Adjustable supportive and dynamic orthotic device
United States Patent Villanveva 51 Apr. 22, 1975 [54] ADJUSTABLE SUPPORTIVE AND DYNAMIC 2859.746 1 H1958 Roberson 128/87 R ORTHOTIC DEVICE I 3.029.810 4/1962 Martin 2/44 X [76] lnventor: Raul Villanueva, 7006 Lacy Hill,  
 Houston, Tex. 77036 [22] Filed: Nov. 12, 1973 [21] Appl. No.: 414,840  
 [52] US. Cl. 128/78; l28/D1G. 19; 2/44 [51] Int. Cl. A6&#34; 5/02 [58] Field of Search 128/78. D16. 19. 87; 2/44. 2/45 [56] References Cited UNITED STATES PATENTS 170.655 12/1875 Allen 128/78 492,903 3/1893 Gerlitz 128/78 970.781 9/1910 Battershall 128/78 1.595.739 8/1926 Stewart 128/78 2.687.129 8/1954 Tulkish 128/78 Primary E.\&#39;aminerRichard A. Gaudet Assistant E.\aminer.l. Yasko Attorney. Agent. or FirmRanseler O. Wyatt [57] ABSTRACT An orthotic device for raising and supporting the shoulder of a surgical patient or in some instances of muscular dystrophy, where a muscle imbalance resulting from a shoulder dysfunction is present. the device having a pelvic mold, fitted to the body of the wearer. and a pair of longitudinally adjustable bars terminating in a half crutch which is cushioned and maintained in place by a harness, the pelvic mold being strapped to the body and the half crutch bearing upwardly and rearwardly against the shoulder.  
 6 Claims, 3 Drawing Figures ADJUSTABLE SUPPORTIVE AND DYNAMIC ORTHOTIC DEVICE BACKGROUND OF THE INVENTION In the course of some surgical procedures for the treatment of cancer of the head and neck. a nerve or nerves are also removed. creating a muscle imbalance and a shoulder dysfunction. An orthoses is needed to support the shoulder and diminish the muscle imbalance. minimizing the chances of pain due to strain and to improve shoulder function.  
  It is universally known that in the treatment of cancer of the head and neck. several surgical procedures are performed. In some patients the accessory nerve is removed in the block. In another very small group of patients. a nerve graft is done. In another group. primarily a temporary loss of function of the accessory nerve is experienced due to the trauma and edema and in another group. muscular dystrophy causes a weakening of these muscles. requiring an orthotic correction. Which ever is the case. the result is a partial or complete loss of function of the trapezius muscle. This muscle is the prime fixator of the shoulder. including the scapula. and it is necessary to accomplish all motions of the shoulder. primarily abduction and abduction-external rotation.  
  When resistance is added to abduction. the deficit becomes much more obvious and the ability ofthe person to complete the task may be impaired. Although flexion is much easier to accomplish when resistance is added. the endurance decreases primarily due to pain.  
  In all cases of weakness or paralysis. motion is accomplished by learning to substitute and use other muscles. However. in the case of these particular patients. the substitution is not well accomplished because of the greater power of the musculature of the chest compared with the remaining musculature of the shoulder girdle. This imbalance creates a malalignment of the shoulder joint and a subluxation of the arm. that in some cases may be one half inch. or greater.  
  In flexion of the arm. the pectoralis major becomes the primary mover and its sternal and clavicular portions will tend to hypertrophy. Because of their insertion in the humerus. they are capable of producing a postural defect known as round shoulder when the posterior shoulder girdle musculature is weak. Because of the paralysis of the trapezius in these patients. the above mentioned problem may be greater.  
  In addition, the pectoralis minor. because of its insertion at the coracoid process of the scapula and its oblique course from its origin at the third. fourth. and fifth ribs. becomes an unopposed force against the scapula and causes it to rotate up and outward. These forces against the humerus and the scapula produce a change of the normal alignment of the glenoid cavity and also for the normal course of several of the muscles and their tendons. Because of these changes additional support of the shoulder joint and muscle strength is lost.  
  Another very important factor is the laxity caused to the capsula. that results in an additional factor in the subluxation of the arm previously mentioned. Because of all of the previously mentioned factors. the patients ability to accomplish even some of the most essential activities of daily living become impaired.  
 SUMMARY OF THE INVENTION An adjustable dynamic orthotic device consisting of a moldable pelvic member mountable on the pelvic area of a user and having means for maintaining same in position. and a rigid member extending from said pelvic member upwardly and posteriorly. with relation to the body ofthe user. and terminating in a half crutch adjustable to move the shoulder into approximately normal alignment with the other shoulder and a harness extending from the half crutch across the back of the user and secured around the other shoulder to assist in correcting the dysfunction attributable to muscular or nerve damage due to surgery and the method of correcting said dysfunction by orthosis.  
 BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side perspective view of the device.  
  FIG. 2 is a front view of the device in position on a body.  
  FIG. 3 is a rear view of the device in position on a body.  
 DESCRIPTION OF THE PREFERRED EMBODIMENT In the drawings. the numeral 1 designates a pelvic mold which is formed of moldable plastic. such as Polysar. which is a plastic polymer of one quarter inch thickness. and which will. at temperatures of 190 and above. become soft and pliable. and thus may be easily molded to the contour of the individual patient. The mold thus formed has a means for anchoring same to the body of the user. such as the strap or webbing 2. adapted to pass around the torso ofthe individual user. and a suitable buckle. as 3. receives the free end of the strap 2 to maintain the mold in place on the body of the user. A rigid lower bar 4 is attached to the mold l. at a point approximately 2 inches medially from the anterior superior iliac crest. and is so mounted at an angle of less than 20. and extends upwardly and outwardly. usually about 10 inches. with the upper 4 inches provided with spaced. internally threaded apertures (not shown) spaced about A inch apart. and the upper or topmost bar 6, formed of rigid material such as stainless steel. or aluminum. of suitable length. such as about 8 inches. and provided with similar internally threaded apertures 5, 5 adapted to be brought into alignment. selectively. with at least a pair of the apertures in the lowermost bar 4. and set screws. as 7 are employed to anchor the upper and lower bars in place to accomodate the individual patient.  
  The upper end of the top bar 6 is bent laterally from fifteen to twenty degrees. to apply a posterior thrust against the crutch and to urge the shoulder posterioraly. the degree of bend being according to the need of the individual patient. and the extended end of the top bar being anchored to the half crutch 8. and the half crutch 8 is adapted to extend from the infraclavicular space of the patient. medial to the head of the humerus. in an are down to the anterior axillary line and continues upwardly therefrom to above the clavicle. The half crutch is formed of a rigid material and is padded and covered with a suitable. durable cover. such as leather. or the like. Attached to the said half crutch 8 is the strap. such as the webbing 9. which passes under the axilla to the posterior axillar line and forms a complete loop. adapted to cross the scapula vertically at the medial one third. With the pelvic mold l and the half crutch in place as above described. it is evident there will be accomplished an upward. and a backward thrust to the shoulder. This force is applied against the thick tendon of the pectoralis muscles and should have no ill effect.  
  From the loop 9, two horizontal. yieldable straps l0. l such as a heavy elastic material. each of which are at least 5 inches long. the upper strap being situated below the spine of the scapula and the lower strap is at the lower one third of the scapula. The straps l0. l0 and the adjustable buckles l2. 12 are connected to the loop 11. adapted to receive the opposite shoulder.  
  The loops 9., 11 connected by the straps l0. form the harness which will supply part ofthe function of the mid trapezius. said function being to fix the scapula against the chest wall when either flexion or abduction of the shoulder is intended. At the same time. this will act as a force against the forward pull from the pectoralis minor muscle. and will assist in adduetion of the scapula when in relaxed state.  
  Physiologically. this device restores almost to the normal the alignment of the shoulder joint. supplements the strength of the involved musculature. by the fact that the pectoralis majors force will no longer be unopposed. it will. in addition. prevent the subluxation of the arm and relieve one of the major sources of pain for these patients. therefore cutting down on medication needed. even when their activities increase multifold.  
  Cosmetically. the use of this device is very acceptable. because it is small enough to be worn under most garments so that it is not normally seen. and because it restores the normal position of the shoulder so that the unsightliness of the shoulder drop is not present.  
  Another very important feature is the psycological effect. which is accomplished by the very combination of all of the above. and will make the patient&#39;s rehabilitation more easily to obtain and their lives more enjoyable and productive.  
  The method taught by this invention consists of forming an orthotic device. having a pelvic support for the upper and rearward lift required. and a harness mountable on the opposite shoulder to provide the musculature pressure lost. to lift and maintain a shoulder in alignment with the other shoulder. and to accomplish this result with a cosmetically acceptable mechanism.  
 What I claim is:  
  1. An adjustable supportive and dynamic orthotic device. a pelvic mold. a half crutch. a strut extending from said mold. said strut having two distinct angles the lower end of the strut being angled outwardly from said mold and the upper end of the strut being angled outwardly from said half crutch for delivering an upward and backward thrust. said half crutch supported by said strut and selectively adjustable to lift and maintain pressure over the tendon of the pectoral muscle in an upward and backward thrust to maintain the&#39;shoulder of a user in normal position.  
  2. The device defined by claim 1 wherein said half crutch is provided with means for anchoring same dynamically to the body of the user.  
  3. The device defined by claim 1 wherein said pelvic mold has a rigid lower bar extending therefrom and said half crutch has a rigid upper bar extending therefrom. forming said strut. internally threaded apertures in said bars adapted to receive set screws to anchor the upper and lower bars in a selected longitudinal position for each user. the lower bar being angled outwardly from said mold and the upper bar being angled outwardly from said half crutch providing said two distinct angles to maintain said posterior thrust over the tendon of the pectoral muscle.  
  4. The device defined by claim 1 wherein said half crutch is provided with yieldable and adjustable harness for assisting in maintaining said shoulder of the wearer in the desired position to oppose the pectoralis major&#39;s force by providing lateral support to aid the upward and posterior support of the said strut.  
  5. The device defined in claim 1 wherein said half crutch is provided with a cosmetic support consisting of a harness of webbing cooperating with said half crutch forming a loop for the shoulder to be lifted and forming a loop for the opposite shoulder and said loops being connected by elastic straps yieldably providing lateral support in cooperation with the upward and posterior support of the said strut.  
  6. The device defined in claim lwherein said half crutch is maintained in position on the user to restore alignment of the shoulder by employing said two distinct angles of the strut for applying pressure to the tendon of the pectoral muscle by means of a harness consisting of a strap extending from the respective ends of said half crutch forming a loop for the shoulder to be raised. and a loop formed of flexible material for the opposite shoulder and connecting straps of elastic material in horizontal parallel alignment. the upper strap being positioned to extend below the spine of the scapula and the lower strap positioned over the lower one third of the scapula to supply part of the function of the mid-trapezius which is to fix the scapula against the chest wall when either flexion or abduction of the shoulder is intended.