Arm restraining device and board connectable to a patient support apparatus for medical and surgical procedures

Abstract

A system comprising an arm board and a restraining device for positioning and restraining a patient's arm during a medical or surgical procedure is disclosed. The arm board includes rotation joint such as a hirth joint to which a clamp is attached. The clamp allows the arm board to be clamped to a patient support apparatus such as a table or chair, while the hirth joint allows an angle between the arm board and the patient support apparatus to be set. The restraining device includes an adjustable hand plate to affix the hand and / or fingers of the affected arm. The restraining device is clamped to the arm board, and is adjustable in several different manners to allow the arm to be restrained and tensioned as necessary for the procedure being performed.

Description

Arm Restraining Device and Board Connectable to a Patient Support Apparatus for Medical and Surgical ProceduresFIELD OF THE INVENTION

[0001] This application relates to an arm board used to position a patient’s upper extremity- for example during a medical or surgical procedure.INTRODUCTION

[0002] Medical or surgical procedures involving a patient's arm and related structures — such as the forearm, wrist, and / or hand — are common. One such procedure is carpal tunnel release, which involves cutting ligaments at a patient’s wrist. When performing such procedures, it is often useful to restrain the arm in a position that best gives the clinician access to the relevant structures. Additionally, it can be useful to apply traction, i.e., to provide tension to some portion of the arm. Traction may be used to separate and / or realign bones during the repair of fractures, and may also be used during certain surgical procedures as well. Providing traction can also be beneficial during radiological procedures such as when X-raying the patient’s arm during surgery.

[0003] Traditionally, when restraint or traction is needed during a procedure, a clinician may need to apply this manually using his hands, which can be cumbersome for the clinician performing the procedure. An additional clinician may need to be present to provide such restraint or traction, which is inefficient. Further, manually providing traction is not practical should the patient’s arm need to be X-rayed under tension.

[0004] Many medical and surgical procedures on a patient’s arm may be outpatient in nature, with the patient sitting in a surgical chair or lying on a surgical table. This can make restraining and tensioning the arm difficult, particularly when considering the plurality of different manners in which the arm may need to be positioned for different procedures. This disclosure provides apparatuses for positioning, restraining, and tensioning the arm during medical or surgical procedures.SUMMARY

[0005] A system usable during a medical or surgical procedure is disclosed, which may comprise: a chassis; a top surface connected to the chassis and configured to support a limb of a patient during the medical or surgical procedure; a rotation j oint coupled to a first edge of thechassis; a clamp coupled to the rotation joint and configured to affix to a patient support apparatus for the patient; and wherein the rotation joint is configured to allow an angle between the top surface and the patient support apparatus to be adjusted and locked into place.

[0006] In one example, the top surface is radiolucent. In one example, the top surface is removable from the chassis. In one example, the top surface is configured to support an arm of the patient. In one example, the system further comprises at least one strap affixable to the chassis to restrain the limb of the patient against the top surface. In one example, the rotation joint comprises a first ring and a second ring withing a housing. In one example, the first ring and second rings are configured to be rotatable with respect to each other to allow the angle to be adjusted. In one example, the second ring is coupled to the chassis, and wherein the first ring is coupled to the clamp. In one example, the first and second rings have opposing faces. In one example, the opposing faces are flat, and wherein the opposing faces are in contact to lock the angle by friction between the opposing faces. In one example, the first and second rings are controllable to bring the opposing faces into contact to lock the angle, and to space the opposing faces to adjust the angle. In one example, the opposing faces comprise radial teeth that intermesh when the opposing faces are brought into contact and do not intermesh when the opposing faces are spaced. In one example, the opposing faces are flat, wherein bringing the opposing faces into contact locks the angle by friction between the opposing faces. In one example, the system further comprises a first screw, wherein the first screw is configured to be rotatable by the user to control the first and second rings. In one example, the first screw is rotatable in a first direction to bring the opposing faces into contact, and wherein the first screw is rotatable in a second direction to space the opposing faces. In one example, the system further comprises a first knob configured to rotate the first screw. In one example, the clamp comprises a first portion and a second portion, wherein the first and second portions are controllable to clamp to and release from the patient support apparatus. In one example, the first and second portions are configured to clamp to and release from a rail of the patient support apparatus. In one example, the first portion is coupled to the rotation joint. In one example, the first portion is above the second portion. In one example, the rotation joint comprises a first ring and a second ring withing a housing, wherein the first ring and second ring are rotatable with respect to each other to allow the angle to be adjusted. In one example, the second ring is coupled to the chassis, and wherein the first ring is coupled to the first portion. In one example, the first and second portions comprise contacting angled surfaces. In one example, the angled surfaces are not horizontal or vertical. In one example, the system further comprises a second screw, wherein the second screw is connected to a second knob rotatableby the user to control the first and second portions. In one example, the second screw is configured to be rotatable in a first direction to control the first and second portions to clamp to the patient support apparatus, and wherein the second screw is rotatable in a second direction to control the first and second portions to release from the patient support apparatus. In one example, the screw in the first direction causes the angled surface of the second portion to slide on the angled surface of the first portion, thus causing the second portion to move in a first horizontal direction and to move in a first vertical direction to decrease a distance between the first and second portions. In one example, rotating the screw in the second direction causes the angled surface of the second portion to slide on the angled surface of the first portion, thus causing the second portion to move in a second horizontal direction and to move in a second vertical direction to increase a distance between the first and second portions. In one example, the system further comprises at least one rail affixed to a second edge of the chassis. In one example, the second edge is perpendicular to the first edge. In one example, the at least one rail is configured for attachment to a restraining device for restraining the patient’s limb. In one example, the system further comprises the restraining device affixed to one of the at least one rails. In one example, the restraining device comprises an adjustable wrist retractor.

[0007] An arm restraining device usable during a medical or surgical procedure is disclosed, which may comprise: a member having a long axis; a first mechanism affixed to the member, wherein the first mechanism comprises a clamp affixable to a surface configured to support an arm of a patient; a hand plate affixed to the member by a second adjustment mechanism, wherein the hand plate is configured to secure to a hand of the patient; a third mechanism configured to allow a first distance between the hand plate and the first mechanism to be adjusted parallel to the long axis of the member, wherein the second mechanism comprises a first knob, wherein rotating the first knob decreases a second distance between the hand plate and the member parallel to the long axis of the member to provide tension to the patient’s arm when the hand is secured to the hand plate.

[0008] In one example, the first mechanism further comprises a rotation joint configured to allow a first angle between the long axis of the member and the surface to be adjusted. In one example, the clamp comprises an upper portion and a lower portion configured to clamp to the surface. In one example, the rotation joint comprises a first ring and a second ring withing a housing, wherein the housing is connected to the member. In one example, the first ring and second rings are configured to be rotatable with respect to each other to allow the first angle to be adjusted. In one example, the second ring is coupled to the housing, and wherein the first ring is coupled to the upper portion. In one example, the first and second ringshave opposing faces. In one example, the first mechanism comprises a second knob configured when loosened to space the opposing faces to adjust the first angle, and when tightened to bring the opposing faces into contact to lock the first angle. In one example, the first angle is adjustable between 0 and 90 degrees. In one example, the member comprises a lower member and an upper member connected along the long axis, wherein the first mechanism is affixed to the lower member, and wherein the hand plate is affixed to the upper member by the second adjustment mechanism. In one example, the third mechanism is further configured to allow a second angle of the hand plate to be adjusted around the long axis. In one example, the second member comprises a horizontal member perpendicular to the long axis, wherein the hand plate is affixed to the horizontal member by the second adjustment mechanism. In one example, the upper and lower members connect in sliding telescoping fashion, and wherein the third mechanism adjusts the first distance by adjusting how far the upper and lower members are telescoped. In one example, the third mechanism comprises a third knob configured when loosened to allow the upper and lower members to slide telescopically to adjust the first distance, and when tightened to prevent the upper and lower members from sliding telescopically to lock the first distance. In one example, the hand plate comprises a plurality of finger traps, wherein the finger traps are configured to secure the hand of the patient by trapping fingers of the patient’s hand between adjacent finger traps. In one example, the hand plate comprises a plurality of tracks angled with respect to each other, wherein one of the plurality of finger traps is configured to slide in one of the tracks. In one example, rotating the first knob to decrease the second distance causes the plurality of finger traps to slide downw ard in the tracks, thus compressing the fingers between the adjacent finger traps. In one example, the second mechanism further comprises a ball j oint, wherein the hand plate is affixed to a ball in the ball joint. In one example, the second mechanism comprises a compression screw and a fourth knob, wherein the fourth knob is configured when loosened to space the compression screw- away from the ball to allows an angle of the hand plate to be adjusted, and w hen tightened to cause the compression screw7to contact the ball to lock the angle of the hand plate. In one example, the angle of the hand plate is adjustable by adjusting the pitch, yaw, and / or roll of the hand plate with respect to a long axis of the second mechanism. In one example, the first knob and the fourth knob are both rotatable around the long axis of the second mechanism.BRIEF DESCRIPTION OF THE DRAWINGS

[0009] Figure 1 shows a system for positioning, restraining, and tensioning an arm of a patient during a medical or surgical procedure, comprising an adjustable wrist retractor coupled to an arm board coupleable to a patient support apparatus.

[0010] Figures 2 and 3 show top and bottom views of the arm board, with Figure 3 additionally showing adjustment mechanisms, including a rotatable knob for controlling the rail clamp, and a lever for adjusting an angle 0 of the arm board relative to the patient support apparatus.

[0011] Figures 4 and 5 show details of the rail clamp.

[0012] Figure 6 shows the operation of the rail clamp as controlled by the rotatable knob.

[0013] Figures 7-9 show the construction and operation of a rotation joint controlled by the lever to adjust the angle 0 of the arm board.

[0014] Figure 10 shows an adjustable restraining device affixable to the arm board, and useable to restrain and tension a patient's arm.

[0015] Figures 11A and 11B show details of components used to adjust a distance of the restraining device relative to its point of connection to the arm board.

[0016] Figures 12A and 12B show a hand plate of the restraining device useable to restrain the patient’s hand, and in particular the fingers.

[0017] Figures 13A and 13B show adjustment mechanisms used to adjust an angle of the hand plate and to provide tension to the arm, with Figure 14A-14D showing details of the components in these mechanisms.DETAILED DESCRIPTION

[0018] Figure 1 shows an embodiment of a system 90 for positioning, restraining, and tensioning an arm of a patient during a medical or surgical procedure. The system 90 comprises an arm board 102 and an adjustable wrist retractor 100 that can be connected to the arm board, as discussed further below. Also shown for context is a patient's arm as might be restrained and / or tensioned in the system 90, including the patient’s upper arm 130, forearm 132. wrist 133, and hand 134. The adjustable wrist retractor 100 is described in detail later (Fig. 10 et seq.), but briefly comprises a means for stabilizing the arm by restraining the upper arm 130 and providing traction by connection of the hand 134 to a hand plate 122 of the wrist retractor 100. The wrist retractor 100 is just one example of a restraining device that is couplable to the arm board 102.

[0019] The arm board 102 is affixable to a patient support apparatus, such as an operating bed, a surgical chair or wheelchair, a surgical table, etc., which is shown generically as element 140. Specifically, a rail clamp 128 coupled to an edge 146 of the chassis 150 of the board 102 is shaped to slide over a corresponding rail 142 affixed to the patient support apparatus 140. This rail 142 can be located at different positions depending on the configuration of patient support apparatus 140. For example, if 140 comprises a table, rail 142 can be affixed to an edge of the table. If 140 comprises a chair, rail 142 can be affixed to an arm rest of the chair. The arm board 102 via clamp 128 can be affixed to other structures as well.

[0020] The restraining device 100 such as the illustrated adjustable wrist retractor can also be affixed to the arm board 102 using a similar rail / clamp arrangement. Thus, one end of the restraining device 100 includes a rail clamp 114 which is shaped to slide over a corresponding rail 116 affixed to edge 146 of the arm board 102. As shown, there may be more than one rail 116 on the arm board 102, such as on the edges 146 perpendicular to the edge coupled to the clamp 128, to allow flexibility in attaching a restraining device to the arm board. The clamps 128 and 114. and the rails 116 and 142. may be of the same design, and are described further below.

[0021] To assist in securing the arm, the arm board 102 includes a strap 124 to secure the patient's upper arm 130 to a top surface 103 of the arm board 102. In one example, the strap 124 is affixable to loops 129 on the edges 146 on the chassis 150 perpendicular to the clamp 128. Preferably, the length of the strap 124 may be adjustable using Velcro or buckles (not shown), allowing arms of different sizes to be secured. Strap 124 may also be comprised of a stretchable material capable of deforming to secure the arm. Securing the upper arm 130 against the top surface 103 of the arm board 102 generally fixes the position of the arm. Further, this allows the restraining device 100 to pull the hand 134 upwards, thus placing the forearm 132, wrist 133, and hand 134 under tension, as explained later. Other means to attach the strap 124 to the arm board 102 and to adjust its length are possible. For example, the strap 124 can include notches that can affix to studs on the edges 146 (not shown).

[0022] Additional strap attachment means can also be provided, such as at location 129’, where another pair of loops 129 and an additional strap 124 can be provided (not shown). This would allow the patient’s forearm 132 to be secured against the top surface 103, thus laying the patient’s arm flat on the board 102, as would be useful in some medical or surgical procedures. When the arm is secured in this manner, the angle (cp, discussed further below) of restraining device 100 may be adjusted to roughly zero degrees. Alternatively, use of therestraining device 100 may simply not be necessary. In this regard, note that it is not strictly necessary’ to use a restraining device 100 with the arm board 102, as the arm board can be used alone depending on the procedure being performed.

[0023] The system 90 includes a number of adjustment mechanisms to accommodate arms of different sizes, and to allow the arm (and in particular the hand 134, wrist 133, and forearm 132) to be restrained and tensioned in different positions and orientations. While these mechanisms are discussed in detail later, they are briefly introduced and shown in Figure 1.

[0024] The arm board 102 is adjustable to change a rotational angle 0 around an axis 210 (Fig. 4), thus adjusting the angle of the arm board 102 (and the restraining device 100 attached to it) relative to the patient support apparatus 140. This adjustment to angle 0 is affected via a rotatable lever 154 on the underside of the arm board 102 (see Fig. 3), as discussed further later.

[0025] The restraining device 100 is also adjustable relative to the arm board 102, or to any structure to which it is affixed (such as a surgical table), in various manners. A first knob 250 is provided to adjust and lock an angle cp between a first long axis 260 of the restraining device 100 and the top surface of the arm board 102. A second knob 270 can be used to adjust and lock a distance (DI) of the restraining device, and thus a distance of the hand plate 122, relative to its point of connection to the arm board 102. Depending on how mechanisms associated with knob 270 are configured, knob 270 may also allow the hand plate 122 to be rotated and locked at an angle A around the long axis 260 of the restraining mechanism 100, as discussed further below with reference to Figure 1 IB. A third knob 290 can be used to adjust and lock the orientation of the hand plate 122 relative to a second axis 300 of the restraining device 100 (which is parallel to first axis 260). As described later, this knob 290 controls a ball joint, which allows the pitch, yaw. and roll of the hand plate 122 to be freely adjusted in these different degrees of freedom. A fourth knob 310 allows a hand 134 generally secured in the hand plate 122 to be pulled upwards, thus controllably tensioning the hand 134, wrist 133, and forearm 132 of the patient. Such tensioning occurs by turning knob 310 to move the hand plate 122 a distance (D2) upwards towards a horizontal member 232c of the restraining device 100, thus pulling the restrained hand 134 upwards and placing the arm under tension.

[0026] The top surface 103 preferably comprises any rigid material, such as medicalgrade metals or plastics, as may be suitable for the medical or surgical procedure with which the arm board 102 will be used. In an application where it may be necessary to X-ray the patient's arm while restrained in the arm board 102, the top surface 103 is preferably made of a radiolucent material such as plastic or a composite. As shown in Figure 1, the length L ofthe top surface 103 of the arm board 102 is preferably of sufficient length to allow the arm and hand to be fully extended and laid flat, which as noted earlier may be useful during certain medical procedures.

[0027] Figures 2 and 3 respectively show the top and underside of the arm board 102, and show details of its construction. As best seen in Figure 3, various structural members can be connected together to form the chassis 150, which as shown is roughly box shaped. In one example, these structural members can comprise rectangular metallic or composite tubing, with outside edges of these members forming the edges 146 referred to earlier. The top surface 103 can be coupled to the chassis 150 by any usual means, such as epoxy, using rivets, etc. The top surface 103 may also be removable from the chassis 150. In the example shown, the chassis 150 does not extend the entire length L (Fig. 1) of the top surface 103. which reduces weight and cost. However, this is not strictly necessary, and instead the chassis 150 and top surface 103 could also be coterminous.

[0028] Figure 3 also shows a rotatable knob 152 used for loosening and tightening the rail clamp 128 to a rail 142 on the patient support apparatus 140. This knob 152 is shown underneath the clamp 128, and while this positioning isn’t strictly required, this allows the patient’s arm to rest on the arm board 102 without interference. Lever 154 allows the angle 0 of the arm board to be adjusted relative to the patient support apparatus 140. Again, this lever 154 is preferably underneath the top surface 103 but could be positioned elsewhere. Both of these mechanisms are explained in detail later.

[0029] Figures 4 and 5 show details of the rail clamp 128. The rail clamp comprises an upper portion 128a and a lower portion 128b, which clamp together to form a roughly C- shaped area to trap and affix a rail (e.g., rail 142 on the patient support apparatus 140), as explained in detail with reference to Figure 6. The upper portion 128a connects to a rotation joint 160, which is in turn connected to the chassis 150, as explained in detail later.

[0030] As best seen in Figure 5, the upper and lower portions 128a and 128b respectively include angled contact surfaces 162a and 162b which are neither vertical or horizontal. The upper portion 128a includes threaded openings 164 to accept screws 186 (Fig. 7), thus allowing the clamp to be affixed to the rotation joint 160. The lower portion 128b includes a recess 166 for housing a leaf spring 168, which as explained later tends to bias the clamp 128 in an extended position. The lower portion 128b includes a central non-threaded opening 170 which meets with a threaded opening 172 in the upper portion 128b when the angled surfaces 162a and 162b are in contact. Openings 170 and 172 accept a screw 153 connected to the knob 152, and as explained later with reference to Figure 6, tightening thescrew 153 will cause the lower portion 128b to ride upwards relative to the upper portion 128a to close the clamp.

[0031] The upper and lower portions 128a and 128b can optionally respectively include non-threaded openings 174 and 176 at its ends that flank openings 170 and 172. Openings 174 and 176 can accommodate and retain dowel pins (not shown) which keep the upper and lower portions 128a and 128b aligned and guide the movement of the lower portion 128b relative to the upper portion 128a. The dowel pins are not shown for simplicity. Note that the nonthreaded openings 170 and 174 are not circular, but instead are horizontally extended (x) for reasons explained shortly.

[0032] Figure 6 explains operation of the rail clamp 128. As noted earlier, knob 152 is connected to a threaded screw 153, which is positioned through non-threaded opening 170 in the lower portion 128b, and threaded into threaded opening 172 in the upper portion 128a. When knob 152 is rotated counterclockwise, the screw 153 is backed out of opening 172, and the clamp is extended, as shown to the left in Figure 6. The low er portion 128b rests on the upper surface of the knob 152 (or on an intervening structure between the lower portion and the knob, such as a washer (not shown)), and so in this extended position, the upper and lower portions 128a and 128b are vertically relatively far apart (yl). Further, because the angled surface 162b of low er portion 128b slides with respect to the angled surface 162a of the upper portion 128a, the lower portion 128b also moves horizontally (to the left) by a distance z. Spring 168 tends to bias the clamp 128 into this extended position by pushing the lower portion 128b to the left relative to the rotation joint 160. Notice in this position that the screw 153 is to the right of the horizontally extended (x) opening 170 in the lower portion 128b, because the lower portion 128 has moved horizontally to the left relative to the screw 153. (Horizontal and vertical as used herein are relative terms, and do not necessarily and respectively connote left / right and up / down).

[0033] In this extended position, the upper and lower portions 128a and 128b do not rigidly clamp to the rail 142 (e.g., of the patient support apparatus 140), and thus the clamp 128 can be slid over the rail when installing the arm board 102. Although the rail 142 is not yet rigidly clamped, extensions 129 of the upper and lower potions 128a and 128b will still retain the rail 142 within the clamp 128, which allows the arm board 102 to be positioned on the rail 142 without falling.

[0034] The right in Figure 6 shows the clamp 128 in a clamped or closed position around the rail 142. Here, the knob 152 has been rotated clockwise, which moves the screw 153 further into the threaded opening 172. This advances the knob 153, which pushes thelower portion 128b vertically upwards towards the upper portion 128a. lessening the distance between the upper and lower portions 128a and 128b (y2<y 1) to bring these portions into firm contact with the rail 142. Further, as the lower portion 128b moves upwards, the angled surfaces 162a and 162b of the upper and lower portions cause the lower portion 128b to slide horizontally (to the to the right) by a distance z. This compresses and overcomes the bias of the spring 168 between the clamp 128 and the rotation joint 160 as shown. Notice in this closed position that the screw 153 is to the left of the horizontally extended (x) opening 170, because the lower portion 128b has moved horizontally to the right relative to the screw 153. (Although not shown, the horizontally extended openings 174 (Fig. 5) will likewise also permit the lower portion 128b to move horizontally with respect to the dowel pins retained in openings 176). In this position, the upper and lower portions 128a and 128b clamp to the rail 142, thus rigidly affixing the arm board 102 to the rail.

[0035] It is not strictly required that the clamp 128 be configured and shaped to clamp to a rail 142 of the patient support apparatus 140. Instead, the upper and lower portions could instead be shaped to clamp directly to some portion of the patient support apparatus 140 (e.g., the edge of a table, or an armrest of a chair).

[0036] Figures 7-9 disclose operation of the rotation joint 160 and how it is connected to components of the arm board 102. The rotation joint is controlled by lever 154, and can be used to adjust the angle 0 (Fig. 1) of the arm board 102 relative to the patient support apparatus 140 to which it is connected. Lever 154 can comprise an adjustable handle or a cam lever.

[0037] The rotation joint 160 includes a housing 188 which houses rings 190a and 190b, which are shown in an exploded view in Figure 8. These rings 190a and 190b include opposing faces 193, and in this example these faces 193 include radial teeth 194. Figure 8 only shows a few of these teeth 194 on each face 193, but one skilled will understand that the teeth 194 can appear around the entirety of the periphery of each face 193. This type of rotation joint is commonly referred to as a hirth joint.

[0038] As best seen in Figure 8, housing 188 is preferably closed proximate to ring 190a. but open proximate to ring 190b. This opening allows the rings 190a and 190b to be installed within housing 188, and also allows ring 190b to be connected to upper portion 128a of the clamp. This connection is established using screws 186 (Fig. 7), which pass through holes 196 in ring 190b, and which are screw ed into threaded openings 164 (Fig. 5) in the upper portion 128a. Screws 184 (Fig. 7) pass through holes 202 in ring 190a and holes 206 in the housing 188, and are screwed into threaded openings 151 in the chassis 160. These connections using screws 184 and 186 are shown in detail in the top cross-sectional view of Figure 7.

[0039] Also within the housing 188 and intervening between the rings 190a and 190b is a helical spring 192 (Fig. 8). This spring 192 can be cone shaped (and is largely shown as a solid cone for ease of illustration). Spring 192 tends to bias the rings 190a and 190b apart from one another in the housing 188, such that the teeth 194 of each ring will not intermesh, as explained further below.

[0040] As shown in Figure 7, lever 154 is formed with a shoulder 180, and a screw 182 is rigidly affixed within the shoulder 180. Lever 154 is shown as being roughly perpendicular to screw 182, thus providing the user a handle. As best seen in Figure 8, screw 182 passes in order through a non-threaded opening 204 in the housing; through a non-threaded opening 200 in ring 190a; through a non-threaded hole 206 in the spring 192 (i.e., through the middle of the spring); and terminates at a threaded opening 198 in ring 190b.

[0041] Figure 9 explains operation of the rotation joint 160 as so connected using side cross-sectional views. The top view shows the rotation joint 160 in an unlocked position. In this position, the lever 154 has been rotated (e.g.. counterclockwise) such that the screw 182 only partially threads into the threaded opening 198 in ring 190b. As assisted by spring 192, this allows ring 190b to be spaced from nng 190a in the housing 188 such that the radial teeth 194 on rings 190a and 190b are not intermeshed, which allows the rings to rotate relative to each other. More specifically, this allows the arm board 102 to rotate around the long axis 210 of the screw 182: when the top surface 103 and chassis 150 are rotated by the user to set angle 0, the housing 188 and ring 190a will also rotate, because these components are fixed relative to each other via screws 184. Ring 190b and upper portion 128a of the clamp 128, coupled by screw's 186, will by contrast remain stationary. Assuming the clamp 128 has been affixed to a patient support apparatus 140, the user can thus set angle 0 of the arm board 102 relative to the apparatus 140 to best suit the medical or surgical procedure to be performed.

[0042] The bottom view of Figure 9 show's the rotation joint 160 in a locked position. In this position (and once the user has set angle 0 of the arm board 102), the lever 154 has been rotated (e.g., clockwise) to more fully thread screw 182 into the threaded opening 198 in ring 190b. Because the shoulder 180 of the lever 154 abuts the chassis 150, this additional threading overcomes the bias of spring 192 and draws ring 190b towards ring 190a, such that their teeth 194 now intermesh. This locks rings 190a and 190b to fix the angle 0 of the arm board 102 relative to the patient support apparatus 140 that was set earlier. If angle 0 needs readjustment, the user can rotate lever 154 (e.g., counterclockwise) to back the screw 182 out of threaded opening 198 to the unlocked position, which, as assisted by spring 192. will allow the rings 190a and 190b to separate such that their teeth 194 are no longer intermeshed.

[0043] It is not strictly required that the rotation joint 160 comprise a hirth joint having intermeshing teeth 194 on the opposing faces 193 of the rings 190a and 190b. Instead, and although not illustrated, the faces 193 can be flat, thus locking the rotation joint 160 by friction when the screw 182 is advanced far enough that the faces 193 of rings 190a and 190b are brought into frictional contact. When the rotation joint 160 is configured this way, the angle 0 can still be set and generally locked into place via lever 154. However, the clinician may be able to overcome this friction by grabbing the arm board 102 and manually adjusting it to a new angle 0 even when the rotation joint 160 is locked or closed. This may be a preferable to configure the rotation joint 160 depending on the circumstances, as it w ould allow the clinician to adjust and fix angle 0 without having to loosen and re-tighten the rotation clamp 160 via lever 154. In this respect, the rotation joint 160 can in other examples not include a lever 154 at all, but instead may be configured to always be locked or closed, with adjustments to angle 0 involving overcoming the friction that otherwise normally keeps angle 0 set.

[0044] One skilled in the art will appreciate that components of the rotation j oint 160 can be engineered such that the lever 154 need only swing a particular angle between the locked and unlocked positions illustrated in Figure 9. For example, the rotation joint 160 can be unlocked if the lever 154 is pointed downward (perpendicular to the top surface 103), and locked by rotating the lever 154 roughly 90 degrees such that the lever 154 is now' roughly parallel to the top surface 103. Alternatively, the rotation j oint 160 can be unlocked if the lever 154 is parallel to the top surface 103 and pointing in one direction, and locked by rotating the lever 154 roughly 180 degrees such that the lever 154 is again roughly parallel to the top surface 103, but pointing in the opposite direction. Although, not shown, the same locking effect can be achieved with a cam lever, displacing both rings of the hirth joint towards each other on its highest position, and unlocking it on its lowest.

[0045] During construction, ring 190a is placed in housing 188 and affixed to the chassis (screws 184). Ring 190a is affixed to the upper portion 128a of the clamp (screws 186). The spring 192 is then placed in the housing 188, followed by ring 190b. Then, the screw 182 is partially threaded into ring 190b, which (in conjunction with shoulder 180) prevent ring 190a from falling out of the housing.

[0046] While described as an arm board, it should be understood that board 102 and its components can also be used to position, restrain, and tension other body parts of a patient, such as the legs, the head, etc.

[0047] Figure 10 shows details of the adjustable wrist tensioner 100 (restraining device 100 more generally) affixable to the arm board 102. As noted earlier, the restraining device100 includes a clamp 114 at its lower end to affix to one of the rails 116 on the edges 146 of the arm board 102. This clamp 114 can be formed the same as clamp 128 discussed earlier, and thus is only briefly discussed. Thus, clamp 114 includes upper and lower portions 1 14a and 114b which includes angled contact surfaces (similar to surfaces 162a and 162b described earlier). Knob 252 of the clamp 114 can be tightened or loosened to move the portions 114a and 114b relative to each other as explained before to clamp or release the rail 116. While clamp 114 can be used to affix the restraining device 100 to the disclosed arm board 102, clamp 114 can also be affixed to any surface configured to support an arm of a patient. The restraining device 100 can be used without the arm board 102, in which case the restraining device could be clamped to another structure, such as to a surgical table. Further, the restraining device 100 could be used for purposes other than affixing and tensioning the arm. For example, the restraining device could be used as a soft tissue retractor more generally, or as a surgical instrument holder.

[0048] The upper portion 114a of the clamp is affixed to a rotation joint 230. This rotation joint 230 can be formed the same as rotation joint 160 as explained earlier, and again is only briefly explained. Although not shown, rotation joint 230 can include rings (similar to 190a and 190b described earlier) within a housing 231. Knob 250 is controllable to loosen or tighten the rotation joint 230 (contact between its the rings) as described earlier. When knob 250 is loosened, the housing 231 (and the ring to which it is attached) can rotate (relative to the other ring affixed to the upper portion 114a of the clamp 114), as described earlier.

[0049] The housing 231 of the rotation joint is affixed (wielded) to a lower member 232a to which other components of the restraining device 100 are attached, as described further below; As such, loosening the rotation joint 230 allows angle cp to be set between the long axis 260 of the restraining device 100 and the arm board 102 (see also Fig. 1). Typically, this angle cp would be set anywhere from 0 degrees (arm lying flat) to 90 degrees (arm pointing upwards), but can be set to other angles as w ell depending on the procedure being performed.

[0050] The restraining device 100 includes a member which may be singular, but which more preferably comprises a lower member 232a and an upper member 232b. The upper member 232b is roughly L shaped, and includes a horizontal portion 232c to which the hand plate 122 is connected. The upper member 232b is made to telescope within the lower member 232a, which allows the distance DI to be adjusted. Notice that this distance DI is parallel to long axis 260, and may be angled (cp). This distance DI is shown in Figure 10 as a distance between the horizontal member 232c and point of connection to the arm board 102, but perhaps more meaningfully describes the distance to the hand plate 122.

[0051] This distance adjustment is controlled by knob 270, with details discussed with reference to Figure 11A. During construction, the upper member 232b is slid into lower member 232a, with a collar 271 positioned around them. This collar 271 is temporarily slid out of the way (upwards), thus allowing a pressure plate 272 to be positioned loosely in a window 276 in the lower member 232a. This collar 271 is then slid over these components (downward) until a shoulder of the collar 271 comes to rest on an upper end of the lower member 232a, as best seen in the cross section in Figure 11A. The collar 271 is then bolted into place using bolt 273, which passes (in order) through a first opening 279 in the collar 271, a first opening 277 in the lower member 232a, slots 274 on both sides of the upper member 232b (only one is shown), and a second opening 277 in the lower member 232a. The end of the bolt 273 then meets with a second threaded opening 279 in the collar (not shown), into which the end of the bolt 273 is screwed. With the collar 271 now firmly attached, notice that the upper member 232b is now captured by the bolt 273, but can move upwards or downwards around the bolt 273 as assisted by slots 274. Further, the pressure plate 272, although loose, is now sandwiched between the collar 271 and the upper member 232b through the window 276 in the lower member 232a.

[0052] The knob 270 includes a screw 275, which is then threaded through a threaded opening 278 in the collar 271, which brings the end of the screw 275 into contact with the pressure plate 272. If the knob 270 is tightened, the screw 275 will advance and push the pressure plate 272 against the side of the upper member 232b, thus preventing the upper member 232b from sliding in the lower member 232a, and setting the desired distance DI for the restraining device 100. Likewise, if the knob 270 is loosened, the screw 275 will retract to relieve the pressure of the pressure plate 272 against the side of the upper member 232b, thus allowing the upper member 232b to slide (via slots 274) relative to the lower member 232a, which allows the distance DI to be adjusted.

[0053] Figure 11B shows an alternative mechanism for adjusting distance DI. This mechanism is different in that it does not use slots 274 on either of the member 232a or 232b. Nor does either member include a window 276. Further, the design of the mechanism of Figure 11B, which is not restrained in its rotation by slots 274 and screw 273, will allow the upper member 232b to rotate within the upper member to set an angle A around the long axis 260 (see Fig. 1). In this regard, the design of Figure 11B is simpler, cheaper, more flexible, and easier to manufacture than the design of Figure 11 A. Elements analogous to those shown in Figure 11A are denoted in Figure 1 IB with a prime symbol.

[0054] During construction, the upper member 232b is slid into lower member 232a, with a collar 271 ’ positioned around them. The collar 271 ’ includes a pressure plate 272’, and these components are slid (downward) until a shoulder of the collar 271 ’ and a shoulder of the pressure plate 272’ come to rest on an upper end of the low er member 232a. A pressure plate 281’ is slid under the collar 271’ and affixed into place using a set screw' 277', which affixes the collar 271’ in place to the lower member 232a. Pressure plate 281’ isn’t strictly required, and instead the set screw 277’ alone can make direct contact with the lower member 232a to affix the collar 271’. A knob 270’ (show- here as awing screws) having a screw 275’ is threaded through a threaded opening 278’ in the collar 271 ’, where it comes into contact with pressure plate 272’. If the knob 270' is tightened, the screw- 275' will advance and push the pressure plate 272’ against the side of the upper member 232b. thus preventing the upper member 232b from sliding in the lower member 232a, and setting the desired distance DI for the restraining device 100. Likewise, if the knob 270’ is loosened, the screw 275’ will retract to relieve the pressure of the pressure plate 272’ against the side of the upper member 232b, thus allowing the upper member 232b to slide relative to the lower member 232a. which allows the distance DI to be adjusted.

[0055] As noted, because the upper member 232b is not restrained in its rotation relative to the lower member 232a (e.g., by slots 274 and screw 273), loosening the knob 270’ can also be used to set an angle A around the long axis 260 (see Fig. 1) as well as to adjust distance DI. This adds flexibility to the restraining device 100. because angle A can set the hand plate 122 at a desired angular position, which imparts a twist to the restrained arm, thus providing an additional degree of freedom for the clinician when properly positioning the arm for a particular procedure.

[0056] Figures 12A and 12B show construction and mechanisms of the hand plate 122, and how this plate is usable to secure a patient’s hand 134. The hand plate 122 can be made of any material, such as plastic. As shown in Figure 12A, the top of the hand plate 122 is affixed to a bracket 362. This bracket 362 is in turn connected by a screw 364 to a ball 366 of a ball joint, which is in turn connected to the horizontal portion 232c of the upper member 232b via mechanisms described subsequently. This ball joint, and how it can be used to adjust the position of the hand plate 122, is discussed later.

[0057] The hand plate 122 includes a number of channels 354 in which moveable finger traps 350 are inserted. Specifically, the back of each finger trap 350 includes a retaining member 360 which is sized to fit through a larger opening 352 in line with one of the channels 354, but which is also sized larger than the width of the channels. In this manner, the retainingmember 360 can pass through the opening 352 and slide downwards into the channel 354. Once slid into the channel 354. and because the retaining member 360 is wider than the channel 354, the finger trap 350 is retained but can still slide up and down through the channel 354. The left-most finger trap 350 in Figure 12A is shown slid upwards in its channel 354 while the other finger traps are shown slid to the bottom of their channels. The finger traps 350 are preferably made from plastic. Notice that the finger traps 350 include indentations 358 on each side, which are generally shaped to conform to and trap a patient’s finger 135. as explained next.

[0058] Figure 12B explains how the finger traps 350 can be used to trap a patient’s fingers 135, hence securing the patient’s hand 134 to the hand board 122. Notice that the channels 354 are angled with respect to each other (a). Similarly, the edges of each of the finger traps 350, and more specifically the indentations 358 of each trap, are also angled at approximately this same angle a. When restraining the hand 134 (and preferably after adjusting other aspects of the restraining device 100, such as its angle q> and distance DI as appropriate for the patient), each of the patient’s fingers 135 are moved upwards into spaces between adjacent finger traps 350. As shown to the left in Figure 12B, this generally pushes the traps 350 upwards and places each finger 135 in frictional contact with the indentations 358 on adjacent finger traps 350.

[0059] Thereafter, when the hand plate 122 is pulled upwards as shown to the right in Figure 12B, or when the hand 134 is pulled downwards (e.g., under force of gravity, by having the patient relax his arm for example), the frictional contact between the fingers 135 and the finger traps 350 will draw the traps downwards in the channels 354. Because these channels 354 are angled (a), this draws adjacent finger traps 350 closer to one another, thus placing a normal force F on the intervening finger 135. Because the indentations 358 of the finger traps 350 are also angled (a), this downward movement of the finger traps 350 narrows the distance between adjacent indentations 358 generally equally along their lengths, thus compressing or “sandwiching” the finger 135 along its length. Because the distance betw een the indentations narrows as the hand plate 122 is drawn further upwards, this force will increase, thus more forcibly securing the fingers 135. Trapping the fingers 135 in this manner secures the hand 134 in the restraining device 100, and allows the patient’s arm (hand 134, wrist 133, forearm 132) to be placed under tension by pulling the hand plate 122 upwards. A mechanism for providing such tensioning in the restraining device 100 is described shortly.

[0060] The hand plate 122 as shown in Figure 12A includes five finger traps 350 and thus can trap four fingers 135 of the patient’s hand 134 between them. (Figure 12B forsimplicity' shows only three traps trapping two fingers). Generally, a hand 134 secured in this fashion would have the palm facing outwards away from the hand plate 122. but this is not required, and the hand could also secured with the palm facing the hand plate depending on the procedure being performed. Preferably, the four fingers 135 trapped would not comprise the thumb, because trapping the patient's four primary7fingers is generally suitable to restrain the hand 134 and the place the arm under tension. If desired, although not shown, the thumb could also be restrained, for example by adding a sixth finger trap 350 to the hand plate 122, or otherwise by simply securing the thumb to the hand board 122.

[0061] In this regard, note that a patient’s digits can be secured to the hand board 112 by means other than the disclosed finger traps 350. For example, and as shown in Figure 12A, each of the channels 354 of the hand plate is flanked by a pair of slots 368 that can also be used to retain the digits. Although not shown, a clip or strap can pass through these slots 368 to secure a single digit. In a simple example, this strap can comprise a Velcro strap yvhose ends can be passed through the slots 368, and affixed together on the back side of the hand plate 122. Different securing mechanisms could also be used to secure the patient’s hand 134 to the hand board 112 in manners not involving securing of the digits. For example, straps could be used to secure the palm or w rist 133 the hand plate 122, etc.

[0062] Figures 14A-14D shows various views of the mechanisms involved for setting an angle of the hand plate 112 as controlled by knob 290, and for tensioning a patient's arm once their hand 134 has been secured to the hand plate 122 as controlled by knob 310. Before discussing the details of these mechanisms, the basic functionality of these knobs 290 and 310 are briefly discussed with reference to Figures 13A and 13B.

[0063] Figure 13A illustrates how the knob 290 can be used to control an angle of the hand plate 112 with respect to, or around, axis 300 through the mechanisms that connect the hand plate 122 to the horizontal member 232c. As noted earlier, the hand plate 122 (via bracket 362 and screws 364) is connected to a ball 366 of a ball joint. This ball 366 can rotate within components described later or be locked in place. Specifically, when knob 290 is loosened, the ball 366 is free to rotate to set the hand plate 122 to a particular angular position. Given the rotational nature of ball 366. this angle is variable with three different degrees of freedom. The hand plate 122 can: pitch (by changing angle J in the YZ plane); yaw (by changing angle I in the XY plane); and roll (by changing angle K in the XZ plane). As described, the ball 366, despite being rotatable, preferably holds a desired angle under friction, which allows a clinician to temporarily manually set an appropriate angle for the patient and the procedure beingperformed by moving the hand plate 122. Once the angle has been adjusted as desired, knob 290 can be tightened to lock the position of the ball 366 and set that angle.

[0064] Figure 13B illustrates how knob 310 can be used to tension the patient’s arm when their hand 134 is secured in the hand plate 122 (e.g., using finger traps 350 described earlier). Figure 13A shows the position of the hand plate 122 when the knob 310 is fully loosened. Notice that that the hand plate 122 is relatively far from the horizontal member 232c, and that a significant space 370 is apparent between housing 372 attached to the horizontal member 232c and the knob 290. When knob 310 tightened, certain components along axis 300 (including the knob 290, the ball 366, screw / bracket 366 / 362), including the hand plate 122, are drawn upwards. This shortens the distance between the hand plate 122 and the horizontal member 232c, and narrows the space 370 between housing 372 and the knob 290. In short, tightening knob 310 draws the hand plate 112 upwards by distance D2. Because the patient’s arm (upper arm 130) is restrained at the arm board 102, and because the patient’s fingers 135 are affixed and trapped as described earlier, this places the patient’s arm (forearm 132, wrist 133, and hand 134) under tension.

[0065] The tension imparted by knob 310 is variable, and depends on how far the knob 310 has been rotated. To allow the clinician to quantify this tension, a component visible through the space 370 (specifically, the core member 384 as discussed further below) can include a number of indicator bars 374. About four indicator bars 374 are visible in Figure 13 A before tensioning (indicating no tension, or D2 = 0). whereas no indicator bars are apparent in Figure 13B (indicating that tension and D2 have been maximized). Knob 310 could however be rotated to a middle position where (e.g.) two indicator bars 374 are shown (indicating moderate tension and distance D2).

[0066] Figures 14A-14D show details and components involved in these adjustment mechanisms in various views, with Figure 14A showing an exploded view, Figure 14B a cross- sectional view, Figure 14C an isometric view with knob 290 removed to show internal details, and Figure 14D a cross section through knob 290. Horizontal member 232c of the upper member 232b is preferably welded to a housing 372. This housing 372 and other components of the mechanism described subsequently are generally formed in line and symmetrically around axis 300. A nut 376 is placed in this housing 372, upon which knob 310 is press fit.

[0067] A screw' 392 of a core member 384 is threaded within a threaded opening 377 (Fig. 14B) in nut 376. This core member 384 is shown in isolation in Figure 14A. Turning the knob 310 turns the nut 376, which draws the screw 392 upwards or downwards in the opening 377, and causes the core member 384 to move upwards or downw ards as well. The upward ordownward movement of the core member 384 and its screw 392 is assisted by tracks 394 on the outer perimeter of the core member 384, which meet with set screws 406 passing through threaded openings 408 in the housing 372. Although not apparent in all the drawings, there are preferably three pairs of tracks 394 and set screws 406 equally spaced around the circumference of the housing 408 and the core member 384. These set screws 406 also pass through a cylinder 385 (acting as a linear washer) positioned between a lock ring 380 and a washer 387. [Lock ring 380 is used to ensure that the nut 376 and washer 378. stay in place while when core member 384 translates upwards or downwards. The lock ring 380 can be set by threads within housing 372 (not shown), or via set screw s akin to 406 (not shown). As the knob 310 is turned, interaction between the set screws 406 and the tracks 394 causes the screw 392 to move up or down in the threaded opening 377. in turn moving the core member 384 up or down relative to the cylinder 385.

[0068] Because the lower portion of the core member 384 is connected to lower components in the mechanism, these components are also drawn upwards or downwards when knob 310 is turned. In particular, the lower portion of the core member 384 is threaded on its outer diameter 400 to a collar 390 which includes a spherical opening on its bottom for the ball 366 of the ball joint. Screw 364, bracket 362, and the hand plate 122 are connected to the bottom of ball 366 as already discussed. Threads 400 are useful during construction of the mechanism to attach the ball 366, its compression screw 388 (discussed below), and the collar 390 to the core member 384. However, threads 400 are configured to lock tight to the collar 390 once the mechanisms is constructed, and are not configured to slip as the mechanism operates. The lower part of the core member 384 also includes threads 401 on its inner diameter that connect with threads 402 of the compression screw 388. Unlike threads 400, the connection between threads 401 and 402 are designed to slip with respect to each other as knob 290 is turned, as discussed further below. The lower portion of the core member 384 is also connected to knob 290 via a screw- 398. Note that this screw 398 passes through openings 410 in the compression screw' 388 and windows 396 in the core member 384, as discussed further below with reference to Figure 14D.

[0069] To summarize, turning the knob 310 moves the core member 384 upw ards or downwards, which also moves these lower-connected components (the collar 390, the compression screw' 388, knob 290) upwards or downwards as well, including the hand plate 122, which again allow- tension in the restrained hand 134 to be set (D2). As noted earlier, the movement of these lower components changes the length of space 370, making more or less of the indicator bars 374 visible. Furthermore, movement of the core member 384 upwardscompresses a spring 386 positioned between spacer 387 (in contact with the base of cylinder 385) and spacer 389 in contact with a shoulder of the core member 384. This spring 386 provides a bias making it easier to loosen the knob 310 and move the core member 384 downwards, returning the mechanism to a position of minimal tension.

[0070] Operation of knob 290 to set the angle of the hand plate 122 is discussed next. As mentioned above, screw 398 passes through and threads to the knob 290 through openings 410 in the compression screw 388 and windows 396 in the core member 384. These openings 410 and windows 396 are best seen in the cross-sectional view of Figure 14D. As shown, there are several openings 410 in the compression screw 388 (e.g., three oriented at 120 degrees), but this is simply a manufacturing convenience to ensure that screw 398 will be able to interact with at least one opening 410 through the windows 396 in the core member 384. If the compression screw 388 is appropriately positioned, only one opening 410 would be required in the compression screws The windows 396 in the core member 384 have an arc length G. As best seen in Figure 14B, notice that the compression screw" 388 includes a spherical contact surface 404 shaped to contact and conform to the shape of the ball 366 in the ball joint.

[0071] The knob 290 can be turned through an angle |3. as best seen in Figure 14D. which is constrained by the interaction betw een the screw 398 and the arc length G of the window s 396 in the core member. When the knob 290 is turned to a point brining the screw7398 in contact with an edge of a window 396, the core member 384 will not rotate, as it is connected to other components as described earlier. However, the tight interaction between the openings 410 in the compression screw 388 and the screw7398 will cause the compression screw7388 to turn within the core member 384 — slipping at the junction of threads 401 on the core member 384 and the threads 402 on the compression screw7388. More particularly, loosening knob 290 will guide the compression screw 388 upwards within the core member 384, raising its spherical contact surface 404 away from the ball 366 of the ball joint. In this position, the clinician can manually move the hand plate 122 to a desired angular position, as described earlier. Preferably, the ball 366 will experience some friction even when the compression screw 388 is lifted upward using knob 290. This allows the clinician, as described earlier, to manually set and temporarily hole a particular angle for the hand plate 122 to properly position the patient’s hand 134 and arm.

[0072] Once a proper angle has been achieved, the clinician can tighten the knob 290 in the other direction. This causes the compression screw 388 to rotate within the core member 384 in the other direction, with the compression screw 388 also moving downward by operation of threads 401 and 402. When the knob 290 is rotated sufficiently far, the spherical contactsurface 404 is brought into firm contact with the ball 366, which prevents it from rotating further. In this manner, the angle of the hand plate 122 established earlier can be locked into plate to prevent the hand plate 122 from rotating further.

[0073] With details of the arm board 102 and the restraining device 100 now in hand, a brief description of the manner in which this system 90 can be used is now set forth in one example. A patient needing a medical procedure on his forearm 132, wrist 133, or hand 134 is placed in a patient support apparatus 140. such as a chair, and the arm board 102 is clamped (128) to the apparatus 140. Lever 154 is the used to adjust the angle 0 between the arm board 102 and the apparatus, and locked into place. The restraining device 100 is then clamped (114) to the arm board 102. The patient extends his arm over the board, and his upper arm 130 is secured (124) to the arm board 102. An angle (p for the restraining device 100 relative to the arm board 102 is then set and locked using knob 250, and a distance DI for the restraining device 100 (that will place the patient’s hand 134 at an appropriate position relative to the hand plate 122) is set and locked using knob 270. At this point, angle A for the hand plate 122 could also be set and locked using knob 270 (more particularly, knob 270’ of the mechanism of Figure 1 IB). The patient’s hand 134 is then slid upwards into the hand plate 122 to bring their fingers 135 in contact with the finger traps 350 of the plate to a point where their fingers are loosely trapped. At this point, knob 290 can be used to adjust and set an angle for the hand plate 122 appropriate for the procedure. Lastly, the patient's arm as now restrained can be tensioned using knob 310. which as discussed earlier, pulls the hand plate 122 upwards (D2) which further traps the fingers and pulls on the patient’s arm. Of course, these various adjustable mechanisms do not need to be set or adjusted in this exact order, and one would expect the clinician to refine and further adjust these mechanisms as necessary', and in whatever order is logical.

[0074] Rotatable adjustment elements as described herein (e.g., 152, 154, 250, 252, 270, 290, 310) have been referred to as levers or knobs. As these rotatable mechanisms are essentially the same in function, and vary only in their form factors, they are both referred to as "‘knobs” in the claims, and thus knobs should be construed as including both traditional knobs, levers, wingnuts, and other rotatable elements.

[0075] Although particular embodiments of the present invention have been shown and described, it should be understood that the above discussion is not intended to limit the present invention to these embodiments. It will be obvious to those skilled in the art that various changes and modifications may be made without departing from the spirit and scope of the present invention. Thus, the present invention is intended to cover alternatives, modifications,and equivalents that may fall within the spirit and scope of the present invention as defined by the claims.

Claims

WHAT IS CLAIMED IS:

1. An arm restraining device usable during a medical or surgical procedure, comprising: a member having a long axis; a first mechanism affixed to the member, wherein the first mechanism comprises a clamp affixable to a surface configured to support an arm of a patient; a hand plate affixed to the member by a second adjustment mechanism, wherein the hand plate is configured to secure to a hand of the patient; a third mechanism configured to allow a first distance between the hand plate and the first mechanism to be adjusted parallel to the long axis of the member, wherein the second mechanism comprises a first knob, wherein rotating the first knob decreases a second distance between the hand plate and the member parallel to the long axis of the member to provide tension to the patient’s arm when the hand is secured to the hand plate.

2. The system of claim 1, wherein the first mechanism further comprises a rotation joint configured to allow a first angle between the long axis of the member and the surface to be adjusted.

3. The system of claims 1 or 2, wherein the clamp comprises an upper portion and a lower portion configured to clamp to the surface.

4. The system of claim 3, wherein the rotation joint comprises a first ring and a second ring withing a housing, wherein the housing is connected to the member.

5. The system of claim 4, wherein the first ring and second rings are configured to be rotatable with respect to each other to allow the first angle to be adjusted.

6. The system of claim 5, wherein the second ring is coupled to the housing, and wherein the first ring is coupled to the upper portion.

7. The system of claim 6, wherein the first and second rings have opposing faces.

8. The system of claim 7, wherein the first mechanism comprises a second knob configured when loosened to space the opposing faces to adjust the first angle, and when tightened to bring the opposing faces into contact to lock the first angle.

9. The system of any of claims 2-8, wherein the first angle is adjustable between 0 and 90 degrees.

10. The system of any of claim 1-9, wherein the member comprises a lower member and an upper member connected along the long axis, wherein the first mechanism is affixed to the lower member, and wherein the hand plate is affixed to the upper member by the second adjustment mechanism.

11. The system of claim 10, wherein the third mechanism is further configured to allow a second angle of the hand plate to be adjusted around the long axis.

12. The system of claims 10 or 11. wherein the second member comprises a horizontal member perpendicular to the long axis, wherein the hand plate is affixed to the horizontal member by the second adjustment mechanism.

13. The system of any of claims 10-12, wherein the upper and lower members connect in sliding telescoping fashion, and wherein the third mechanism adjusts the first distance by adjusting how far the upper and lower members are telescoped.

14. The system of claim 13, wherein the third mechanism comprises a third knob configured when loosened to allow the upper and lower members to slide telescopically to adjust the first distance, and when tightened to prevent the upper and lower members from sliding telescopically to lock the first distance.

15. The system of any of claims 1-14, wherein the hand plate comprises a plurality of finger traps, wherein the finger traps are configured to secure the hand of the patient by trapping fingers of the patient’s hand between adjacent finger traps.

16. The system of claim 15, wherein the hand plate comprises a plurality of tracks angled with respect to each other, wherein one of the plurality of finger traps is configured to slide in one of the tracks.

17. The system of claim 16, wherein rotating the first knob to decrease the second distance causes the plurality of finger traps to slide downward in the tracks, thus compressing the fingers between the adjacent finger traps.

18. The system of any of claims 1-17, wherein the second mechanism further comprises a ball joint, wherein the hand plate is affixed to a ball in the ball joint.

19. The system of claim 18, wherein the second mechanism comprises a compression screw and a fourth knob, wherein the fourth knob is configured when loosened to space the compression screw away from the ball to allow an angle of the hand plate to be adjusted, and when tightened to cause the compression screw to contact the ball to lock the angle of the hand plate.

20. The system of claim 19, wherein the angle of the hand plate is adjustable by adjusting the pitch, yaw, and / or roll of the hand plate with respect to a long axis of the second mechanism, wherein the first knob and the fourth knob are both rotatable around the long axis of the second mechanism.

21. A system usable during a medical or surgical procedure, comprising: a chassis; a top surface connected to the chassis and configured to support a limb of a patient during the medical or surgical procedure; a rotation joint coupled to a first edge of the chassis; a clamp coupled to the rotation joint and configured to affix to a patient support apparatus for the patient; and wherein the rotation joint is configured to allow" an angle between the top surface and the patient support apparatus to be adjusted and locked into place.

22. The system of claim 21, wherein the top surface is radiolucent.

23. The system of claims 21 or 22, wherein the top surface is configured to support an arm of the patient.

24. The system of any of claims 21-23, further comprising at least one strap affixable to the chassis to restrain the limb of the patient against the top surface.

25. The system of any of claims 21-24, wherein the rotation joint comprises a first ring and a second ring withing a housing.

26. The system of claim 25, wherein the first ring and second rings are configured to be rotatable with respect to each other to allow the angle to be adjusted.

27. The system of claim 26, wherein the second ring is coupled to the chassis, and wherein the first ring is coupled to the clamp.

28. The system of claim 27, wherein the first and second rings have opposing faces.

29. The system of claim 28, wherein the first and second rings are controllable to bring the opposing faces into contact to lock the angle, and to space the opposing faces to adjust the angle.

30. The system of claim 29, further comprising a first screw, wherein the first screw is configured to be rotatable by the user to control the first and second rings, wherein the first screw is rotatable in a first direction to bring the opposing faces into contact, and wherein the first screw is rotatable in a second direction to space the opposing faces.

31. The system of any of claims 21-30, wherein the clamp comprises a first portion and a second portion, wherein the first and second portions are controllable to clamp to and release from the patient support apparatus.

32. The system of claim 31, wherein the first and second portions are configured to clamp to and release from a rail of the patient support apparatus.

33. The system of claims 31 or 32. wherein only the first portion is coupled to the rotation joint.

34. The system of claim 33, wherein the rotation j oint comprises a first ring and a second ring withing a housing, wherein the first ring and second ring are rotatable with respect to each other to allow the angle to be adjusted.

35. The system of claim 34, wherein the second ring is coupled to the chassis, and wherein the first ring is coupled to the first portion.

36. The system of any of claims 31-35, wherein the first and second portions comprise contacting angled surfaces that are not horizontal or vertical.

37. The system of claim 36, further comprising a second screw, wherein the second screw is connected to a second knob rotatable by the user to control the first and second portions, wherein the second screw is configured to be rotatable in a first direction to control the first and second portions to clamp to the patient support apparatus, and wherein the second screw is rotatable in a second direction to control the first and second portions to release from the patient support apparatus.

38. The system of claim 37, wherein rotating the screw in the first direction causes the angled surface of the second portion to slide on the angled surface of the first portion, thus causing the second portion to move in a first horizontal direction and to move in a first vertical direction to decrease a distance between the first and second portions.

39. The system of any of claims 21-38, further comprising at least one rail affixed to a second edge of the chassis, wherein the second edge is perpendicular to the first edge, wherein the at least one rail is configured for attachment to a restraining device for restraining the patient’s limb.

40. The system of claim 39, further comprising the restraining device affixed to one of the at least one rails, wherein the restraining device comprises an adjustable wrist retractor.

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