Patent Publication Number: US-2004049143-A1

Title: Shoulder reduction device

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001] Not Applicable.  
       STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT.  
       [0002] Not applicable.  
       BACKGROUND OF THE INVENTION  
       [0003] 1. Field of the Invention  
       [0004] The present invention is related to an apparatus for placing a shoulder joint in traction to reduce a dislocated shoulder joint or to stabilize a fractured humerus. More particularly, the present invention is related to a device that allows a single person to reduce the shoulder joint without assistance.  
       [0005] 2. Description of the Related Art Including Information Disclosed Under 37 C.F.R. 1.97 and 1.98  
       [0006] The human shoulder joint consists of a ball in the upper arm bone, that is, humeral head, that is seated in a socket in the shoulder, that is the glenoid fossa, but the socket is rather shallow, more like a saucer than an actual socket, which allows for more freedom of movement, but also relies almost entirely on ligaments and muscles to keep the joint together. In some circumstances, these ligaments and muscles stretch too much, allowing the ball to slip out of the socket, which does not itself firmly hold the ball in place. When the stretching forces are removed from the joint, the ligaments snap back to their original length, pulling the ball back toward the shoulder, but, often, not into the socket, resulting in a dislocated shoulder joint. The ball cannot slip back into the socket on its own because the ball portion of the joint has been pulled up into a space in the shoulder that is more inward of the shoulder than the socket portion of the joint. The only way to relocate the ball into the shoulder joint is to provide a smooth constant traction or stretching force onto the arm pulling the arm away from the shoulder. A force of perhaps fifty pounds, more or less, is typically required to stretch the ligaments and muscles and to pull the ball away from the shoulder joint enough so that the ball reseats in the socket when the traction force is gradually reduced. It is not necessary to manipulate the arm to any significant extent to reduce the dislocated shoulder because the natural place for the ball is in the socket and ligaments are naturally designed to hold the joint together.  
       [0007] Dislocated shoulders are fairly common. Although often associated with sports players, this injury is common among the general population. It is caused by some trauma that stretches the ligaments too much. Frequently, for example, it seems that if a person falls over backward and extends his arms downward ly behind his back to break his fall, a dislocated shoulder frequently results, but can also result from as simple an act as shrugging to put on a coat. Dislocated shoulders are also fairly common in adults who have suffered a previous dislocated shoulder, since the stretched ligaments may not return to their original length and may not be as strong as they should be.  
       [0008] Since a dislocated shoulder is very painful and obviously the shoulder joint cannot operate properly when the ball and socket are not mated, it is essential that the joint be restored to its natural condition, that is, reduced, as quickly as possible with as little pain as possible. A number of prior art techniques and devices to accomplish shoulder reduction have been developed and a number have led to issued patents, such as those discussed below.  
       [0009] U.S. Pat. No. 5,788,659, issued to Haas on Aug. 4, 1998, discloses a “Shoulder Traction Device for Relocating a Dislocated Shoulder” comprising a strap that is passed under the armpit of the affected arm and is held by an assistant, who has a portion of the strap wrapped around his waist and a separate arm isolation component for isolating the elbow from the injured shoulder joint. The attending physician pulls on and manipulates the dislocated shoulder. The patent covers the specific structure of the various straps and adjustment buckles, and so forth. This invention requires two people to effect the reduction.  
       [0010] U.S. Pat. No. 3,680,552, issued to Bell et al. on Aug. 1, 1972, discloses a “Traction Splint” comprising a traction splint for the arm or the leg having a pallet or cradle and a cuff that attaches an upper portion of the limb to the cradle and a second cuff attached to the lower end of the limb. The second cuff is attached to a cable that is manually pulled to apply traction to the limb. A latch allows the cable to be held under tension and allows that tension to be quickly and easily released. The device is intended to relieve the pain of a broken bone by applying some traction. This device is designed specifically to provide some tension on a broken bone to relieve pain prior to setting the bone.  
       [0011] U.S. Pat. No. 3,477,428, issued to Hare on Nov. 11, 1969, discloses a “Combined Splint and Traction Device” comprising a splint cradle that is strapped to a leg and has a roughly semi-circular proximal end that fits against the patient&#39;s hip. A strap is wrapped around the ankle and foot and is connected to a rachet mechanism that pulls on the ankle strap to apply traction to the leg. The rachet mechanism is connected to the frame of the distal end of the splint. The tension on the ankle strap can be easily and quickly released by releasing the rachet pawl. This device is designed specifically for a hip joint and does not address reduction of the shoulder joint and is designed to provide traction to a broken leg bone.  
       [0012] U.S. Pat. No. 2,590,739, issued to Wagner et al. on Mar. 25, 1952, discloses an “Orthopedic Bone Aligning and Fixing Mechanism” a mechanical device with a large frame cantilevered from the patient&#39;s bed and having many joints and adjustments. The device is designed to allow end bones, such as the humerus, to be set after being broken. The device further comprises a strap wrapped around the patient&#39;s chest adjacent to the armpit on the affected side and secured to a rigid upstanding post  60  adjacent to the opposite side of the patient&#39;s body. This device requires the patient to be placed on a bed and requires a substantial amount of dedicated space for its complex and large apparatus.  
       [0013] U.S. Pat. No. 2,515,590, issued to Chaffin on Jul. 18, 1950, discloses an “Apparatus for Tensioning an Arm” designed to assist in setting fractures in the forearm or certain other injuries in the forearm. The device includes a strap about the biceps portion of the arm and fastened to a support or held by a person. A sleeve is connected to the wrist and is connected to a cable and pulley system. An anchoring cable is fastened to a fixed support. This device allows for applying tension along a line from the back to the front of the patient, which is not the direction of tension required for shoulder reduction and its use requires two medical personnel.  
       [0014] In many medical facilities, particularly in rural areas, on ambulances, and so forth, there may not be two skilled medical workers to attend to a single patient; there may not be enough space to dedicate a significant amount of room to a specialized shoulder reduction area; there may not be enough financial resources for an expensive complex shoulder reduction system. Further, considerable physical strength and stamina are needed to reduce the dislocated shoulder using prior art techniques and the available workers may well not have the strength needed.  
       [0015] Therefore, a need exists for a shoulder reduction and splint device that can be operated by a single skilled medical worker; that does not require any significant amount of space, during either use or storage; that is inexpensive to purchase and maintain; and that does not require significant physical strength to use successfully.  
       BRIEF SUMMARY OF THE INVENTION  
       [0016] Accordingly, it is a primary object of the present invention to provide a shoulder reduction device and splint device that can be successfully and easily operated by a single skilled medical worker without assistance and without any secondary anchoring system or strap.  
       [0017] It is another object of the present invention to provide a shoulder reduction and splint device that does not require any significant amount of space during either use or storage.  
       [0018] It is another object of the present invention to provide a shoulder reduction and splint device that is inexpensive to purchase and to maintain.  
       [0019] It is another object of the present invention to provide a shoulder reduction and splint device that does not require significant physical strength to use successfully.  
       [0020] These and other objects of the present invention are achieved by providing a staff having a distal end that is placed in the armpit under the patient&#39;s dislocated shoulder joint and a proximal end that is braced against the stomach or torso of a skilled medical worker. The distal end is preferably provided with a cross member or horizontal portion that is padded or cushioned to reduce the pressure in the patient&#39;s armpit. A wrist cuff is attached to the wrist of the affected arm and adjusted so that the patient&#39;s hand cannot pass through it. A traction cord is fastened to the wrist cuff and includes a pulling end having a handle, which the skilled medical worker pulls on to apply the traction needed to reduce the dislocated shoulder. The wrist cuff and traction cord may be separate from the staff.  
       [0021] Preferably, however, the traction cord includes a fixed end that is attached to the staff adjacent to the proximal end of the staff and is operatively routed through a rachet mechanism so that the skilled medical worker can relax during the reduction without losing the traction applied prior to relaxing. The traction is then maintained by the portion of the traction cord between the fixed end of the traction cord and the rachet mechanism.  
       [0022] The length of the staff can be adjusted to facilitate its use with arms of greatly differing lengths and to suit the needs of different medical workers. The length of the staff can be adjusted by telescoping staff sections that can be fixed into specific lengths by a spring-loaded protruding button that projects through a selected length adjustment aperture selected from a row of spaced adjustment apertures. Alternatively or in addition, the length of the staff can be adjusted by turning a long screw that runs the length of a lower section of the staff and is received by a threaded nut fixed in a distal end of a middle section of the staff.  
       [0023] Other objects and advantages of the present invention will become apparent from the following description taken in connection with the accompanying drawings, wherein is set forth by way of illustration and example, the preferred embodiment of the present invention and the best mode currently known to the inventor for carrying out his invention.  
     
    
    
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS  
     [0024]FIG. 1 is a perspective view of a prior art shoulder reduction in progress in which the patient is supine.  
     [0025]FIG. 2 is a top plan view, that is, looking down on the supine patient, of a prior art shoulder reduction in progress in which the patient is supine.  
     [0026]FIG. 3 is a perspective view of the preferred embodiment of a shoulder reduction device in accordance with the present invention.  
     [0027]FIG. 4 is an enlarged fragmentary perspective view of the proximal (lower) end of the staff portion of the shoulder reduction device of FIG. 3 showing the attachment of the traction cord to the staff.  
     [0028]FIG. 5 is a perspective view of a shoulder reduction in progress utilizing the preferred embodiment of the present invention with the patient in a supine position.  
     [0029]FIG. 6 is a perspective view of an alternative embodiment of a shoulder reduction device in accordance with the present invention.  
     [0030]FIG. 7 is an enlarged fragmentary view of the lower portion of the staff of FIG. 6 showing the screw mechanism for adjusting the length of the staff.  
     [0031]FIG. 8 is a perspective view of an alternative embodiment of the shoulder reduction device of FIG. 3 in which the traction cord and associated parts are not connected to the staff.  
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
     [0032] Referring to FIGS. 1, 2 a standard prior art sling technique is illustrated. As shown in FIG. 1, a skilled medical worker  11 , such as a physician or physician&#39;s assistant, holds the patient&#39;s affected (right) arm  12  bent upwardly at the elbow, while a clothe sling  14  is wrapped around the medical worker&#39;s waist  16  and the patient&#39;s arm  12  at the elbow  18 . The medical worker  10  applies a force in the direction of the arrow  20  basically by leaning backward. In order that the for force in the direction of the arrow  20  to apply traction to the shoulder and not simply pull the patient  24  off the bed  26 , an assistant  28 , who need not be skilled, pulls in more or less the opposite direction in the direction of the arrow  30  on the assistant&#39;s sling  34 , which is wrapped about the patient  24  at his torso  36  under his armpit  38 . As shown in FIG. 1, the patient  24  is supine.  
     [0033] Referring to FIG. 2, a similar procedure with the patient  24  in a supine position is illustrated, but the skilled medical worker  11  does not use a sling and simply pulls downwardly along the natural line of the patients affected (left) arm  40 , that is, along the arrow  42 , while the assistant  28  pulls in basically the opposite direction along the arrow by applying force to the assistant&#39;s sling  34 , which is looped under the patient&#39;s left armpit  46 .  
     [0034] In the case of either FIG. 1 or  2 , two workers are required. Further it is evident from the drawings that the forces applied by the skilled medical worker  11  and the assistant  28  are not operating in opposite directions along the same line. Rather, the force applied by the assistant  28  are along a line that is downwardly offset from the force applied by skilled medical worker  11 , thereby resulting in shear forces in the affected shoulder joint  48  of the patient  24 . Ideally, the opposing forces should be as nearly along the same line as possible to minimize the resulting pain, asymmetrical stretching of ligaments on different sides of the affected shoulder joint  48  and to minimize the stretching required for the shoulder reduction. The prior art technique of both FIGS. 1, 2 may be used only when the patient  24  is supine. In virtually every case the patient will be supine and this is also the case with the shoulder reduction device  10  disclosed herein, but it would be possible to use the device  10  when the patient is standing.  
     [0035] Referring now to FIG. 3, there is shown the preferred embodiment of a shoulder reduction device  10  according to the present invention, which includes an elongated tubular staff  50  having a proximal end  52  (closest to the skilled medical worker  11  during use) covered with a padded sleeve  54  such as a foam grip, to reduce the pressure when the proximal end  52  is pushed into the skilled medical worker&#39;s stomach during use and to provide a high-friction grip. A distal end  56  (farthest from the skilled medical worker  11  during use) includes a crooked portion  58  bent outwardly from the general line of the elongated tubular staff  50 , preferably aluminum, and an inward bend  60  leading to a perpendicular portion, or armpit brace, or force distribution member or portion,  62 , which is substantially straight, but which includes a dip  64 , which distributes the force applied by the skilled medical worker  11  over a large area of the patient&#39;s armpit  38 ,  46  to reduce the pressure relative to a staff  50  alone and thereby reduce any discomfort to the patient  24 . The perpendicular portion  62  is perpendicular to the general line or longitudinal axis of the elongated tubular staff  50 , fits comfortably into the armpit of the patient  24  and is covered by a tubular cushioned sleeve  66  to improve patient comfort and to increase the holding friction between the shoulder reduction device  10  and the patient&#39;s armpit  38 ,  46  under the affected shoulder. Bending the elongated tubular staff  50  so that it also includes the armpit brace  62  allows a single piece of tubular material to serve as the staff and an armpit brace, simplifying construction. Alternatively, the armpit brace could be a separate member, such as a cross member, crutch top or the like fastened to a straight staff, but this would generally require two separate pieces that would be assembled (unless the entire assembly were molded). Attached to the elongated tubular staff  50  approximately adjacent to the crooked portion  58  is an arm cuff  68 , which is optionally used to hold the patient&#39;s upper arm against the elongated tubular staff  50  to insure that the line of the patient&#39;s arm lies along the line of the elongated tubular staff  50  (See FIG. 5). The arm cuff  68  is fastened to itself after being passed around the patient&#39;s arm by mating hook and loop fasteners, buckles or the like.  
     [0036] Still referring to FIG. 3, a substantially cylindrical wrist cuff  70  is connected to a pair of force transmitting straps  72 , which are fastened to a lower edge  74  of the wrist cuff  70  by sewing or the like and which are located across a diameter of the wrist cuff  70  from each other. A proximal end  76  of each of the two force transmitting straps  72  is folded over itself and a D-ring  78  and the two resulting layers of straps are sewn together or otherwise fastened to secure the D-rings  78  to the straps  72 . An S-hook  80 , or other type hook or fastener, attached to a quick-release rachet mechanism  82 , such as that described in U.S. Pat. No. 5,368,281, issued Nov. 29, 1994 to Skyba, which is hereby incorporated by reference, is inserted into the D-rings  78 . Alternatively, a simple pulley without a rachet mechanism may be used, but this option requires a stronger and steadier hand to apply and maintain the proper amount of traction. A traction cord or rope  84  is operatively routed or threaded through the rachet mechanism and includes a fixed end  86  that is seated in and fixed to the proximal end  52  of the elongated tubular staff  50  and a pulling end  88 , which terminates in a T-handle  90  that is pulled by the skilled medical worker  11 . Using the rachet mechanism  82  allows the skilled medical worker  11  to relax after applying a certain amount of traction to the traction cord  84  (and hence to the affected shoulder) without having the traction forces released. As shown in FIG. 4, the fixed end  86  of the traction cord  84  is threaded through a grommet  92 , seated in an aperture  94  adjacent to the distal end  56  of the elongated tubular staff  50  and is tied in a knot  96  to retain it in the staff  50 . The T-handle  90  is similarly fastened to the other end of the traction cord  84 . Alternatively, the traction cord may be simply fastened to the wrist cuff  70  as described above without being connected to the staff  50  at all or to any pulley or rachet mechanism, as shown in FIG. 8, in which case, the skilled medical worker  11  simply pulls on the traction cord  84  at the T-handle  90 . In this case, the traction cord  84  and wrist cuff  70  are related to the staff  50  but are not a part of it and are not connected to it. In the embodiment of FIG. 8, either the staff  50  of FIG. 3 or the length adjustable staff  50  of FIG. 6 may be utilized. The length of the staff  50  as shown in FIG. 3 is fixed, although it may be made adjustable as shown in FIG. 6.  
     [0037] Referring now to FIG. 5, in use, the skilled medical worker  11  places the proximal end  52  of the staff  50  against her stomach  98  and the distal end  56  in the patient&#39;s armpit under the affected joint (left shoulder  99 ), applies the wrist cuff  70  to the patient&#39; wrist using the hook and loop fasteners  100 , and then pulls on the T-handle  90 , while bracing the staff  50 . The wrist cuff  70  is closed to a diameter that is too small to allow the patient&#39;s hand  101  to pass through it, allowing traction to be pulled on the affected joint. Typically, her  11  right hand  104  holds and pulls the T-handle  90 , while her left hand  102  grips the padded sleeve  54  to stabilize the staff  50 . Traction or traction force is defined as a force pulling on the patient&#39;s arm away from the patient&#39;s body, more or less along the line of the arrow  91  in FIG. 5 and may or may not lie along the line of actual force applied by the skilled medical worker  11 , since that force may be translated along a different direction by the traction cord  84  and associated hardware.  
     [0038] Referring now to FIG. 6, an alternative embodiment of the shoulder reduction device  10  features a staff  50  whose length can be adjusted to accommodate different lengths of arms of patients or doctors by utilizing a telescoping staff  50  consisting of an upper staff member section  114 , a middle staff member section  126  and a lower staff member section  132 . This embodiment is similar to the preferred embodiment of FIG. 3, but also includes a length-adjustable staff  50 . The wrist cuff  70 , attached force transmitting straps  72 , D-rings  78 , rachet mechanism and traction cord  84  are the same and operate the same as in the embodiment shown in FIG. 3. The fixed end  86  of the traction cord  84  is attached to a D-ring  106 , which is slipped over an end of an S-hook  108 , which is seated in a aperture  110  in the staff  50  adjacent to the proximal end  112 . The shaft  50 , which may be a tubular shaft having a cylindrical cross section as shown, a square cross section or any other desired cross section, is provided in three sections, allowing for gross and fine adjustment of the length of the shaft  50  as used.  
     [0039] Still referring to FIG. 6, an upper staff section  114  includes a distal end  116  that is a projecting threaded stud  118 , adapted to be received by a threaded aperture  120  in the middle of a force distribution member  122 , which is covered and padded by a cushion member  124 , thereby forming a T-shaped structure. The force distribution member  122  is seated in the affected armpit  99  (see FIG. 5) during reduction.  
     [0040] Still referring to FIG. 6, a middle staff section  126  includes a conventional spring-loaded protruding locking member  126  that can be depressed to be level with the outer surface of the middle staff section  126 , while the upper staff section  114  is slid along and concentric with the middle staff section  126  until the desired length adjustment aperture  130  is located over the protruding locking member  126 , which then springs up, locking the upper staff section  114  and the middle staff section  126  together at a desired length. The protruding locking member  126  is fixed to the middle staff section  126  adjacent to a distal end  129  of the middle staff section  126 . Four spaced length adjustment apertures  130  are provided, all aligned along a straight line. This provides for a gross adjustment of the length of the staff  50 .  
     [0041] Referring to FIGS. 6, 7, fine length control of the staff  50  is accomplished by a screw mechanism utilizing the threaded stud  134 . A lower staff member section  132  includes a proximal end  112  having a protruding threaded stud  134  that accepts a cylindrical drilled spacing collar  136 , washer  138  and a padded knob  140 , which includes a threaded bore that is screwed onto the threaded stud  134 . The threaded stud  134  extends throughout the length of the lower staff member section  132  and projects outwardly from both ends of the lower staff member section  132 . The spacing collar  36  is restrained in the distance it can move along the threaded stud  134  by the stop member  144  fixed to the threaded stud  134 . The threaded stud  134  extends though the entire length of the lower staff member section  132  and includes a distal end portion  146  that is received by a threaded nut  148  fixed into a proximal end  150  of the middle staff section  126 . Rotating the padded knob  140  in one direction (typically clockwise as seen from the viewpoint of the skilled medical worker  11  in FIG. 5) thereby draws the threaded stud  134  farther into the middle staff section  126 , thereby shortening the length of the complete staff, while rotating the padded knob  140  in the opposite direction shortens the overall length of the staff  50 , thereby providing fine adjustment of the length of the staff  50 . Rotation of the padded knob in either direction is indicated by the arrow  141 , which is translated by the screw  118  into the linear movement of the middle staff member  126  section  126  as shown by the arrow  143  and drawing the middle staff member  126  into the lower staff member section  132  or pushing it away from the lower staff member section  132 , thereby shortening or lengthening the overall elongated tubular staff  50 , respectively.  
     [0042] Referring to FIG. 8, an alternative embodiment of the shoulder reduction device  10  is illustrated in which the traction cord  84  is connected to a T-handle  90  at the pulling end  88  of the traction cord  84  and the distal end  93  is folded over itself and sewn or the like along the seam  152  to form the loop  154 , which is slipped over the S-hook  80 , and which is attached to the wrist cuff  70  in the same fashion as described above in connection with FIG. 3. In this embodiment, the skilled medical worker  11  attaches the wrist cuff  70  to the patient&#39;s wrist on the hand of the affected arm, braces the staff  50  between her body and the patient&#39;s armpit, and pulls on the T-handle  90 , as described above. This embodiment is simpler to make but is somewhat harder to use because the staff  50  does not assist in properly aligning the traction forces and does not allow the skilled medical worker  11  to relax the arm that is applying traction to the arm. The ability for the skilled medical worker to relax during the procedure is a principal benefit of utilizing the rachet mechanism  82  in the embodiment illustrated in FIGS. 3, 5, and  6 .  
     [0043] In using either embodiment of the embodiment of the shoulder reduction device  10 , it is not necessary for the skilled medical worker  11  to hold or touch the affected arm or shoulder because the shoulder joint does not need guidance in order to accomplish reduction—it only needs firm sufficient stretching of the joint ligaments, which will snap the joint back together once the ligaments have been stretched sufficiently. Since it is highly desirable to release the traction on the joint quickly after reduction is achieved, a quick release rachet mechanism  82  is preferred in the preferred embodiment. Either embodiment of the shoulder reduction device  10  may be used for reduction of either the left-hand or right-hand shoulder joint. Neither embodiment of the shoulder reduction device  10  has a handedness, so the skilled medical worker  11  can use either hand to pull on the T-handle  90  and either hand to hold the shoulder reduction device  10 , as desired. Further, only one person, a skilled medical worker, is needed to operate the shoulder reduction device  10  successfully.  
     [0044] It has been found that using the shoulder traction device  10  can dramatically reduce the time needed for reduction of a dislocated shoulder because the rachet mechanism  82  allows the skilled medical worker  11  to apply steady even force to the affected shoulder joint. When the two-person prior art technique is used, one person may relax a bit or may pull a little harder and its very difficult, if not impossible, for the other worker to compensate for the changing forces, resulting in the uneven application of force to the dislocated shoulder. In one actual case, a physician and an assistant unsuccessfully struggled for more than two hours to reduce a dislocated shoulder and then a single skilled medical worker utilizing the shoulder reduction device according to the present invention was able to reduce the dislocation in about two and one-half minutes. The key to a quick, minimally painful shoulder joint reduction is the application of steady force that can be incrementally increased and well-controlled until the force required to draw the humeral head to relocate back into its socket, which is greatly facilitated by the shoulder reduction device  10 . The shoulder reduction device  10  can also be used to stabilize a fractured humerus by using the device  10  as a splint with straps wrapped around the fractured limb and applying traction to hold the fractured bone ends apart to alleviate pain and further damage to the bones until the fracture can be set.  
     [0045] While the present invention has been described in accordance with the preferred embodiments thereof, the description is for illustration only and should not be construed as limiting the scope of the invention. Various changes and modifications may be made by those skilled in the art without departing from the spirit and scope of the invention as defined by the following claims.