RU2487695C2 - Device for development of wrist joint and fingers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular, to devices, and is intended for correction and fixation of forearm and hand in functionally-effective position with simultaneous development of fingers. Device contains hand-holder or finger-holders. Metal construction, containing bracket with fastened to it rod with bracket in such way as to insure individual changing of interposition of metal construction elements simultaneously in three planes during preparation for application on a particular patient, is fixed to splint. Hand-holder or finger-holders on elastic traction are fastened to distally located bracket. Splint is made from light high-strength materials. Form of splint is made such as to insure maximal effective position of upper extremity segments.

EFFECT: possibility of correction and further fixation of forearm and hand in effective for functioning position with simultaneous active independent development of wrist joint and fingers.

3 cl, 3 ex, 4 dwg

Description

The invention relates to medicine, in particular to devices, and is intended for correction and fixation of the forearm and hand in a functionally advantageous position with the simultaneous development of the fingers of the hand. The device is used on sick children and adults with cerebral palsy, the consequences of strokes and the consequences of traumatic brain injury with lesions of the upper limb; flaccid paresis of the upper limb caused by various diseases (obstetric paresis, the effects of neuroinfection, in particular poliomyelitis), rheumatic diseases with damage to the joints of the hand (rheumatoid arthritis, psoriatic arthritis, metabolic-dystrophic arthritis, with diffuse connective tissue diseases and systemic inflammatory diseases of the connective tissue with lesions of the joints of the hand, systemic vasculitis with damage to the joints of the hand, seronegative spondylitis with damage to the hand, damage to the hand with infection diseases, diseases of extraarticular soft tissues of the hand, microcrystalline arthritis of the joints of the hand, deforming arthrosis of the wrist joint and joints of the hand), the consequences of injuries with damage to the hand.

Known devices for the development of movements in the joints of the upper limb (a positive decision on the application No. FAP20050021 of 04/18/2007; TR Tagaev // Orthopedics genius No. 3, 2007, pp. 101-102) and a device for developing contractures of the upper limb (St. No. 1158195), as well as the training device according to the patent No. 2027423, the authors Ioffe D.I., Golembiovskaya O.N. etc. The disadvantage of all of the above devices is the lack of fixation of the hand in the required position and the lack of development of the joints of the hand.

Closest to our proposed technical solution is a device for eliminating contractures of the wrist joint (application 99107891/14; authors Novikov A.V., Dmitriev G.I. et al.). The above device is used to develop the wrist and wrist joint. A device for eliminating contractures of the wrist joint contains a base, braking and loading mechanisms. At one end of the base of the rod, a lodgement for the forearm and a module in the form of a rack with a fixed disk rigidly mounted on it and a shaft passing through its center with a handle and a movable disk, on the front surface of which there is a loading and brake mechanism, are installed, and at the other end, articulated lodges for the shoulder and elbow joint. The technical result of the above device is the possibility of active pronation-supination movements in the wrist joint with a metered load and fixation of the hand in the reached position.

The disadvantages of this device:

1. The device is stationary, bulky, with the presence of many metal parts and mechanisms.

2. Fixation of the forearm and hand in the reached position (pronation or supination) without taking into account flexion and extension in the wrist joint.

3. Fingers of a brush are developed only in the presence of the capture of a brush restored in advance (before working on this device).

4. Rigid fixation of segments of the upper limb, mentioned in this device, is not always justified.

5. This device is used only in patients with the consequences of injuries.

6. The device is not individual.

7. Applicable only in medical facilities with mandatory medical care.

8. A device for eliminating contractures of the wrist joint is used only as an independent type of treatment, but the authors do not mention a comprehensive approach to treatment (massage, physiotherapy, etc.).

The technical result of our invention is the possibility of correction and further fixation of the forearm and hand in a position favorable for the function with the simultaneous active independent development of the wrist joint and fingers.

The goal of developing the wrist joint and finger joints is to achieve the maximum possible range of motion in the wrist, metacarpophalangeal, interphalangeal joints and restore the strength of the affected upper limb, restore or acquire fine motor skills of the hand.

The specified technical result is achieved by the fact that the forearm is corrected and fixed with a longt made of materials (polyvik, bichkast, turbocast, thermoline, thermoplastic, polyamide resin) in the mid-physiological position, the span is fixed with an ordinary or elastic bandage to the forearm. A 3-hole bracket with a threaded tail is attached to the socket, fixed with a nut rigidly to the socket. The bracket is installed depending on the required correction, the patient has a pathological installation (or contracture, deformation) of the wrist joint, small joints of the hand, metacarpophalangeal and interphalangeal joints of the fingers. To do this, the bracket rotates in a horizontal plane in the required direction. After that, the three-hole bracket with a threaded tail is rigidly fixed with a nut to the spindle. A rod is attached to the bracket with a bracket fixed to it with an internal threaded hole. The rod is exposed in the frontal plane (above, below), as there is a choice of three holes. The height of the rod installation is made taking into account the necessary correction of the patient's pathological installation (or contracture, deformation) in the wrist joint, small joints of the hand, metacarpophalangeal, interphalangeal joints from the 2nd to 4th fingers. The rod with the bracket is also exposed in the sagittal plane (longer, shorter) and is fixed individually for each patient, depending on the length of the hand, fingers, and the severity of the deformation (or contracture). A rod with a fixed bracket with an internal threaded hole is attached to the bracket, a rod with a bracket is exposed and fixed individually for each patient (depending on the length of the brush, fingers and deformation of the brush, fingers). An elastic-traction brush holder (rubber bandage) is put on the brush, which is attached to the bracket that extends beyond the span. Elastic traction is stretched to an angle of 150-130 ° in the wrist joint in the back side. I variant: Fingers from II to IV are fixed by the brush holder, but at the same time the middle and distal phalanges remain free and can move with the greatest possible force in this patient: compress into a fist, contrasting the II-IV fingers in the hand of the I finger and allows the development of fine motor skills brushes. Or option II: the fingers of the hand are fixed with finger holders (individually), taking into account the severity of contractures in the joints of each individual finger.

Clinical example No. 1

Patient Arteeva TA, 37 years old, medical history No. 2149, rheumatology department, ticket from 10/31 to 11/23/2000. Diagnosis: rheumatoid arthritis, polyarthritis, articular form, slowly progressing course. Activity II, NPS II, R-stage II; gray (-) arthritis with damage to the joints of the hand and foot. Pathological flexion systems in the interphalangeal and metacarpophalangeal joints of the fingers.

Received with complaints of pain during movements and restriction of movements in the fingers of the hands, weakness in the hands, difficulties in self-care.

Upon admission to the rheumatology department of the Pyatigorsk clinic, rough combined contractures were revealed in the interphalangeal and metacarpophalangeal joints of the fingers (both flexion and extension are limited).

To squeeze into a fist brush can only 2/3 of the volume. The contrast of the I-th finger to the II-V-th is sharply limited due to stiffness. Hand grip strength D = S = 1 point.

The patient underwent balneotherapy: radon baths, 40 nCi / l, every other day, lasting 15 minutes, No. 10, at the same time massage and physiotherapy exercises were performed. At the time of treatment, a device was developed for the patient to develop the fingers of the right hand. The patient dressed the device on her own and practiced in her spare time from the procedures.

At the time of discharge, the range of motion in the joints of the right hand increased both by flexion and extension, the movements became painless. Hand grip strength D 2 points, S 1 point. Comparing the right and left hands (equally affected by rheumatoid arthritis), the right hand is fully compressed into a fist, the strength of the right hand has increased, and fine motor skills of the right hand have improved compared to the left. The stiffness in the D hand disappeared. Self catering has improved. Discharged with significant improvement.

Clinical example No. 2

Patient Durnev M., 9 years old. The consequences of obstetric paresis of the left upper limb. Case history No. 1382, ticket from 07.08. on 08.24.2000. Complaints: shortening of the left hand. In self-care, he uses his left hand only to maintain clothing.

Clinically: the left forearm is in maximum pronation, the hand hangs in the palmar flexion. Fine motor skills of the left hand are absent, fingers are not clenched into a fist. The patient received USV bath temperature 37 °, 10 minutes, every other day, No. 8; mud applications with a temperature of 39 °, 10 minutes, on the cervical-collar zone and both upper limbs, No. 7. Massage of the cervical-collar zone, back and upper limbs No. 8. At the same time engaged in physical therapy. The patient’s mother was given a device made by us for fixing the left forearm and hand with the simultaneous development of the fingers of the left hand. I practiced 3 times a day for 30-40 minutes, daily.

After the course of treatment was discharged with significant improvement. Fine motor skills of the left hand improved, self-service improved. It can compress the left hand into a fist (the strength of the brush D is 5 points, S is 1 point).

Clinical example No. 3

Mikhailenko S., 10 years old, case history No. 1689, ticket from 08.22 to 05.10.2001, Diagnosis: cerebral palsy, right-side hemiparesis. Complaints: violation of self-care with his right hand, writes with his left. With his right hand, he can only carry bags on a bent forearm. Received a course of treatment: radon baths 20 nCi / l, 10 minutes, after 1-2 days, No. 10; mud applications on the right extremities with a temperature of 39 ° 10 minutes, after 1-2 days, No. 10. At the same time, massage and physiotherapy exercises were carried out.

During the treatment in the department, the device for developing the right hand was given to the patient, the nurse helped put on the device we made to the child during the development of the right hand, which was carried out 2-3 times a day for 30-40 minutes. The device was worn on the right forearm and hand (with finger holders) and for the duration of classes with a speech therapist.

After the course of treatment, the patient was discharged with improvement. Fine motor skills of the right hand improved, self-service improved.

In total, 69 patients were treated with this device since 1999.

The essence of the invention lies in the fact that the device for the development of the wrist joint and joints of the hand provides forcible individual correction of pathological settings (multi-plane deformations, contractures) in the forearm and hand.

Correction is carried out in 3 planes, individually: frontal, sagittal and horizontal due to the design of our device. The installation allows fixing to be achieved in the position that is most advantageous for the function. The device provides the creation of conditions for self-active development of the joints of the fingers and wrist joint, overcoming the resistance of elastic traction. This device increases the amplitude of possible movements in the patient in the wrist and joints of the hand. The device expands the possibilities of rehabilitation of patients with pathological settings, contractures, deformities in the wrist joint, joints of the hand and fingers (of various etiologies). The device reduces the time of rehabilitation, increases the effectiveness of treatment. The proposed device is simple and reliable. It can be used in hospitals, clinics, at the place of residence, in centers engaged in rehabilitation treatment, it is possible to use this invention in the conditions of spa treatment.

Brief description of the illustrations (Fig. 1, 2, 3, 4)

Figures 1 and 2 show a device for the simultaneous development of the wrist joint and fingers.

The device consists of a span (1) (from materials: watering, bichkast, turbocast, thermoline, thermoplastic, polyamide resin), to which a bracket with a threaded tail (2) is attached, is fixed with a nut (5) through the washer (6) to the spindle. A threaded metal rod (3) passes through the bracket with a bracket fixed to it with an internal threaded hole (4). The brush is fixed with a brush holder (7), consisting of plywood covered with cotton and bandage, on an elastic rod (8) (rubber bandage).

Figures 3 and 4 show a device for individual fixation and further development of the joints of each of the 4 fingers. The device consists of a span (1) (from materials: watering, bicast, turbocast, thermoline, thermoplastic, polyamide resin), to which an arm with a threaded tail (2) is attached, is fixed with a nut (5) through the washer (6) to the spindle. A threaded metal rod (3) passes through the bracket with a bracket fixed to it with an internal threaded hole (4). There is an individual fixation of fingers by finger holders (7). The finger holder consists of plywood, covered with cotton and bandage, elastic traction (8) (household rubber or thinly cut rubber bandage), fixing hooks (9) made of metal wire.

The device operates as follows. After the manufacture of spacers (individual or pre-made in advance), the metal structure is rigidly fixed individually on the sponge, taking into account the type and severity of the pathology corrected. The metal structure, adjusted in three planes, is rigidly fixed by parts between each other and to the span.

1st option. An elastic traction holder is made. The wrist holder is put on the hand, capturing the area from the 1st finger to the metacarpophalangeal joints from the 2nd to 5th fingers. In this case, the metacarpophalangeal, interphalangeal joints remain free. The wrist holder can move distally to the proximal interphalangeal joints, depending on the type and severity of the corrected pathology. Elastic traction is fixed to the distal bracket by strapping around the rubber bandage with a thread.

2nd option. Finger holders are made on elastic traction. Finger holders of the fingers from the 2nd to the 5th. The finger holders are pulled by elastic traction until the desired correction is achieved, taking into account the severity and type of correctable pathology. Pulling is performed in isolation on each finger. Finger holders can be located both on the proximal and distal phalanges of the fingers (taking into account pathology). The elastic traction is fixed to the distal bracket made by pre-made hooks.

Development in the device is carried out by independent active movements of the fingers to bend and contrast the first finger.

Claims (3)

1. A device for the development of the wrist joint and wrist joints, characterized in that it contains a wrist holder or finger holders, a splint, to which a metal structure is attached, containing a bracket with a rod attached to it with a bracket in such a way as to provide an individual change in the relative position of the metal structure at the same time three planes in preparation for use in a particular patient, while the cradle holder or finger holders on elastic traction fixed pronounced by us to the distal arm. 2. The device according to claim 1, characterized in that the span is made of lightweight high-strength materials - polyvic, bicast, turbocast, thermoline, thermoplastic, polyamide resin. 3. The device according to claims 1 and 2, characterized in that the shape of the span is made in such a way as to provide the most favorable position for correcting the function of segments of the upper limb with further fixation of the segments.

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