Abstract:
The portable resetting device ( 100 ) has a portable pedestal ( 126 ) with telescoping sections ( 172/170 ). An underarm support ( 102 ) of adjustable height is mounted to a lower support ( 114 ) that is mounted to the pedestal ( 126 ). A traction structure ( 112 ) for transmitting forces to an injured arm is mounted to the lower support ( 114 ). A computer controllable motor ( 124 ) is operatively connected between the lower support ( 114 ) and the pedestal ( 108 ) so that an angle of tilt ( 116 ) may be placed thereon. An arm-holding plate ( 136 ) is attached to the lower support ( 114 ) and moves in a longitudinal direction by means of another computer controllable motor ( 118 ) operatively connected therebetween. An auxiliary arm support ( 122 ) is operatively connected by a computer controllable motor ( 120 ) on the lower support ( 114 ) and provides an additional force to the humerus head. A computer ( 302 ) controls the resetting device ( 100 ) and may communicate to a support computer ( 210 ) for treatment advice.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present patent applications is related to International Patent Application PCT/US2008/003516 filed on 18 Mar. 2008, and claims priority to Hungarian Patent Application Serial Number P 07 00228 filed on 20 Mar. 2007, and to U.S. patent application Ser. No. 12/309,366 filed Jan. 15, 2009. 
     
    
       [0002]    Reference to Federally sponsored research or development: NA 
         [0003]    Reference to joint research agreements: NA 
         [0004]    Reference to Sequence Listing: NA 
       BACKGROUND OF THE INVENTION 
       [0005]    1. Field of the Invention 
         [0006]    The present invention relates generally to medical systems for use in the treatment of injuries, and, in particular, relates to a device for treating joint injuries, and, in great particularity, relates to a device for resetting a joint dislocation, and in greater particularity, relates to an electro-mechanical means for controlling the treatment to minimize pain and the use of anesthesia. 
         [0007]    2. Description of the Prior Art 
         [0008]    With people being more active in sports today such as soccer, football, basketball, hockey, etc., more and more people are receiving shoulder injuries, and in particular, dislocations of the shoulder wherein the humerus head of the arm is pulled away from the tablet of the fossa glenoidalis joint surface. This is a painful injury. 
         [0009]    Resetting of the shoulder is primarily addressed by peculiar manipulations or pulling of the upper arm in various directions as has been done in the past. It is a well known fact that moving the dislocated joint is painful so most methods are not even attempted without administering pain reduction drugs. In the pulling method, the pulling is typically done by human strength—in various directions—or with a weight, acting mostly downward according to the law of gravity. 
         [0010]    An example of the latter method for relocating shoulder dislocations is the so-called Stimson technique, during which the injured arm of the patient, who is lying on his/her abdomen, is pulled down perpendicular to the body with the use of weights. This method is disclosed in U.S. Pat. No. 5,997,494, according to which a quantity of fixed weights depending on the patient&#39;s physical condition and the state of the dislocation (advantageously with a mass of 4.5-12 kg) is placed in a weight container connected to a cuff attached to the lower arm of the patient. Alternatively, water may be added to a container in an increasing amount; in this manner, a smooth extension can be achieved. 
         [0011]    Another prior art example for treating the shoulder dislocation is disclosed in U.S. Pat. No. 4,616,637, according to which the arm of the injured person, who is lying on his/her side, is pulled upward by attaching to the hand a rope passing through an overhead pulley. 
         [0012]    The essence of the above examples is thus that the limb of the injured person is pulled with weights thereby extending the muscles whose contraction must be overcome during the relocation of the dislocation. Their disadvantage is the length of the traction pull and the solutions used to exert force can cause pain because of possible displacements of the arm; therefore drugs (sedatives, local anesthesia, muscle relaxants) are generally needed. Administering drugs, however, can always be associated with side effects, including serious complications. 
         [0013]    Only a few methods may work without drug administration. One of these is the Arlt method, where the relocation always takes place without giving drugs! (Arlt: “Erfahrungen bei Einrichtung der Schulterverrenkungen” [Experiences in Relocating Shoulder Dislocations],  Der Chirurg.  1941, vol. 13, page 416 2). This method has been practiced in a sparing manner and mostly painless. Its essence is that for every dislocation, there is one position that is “practically” pain free. This is generally the position where the patient holds the dislocated arm with the good arm. 
         [0014]    Sometimes, however, the task of the physician is to find this pain-free position by fine movements of the shoulder. Maintaining this position, the patient is made to sit so that his shoulder girdle is supported in the underarm by a back support of a chair, then, while maintaining this position, the arm is pulled downward in a sparing manner and gradually until the dislocated humerus head jumps back into the glenoid cavity. A chair having this adjustable underarm support has been specifically designed for this procedure: (manufacturer: Dr. Franz Merska, Vienna, Austria, product name: “REPOSITIONSSTUHL” [REPOSITION CHAIR]”). 
         [0015]    The above methods may present one or more disadvantages to the patient. For example, the position of the arm changes during pulling by manual force thus causing pain. It also has the disadvantage that the extent and strength of the pulling force cannot be measured exactly in relation to the extension of the arm; one of the main reasons for failure, however, is that the physician gets tired and gives up. 
         [0016]    Accordingly, there is an established need for a device that prevents the above mentioned uncertainties and can be applied in a controlled manner without the use of drugs for resetting a dislocated shoulder. 
       SUMMARY OF THE INVENTION 
       [0017]    The present invention is thus achieved by a portable resetting device that overcomes the above disadvantages and provides a device that assures painless reduction of the shoulder dislocation. 
         [0018]    The device of the present invention is directed at a goal of providing a pain-free position while relocating the humerus head into the tablet. The device of the present invention for reduction of a shoulder dislocation provides a portable resetting device having an underarm support of adjustable height upon a pedestal with the resetting device being located near to a chair having the patient therein and the injured arm on the same side as the resetting device. The resetting device is portable and thus may be readily moved to the patient. A traction structure suitable for transmitting a mechanical force in a downward direction to the injured arm is mounted to a lower support that is further mounted to the top of the pedestal. The traction structure has the lower support/section/part connected to the pedestal. A computer controllable motor is operatively connected between the lower support and the pedestal so that an angle of tilt may be placed thereon. An arm-holding plate that serves to hold the injured arm is attached to the lower support having arm holding supports and/or cuffs attached that keep the arm in a bent and fixed position; the arm-holding plate and the lower support of the traction structure are slideably connected to each other so as to permit them to move in the longitudinal direction with respect to each other by means of another computer controllable motor operatively connected therebetween. An auxiliary arm support is operatively connected by a controllable motor on the lower support. The pedestal includes the controllable motors for moving the lower support in angular displacement and for adjustment in the height of the underarm support. Appropriate electronic circuits are provided to control the motors, to display device information, and to remotely control the motors. The resetting device may further be connected through a network or the Internet to a central office where patient treatment information may be placed in a database and a treatment plan provided. 
         [0019]    The resetting device may be a stand-alone device, or may communicate to a support program over the Internet for assistance and advice in the treatment of patients. 
         [0020]    Therefore, one aspect of the present invention is a traction structure adjustable through an angle of about 20 to about 50 degrees with respect to a vertical plane, and even more advantageously between 30 and 40 degrees; 
         [0021]    It is another aspect of the present invention to provide a means for measuring the force of extension of the joint so that the physician can control the application of force to the shoulder in an accurate manner; 
         [0022]    It is yet another aspect of the present invention to provide, in addition to the underarm support, an auxiliary arm support placed in a position more distant from the body for moving the humerus head further away from the body as needed; 
         [0023]    It is still a further aspect of the present invention to provide stabilization of the bent arm by one or more supports; one of which is placed nearer the elbow on the side opposite to the direction of the pulling force and the other placed on the side nearer the wrist, in the direction of the pulling; and 
         [0024]    It is still a further aspect of the present invention to provide for the resetting device being portable and controllable to better suit the conditions of the patient. 
         [0025]    These and other objects, features, and advantages of the present invention will become more readily apparent from the attached drawings and the detailed description of the preferred embodiments, which follow. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0026]    The preferred embodiments of the invention will hereinafter be described in conjunction with the appended drawings provided to illustrate and not to limit the invention, where like designations denote like elements, and in which: 
           [0027]      FIG. 1A  is a front-side perspective view of a resetting device of the present invention; 
           [0028]      FIG. 1B  is an x-ray view of a top of a pedestal of the resetting device; 
           [0029]      FIG. 1C  is an x-ray view of a bottom of the pedestal of  FIGS. 1A and 1B   
           [0030]      FIG. 1D  is a partial perspective view of a traction structure with the arm-holding plate partially deployed; 
           [0031]      FIG. 1E  is a partial view of an underarm support and auxiliary arm support; 
           [0032]      FIG. 1F  is a top view of a lower support of the traction structure; 
           [0033]      FIG. 2  is a diagram showing the resetting device communicating to a support program; 
           [0034]      FIG. 3  is an electrical block diagram for the resetting device of the present invention; 
           [0035]      FIG. 4  is a front view of a remote controller for operating the resetting device of the present invention; 
           [0036]      FIG. 5  is a flow diagram for operating the resetting device of the present invention; and 
           [0037]      FIG. 6  is a flow chart for a reduction program; 
       
    
    
       [0038]    Like reference numerals refer to like parts throughout the several views of the drawings. 
       DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0039]    The present invention is directed at a resetting device for reduction of a shoulder dislocation that minimizes pain, and further eliminates or greatly reduces the need for any pain drugs for the procedure. 
         [0040]    Turning to the drawings, wherein like components are designated by like reference numerals throughout the various figures, attention is initially directed to  FIGS. 1A to 1F  which illustrate a resetting device  100 , and, in particular,  FIG. 1A  which is a front-side perspective view of an embodiment of the resetting device  100 . 
         [0041]    In  FIG. 1A , a right side injured shoulder, for example, not shown, is supported by an underarm support  102  having an underarm support member  103 . A patient, not shown, is sitting in a chair, not shown, facing the front with the right arm, not shown, over the underarm support member  103  with the armpit resting against the underarm support member  103 . The height of the underarm support  102  can be adjusted by a computer controlled motor  104 ,  FIG. 1C , located in a base  106  of a pedestal  108  of the resetting device  100 . It should be understood that the controlled motors driving a screw may be otherwise accomplished in that function. Forces, distances and angles may be visibly measured by scales attached to the appropriate devices. Pneumatic or hydraulic or mechanical drive systems may be adapted to similarly function as would be understood by one skilled in the art knowing of the present invention as disclosed herein. The pedestal  108  has a lower section  170  and an upper section  172  that telescopes out of the lower section  170 . The control motor  104  drives a screw  105  that is rotatably attached to an end plate  109  located in the upper section  172 . The base  106  has a triangular set of feet  110 . A traction structure  112  is adjustably attached to a lower support  114 . Attached to the upper part of the lower support  114  is an auxiliary arm support  122  having an auxiliary arm support member  162  that is parallel to the underarm support member  103 . 
         [0042]    As seen in  FIG. 1B , the traction structure  112  is adjustably attached to the pedestal  108  at a top mount  148 . An arm-holding plate  136  is translatably mounted to the lower support  114  and moves along a pair of slides  140 ,  FIG. 1D . A tilt angle α,  FIG. 1A , between the traction structure  112  and a vertical axis  116  of the pedestal  108  is adjustable through a tilt angle computer controlled motor  124  mounted in the upper section  172  of the pedestal  108 ,  FIG. 1B . The motor  124  turns a screw  142  that translates a platform  144  therein. Pivotally mounted to the platform  144  is an arm  146  that is further mounted pivotally to the backside of the lower support  114 . As the platform  144  is raised, the arm  146  pushes up the lower support  114  which is further pivotally mounted to the top mount  148 . The translation of the platform  144  causes the lower support  144  to pivot off of the top mount  148 . 
         [0043]    The movement of the arm-holding plate  136 ,  FIGS. 1A ,  1 D and  1 E, is adjustable through a force providing computer controlled motor  118  that is also adjustable. The motor  118  is mounted in the lower support  114  and drives a screw  150 ,  FIG. 1F , that has a translatable bracket  152  mounted thereto that is further mounted to a backside of the arm-holding plate  136 . 
         [0044]    A further feature of the resetting device  100  is an auxiliary arm support  122 ,  FIGS. 1A ,  1 D,  1 E, and  1 F, that may be moved to a distal location parallel to the underarm support member  103 . An auxiliary arm support computer controlled motor  120 ,  FIG. 1F , is located in the lower support  114  of the traction structure  112  and is adjustable and drives linkage  128  that causes the auxiliary arm support member  162  to rotate about a pivot  130 . As seen in  FIG. 1D , the motor  120 , not shown, drives a screw  154  that has a translatable bracket  156  thereon. The bracket  156  has a lower arm  158  pivotally attached thereto and is further pivotally connected to an upper arm  160  that is connected to the auxiliary arm support member  162 . As the bracket  156  is moved up, for example, the lower arm  158  pushes the upper arm  160  up also and causes the member  162  to move away from the parallel underarm support member  103  by rotating on the pivot  130 . 
         [0045]    The role of the auxiliary arm support  122  becomes important if the traction force on the stabilized arm in the pulling direction, as shown by an arrow  132 ,  FIG. 1 , is insufficient by itself to reset the dislocated shoulder. In this case, repositioning is achieved by actuating the motor  120  that acts through linkage  128  to move the auxiliary arm support member  162  away from the body by means of the pivot  130 ; thus exerting an additional outward pressure on the upper arm. 
         [0046]    In carrying out the method of the present invention, the patient is made to sit in a chair adjacent to the resetting device  100 . The underarm support member  103  is placed below the injured shoulder with the aid of the height adjustment motor  104  lifting the underarm support member  103  upwards into the armpit. Movement of the patient&#39;s injured shoulder should be minimized and thus the underarm support lowered initially to clear the armpit. Because of variations in patient&#39;s height and size, the chair may be lowered or raised also. The angle α of the traction structure  112  is set and fixed corresponding to a pain-free position as determined by the treating doctor. The traction structure  112  is able to rotate over an angle α, wherein the angle α ranges from about 20 to 50 degrees with respect to a vertical plane, and more effectively in a range between about 30 to about 40 degrees. The lower arm of the patient is stabilized in a bent position with the aid of the supports attached to the arm-holding plate  136 . The patient may be secured in the chair to prevent undesired movements that may result during the treatment. 
         [0047]    The following is an example, and only provides a general description of the manner of applying the force to the shoulder dislocation. The traction force, in direction  132 , is initially set to start at 50 N (MKS system, Newton). The traction force is set with the aid of a remote controller  400  as shown in  FIG. 4 . The remote controller  400  may communicate to a computing device  302 ,  FIG. 3 , by hardwire or by RF or by IR sensor  402 . Further, the information presented and actions needed may also be taken and shown on a display of the computing device  302 . The power to the resetting device  100  is turned on by pressing a power button  408  that may be illuminated green when actuated. A power shut off button  404  or kill switch is used to immediately stop the procedure and return the resetting device  100  to its initial or default settings. A start/stop button  410  is used to stop the treatment temporarily so that adjusts can be made and then restarted. The initial settings or adjust settings are entered via a set  412  of switches that control the motors on the resetting device  100 . Normally the switches are off unless either an up button  414  or down button  416  are actuated. Buttons  414  and  416  are for controlling the height of the underarm support  102  by adjusting the height of the pedestal  108 . Optionally related information may be shown in a remote controller display  418 . For example, an angle switch  420  when either actuated up  422  or down  424  will then display the actual angle in degrees. An auxiliary arm support switch  426  having an up  428  and a down  430  switch will then display the angle in the display  418 . A force button  432  with an up  434  and a down  436  buttons when actuated will then display the force in metric Newtons or English pounds. As the up or down button is held, the appropriate motor will adjust the device in a controlled manner, from the last setting, not to cause any alarm or pain in the patient. For example, the force button  432  may be tapped to cause the force to come up to the desired level. A light within the button may flash when this adjustment is being made. This is within the control of the treating doctor based upon the conditions of the patient. The traction is started by pushing the start button  410 . At this time, the force motor will start to increase the force on the arm-holding plate in a downward direction. The traction is continued for about 1 minute, then the traction force is increased in steps of 25 N at further 1-minute intervals (to a maximum of 200 N). The extension may be further observed with the aid of a scale attached between the arm-holding plate  136  and the lower support  114  of the traction structure  112 . If repositioning does not occur, then the auxiliary arm support  122  is moved away from the body as desired. As this is done, an additional force appears in the outward direction, perpendicular to the axis of the extended position of the joint. 
         [0048]      FIG. 5  illustrates by flow chart the steps required in the treatment of a patient using the resetting device  100  of the present invention. Patent information is taken in step  502  which would include sex, age, weight, height, present medication, nature of the injury, whether it has happened before, prior treating doctors, hospitals, medications given, etc. This information is then evaluated in step  504  which may also include x-rays, MRIs, physical examinations, etc. A treatment plan is then proposed in step  505 . The patient is then positioned in the resetting device  100  in step  506 . Initial settings are entered into the computing devices associated with the device  100  in step  508 . The treatment is initiated by pressing the start button in step  510 . If this initial treatment is not effective in resetting the shoulder, the settings are adjusted in step  514  and the treatment is again continued and evaluated. 
         [0049]      FIG. 2  indicates a plurality of resetting device  202 ,  204 ,  206 , et. seq., that communicate through a network, such as the Internet  208 , to one or more shoulder reduction centers  210  that operate one or more programs  600 ,  FIG. 6 , for managing the resetting devices in a shoulder reduction system  200 . It should be understood that the system  200  may be a Windows® based program owned by Microsoft. The treating doctor after logging into the system  200 , step  602 , would enter the patient&#39;s information, step  604 , such as noted above. The system  200  would then evaluation the patient information in light of a treatment database in step  606 . Based upon this information, optimal treatment settings in step  608  such as height of the arm support  102 , the angle of the arm holding plate α 116 , the extension of the arm holding plate  112  with an initial force, and if needed the angle of the auxiliary arm support  122 , are provide in step  610 . The resetting device would upload patient information and this would be evaluated based upon past histories maintained in one or more databases in the centers  210  to recommend possible treatment plans. If the treatment is successful in step  614 , and the shoulder is reset, step  516 , the treatment history is entered into the support program database in step  518 , and step  618 . If the initial settings did not reset the shoulder, adjusted settings would be provided in step  616  through the program  600 . This information would be clearly labeled advisory in nature and subject to the actual conditions of the patient as seen by the treating doctor. 
         [0050]      FIG. 3  illustrates the computing device  302  for operating the resetting device  100 . The computing device  302  may also include additional computers such as laptop computers that are interfaced thereto to display and control information. Inputs into the computing device  302  include but are not limited to the remote controller  400 , a patient “kill” switch  134 , and other traditional devices such as a mouse  304 , a modem  306  connected to a network and/or the Internet, a keyboard  308 , a touch screen display, etc. The patient “kill” switch  134  may also be provided that allows the patient to terminate the treatment cycle if the pain is excessive. These operate through a conventional microprocessor unit  310  having a data storage unit  312  that would be running a dedicated program for supporting the resetting device  100 . Outputs would include displays  314  and, in particular, a motor controller  316 . The motor controller  316  would operate through interfaces  318 ,  320 ,  322 , and  324 , to control adjustable height motor  326 , angle adjustment motor  328 , auxiliary arm support adjustment motor  330 , and force adjustment motor  332 . The operations of these motors would be monitored by sensors  334 ,  336 ,  338 , and  340  that would communicate this information back to the processor  310  and the motor controller  316 . 
         [0051]    For example, if there is no resistance to moving the arm-holding plate, the current through the force adjustment motor  332  will be a fixed value, but if there is resistance, i.e., the arm is being pulled, the current will increase and this corresponds to a force applied. The motor controller  316  will note this increased current by an increase in voltage across a resistor in that circuit, for example. This voltage will correspond to a particular applied force determined empirically and stored in a table in the data storage unit  312  of the computing device. The adjustable height motor  326 , the angle adjustment motor  328 , and auxiliary arm support adjustment motor  330  may be controlled based upon the run-time. For example, the angle adjustment motor  328  run-time would correspond to an angle of the arm-holding plate/traction structure in another table, run-time versus angle, stored in the computing means. Similarly to both the adjustable height motor  326  and the auxiliary arm support adjustment motor  330  where the run-time would correspond to distance. This information thus can be digitized and displayed and further changed based upon inputs from the remote controller  400 . 
         [0052]    It should be understood that all electrical wiring to the electric motors and control wires and other electronic devices are considered conventional and would be known to one skill in the art with knowledge of the present invention and as illustrated in  FIG. 3 . 
         [0053]    With the system and method of the present invention, a pain-free relocation of the shoulder joint can be achieved, during which, the physician only has to pay attention to directing and checking the process and the patient. During the process, the amount of extension and the direction can be monitored and kept under control. Further, data is produced, previously unknown, which can be very important in treating dislocations in the future. The following important features of the present invention are thus provided: 1) To support the shoulder by measuring the desired height; 2) To set the basic pain-free position by setting the arm-body angle; 3) To maintain the pain-free position during the entire traction period; 4) To know the traction force at all times, continually, or to make periodic changes to the settings, as desired; 5) To measure the muscle relaxing—arm extension; 6) To direct the pressure on the upper arm outward, which is an important element of certain repositioning techniques. 
         [0054]    Since many modifications, variations, and changes in detail can be made to the described embodiments of the invention, it is intended that all matters in the foregoing description and shown in the accompanying drawings be interpreted as illustrative and not in a limiting sense. Thus, the scope of the invention should be determined by the appended claims and their legal equivalents.