder.

[0011] The invention is therefore based on the objective of eliminating or at least reducing the disadvantages of the prior art.

[0012] The invention solves the stated problem by a method for attaching an orthosis of the above-mentioned type, which comprises the following steps: Applying the dimensionally stable shell to an upper arm, tensioning the clamping element so that a tensile force is exerted on the ventral flap and the dorsal flap, acting in a proximal direction.

[0013] The rigid shell of the orthosis is preferably designed so that its geometric shape is adapted to the upper arm. This can be achieved either by a shell individually adapted to the upper arm of the respective wearer or by a generic shell that is generally adapted to an upper arm. Preferably, the rigid shell is not positioned directly on the wearer's skin, which, due to its rigidity, can lead to pain or at least an unpleasant feeling of pressure, especially during upper arm movements. This is particularly likely if the rigid shell is not individually adapted to the upper arm.

[0014] Preferably, the dimensionally stable shell has a cushioning element on one side facing the upper arm. The cushioning element is part of the shell and is arranged on the dimensionally stable shell in such a way that it comes into contact with the upper arm when the shell is placed on the upper arm. The cushioning element is preferably flexible, and particularly preferably elastic. In one embodiment of the invention, the cushioning element is designed as a textile cushioning element.

[0015] Such a padding element, particularly a textile padding element, is therefore not necessarily dimensionally stable itself. In this case, the dimensional stability of the dimensionally stable shell is not provided by the padding element, but by another dimensionally stable component of the shell. The padding element, particularly a textile padding element, can be significantly larger than the dimensionally stable component of the dimensionally stable shell. This means that the padding element comes into contact with a considerably larger area of ​​the arm than the dimensionally stable component of the dimensionally stable shell would.

[0016] Preferably, the rigid shell is shaped such that it at least partially surrounds the upper arm. Preferably, it can be closed via a strap or similar element so that it completely surrounds the upper arm. In this case, the strap or similar element is part of the rigid shell. Such a strap can, for example, be attached to the rigid shell at one end, preferably permanently, and most preferably sewn on, and have a positive-locking element at the opposite end that is designed to interact with a correspondingly designed second positive-locking element, which is, for example, attached to the rigid shell. After such a strap is closed, the wearer's upper arm is completely surrounded by the rigid shell.Preferably, at least one frictional connection is formed between the rigid shell, preferably the padding element, and the upper arm, so that a force acting on the shell is transferred to the upper arm. The padding element of the rigid shell is preferably made of an elastic material, which is preferably stretched when the orthosis is applied to the upper arm. This strengthens the frictional connection between the shell and the upper arm. The rigid shell, preferably the padding element, is preferably provided on the side facing the upper arm with a non-slip coating, for example, a silicone coating.

[0017] After the rigid shell is applied to the upper arm, the dorsal and ventral flaps extend proximally, meaning upwards when the upper arm is hanging downwards. They are connected or connectable above the shoulder. It is not necessary for a force acting proximally to be transmitted to the upper arm in this state. This preferably occurs only when the tensioning element is tightened. Due to the special design of this tensioning element, unlike prior art orthoses, no unilateral force is exerted on the element of the orthosis resting against the upper arm. Rather, the tensile force is applied to both the ventral and dorsal flaps. This results in a uniform force transmission and thus a force acting only proximally.

[0018] For example, straps are known from the prior art which are permanently attached at one end to one of the two tabs, for example, the dorsal tab, by means of stitching. At the opposite end is a hook-and-loop fastener element that can interact with a corresponding hook-and-loop fastener element, which is preferably located on the other tab, for example, the ventral tab. To tighten such a fastener element, a tensile force is applied to the strap, acting exclusively on the dorsal tab. Only after the two hook-and-loop fastener elements interact and a positive connection is formed is a force also exerted on the other tab, in this case, the ventral tab. Thus, during tightening, there is no simultaneous application of force to both tabs. This is different in the present invention.Here, when the clamping element is tightened, the tensile force is introduced into both the ventral and dorsal tabs.

[0019] Preferably, the ventral and dorsal flaps are connected to each other before the clamping element is tensioned, and particularly preferably, attached to each other. This can be achieved, for example, by positive locking elements arranged on the two flaps that can interact with each other. In a particularly simple embodiment, a hook-and-loop fastener element is arranged on one of the two flaps and the corresponding hook-and-loop fastener counterpart element on the other flap. Alternatively, a connecting element, such as a strip of fabric or textile, a band, or a strap, can be used that can be connected to or is connected to the two flaps to join them together. It is important that this can be done completely or almost completely without any tensile force acting on the flaps and thus serves only to hold the two flaps in the desired position.The proximal force, which is important for a good fit and functionality of the orthosis, is preferably not generated when connecting the two tabs, but is only caused by tensioning the tensioning element.

[0020] Preferably, the ventral and dorsal flaps are connected to each other above the shoulder, preferably by fastening them together. However, this is not necessary. Fastening or connecting can also occur at any other point.

[0021] The invention further solves the stated problem by means of an orthosis for carrying out a method of the type described above, wherein this orthosis has a dimensionally stable shell with a ventral flap and a dorsal flap, wherein the orthosis is characterized in that it has a tensioning element by which a tensile force can be applied to the ventral flap and the dorsal flap, wherein this tensile force is increased by tightening the tensioning element. As already explained, when increasing the tensile force by tightening the tensioning element, it is important that the tensile force acts on both flaps simultaneously and is increased accordingly.

[0022] A dimensionally stable shell is, for example, a shell that retains its shape without the influence of external forces other than gravity. If a dimensionally stable shell is placed on a surface, it retains its shape at least to a large extent, but preferably completely. A shell made of a simple textile, on the other hand, would collapse in on itself. The dimensionally stable shell has at least a tubular or partially tubular section. A tubular section completely encloses the upper arm of the wearer, i.e., over its entire circumference. A partially tubular section encloses the upper arm only over part of its circumference. The tubular or partially tubular section of the shell is designed in such a way that it retains its open shape even when placed on a surface.The dimensionally stable shell, and in particular the tubular or semi-tubular section, is preferably designed so that the user can easily thread it onto the arm to be fitted with the orthosis using their healthy arm until it reaches the desired final position on the upper arm. In a particular embodiment, the shell is designed to be dimensionally stable enough to reduce and / or dampen any swinging of the upper arm to which it is applied. It is especially preferred that it suppresses excessive swinging. Preferably, the swinging is reduced by 25% to 50%. This adapts the arm movement to a natural movement pattern, particularly the natural gait pattern (arm swing) when walking.

[0023] The geometric shape of the shell is preferably adapted to the upper arm to which the dimensionally stable shell is to be applied. The dimensionally stable shell is designed, in particular, to absorb shear forces introduced perpendicular to the thickness of the material. These shear forces occur, for example, when the orthosis is moved into its final position against the friction of the skin during application to the upper arm. The dimensionally stable shell preferably does not deform under these conditions. When applying the orthosis to the upper arm, friction with the skin of the wearer's arm occurs, especially if the orthosis has a section that completely encloses the upper arm and is threaded onto the arm. In such cases, close contact between the orthosis and the wearer's skin often occurs first in the forearm area and then in the upper arm area.A purely textile orthosis would fold into wrinkles and could not easily be moved into its final position. This would only be possible by applying a tensile force to the upper end of the textile.

[0024] Due to its dimensionally stable property of being able to absorb shear forces, the orthosis can be pushed onto the arm when, for example, the tubular or semi-tubular area of ​​the shell is moved.

[0025] The dimensionally stable shell can be made, for example, of a plastic, a fiber-reinforced plastic (such as GRP or CFRP), or a metal (such as aluminum). Preferably, the dimensionally stable shell includes a dimensionally stable foam element. The foam element can be connected to the padding element on the side facing the wearer's skin. In a preferred embodiment, the foam element is connected to a textile on the side facing the wearer's skin. The textile is intended to ensure a comfortable feel. On the opposite side of the foam element, another layer of plastic or textile can be applied to reduce susceptibility to external influences, such as soiling. The foam element preferably has a flexural modulus of at least 7 MPa, preferably at least 10 MPa, particularly preferably at least 13 MPa, and at most 100 MPa.

[0026] The dorsal flap extends dorsally, preferably to just below the spine of the scapula. The distance to the spine is preferably less than 5 cm, and particularly preferably less than 2 cm. The dorsal projection forms the counter-surface for the ventral flap extending anteriorly on the upper arm. This flap design limits any potential posterior pendulum movement of the upper arm and positions it. The ventral flap of the brace preferably extends along the shoulder girdle to just before the clavicle. The distance to the clavicle is preferably less than 5 cm, and particularly preferably less than 2 cm. The ventral flap serves to lift the arm when the tensioning element is tightened. The brace can be individually adjusted to the user's anatomical features.For example, a pre-made shell is incorporated and reworked, or a shell is individually manufactured using additive manufacturing or manual production.

[0027] The orthosis preferably has at least one, and preferably two, support straps, which are preferably arranged approximately in the middle of the wearer's upper arm and extend to form an upper body strap encircling the torso. These serve to reduce / limit the swinging of the arm forwards or backwards. The length of these straps can be individually adjusted.

[0028] Preferably, the tensioning element comprises a strap that is attached at one end to a first tab, can be attached at the other end to the first tab, and is guided through a deflection loop on the second of the two tabs. When such a tensioning element is tensioned, the second end, which is not yet attached to a first tab, is guided through the deflection loop. Subsequently, a tensile force can be applied to this second end of the tensioning element. This tensile force results in a tensile force on both tabs, as it is transmitted via the deflection loop to the second tab and via the first end of the strap, which is attached to the first tab, to the first tab. Once a sufficient tensile force has been applied, the second end of the strap can be attached to the first tab.

[0029] Alternatively or additionally, the tensioning element has a pull cord connected to the ventral and dorsal tabs, the effective length of which is adjustable. Such a pull cord can also be in the form of a wire. Preferably, such a tensioning element has an actuating element by which the effective length of the pull cord can be changed. Such an element is offered, for example, by the company BOA. In this case, the actuating element is a rotary element, for example, a knob, which is rotated around a pivot axis. The pull cord is wound onto a spindle or spool, thus reducing its effective length, i.e., in particular the distances between the actuating element and its spindle or spool on the one hand, and the positions where the pull cord is connected to the respective tab on the other. This exerts a tensile force on the tab and thus on the dimensionally stable shell of the orthosis.

[0030] In a preferred embodiment, the pull cord is guided through a loop on the ventral tab and / or a loop on the dorsal tab. This allows for a particularly simple attachment and connection between the respective tab and the pull cord, which can be manufactured with exceptional ease. In a preferred embodiment, the pull cord is guided over at least one pulley, and more preferably over several pulleys. This creates the effect of a pulley system, enabling even wearers with limited motor skills or physical weakness to apply the required force.

[0031] In a preferred embodiment, a stiffening element is arranged on the rigid shell. This reinforces the rigid shell. The stiffening element is, for example, designed as a second shell or as at least one strut. The stiffening element is preferably permanently connected to the first rigid shell, for example by gluing or welding. Alternatively, the stiffening element is detachably connected to the rigid shell, for example by plugging it in or using a hook-and-loop fastener. Preferably, the rigid shell and the stiffening element can be individually adapted to the patient in this way. In a preferred embodiment, the rigid shell is less rigid than the stiffening element.

[0032] The stiffening element can also be referred to as a brace and is preferably rigidly connected to the rigid shell. The stiffening element preferably has a dorsal projection and / or a ventral projection. The dorsal projection extends along the dorsal tab, and the ventral projection extends along the ventral tab. Preferably, the stiffening element is designed as a shell. The stiffening element is preferably arranged on the rigid shell, preferably on the side facing away from the upper arm. The stiffening element is preferably made of a metal, for example, aluminum or steel, or of a plastic, a fiber-reinforced plastic, for example, GRP or CFRP.

[0033] Preferably, the clamping element is attached directly or indirectly, for example via a strap, to the stiffening element. Preferably, the clamping element is attached directly or indirectly, for example via a strap, to the two projections of the stiffening element.

[0034] Preferably, at least one element of an orthotic splint system is attached or attachable to the rigid shell and / or the stiffening element. This is particularly advantageous if, for example, the orthosis is also intended to support, stabilize, or protect a forearm. The splint element then extends in the desired direction and can, for example, fix or support a forearm in a specific and desired position. Preferably, the splint element can be attached to the rigid shell of the orthosis in different positions and / or orientations. This can be achieved by a clamping mechanism, a clip or snap mechanism, or by screw connections.

[0035] The rail system is particularly preferably part of the orthosis and comprises at least one body attachment element, preferably a forearm element for attaching to a forearm and / or a hand element for attaching to a hand. The rail system particularly preferably has at least two elements that are positioned together by means of a joint. Advantageously, the rail system has at least one actuator configured to move one element of the rail system relative to another element of the rail system.

[0036] By attaching a rail system to the rigid shell and / or the stiffening element, forces from an elbow, forearm, and / or hand are transferred at least partially, but preferably completely, to the clamping element. As a result, the load caused by these forces, which can be generated, for example, by the weight of the arm and the orthosis, does not act, or does not act solely, on the upper arm or shoulder joint, but is at least partially, preferably completely, diverted via the clamping element. To the extent that this load is diverted, it does not act as a tensile force on the upper arm, but rather as a compressive force acting downwards on the shoulder.

[0037] The joint of the orthotic splint system is preferably an elbow joint, which is particularly preferably arranged such that its pivot axis coincides with the pivot axis of the wearer's natural elbow. Unlike a textile orthosis, displacement or rotation of the joint relative to the wearer's body part is either impossible or severely limited. This allows the established position and orientation of the joint to be maintained for a long time, thus preserving the functionality of the orthosis.

[0038] This applies not only to elbow joints, but in principle to all elements of the orthotic splint system that are directly or indirectly attached to the rigid shell and / or the stiffening element. This includes, for example, fixation splints, elbow and wrist splints. All of these can be aligned relative to the body part of the orthosis wearer and, due to the rigid design of the individual components, remain stable in this alignment.

[0039] Preferably, a flexible, preferably elastic, cushioning element, preferably a textile cushioning element, is arranged on a side of the dimensionally stable shell facing the upper arm.

[0040] Preferably, the dorsal flap and / or the ventral flap are part of the upholstery element or are attached to it, preferably sewn or glued on.

[0041] Preferably, the rigid shell connects the ventral and dorsal flaps on the medial side of the arm. This means that the shell extends between the arm and the wearer's torso when the arm hangs relaxed. The opposite side, i.e., the lateral side, is preferably open. The opening there can be spanned or bridged by one or more straps; however, preferably no strap is present.

[0042] Preferably, the joint, for example the elbow joint, is located medially on the arm. This is particularly easy to achieve if the rigid shell is located medially.

[0043] With the aid of the accompanying figures, some exemplary embodiments of the present invention are explained in more detail below. It shows Figures 1 and 2 - Schematic representations of an orthosis according to a first embodiment of the present invention Figure 3- a schematic representation of an orthosis according to a further embodiment, Figures 4 to 6 - an orthosis according to a further embodiment of the present invention in different views and Figures 7 and 8 - an orthosis according to a further embodiment of the present invention in the applied and unapplied state.

[0044] Figure 1Figure 1 shows an orthosis according to a first embodiment of the present invention. It has a dimensionally stable shell 2 to which a stiffening element 4 is attached. The dimensionally stable shell has a ventral flap 6 and a dorsal flap 8. The stiffening element 4 also has two projections 10 that extend along the two flaps 6 and 8. Above the shoulder, the two flaps 6 and 8 are connected to each other by a strap 12. An actuating element 14, designed as a rotary knob in the illustrated embodiment, is located on this strap 12. It is configured to tension a tensioning element, which is not shown in the figures. Two additional retaining straps 16, which connect the dimensionally stable shell 2 to an upper body strap 18, further restrict the range of motion of the upper arm when the orthosis is worn.

[0045] Figure 2 The orthosis shows Figure 1In another view, the upper body strap 18, to which one of the two retaining straps 16 is attached, is now more clearly visible. It is also easy to see that the ventral flap 6 extends proximally from the wearer's upper arm, and that one of the two projections 10 of the stiffening element 4 extends along this ventral flap 6.

[0046] Figure 3Figure 1 shows a side view of another embodiment of an orthosis according to the present invention. The stiffening element 4 has two projections 10 extending along the ventral flap 6 and the dorsal flap 8. The two flaps 6 and 8 are again part of the rigid shell 2. The two retaining straps 16 are also present. Above the shoulder, the two flaps 6 and 8 are connected to the strap 12, on which the actuating element 14 for the tensioning element is located. In the distal region of the rigid shell 2, a rail element 20 is arranged on the stiffening element 4, at the lower end of which a joint 22 of a rail system is arranged.

[0047] Figure 4Figure 1 shows a side view of a further embodiment of an orthosis according to the present invention. The stiffening element 4 is attached to the rail element 20 with the joint 22 arranged thereon. In the illustrated embodiment, this joint 22 connects the rail element 20, which runs along the upper arm of the wearer when applied, to a forearm splint 24, which runs along the forearm. The joint 22 is preferably arranged on the rail element 20 and the forearm splint 24 such that its pivot axis runs parallel to, and preferably coaxial with, the pivot axis of the elbow joint of the wearer. The forearm splint 24 can be attached to the forearm by means of forearm straps 26, thus ensuring a firm and secure hold of the orthosis on the forearm as well.The orthosis, via the joint 22 and the connected rails 20, 24, is designed to apply force to the forearm, to support, limit, and / or train the movement of the wearer's elbow joint, and / or to support, relieve, and / or protect the elbow joint. A fastening element 28 is arranged on the forearm rail 24, to which a hand support element (not shown) can be attached. Thus, the orthosis shown can be combined with a known hand orthosis.

[0048] Figures 5 and 6 show the orthosis Figure 4 in other views. The figure shows a frontal view. The upper body strap 18, which is routed around the upper body, and the restraint strap 16, which restricts the movement of the upper arm, are particularly clearly visible. In the Figure 6The rear view shown illustrates that the upper body strap 18 is routed around the upper body. It preferably connects the ventral flap 6 with the dorsal flap 8. In the illustrated embodiment, the orthosis also has a retaining strap 16 in the posterior region.

[0049] Figure 7 shows an orthosis according to a further embodiment of the present invention in the applied state. Figure 8Figure 1 shows the same orthosis in its unused state in a lateral view. The ventral flap 6 and the dorsal flap 8 are each formed as part of the dimensionally stable shell 2. The shell 2 and the two flaps 6 and 8 are manufactured as components from carbon fiber reinforced polymer (CFRP), which gives them sufficient mechanical stability with low weight. The strap 12 runs over the wearer's shoulder. The tensioning element 14 allows the effective length of the tensioning cable to be changed. Such an element is offered, for example, by the company BOA. The shell 2 is positioned medially, thus extending between the arm and the upper body of the user. The joint 22 is also positioned medially on the arm.

[0050] At the distal end of the rigid shell 2, a forearm splint 24 is arranged via a joint 22; in the illustrated embodiment, this splint is designed as a CFRP component. The CFRP components are provided with a cushioning layer that faces the body part.

[0051] One can recognize this particularly in Figure 8The shell is designed in two parts: an upper or proximal portion and a lower or distal portion. These two portions are connected by a pivoting mechanism, allowing them to pivot relative to each other. This enables the forearm, on which the forearm splint is positioned, to be pivoted within a predetermined angular range. This allows, for example, the forearm's position relative to the shoulder to be adjusted. The forearm can be moved either by an external force, such as movement by the user's other arm, or by the user's own effort. Reference symbol list

[0052] 2 dimensionally stable shell 4 stiffening element 6 ventral tab 8 dorsal tab 10 projection 12 strap 14 actuating element 16 restraint strap 18 upper body strap 20 splint element 22 joint 24 forearm splint 26 forearm strap 28 fastening element

Claims

1. A method for fastening an shoulder orthesis to an upper arm, the shoulder orthosis comprising a dimensionally stable shell (2) with a ventral tab (6) and a dorsal tab (8), wherein the ventral tab (6) and the dorsal tab (8) are or can be connected by means of a tensioning element, the method comprising the following steps: - applying the dimensionally stable shell (2) to an upper arm, - tensioning the tensioning element so that a tensile force is exerted on the ventral tab (6) and the dorsal tab (8), said force acting in the proximal direction.

2. The method according to claim 1, characterized in that the ventral tab (6) and the dorsal tab (8) are connected to each other, preferably fastened to each other, before the tensioning element is tensioned.

3. The method according to claim 2, characterized in that the ventral tab (6) and the dorsal tab (8) are connected to each other, preferably fastened to each other, above the shoulder.

4. A shoulder orthosis for carrying out a method according to one of the preceding claims, the shoulder orthosis comprising a dimensionally stable shell (2) with a ventral tab (6) and a dorsal tab (8), wherein the shoulder orthosis comprises a tensioning element characterized in that by the tensioning element a tensile force can be applied to the ventral tab (6) and the dorsal tab (8), wherein the tensile force can be increased by tensioning the tensioning element.

5. The shoulder orthosis according to claim 4, characterized in that the tensioning element comprises a strap (12) that is fastened at one end to one of the tabs (6, 8), that can be fastened at the second end to the tab (6, 8) and that is guided through a guide loop on the other tab (8, 6).

6. The shoulder orthosis according to claim 4 or 5, characterized in that the tensioning element has a tensioning cord, which is connected to the ventral tab (6) and the dorsal tab (8) and the effective length of which can be altered.

7. The shoulder orthosis according to claim 6, characterized in that the tensioning cord is guided through at least one loop on the ventral tab (6) and / or at least one loop on the dorsal tab (8).

8. The shoulder orthosis according to one of the claims 4 to 7, characterized in that a reinforcement element (4) is arranged on the dimensionally stable shell (2).

9. The shoulder orthosis according to claim 8, characterized in that the reinforcement element (4) is made of a metal, such as aluminium or steel, or a plastic or a fiber-reinforced plastic, such as GRP or CFRP.

10. The shoulder orthosis according to claim 8 or 9, characterized in that the reinforcement element (4) comprises at least one, preferably two, projections (10), which are arranged on the dorsal and / or on the ventral tab (8, 6).

11. The shoulder orthosis according to one of the claims 4 to 10, characterized in that an element (20) of an orthopedic splint system is or can be fastened to the dimensionally stable shell (2) and / or the reinforcement element (4).

12. The shoulder orthosis according to claim 11, characterized in that the splint system is part of the shoulder orthosis and comprises at least one body contact element, preferably a lower arm element to be applied to a lower arm and / or a hand element to be applied to a hand.

13. The shoulder orthosis according to claim 11 or 12, characterized in that the splint system comprises at least two elements that are arranged together by means of a joint (22).

14. The shoulder orthosis according to claim 11, 12 or 13, characterized in that at least one actuator is arranged on the splint system, said actuator being configured to move an element of the splint system relative to another element of the splint system.

15. The shoulder orthosis according to one of the claims 4 to 14, characterized in that the geometric form of the dimensionally stable shell (2) is adapted to the upper arm.

16. The shoulder orthosis according to one of the claims 4 to 15, characterized in that a flexible, preferably elastic, padding element is arranged on a side of the dimensionally stable shell (2) facing the upper arm, said padding element preferably being a textile padding element.