Dynamic adjustable shoulder orthosis with rehabilitation by adduction

A shoulder orthosis is provided for maintenance of a patients arm in a postoperative shoulder immobilization posture in the context of tearing of rotator cuff muscles. The orthosis comprises a belt, an arm splint, and a column member with axial mechanical spring continuously adjustable by a manual adjustment handle and interconnecting the belt to the splint and biasing the splint to an abduction upper limit position. The orthosis provides stable support for the patients forearm around a horizontal plane, while allowing pivoting movement of the patients injured arm about a vertical axis intersecting the patients elbow and approaching the patients torso in a transverse plane. This orthosis also allows a cyclical back and forth movement of the splint, the free downward movement of the patients arm by his healthy muscles, assisted by the adductor muscles against the bias of the adjustable spring without active movement of the rotator cuff. A control handle incrementally locks the spring in a selected retracted position of the axial spring. The axial spring column member remains closely spaced against the patients torso during movements of the splint relative to the patients waist belt.

This patent application claims convention priority based upon currently co-pending Canadian patent application No 3,020,566 filed 12 Oct. 2018.

FIELD OF THE INVENTION

The present invention relates to a shoulder orthosis for supporting a patient's arm in abduction after post-operative surgical repair of rotator cuff muscle tearing lesions. The shoulder orthosis includes a stabilized height adjustable column member allowing a cyclical exercise of the patient's arm uninjured adductor muscles.

The present invention is therefore a shoulder immobilization orthosis for supporting, in treatment for a shoulder lesion, a patient's injured arm in a prescribed position while the elbow is bent at a right angle in a patient's arm hanging position.

The present invention aims to improve such an orthosis as disclosed in U.S. Pat. No. 9,204,989 issued Dec. 8, 2015 to Université de Montreal jointly with Canadian corporation 2330-2029 Québec inc.

BACKGROUND OF THE INVENTION

Muscular tears are degenerative-type bodily injuries, the occurrence of which increases with age, especially over 50 years old individuals for manual labor or 70 to 80 years old individuals for non-manual labor. Torn shoulder muscle injuries usually occur when a person repeatedly lifts heavy loads over his or her head and appear regularly during sporting activities such as swimming and football matches, professional activities such as window cleaning, and gymnastics and fitness exercises.

An arm splint and sling may be a good initial short-term treatment for any painful shoulder injury. Using a splint helps keep an injured limb from moving. This may temporarily help prevent further injury. Therefore, in a number of cases, a conventional arm sling suffices, provided there is no excessive force on the base of the patient's neck and the sling use is short term. The splint is positioned so the injured limb cannot bend. One should splint from a joint above the injury to a joint below it. To splint an injury, the injured arm is tied to a rigid patient's arm rest. A sling is a bandage used to support and de-weight an injured arm. To apply that sling, the patient's arm needs to be supported above and below the site of the injury, the triangular bandage is placed under the injured arm and over the uninjured shoulder to form a sling, and the bandage opposite ends are tied around the back of the neck.

However, for more than three weeks duration of treatment of shoulder lesions, shoulder orthosis will usually be required, especially after post-operative surgical repair of rotator cuff. A significant portion of the medical treatment of a repaired shoulder muscle may require stabilization and patient's injured arm support in abduction (i.e. away from the patient's sagittal plane) during the healing period associated with the rehabilitation, which usually lasts from four to twelve weeks. Muscle injuries to the shoulder can be of different types and involve different sets of muscles. Different medical treatments involving surgery may be required depending on the type and severity of the injury. In each case, proper healing requires that the patient's arm be stabilized at a specific angle to the body to maintain the shoulder in the optimal position for rehabilitating the injured muscle. As healing progresses, the angle of stabilization of the patient's injured arm is often reduced, bringing the injured arm into adduction (closer to the patient's sagittal plane), that is, progressively closer to its natural position along the body. In addition, these lesions generally affect only a portion of the shoulder muscles, often the supra-spinatus muscle (and possibly also with the infra-spinatus), the length of the tear generally varying between 1 and 20 mm; the other muscles of the shoulder remaining healthy and without lesions. All the abduction brace do immobilize all of the patient's injured arm shoulder, elbow and wrist.

After an initial healing period, it is recommended to progressively start loading once again the muscle of the remaining healthy (i.e. uninjured) shoulder muscles, including the pectoralis major muscle and possibly the latissimus muscle—to maintain the tone of these healthy muscles. This exercise is limited to a certain set of movements that minimize the use of injured or repaired muscles. For example, in many types of rotator cuff injuries, after a certain period of healing, the patient is advised to repeatedly exercise his adduction muscles. When the patient's injured arm immobilization lasts more than about three weeks, ankyloses and atrophy will occur in the upper limbs.

Numerous patient's shoulder orthoses and arm stabilization devices known in the state of the art may be used to stabilize the arm in a single given static position. Other prior art devices provide adjustment mechanisms to change the height at which the patient's arm is stabilized. But these known mechanisms of patient's arm height adjustment often require external intervention and cannot be used without external help. Some also require complex or lengthy procedures, requiring first removal of the orthosis, or involving spare parts, or even special tools. Some also have unstable harnesses and splints relative to the patient's body, or they have several support structures that are often cumbersome and uncomfortable.

In addition, most of these orthoses allow no movement of the free uninjured patient's arm, which is a major disadvantage when several weeks of rehabilitation are needed. In addition, orthotics known in the art do not allow the forearm flexion/extension of the forearm around the elbow of the patient's injured arm.

The aforementioned U.S. Pat. No. 9,204,989 discloses a shoulder orthosis for surgically repaired rotator cuffs, and more specifically for surgically repaired rotator cuff muscles after tearing of the supra-spinatus muscle group only or for the combination of the supra-spinatus and infra-spinatus muscles. This shoulder brace allows for muscle conditioning exercises of the other healthy muscles of the patient's arm while minimizing muscle contraction and stress with rotator cuff injury. This shoulder brace also allows the flexion/extension of the patient's forearm around the elbow while keeping the patient's arm generally horizontal at a constant height. This shoulder brace also stabilizes the arm at different angles relative to the nature of the body, the severity and the healing level of the wound. Flexion/extension of the patient's elbow without arm movement allows activation of the elbow flexors/extensors (biceps and triceps), as well as being more functional and allowing the patient's forearm to be brought closer to the patient's torso. This facilitates daily activities, such as engaging a narrow door frame, donning and wearing a coat and drawing sheets towards the patient's torso while in bed. The orthosis allows the movement of the shoulder and elbow, to prevent the syndrome of “frozen shoulder” and stiffness of the joints.

In general, the invention disclosed in U.S. Pat. No. 9,204,989 relates to a shoulder orthosis intended to withstand in the long term (several weeks) the arm of a patient in a postoperative shoulder immobilization posture with a torn rotator cuff including a waist belt, an arched forearm support, and a piston and cylinder assembly connecting the belt to the forearm support and forcing the forearm support to an upper limit position. This orthosis thus provides some forearm support around a horizontal plane, while allowing pivoting movement of the patient's arm about a vertical axis intersecting the patient's elbow and approaching the patient's torso in that area.

This orthosis also allows a cyclical movement up and down the forearm support, the downward movement being well assisted by an adductor against the bias of the piston/cylinder assembly. A locking system releasably locks the piston and the cylinder in a selected retracted position of the piston rod.

A feature of the orthosis disclosed in prior U.S. Pat. No. 9,204,989 is that the piston and cylinder assembly interconnecting the waist belt to the patient's injured arm supporting splint diverges upwardly outwardly from the waist belt progressively away from the patient's torso to reach the injured arm elbow far away from the injured arm shoulder. Therefore, a sector-shape gap is formed between the piston and cylinder assembly and the patient's torso. Accordingly, donning a shirt or coat can become a challenge because the shirt/coat sleeve will extend over only outer forearm part of the injured arm but will not extend beyond the elbow. An awkward shirt/coat engagement may thus result.

U.S. Pat. No. 9,204,989 also relates to a method of using a shoulder orthosis, said method comprising the steps of: attaching said belt to the size of the patient; attaching the patient's arm to said arm splint; deactivating said locking means; and engaging the adductor muscles of the patient to at least partially retract said connector member from said first fully extended boundary condition to said second boundary condition thereof; wherein the axial spring arm remains directly applied to the patient's torso during movements of the splint relative to the patient's support belt.

OBJECTS OF THE INVENTION

An object of the present invention is therefore to increase a shoulder orthosis intrinsic stability in translation of the patient's injured arm as supported by the orthosis splint arm supporting cradle.

Another object of the invention is to provide a better adjustment of the rehabilitation mechanism.

Another object of the invention is to orient the column member axial spring member so that it generally rests against the torso of the patient (instead of diverging obliquely as with the aforementioned U.S. Pat. No. 9,204,989) so it makes it easier for the patient to put on or take off a coat without removing the orthosis each time

SUMMARY OF THE INVENTION

Generally speaking, the invention relates to a shoulder orthosis for maintenance of a patient's arm in a postoperative shoulder immobilization posture in the context of tearing of rotator cuff muscles. The orthosis comprises a belt, an arm splint, and a column member with axial mechanical spring continuously adjustable by a manual adjustment handle and interconnecting the belt to the splint and biasing the splint to an abduction upper limit position. The orthosis provides stable support for the patient's forearm around a horizontal plane, while allowing pivoting movement of the patient's injured arm about a vertical axis intersecting the patient's elbow and approaching the patient's torso in a transverse plane. This orthosis also allows a cyclical back and forth movement of the splint, the free downward movement of the patient's arm by his healthy muscles, assisted by the adductor muscles against the bias of the adjustable spring without active movement of rotator cuff. A control handle incrementally locks the spring in a selected retracted position of the axial spring. The axial spring column member remains closely spaced against the patient's torso during movements of the splint relative to the patient's waist belt.

Accordingly, the present invention more specifically relates to a shoulder orthosis for support of a patient's arm in a postoperative angularly adjustable shoulder immobilization abduction posture in a context of injured rotator cuff muscle tear, said orthosis comprising: a) a waistband belt member, for adjustably fitting around the patient's waist, and defining a belt support section; b) a splint, defining a rigid main body having opposite outer and inner end portions, for removably supporting a patient's injured arm; c) an elongated column member, defining top and bottom end portions, said bottom end portion thereof anchored to said belt support section and said top end portion thereof anchored to said inner end portion of the splint; d) joint means interconnecting said splint inner end portion to said column member top end portion for relative movement of said splint thereabout; e) biasing means, cooperating with said column member in providing resistance to patient's injured arm adduction at said splint; f) locking means, applying tension on said biasing means in a conditioning exercise mode of said orthosis, and releasably locking said extensible connector column member in a selected angular orientation relative to said splint, whereby said splint forms a cantilever with said column member; and g) chord adjustment tensioning means, cooperating with said biasing means in enabling transmission of patient's injured arm adduction movement at said splint;wherein said orthosis allows the cyclical exercise of the healthy adductor muscles of the patient's injured arm while minimizing the contraction of the injured arm rotator cuff muscles.

In one embodiment, there is further included telescopic extension means providing adjustable extension of the length of said elongated column member.

In one embodiment, an axial spring means cooperates with said column member and biases said splint away from said waistband belt member, wherein said spring means allows cyclical extension/retraction of said adjustable length column member between opposite first and second limit conditions thereof; characterized in that said column member remains closely spacedly applied against the patient's torso during movements of the splint relative to the patient's waistband belt.

In one embodiment, said locking means consists of a spring-loaded twist activated plunger, anchoring said axial coil spring means in an operative condition whereby tension is applied onto said coil spring means in the conditioning exercise mode of said orthosis, and releasing said axial coil spring means in an inoperative condition thereof, and pin means cooperating with said column member in setting a lower threshold limit stop for minimal angular inclination between said splint relative to said column member.

In one embodiment, said axial spring means would consists of an elongated compression coil spring member coaxially mounted lengthwisely inside said column member within a telescopic female tubular member therein, and engaging at its top end a male tubular member within said female tubular member and said chord adjustment tensioning means being an internal chord at a bottom end thereof, carried by a seat transversely mounted integral to said column member bottom end portion, characterized in that said internal chord provides transmission of the adduction movement, while coil spring member inside column member provides resistance to adduction of the patient's injured arm.

In one embodiment, said joint means provides internal/external rotation capability of the splint main body relative to said column member. Said joint means could then further provide angular tilt capability of the splint main body relative to said column member, whereby said splint main body would be movable in translation between a first fully extended abduction limit condition and a second retracted adduction limit condition, angularly with respect to the patient's torso.

There could be provided a flexible elongated sling band anchored at one end to a section of said waistband belt and forming a loop around the patient's uninjured shoulder at another end thereof opposite said one end thereof.

In one embodiment, there is provided an elongated forearm support cradle, integrally carried at said outer end portion of the splint main body and defining a free end portion opposite said splint main body. A hand-rest member could then be added, carried by said cradle at said free end portion thereof. Multiple moisture ventilation perforations could also be made in said cradle.

In one embodiment, said joint means provides angular tilt capability of the splint main body relative to said column member, for example with an angular tilt capability selected from the following discrete values: 30°, 45°, 60° and 75°.

In one embodiment, said belt member includes a hook and loop fastener means enabling width adjustment of said waistband belt, the latter being also padded for added patient's comfort and adapted for right or left shoulder injuries.

In one embodiment, there is provided a cradle telescoping means providing adjustable coaxial displacement of said cradle relative to said splint main body, and/or lengthwise cradle telescopic adjustment means for lengthwise cradle extension/retraction; and/or cradle roll adjustment means cooperating with said cradle telescopic adjustment means for rolling motion of said cradle.

The present invention also relates to a method of using such a shoulder orthosis, wherein said method comprises the following steps:—attaching said waistband belt to the patient's waist; —attaching the patient's arm to said splint; —deactivating said locking means; and—engaging the patient's adductor muscles to at least partially retract said connector column member from said first fully extended limit condition to said second limit condition thereof; characterized in that said column member remains closely spacedly applied against the patient's torso during movements of the splint relative to the patient's waistband belt.

The shoulder orthosis according to the present invention enables adjustment of internal and external rotation for different patients, to control shoulder abduction, which was not possible with prior art shoulder orthosis.

DETAILED DESCRIPTION OF THE EMBODIMENTS OF THE INVENTION

As seen in the drawings, e.g.FIGS.1-2and7, the orthosis40includes an anchor plate42for attachment to a waistband belt member43around the waist of a patient, a forearm rigid support member or splint44, a cradle member46carried at an outer end of splint44by a mounting means48for relative movement thereabout, an upright connector or column member50connecting at its top end portion thereof to the inner end portion of splint main body44about pivot mount100, and at its bottom end portion to anchor plate42. The splint44forms a cantilever with the upright column member50.

In one embodiment, mounting means48forms an elbow joint, providing continuous elbow mobility in angularly variable condition ranging e.g. between 30° and 165° as an unlocked joint, and locking capabilities at various positions e.g. in 25° increments.

With further reference toFIGS.5A,5B and7, the splint cantilever carries the patient's arm load to the column member50where it is forced against by moment and shear stress, allowing the splint44and supported patient's arm to overhang, however without external oblique bracing load as was the case with prior art U.S. Pat. No. 9,204,989. Thus, the patient's injured arm elbow clears the supporting column member50.

In one embodiment, the splint44consists of two telescopic segments51and52, wherein a bolt54transversely extends through female splint segment52and releasably lockingly engages an ovoidal slot56extending lengthwisely of male splint segment51.

In the embodiment shown e.g. atFIGS.13and13A and17, mounting means48forms a pivot mount pivotally interconnecting splint segment51to one end of an elongated generally rectangular carrier77e.g. with rounded corners as shown. Carrier77defines an elongated ovoidal slot77A through which extends a few slider bolts79,79′, which slidingly releasably lockingly interconnect cradle member46and carrier77transversely thereof. Slider bolts79,79′, and elongated carrier77therefore provide telescopic extension/retraction motion capability of cradle member46relative to splint main body40. Cradle member46may further include a number of moisture venting bores46A. A handle rest member81may be carried at the outer end of cradle member46opposite splint mounting means48, by way of a joint member83. Hand rest member81may also have moisture venting slits81A.

In one embodiment best illustrated inFIGS.13A and17, a few (e.g. two) ovoidal slots85,85′ are made in cradle46transversely of and opening into cradle member ovoidal lengthwise slot77A, to provide transverse roll adjustment over and above the telescopic lengthwise adjustment capability for cradle member46.

In one embodiment shown e.g. inFIG.2, the width of waistbelt member43is adjustable by way of hook and loop fastener bands45. Belt43may include breathable cushioning.

The technical improvements of the present invention thus include the following ingenious elements: bilateral use; stability and mobility of the orthosis; adding an articulation to the hip; and adjustment in the transverse plane.

As best shown inFIGS.1A,2,9-10and13D, in one embodiment, tubular member50B is made from a resilient compressible nylon material and defines a slit290made lengthwisely of a lower lateral wall portion thereof. On opposite sides of slit290are carried radially outward frictional interlock plates300,302, spaced by a gap292. Each transverse plate300,302, includes a pair of transversely registering threaded bores293,294and295and296respectively, wherein registering bores293and294are threadingly engaged by first tightening screw304and registering bores295and296are engaged by second tightening screw306. When screws304and306are released, tubular elements50A and69become free to rotate about stationary tubular base50B; whereas when screws304and306are tightened, plates300and302are brought toward one another wherein gap292diminishes in width and tubular members50B and69frictionally interlock with one another thus interlocking tubular elements50B,69and50A.

As can be seen inFIG.11Bof the drawings according to the invention, there is added a shoulder joint100. This joint100results in stabilization by attachment to the patient's injured arm in addition to the patient's coextensive forearm, continuous adjustment from 0° to 90° in the sagittal plane (internal-external rotation) with locking, and incremental adjustment in the frontal plane to fixed (discrete) angles selected for example between 30°, 35°, 45°, 60° and/or 75°.

As best illustrated inFIGS.5A,5B,11B and17A, in one embodiment, telescopic splint elements51and52each have a cross-sectional U-shape main body are further interconnected by a fixed screw250anchored at one end to inner splint element51by arcuate integral bracket252and at its opposite end to outer splint element52by transverse integral bracket254. Screw250provides dampening means when splint elements51and52are rotated.

Splint elements51and52provide external and internal rotation capability of the shoulder adjustment to precise the position of immobilization, depending on the type of surgery.

The hip-shoulder upright column member50is characterized in that it extends generally parallel and closely spaced from the patient's torso. This upright hip-shoulder column member50has a telescopic length adjustment means which can be releasably locked at selected conditions. More particularly, and as best shown inFIGS.3,11and13C, this length adjustment means is embodied by the lower portion of column member tubular portion50A including a number of lengthwisely spaced bores65, any of which may be selectively engaged by screw member62. By selecting one of bores65,65′, . . . engaged by screw62therein, adjustment of telescopic extension of male tube50A relative to female tube69and associated bottom base tube element50B will be enabled, according to the height of the patient's torso. The external handle part of screw member62is fitted to enable manual adjustment control of spring tension for axial spring60.

The splint member cradle may be perforated with multiple moisture venting perforations or bores46A (see e.g.FIG.13A) for accommodating patient's arm sweating/perspiration.

As illustrated in the embodiment ofFIGS.11,11B and13A, the column member50includes a lowermost base tubular element50B, from which projects a rotatable tubular element carrying a +telescopic assembly comprising a male tubular member50C and a female tubular member50A. That is to say, column member female segment tubular member50A is telescopic and defines an inner tubular segment50C lengthwisely movable within the hollow of upper tubular segment50A.

As best illustrated inFIGS.5B,5D,7,13A,13C and17Bof the drawings, in one embodiment, an elongated compression coil spring60is coaxially mounted lengthwisely inside the hollow of column member telescopic female tubular member50A, engaging at its top end male tubular member50C and at its bottom end a cross-sectionally hexagonal rod or “internal chord”61carried by a seat63within the hollow of and integral to the upper portion of rotatable tubular member69. The top end of rod61also carries a discoid seat320integral to the bottom end of coil spring60. The bottom end of rod61forms a free end head61A for releasable engagement by an Allen key W. Access to rod bolt head61A by Allen key W is made possible via a bottom mouth62A made at the bottom end of radially outward tubular members50B and radially inward tubular member69, and through the axial hollow69B of inner tubular member69. Upright internal chord61enables transmission of the patient's injured arm adduction movement on splint cradle46, while axial coil spring60inside upright column member50provides resistance to patient's injured arm adduction on splint cradle46.

As shown in inFIG.13C, screw member62is carried by sleeve69rotatably mounted within stationary tubular base50B. This is suggested by double arrow band R.

In the embodiment ofFIGS.11and21, a flexible sling band or strap80connects the waistband anchor section42to the patient's uninjured shoulder S′ opposite the patient's injured shoulder S for patient P.

As illustrated inFIG.21, the patient's uninjured shoulder S′ may be covered with a short sleeve shirt section, whereby sling band80will abut thereagainst for patient's comfort and treatment compliance.

The sectional views in the orthosis embodiment ofFIGS.5A,11B and17Aof the drawings, in combination with the exploded view ofFIG.11A, sequentially suggest how transverse splint member44pivots relative to upright column member50. Splint inner segment44comprises an inner free end yoke section120defining a main body122with a first intermediate transverse bore124, and two transversely spaced innermost ears126and128each having a corresponding bore130and132respectively in transverse register with one another. To the top end of upper tubular male element50A of column50is fitted a tubular cap member134having a transverse bore136. In one embodiment, the top end of cap member134is covered by an arcuate integral cover plate138. Polygonal bracket plates140,142, are also provided, each including a top bore144,146, respectively and a vertical ovoidal slot148. Bores130,132,136,144and146are sized and shaped to accommodate therethrough a bolt150releasably pivotally engaging therethrough upon engagement of ears126,128, around cap body134and engagement of bracket plates140,142against the upper portion of column tubular element50A. Hence, splint member44is pivotable relative to upright column50about pivot bolt axle150.

As shown inFIGS.11A and11B, further pivot means152is provided to follow splint arm44at a selected angular value relative to column member50, e.g. at discrete angular values selected from 30°, 45°, 60° and 75°. Pivot means152includes a screw member154and a nut member156, having opposite end yoke connectors158,160, respectively. Screw member yoke connector158defines two transversely spaced ears162,162, each having a transverse bore166,166. Both ears162are sized to transversely fit into the hollow120A of cross-sectionally U-shape splint member yoke section body120. Bores124and166are sized and shaped to accommodate a bolt168to pivotally releasably interconnect screw member154to splint member body120about the thus formed pivot bolt axle168engaging bore124.

Screw member154further defines a male threaded shaft170opposite ears166, and nut member156defines female threaded socket172sized and shaped to threadingly accommodate threaded shaft170.

It is understood that upon threading interengagement of shaft170into socket172, the overall length of the combination of screw member154and nut member156will vary, i.e. can be adjusted by rotation of one of screw member154or nut member156relative to the other.

An L-shaped anchor plate174is further provided defining an intermediate bore176and two opposite bores178and180. Nut member yoke connectors160each includes a transverse bore164,164, transversely pivotally engaged by a bolt182. Anchor plate174is engaged between ears160in such a fashion that anchor plate bore180come in transverse register with nut member bores164and is transversely engaged by bolt182, while anchor plate bores176and178clear nut member yoke section160.

As best seen inFIGS.11A and17A, anchor plate bores176and178are engaged by corresponding pins185and187which engage a selected one of lengthwisely spaced cavities183,183′ (FIG.17A) made in a top portion of male telescopic tubular member50C, while one transverse leg174A of L-shape anchor plate174projects transversely outwardly from male member50C through a registering aperture184in the wall of female telescopic member50A. Nuts179cooperate with bolts168,180and182to lock them as stated above.

It can now be understood from the sequence ofFIGS.5A,11B and17A, that the overall length of threadingly interconnected screw member154and nut member156is progressively adjustably reduced by rotation of one of members154or156relative to the other. The L-shape anchor plate174will carry telescopic member50C in a downward sliding motion away from pivotal bolt axle150and from the hollow of tubular female member50A, pivotally bringing therein the inner portion of splint arm44adjacent pivot axle150, so that the angular value between splint member44and column member50decreases from a large angular value Θ1(FIG.5A) to a slightly smaller angular value of Θ2(FIG.11B), down to a still smaller angular value Θ3(FIG.17A).

In one embodiment, telescopic male tubular member50C will have a series of lengthwisely spaced transverse bores190,190′,190″,190,′″, . . . adapted to come in register with a bore192made transversely through an intermediate section of female tubular member50A, wherein bores192and a selected one of bores190,190′, . . . will become releasably engaged by a pin194sized and shaped for engagement therethrough. As the angular value of splint member44relative to column member50shifts from

Θ1to Θ2to Θ3, pin194is released from bottom bore190′″ and moved to intermediate bore190′ and eventually to top bore190of column member male telescopic tubular member50C. In other words, as shown inFIG.11B, by moving pin194into a selected one of bores192of tube member50C, there is modified the patient's injured arm adduction limit angular value, wherein in one embodiment this angular value is selected from discrete values between 30°, 45°, 60° and 75°.

As best shown inFIGS.5A and5C, spring-loaded twist activated plunger68defines a main body68A projecting freely outwardly transversely from tubular member50A through upper bore193of column tubular member50A and into a frusto-conical cavity202made transversely of inner tubular member50C adjacent anchor plate174.

FIG.5Ashows spring-loaded twist activated plunger68in retracted condition substantially clearing cavity202, whileFIG.5Cshows spring-loaded twist activated plunger68in its fully extended condition inside cavity202. When spring-loaded twist activated plunger68is in its fully extended condition inside cavity202, movement is locked in the position determined by immobilization of pin194inside the selected bore192, forming a patient's injured arm abduction lower limit condition at splint arm44. The purpose of spring-loaded twist activated plunger68is to apply tension on coil spring60in the conditioning exercising mode of the present orthosis. Upon release of spring-loaded twist activated plunger68(FIG.5A), coil spring60is also released or freed. Pin194will set a lower threshold limit stop determining minimal angular inclination between pivotal arm44relative to upright column50, the purpose of this being to minimize risk of muscular fibers damage for the patient's injured muscle or tendon. Arm44may be lowered against spring bias from column spring60, which enables muscular reinforcement conditioning exercise, wherein muscular rehabilitation is promoted. Patient's uninjured muscles thereby benefit from conditioning exercise.

Spring-loaded twist activated plunger68will be released from top tubular element50A to enable conditioning exercise at any angular value such as Θ1, Θ2and Θ3as adjusted by pin194and as prescribed by the medical specialist.

Thus, according to an embodiment of the present invention, the gas cylinder of the re-adaptation mechanism of U.S. Pat. No. 9,204,989 is replaced by a pre-stressed mechanical coil spring60whose stress level is adjustable. Such an adjustable mechanism of rehabilitation allows the orthosis to dynamically accompany the progression of the patient's healing over time, allowing to modify (i.e. adjust) progressively and continuously the level of spring stress applied to the patient's muscles. This modified adjustable mechanism also makes it possible to better adapt to the morphology of the patient including size, age, muscle tone, general posture, etc.

In one embodiment in particular, the present orthosis is adapted to fit patients height ranging e.g. from 5 to 6.5 feet (i.e. about 1.5 meter to 2 meters).

The present invention thus relates to an abduction orthosis40, properly anchored around a patient's waist. With the present dynamic arm support orthosis, the patient's arm is strapped to a forearm trough or cradle member46, which is mechanically coupled to a waistband belt43anchored around the waist of the patient. The coupling between the forearm trough46and waistband belt43can be adjusted. The patient's arm and hand are held in a cosmetically pleasing pose, and the patient's hand from the injured patient's arm is available for use, enabling early functional recovery. The dynamic arm and shoulder support orthosis is easy to put on and take off, and full de-weighting of the patient's arm is feasible.

Rehabilitation exercises are thus performed in the patient's frontal plane. There is integration of the rehabilitation mechanism (column member axial spring60) in the hip-shoulder column member50. There is also adjustment of the resistance of the rehabilitation mechanism by a screw means61-63integrated in the hip joint.

The waist band43in the present shoulder orthosis40prevents anterior migration that is common with prior art shoulder braces for injured football players or gymnasts.

Contra-lateral suspension from the uninjured shoulder S′ supported sling band80is comfortable and secure, resists displacement while allowing a broad range of independent patient's activities. In one embodiment, a wide-sculpted sling band80is provided, to enhance comfort for promoting treatment compliance.

The forearm and hand rest in carefully contoured cradle members46,81, respectively. A pair of padded loop straps360(FIG.21) around patient's injured arm and attached to cradle member46may be added so that patient's arm and splint40become integral during treatment, so as to avoid accidental release.

The device is worn by the patient inconspicuously under a garment, is useful either during mobility, while seated or when recumbent, and is applicable to human beings whose willful control of the shoulder joint is absent or decreased as the result of illness or injury.