Abstract:
High friction scapular retraction straps for application directly to the tops of the respective shoulders of a patient and connected with tension straps to draw the gripper straps and, consequently, the shoulders rearwardly, and including fasteners to fasten to a garment worn by the patient to hold the shoulders rearward.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to medical orthopedic devices and particularly to braces for improving the posture of a patient to treat medical ailments. 
     2. Brief Description of Related Art 
     Medical costs are one of the greatest concerns to various societies throughout the world, including the United States, which is involved in disputes over procedures and laws to be followed in an effort to reduce the tremendous expenses to consumers, taxpayers, the government and insurance companies stemming from various different types of maladies. Additionally, may patients suffering from spinal or structural maladies are forced to endure long term pain and deterioration of the body stemming from various injuries, skeletal deterioration, osteoporosis and the like. 
     Tasks involved in everyday work compound the problems encountered by patients tending to suffer from the affliction stemming from improper posture. Much of the work performed by various individuals involves addressing work pieces located forward of the body, such as on a desk or the like, as in the case of personal computers, where workers tend to sometimes hunch over, bend the spine forward and oftentimes fold the shoulders forwardly into improper posture positions. 
     The bones in the thoracic and particularly in the shoulder girdle area, include the clavicle and scapula, which can be generally described as a flat or planar bone of triangular shape, situated back of the rib cage and typically articulated with movement of the arms, oftentimes shifted forwardly and downwardly when the worker concentrates intently on desk work or machining or work activity located forwardly and downwardly from the worker&#39;s head or neck. The shoulder joint is a ball-and-socket joint formed by a large globular head of the humerus and the elongated glenoid cavity in the scapula which receives the humeral head. The ligaments of the shoulder encircle the ball-and-socket structure and are often exposed to considerable stress or repetitive movement, all too frequently resulting in irritation and inflammation of the muscles and tendons, even to the point requiring surgery or considerable physical therapy in an effort to overcome the pain and discomfort involved. 
     The thoracic spine and shoulder are constructed to work in tandem to maintain the patient standing tall and with a pleasing posture. Injury or instability can result in stooping, leading to pain throughout the body from headaches to lower back pain, and general diminishment in the quality of life. 
     It has been recognized that spinal injury typically stems from imbalance, such as a person&#39;s posture slouching forward for extended periods of time, which may cause tight anterior musculature and weak posterior musculature, sometimes even resulting in pectoral muscles in the chest becoming permanently shortened, thus making it difficult of not impossible for the worker to fully straighten his or her back and hold the shoulders back. This imbalance is the cause of numerous different injuries and afflictions, specifically in the neck, shoulder and spine area, oftentimes resulting in the loss of work time sometimes even debilitating the worker to the point where he or she must be assigned different tasks. 
     Posture changes which occur over time are typically referred to as kyphosis. When the vertebrae fracture, typically in the upper (thoracic) spine, the patient will oftentimes experience pain, height loss, and a stooped or hunched posture. 
     The spine is made up of numerous small bones called vertebrae. The various regions of the spine from the bottom (sacrum), to the middle (thoracic) to the top (cervical) can be hunched leaving the head and/or shoulders hunched forwardly of the torso to present undesirable posture. 
     Osteoporosis afflicts some 50% of women over 50 years of age and decreases of the density of the vertebrae of the spine which oftentimes leads to vertebral fractures which can result in severe pain and discomfort in the patient and millions of dollars in medical costs. The available data reveals that spinal fractures and/or compression fractures in the spine occur in some 550,000 cases per year as a result of osteoporosis. 
     A patient&#39;s recovery from surgery or injury can be stimulated by inducing the patient to assume a more appropriate posture. The various types of injuries experienced can include torn rotor cuff, SLAP (Superior Labral from Anterior to Posterior) tear, shoulder instability, sub-acromial decompression, labral tears, and impingement on the nerves or joints. In each instance rehabilitation may benefit from some degree of posture improvement and/or immobilization. 
     Various types of harnesses have been proposed for improving posture, typically incorporating upper straps extending over the shoulders and lower straps which extend underneath the armpits to partially embrace the shoulders. These devices typically suffer the shortcoming that the straps underneath the arms contribute to the discomfort of the patient wearing the device, thus discouraging use and defeating the effect sought in treatment of the patient&#39;s posture 
     In recognition of the benefits that could be experienced from braces and therapeutic devices to induce better posture, it has been proposed to fit the patient with a short-sleeved shirt such as a t-shirt or other garment and provide crossed straps extending over the shoulders, attached to run across the exterior of the t-shirt or garment and attached at the lower extremities to a device on the garment to hopefully draw the shoulders rearwardly. A device of this type is shown in U.S. Pat. No. 6,440,094 to Maas. A similar device but for use with a pad or the like to be held in the center of the back is shown in U.S. Pat. No. 7,871,388 to Brown. 
     While serving some of the intended purpose, the shortcoming of devices of this type is that the patient typically benefits most from having the upper area of the shoulders drawn rearwardly to maintain the shoulder blade or scapula in more of a vertical plane. It has been discovered that by extending the restraining straps over the outside of the garment and over the top of the shoulders, the effectiveness of holding the shoulders back is compromised, and thus does not provide the desired effectiveness for improving posture and serving to rehabilitate patient&#39;s injuries and the like. 
     SUMMARY OF THE INVENTION 
     Briefly and in general terms, the present invention is directed to a scapula retaining device including friction straps extending from the pectoral areas at opposite sides where they are anchored to the interior of a garment to extend over the respective shoulders, gripping directly against the tops of the shoulders, to attach to tension straps which pass diagonally across the back and exit the opposite sides of the garment to releasably attach to the exterior of the garment to anchor such tension straps down drawing the tops of the shoulders rearwardly. 
     The features and advantages of the invention will be more readily understood from the following detailed description which should be read in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a front view of a dynamic thoracic lumbar sacral posture garment device incorporating the present invention; 
         FIG. 2  is a front view of a rigid back brace that may be used with the garment device of  FIG. 1 ; 
         FIG. 3  is a front view of a second embodiment of a rigid back brace that may be employed with the garment device shown in  FIG. 1 ; 
         FIG. 4  is a back view of the dynamic thoracic lumbar sacral posture garment device shown in  FIG. 1 ; 
         FIG. 5  is a transverse sectional view, in enlarged scale, taken along the line  5 - 5  of  FIG. 4 ; 
         FIG. 6  is a partial side view taken along the line  6 - 6  of  FIG. 5 ; 
         FIG. 7  is a back view of the posterior panel shown in  FIG. 2 ; 
         FIG. 8  is a back view similar to  FIG. 7  but showing a modification where the back panel is covered with fabric; 
         FIG. 9  is a transverse sectional view, in enlarged scale, taken along the line  9 - 9  of  FIG. 8 ; 
         FIG. 10  is a front view of the posterior brace shown in  FIG. 3 ; 
         FIGS. 11 ,  12  and  13  are transverse sectional views taken along the lines  11 - 11 ,  12 - 12  and  13 - 13  respectively of  FIG. 10 ; 
         FIG. 14  is a front view of the garment device shown in  FIG. 1  in its open position; 
         FIG. 15  is a front view similar to  FIG. 14  but showing the posterior panel of  FIG. 3  disposed in position; 
         FIG. 16  is a vertical sectional view, in enlarged scale, taken along the line  16 - 16  of  FIG. 15  showing the garment on a patient and with the brace of  FIG. 3  disposed in position; and 
         FIG. 17  is a three-quarter rear perspective view of the garment device shown in  FIG. 1  worn by a patient. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring now in more detail to the exemplary drawings for purposes of illustrating embodiments of the invention, wherein like reference numerals designate corresponding or like elements among the several views, 
     The thoracic lumbar sacral posture garment of the present invention includes, generally, a garment  31  formed with a back panel  33 , front panels  35 , fastened by a zipper  38 , shoulder straps  37 , and an interior tensioning device, generally designated  39 . The tensioning device includes respective scapular gripping straps  41  anchored to the garment in the pectoral area  43  to pass over the patient&#39;s shoulder and be attached to respective tension straps  45  which cross over one another in the back of the patient and pass through respective access slots  47  in the front panels to attach at their respective free extremities to fasteners, jointly designated  51 , on the lower portion of the respective front panels. 
     It is important to alignment of the spine and relief of spine-related and even shoulder-related maladies that the top of the shoulders  59  ( FIG. 17 ) of the patient be drawn rearwardly thereby straightening the scapulas and tending to straighten and unload the spine to thereby maintain the desired posture for facilitating recovery and to minimize further injury stemming from fractures, ligament inflammation, ligament tears and afflictions related to osteoporosis. In this regard, it is an objective of the present invention that the internal tensioning device  39  provide for a gripping action at the top surface of the patient&#39;s shoulders  59  and apply rearward forces to the top of the shoulders, to preferably torque the scapulas as the shoulders are drawn rearwardly or posterially to maintain the desired posture itself. 
     To this end, the garment in the preferred embodiment is constructed of stretchable, elastic breathable material capable of applying substantial compression to compression upon being stretched tight on the patient&#39;s torso to thereby maintain a firm grip on the patient&#39;s waist area to thus provide secure anchoring so that the rearward forces applied by the tensioning device  39  will apply the desired rearward forces to the tops of the patient&#39;s shoulders. 
     In this regard, the garment  31  serves as somewhat of a harness, having a high level of elasticity, but with a great degree of constraint to thereby, when the zipper fastener  38  is fastened, hold the garment relatively tight around the patient&#39;s abdomen and waist to thereby form a solid anchor for the tensioning device  39 . A material which serves this function quite favorably is a seamless orthopedic compression material with 360 degree stitching with three dimensional compression available from QSD, Lavel, QC, Canada, HZS 2G2. 
     In construction, the garment includes the usual marginal reinforcing bands  61  and  67  to which the respective zipper sections are connected, and includes a waistband  63  ( FIG. 14 ). Wire eyes  46  are attached in vertically spaced apart relationship on one marginal edge along the zipper and wire hooks  48  attached to the confronting marginal edge for hooking into the respective eyes to hold the garment in closed relationship. 
     The garment is formed in the lower waist portion with a pair of expandable, downwardly opening, V-shaped vents  67  with which allow for expansion of the waist area to accommodate different waistlines. 
     The scapula gripping straps  41  of the tensioning device  39  are constructed of high-friction material such as neoprene, silicone, breathoprene, adhesive foam or any other material that has a high friction surface to securely and positively grip the top surfaces of the patient&#39;s shoulder to provide for high-friction contact to thereby cooperate in the tension straps pulling forward on the tension straps to thereby draw the top area of the shoulders forwardly, thereby improving the patient&#39;s posture. In the preferred embodiment, these straps  41  are inelastic at the level of forces applied of about 25 pounds so as to minimize stretching and relative movement on the surfaces of the shoulders to thus minimize the tendency to break contact, thereby maintaining the grip. 
     In the preferred embodiment, the tension straps  45  are elastic so that upon application of 10-15 pounds force or more they will stretch to thereby allow for bending and turning of the patient&#39;s torso while maintaining the desired tension drawing the back ends of the respective gripper strips  41  rearwardly and downwardly to maintain a firm application of force on the tops of the respective shoulders. 
     Referring to  FIGS. 14 and 17 , it will be noted that the shoulder straps  37  formed with the garment are configured to rest on the tops of the shoulders and preferably incorporate restraining straps  71  ( FIG. 5 ) which constrain the scapula gripping straps  41  ( FIG. 5 ) in position to thus maintain those scapula straps in the most preferential position for applying torque to the tops of the shoulders to draw them rearwardly as tension is applied thereto. 
     Referring to  FIGS. 1 and 4 , in the preferred embodiment the garment device includes a waist belt, generally designated  79 , which will fit over the lower waist area of the garment and includes on its opposite ends respective fasteners typically in the form of loops and pile  81  and hooks  83  for adjustably fastening the waist band over the lower portion of the garment device to cooperate in holding it downwardly on the torso of the patient. 
     In practice, the garment is so constructed that its elasticity cooperates in gripping the wearer&#39;s waist and torso area, as augmented by the belt  79  when the fasteners  81  and  83  are closed on one another in tight relationship to establish a secure anchor for the lower portion of the garment as the tension straps are tightened. The passage of the tension straps  45  from the interior to the exterior of the garment as dictated by the passage slots  47  is preferably spaced below the armpits, typically in the height of the midriff or thoracic area and is angled and oriented such that the straps themselves will be directed toward the respective fastener panels  51  on the front panels of the garment ( FIGS. 1 ,  14  and  17 ). 
     Some embodiments of the garment are configured to incorporate a back support plate, generally designated  101 , ( FIG. 2 ) or a back support plate stem  103  (FIGS.  3  and  10 - 13 ). The back plate  101  may be constructed with a generally forwardly opening structure configured on its opposite sides with outwardly flared upper and lower wings  107  and  109  into which the upper and lower thoracic areas of the wearer&#39;s body might nest. In the preferred embodiment, the plate  101  is formed centrally with a ventilation opening  111  and may be covered with a fabric  113  ( FIGS. 8 and 9 ). In one modification, the plate  111  may be formed with a downwardly opening u-shaped reinforcing ribs  115  ( FIG. 7 ). 
     The stem plate  103  is somewhat t-shaped in a vertical plane and incorporates a stem  121  spaced along its central area with ventilation apertures  123  and configured in its upper extremity with upwardly flared support wings  125  which also include upward and outwardly angled apertures  127 . 
     The bodies of the support plate  101  and stem  103  incorporate hard plastic or may in some instances be constructed of thin aluminum, carbon steel or other relatively rigid materials to lend support to the wearer tending to immobilize the spine and body parts for cooperating with the scapular tension straps to provide support for the wearer and further cooperate in tending to provide somewhat of a pivot point for rotation of the upper portions of the scapulas when the tension straps are tightened and the upper portions of the shoulders drawn rearwardly. 
     In operation, it will be appreciated that when the garment is to be donned by a wearer, the tab  50  of the zipper fastener  38  will be grasped to unzip the garment to be more or less laid open as shown in  FIG. 14 . The garment may then be raised to be placed over the wearer&#39;s shoulder by inserting the arms through the respective openings  40  under the respective shoulder straps and the scapula gripping straps placed over the shoulders to dispose the respective gripping surfaces  42  in direct contact with the wearer&#39;s skin to provide for frictional contact of such surface for high-friction engagement and to provide resistance against rearward sliding of the straps on the surface of the skin. The garment may then be drawn forwardly around wearer&#39;s sides so the wearer may engage the hook and eyes  46  and  48  to hold the marginal edges of the garment in close proximity to one another as the wearer or technician grasps the zipper tab  50  to fit the zipper together and draw the garment further together around the patient&#39;s thoracic  90 , lumbar  92  and sacral  94  of the wearer to thereby apply constraining forces and high friction to the lower portion of the torso, to thereby provide secure anchorage to the torso of the wearer (FIG.  17 ). The belt  79  may then be wrapped about the waist of the garment and drawn tight to secure the fasteners  81  and  83  ( FIG. 1 ). The wearer or medical technician may then grasp the free ends of the tension straps  45  on the exterior of the garment and draw the tension straps firmly around the thoracic to draw the scapula gripping straps rearwardly to draw the tops of the shoulders rearwardly and, while maintaining the tension, attach the loop and pile fasteners  48  and  52  in tensioning relationship on the respective loop and pile fastener panels  51  to thereby cause the frictional engagement of the scapular straps  41  to maintain the upper portion of the shoulders  59  rearwardly as shown in  FIG. 17 , thereby pivoting the patient&#39;s scapulas rearwardly and enhancing the posture of the patient, and, with fastening of the fasteners on the panels  51 , cause the shoulders to be so maintained in favorable posture position. 
     Then, the patient may go about his or her dynamic daily activities with the shoulders held rearwardly at the upper extremities, free to maneuver his or her chest area about in different directions with the arms free to undertake their daily tasks, all the while secure in the recognition that the top of the shoulders are held rearwardly and constantly reminded of the fact that the shoulder should be so maintained in rearward orientation to thereby provide support for the particular shoulder injury, spine injury or the like being treated so that the improved posture and support will facilitate healing of the particular tears or fractures being treated and restrict forward and downward movement of the shoulders which would otherwise further irritate or aggravate the particular injury. 
     It will be appreciated that with this particular construction, the top of the shoulders are held rearwardly while leaving the arms free to move about in a normal fashion without restriction by straps and retainers extending underneath the armpits and the like. 
     This support then tends to facilitate more rapid and full recovery from many types of shoulder injuries, spinal dysfunction and further affords support against stooping posture. By stabilizing the thoracic and lumbar spine, the vertebrae and other structure which may be suffering from injury will heal more rapidly. Holding the tops of the shoulders rearwardly induces muscular activation in a favorable manner, tending to strengthen and shorten the back muscles while extending the pectoral muscles extend to thereby tend towards more favorable posture and support to overcome weak posterior musculature conditions. The support afforded will tend to accelerate rehabilitation of injuries to the rotor cuff labrum and provide support against shoulder instability, relieves discomfort from osteoporosis and will tend to retrain the patient&#39;s movement away from postural dysfunction. 
     For certain types of spinal dysfunction or ailments, it is desirable to incorporate the support and posture positioning of the inventive garment with additional more rigid back support, either along the line of the spine or, in some instances, extending laterally about the back area. For the more extensive support across the lateral back area, a back support panel  101  may be inserted inside the back area of the garment during the application of the garment to the wearer and prior to tightening the tension straps  45 . In this regard, in some embodiments, a pocket similar to the pocket  91  for the stem support  105  is provided for nesting of the back support panel  101  in position as the garment is placed on the wearer. Then, as the tension straps are tightened to draw the scapula support straps  41  rearwardly, tension is also applied to the back support panel  101  to provide for stabilization of the spinal area, as well as applying support to the lower portion of the patient&#39;s scapulas to thus to maintain the lower portion of the scapulas pressed forwardly and providing a fulcrum for the scapulas as the support straps  41  are drawn rearwardly to thus enhance the tendency of the upper portion of the scapulas to be drawn rearwardly and affording additional support tending to maintain the scapulas in their preferred positions to improve posture. Likewise, the wings  107  on the opposite sides of the support panel tend to hold the thoracic area in a stabilized condition tending to enhance immobilization of the spine and related areas thus enhancing the overall healing effect of the combination. 
     In other applications, the therapeutic prescription may call for more support in the spine area of the patient, and with less concern for stabilization of the lateral portions of the back, thereby dictating application of the stem brace  103  in a manner similar to that just described for the support panel  101 . In those instances, it is possible to merely insert the spine brace  103  within the panel before the tension straps  45  are tightened. In those embodiments where a pocket  91  ( FIG. 15 ) is formed in the interior lower waist area of the garment, the bottom end of the stem may be inserted in that pocket to thus facilitate positioning during application of the garment itself to the patient. 
     In either the case of the support panel  101  or stem brace  103 , it will be appreciated that use of those rigid supports in combination with the garment itself will facilitate immobilization of the various body parts and tend to maintain the shoulders drawn rearwardly and somewhat stabilized, thereby tending to enhance the rate of healing for the particular ailment being treated. 
     With the foregoing, it will be appreciated that the garment of the present invention provides a particularly effective support for the patient and will enhance the effectiveness of the garment to maintain the top of the shoulders drawn rearwardly to thereby improve posture and potentially accelerate the healing effect stemming from such improved posture and tendency for immobilization. 
     The invention may be embodied in other forms without departure from the spirit and essential characteristics thereof. The embodiments described therefore are to be considered in all respects as illustrative and not restrictive. Although the present invention has been described in terms of certain preferred embodiments, other embodiments that are apparent to those of ordinary skill in the art are also within the scope of the invention. Accordingly, the scope of the invention is intended to be defined only by reference to the appended claims.