Abstract:
The invention relates to a medical device and method for evaluating and treating scapulothoracic mobility disorders. The invention facilities examination and treatment of the scapulothoracic motion interface.

Description:
FIELD OF THE INVENTION 
     The invention relates to a medical device and method for evaluating and treating scapulothoracic mobility disorders. 
     BACKGROUND OF THE INVENTION 
     Healthy shoulder movement depends the scapulothoracic interface. The scapulothoracic motion interface is the site of movement between the scapula (shoulder blade) and the rear chest wall (thoracic cavity or ribcage). In normal motion, the scapula moves across the rear chest wall by gliding on the scapulothoracic interface. 
     Tight body tissues located at the interface between the scapula and rear chest wall limit scapulothoracic mobility, thus limiting shoulder movement and contributing to upper extremity pain. Conventional therapy for relieving tightness involves a therapist manipulating these tissues by extending their fingers underneath and between the scapula and ribcage. This requires exerting force on the tissues and scapula during which the small bones of the therapist&#39;s hands are placed under stress and may tire quickly or become injured. 
     The therapist subjectively evaluates the seriousness of the tissue tightness by-feel from mild to moderate to severe and lacks a method to objectively measure scapulothoracic interface tightness and the effectiveness of treatments. 
     Another problem with the scapulothoracic interface is scapular winging. Scapular winging is the result of weak or injured muscles between the scapula and rear chest wall so that the scapula rises away from the chest wall. Scapular winging can also limit scapulothoracic mobility and related shoulder movement. 
     Scapular winging is subjectively evaluated by visual inspection from “mild” to “moderate” to “severe”. Therapists lack a method to objectively measure scapular winging and the effectiveness of treatments. 
     Thus there is a need for a medical device for evaluating and treating scapulothoracic mobility disorders. The medical device should allow a therapist to objectively measure patient scapulothoracic tightness and scapulothoracic winging and evaluate patient condition and the effectiveness of treatment. The device should allow a therapist to exert force on scapulothoracic tissues without stressing the therapist&#39;s hands. 
     SUMMARY OF THE INVENTION 
     The invention is a medical device for evaluating and treating scapulothoracic mobility disorders. The medical device allows a therapist to objectively measure a patient&#39;s scapulothoracic tissue tightness and scapulothoracic winging to evaluate patient condition and the effectiveness of treatment. The device allows a therapist to exert force on tissues at the scapulothoracic interface without stressing the therapist&#39;s hands. 
     The medical device includes a base that is placed on a patient&#39;s back and a handle for control of the device. The base includes a measurement edge that is extended under a patient&#39;s scapula. The base includes a gage that allows a therapist to measure the depth of measurement edge insertion into the recess formed between the scapula and rear chest wall. The depth of insertion provides an objective indication of scapulothoracic mobility. 
     In further use, the therapist can use the device to exert forces on the tissues at the scapulothoracic interface while measurement edge is inserted under the patient&#39;s scapula. The handle allows easy use by either hand and prevents stresses from being transmitted to the small bones of the hand during treatment. The handle additionally allows the therapist exert forces on the handle using two hands or a forearm. This allows the therapist to conduct longer and more concentrated treatment sessions with lowered risk of hand stress and injury. 
     The device may also measure scapular winging by including a second gage that measures the distance of vertical separation between the scapula and the rear chest wall. The second gage objectively measures scapular winging. 
     Other objects and features of the invention will become apparent as the description proceeds, especially when taken in conjunction with the accompanying drawing sheets illustrating embodiments of the invention. 
    
    
     
       DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of the device; 
         FIG. 2  is an top view of the device; 
         FIG. 3  is an top view for a preform for producing the device body; 
         FIG. 4  is a top view of the sliding gage assembly housing; 
         FIG. 5  is a front view of the sliding gage assembly housing; 
         FIG. 6  is a side view of the sliding gage assembly housing; 
         FIG. 7  is a side view of the sliding gage assembly sliding member; 
         FIG. 8  is a top view of the sliding gage assembly sliding member; 
         FIG. 9  is a front view of the sliding gage assembly sliding member; 
         FIG. 10  is a cutaway side view of the device in use on a patient; 
         FIG. 11  is a top view of the device in use on a patient; 
         FIG. 12  is a top view of the device in use with patient skin removed; 
         FIG. 13  is a top view of the device in use on a patient; 
         FIG. 14  shows the device prepared to manipulate a patient&#39;s scapula; and 
         FIG. 15  shows the device used to manipulate a patient&#39;s scapula. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Scapulothoracic interface medical device  10  is made up of an elongate, generally L-shaped body  12  having a base  14  and a handle  16 . Body  12  may be formed from plastic, such as acrylic, polycarbonate or other commonly available formable materials. 
     Base  14  is generally rectangular with a length  18  and a width  20  and includes bottom contact surface  22 , top surface  24  and measurement edge  26 . Engagement surface  27  extends from measurement edge  26  to bottom contact surface  22 . The top surface  24  of base  14  includes a measurement scale  28  made up of a number of printed or etched lines parallel to measurement edge  26  and extending at regular distances from edge  26  toward handle  16 . Base  14  may also include rounded corners  30 . 
     Handle  16  is generally rectangular with a length  32  and a width  34 . The handle includes a grip  36  and a handle aperture  38  to allow a therapist to use their thumb to control handle  16  as seen in  FIGS. 11-15 . Aperture  38  may be centrally located on the handle and symmetrically ovular or elliptical in shape to allow a therapist to use either their right or left thumb when gripping the handle. Alternatively, a therapist may grip the handle with two hands or use their forearm to transmit forces to the handle. 
     Handle  16  may also include contours extending along length  32  to either side of handle aperture  38  (not illustrated). The contours may be shaped to conform a therapist&#39;s hand when a right or left thumb is used to gripping to the handle. 
     Base  14  may have a length  18  less than handle length  32 . The larger handle length  32  allows a therapist to effectively apply a concentrated force to measurement edge  26  as well as allow a therapist to use two hands or a forearm when controlling device  10  as explained in greater detail below. 
     Body  12  may be formed from preform  40 , which is molded or cut from plastic of other materials. See  FIG. 3 . Preform  40  is folded or bent along line  42  to form a L-shaped body  12 . 
     If desired, device  10  may include sliding gage assembly  44 . Assembly  44  is made up of housing  46  and sliding member  48 . Housing  46  is formed from base  50  and two legs  52  extending away from base  50  and generally parallel to each other to form a generally U-shaped housing. Fastener aperture  54  extends though base  50  at one end of the housing. Housing  46  is joined to body  12  at the intersection of base  14  and handle  16  so that base  14 , base top surface  24  and legs  40  form passage  56 . 
     Sliding member  48  is made up of a plate  58  attached to elongate beam  60  so that the bottoms of the plate and beam are aligned and the beam is substantially perpendicular to the length of the plate. Groove  62  is located on the upward facing portion of beam  62 . Groove  62  extends from the end of the beam attached to the plate to a stop  64  located at the other end of the beam. 
     Sliding gage assembly  44  is formed by inserting the free end of beam  60  into passage  56 . Sliding member  48  is held in place by inserting a fastener  66  though fastener aperture  54  so that the lower end of fastener  66  extends into groove  62 . Stop  64  prevents sliding member  48  from becoming detached form assembly  44  while fastener  66  is in place. 
     If desired, the front face  68  of plate  58  may include a second measurement scale  70  like scale  28  made up of a number of printed or etched lines as shown in  FIG. 9 . 
     Housing  46  and sliding member  48  may be formed from the same material as body  12 . 
     In use, device  10  is placed on a patient&#39;s back  74  so that contact surface  22  rests on the layer of soft thoracic tissues  76  located above the patient&#39;s rib cage  78 . Scapula  80  is surrounded by soft scapular tissue  82 . Back tissue  76  and scapular tissue  82  join at scapulothoracic interface  84 . 
     To evaluate scapulothoracic mobility for a shoulder, a therapist places base  14  along the patient&#39;s back so that contact surface  22  is in contact with the back and measurement edge  28  is placed adjacent scapula  80 . Base  14  is then gently slid underneath scapula  80 . Flat contact surface  22  and rounded corners  30  facilitate sliding base  14  underneath scapula  80 . 
     As base  14  is slid underneath scapula  80 , the base forms a recess  86  between the scapula and the rear chest and engagement surface  27  establishes contact with the soft tissue at scapulothoracic interface  84 . When surface  27  meets resistance from the soft tissue at scapulothoracic interface  84 , the therapist stops sliding base  14  under scapula  80 . 
     The therapist then measures the location of outer scapula edge  88  on measurement scale  26  as shown in  FIGS. 11 through 13 . Sliding gage assembly  44  may be used with measurement scale  28  to measure the distance between scapulothoracic interface  84  and scapula edge  88 . The distance is noted by the therapist as an objective indication of the tightness of soft tissue at the scapulothoracic interface. 
     The therapist may then continue to use the device to treat the soft tissues at the scapulothoracic interface. Treatment is applied by the therapist exerting pressure on the scapulothoracic tissues. The pressure encourages loosening of the tissues. This loosening increases mobility between the scapula and the rear chest wall. 
     The therapist may grasp the patient&#39;s shoulder  90  as shown in  FIG. 14  and turn it slightly upward as shown in  FIG. 15 . As the shoulder is turned, the therapist allows base  14  to more fully apply pressure from engagement surface  27  to the soft tissues at scapulothoracic interface  84 . Pressure is maintained until the therapist determines that a loosening effect upon the soft tissues has been achieved. 
     Device  10  may be held by handle  16  by one hand as shown in  FIGS. 14 and 15 . Alternatively, the therapist may choose to place a forearm against handle  16  or use two hands on the handle in order to exert a greater force against the soft tissues at scapulothoracic interface  84 . The handle allows easy use by one hand, two hands or by the therapist&#39;s forearm. A handle having a grip  36  larger area than engagement surface  27  base allow the therapist to apply concentrated forces to the soft tissues at scapulothoracic interface  84  without exposing their hands to undue pressures. 
     To evaluate scapular winging, the therapist places base  14  along the patient&#39;s back  74  so that contact surface  22  is in contact with the back and measurement edge  28  is placed adjacent scapula  80 . Base  14  is placed adjacent scapula  80 . The therapist then measures the position of edge  80  on second measurement scale  70 . The reading on measures the winging distance between scapula edge  88  and the back  74 . The distance is noted by the therapist as an objective indication of the weakened or damaged muscles at the scapulothoracic interface. 
     Alternatively, scapular winging may be measured by placing device  10  on the patient&#39;s back  74  so that base  14  is placed generally perpendicular to the back and measurement edge  26  is in contact with back  74 . The therapist may then measure the position of edge  80  on measurement scale  28 . 
     While I have illustrated and described preferred embodiments of my invention, it is understood that there are capable of modification, and I therefore do not wish to be limited to the precise details set forth, but desire to avail myself of such changes and alterations as fall within purview of the following claims.