Patent Publication Number: US-11026857-B2

Title: Shoulder hold-down and locking mechanism therefor for use with a surgical frame

Description:
FIELD 
     The present technology is generally related to a shoulder hold-down and a locking mechanism therefor for use with a surgical frame. 
     BACKGROUND 
     Surgical frames have been used to position and reposition a patient during surgery. For example, surgical frames have been configured to manipulate the rotational position of the patient before, during, and even after surgery. Such surgical frames include support structures to facilitate the rotational movement of the patient. Typical support structures can include main beams supported at either ends thereof for rotational movement about axes of rotation extending along the lengths of the surgical frames. The main beams can be positioned and repositioned to afford various positions of a patient positioned thereon. To illustrate, the main beams can be rotated for positioning a patient in prone positions, lateral positions, and positions 45° between the prone and lateral positions. However, given the rotational movement of the main beams, there is a desire for one or more shoulder hold-downs used in securing a shoulder or shoulders of the patient in position during such rotation. 
     SUMMARY 
     The techniques of this disclosure generally relate to one or more shoulder hold-downs and/or locking mechanisms therefor used for securing the shoulder or shoulders of a patient in position to facilitate rotational positioning and repositioning of the patient using a surgical frame. 
     In one aspect, the present disclosure provides a locking mechanism for use with a surgical frame, the locking mechanism including an arm portion including a first shaft portion, a second shaft portion, and a first flange portion, the arm portion including a first end, an opposite second end, a mid-longitudinal axis extending through the first end and the second end, and a channel extending from at least adjacent the first end to at least adjacent the second end along the mid-longitudinal axis, the channel receiving portions of the second shaft portion therein, the first shaft portion including a first exterior surface, the second shaft portion including a second exterior surface, the first shaft portion adjacent the first end of the arm portion including a first aperture on a first side of the channel, the first shaft portion adjacent the first end of the arm portion including a second aperture on a second side of the channel, and the second shaft portion adjacent the first end of the arm portion including a third aperture; a handle portion having a clevis portion including a first lateral portion and a second lateral portion, the first lateral portion and the second lateral portion of the handle portion being spaced apart from one another, the first lateral portion of the handle portion including a fourth aperture and a first cam surface formed thereon, and the second lateral portion of the handle portion including a fifth aperture and a second cam surface formed thereon, end portions of each of the first shaft portion and the second shaft portion adjacent the first end of the arm portion being received between the first lateral portion and the second lateral portion of the clevis portion; a bracket portion and a second flange portion, the bracket portion including at least a third lateral portion and a fourth lateral portion, the third lateral portion and the fourth lateral portion of the bracket portion being spaced apart from one another, the second flange portion being positioned between the third lateral portion and the fourth lateral portion of the bracket portion, the third lateral portion of the bracket portion including a sixth aperture, and the fourth lateral portion of the bracket portion including a seventh aperture, the first lateral portion and the second lateral portion of the handle portion being received between the third lateral portion and the fourth lateral portion of the bracket portion; and one of a rod and a fastener extending through the first aperture, the second aperture, the third aperture, the fourth aperture, the fifth aperture, the sixth aperture, and the seventh aperture to attach the arm portion, the bracket portion, and the handle portion to one another; where the first cam surface and the second cam surface of the handle portion are contactable to at least one surface of the first flange portion, and movement of the handle portion from an unactuated position to an actuated position causes the first cam surface and the second cam surface to translate on the at least one surface, and simultaneously move the first contact surface of the first flange and the second contact surface of the second flange toward one another, and move the second shaft portion at least partially out of the channel in the first shaft portion to expand the first shaft portion and the second shaft portion relative to one another via interaction of the one of the rod and the fastener in the first aperture, the second aperture, the third aperture, the fourth aperture, the fifth aperture, the sixth aperture, and the seventh aperture. 
     In another aspect, the disclosure provides a locking mechanism for use with a surgical frame, the locking mechanism including an arm portion including a first shaft portion, a second shaft portion, and a first flange portion, the arm portion including a first end, an opposite second end, a mid-longitudinal axis extending through the first end and the second end, and a channel extending from at least adjacent the first end to at least adjacent the second end along the mid-longitudinal axis, portions of the second shaft portion being moveable into and out of the channel, the first shaft portion including a first exterior surface, the second shaft portion including a second exterior surface, the first shaft portion adjacent the first end of the arm portion including a first aperture on a first side of the channel, the first shaft portion adjacent the first end of the arm portion including a second aperture on a second side of the channel, and the second shaft portion adjacent the first end of the arm portion including a third aperture; a handle portion having a clevis portion including a first lateral portion and a second lateral portion, the first lateral portion and the second lateral portion of the handle portion being spaced apart from one another, the first lateral portion of the handle portion including a fourth aperture and a first cam surface formed thereon, and the second lateral portion of the handle portion including a fifth aperture and a second cam surface formed thereon; a bracket portion and a second flange portion, the bracket portion including at least a third lateral portion and a fourth lateral portion, the third lateral portion and the fourth lateral portion of the bracket portion being spaced apart from one another, the second flange portion being positioned between the third lateral portion and the fourth lateral portion of the bracket portion, the third lateral portion of the bracket portion including a sixth aperture, and the fourth lateral portion of the bracket portion including a seventh aperture; and one of a rod and a fastener extending through the first aperture, the second aperture, the third aperture, the fourth aperture, the fifth aperture, the sixth aperture, and the seventh aperture to attach the arm portion, the bracket portion, and the handle portion to one another; where, when the locking mechanism is assembled, the portions of the second shaft portion are received in the channel of the first shaft portion, end portions of each of the first shaft portion and the second shaft portion adjacent the first end of the arm portion being received between the first lateral portion and the second lateral portion of the handle portion, and the first lateral portion and the second lateral portion of the handle portion being received between the third lateral portion and the fourth lateral portion of the bracket portion, and where the first cam surface and the second cam surface of the handle portion are contactable to at least one surface of the first flange portion, and movement of the handle portion from an unactuated position to an actuated position causes the first cam surface and the second cam surface to translate on the at least one surface, and simultaneously move the first contact surface of the first flange and the second contact surface of the second flange toward one another, and move the second shaft portion at least partially out of the channel in the first shaft portion to expand the first shaft portion and the second shaft portion relative to one another. 
     In yet another aspect, the disclosure provides a shoulder hold-down for use in securing at least a shoulder of a patient in position relative to a surgical frame, the shoulder hold-down including a support shaft portion including a first end, an opposite second end, and being configured to be received between the first contact surface and the second contact surface of the locking mechanism; a shoulder engaging portion being attached to the first end of the support shaft portion, and including a shoulder contacting structure configured to contact at least the shoulder of the patient; and a locking mechanism including: an arm portion including a first shaft portion, a second shaft portion, and a first flange portion, the arm portion including a first end, an opposite second end, a mid-longitudinal axis extending through the first end and the second end, and a channel extending from at least adjacent the first end to at least adjacent the second end along the mid-longitudinal axis, the channel receiving portions of the second shaft portion therein, the first shaft portion including a first exterior surface, the second shaft portion including a second exterior surface, the first shaft portion adjacent the first end of the arm portion including a first aperture on a first side of the channel, the first shaft portion adjacent the first end of the arm portion including a second aperture on a second side of the channel, and the second shaft portion adjacent the first end of the arm portion including a third aperture; a handle portion having a clevis portion including a first lateral portion and a second lateral portion, the first lateral portion and the second lateral portion of the handle portion being spaced apart from one another, the first lateral portion of the handle portion including a fourth aperture and a first cam surface formed thereon, and the second lateral portion of the handle portion including a fifth aperture and a second cam surface formed thereon, end portions of each of the first shaft portion and the second shaft portion adjacent the first end of the arm portion being received between the first lateral portion and the second lateral portion of the clevis portion; a bracket portion and a second flange portion, the bracket portion including at least a third lateral portion and a fourth lateral portion, the third lateral portion and the fourth lateral portion of the bracket portion being spaced apart from one another, the second flange portion being positioned between the third lateral portion and the fourth lateral portion of the bracket portion, the third lateral portion of the bracket portion including a sixth aperture, and the fourth lateral portion of the bracket portion including a seventh aperture, the first lateral portion and the second lateral portion of the handle portion being received between the third lateral portion and the fourth lateral portion of the bracket portion; and one of a rod and a fastener extending through the first aperture, the second aperture, the third aperture, the fourth aperture, the fifth aperture, the sixth aperture, and the seventh aperture to attach the arm portion, the bracket portion, and the handle portion to one another; where the support shaft portion is received between the first contact surface of the first flange and the second contact surface of the second flange, and where the first cam surface and the second cam surface of the handle portion are contactable to at least one surface of the first flange portion, and movement of the handle portion from an unactuated position to an actuated position causes the first cam surface and the second cam surface to translate on the at least one surface, and move the first contact surface of the first flange and the second contact surface of the second flange toward one another to impinge on the support shaft and hold the support shaft in position, and move the second shaft portion at least partially out of the channel in the first shaft portion to expand the first shaft portion and the second shaft portion relative to one another via interaction of the one of the rod and the fastener in the first aperture, the second aperture, the third aperture, the fourth aperture, the fifth aperture, the sixth aperture, and the seventh aperture. 
     The details of one or more aspects of the disclosure as set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is a top, side perspective view that illustrates an embodiment of a shoulder hold-down; 
         FIG. 2  is a top, side perspective view that illustrates a portion of a surgical frame  20  incorporating a first one and a second one of the shoulder hold-down of  FIG. 1 ; 
         FIG. 3  is a top, side exploded view that illustrates a locking mechanism of the shoulder hold-down; 
         FIG. 4  is a side perspective view that illustrates the locking mechanism of  FIG. 1  in an unactuated position; 
         FIG. 5  is a side, cutaway perspective view of the locking mechanism similar to  FIG. 4  that illustrates portions of the locking mechanism in the unactuated position; 
         FIG. 6  is a side perspective view that illustrates the locking mechanism of  FIG. 1  is an actuated position; and 
         FIG. 7  is a side, cutaway perspective view of the locking mechanism similar to  FIG. 6  that illustrates portions of the locking mechanism in the actuated position. 
     
    
    
     DETAILED DESCRIPTION 
     Shoulder hold-downs according to a preferred embodiment of the present disclosure are generally indicated by the numeral  10  in  FIGS. 1 and 2 . Each of the shoulder hold-downs  10  includes a locking mechanism  12  facilitating at least four (4) modes of adjustment and for locking the adjusted portions of each of the shoulder hold-downs  10  in position. The locking mechanism  12  is not limited to use with the shoulder hold-downs  10 , and can be used in other environments. As discussed below, the shoulder hold-downs  10  are for holding the right shoulder and the left shoulder of a patient P and portions of the patient&#39;s back in position relative to a surgical frame  20 . 
     The shoulder hold-downs  10  can be used with surgical frames such as that disclosed in U.S. application Ser. Nos. 15/239,256, 15/639,080 and 15/672,005, which are hereby incorporated by reference in their entireties. As such, the shoulder hold-downs  10  can used with a surgical frame  20  that is similar to those of the above-referenced U.S. application Nos., of which portions are depicted in  FIG. 2 . The shoulder hold-downs  10  are used in conjunction with other componentry of the surgical frame  20  to secure the patient P in position on the surgical frame  20  to facilitate rotation of the patient P by the surgical frame  20 . More specifically, the shoulder hold-downs  10  are used in holding the right shoulder and the left shoulder in position relative to the surgical frame  20 . As depicted in  FIG. 2 , a first one of the shoulder hold-downs  10  is positioned on the right side of the patient P, and a second one of the shoulder hold-downs  10  is positioned on the left side of the patient P. Furthermore, to facilitate use of the first one and the second one of the shoulder hold-downs  10  on opposite lateral sides of the patient P, componentry of the shoulder hold-downs  10  can be mirrored with respect to one another. 
     As depicted in  FIG. 2 , the surgical frame  20  includes a main beam  22 , a chest support portion  24  supported by the main beam  22 , and adjustable arm portions  26  also supported by the main beam  22 . The chest support portion  24  is used for supporting portions of the torso (including the chest) of the patient P relative to the main beam  22 , and the adjustable arm portions  26  are used to facilitate positioning of the shoulder hold-downs  10  relative to the patient P. Furthermore, although only one of the adjustable arm portions  26  is depicted in  FIG. 2  supporting the first one of the shoulder hold-downs  10  on the right side of the patient P, another of the adjustable arm portions  26  can be positioned on the left side of the patient P to support the second one of the shoulder hold-downs  10 . 
     The main beam  22  can support other componentry (such as, for example, hip support(s) and/or leg support(s) (not shown)) for supporting portions of the patient P relative to the main beam  22 . Likewise, the adjustable arm portions  26  (supported by the main beam  22 ) can support other componentry (such as, for example, head support(s) (not shown) for supporting portions of the patient P relative to the main beam  22 . 
     The adjustable arm portion  26 , as depicted in  FIG. 2 , includes a first arm portion  30 , a second arm portion  32 , and a third arm portion  34 . Although the attachment thereof is not shown in  FIG. 2 , the first arm portion  30  is attachable relative to the main beam  22 . The attachment of the first arm portion  30  to the main beam  22  can be fixed, or the attachment of the first arm portion  30  to the main beam  22  can be moveable to facilitate positioning of the first arm portion  30  relative to the main beam  22 . The first arm portion  30  includes a first hub portion  40  at an end thereof opposite from the attachment to the main beam  22 . 
     Although the attachment thereof is not shown in  FIG. 2 , the second arm portion  32  is attachable relative to the first hub portion  40 . The attachment of the second arm portion  32  to the first hub portion  40  can be fixed, or the attachment of the second arm portion  32  to the first hub portion  40  can be moveable to facilitate positioning of the second arm portion  32  relative to the first arm portion  30 . For example, the moveable attachment of the second arm portion  32  relative to the first hub  40  can facilitate rotation of the second arm portion  32  relative to the first arm portion  30 . The second arm portion  32  includes a second hub portion  42  at an end thereof opposite from the attachment to the first hub portion  40 . 
     The second hub portion  42 , as depicted in  FIG. 2 , can be fixedly or moveably attached to the second arm portion  32 , and includes an aperture  44  therein for receiving the third arm portion  34  therethrough. The moveable attachment of the second hub portion  42  relative to the second arm portion  32  can facilitate rotation of the third arm portion  34  relative to the second arm portion  32 . Furthermore, the receipt of the third arm portion  34  in the aperture  44  facilitates movement of a first end portion  46  and a second end portion  48  of the third arm portion  34  toward and away from the patient P. The third arm portion  34  can include one or more stops  50  provided at the first end portion  46  and/or the second end portion  48  for preventing withdrawal of the third arm portion  34  from the aperture  44  of the second hub portion  42 . Also, a set screw  52  can be received in an aperture  54  in the second hub portion  42  to impinge on the third arm portion  34  to maintain the position of the third arm portion  34  with respect to the second hub portion  42 . 
     The first one of the shoulder hold-downs  10 , as depicted in  FIG. 2 , is moveable toward and away from the patient P along the third arm portion  34  of the adjustable arm portion  26  positioned on the right side of the patient P. Likewise, the second one of the shoulder hold-downs  10  would be moveable toward and away from the patient P along the third arm portion  34  of the adjustable arm portion  26  positioned on the left side of the patient P. 
     As depicted in  FIG. 1 , the shoulder hold-down  10  includes a base portion  60 , a leg portion  62  depending downwardly from the base portion  60 , and an arm portion  64  moveable upwardly and downwardly with respect to the base portion  60 . The shoulder hold-down  10  depicted in  FIG. 1  is also depicted in  FIG. 2  as the first one of the shoulder hold-downs  10  on the right side of the patient P. The second one of the shoulder hold-downs  10  on the left side of the patient P in  FIG. 2  can have componentry (such as the base portion  60 , the leg portion  62 , and the arm portion  64 ) that is mirrored with respect to the shoulder hold-down  10  on the right side of the patient P. 
     The leg portion  62  of the shoulder hold-down  10  includes a first end  66  and a second end  68 . The leg portion  62  at the first end  66  is fixedly attached to the base portion  60  via fasteners (not shown) or other attachment mechanism such as adhesives, brazing, and/or welding. Furthermore, the leg portion  62  at the second end  68  includes an opening  70  for receiving the third arm portion  34  of the adjustable arm portion  26  therethrough. 
     One of the opening  70  and the third arm portion  34  can include a key, and the other of the opening  70  and the third arm portion  34  can include a keyway. As depicted in  FIG. 1 , the opening  70  includes a key  72  receivable in a keyway (not shown) formed in the third arm portion  34 . If one of the opening  70  and the third arm portion  34  include the key  72  and the other of the opening  70  and the third arm portion  34  include the keyway, the leg portion  62  would not be rotatable on the third arm portion  34 . If the key  72  and the keyway are not provided, the leg portion  62  could rotate on the third arm portion  34 . Also, a set screw (not shown) can be received in an aperture (not shown) in the base portion  60  to impinge on the third arm portion  34  to maintain the position of the base portion  60  with respect to the third arm portion  34 . 
     The base portion  60 , as depicted in  FIG. 1 , includes an opening  80  for receiving portions of the arm portion  64  therein. The opening  80  includes an interior surface  82 , and the arm portion  64  is moveable upwardly and downwardly with respect to the base portion  60  via travel thereof in the opening  80 . The arm portion  64  is part of the locking mechanism  12 , and the locking mechanism  12  is used both for fixing the position of the arm portion  64  relative to the base portion  60 , and for fixing the position of a support shaft portion  84 . As discussed below, the support shaft portion  84  supports a shoulder engaging portion  86 , and both the support shaft portion  84  and the shoulder engaging portion  86  are also part of the shoulder hold-down  10 . 
     As depicted in  FIG. 3 , the arm portion  64  includes a first shaft portion  90 , a second shaft portion  92 , a cap portion  94 , and a first flange portion  96 . As discussed below, a second flange portion  98 , a bracket portion  100 , and a handle portion  102  are attached relative to the arm portion  64 . 
     As depicted in  FIGS. 1, 4, and 6 , the first shaft portion  90  includes a channel  110  for receiving the second shaft portion  92 . Furthermore, as depicted in  FIGS. 3, 5, and 7 , the first shaft portion  90  includes first teeth  112  formed in the channel  110 , and the second shaft portion  92  includes second teeth  114  formed thereon. The first teeth  112  and the second teeth  114  are engageable to one another, and, as discussed below, movement of the second teeth  114  on the first teeth  112  causes the second shaft portion  92  to move outwardly from the channel  110 . In doing so, the first shaft portion  90  and the second shaft portion  92  are expanded with respect to one another due to the contact of the first teeth  112  and the second teeth  114  sliding on each other. The first shaft portion  90  includes at least a first exterior surface  116  and the second shaft portion  92  includes at least a second exterior surface  118 . 
     As discussed below, operation of the locking mechanism  12  causes the second shaft portion  92  to move from a retracted position within the channel  110  to a position partially out of the channel  110 , and expand the first shaft portion  90  and the second shaft portion  92  with respect to one another. Thus, as the first shaft portion  90  and the second shaft portion  92  are expanded, the first exterior surface  116  and the second exterior surface  118  are pressed against portions of the interior surface  82  of the opening  80  to hold the first shaft portion  90  and the second shaft portion  92  in position relative to the base portion  60 . 
     The first shaft portion  90  includes a first end  120  and a second end  122 , and the second shaft portion  92  includes a first end  124  and a second end  126 . As depicted in  FIGS. 3, 5 and 7 , the first end  120  of the first shaft portion  90  and the first end  124  of the second shaft portion  92  are received in an internal cavity of the cap portion  94 , and the cap portion  94  is attached to the first shaft portion  90  using a fastener  128 . The second end  126  of the second shaft portion  92  includes an indentation  130  which affords movement of the second shaft portion  92  out of the channel  110 . 
     As depicted in  FIG. 2 , the first flange portion  96  is fixedly attached to the first shaft portion  90  via adhesives, fasteners, brazing, and/or welding, the second flange portion  98  is fixedly attached to the bracket portion  100  via fasteners  132  or other attachment mechanism such as adhesives, brazing, and/or welding. Alternatively, the first flange portion  96  can be integrally formed with the first shaft portion  90 , and the second flange portion  98  can be integrally formed with the bracket portion  100 . The first flange portion  96  and the second flange portion  98  include a first contact surface  134  and a second contact surface  136 , respectively. As discussed below, operation of the locking mechanism  12  causes clamping of the support shaft portion  84  between the first contact surface  134  and the second contact surface  136 , and holds the support shaft portion  84  in position relative to the arm portion  64 . 
     The second shaft portion  92 , the bracket portion  100 , and a handle portion  102  are attached to the first shaft portion  90  using a fastener or rod  138 . The handle portion  102  is also part of the locking mechanism  12 , and actuation of the handle portion  102  operates the locking mechanism to cause the second shaft portion  92  to move out of the channel  110  to expand the first shaft portion  90  and the second shaft portion  92  with respect to one another, and to cause clamping of the support shaft portion  84  between the first contact surface  134  and the second contact surface  136  to hold the support shaft portion  84  in position relative to the arm portion  64 . 
     To facilitate attachment thereof using the fastener  138 , the first shaft portion includes an end portion  140  at the second end  122  thereof including a groove  142  communicating with the channel  110 , a first aperture  144  in the end portion  140  on one side of the groove  142 , and a second aperture  146  in the end portion  140  on the other side of the groove  142 ; the second shaft portion includes an end portion  148  at the second end  126  thereof including an aperture  150 ; the bracket portion  100  includes a connecting portion  152 , a first lateral portion  154 , a second lateral portion  156 , a first opening  160  in the first lateral portion  154 , a second opening  162  in the second lateral portion  156 , and a gap  164  between the first lateral portion  154  and the second lateral portion  156 ; and the handle portion  102  includes a clevis portion  170  including a first lateral portion  172 , a second lateral portion  174 , a first opening  176  in the first lateral portion  172 , a second opening  178  in the second lateral portion  174 , and a gap  180  between the first lateral portion  172  and the second lateral portion  174 . 
     To assemble the first shaft portion  90 , the second shaft portion  92 , the bracket portion  100 , and the handle portion H, the second shaft portion  92  is received in the channel  110  and the end portion  148  of the second shaft portion  92  is received in the groove  142  formed in the end portion  140  of the first shaft portion  90 ; the end portion  140  of the first shaft portion  90  is received in the gap  180  between the first lateral portion  172  and the second lateral portion  174 ; and the clevis portion  170  is received in the gap  164  between the first lateral portion  154  and the second lateral portion  156  of the bracket portion  100 . 
     In doing so, the first aperture  144  and the second aperture  146  in the first shaft portion  90 , the aperture  150  in the second shaft portion  92 , the first opening  160  and the second opening  162  in the bracket portion  100 , and the first opening  176  and the second opening  178  in the clevis portion  170  are aligned with one another. 
     The fastener  138  is inserted in these openings and apertures to attach the first shaft portion  90 , the second shaft portion  92 , the bracket portion  100 , and the handle portion  102  to one another. One of the first opening  160  and the second opening  162  in the bracket portion  100  can include threads for engaging complimentary threads on the fastener  138  to hold the first shaft portion  90 , the second shaft portion  92 , the bracket portion  100 , and the handle portion  102  together. Alternately, a nut having threads can be engageable to complimentary threads on the fastener  138  to hold the first shaft portion  90 , the second shaft portion  92 , the bracket portion  100 , and the handle portion  102  together. As depicted in  FIG. 3 , the second opening  162  in the bracket portion  100  includes threads  182  formed therein, and the fastener  138  includes threads  184  formed therein. As such, to hold these components together, the fastener  138  is inserted through the first opening  160  in the bracket portion  100 , through the first opening  176  in the handle portion H, through the first aperture  144  in the first shaft portion  90 , through the aperture  150  in the second shaft portion  92 , through the second aperture  146  in the first shaft portion  90 , through the second opening  178  in the handle portion H, into the second opening  162  in the bracket portion  100 , and the threads  184  are engaged to the threads  182  in the second opening  162 . 
     Each of the first aperture  144  and the second aperture  146  in the first shaft portion  90 , and the aperture  150  in the second shaft portion  92  are oblong, and correspondingly afford play between componentry of the locking mechanism  12 . For example, the longitudinal axes of the first aperture  144  and the second aperture  146  in the first shaft portion  90  are oriented vertically as seen in  FIG. 3 , and such an orientation affords leftward and rightward movement, as depicted in  FIGS. 4-7 , of the second shaft portion  92 , the bracket portion  100 , and the handle portion  102  via interplay of the fastener  138  in the various openings and apertures of the components of the locking mechanism  12 . Furthermore, the longitudinal axis of the aperture  150  in the second shaft portion  92  is oriented horizontally as seen in  FIG. 3 , and such an orientation affords inward and outward movement, as depicted in  FIGS. 4-7 , of the second shaft portion  92  relative to the channel  110  via interplay of the fastener  138  in the various openings and apertures of the components of the locking mechanism  12 . 
       FIGS. 4 and 5  depict the handle portion  102  in an unactuated position, and  FIGS. 6 and 7  depict the handle portion  102  in an actuated position. When the handle portion  102  is in the unactuated position ( FIGS. 4 and 5 ), the first flange portion  96  and the second flange portion  98  are spaced apart from one another, and the second shaft portion  92  is in the retracted position within the channel  110 . Furthermore, when the handle portion  102  is in an actuated position ( FIGS. 6 and 7 ), the first flange portion  96  and the second flange portion  98  are contacted to one another, and the second arm portion  92  is in the position partially out of the channel  110 . 
     The interaction of portions of the handle portion  102  with the first flange portion  96  via actuation thereof moves the first flange portion  96  and the second flange portion  98  from the position depicted in  FIGS. 4 and 5  to the position depicted in  FIGS. 6 and 7 , and moves the second shaft portion  92  from the position depicted in  FIGS. 4 and 5  to the position depicted in  FIGS. 6 and 7 . Such movement is facilitated by the contact of a first cam surface  190  formed on the first lateral portion  172  and a second cam surface  192  formed on the second lateral portion  174  with a first contact surface  194  and a second contact surface  196  formed on the underside of the first flange portion  96 , as depicted in  FIG. 3-7 . 
     As the handle portion  102  is moved from the unactuated position to the actuated position, the contact of the first cam surface  190  with the first contact surface  194 , and the contact of the second cam surface  192  with the second contact surface  196  causes rightward movement, as depicted in  FIGS. 4-7 , of the fastener  138  which in turn causes rightward movement of the bracket portion  100  and the second shaft portion  92  relative to the first shaft portion  90  that is afforded by the orientation of the first aperture  144  and the second aperture  146 . Rightward movement of the bracket portion  100  forces the first flange portion  96  and the second flange portion  98  together, as depicted in  FIGS. 6 and 7 . Furthermore, rightward movement of the second shaft portion  92  causes the second teeth  114  to slide along the first teeth  112  that is afforded by the orientation of the aperture  150 . The sliding of the second teeth  114  over the first teeth  112  moves the second shaft portion  92  from the retracted position within the channel  110  to the position partially out of the channel  110 , and expands the first shaft portion  90  and the second shaft portion  92  with respect to one another. 
     Operation of the locking mechanism  12  via actuation of the handle portion  102  facilitates clamping of the support shaft portion  84  between the first contact surface  134  and the second contact surface  136  of the first flange portion  96  and the second flange portion  98 , respectively, to lock the support shaft portion  84  in position relative to the arm portion  64 . And, operation of the locking mechanism  12  via actuation of the handle portion  102  facilitates movement of the second shaft portion  92  from the retracted position within the channel  110  to a position partially out of the channel  110 , and correspondingly, presses the first exterior surface  116  and the second exterior surface  118  against portions of the interior surface  82  of the opening  80  to lock the first shaft portion  90  and the second shaft portion  92  in position relative to the base portion  60 . As such, the locking mechanism  12  serves to lock the support shaft portion  84  in position, and also to lock the arm portion  64  in position. Thus, the locking mechanism  12  serves as a double-lock. 
     As discussed above, the support shaft  84  supports a shoulder engaging portion  86 . The arm portion  64  can be moved with respect to the base portion  60 , when not held in position via contact the first exterior surface  116  and the second exterior surface  118  against portions of the interior surface  82 . Such movement affords two (2) modes of adjustment including slidable movement and axial rotation of the arm portion  64  within the opening  80 . Thus, via operation of the locking mechanism  12 , the shoulder engaging portion  86  supported by the arm portion  64  (via the locking mechanism  12  and the support shaft  84 ) is moveable upwardly and downwardly with respect to the patient P, and also rotatable with respect to the patient P. 
     Additionally, the support shaft  84  can be moved with respect to the locking mechanism  12 , when not held in position via contact with the first contact surface  134  and the second contact surface  136 . Such movement affords two (2) modes of adjustment including slidable movement and axial rotation of the support shaft  84  between the first contact surface  134  and the second contact surface  136 . Thus, via operation of the locking mechanism  12 , the shoulder engaging portion  86  supported by the support shaft  84  is moveable inwardly and outwardly with respect to the patient P, and also rotatable with respect to the patient P. 
     An additional mode of adjustment of the shoulder engaging portion  86  is afforded by a pivot bracket  200 . The pivot bracket  200 , as depicted in  FIG. 1 , includes a first portion  202 , a second portion  204 , a pivotal connection  206  between the first portion  202  and the second portion  204 , and a knob portion  208 . The first portion  202  is attached to the support shaft  84 , and the second portion  204  is attached to the shoulder engaging portion  86 . The pivot connection  206  affords pivotal movement between the first portion  202  and the second portion  204 , and hence, affords pivotal movement of the shoulder engaging portion  86  relative to the support shaft  84 . As such, in addition to the adjustment afforded by movement of the arm portion  64  and the support shaft  84 , the pivot bracket  200  affords pivotal movement of the shoulder engaging portion  86 . 
     The shoulder engaging portion  86  includes an attachment bracket  210  and a shoulder contacting structure  212 . The attachment bracket  210  is attached to the second portion  204  of the pivot bracket  200 , and supports the shoulder contacting structure  212  relative to the pivot bracket  200 . The attachment bracket  210  can be integrally formed with the second portion  204  of the pivot bracket  200 , or can be attached to the second portion  204  via fasteners (not shown) or other attachment mechanism such as adhesives, brazing, and/or welding. 
     The shoulder contacting structure  212  includes a first portion  214  and a second portion  216 . As depicted in  FIGS. 1 and 2 , the curvatures of the first portion  214  and the second portion  216  are provided to conform to the typical shape and size of a patient&#39;s shoulder and back, respectively. To that end, the first portion  214  has a relatively large curvature such that the first portion  214  curves upwardly and extends away from the attachment bracket  210 , and the second portion  216  has a relatively small curvature such that the second portion  216  is slightly curved and extends outwardly from the first portion  214 . 
     The second portion  216  can include an aperture  220  therethrough for receiving straps (not shown) extending between the first one and/or the second one shoulder hold-downs  10  and the surgical frame  20 . The straps can also be received through and extend between the apertures  220  of the first one and the second one of the shoulder hold downs  10 . In doing so, the straps can be used in securing the torso of the patient P to the surgical frame  20 . 
     Use of the first one and the second one of the shoulder hold-downs  10  serve to contact the right shoulder and the left shoulder, respectively, and portions of the patient&#39;s back to aid in securing the position of the patient P relative to the main beam  22 . The modes of adjustment afford manipulation of the hold-downs  10  to facilitate positioning of the shoulder engaging portions  86  relative to the patient P. The positioning of the shoulder hold-downs  10  also is aided by movement thereof along the adjustable arm portions  26 . When the shoulder hold-downs  10  are used with the other componentry for supporting portions of the patient P relative to the main beam  22 , the main beam  22  can be rotated to position and reposition the patient P for surgery. 
     It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and the accompanying drawings. It should also be understood that, depending on the example, certain acts or events of any of the processes of methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques). In addition, while certain aspect of this disclosure are described as being performed by a single module or unit for purposes of clarity, it should be understood that the techniques of this disclosure may be performed by a combination of units or modules associated with, for example, a medical device.