WO1997023176A1

WO1997023176A1 - Removable wrist-band for the carpal tunnel syndrome

Info

Publication number: WO1997023176A1
Application number: PCT/IT1996/000262
Authority: WO
Inventors: Gabriele Massi; Stefano Massi
Original assignee: Gabriele Massi; Stefano Massi
Priority date: 1995-12-21
Filing date: 1996-12-20
Publication date: 1997-07-03
Also published as: ITFI950257A1; IT1278808B1; AU1397997A; ITFI950257A0

Abstract

The present invention belongs to the field of orthopedic remedies and it relates to a removable wrist-band adjuvant for all the muscular and tendinous pathologies of the wrist and particularly for the carpal tunnel syndrome, the peculiarity of which consists in comprising an armband provided with means for controlling or preventing bending movements, extension movements, radial or cubital inclination movements and movements of rotation of the carpiradialis and carpiulnaris articulations of the wrist and of the hand.

Description

Removable wrist-band Tor the carpal tunnel syndrome

The present invention belongs to the field ofthe orthopedic remedies and it relates to a removable wrist-band adjuvant for all the muscular and tendinous pathologies of the wrist and particularly for the treatment ofthe carpal tunnel syndrome.

Skilled persons of this particular field know very well problems relating to articular neuropathies ofthe wrist often due to endogenous disorders such as cervical arthrosis or due to circulatory insufficiency, submitted to specialistic treatment late or often treated with inappropriate cures. To better understand the problem it is useful to describe the moφhology of the human wrist according to its movements. For this purpose it is necessary to consider that in the carpiradialis and carpiulnaris articulations movements which cause the changing of position of the hand according to the forearm are accomplished; bending movements, extension movements, radial and cubital inclination movements, circling and rotation movements are recognized; for the bending movement, the palmar face of the hand bends itself according to the medial surface of the forearm, whereas for the extension movement, the dorsal face ofthe hand bends itself according to the lateral surface ofthe forearm; accomplishing the cubital inclination movement, the hand bends itself towards the cubital side ofthe forearm and in the radial inclination movement the hand bends itself towards the radial side. The sequence and the combination of the above described movements cause the circling, whereas the rotation is obtained by the movement ofthe hand on its own axis.

All these movements are accomplished through the adjuvant presence of the carpiradialis and carpiulnaris articulations and through the flexor and extensor muscles of the forearm and of the hand, which are innervated by a median nerve which crosses the carpal canal constituted by the rigid osseous sulcus of the carpal bones on which the traverse ligament is stretched.

The neuropathy results from the unbalanced relation between containment (cavity constituting the carpal canal and its sheath) and content (nerve) and many endogenous and exogenous factors may cause such degenerative process, such as: inflammatory processes (rheumatoid arthritis), fractures ofthe wrist and of osseous corn, acromegaiy (abnormal swelling ofthe bones), pregnancy etc.

However, it has been noted a very frequent etiology due to an exogenous factor, that is the frequent constrained position of extension and bending of the wrist which for the

PY forced mechanical motion arouses a deformity of the median nerve caused by the hyperextension and hyperbending of the wrist itself

Consequences ofthe pathology are inflammatory disorders, paresthesia (tingling), as well as an insufficient efficacy of the grasping and contractile strength of some muscles which, in certain cases, leads to the atrophy ofthe muscles themselves The most usual treatment used for the cure of this pathology is of conservative type, wherein anti- inflammatory medications are used even with infiltrations along the nerve, such treatment causes relevant inconveniences which are even more evident considering that some histological reports indicate the damage caused by such medicament and that the eventual advantage obtained is temporary

An alternative treatment includes wrist splints obtained by using metal splints having a padding which preventing movements of hyperextension and hyperbending relieve the suffering ofthe nerve, the inconveniences caused by this remedy are evident and relevant A first inconvenience is the necessity to arrange the wrist-splint in the proper way and in the correct position "ad hoc and in situ" on the wrist by a technician, an other inconvenience is the impossibility for the patient to remove the splint without help of an other person, an other inconvenience is that the splint applied to one wrist or to both wrists causes a limitation ofthe daily and working activities ofthe patient, a further inconvenience is the possibility of using this remedy only for short periods of

The main aim ofthe present invention is to obviate or at least to assist the treatment ofthe carpal tunnel syndrome and of all the muscular and tendinous pathologies ofthe wrist, without using pharmacological medicaments and by using a device which, prescribed by the doctor, may be used directly by the patient without the help of a technician, an other aim is to allow the use ofthe device by the patient according to the movements of its limbs and obtaining the easy positioning and removal ofthe remedy, a further aim is to obtain a remedy which, when in use applied on the wrist, does not prevent to the patient to carry out its own working activities, but it only controls or avoids, as possible, the bending movements and particularly the extension movements Not least aim of the invention is to obtain a device of easy and inexpensive manufacturing without using specialized work-people and which is reproducible on an industrial scale without the use of sophisticated technologies These and other aims are achieved by a removable wrist-band for muscular and tendinous pathologies and in particular for the carpal tunnel syndrome to use for the control ofthe bending movements, extension movements, radial and cubital inclination movements and movements of rotation ofthe carpiradialis and carpiulnaris articulations of the wrist and of the hand characterized by being constituted by a padded armband countershaped according to the wrist and partially to the hand, provided with blocking means to the wrist, said armband constituted by a semi-circular shell having a rigid frame, said semi-circular shell presenting two sides the smaller of which, by using the wrist-band applied on the dorsal face ofthe hand, is turned towards the forearm and the larger is turned towards the digits of the hand, said semi-circular shell presenting two longitudinal edges slightly diverging, the first edge, when the wrist-band is used, being coincident with the area corresponding to the capital of the radius and to the first metacarpal and the second edge being coincident with the capital ofthe ulna and the fifth metacarpal, said first blocking means starting from said edges are provided with further means to allow the reversible joining ofthe sides to the armband and obtaining the wrist¬ band.

Further characteristics and advantages ofthe invention will more clearly arise from the description of a preferred but not exclusive embodiment ofthe wrist-band shown as an indicative and not limitative way in the attached drawings in which: - figure 1 shows a dorsal view ofthe open wrist -band;

- figure 2 shows an internal view ofthe open wrist-band;

- figure 3 shows a cross section view ofthe central body ofthe wrist -band;

- figure 4 shows a schematic view of the frame of the wrist-band according to the skeleton ofthe wrist and ofthe hand; - figure 5 shows a dorsal view ofthe wrist-band in a step of positioning obtaining a first rest position;

- figure 6 shows a dorsal view of the wrist-band put on the wrist in a rest position according to figure 5;

- figure 7 shows a palmar view ofthe wrist-band in a step of positioning obtaining a second working position;

- figure 8 shows a palmar view ofthe wrist-band put on the wrist in the working position according to figure 7.

The wrist-band as shown in the drawings is constituted by a padded armband 1, substantially a semi-circular shell 2, countershaped according to the wrist and partially to the hand, which presents three belts of different length and shape pointed out respectively with the numbers 3, 4, 5; said semi-circular shell 2 has a smaller side 21 , which with the wrist-band in use, is turned towards the forearm and an opposed larger side 1 1 which, with the wrist-band in use, is turned towards the digits ofthe hand. The arc constituting the channel 40 ofthe semi-circular shell, presents two longitudinal edges

31 and 41 which, when the wrist -band is in use positioned on the wrist of the patient on the dorsal face ofthe right hand, result being coincident, the first 31 with the lateral area corresponding to the capital ofthe radius 32 and then to the first metacarpal 34, whereas the second 41 results coincident with the capital of the ulna 42 and successively to the fifth metacarpal 44.

The armband 1 has an internal frame constituted by a rigid semi-circular membrane 16 having an outline slightly flared out from the terminal part 21 to the opposed terminal part 1 1 , above this structural membrane 16, on its superior face, five rods for the stiffening of the wrist-band 36, 38, 43, 46, 48 are longitudinally placed such that with the wrist-band used in a working position they result corresponding to the bones ofthe carpus and ofthe metacarpus, respectively the rod 36 presses on the capital ofthe radius

32 proceeding on the trapezium 33 and on the first metacarpal 34, also the rod 38 presses on the capital of the radius 32 proceeding on the navicular 35, on the trapezoid 37 and on the second metacarpal 39; the rod 43 presses on the capital of the radius 32 and proceeds on the semi lunate 45, on the capitate 47 and on the third metacarpal 49, the rod 46 presses on the capital of the ulna 42 and proceeds on the pyramidal bone 51, on the hamate 52 and on the forth metacarpal 53, the rod 48 presses on the capital of the ulna 42 proceeding on the pisiform 54 and on the fifth metacarpal 44

Below the concave face of the structural membrane 16 a layer of continuous padding 18 is placed, starting from the larger side 1 1, with thickness sloping down towards the smaller side 21, and being different shaped in some areas according to a map corresponding to the morphology of the wrist and more precisely presenting a semi- annular raised area 30, in the portion corresponding to the larger side 1 1 to the base of the digits and a hollow area 26, on the opposed terminal part towards the wrist corresponding to the capital ofthe ulna 42

The frame and the padding are completed by a sheath 10 in a water-repellent fabric which, as well as constituting the covering touching the wrist and the external, has a morphological shape such to allow the carrying out ofthe belts.

Considering the identical and symmetrical shape of both wrists, the present description is referred to a wrist-band fit for the right wrist and consequently the shape ofthe side 1 1 results bent upwards, with its outline from the left area 1 la to the right area l ib, consequently the belts 4 and 5 start from the edge 41, respectively from the terminal opposed areas 1 lb and 21b towards the sides, whereas the belt 3 starts from the terminal area 1 la ofthe edge 31 as continuous part ofthe side 1 1.

Said strap-shaped belts 3 and 5 are of different length, respectively the belt 3 results of larger length than the belt 5, such lengths are determined by the dimensions respectively ofthe metacarpal area, ofthe ulnaris area and ofthe radialis area which said belts will have to surround together with the padded semi-circular shell which will constitute the removable wrist-band

The belt 4 has a larger length than the other ones and presents approximately in the median area an enlarged shape fit for housing, between the two layers of fabric which constitute said belt, a rigid plate 19 having thin thickness with a slightly concave outline and having a substantially trapezoidal shape with rounded sides and angles, said belt 4 is further provided with two joining strips 17 and 27, placed respectively on the terminal portion ofthe internal face 24 and ofthe external face 14 Said belt 4, opposed to the belt 3, when in use, as well as for surrounding the metacarpal area and joining in such a way the two edges 41 and 31 ofthe padded semi-circular shell 2, is fit for carrying out a rigid support which involves the area ofthe traverse ligament 50 ofthe hand, in the internal part of which the muscular and tendinous pathologies of the wrist take place and particularly regarding the cavity constituting the carpal canal and the sheath containing the nerve which in pathology causes the carpal tunnel syndrome

On the superior face 12 of the padded semi-circular shell 2, on the area 57, approximately in the center, ofthe side 1 1, on the left lateral area 59 ofthe side 21, as well as on the approximately middle-right area 58 ofthe edge 41, three transversal strips

7, 8, 9 are placed for the fast joining of three corresponding strips 27, 28, 29, placed on the terminal portions ofthe internal faces 24, 23, 25, respectively ofthe belts 4, 3, 5

The joining ofthe belts 3, 4, 5 through the corresponding strips 28, 27, 29 present on the respective internal faces with the strips 8, 7, 9 is obtained through a light pressure to carry out when said strips overlap each other, such case takes place when the wrist-band is placed on the involved wrist, said belts being able to surround the wrist with similar outline but inverse, and in said positions they can be joined in a sufficiently steady way by applying a simple pressure and from said positions they can be removed simply with a light pull When using the wrist-band and for the above described pathologies, the patient will have two ways of using it: in a first way he will let down the semi-circular shell 2 on the dorsal face ofthe hand (figures 5 and 6), with the smaller side 21 towards the wrist and the larger side 1 1 towards the digits, then he will turn the belt 5 below the wrist according to direction 55, applying it to the strip 9 present on the semi-circular shell and fastening it tightly; then he will proceed with the same succession but following the inverse direction 56, turning the belt 3 and applying it to the strip 8; obtaining such position the patient will control the bending movements, the extension movements, the radial and cubital inclination movements, the rotation movements, maintaining nevertheless an efficient and compatible use of the limb according to its daily activities; such position of the wrist -band will be obtained by passing the belt 4 according to the direction 60 above the face 12 ofthe semi-circular shell and blocking it by joining ofthe strip 27 with the strip 6, in such case an efficient use of the rigid area involved by the plate 19 will be excluded. In a second way of use, when the patient will obtain a more relevant therapeutic advantage from the removable wrist-band, for example during the night or when the limb is on rest, he will choose the immobilizing effect obtained from the larger belt 4, releasing it from the engage with the two joining strips 27 and 6 and he will turn the same belt inversely according to the direction 61 , by passing it below the palm of the hand and fastening it tightly by joining the opposed strip 17 with the strip 6, obtaining that the rigid area housing the plate 9 will become coincident with the area 50 ofthe traverse ligament so that the limb will result almost immobilized according to the carpiradialis and carpiulnaris articulations, particularly for the bending and extension motions.

The wrist-band could be easily removed with an easy pull motion to be carried out on the terminal part of each of the three belts, avoiding the joining ofthe strips.

Advantageously it will be necessary foresee a removable wrist-band for the right hand and an identical and symmetrical removable wrist-hand for the left hand.

The so conceived invention is suitable to modifications and variations, without leaving the present inventive concept; furthermore all the details can be replaced with others having equivalent functions.

Claims

1 A removable wrist-band for muscular and tendinous pathologies and in particular for the carpal tunnel syndrome to use for controlling bending movements, extension movements, radial and cubital inclination movements and movements of rotation ofthe carpiradialis and carpiulnaris articulations ofthe wrist and ofthe hand characterized by being constituted by a padded armband countershaped according to the wrist and partially to the hand provided with blocking means to the wrist, said armband constituted by a semi-circular shell having a rigid frame, said semi-circular shell presenting two sides the smaller of which, by using the wrist-band applied on the dorsal face of the hand being turned towards the forearm and the larger being turned towards the digits of the hand, said semi-circular shell presenting two longitudinal edges slightly diverging, the first edge of which, when the wrist-band is used, being coincident with the area corresponding to the capital ofthe radius and to the first metacarpal and the second edge being coincident with the capital of the ulna and the fifth metacarpal, said first blocking means starting from said edges being provided with further means to allow the reversible joining ofthe sides to the armband and obtaining the wrist-band.

2 Removable wrist-band according to claim 1 , characterized by the fact that the armband has an internal frame constituted by a rigid semi-circular membrane having an outline flared out from one terminal part to the other and countershaped according to the area on which said armband is being applied

3 Removable wrist-band according to claim 2, characterized by the fact that above the membrane at least five rigid longitudinally placed rods are present in a position corresponding to the skeleton of the bones of the hand on which they press 4 Removable wrist-band according to claim 1, characterized by the fact that the armband presents below its frame on the face touching the hand, a layer of continuous padding

5 Removable wrist-band according to claim 4, characterized by the fact that the padding has a thickness sloping down from the larger side ofthe semi-circular shell to the smaller side

6 Removable wrist-band according to claim 4, characterized by the fact that the padding has a different thickness variable preferably according to the moφhology ofthe area ofthe wrist and ofthe hand on which the armband press

7 Removable wrist-band according to claim 4, characterized by the fact that the padding presents a semi-annular raised area on the portion corresponding to the larger side of the semi-circular shell towards the base of the digits and a hollow area to the opposed terminal part towards the wrist in an area corresponding to the capital ofthe ulna 8 Removable wrist-band according to claim 1, characterized by the fact that the armband presents a sheath comprising structural supporting members and the padding

9 Removable wrist-band according to claim 8, characterized by the fact that said sheath is made up in water-repellent fabric

10 Removable wrist-band according to claim 1 and to any ofthe previous claims, characterized by the fact that in a wrist -band for the right hand, the shape ofthe side of the semi-circular shell is bent upwards having an outline from the left area to the right area considering it from the dorsal face

1 1 Removable wrist-band according to claim 1 and to any ofthe previous claims, characterized by the fact that in a wrist-band for the left hand, the shape ofthe side ofthe semi-circular shell is bent upwards having an outline from the right area to the left area considering from the dorsal face

12 Removable wrist-band according to claim 1, characterized by the fact that the means allowing the blockage ofthe armband on the wrist consist of a plurality of belts having different length and shape and being provided along their internal face with further means for the reversible joining to the armband being constituted by strips which engage themselves through pressure with corresponding strips on the armband

13 Removable wrist -band according to claim 12, characterized by the fact that at least two first belts start from the two opposed edges of the armband and are of dimension equivalent to the circumference ofthe wrist and ofthe area around which they have to be rolled and a portion fit for joining itself with a corresponding area on the armband

14 Removable wrist-band according to claim 12, characterized by the fact that at least a third belt starts from any ofthe edges ofthe armband and it is of a larger length than the others and presents on the median area a rigid portion constituted by the presence of a rigid plate having thin thickness said plate having a trapezoidal shape with rounded sides and angles

15 Removable wrist -band according to claim 14, characterized by the fact that the larger belt is provided with a first joining strip present on the terminal portion of its own internal face and a second joining strip present on the terminal portion of the second external face

16 Removable wrist-band according to claim 1 , characterized by the fact that on the superior face o the padded semi-circular shell a plurality of areas provided with joining means corresponding to the belts starting from the edges are present 17 Removable wrist-band according to claim 1 , characterized by the fact that on the superior face ofthe padded semi-circular shell on the superior surface ofthe sheath three transversal strips are present for a fast joining, a first one being placed on the approximately central area towards the smaller side, a second one being placed on the left lateral area, a third one on the median-right area, the joining of said strips with the corresponding strips on the terminal part ofthe belts being carried out by a light pressure when said strips overlap each other and with the inverse manoeuvre being carried out the removal

18 Removable wrist-band according to claim 1 and any of the previous claims, characterized by the fact that for a first way of use of the wrist-band the armband is being applied on the dorsal side of the hand in an area including the caφiradialis, carpiulnaris and metacarpal articulations, the two first belts being passing below the wrist and the palm ofthe hand and joined through the terminal parts ofthe joining strips present on the padded semi-circular shell, the third larger belt passing above the padded semi-circular shell and joining to the armband through the engagement ofthe joining strip present on the external face of its terminal part, said first use being fit for controlling but not preventing the movements of the articulation of the hand achieving a consequent moderate therapeutic advantage but maintaining a broad use ofthe limb

19 Removable wrist-band according to claim 1 and any of the previous claims, characterized by the fact that for a second way of use ofthe wrist-band the armband is being applied on the dorsal side of the hand in an area including the caφiradialis, caφiulnaris and metacaφal articulations, the two first belts being passing below the wrist and the palm of the hand and joined through the terminal parts of the joining strips present on the padded semi-circular shell, the third larger belt passing below the palmar side ofthe hand corresponding to the area concerning the traverse ligament next to the caφal canal and to the sheath containing the median nerve, said belt joining itself to the armband through the engagement of the joining strip present on the internal face of its terminal part, said second way of use obtains the preventing of the movements of the articulation of the hand and particularly of the bending and the extension movements achieving a consequent relevant therapeutic advantage