Abstract:
A modular shoulder cooling system. A retention panel is affixed over the shoulder. The retention panel is hald in position by a pair of straps attached to a belt around the user&#39;s waist. At least a portion of the inward facing surface of the retention panel is covered in loop material. Bags containing cooling medium are furnished. These are referred to as “cold packs.” Each cold pack has a first side with a soft, tactilly pleasing surface. This first surface is intended to face the user. Each cold pack also has a second side intented to face the inward facing surface of the retention panel. This second side includes one or more hook panels configured to engage the loop material on the inward facing surface of the retention panel. The user can attach a cold pack or packs to the rentention panel by pressing the hook panels on each cold pack against the loop material on the retention panel. Thus, no pockets are required.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
       [0001]    This application is a non-provisional application claiming priority to U.S. Provisional Application No. 61/640,902 filed on May 1, 2012. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0002]    Not Applicable. 
       MICROFICHE APPENDIX 
       [0003]    Not Applicable 
       BACKGROUND OF THE INVENTION 
       [0004]    1. Field of the Invention 
         [0005]    This invention relates to the field of medical products. More specifically, the invention comprises a modular system for applying cryotherapy to a patient&#39;s shoulder. 
         [0006]    2. Description of the Related Art 
         [0007]    It is now widely recognized that the application and maintenance of “cold therapy” in the hours and days following surgery significantly improves patient outcomes. The terms “cold therapy” and “cryo therapy” are often used interchangeably. The present application will use the term “cryo therapy.” 
         [0008]    Ice packs are often used for cryo therapy. These are placed on the affected shoulder and held in position using compressive wraps or other known techniques. “Gel packs” may be substituted for the ice packs in some applications. Another less common approach is the use of cooled fluid (often water) circulated through a sealed bladder which is placed in contact with the affected area. 
         [0009]    The use of ice packs has several known disadvantages. One disadvantage is that the patient&#39;s skin must be separated from the ice pack by a layer of appropriately insulating material. This is often required to prevent frost burns. Since the ice pack will remain at 0 degrees Celsius while the phase change from solid to liquid is progressing, it is capable of cooling the patient&#39;s skin to a harmful extent. Thus, it is often necessary to use an insulating layer which provides some (but not too much) insulation. 
         [0010]    Gel packs alleviate some of the frost burn concern since they generally do not undergo a phase change. The gel pack remains liquid at the temperatures found in most freezers. Thus, when placed on the patient, a gel pack warms up to a more acceptable temperature (well above) degrees Celsius) in a relatively short period of time). Of course, lacking a phase change, the gel pack cannot absorb as much heat as a conventional ice pack. 
         [0011]    In addition, both the conventional ice packs and the gel packs are difficult to remove and replace. Such packs must be frequently exchanged for fresh ones in order to make the cryo therapy effective. One set of packs is typically applied to the patient while one or more other sets of packs are cooling in a nearby freezer. The packs on the patient must be exchanged for new ones once they reach an ineffective temperature (typically about 10 degrees Celsius). This process is difficult in the prior art because the compressive wrap used to hold the packs in place must be unwound and then reapplied. 
         [0012]    The use of a cooled circulating fluid avoids the frost burn problems present with ice packs and—to a lesser extent—gel packs. However, the bladder in such a system must be connected to a large and bulky cooling unit by an input and output line. This restricts patient mobility. The cooling unit also tends to be noisy, which can disturb patient sleep patterns. 
         [0013]    The present invention seeks to eliminate or reduce the problems present in the prior art. It uses replaceable packs containing a suitable cooling mediaum. The preferred cooling medium is one that freezes between about 5 degrees Celsius and about 20 degrees Celsius. Such a medium can absorb considerable heat via the phase change from a solid to a liquid. In addition, such a cooling medium poses little risk of tissue damage (as it will remain at its melting temperature until all the medium has transitioned from a solid to a liquid). 
         [0014]    The solid phase of the cooling medium is also significant. It is obviously undesirable for a bag of liquid cooling medium to freeze into a solid block. It is preferable to have the phase change transition into a highly structured crystalline form akin to snow. The bag of frozen cooling medium will then be soft and malleable. 
         [0015]    The present invention provides a modular shoulder cooling system using bags of frozen cooling medium. The system facilitates easy exchange of the bags so that the bags can be replaced once their ability to absorb heat is diminished. 
       BRIEF SUMMARY OF THE PRESENT INVENTION 
       [0016]    The present invention comprises a modular shoulder cooling system. A retention panel is affixed over the shoulder. The retention panel is hald in position by a pair of straps attached to a belt around the user&#39;s waist. At least a portion of the inward facing surface of the retention panel is covered in loop material. 
         [0017]    Bags containing cooling medium are furnished. These are referred to as “cold packs.” Each cold pack has a first side with a soft, tactilly pleasing surface. This first surface is intended to face the user. Each cold pack also has a second side intented to face the inward facing surface of the retention panel. This second side includes one or more hook panels configured to engage the loop material on the inward facing surface of the retention panel. 
         [0018]    The retention panel includes an upper portion and a lower portion. While the retention panel remains in position on a patient&#39; shoulder, a user can fold the upper portion over the lower portion, thereby exposing the inward facing surface of the retention panel. The user can then attach a cold pack to the upper portion by pressing the hook panel(s) on the cold pack into the loop material on the upper portion. The upper portion is then folded back into its normal position, in which it retains the cold pack on the upper portion of the patient&#39;s shoulder. 
         [0019]    The same operation can be performed for the lower portion of the retention panel. It may be folded over the upper portion—thereby providing access to remove and/or replace a cold pack on the lower portion. Using this methodology, the cold packs can be easily replaced without removing the retention panel. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
         [0020]      FIG. 1  is a perspective view, showing a patient with her arm positioned to receive a sling. 
           [0021]      FIG. 2  is a perspective view, showing the patient of  FIG. 1  with a sling installed. 
           [0022]      FIG. 3  is a perspective view, showing the installation of an abduction pillow. 
           [0023]      FIG. 4  is a perspective view, showing the abduction pillow in an installed position. 
           [0024]      FIG. 5  is a perspective view, showing the same configuration as  FIG. 4  from an elevated perspective looking downward. 
           [0025]      FIG. 6  is a perspective view showing two external rotation wedges. 
           [0026]      FIG. 7  is a perspective view showing the external rotation wedges of  FIG. 6  from a different vantage point. 
           [0027]      FIG. 8  is a perspective view, showing the abduction pillow of  FIGS. 4 and 5  in more detail. 
           [0028]      FIG. 9  is a perspective view, showing the installation of an external rotation wedge on an abduction pillow. 
           [0029]      FIG. 10  is a perspective view, showing the complete assembly of the abduction pillow, the external rotation wedge, and the sling. 
           [0030]      FIG. 11  is a perspective view, showing a patient with her opposite (non-affected) arm raised. 
           [0031]      FIG. 12  is an elevation view, showing a contralateral pad. 
           [0032]      FIG. 13  is a perspective view, showing the contralateral pad installed on a belt. 
           [0033]      FIG. 14  is a perspective view, showing a retention panel and its associated mounting straps. 
           [0034]      FIG. 15  is a perspective view, showing the retention panel attached to the contralateral pad. 
           [0035]      FIG. 16  is a perspective view, showing the retention panel attached to the contralateral pad. 
           [0036]      FIG. 17  is a perspective view, showing the retention panel in position from an elevated vantage point. 
           [0037]      FIG. 18  is a perspective view, showing a pair of cold packs. 
           [0038]      FIG. 19  is a perspective view, showing the retention panel from the side of the affected arm. 
           [0039]      FIG. 20  is a perspective view, showing the lower portion of the retention panel being folded upward. 
           [0040]      FIG. 21  is a perspective view, showing the placement of a cold pack. 
           [0041]      FIG. 22  is a perspective view, showing the placement of a cold pack. 
           [0042]      FIG. 23  is a perspective view, showing two cold packs in position on the affected shoulder. 
       
    
    
       [0043]      
         [0000]    
       
         
               
             
               
               
               
               
             
           
               
                   
               
               
                 REFERENCE NUMERALS IN THE DRAWINGS 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 10 
                 patient 
                 12 
                 upper arm 
               
               
                 14 
                 forearm 
                 16 
                 waist 
               
               
                 18 
                 lateral chest 
                 20 
                 sling 
               
               
                 22 
                 shoulder strap 
                 24 
                 clip 
               
               
                 26 
                 release assembly 
                 28 
                 belt 
               
               
                 30 
                 female release 
                 32 
                 male release 
               
               
                 34 
                 abduction pillow 
                 36 
                 hook panel 
               
               
                 38 
                 pad 
                 40 
                 neutral axis 
               
               
                 42 
                 external rotation 
                 44 
                 external rotation 
               
               
                   
                 wedge (15°) 
                   
                 wedge (30°) 
               
               
                 46 
                 hook panel 
                 48 
                 hook panel 
               
               
                 50 
                 hook panel 
                 52 
                 hook panel 
               
               
                 54 
                 wedge portion 
                 56 
                 front portion 
               
               
                 58 
                 corner 
                 60 
                 anterior surface 
               
               
                 62 
                 body relief 
                 64 
                 external rotation axis 
               
               
                 66 
                 lateral surface 
                 68 
                 lateral surface 
               
               
                 70 
                 lateral mounting surface 
                 72 
                 posterior mounting surface 
               
               
                 74 
                 corner 
                 76 
                 affected shoulder 
               
               
                 78 
                 opposite arm 
                 80 
                 contralateral pad 
               
               
                 82 
                 anchor panel 
                 84 
                 pivot 
               
               
                 86 
                 female release 
                 88 
                 hook panel 
               
               
                 90 
                 retention panel 
                 92 
                 anterior buckle 
               
               
                 94 
                 posterior buckle 
                 96 
                 anterior strap 
               
               
                 98 
                 posterior strap 
                 100 
                 male release 
               
               
                 102 
                 female release 
                 104 
                 hook panel 
               
               
                 106 
                 lower extension leg 
                 108 
                 channel 
               
               
                 109 
                 upper extension leg 
                 110 
                 connective strap 
               
               
                 112 
                 cold pack 
                 114 
                 vent 
               
               
                 116 
                 relief 
                 118 
                 hook panel 
               
               
                 120 
                 lower portion 
                 122 
                 upper portion 
               
               
                 124 
                 soft surface 
                 126 
                 lower edge 
               
               
                 128 
                 upper edge 
               
               
                   
               
             
          
         
       
     
       DETAILED DESCRIPTION OF THE INVENTION 
       [0044]    The present invention applies cryo therapy to a patient&#39;s shoulder. The application of shoulder cryo therapy is advantageous in a wide variety of situations, including trauma care and post-surgical care. It is commonly used in post-surgical care where other shoulder stabilizing components are present. Thus, the invention is preferably able to work in conjunction with these other components. 
         [0045]      FIGS. 1-10  illustrate exemplary shoulder stabilizing components. The present invention is by no means limited to use with the types of other components illustrated. However, as it is beneficial to the reader&#39;s understanding to have some knowledge of these other components they will be briefly explained. 
         [0046]      FIG. 1  shows patient  10  holding her right arm in a position which is used to stabilize the shoulder joint. She has upper arm  12  positioned proximate lateral chest  18 . Forearm  14  is positioned in front of the abdomen, just above waist  16 . 
         [0047]      FIG. 2  shows the same patient after sling  20  has been placed around her arm. Slings similar to the one shown in  FIG. 2  are well known in the art. However, the specific sling illustrated is unique and is therefore not designated “prior art.” 
         [0048]    The sling is preferably made of a breathable fabric which has a VELCRO loop covering on its exterior. Shoulder strap  22  is connected to a posterior portion of the sling. It passes over the shoulder and connects to sling  20  near the patient&#39;s hand. Clip  24  is provided with a VELCRO hook covering so that when it is pressed against the loop covering on the exterior of sling  20  it stays in place. Thus, the user may attach shoulder strap  22  to sling  20  in a suitable position according to the particular patient&#39;s anatomy. 
         [0049]    Release  26  is preferably a snap-type quick release, where pressing one or more movable portion disengages the connection. This feature allows the patient or practitioner to easily detach and reattach the shoulder strap without shifting the anchor point set by clip  24 . Pad  38  is preferably provided to spread the load of the shoulder strap more evenly across the patient&#39;s shoulder. 
         [0050]    For many procedures, it is desirable to abduct the shoulder joint to some extent prior to immobilizing it. Returning to  FIG. 1 , abducting the shoulder joint generally refers to pivoting upper arm  12  away from lateral chest  18 .  FIG. 3  shows a device which is commonly used for this purpose. Abduction pillow  34  is attached to the patient by circling belt  28  around the patient&#39;s waist. Male release  32  is then snapped into female release  30 . 
         [0051]    Once the patient&#39;s arm is properly positioned, the user presses the sling against the abduction pillow. Hook panel  36  then engages the VELCRO loop covering on the outward facing surfaces of the sling and holds the sling and abduction pillow in the desired position. 
         [0052]      FIG. 4  shows the installed abduction pillow  34  and sling  20 . The position shown is considered to be a “neutral” position. The shoulder joint is abducted somewhat (pivoted outward) but is not rotated internally or externally.  FIG. 5  shows the same assembly from a raised position looking downward. Neutral axis  40  is shown extending outward along the approximate centerline of the patient&#39;s forearm. 
         [0053]      FIG. 5  shows the patient&#39;s shoulder joint in a stabilized position. Sling  20  is attached to abduction pillow  34 , which is attached to the patient via belt  28 . Shoulder strap  22  supports the forward portion of the sling, proximate the patient&#39;s wrist. The use of hook-and-loop (VELCRO) fasteners to join the sling to the abduction pillow allows the sling to be properly positioned despite a wide variation in patient anatomy. The use of the release assemblies on belt  28  and shoulder strap  22  also allows the device to be easily installed and removed without altering its adjusted position. 
         [0054]      FIG. 5  shows an orientation in which the user&#39;s forearm is roughly aligned with neutral axis  40 . The shoulder joint is abducted somewhat—meaning that the upper arm is pivoted outward with respect to the lateral chest wall. However, no external rotation has been applied. The term “external rotation” is defined with respect to the upper arm, the forearm, and the elbow. External rotation is created by keeping the upper arm and elbow in the same position while moving the wrist outward away from the body. This motion externally rotates the shoulder joint. 
         [0055]      FIG. 5  shows the patient&#39;s wrist in the neutral position (lying on neutral axis  40 ). If the wrist is moved toward the waist then internal rotation is produced. If the wrist is moved outward then external rotation is produced.  FIGS. 6 and 7  depict a pair of external rotation wedges used to create a desired degree of external rotation. These wedges are designed to be added to the abduction pillow. It is preferable to provide a plurality of external rotation wedges with differing amounts of angular offset. External rotation wedge  42  provides 15 degrees of external rotation whereas external rotation wedge  44  provides 30 degrees of external rotation. 
         [0056]    Each external rotation wedge includes a lateral surface  68 . This lateral surface includes a hook panel (hook panel  46  for the upper rotation wedge and hook panel  48  for the lower one). Wedge portion  54  includes a fixed angular displacement. Front portion  56  faces forward. The wedge is roughly in an “L” shape when viewed from above—with the two portions joining at corner  58 . 
         [0057]      FIG. 7  shows the same pair of external rotation wedges from the opposite side. Posterior mounting surface  72  is intended to face toward the rear, while lateral mounting surface  70  is intended to face toward the side of the patient. Each posterior mounting surface  72  includes a hook panel (hook panel  50  on the upper wedge and hook panel  52  on the lower wedge). Corner  58  is formed by the intersection of the posterior mounting surface and the lateral mounting surface. The lateral mounting surface is preferably covered with loop material. 
         [0058]    The angle between lateral mounting surface  70  and lateral surface  68  (shown in  FIG. 6 ) defines the degree of external rotation provided by the particular wedge. The angular displacement between these surfaces is 15 degrees for the wedge shown at the top of the view. The angular displacement is 30 degrees for the wedge shown at the bottom of the view. A variety of angular displacements are preferably provided so that a physician or physical therapist is able to select the right amount for each particular patient. 
         [0059]      FIG. 8  shows a detailed perspective view of abduction pillow  34 . Body relief  62  is provided to conform the pillow to the user&#39;s side. The inward facing surface (not shown) is preferably provided with a material which holds the pillow in position. Anterior surface  60  is preferably covered in loop material. Lateral surface  66  includes a hook panel  36 . Corner  74  is formed by the intersection of anterior surface  60  and lateral surface  66 . 
         [0060]    Returning now to  FIG. 7 , an external rotation wedge is designed to attach to the abduction pillow by mating corner  58  on the wedge with corner  74  on the abduction pillow. The external rotation wedges are preferably made of pliable material (such as a fabric covered foam) so that the user can bend the two legs of the “L” outward. The user then presses corner  58  against corner  74  and presses the two legs back inward. The loop covering on lateral mounting surface  70  engages hook panel  36  on abduction pillow  34 . Likewise, hook panel  52  on the abduction wedge engages the loop covering on anterior surface  60  on the abduction pillow. 
         [0061]      FIG. 9  shows external rotation wedge  44  (having 30 degrees of angular displacement) installed on abduction pillow  34 . The reader will observe how hook panel  48  faces outward toward sling  20 . The sling is covered in loop material so that when the sling is pressed inward against hook panel  48  it will become attached to the external rotation wedge. 
         [0062]      FIG. 10  shows the patient after the sling has been attached to the abduction pillow. The external rotation wedge has rotated the forearm outward so that the centerline of the forearm (external rotation axis  64 ) is rotated well away from neutral axis  40 . 
         [0063]    The present invention is preferably able to function without disturbing the function of components such as those illustrated in  FIG. 10 . Accordingly, it is best to design it to fit over the existing components (though it could certainly be designed in other ways as well). 
         [0064]      FIG. 11  shows a front view of the patient with a belt and abduction pillow installed (but in this case with no external rotation wedges). It is desirable to apply cryo therapy to affected shoulder  76 . The cryo therapy device should be attached to the patient. One way to do this is to attach the cryo therapy device to belt  28  beneath opposite arm  78  (“opposite” meaning the arm that it not attached to the affected shoulder). 
         [0065]    Attachment features can be provided as part of belt  28 . As cryo therapy will not always be used, however, it is preferable to make the attachment features removable.  FIG. 12  shows contralateral pad  80 , which includes the attachment features. The contralateral pad has hook panel  88  across its width and extending a short distance out the lateral sides. (The hooks face away from the viewer in  FIG. 12 ). Hook panel  88  contains hook features facing away from the viewer in  FIG. 12 . The belt beneath opposite arm  78  contains an outward-facing loop covering. Thus, when contralateral pad  80  is pressed into the belt hook panel  88  will engage the loop covering and retain the contralateral pad in position. 
         [0066]    Two female releases  86  are attached to anchor panel  82  via pivots  84 . These female releases are part of a quick-release system that allows a user to attach and detach straps to the contralateral pad. A quick-release is any one of a number of configurations that allows the user to unlatch the release assembly by pressing on a portion or portions thereof. 
         [0067]      FIG. 13  shows contralateral pad  80  installed on belt  28  beneath opposite arm  78 . Hook panel  88  is locked into the loop covering on the exterior of belt  28  to maintain the desired position.  FIG. 14  shows the device which actually applies the cryo therapy to the shoulder. Retention panel  90  is intended to press inward against the affected shoulder. It has an inward facing surface intended to bear against the shoulder. This inward facing surface is preferably provided with loop covering. 
         [0068]    In order to conform to the curved shape of the human shoulder the retention panel is preferably divided into two sections split by channels  108 . Lower extension legs  106  lie on one side of the channel while upper extension legs  109  lie on the other. Each pair of upper and lower extension arms is joined by a connecting strap  110 . The connecting strap  110  closest to the viewer in  FIG. 14  passes through anterior buckle  92 . The connecting strap that is farthest from the viewer passes through posterior buckle  94 . 
         [0069]    The retention panel must be attached to the patient so that it remains in the propoer position. One way to accomplish this goal is to use straps.  FIG. 14  shows anterior strap  96  passed through anterior buckle  92 . One end of the anterior strap includes male release  100 . This is configured to snap into one of the female releases  86  on contralateral pad  80 . 
         [0070]    Posterior strap  98  passes through posterior buckle  94 . It includes female release  102 , which is also configured to attach to contralateral pad  80 . The straps may be adjusted and secured using any suitable hardware. One approach is to provide a hook panel  104  on the free end of each strap (The hook panel on anterior strap  96  is facing away from the viewer in  FIG. 14  and is therefore not visible). 
         [0071]    The outward facing surfaces of the two straps are preferably provided with a loop covering. It is thus possible to pass the straps through the respective buckles, pull them to the appropriate length, and then press the hook panel on each strap into the loop covering in order to secure the strap in position. 
         [0072]      FIGS. 15 and 16  show these steps. In  FIG. 15 , anterior strap  96  and posterior strap  98  have each been connected to contralateral pad  80 . Once retention panel  90  and the securing straps are in position, the user can grasp the free ends of the two straps and pull them toward the contralateral pad. 
         [0073]    It is preferable to provide an elastic element in the straps so that they can elongate to some extent. Once the desired amount of tension is achieved, the user presses the hook panel  104  on each strap against the loop covering on the opposite side of each strap.  FIG. 16  shows the assembly with the two straps fixed in position. The retention panel is thereby properly positioned on the affected shoulder. 
         [0074]      FIG. 17  shows retention panel  90  lying over the affected shoulder. The reader will note how the anterior lower leg extension  106  and upper leg extension  109  overlap each other—thereby allowing the retention panel to conform to the curved shape of the shoulder. Connector strap  110  slides freely through anterior buckle  92  in order to evenly distribute the tension supplied by anterior strap  96 . 
         [0075]    The reader will also observe how the cryo therapy devices lie over the top of the shoulder stabilizing hardware (shoulder strap  22 , etc.). Thr cryo therapy devices do not interfere with the function of the other devices. 
         [0076]    As stated previously, a cryo therapy system preferably includes the ability to exchange expended “cold packs” for fresh ones.  FIG. 18  shows the type of cold pack which is preferred for the present invention (though the invention will function with many different types of cold packs). Two cold packs  112  are shown in the view. Each cold pack has two sides. The first side preferably includes a smooth fabric covering that is intended to face toward the user&#39;s shoulder. The second side faces away from the user and is intended to face toward the inward facing surface of the retention panel. 
         [0077]    The cold pack  112  at the top of  FIG. 18  has its first side facing upward (soft surface  124 ). The cold pack  112  at the bottom of  FIG. 18  has its second side facing upward. The second side includes one or more hook panels  118 . These hook panels are configured to engage the loop covering on the inward facing surface of the retention panel. 
         [0078]    Each cold pack  112  also preferably contains a vent  114 . As stated previously, the preferred embodiment of the cold pack uses a cooling medium which freezes in a random crystalline structure similar to snow. When the freezing is occurring the cooling medium expands substantially and bulges the cold pack outward (like a pillow). Vent  114  allows ambient air to enter the cool pack so that it can more freely expand. 
         [0079]    When the cool pack is applied to the shoulder, heat from the patient&#39;s body melt&#39;s the frozen cooling medium and it gradually transitions back to a liquid. Vent  114  then allows some of the air within the cold pack to escape so that the cold pack collapses into a flat state. The vent is designed to prevent any leakage of the cooling medium itself. 
         [0080]    The cold packs can be made in any suitable shape. For example, it may be desirable to provide arcuate relief  116  so that the pack may more easily rest proximate the neck. 
         [0081]    Now that the retention panel and the cold packs have been explained in detail, the method of using the invention will be discussed.  FIGS. 19-23  illustrate this process.  FIG. 19  shows retention panel  90  in place on the affected shoulder of a patient. Retention panel  90  has lower edge  126  on its lower extreme and upper edge  128  on its upper extreme. 
         [0082]    In order to install a cold pack, a user grasps lower edge  126  and flips it upward as shown in  FIG. 20 . This action exposes the loop covering on the inward facing surface of the retention panel. The retention panel may be thought of as being divided into two portions (lower portion  120  and upper portion  122 ). Lower edge  126  is folded over upper portion  122 . The retention panel preferably remains in the folded state shown without a user having to hold it there. 
         [0083]    In  FIG. 21 , the user has pressed a cold pack  112  (with the hook panels facing inward) against the loop covering on lower portion  120 . Soft panel  124  is facing outward in the configuration shown. Once the cold pack is secured, the user flips lower edge  126  back to its starting position. The cold pack is thereby inverted and placed against the patient. 
         [0084]      FIG. 22  shows the same process being performed for upper portion  122 . The user has flipped upper edge  128  downward to expose the loop covering on the inward facing surface of upper portion  122 . The user places a second cold pack  112  on this surface by pressing it into position. The user then flips upper edge  128  back upward into position. 
         [0085]      FIG. 23  shows retention panel  90  in position with two of the cold packs installed. The user may optionally adjust the anterior and posterior straps to provide a comfortable fit with the cold packs in place. 
         [0086]    Of course, the sequence of steps described can be performed in any desired order. The user may elect to place the upper cold pack first and then place the lower cold pack. The user may only place a single cold pack under the retention panel. The entire inward facing surface of the retention panel is preferably covered in loop material so that the user may place the cold pack(s) in many different positions. 
         [0087]    Although the preceding descriptions present considerable detail they should be properly be viewed as illustrating embodiments of the present invention rather than limiting the scope of the invention. Many more embodiments following the same principles will occur to those skilled in the art. For example, snaps or buckles could be substituted for the hook-and-loop attachments described. As a second example, the retention panel could be attached to the patient using attachment points other than the belt. Accordingly, the scope of the invention should be fixed by the following claims rather than by the examples given.