SYSTEMS AND METHODS FOR TREATMENT OF COMPRESSED NERVES

• US 20110087255A1
• Filed: 08/06/2010
• Published: 04/14/2011
• Est. Priority Date: 08/07/2009
• Status: Active Grant

• Current Assignee: Thayer Intellectual Property, Inc.
• Original Assignee: Thayer Intellectual Property, Inc.
• Inventors: Tanaka, Shigeru, McCormack, Bruce M., Leugers, Martin, Smith, Jeffrey D., Carver, Jonathan, Druker, Joshua, How, Peter, Liou, Edward, Eyster, Edward Fletcher
• Granted Patent: US 8,348,966 B2
• Time in Patent Office: Days
• US Class Current: 606/167
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/149 Chain, wire or band saws
• CPC Class Codes: A61B 17/320036 adapted for use within the carpal tunnel
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 2017/0042 with special provisions for gripping
• CPC Class Codes: A61B 2017/32006 with a cutting strip, band or chain, e.g. like a chainsaw
• CPC Class Codes: A61B 5/242 Detecting biomagnetic fields, e.g. magnetic fields produced by bioelectric currents
• CPC Class Codes: A61B 5/248 specially adapted for magnetoneurographic [MNG] signals, e.g. magnetospinographic [MSG] signals
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61G 13/124 Hands or wrists

Abstract

Disclosed herein is a system for releasing a ligament. In one embodiment, the system includes a proximal handle, a tubular body, and a flexible body. The tubular body includes a proximal end and a distal end. The handle is coupled to the proximal end. The flexible body extends through the tubular body and includes a tissue cutting portion. The flexible body is longitudinally displaceable relative to the tubular body to move the tissue cutting portion between a non-deployed state and a deployed state.

Claims

25. The system of claim 25, wherein the nerve sensing system is configured to sense nerve impulses or action potentials.

1. A system for releasing a ligament, the system comprising:

a proximal handle;

a tubular body comprising a proximal end and a distal end, the handle coupled to the proximal end; and

a flexible body extending through the tubular body and comprising a tissue cutting portion, the flexible body longitudinally displaceable relative to the tubular body to move the tissue cutting portion between a non-deployed state and a deployed state.

2. The system of claim 1, wherein the tissue cutting portion includes a plurality of teeth or an abrasive surface.

3. The system of claim 1, wherein the tissue cutting portion includes an RF energy cutter or a water jet.

4. The system of claim 1, wherein the flexible body is longitudinally displaced relative to the tubular body during a tissue cutting motion.

5. The system of claim 1, wherein the flexible body and tubular body are moved together during a tissue cutting motion.

6. The system of claim 1, wherein the flexible body is axially rotationally displaced relative to the tubular body during a tissue cutting motion.

7. The system of claim 1, wherein the tubular body further comprises a window, wherein, when the flexible body is longitudinally displaced relative to the tubular body to move the tissue cutting portion from the non-deployed state to the deployed state, the cutting portion moves from being generally hidden within the tubular body to being generally exposed in the window.

8. The system of claim 1, wherein the tubular body further comprises a window, wherein, when the flexible body is longitudinally displaced relative to the tubular body to move the tissue cutting portion from the non-deployed state to the deployed state, the cutting portion moves from being generally recessed within the tubular body to being generally exposed in the window.

9. The system of claim 8, wherein, when the cutting portion is in the deployed state, the cutting portion assumes a bow-like arrangement with the tubular body.

10. The system of claim 1, further comprising an actuator near the proximal end of the tubular body that causes the cutting portion to move between the non-deployed state and the non-deployed state.

11. The system of claim 10, wherein the handle includes the actuator.

12. The system of claim 1, further comprising a distal handle configured to operably couple to the distal end of the tubular body.

13. The system of claim 12, wherein the flexible body further comprises a distal end comprising a tissue penetration tip that moves from a recessed state to a tissue penetration state when the flexible body is longitudinally displace relative to the tubular body.

14. The system of claim 13, wherein, when the penetration tip is in the recessed state, the tissue cutting portion is in the non-deployed state.

15. The system of claim 13, wherein, when the penetration tip is in the tissue penetration state, the tissue cutting portion is in the deployed state.

16. The system of claim 13, wherein the distal handle is configured to operably couple to the distal end of the tubular body by being directly connected to the distal end of the flexible body when the penetration tip is in the penetration state.

17. The system of claim 13, further comprising an adjustable lock supported on the tubular body that limits a distal cutting stroke displacement of the system.

18. The system of claim 17, wherein the distal cutting stroke displacement of the system can be limited by the adjustable lock such that the tubular body will extend through an exit hole created in the palm by the penetration tip.

19. The system of claim 1, wherein the flexible body further comprises a distal end comprising a tissue penetration tip that moves from a recessed state to a tissue penetration state when the flexible body is longitudinally displace relative to the tubular body.

20. The system of claim 19, wherein, when the penetration tip is in the recessed state, the tissue cutting portion is in the non-deployed state.

21. The system of claim 19, wherein, when the penetration tip is in the tissue penetration state, the tissue cutting portion is in the deployed state.

22. The system of claim 19, further comprising an adjustable lock supported on the tubular body that limits a distal cutting stroke displacement of the system.

23. The system of claim 22, wherein the distal cutting stroke displacement of the system can be limited by the adjustable lock such that the tubular body will extend through an exit hole created in the palm by the penetration tip.

24. The system of claim 1, further comprising a nerve sensing system electrically coupled to the tubular body or flexible body.

26. The system of claim 25, wherein the nerve sensing system includes an ultrasound probe operably coupled to the tubular body.

37. The method of claim 26, further comprising causing the distal end of the flexible body to percutaneously penetrate at a second location.

38. The method of claim 37, further comprising causing the distal end of the tubular body to percutaneously penetrate at the second location.

39. The method of claim 37, wherein the distal end of the flexible body percutaneously penetrating at a second location includes causing a tissue penetration tip of the distal end of the flexible body to move from a recessed state to a tissue penetration state when the flexible body is longitudinally displace relative to the tubular body.

40. The method of claim 39, wherein, when the penetration tip is in the recessed state, the tissue cutting portion is in the non-deployed state.

41. The method of claim 39, wherein, when the penetration tip is in the tissue penetration state, the tissue cutting portion is in the deployed state.

26-1. The system of claim 25, wherein the nerve sensing system includes a hardness sensor operably coupled to the tubular body.

27. A method of releasing a ligament, the method comprising:

percutaneously penetrating at a first location with a tubular body;

positioning the tubular body adjacent the ligament;

employing a nerve sensing system to position a tissue cutting portion away from a nerve, the tissue cutting portion being part of a flexible body longitudinally displaceable relative to the tubular body between a non-deployed state and a deployed state of the tissue cutting portion;

causing the tissue cutting portion to longitudinally displace from the non-deployed state to the deployed state; and

releasing the ligament with the tissue cutting portion.

28. The method of claim 27, wherein releasing the ligament with the tissue cutting portion includes causing the tissue cutting portion to longitudinally displace relative to the tubular body.

29. The method of claim 27, wherein releasing the ligament with the tissue cutting portion includes causing the tissue cutting portion and the tubular body to longitudinally displace together.

30. The method of claim 27, wherein releasing the ligament with the tissue cutting portion includes causing the tissue cutting portion to axially rotationally displace relative to the tubular body.

31. The method of claim 27, wherein the tissue cutting portion includes a plurality of teeth or an abrasive surface.

32. The method of claim 27, wherein the tissue cutting portion includes an RF energy cutter or a water jet.

33. The method of claim 27, wherein the tubular body comprises a window, wherein, when the flexible body is longitudinally displaced relative to the tubular body to move the tissue cutting portion from the non-deployed state to the deployed state, the cutting portion moves from being generally hidden within the tubular body to being generally exposed in the window.

34. The method of claim 27, wherein the tubular body comprises a window, wherein, when the flexible body is longitudinally displaced relative to the tubular body to move the tissue cutting portion from the non-deployed state to the deployed state, the cutting portion moves from being generally recessed within the tubular body to being generally exposed in the window.

35. The method of claim 34, wherein, when the cutting portion is in the deployed state, the cutting portion assumes a bow-like arrangement with the tubular body.

36. The method of claim 27, further comprising operably coupling a distal handle to a distal end of the flexible body or a distal end of the tubular body.

42. The method of claim 27, further comprising adjusting a lock supported on the tubular body to limit a distal cutting stroke displacement tissue cutting portion.

43. A system for releasing a ligament, the system comprising:

an introducer comprising a distal end and a proximal end;

a flexible body comprising a first end, a second end and a length extending between the first end and the second end, the length forming a loop distally extending from the distal end of the introducer and configured to have the ligament in the loop, the length comprising a tissue cutting portion, the first end and the second end proximally extending from the proximal end of the introducer.

44. The system of claim 43, wherein the tissue cutting portion includes a plurality of teeth or an abrasive surface.

45. The system of claim 43, further comprising an elongated body configured to be extended through the introducer proximal to distal and engage the first end and pull the first end around the ligament and through the introducer to form the loop such that the first end is adjacent the second end extending proximally from the proximal end of the introducer, the elongated body including a first engagement feature configured to engage a second engagement feature on the first end.

46. The system of claim 45, wherein the first engagement feature includes a hook and the second engagement feature includes a ball.

47. The system of claim 45, wherein the elongated body includes forceps.

48. The system of claim 43, further comprising a first handle operably coupled to the first end and a second handle operably coupled to the second end.

50. The system of claim 43, further comprising a nerve detection system coupled to the flexible body.

51. A method for releasing a ligament, the system comprising:

percutaneously penetrating at a first location with an introducer comprising a distal end and a proximal end;

providing a flexible body comprising a first end, a second end and a length extending between the first end and the second end and comprising a tissue cutting portion;

routing the first end distally through the introducer, around the ligament and proximally back through the introducer such that the length forms a loop around the ligament, the loop distally extending from the distal end of the introducer, the first end and the second end proximally extending from the proximal end of the introducer; and

employing the tissue cutting portion to release the ligament.

52. The method of claim 51, wherein the tissue cutting portion includes a plurality of teeth or an abrasive surface.

53. The method of claim 51, further comprising employing an elongated body configured to be extended through the introducer proximal to distal to engage the first end and pull the first end around the ligament and through the introducer to form the loop.

54. The method of claim 51, further comprising securing a handle to at least one of the first end or second end.

55. The method of claim 51, further comprising employing a nerve sensing system to position the tissue cutting portion away from a nerve.

56. A handboard assembly for securing a hand and forearm of a patient undergoing a carpal tunnel surgery, the assembly comprising:

a chassis base including a first end and a second end; and

a flex board including a third end, a fourth end, a first planar region adjacent the third end, a second planar region adjacent the fourth end and a flex region between the first planar region and the second planar region, the third end operably coupled to the first end and the fourth end operably coupled to the second end, the flex region configured to result in a bend in the flex board when the first planar region and the second planar region are each caused to assume an incline relative to the chassis base.

57. The assembly of claim 56, wherein the first planar region is adapted to receive the hand and the second planar region is adapted to receive the forearm.

58. The assembly of claim 56, wherein the first planar region includes a finger receiving portion with a finger securing mechanism and a thumb receiving portion with a thumb securing mechanism, and the second planar region includes a forearm securing mechanism.

59. The assembly of claim 57, wherein at least one of the finger securing mechanism, thumb securing mechanism, or the forearm securing mechanism includes a strap arrangement.

60. The assembly of claim 57, wherein the strap arrangement includes hook and loop regions.