Orthosis with joint distraction

• US 5,213,094 A
• Filed: 04/17/1991
• Issued: 05/25/1993
• Est. Priority Date: 07/30/1990
• Status: Expired due to Term

• Current Assignee: Bonutti Research Incorporated (Bonutti IP LLC)
• Original Assignee: Peter M. Bonutti
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Apley, Richard J.
• Assistant Examiner(s): DVORAK, LINDA C
• Application Number:
  US07/686,811
• Time in Patent Office: 769 Days
• Field of Search: 602/5, 602/16, 602/20, 602/23, 602/26, 482/124, 482/130, 482/139, 128/25 R, 128/25 B, 128/26, 128/25 C
• US Class Current: 601/33
• CPC Class Codes: A61F 2005/0137 with two parallel pivots
• CPC Class Codes: A61F 2005/0139 geared
• CPC Class Codes: A61F 2005/0153 combining rotational and stretching movements
• CPC Class Codes: A61F 5/0123 for the knees A61F5/0106 takes precedence
• CPC Class Codes: A61F 5/013 for the arms, hands or fingers A61F5/0118 takes precedence

Abstract

An orthosis for extension and flexion of a joint of a limb provides for distraction of the joint upon extension. In one embodiment, a spreading arrangement positively moves the orthosis arms longitudinally outwardly relative to each other upon rotation from a flexed position to an extended position. In another embodiment, the axis of rotation of the orthosis arms is located outwardly from the axis of rotation of the limb. Upon rotation of the arms relative to each other from a flexed position to an extended position, the orthosis arms move longitudinally outwardly because of the geometry of the orthosis. Because the cuffs on the arms are clamped to the limb segments, the limb segments are also forced outwardly, providing joint distraction. Structure is provided for limiting the amount of joint distraction and avoiding injury to the joint. The inner ends of the orthosis arms are linked together to maintain them in position relative to each other. The cuffs which attach the arms to the limb segments are adjustable longitudinally along the arms, to provide for different positions of the cuffs on the on limb, different length limbs, and the use of the orthosis on either a knee joint or an elbow joint.

Claims

1. An apparatus for establishing extremes of motion of a joint between first and second relatively pivotable body portions, by stretching tissue around the joint during movement of the joint, the joint and the first and second body portions defining on one side of the joint an inner sector which decreases in angle as the joint is flexed and defining on the opposite side of the joint an outer sector which decreases in angle as the joint is extended, comprising:

a first arm having proximal and distal end portions, and first clamping means on said first arm for clamping said first arm to the first body portion;

a second arm having proximal and distal end portions, and second clamping means on said second arm for clamping said second arm to the second body portion;

pivot means for pivotally interconnecting said proximal end portions of said first and second arms, at least one of said first and second arms having portions cooperating with said pivot means for forcing said proximal end portions of said first and second arms longitudinally apart from each other upon pivoting movement of said first and second arms from a relatively flexed position to a relatively extended position, to thereby exert a force upon at least one of said first and second body portions to distract the joint; and

actuator means connected to said first and second arms for applying force to said first and second arms to pivot said first and second arms relative to each other to move the joint.

2. An apparatus as defined in claim 1 wherein said means operable to spread said first and second arms comprises:

means defining a cam slot in said means for pivotally connecting said first and second arms, and

a pin on one of said first and second arms and received in said cam slot, said cam slot having surface means for moving said pin and thereby said one arm longitudinally outwardly relative to said means for pivotally connecting said first and second arms upon relative extension of said arms.

3. An apparatus as defined in claim 1 wherein said means operable to spread said first and second arms comprises an eccentric surface located on one of said first and second arms and in abutting engagement with the other of said first and second arms, pivoting movement of said first and second arms from a relatively flexed position to a relatively extended position causing relative movement of said abutting surfaces to move said first and second arms longitudinally outwardly relative each other.

4. An apparatus as defined in claim 1 including flexible force transmitting means connected with at least one of said arms, and drive means connected with said flexible force transmitting means for applying force to said flexible force transmitting means to move said first and second arms relative to each other.

5. An apparatus as defined in claim 4 including a rigid support member having an inner end connected with said means for pivotally connecting said first and second arms and an outer end located in the outer sector, said flexible force transmitting means being connected between a location on said rigid support member in said outer sector and said first and second arms.

6. An apparatus as defined in claim 1 wherein said pivot axis of said arms is located in the outer sector to effect distraction of the joint upon pivoting movement of said first and second arms from a relatively flexed position to a relatively extended position.

7. An apparatus as defined in claim 6 including flexible force transmitting means connected with at least one of said arms, and drive means for applying force to said flexible force transmitting means to move said first and second arms relative to each other.

8. An apparatus as defined in claim 7 including a rigid support member having an inner end connected with said means for pivotally connecting said first and second arms and an outer end located in the outer sector, said flexible force transmitting means being connected between said outer end of said rigid support member and said first and second arms.

9. An apparatus as defined in claim 1 including means for limiting the amount of joint distraction while still permitting said first and second arms to pivot relative to each other from a relatively flexed position to a relatively extended position.

10. An apparatus as defined in claim 9 wherein said means for limiting the amount of joint distraction comprises means for resiliently slidably interconnecting said first and second clamping means to said first and second arms.

11. An apparatus as defined in claim 9 wherein said actuator means comprises rotatable drive means and said means for limiting the amount of joint distraction comprises a slip clutch operatively connected with said rotatable drive means.

12. An apparatus as defined in claim 9 including flexible force transmitting means connected with at least one of said arms, and wherein said means for limiting the amount of joint distraction comprises an elastic portion in said flexible force transmitting means.

13. An apparatus as defined in claim 9 including flexible force transmitting means connected with at least one of said arms, and wherein said means for limiting the amount of joint distraction comprises a frangible portion in said flexible force transmitting means.

14. An apparatus as defined in claim 1 wherein said actuator means comprises drive means mounted on one of said first and second arms.

15. An apparatus for establishing extremes of motion by stretching tissue around a joint between first and second relatively pivotable body portions, the joint and the first and second body portions defining on one side of the joint an inner sector which decreases in angle as the joint is flexed and defining on the opposite side of the joint an outer sector which decreases in angle as the joint is extended, comprising:

a first arm, and first clamping means on said first arm for clamping said first arm to the first body portion;

a second arm, and second clamping means on said second arm for clamping said second arm to the second body portion;

means for pivotally connecting said first and second arms with each other at a pivot axis intermediate said first and second clamping means; and

actuator means connected to said first and second arms for applying force to said first and second arms to pivot said first and second arms relative to each other to move the joint;

said first and second clamping means exerting a force upon at least one of said first and second body portions in a direction outwardly along said at least one body portion and away from said means for pivotally connecting said first and second arms with each other to distract the joint upon pivoting movement of said first and second arms from a relatively flexed position to a relatively extended position;

wherein said actuator means comprises winch means rotatable in winding and unwinding directions for winding and unwinding a cable connected with said arms and ratchet means for selectively blocking rotating movement of said winch means in a selected direction, said winch means and said ratchet means being selectively operable to provide incremental winding of said cable between a plurality of locking positions.

16. An apparatus for establishing extremes of motion by stretching tissue around a joint between first and second relatively pivotable body portions, the joint and the first and second body portions defining on one side of the joint an inner sector which decreases in angle as the joint is flexed and defining on the opposite side of the joint an outer sector which decreases in angle as the joint is extended, comprising:

a first arm, and first clamping means on said first arm for clamping said first arm to the first body portion;

a second arm, and second clamping means on said second arm for clamping said second arm to the second body portion;

means for pivotally connecting said first and second arms with each other at a pivot axis intermediate said first and second clamping means; and

actuator means connected to said first and second arms for applying force to said first and second arms to pivot said first and second arms relative to each other to move the joint;

said first and second clamping means exerting a force upon at least one of said first and second body portions in a direction outwardly along said at least one body portion and away from said means for pivotally connecting said first and second arms with each other to distract the joint upon pivoting movement of said first and second arms from a relatively flexed position to a relatively extended position;

said actuator means comprising drive means mounted on one of said first and second arms, said drive means comprising winch means rotatable in winding and unwinding directions for winding and unwinding said cable and ratchet means for selectively blocking rotating movement of said winch means in a selected direction, said winch means and said ratchet means being selectively operable to provide incremental winding of said cable between a plurality of locking positions.

17. A orthosis for stretching tissue around a joint between first and second relatively pivotable body portions, the joint and the first and second body portions defining on one side of the joint an inner sector which decreases in angle as the joint is flexed and defining on the opposite side of the joint an outer sector which decreases in angle as the joint is extended, comprising:

a first arm, and first clamping means on said first arm for clamping said first arm to the first body portion;

a second arm, and second clamping means on said second arm for clamping said second arm to the second body portion;

means for pivotally connecting said first and second arms with each other at a pivot axis intermediate said first and second clamping means; and

actuator means connected to said first and second arms for receiving force not generated by relative pivotal movement of said first and second body portions and for applying force to said first and second arms to pivot said first and second arms relative to each other to move the joint;

wherein said pivot axis of said arms is spaced apart from the axis of rotation of the joint and disposed in the outer sector to effect distraction of the joint upon pivoting movement of said first and second arms from a relatively flexed position to a relatively extended position.

18. An orthosis as set forth in claim 17 including flexible force transmitting means, drive means connected with said flexible force transmitting means for applying force to said flexible force transmitting means at a location in the outer sector to move said first and second arms relative to each other to move the joint.

19. An orthosis as set forth in claim 18 including a rigid support member having an inner end connected with said means for pivotally connecting said first and second arms and an outer end located in the outer sector, said flexible force transmitting means being connected between said outer end of said rigid support member and said first and second arms.

20. An apparatus as defined in claim 17 wherein said pivot axis of said arms is located in the outer sector.

21. An orthosis as set forth in claim 17 wherein said actuator means comprises a tower projecting into said outer sector from said means for pivotally connecting said first and second arms with each other and a manually engageable member on said tower for receiving the force to pivot said first and second arms relative to each other to move the joint.

22. An orthosis as set forth in claim 17 wherein said actuator means for receiving force not generated by relative pivotal movement of said first and second body portions comprises a manually engageable member actuable by a patient or a therapist to apply force to said first and second arms to pivot said first and second arms relative to each other to move the joint.

23. An orthosis as set forth in claim 17 wherein said actuator means comprises a tower projecting from said means for pivotally connecting said first and second arms with each other, said tower having at least two force transmitting members extending at an angle from said tower to said arms to apply force to said first and second arms to pivot said first and second arms relative to each other to move the joint.

24. An orthosis as set forth in claim 17 wherein said first clamping means comprises a first cuff slidably mounted on said first arm and said second clamping means comprises a second cuff slidably mounted on said second arm.

25. An orthosis as set forth in claim 17 wherein said pivot axis of said arms is disposed at a location in the outer sector spaced outwardly away from said pivot axis approximately along a line bisecting the angle between said arms.

26. An orthosis for establishing terminal extremes of motion by stretching soft tissue around a joint which is located between first and second relatively movable body portions, comprising:

first and second cuff arms for connecting said orthosis to the first and second body portions; and

means for moving said first cuff arm relative to said second cuff arm about an axis intermediate said first and second cuffs, comprising drive means for receiving force applied to said orthosis and for transmitting the applied force to said first and second cuff arms to thereby move said first cuff arm relative to said second cuff arm, said drive means including means for providing a mechanical advantage by transmitting an increased force to said first and second cuff arms, comprising tower means for spacing said axis of movement of said arms apart from a force application point of said orthosis.

27. An orthosis as defined in claim 26 wherein said means for providing a mechanical advantage comprises means for spacing said axis of movement of said arms apart from the axis of rotation of the joint.

28. An orthosis for establishing terminal extremes of motion by stretching soft tissue around a joint which is located between first and second relatively movable body portions, comprising:

first and second cuff arms for connecting said orthosis to the first and second body portions; and

means for moving said first cuff arm relative to said second cuff arm about an axis intermediate said first and second cuffs, comprising drive means for receiving force applied to said orthosis and for transmitting the applied force to said first and second cuff arms to thereby move said first cuff arm relative to said second cuff arm, said drive means including means for providing a mechanical advantage by transmitting an increased force to said first and second cuff arms, comprising a cable and pulley system.

29. An orthosis for stretching tissue around a joint between first and second relatively pivotable body portions, comprising:

an elongate first cuff arm having proximal and distal end portions;

an elongate second cuff arm having proximal and distal end portions and movably connected to said first cuff arm;

a first cuff on said first cuff arm for connecting said first cuff arm to the first body portion;

a second cuff on said second cuff arm for connecting said second cuff arm to the second body portion; and

said first and second cuff arms having portions cooperating to force said proximal end portions of said first and second arms longitudinally apart from each other upon pivoting movement of said first and second arms from a relatively flexed position to a relatively extended position, to thereby exert a force upon at least one of said first and second body portions to distract the joint; and

actuator means for moving said first cuff arm relative to said second cuff arm, said actuator means being selectively operable to provide incremental movement of said first cuff arm relative to said second cuff arm between a plurality of positions and to lock said arms at said positions.

30. An orthosis as defined in claim 29 wherein said means for moving said first cuff arm relative to said second cuff arm comprises ratchet drive means operable to provide incremental movement of said first cuff arm relative to said second cuff arm between a plurality of positions and to lock said arms at said positions.