Shoulder orthosis

• US 6,113,562 A
• Filed: 06/01/1998
• Issued: 09/05/2000
• Est. Priority Date: 06/01/1998
• Status: Expired due to Term

• Current Assignee: Bonutti Research Incorporated (Bonutti IP LLC)
• Original Assignee: Peter M. Bonutti
• Inventors: Bonutti, Peter M., Leo, Christopher A., Ruholl, Kevin R.
• Primary Examiner(s): LEWIS, KIM M
• Application Number:
  US09/088,134
• Time in Patent Office: 827 Days
• Field of Search: 602/5, 602/16, 602/20, 602/23, 602/26, 602/27, 602/3, 602/36-38, 601/23, 601/33, 601/40, 601/5, 601/27, 601/32, 601/34, 128/898, 482/124, 482/130, 482/139, 482/44, 482/45, 482/46
• US Class Current: 602/20
• CPC Class Codes: A61F 2005/0146 combining rotational and sliding movements, e.g. simulating movements of a natural joint
• CPC Class Codes: A61F 2005/0165 with limits of movement
• CPC Class Codes: A61F 5/0102 specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations
• CPC Class Codes: A61F 5/013 for the arms, hands or fingers A61F5/0118 takes precedence
• CPC Class Codes: A61F 5/05858 for the arms restraining devices, e.g. slings A61F5/37
• CPC Class Codes: A61H 1/0281 Shoulder

Abstract

A shoulder orthosis is utilized to effect relative movement between bones in a body of a patient. The orthosis includes a base section which is connected with a trunk of a patient'"'"'s body, an upper arm section which is connected with an upper portion of an arm of the patient, and a lower arm section which is connected with a lower portion of the arm of a patient. An interconnection between the base section and upper arm section of the orthosis is disposed beneath an axilla between the trunk and arm of the patient. A main drive assembly is operable to rotate the lower arm section of the orthosis is relative to the upper arm section of the orthosis to pivot a humerus bone in the upper arm of the patient relative to a scapula bone in a shoulder of the patient. A secondary drive assembly is operable to move the lower arm section and upper arm section relative to the base section of the orthosis to move the upper arm of the patient into alignment with the shoulder of the patient.

Claims

1. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising first cuff means for gripping a lower portion of an arm of the patient, second cuff means for gripping an upper portion of the arm of the patient, and drive means connected with said first and second cuff means for rotating said first cuff means about an axis which extends along the upper portion of the arm of the patient, said drive means includes a drive member which is rotatable about the axis which extends along the upper portion of the arm of the patient, said first cuff means being connected with said drive member for rotation therewith, said drive member at least partially defines an opening and a portion of the arm of the patient located between said first and second cuff means is disposed in the opening.

2. An apparatus as set forth in claim 1 wherein said drive means is operable to rotate said first cuff means about the axis which extends along the upper portion of the arm of the patient with an elbow between the upper and lower portions of the arm of the patient bent.

3. An apparatus as set forth in claim 1 further including a first cuff arm connected with said first cuff means and a second cuff arm connected with said second cuff means, said drive means being operable to rotate said first cuff arm and said first cuff together relative to said second cuff arm about the axis which extends along the upper portion of the arm of the patient.

4. An apparatus as set forth in claim 3 further including a third cuff arm connected with said second cuff arm, and third cuff means for connecting said third cuff arm with a trunk of the patient'"'"'s body.

5. An apparatus as set forth in claim 3 further including second drive means connected with said second and third cuff arms for rotating said first and second cuff arms together relative to said third cuff arm about an axis which extends transverse to the axis which extends along the upper portion of the arm of the patient.

6. An apparatus as set forth in claim 1 further including second drive means connected with said first and second cuff means for rotating said first and second cuff means together about an axis which extends transverse to the axis which extends along the upper portion of the arm of the patient.

7. An apparatus as set forth in claim 1 further including support means which rotatably supports said drive member for rotation about the axis which extends along the upper portion of the arm of the patient, said support means being offset to one side of the axis which extends along the upper portion of the arm of the patient.

8. An apparatus as set forth in claim 1 further including a base member connected with said second cuff means, said drive member being movable along an arcuate path relative to said base member, an arcuate guide surface connected with one of said base and drive members, a follower connected with a second one of said base and drive members and disposed in engagement with said arcuate guide surface, said arcuate guide surface having a center of curvature which is disposed on the axis which extends along the upper portion of the arm of the patient, said follower and guide surface cooperating to guide movement of said drive member along the arcuate path.

9. An apparatus as set forth in claim 1 further including a first cuff arm connected with said first cuff means, and a second cuff arm connected with said second cuff means, said first and second cuff arms being interconnected by said drive means.

10. An apparatus as set forth in claim 9 further including a third cuff arm pivotally connected with said second cuff arm and third cuff means for connecting said third cuff arm with a trunk of the patient'"'"'s body.

11. An apparatus as set forth in claim 1 wherein said drive includes teeth disposed in an arcuate array which forms only a portion of a circle and has spaced apart end portions, said drive member having an opening which extends between spaced apart end portions of said arcuate array of teeth, said second cuff means being aligned with the opening in said drive member to enable a portion of the arm of the patient to be disposed in the opening in said drive member when the lower portion of the arm of the patient is gripped by said first cuff means and the upper portion of the arm of the patient is gripped by said second cuff means.

12. An apparatus as set forth in claim 11 wherein the axis which extends along the upper portion of the arm of the patient extends through the opening in said drive member and said drive means is operable to rotate said drive member and said first cuff means together about the axis which extends along the upper portion of the arm of the patient.

13. An apparatus as set forth in claim 1 wherein said drive means includes a manually engageable member which is rotatable under the influence of force applied to said manually engageable member by the patient to rotate said first cuff means about the axis which extends along the upper portion of the arm of the patient.

14. An apparatus as set forth in claim 1 further including third cuff means for gripping a trunk of the body of the patient, second drive means connected with said second and third cuff means and disposed beneath an axilla between the trunk and arm of the patient, said second drive means being operable to move said second cuff means relative to said third cuff means.

15. An apparatus as set forth in claim 1 further including support means which rotatably supports said drive member for rotation about the axis which extends along the upper portion of the arm of the patient, said support means being offset to one side of the axis which extends along the upper portion of the arm of the patient.

21. An apparatus as set forth in claim 1 wherein the axis which extends along the upper portion of the arm of the patient extends through the opening in said gear and said drive means is operable to rotate said gear and said first cuff means together about the axis which extends along the upper portion of the arm of the patient.

22. An apparatus as set forth in claim 1 wherein said drive means includes a manually engageable member which is rotatable under the influence of force applied to said manually engageable member by the patient to rotate said first cuff means about the axis which extends along the upper portion of the arm of the patient.

23. An apparatus as set forth in claim 1 further including third cuff means for gripping a trunk of the body of the patient, second drive means connected with said second and third cuff means and disposed beneath an axilla between the trunk and arm of the patient, said second drive means being operable to move said second cuff means relative to said third cuff means.

16. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising first cuff means for gripping a lower portion of an arm of the patient, second cuff means for gripping an upper portion of the arm of the patient, drive means connected with said first and second cuff means for rotating said first cuff means about an axis which extends along the upper portion of the arm of the patient, a base member connected with said second cuff means, said drive means includes a drive member movable along an arcuate path relative to said base member, an arcuate guide surface connected with one of said base and drive members, and a follower connected with a second one of said base and drive members and disposed in engagement with said arcuate guide surface, said arcuate guide surface having a center of curvature which is disposed on the axis which extends along the upper portion of the arm of the patient, said follower and guide surface cooperating to guide movement of said drive member along the arcuate path.

17. An apparatus as set forth in claim 16 wherein said drive means further includes an arcuate array of teeth disposed on said drive member and having a center of curvature which is disposed on the axis which extends along the upper portion of the arm of the patient.

18. An apparatus as set forth in claim 16 wherein said drive means further includes a second arcuate array of teeth disposed in meshing engagement with said arcuate array of teeth on said drive member, said second arcuate array of teeth being rotatable relative to said base member about an axis which extends along the upper portion of the arm of the patient to effect movement of said drive member relative to said base member along the arcuate path.

19. An apparatus as set forth in claim 16 wherein said drive member at least partially defines an opening through which a portion of the arm of the patient extends.

20. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising first cuff means for gripping a lower portion of an arm of the patient, second cuff means for gripping an upper portion of the arm of the patient, and drive means connected with said first and second cuff means for rotating said first cuff means about an axis which extends along the upper portion of the arm of the patient, said drive means includes a gear having gear teeth disposed in an arcuate array which forms only a portion of a circle and has spaced apart end portions, said gear having an opening which extends through a peripheral portion of said gear and between spaced apart end portions of said arcuate array of gear teeth, said first cuff means being connected to said gear and being rotatable with said gear, said second cuff means being aligned with the opening in said gear to enable a portion of the arm of the patient to be disposed in the opening in said gear when the lower portion of the arm of the patient is gripped by said first cuff means and the upper portion of the arm of the patient is gripped by said second cuff means.

24. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, a first cuff which is connected with said first cuff arm and grips a lower portion of an arm of the patient, a second cuff arm connected with said first cuff arm, a second cuff which is connected with said second cuff arm and grips an upper portion of the arm of the patient, and a drive assembly connected with said first and second cuff arms and operable to rotate said first cuff arm and said first cuff relative to said second cuff arm and said second cuff about an axis which extends along said second cuff arm and through said second cuff, said drive assembly includes a main gear which is fixedly connected with said first cuff arm and a second gear which is rotatably mounted on said second cuff arm and is disposed in meshing engagement with said main gear.

25. An apparatus as set forth in claim 24 wherein said first cuff arm has a longitudinal central axis which extends perpendicular to a longitudinal central axis of said second cuff arm during rotation of said first cuff arm and said first cuff relative to said second cuff arm and said second cuff by said drive assembly.

26. An apparatus as set forth in claim 24 wherein said main gear is rotatable about an axis extending parallel to a longitudinal central axis of said second cuff arm.

27. An apparatus as set forth in claim 24 further including a third cuff arm connected with said second cuff arm, a third cuff which is connected with said third cuff arm and grips a trunk of a body of the patient, and a secondary drive assembly connected with said second and third cuff arms and operable to rotate said second cuff arm relative to said third cuff arm about an axis which extends transverse to the axis which extends along said second cuff arm and through said second cuff.

28. An apparatus as set forth in claim 24 wherein said second gear is rotatable relative to said second cuff arm to rotate said first gear and said first cuff arm about the axis which extends along said second cuff arm and through said second cuff, an arcuate track being connected with a first one of said main gear and said second cuff arm, and a follower connected with a second one of said main gear and said second cuff arm and engaging said arcuate track to guide relative movement between said main gear and said second cuff arm.

29. An apparatus as set forth in claim 24 wherein said main gear has an opening which receives at least a portion of the patient'"'"'s arm during rotation of said first cuff arm and said first cuff relative to said second cuff arm and second cuff.

30. An apparatus as set forth in claim 24 wherein said drive assembly is operable to rotate said first cuff about the axis which extends along the second cuff arm and through said second cuff with an elbow between the upper and lower portions of the arm of the patient bent.

31. An apparatus as set forth in claim 24 further including a third cuff arm connected with said second cuff arm, and third cuff connected with said third cuff arm and a trunk of the patient'"'"'s body.

32. An apparatus as set forth in claim 31 further including a second drive assembly connected with said second and third cuff arms for rotating said first and second cuff arms together relative to said third cuff arm about an axis which extends transverse to the axis which extends along said second cuff arm.

33. An apparatus as set forth in claim 24 further including a second drive assembly connected with said first and second cuffs for rotating said first and second cuffs together about an axis which extends transverse to the axis which extends along the upper portion of the arm of the patient.

34. Apparatus as set forth in claim 24 wherein said main gear at least partially defines an opening and a portion of the arm of the patient located between said first and second cuffs is disposed in the opening in said main gear.

35. An apparatus as set forth in claim 24 wherein said main gear is movable along an arcuate path relative to said second cuff arm, an arcuate guide surface connected with one of said second cuff arm and main gear, a follower connected with a second one of said second cuff arm and main gear and disposed in engagement with said arcuate guide surface, said arcuate guide surface having a center of curvature which is disposed on the axis which extends along said second cuff arm, said follower and guide surface cooperating to guide movement of said main gear along the arcuate path.

36. An apparatus as set forth in claim 24 wherein said main gear has gear teeth disposed in an arcuate array which forms only a portion of a circle and has spaced apart end portions, said main gear having an opening which extends through a peripheral portion of said main gear and between spaced apart end portions of said arcuate array of gear teeth, said first cuff being connected to said main gear and being rotatable with said main gear, said second cuff being aligned with the opening in said main gear to enable a portion of the arm of the patient to be disposed in the opening in said main gear when the lower portion of the arm of the patient is gripped by said first cuff and the upper portion of the arm of the patient is gripped by said second cuff.

37. An apparatus as set forth in claim 36 wherein the axis which extends along the second cuff arm and through said second cuff also extends through the opening in said main gear and said drive assembly is operable to rotate said main gear and said first cuff together about the axis which extends along said second cuff arm and through said second cuff.

38. An apparatus as set forth in claim 24 wherein said drive assembly includes a manually engageable member which is rotatable under the influence of force applied to said manually engageable member by the patient to rotate said first cuff about the axis which extends along said second cuff arm and through said second cuff.

39. An apparatus as set forth in claim 24 further including third cuff which grips a trunk of the body of the patient, a second drive assembly connected with said second and third cuff and disposed beneath an axilla between the trunk and arm of the patient, said second drive assembly being operable to move said second cuff relative to said third cuff.

40. An apparatus as set forth in claim 24 wherein the axis which extends along said second cuff arm and through said second cuff also extends through said main gear.

41. An apparatus as set forth in claim 40 wherein said second gear is rotatable about an axis which extends parallel to and is offset from the axis which extends along said second cuff arm and through said second cuff.

42. An apparatus as set forth in claim 24 wherein said drive assembly further includes a retainer which is connected with said second cuff arm and engages said main gear to position said main gear relative to said second cuff arm.

43. An apparatus as set forth in claim 24 wherein said main gear is rotatable about the axis which extends along said second cuff arm and through said second cuff.

44. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, a first cuff which is connected with said first cuff arm and grips a lower portion of an arm of the patient, a second cuff arm connected with said first cuff arm, a second cuff which is connected with said second cuff arm and grips an upper portion of the arm of the patient, and a drive assembly connected with said first and second cuff arms and operable to rotate said first cuff arm and said first cuff relative to said second cuff arm and said second cuff about an axis which extends along said second cuff arm and through said second cuff, said drive assembly includes a first gear connected with said first cuff arm and rotatable relative to said second cuff arm, a second gear connected with said second cuff arm and disposed in meshing engagement with said first gear, said second gear being rotatable relative to said second cuff arm to rotate said first gear and said first cuff arm about the axis which extends along said second cuff arm and through said second cuff, an arcuate track connected with a first one of said first gear and said second cuff arm, and a follower connected with a second one of said first gear and said second cuff arm and engaging said arcuate track to guide relative movement between said first gear and said second cuff arm.

45. An apparatus as set forth in claim 44 wherein the axis which extends along said second cuff arm and through said second cuff extends through said first gear.

46. An apparatus as set forth in claim 44 wherein said first and second gears are rotatable about axes which extend parallel to the axis which extends along said second cuff arm and through said second cuff.

47. An apparatus as set forth in claim 44 wherein said first gear at least partially defines an opening through which a portion of the arm of the patient extends.

48. An for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, first cuff which is connected with said first cuff arm and grips a lower portion of an arm of the patient, a second cuff arm connected with said first cuff arm, a second cuff which is connected with said second cuff arm and grips an upper portion of the arm of the patient, and a drive assembly connected with said first and second cuff arms and operable to rotate said first cuff arm and said first cuff relative to said second cuff arm and said second cuff about an axis which extends along said second cuff arm and through said second cuff, said drive assembly includes a gear which is rotatable about the axis which extends along the second cuff arm and through the second cuff, said gear has an arcuate array of gear teeth which form a portion of a circle, said gear having an opening which extends through a central portion of said gear and which receives at least a portion of the patient'"'"'s arm during rotation of said first cuff arm and said first cuff relative to said second cuff arm and second cuff.

49. An apparatus as set forth in claim 48 wherein said drive assembly includes a second gear which is disposed in meshing engagement with said gear which is rotatable about the axis which extends along the second cuff arm and through the second cuff, and a manually engagable member which is connected with said second gear and is rotatable under the influence of force applied to said manually engagable member to rotate said second gear.

50. An apparatus as set forth in claim 48 further including a third cuff which grips a trunk of the body of the patient, a second drive assembly connected with said second and third cuff and disposed beneath an axilla between the trunk and arm of the patient, said second drive assembly being operable to move said second cuff relative to said third cuff.

51. An apparatus as set forth in claim 48 wherein said first cuff arm has a longitudinal central axis which extends perpendicular to a longitudinal central axis of said second cuff arm during rotation of said first cuff arm and said first cuff relative to said second cuff arm and said second cuff by said drive assembly.

52. An apparatus as set forth in claim 48 wherein said gear is mounted on said second cuff arm, said first cuff arm being connected with said gear for rotation therewith relative to said second cuff arm.

53. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, a first cuff connected with said first cuff arm to hold a lower portion of an arm of a patient, a second cuff arm, a second cuff connected with said second cuff arm to hold an upper portion of the arm of the patient, and a gear rotatably mounted on said second cuff arm and rotatable about an axis which extends along said second cuff arm, said first cuff arm being connected with said gear for rotation therewith and extending outward from said gear in a direction transverse to the axis of rotation of said gear, said gear includes surface means which defines an opening which extends through said gear and receives a portion of the arm of the patient disposed between said first and second cuffs.

54. An apparatus as set forth in claim 53 wherein said first cuff arm has longitudinal central axis which extends perpendicular to a longitudinal central axis of said second cuff arm.

55. An apparatus as set forth in claim 53 wherein said first cuff arm is fixedly connected with said gear and is spaced from said second cuff arm.

56. An apparatus as set forth in claim 53 further including a second gear mounted on said second cuff arm in meshing engagement with said gear, said second gear being rotatable about an axis which extends transverse to the axis about which said gear is rotatable.

57. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first member, means for connecting said first member with a lower portion of an arm of the patient, a second member connected with said first member, means for connecting said second member with an upper portion of an arm of a patient, a third member, connector means for pivotally interconnecting said second and third members, means for connecting said third member with a trunk of the body of the patient with said connector means which pivotally interconnects said second and third members disposed beneath an axilla between the arm and trunk of the patient, first drive means for rotating said first member and the lower portion of the arm of the patient relative to the second member about an axis which extends along the upper portion of the arm of the patient, and second drive means which is at least partially disposed beneath the axilla between the arm and trunk of the patient for moving said first and second members relative to said third member about an axis extending through said connector means.

58. An apparatus as set forth in claim 57 wherein said first drive means includes a gear which is rotatable relative to said second member about the axis which extends along the upper portion of the arm of the patient, said first member being connected with said gear for rotation therewith relative to said second member.

59. An apparatus as set forth in claim 58 wherein said gear includes surface means for at least partially defining an opening through which a portion of the arm of the patient extends.

60. An apparatus as set forth in claim 59 wherein said first drive means includes a worm which is rotatably mounted on said second member and is drivingly connected with said gear.

61. An apparatus as set forth in claim 57 wherein said first drive means includes a first gear having an opening which receives a portion of the arm of the patient, said first member extends into the opening in said gear and is fixedly connected with said gear, and a second gear rotatably mounted on said first member and disposed in meshing engagement with said first gear, said second gear being rotatable relative to said second member to rotate said first gear and said first member relative to said second member.

62. An apparatus as set forth in claim 57 wherein said second drive means includes a drive member which is rotatable about an axis extending through said connector means and a driven member is movable toward and away from said connector means by said drive member to effect movement of said first and second member relative to said third member.

63. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first member, means for connecting said first member with a lower portion of an arm of the patient, a second member connected with said first member, means for connecting said second member with an upper portion of an arm of a patient, a third member, connector means for pivotally interconnecting said second and third members, means for connecting said third member with a trunk of the body of the patient with said connector means which pivotally interconnects said second and third members disposed beneath an axilla between the arm and trunk of the patient, and drive means for rotating said first member and the lower portion of the arm of the patient relative to the second member about an axis which extends along the upper portion of the arm of the patient, said drive means includes a gear which is rotatable relative to said second member about the axis which extends along the upper portion of the arm of the patient, said first member being connected with said gear for rotation therewith relative to said second member, said gear includes surface means for at least partially defining an opening through which a portion of the arm of the patient extends, said drive means includes a worm which is rotatably mounted on said second member and is drivingly connected with said gear.

64. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first member, means for connecting said first member with a lower portion of an arm of the patient, a second member connected with said first member, means for connecting said second member with an upper portion of an arm of a patient, a third member, connector means for pivotally interconnecting said second and third members, means for connecting said third member with a trunk of the body of the patient with said connector means which pivotally interconnects said second and third members disposed beneath an axilla between the arm and trunk of the patient, and drive means for rotating said first member and the lower portion of the arm of the patient relative to the second member about an axis which extends along the upper portion of the arm of the patient, said drive means includes a first gear having an opening which receives a portion of the arm of the patient, said first member extends into the opening in said gear and is fixedly connected with said gear, and a second gear rotatably mounted on said first member and disposed in meshing engagement with said first gear, said second gear being rotatable relative to said second member to rotate said first gear and said first member relative to said second member.

65. An apparatus as set forth in claim 64 further including second drive means which is at least partially disposed beneath the axilla between the arm and trunk of the patient for moving said first and second members relative to said third member about an axis extending through said connector means.

66. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff which is engageable with a lower portion of an arm of the patient, a second cuff which is engageable with an upper portion of the arm of the patient and which is connected with said first cuff, said second cuff having a central axis which extends transverse to a central axis of said first cuff, a third cuff which is engageable with a trunk portion of the body of the patient and which is connected with said second cuff, a main drive assembly connected with said first and second cuffs and operable to rotate said first cuff about an axis extending through said second cuff, and a second drive assembly connected with said second and third cuffs and operable to rotate said first and second cuffs together about an axis which extends through a connection between said second and third cuffs, said main drive assembly includes a drive member which is connected with said first cuff and is rotatable about the central axis of said second cuff with said first cuff, said drive member at least partially defines an opening and a portion of the arm of the patient is received in the opening in said drive member.

67. An apparatus as set forth in claim 66 wherein the central axis of said first cuff extends perpendicular to and intersects the central axis of said second cuff.

68. An apparatus as set forth in claim 66 wherein operation of said second drive assembly is effective to rotate said main drive assembly with said first and second cuffs about the axis which extends through the connection between said second and third cuffs.

69. An apparatus as set forth in claim 66 further including a fourth cuff which is connected with said first and second cuffs and is engageable with an elbow disposed between the upper and lower portions of the arm of the patient.

70. An apparatus as set forth in claim 66 further including a fourth cuff which is connected with said third cuff and is engageable with a hand of the patient which is connected with the lower portion of the arm of the patient.

71. An apparatus as set forth in claim 70 wherein said fourth cuff includes an arcuate surface which is engageable with a palm portion of the hand of the patient and a strap which is engageable with a back portion of the hand of the patient.

72. An apparatus as set forth in claim 66 wherein said second drive assembly is at least partially disposed between said second and third cuffs.

73. An apparatus as set forth in claim 66 wherein the connection between said second and third cuffs is disposed beneath an axilla between the upper portion of the patient and the trunk of the patient when said third cuff is connected with the trunk of the patient.

74. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, a hand cuff which is connected with said first cuff arm and grips a hand connected with an arm of the patient, said hand cuff including an arcuate surface which is engaged by a palm on the hand of the patient, a lower cuff which is connected with said first cuff arm and holds a lower portion of the arm of the patient in a position in which a longitudinal central axis of the lower portion of the arm of the patient intersects said arcuate surface of said hand cuff, a second cuff arm connected with said first cuff arm, an upper cuff which is connected with said second cuff arm and holds an upper portion of the arm of the patient, and a drive assembly connected with said first cuff arm and operable to rotate said first cuff arm about an axis which extends transverse to the longitudinal central axis of the lower portion of the arm of the patient while the arm of the patient is held by said upper and lower cuffs and the hand of the patient is held by said hand cuff with the palm on the hand of the patient in engagement with said arcuate surface, said drive assembly includes a main gear which is fixedly connected with said first cuff arm, and a second gear which is disposed in meshing engagement with said main gear, said second gear being rotatable under the influence of force transmitted from the patient to effect rotation of said main gear, first cuff arm, lower cuff, and hand cuff about the axis which extends transverse to the lower portion of the arm of the patient.

75. An apparatus as set forth in claim 74 wherein said lower cuff has a longitudinal central axis which extends perpendicular to a longitudinal central axis of said upper cuff.

76. An apparatus as set forth in claim 74 further including a third cuff arm which is pivotally connected with said second cuff arm, a base cuff which is connected with said third cuff arm and grips a trunk of the patient, and a second drive assembly which is connected with said second and third cuff arms and is operable to effect pivotal movement between said second and third cuff arms.

77. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising first means for holding an upper portion of an arm of the patient against sidewise movement in a direction transverse to a longitudinal central axis of the upper portion of the arm of the patient, and second means connected with said first means for applying force to a lower portion of the arm of the patient to rotate a bone in the upper portion of the arm of the patient about a central axis of the upper portion of the arm of the patient while said first means holds the upper portion of the arm of the patient against sidewise movement in a direction transverse to the longitudinal central axis of the upper portion of the arm of the patient, said second means includes a first gear which is connected with the lower portion of the arm of the patient, a second gear which is disposed in meshing engagement with said first gear, and a manually rotatable input member which is connected with said second gear and is manually rotatable to effect rotation of said first and second gears.

78. An apparatus as set forth in claim 77 wherein said second means holds the arm of the patient with a bend in the arm of the patient at an elbow between the upper and lower portions of the arm of the patient.

79. An apparatus as set forth in claim 77 wherein said first means includes first cuff means for gripping the upper portion of the arm of the patient, second cuff means for gripping a trunk portion of the body of the patient, and means for holding said first and second cuff means against movement relative to each other.

80. An apparatus as set forth in claim 77 wherein said first gear is rotatable with the lower portion of the arm of the patient about an axis which extends parallel to the central axis of the upper portion of the arm of the patient.

81. An apparatus as set forth in claim 77 wherein said first gear at least partially defines an opening through which a portion of the arm of the patient extends.

82. An apparatus as set forth in claim 77 wherein said first and second gears are rotatable about parallel axes which extend parallel to the central axis of the upper portion of the arm of the patient.

83. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, a first cuff which is connected with said first cuff arm and grips a lower portion of an arm of the patient, a second cuff arm connected with said first cuff arm, a second cuff which is connected with said second cuff arm and grips an upper portion of the arm of the patient, and a drive assembly connected with said first and second cuff arms, said drive assembly includes an input member which is manually rotatable to effect rotation of said first cuff arm and said first cuff relative to said second cuff arm and said second cuff about an axis which extends along said second cuff arm under the influence of force transmitted from said input member to said first cuff arm by said drive assembly.

84. An apparatus as set forth in claim 83 wherein said first cuff arm has a longitudinal central axis which extends perpendicular to a longitudinal central axis of said second cuff arm during rotation of said first cuff arm and said first cuff relative to said second cuff arm and said second cuff under the influence of force transmitted from said input member by said drive assembly.

85. An apparatus as set forth in claim 83 wherein said drive assembly includes a gear mounted on said second cuff arm and rotatable about an axis which extends along said second cuff arm, said first cuff arm being connected with said gear for rotation therewith relative to said second cuff arm.

86. An apparatus as set forth in claim 83 further including a third cuff arm connected with said second cuff arm, a third cuff which is connected with said third cuff arm and grips a trunk of a body of the patient, and a secondary drive assembly connected with said second and third cuff arms, said secondary drive assembly includes a second input member which is manually rotatable to effect rotation of said second cuff arm relative to said third cuff arm about an axis which extends transverse to the axis which extends along said second cuff arm under the influence of force transmitted from said second input member to said second cuff arm by said secondary drive assembly.

87. An apparatus as set forth in claim 83 wherein said drive assembly includes a first gear which is fixedly connected with said first cuff arm and a second gear which is rotatably mounted on said second cuff arm and is disposed in meshing engagement with said first gear, said input member being manually rotatable to effect rotation of said first and second gears.

88. An apparatus as set forth in claim 87 wherein said drive assembly further includes a retainer which is connected with said second cuff arm and engages said first gear to position said first gear relative to said second cuff arm.

89. An apparatus as set forth in claim 87 wherein said first gear is rotatable about the axis which extends along said second cuff arm.

90. An apparatus as set forth in claim 83 wherein said drive assembly includes a first gear connected with said first cuff arm and rotatable relative to said second cuff arm, a second gear connected with said second cuff arm and said input member, second gear being disposed in meshing engagement with said first gear, said second gear being rotatable relative to said second cuff arm under the influence of force transmitted from said input member to said second gear to rotate said first gear and said first cuff arm about the axis which extends along said second cuff arm, an arcuate track connected with a first one of said first gear and said second cuff arm, and a follower connected with a second one of said first gear and said second cuff arm and engaging said arcuate track to guide relative movement between said first gear and said second cuff arm.

91. An apparatus as set forth in claim 83 wherein said drive assembly includes a gear which is rotatable about the axis which extends along the second cuff arm, said gear has an arcuate array of gear teeth which form a portion of a circle, said gear having an opening which extends through a central portion of said gear and which receives at least a portion of the patient'"'"'s arm during rotation of said first cuff arm and said first cuff relative to said second cuff arm and second cuff.

92. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff which grips a lower portion of an arm of the patient, a second cuff which grips an upper portion of the arm of the patient, and a drive assembly connected with said first and second cuffs, said drive assembly includes an input member which is rotatable to effect rotation of said first cuff about an axis which extends along the upper portion of the arm of the patient and through the second cuff under influence of force transmitted from said input member through said drive assembly to said first cuff.

93. An apparatus as set forth in claim 92 wherein said drive assembly is operable to rotate said first cuff about the axis which extends along the upper portion of the arm of the patient and through the second cuff with an elbow between the upper and lower portions of the arm of the patient bent.

94. An apparatus as set forth in claim 92 further including a first cuff arm connected with said first cuff and a second cuff arm connected with said second cuff, said drive assembly being operable under the influence of force transmitted from said input member to rotate said first cuff arm and said first cuff together relative to said second cuff arm about the axis which extends along the upper portion of the arm of the patient and through the second cuff.

95. An apparatus as set forth in claim 94 further including a third cuff arm connected with said second cuff arm, and a third cuff which connects said third cuff arm with a trunk of the patient'"'"'s body.

96. An apparatus as set forth in claim 95 further including a second drive assembly connected with said second and third cuff arms, said second drive assembly includes a second input member which is rotatable to effect rotation of said first and second cuff arms together relative to said third cuff arm about an axis which extends transverse to the axis which extends along the upper portion of the arm of the patient under the influence of force transmitted from said second input member through said second drive assembly to said second cuff arm.

97. An apparatus as set forth in claim 92 further including a second drive assembly connected with said first and second cuffs, said second drive assembly being operable to transmit force which effects rotation of said first and second cuffs together about an axis which extends transverse to the axis which extends along the upper portion of the arm of the patient and through the second cuff.

98. An apparatus as set forth in claim 92 wherein said drive assembly includes a drive member which is rotatable about the axis which extends along the upper portion of the arm of the patient and through the second cuff, said first cuff being connected with said drive member for rotation therewith.

99. An apparatus as set forth in claim 98 wherein said drive member at least partially defines an opening and a portion of the arm of the patient located between said first and second cuffs is disposed in the opening.

100. An apparatus as set forth in claim 99 further including a support assembly which rotatably supports said drive member for rotation about the axis which extends along the upper portion of the arm of the patient and through said second cuff, said support assembly being offset to one side of the axis which extends along the upper portion of the arm of the patient and through the second cuff.

101. An apparatus as set forth in claim 92 further including a base member connected with said second cuff means, said drive assembly includes a drive member movable along an arcuate path relative to said base member, an arcuate guide surface connected with one of said base and drive members, a follower connected with a second one of said base and drive members and disposed in engagement with said arcuate guide surface, said follower and guide surface cooperating to guide movement of said drive member along the arcuate path.

102. An apparatus as set forth in claim 92 further including a first cuff arm connected with said first cuff, and a second cuff arm connected with said second cuff, said first and second cuff arms being interconnected by said drive assembly, said input member being rotatably mounted on said second cuff arm.

103. An apparatus as set forth in claim 102 further including a third cuff arm pivotally connected with said second cuff arm and a third cuff which connects said third cuff arm with a trunk of the patient'"'"'s body.

104. An apparatus as set forth in claim 92 wherein said drive assembly includes a drive member which is rotatable about the axis which extends along the upper portion of the arm of the patient and through said second cuff under the influence of force transmitted from said input member to said drive member, said first cuff arm being fixedly connected with said drive member and being rotatable with said drive member about the axis which extends along the upper portion of the arm of the patient and through said second cuff.

105. An apparatus as set forth in claim 92 wherein said drive assembly includes a gear having teeth disposed in an arcuate array which forms only a portion of a circle and has spaced apart end portions, said gear having an opening which extends through a peripheral portion of said gear and between spaced apart end portions of said arcuate array of teeth, said first cuff being connected to said gear and being rotatable with said gear, said second cuff being aligned with the opening in said gear to enable a portion of the arm of the patient to be disposed in the opening in said gear when the lower portion of the arm of the patient is gripped by said first cuff and the upper portion of the arm of the patient is gripped by said second cuff.

106. An apparatus as set forth in claim 105 wherein the axis which extends along the upper portion of the arm of the patient and through said second cuff also extends through the opening in said gear, said drive assembly is operable to rotate said gear and said first cuff together about the axis which extends along the upper portion of the arm of the patient and through said second cuff under the influence of force transmitted from said input member.

107. An apparatus as set forth in claim 92 wherein said input member is rotatable under the influence of force applied to said input member by the patient to rotate said first cuff about the axis which extends along the upper portion of the arm of the patient and through said second cuff.

108. An apparatus as set forth in claim 92 further including a third cuff which grips a trunk of the body of the patient, a second drive assembly connected with said second and third cuffs and disposed beneath an axilla between the trunk and arm of the patient, said second drive assembly being operable to transmit force which moves said second cuff relative to said third cuff.

109. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, a first cuff connected with said first cuff arm to hold a lower portion of an arm of a patient, a second cuff arm, a second cuff connected with said second cuff arm to hold an upper portion of the arm of the patient, and a gear rotatably mounted on said second cuff arm and rotatable about an axis which extends along said second cuff arm and through said second cuff, said first cuff arm having a first portion connected to said gear for rotation therewith, said first cuff arm having a second portion connected with said first cuff.

110. An apparatus as set forth in claim 109 wherein said first cuff arm has longitudinal central axis which extends through said gear in a direction perpendicular to a longitudinal central axis of said second cuff arm.

111. An apparatus as set forth in claim 109 further including a second gear mounted on said second cuff arm in meshing engagement with said gear, said second gear being rotatable about an axis which extends parallel to the axis about which said gear is rotatable.

112. An apparatus as set forth in claim 109 further including a manually engageable member which is connected with said gear and is rotatable under the influence of force applied to said manually engageable member to rotate said gear and said first cuff arm relative to said second cuff arm.

113. An apparatus as set forth in claim 109 wherein said gear includes surface means which defines an opening which extends through said gear, said first portion of said first cuff arm extends into the opening in said gear.

114. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff which is engageable with a lower portion of an arm of the patient, a second cuff which is engageable with an upper portion of the arm of the patient and which is connected with said first cuff, said second cuff having a central axis which extends transverse to a central axis of said first cuff, a third cuff which is engageable with a trunk portion of the body of the patient and which is connected with said second cuff, a main drive assembly connected with said first and second cuffs and operable to transmit force which rotates said first cuff about an axis extending through said second cuff and through said main drive assembly, and a second drive assembly connected with said second and third cuffs and operable to rotate said first and second cuffs together about an axis which extends through a connection between said second and third cuffs.

115. An apparatus as set forth in claim 114 wherein the central axis of said first cuff extends transverse to and intersects the central axis of said second cuff, the central axes of said first and second cuffs both extend through at least a portion of said main drive assembly.

116. An apparatus as set forth in claim 114 wherein operation of said second drive assembly is effective to rotate said main drive assembly with said first and second cuffs about the axis which extends through the connection between said second and third cuffs.

117. An apparatus as set forth in claim 114 further including a fourth cuff which is connected with said first and second cuffs and is engageable with an elbow disposed between the upper and lower portions of the arm of the patient, said fourth cuff having a central axis which extends along a central axis of said first cuff.

118. An apparatus as set forth in claim 114 further including a fourth cuff which is connected with said first cuff and is engageable with a hand of the patient which is connected with the lower portion of the arm of the patient, said fourth cuff having a central axis which extends along a central axis of said first cuff.

119. An apparatus as set forth in claim 118 wherein said fourth cuff includes an arcuate surface which is engageable with a palm portion of the hand of the patient and a strap which is engageable with a back portion of the hand of the patient.

120. An apparatus as set forth in claim 114 wherein said main drive assembly includes a drive member which is connected with said first cuff and is rotatable about the central axis of said second cuff with said first cuff.

121. An apparatus as set forth in claim 114 wherein said drive member at least partially defines an opening and a portion of the arm of the patient is received in the opening in said drive member.

122. An apparatus as set forth in claim 114 wherein said second drive assembly is at least partially disposed between said second and third cuffs.

123. An apparatus as set forth in claim 114 wherein the connection between said second and third cuffs is disposed beneath an axilla between the upper portion of the arm of the patient and the trunk of the patient when said third cuff is connected with the trunk of the patient.

124. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, a first cuff connected with said first cuff arm to hold a lower portion of an arm of a patient, a second cuff arm, a second cuff connected with said second cuff arm to hold an upper portion of the arm of the patient, and a drive assembly connected with said first and second cuff arms, said drive assembly includes a first gear which is fixedly connected to said first cuff arm and is rotatable about a first axis which extends through said second cuff and a second gear which is disposed in meshing engagement with said first gear, said second gear being rotatable about a second axis to effect rotation of said first gear and said first cuff arm together about said first axis.

125. An apparatus as set forth in claim 124 wherein said first cuff arm has longitudinal central axis which extends transverse to said first axis and extends through a portion of said first gear.

126. An apparatus as set forth in claim 124 further wherein said second gear is rotatably mounted on said second cuff arm, said second gear being rotatable about an axis which extends parallel to the axis about which said first gear is rotatable.

127. An apparatus as set forth in claim 124 further including a manually engageable member which is connected with said second gear and is rotatable under the influence of force applied to said manually engageable member to rotate said first and second gears and said first cuff arm relative to said second cuff arm.

128. An apparatus as set forth in claim 124 wherein said first gear includes an opening which extends through said first gear and receives a portion of the arm of the patient.

129. An apparatus for use in effecting relative movement between bones in a body of a patient, said apparatus comprising a first cuff arm, a first cuff connected with said first cuff arm to hold a lower portion of an arm of a patient, a second cuff arm, a second cuff connected with said second cuff arm to hold an upper portion of an arm of a patient, a first drive assembly connected with said first and second cuff arms and operable to rotate said first cuff arm and said first cuff together relative to said second cuff arm and second cuff, a third cuff arm, a third cuff connected with said third cuff arm to hold a trunk of the patient, and a second drive assembly connected with said first and second cuff arms, said second drive assembly includes an input member which is manually rotatable to effect rotation of said first and second cuff arms and said first and second cuffs relative to said third cuff arm and third cuff under the influence of force transmitted from said input member to said second cuff arm by said second drive assembly.

130. An apparatus as set forth in claim 129 wherein said first and second cuff arms are rotatable together relative to said third cuff arm about a first axis which extends transverse to a longitudinal central axis of said second cuff arm, said input member being rotatable about a second axis which is offset from said first axis to transmit force which effects operation of said second drive assembly to rotate said first and second cuff arms together relative to said third cuff arm.

131. An apparatus as set forth in claim 129 further including a pivot connection interconnecting said first and second cuff arms, said first and second cuff arms have longitudinal axes which extend through said pivot connection, said second drive assembly being operable under the influence of the force transmitted from said input member to rotate said first and second cuff arms together about an axis extending through said pivot connection.

132. An apparatus as set forth in claim 129 wherein said second drive assembly includes an externally threaded member and an internally threaded member disposed in threaded engagement with said externally threaded member, one of said internally and externally threaded members being rotatable relative to the other of said internally and externally threaded members under the influence of force transmitted from said input member to effect rotation of said first and second cuff arms and said first and second cuffs relative to said third cuff arm.

133. An apparatus as set forth in claim 129 wherein said second drive assembly is at least partially disposed beneath an axilla between the upper portion of the arm and the trunk of the patient, said one of said internally and externally threaded members being rotatable about an axis which extends through the axilla between the upper portion of the arm and the trunk of the patient.

134. An apparatus as set forth in claim 129 wherein said input member is manually rotatable about an axis which extends transverse too an axis about which said one of said internally and externally threaded members is rotatable.