Pivotal Edge Hand Table

Abstract

An apparatus comprising as upper plate mounted on a pillar with pivotal means for motion is placed close to the axes of wrist action. By this construct a wide range of wrist positional opportunities is realized without producing unwanted elbow motion in a longitudinal or vertical plane. The practitioner enjoys ample access to the anatomy while being unburdened from repositioning the upper extremity due to unwanted shifts of the elbow and the shoulder. The hand and digits are secured to the upper plate. All materials of the apparatus are made from available stout material able to support the well-positioned upper extremity. A specialized positioning technique with guidelines for verification of proper apparatus utilization further separates the apparatus from the prior art.

Claims

1. A positioning table for a hand and wrist comprising: a lower support plate that remains substantially immobile when placed on a surface; an upper support plate adapted to receive a wrist at an end of the upper support plate, the upper support plate otherwise defining a longitudinal axis for supporting at least a hand; a pillar coupled to the lower support plate at a first end, and to a means for pivotal movement at a second end; a means for pivotal movement with one or more moveable elements coupled to the upper support plate whereby said upper support plate pivots from said end of the upper support plate.

2. The lower support plate of claim 1 wherein said lower support plate provides counterbalance for anatomy proximal to the wrist.

3. The upper support plate of claim 1 further shaped to hold a plurality of digital restraint ties that releasably holds the hand and the wrist.

4. The end of upper support plate of claim 1 wherein said end of the upper support plate is sandwiched between the wrist and the means for pivotal movement.

5. The end of the upper support plate of claim 4 wherein the wrist remains secured to said end of the upper support plate by digital restraint ties of the hand on one side and by the weighted dependent position of the more proximal anatomy on the other side.

6. Means for pivotal movement of claim 1 wherein the upper plate tiltably adjusts relative to the lower plate.

7. Means for pivotal movement of claim 6 wherein a stem is coupled to the upper support plate at said end of the upper support plate.

8. Means for pivotal movement of claim 7 wherein compatible detent means are provided to a socket to resist rotation of the upper support plate relative to the lower support plate.

9. Means for pivotal movement of claim 8 further including a ball and stent wherein said stem is threadably received through a hole at said end of the upper supper plate, the ball lying pivotally recessed within a socket coupled to the pillar.

10. A method for positioning a human upper extremity for a hand-wrist procedure comprises the stops of: providing an apparatus for positioning of a hand-wrist comprising: a lower support plate that remains substantially immobile when placed on a surface, an upper support plate adapted to receive a wrist at an end of the upper support plate, the upper support plate otherwise do lining a longitudinal axis for supporting at least a hand, a pillar coupled to the lower support plate at a first end, and to a means for pivotal movement at a second end, a means for pivotal movement of the upper support plate provided from said end of the upper support plate such that the upper support plate is tiltably adjustable relative to the lower support plate placing the apparatus on a counter of sufficient length to accommodate an outstretched position with the pivotal edge toward the shoulder, placing a human upper extremity on said counter, lifting the hand-wrist to the device, placing a wrist over said end of the upper support plate so that the rotational center of said wrist lies over the means for pivotal movement, securing the hand-wrist and fingers as needed to leave the desired operating field accessible while effectively stabilizing the hand-wrist at the upper support plate, choosing a proper angle of the forearm relative to the desired wrist position, supporting and stabilizing that portion of the upper extremity proximal to the apparatus as necessary to counterbalance the apparatus, rotating the hand-wrist through a range of motion for a planned procedure, whereby wrist action is observed without significant obligators movement of the proximal anatomy.

Description

BRIEF DESCRIPTION OF THE FIGURES

[0056] FIG. 1 Side view of apparatus with upper support plate in neutral position

[0057] FIG. 2 Side view of apparatus with a hand resting on the upper support plate in a neutral position

[0058] FIG. 3 Exploded view of the ball and socket mount to the upper support plate and to the pillar

[0059] FIG. 4 High angle side view of apparatus with upper support plate in neutral position.

[0060] FIG. 5 Front view of apparatus with upper support plate in a degree of left lateral tilt.

[0061] FIG. 6 Side view of apparatus with the upper plate in a degree of extension

[0062] FIG. 7 Side oblique view of apparatus in a degree of plate-flexion

[0063] FIG. 8 High angle side view of apparatus with a hand resting on the upper support plate in a degree of flexion with thumb and digits restrained by ties

[0064] FIG. 9A Side view of the apparatus showing a starting position of the well positioned upper extremity

[0065] FIG. 9B Side view of the apparatus of FIG. 9A showing a final position of the upper extremity

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0066] Before explaining the disclosed embodiments of the present invention in detail it is to be understood that the invention is not limited in its applications to the details of the particular arrangements shown since the invention is capable of other embodiments. Also, the terminology used herein is for the purpose of description and not of limitation.

[0067] A list of the components used in the figures is defined below. [0068] 10. Upper plate. [0069] 15. Pivotal edge (Near edge) [0070] 20. Upper Plate Notch [0071] 30. Hole in upper plate for threaded washer [0072] 40. Hole for wrist restraints tie [0073] 50. Threaded Washer [0074] 60. Ball and threaded stem assembly [0075] 70. Socket. [0076] 80. Notch in socket [0077] 90. Locking mechanism [0078] 100. Pillar [0079] 110. Pillar support assembly [0080] 120. Lower support plate [0081] 130. Digital restraint tie

Detailed Description of the Preferred Embodiments

[0082] FIG. 1 is a side view of the entire apparatus with upper support plate, 10, in neutral position. In this position the upper support plate lies parallel to the lower support plate. The upper support plate contains upper plate notches, 20, that are cut into the plastic. The upper plate notches, 20, retain digital restraint ties for securing the hand generally or to retain a predetermined array of digits. The pivotal edge, 15, is the proximal extent of the upper support plate and its proximity to a threaded washer, 50, is illustrated. The threaded washer is a mounting means for the upper support plate to receive the ball and stem assembly. The ball is recessed within the socket, 70, and is not seen otherwise. A locking mechanism, 90, provides variable friction to slow or stop rotation of the ball within the socket. The socket is mounted on the pillar, 100. The pillar is attached to to the lower support plate, 120, by a pillar support assembly, 110. A hand can be made to rest on the upper support plate by palm-down or backside-down (dorsum) position and remain in the neutral position or be moved pivotally to another desired position.

[0083] FIG. 2 is a side view of apparatus with a hand-wrist resting on the upper support plate, 10, in a near neutral position similar to the apparatus of FIG. 1. The upper support plate contacts the general area of the wrist and hand without encroachment into the upper plate by the forearm. The anatomy is further supported by the threaded washer, 50, and threaded stem assembly. The socket, 70, is threaded and coupled in this way to the pillar. A locking mechanism, 90, secure the ball which is recessed within the socket. The proximity of the rotational axes of the table near the stem, 60, and of the hand (at the wrist) allows near complete wrist action. This mirroring of motions provides a near complete range of motion for the wrist in flexion, extension, radial deviation, ulna deviation, pronation and supination. The digits are restrained against the upper support plate by a string-like ties, 130, held by notches on the plate. The socket is mounted on the pillar, 100, that then attaches to the lower support plate, 120, by a pillar support assembly.

[0084] FIG. 3 is a perspective exploded view of the apparatus without the pillar support assembly and the lower support plate. The view clearly shows the pivoting mechanism (the ball-and-socket assembly) eccentrically placed toward an edge of the table (pivotal edge) for the purpose of producing a rotation of axis for the upper plate as close to the same edge as possible. The upper support plate is flat, smooth and is suitable for hand-wrist contact and support. The edges of the upper support plate are lined with notches, 20, that serve to hold digital restraint ties. The proximal end of the upper support plate in this embodiment has a conspicuous expansion of the proximal end of the upper support plate. This proximal expansion is designed for a right or left thumb to be anchored by digital restraint ties. Several small holes for wrist restraint ties, 40, are also located at the proximal end of the upper support plate, 10. The wrist can be secured to the plate in this way if needed. The upper support plate, 10, contains a hole near an edge through which a threaded washer, 50, is placed. A one piece ball-and-stem stem screws into the threaded washer, specifically, by the threaded portion of the stem. The metal ball, 60, fits into a metal socket, 70, attached to a metal pillar. The socket is notched, 80, for the purpose of allowing the stem, when necessary, to gain additional motion in a desired plane with a maximum of 90 degrees of motion in any plane requiring plate tilt. The socket is threaded and receives the metal pillar, 100. Rotation of the plate is theoretically infinite. The socket can be rotated to a desired position which places the notch at the desired location. A locking mechanism, 90, is a modified screw that increases pressure against the ball within the socket by clockwise rotation.

[0085] FIG. 4 is a high angle side view of the apparatus with the upper support plate, 10, in neutral position (the upper plate lies parallel to the lower plate). The shape of the upper support plate is seen with a flared proximal end. The upper plate notches, 20, are placed along the sides of the upper support plate. The hole for wrist restraints, 40, lie near the pivotal edge, 15, of the plate. The threaded washer, 50, has a central location along the longitudinal plane of the upper support plate, 10 and is close to the pivotal edge, 15. The surface area of the threaded washer, 50, distributes stress received from the weight of the hand-wrist against the upper support plate, 10, and then transferred to the pivoting mechanism ie the ball and socket assembly. The locking mechanism, 90, provides variable compression electively to the ball that is recessed within the socket. A high angle perspective of the pillar, 100, the pillar support assembly, 110, and the lower support plate are illustrated.

[0086] FIG. 5 shows the pivotal edge hand table embodiment from the perspective of the distal edge of the upper support plate, 10, in the foreground. The upper support plate is in a mid-left lateral tilt position which demonstrates the range of motion capabilities of the apparatus. The pivotal edge, 15, is the proximal extent of the plate and in this perspective view appears toward the background. Some estimation of the close proximity of the pivotal edge to the pivoting mechanism (ball and stem, 60) can be appreciated. The ball is seen to lie within the socket, 70. The socket is coupled to the pillar, 100, by threads placed at the end of the pillar. The pillar, pillar support assembly and the lower base support provide load hearing capabilities for the apparatus.

[0087] FIG. 6 is a perspective side view of apparatus with the upper plate in a degree of plate-extension. Plate-extension is produced when the midline of the distal plate lies above, ie higher than its position at neutral position. A maximum of almost 90 degrees of plate-extension motion is possible for this embodiment. The upper support plate is depleted as having pivoted from its proximal end. The pivotal edge, 15, lies at the proximal end of the upper support plate. The threaded washer, 50, is placed as close to the pivotal edge as good manufacturing practices will allow for the plastic upper support plate and the metal threaded washer. The position of the socket, 70, is shown, as is the knob of the locking mechanism, 90. The socket, pillar, pillar support assembly and lower support plate are attached in series. While this position is given the label of being in plate-extension a backside (dorsum) of hand on the table would place in the hand in a degree of anatomic flexion of the hand relative to the forearm. Similarly, a palm on table position would produce anatomic extension of the hand relative to the forearm. The hand is placed such that the wrist (or junction of the hand to the forearm) lies at the edge of the plate which places the rotational axis of the wrist near the rotational axis of the edge of the table.

[0088] FIG. 7 is a perspective side oblique view of apparatus with the upper support plate, 10, in a degree of plate-flexion. Plate-flexion is produced when the midline of the distal plate lies below, ie lower, than its position in a the neutral position. Proportions of the ball size, the socket, 70, and stem length allow a maximum of almost 90 degrees of plate-flexion for this embodiment. The proximal end of the upper support plate shows positions of the pivotal edge, 15, holes for wrist restraints, 40, and the position of the pivoting mechanism assembly as demonstrated by the position of the threaded washer, 50. A general obliqued perspective view of the upper support plate contouring is again seen. While this position is given the label of being in plate-flexion a backside (dorsum) of hand on the table would place in the hand in a degree of anatomic extension (hand relative to the forearm). Similarly, a palm on table position would produce anatomic flexion of the hand relative to the forearm. The hand is placed such that the wrist (or junction of the hand to the forearm) lies at the edge of the plate which places the rotational axis of the wrist near the rotational axis of the edge of the table.

[0089] FIG. 8 is a high angle side view of apparatus with a hand resting on the upper support plate, 10, in a degree of plate-flexion (wrist extension) with thumb and digits restrained by ties, 130. This view displays a secured position of the hand and digits with simple string-like ties that anchor through holes and notches provided by the upper support plate. This drawing emphasizes the well positioned hand-wrist having a close relationships of the wrist to the plate edge, 15, and to the pivoting mechanism. The ties that restrain the digits, 130, maintain the hand in substantially the same position throughout upper plate motion. The position as shown would be suitable for many surgical approaches to the carpal tunnel as the relevant operative field is unobstructed. Note that the wrist does not require specific restraints since the weight of the arm pulls it against the device while the digital ties stabilize the hand otherwise to the upper support plate. The pillar, 100, pillar support assembly, 110, and lower support base support the hand-wrist as shown.

[0090] FIG. 9A is a side view of the elbow, forearm and hand positioned on the apparatus in a starting position. The hand lies on the upper support plate, 10, with the pivotal edge, 15, of the table near the wrist. The elbow rests on a standard positioning block which supports the elbow and upper arm. The presented embodiment requires the anatomy proximal to the hand-wrist to be supported such that the angle of the forearm leads to the upper support plate in a manner suitable for a planned procedure. The decision to modify the base for a different embodiment could be based on the frequency of a given procedure where the elbow must be placed in substantially the same position. The hand relative to the forearm lies in about 5 degrees of extension. The upper support plate lies in a degree of plate-extension. The estimated central axis of the wrist lies at the level of the pivotal edge, 15. The upper extremity is further supported by the pillar, 100, and the lower support plate, 120.

[0091] FIG. 9B is the same view of the apparatus and the upper extremity as shown in FIG. 9A. The hand lies in substantially the same position (spatial orientation) as the FIG. 9A starting position relative to the upper support plate, but the upper support plate has changed positions ie. to a final position. Through wrist motion, the hand, has been moved to approximately 65 degrees of extension, through plate-flexion, without significant lift or drag of the elbow as demonstrated by the minute transnational change in relationship of the elbow to the support block by a subtle forward translation through soft tissues ie within the elastic limits of the skin, subcutaneous tissue and bursal tissues. General support of the hand by the upper support plate, 15, the pillar, 100, and the lower support plate, 120 are shown.

Glossary

[0092] Action (joint action)refers to a change in position of a joint by some manner of contortion (ie configuration adjustment of boney alignment of the joint). For example, by motions of the muscles and tendons moving across the wrist or by passive motion by an external force the bones of a normal and otherwise unrestrained wrist will move relative to each other to produce an overall change in wrist configuration which can provide flexion, extension, torsion, radial deviation and ulnar deviation. All of these motions appear to cause movement of the hand. In contrast movements of the hand, especially for smaller movements, can be made by motions of the elbow and shoulder. (SeeMovement)

[0093] Active motionis motion produced by the musculature of the structure being moved. The opposite of active motion is passive motion in which motion is produced by external force. Most medical positioning apparatuses are described as functioning by passive movements of the anatomy whereby practitioners place the anatomy without cooperative effort from the patient. The Pivoting Hand Table is frequently used on the awake patient where cooperative effort facilitates the positioning process

[0094] Counteras a noun indicates a flat extended supportive surface such as an operating table arm board. The presented embodiment of the Pivoting Hand Table is portable and must be placed at approximately the same height as the support counter/table of, for example, a supine individual.

[0095] DragSubstantial force required to adjust an extremity during a procedure by pulling the extremity to gain length or to push the extremity for shortening relative to the end of the operating table. Drag is the friction created by this motion.

[0096] The Elbowprovides wrist motion by pronation and supination which is allowed by the Pivoting hand table. Flexion-extension actions of the elbow (after initial positioning efforts) are undesirable.

[0097] The Handlies distill to the wrist. Hand motion on the Pivoting Hand table refers to motion of the restrained metacarpals and secured digits.

[0098] Hand motionmovement of the metacarpals through space

[0099] Hand-wrista term for the hand and the wrist that, from a practical perspective, seem to move as one unit while on the Pivoting Hand Table

[0100] Isolated joint movementactive or passive motion of a joint with movement of the distal extremity, but with negligible movement from the anatomy proximal to the joint. For example isolated movement of the normal wrist in all planes produces negligible elbow movement.

[0101] Junction of the wrist and the forearmis an estimate of the location of the central rotational axis of the wrist ie at the capitate. This region is usually lies just beyond (distal to) the most distal bony extent of the forearm.

[0102] Orthogonal planesrefers to planes of motion at right angles. For example, the saggittal planes of hand flexion-extension is orthogonal to the coronal supination-pronation plane of the hand. Note that use of the term orthogonal in this case does not provide discrete information on by what anatomic mechanism or body part the motion occurs. Pronation-Supination movements of the hand can be produced independently by shoulder action or elbow action, and to a scant degree, wrist motion.

[0103] Obligatory movementintentional or unintentional movement of anatomy from the intentional active or passive positioning of anatomy at a different site. For example, a hand table from the prior art with a centrally placed ball and socket pivoting mechanism can produce obligatory elbow motion when the wrist is moved past 30 degrees of flexion; the elbow must move to accommodate the new position of the hand-wrist.

[0104] Lateral Tiltof the Pivotal hand table accommodates pronation-supination movements of the wrist. The table is viewed from the perspective of the plate edge as being the closest part of the upper support plate to the observer. Left lateral tilt is to the left of an imaginary line bisecting the longitudinal axis of the upper support plate. Right lateral tilt is to the right of the same imaginary line. Whether a hand is pronating or supinating depends upon the direction of motion and the orientation of the hand on the upper support plate, for example, palm-up versus palm-down

[0105] Longitudinal Axisan imaginary plane that runs down the line of the outstretched upper extremity.

[0106] Lower support platerefers to the aggregate of those structures that support the pillars, the upper support plate and a portion of the upper extremity (depending on the desired final position of the upper extremity). The lower support plate may be extended in any direction to accomplish tasks not to exclude providing more secure position of the extremity proximal to the upper support plate, or providing an elevated or lower perch for the upper extremity proximal to the upper support plate. The floor may also function as the lower support plate.

[0107] MediateA term used in a technical sense to mean to bring about the physiological effect of.

[0108] Movement (or Motion)refers to a change in spatial position of an object A change in position of an object (action) should not be confused with movement by the object, for example, a wrist that has a surgical fusion (ie, where the joints cannot move) can be said to have changed positions in space by motions of the elbow. Another example, is if a forearm begins motion parallel to the ground and then is angled 45 degrees by elbow flexion then it can be said that the fused wrist and the hand also moved 45 degrees. Similarly a wrist and hand can change positions substantially on a surgical support device with no actions (see actions definition) by the wrist. The definition of movement is any motion of the wrist (or any anatomic structure) through space

Motion-See Movement

[0109] Near edgesee plate edge, the word near refers to an edge of the upper support plate close to the wrist as demonstrated in the ball and socket embodiment of the Pivoting Hand Table

[0110] Neutral positionwhen the position of the upper support plate is parallel to the floor. (see Zero decrees).

[0111] Pivotala mechanism providing motion and positional options for an object attaching to it not to exclude a simple hinge, a ball-and-socket mechanism or more complex mechanisms where motion of an object can be produced by a mechanism having simultaneous mobile elements.

[0112] Pivotal Edgea proximal edge, rotating edge or near edge of the upper support plate. A central structure for the Pivotal Hand Table concept referring to an imaginary line drawn along the proximal most portion of the plate perpendicular to the longitudinal axis) lying adjacent to the wrist. A perfectly aligned pivotal mechanism produces no vertical or longitudinal change along the pivotal edge with any degree of plate movement (within anatomic limits).

[0113] Pivoting Hand table motionsThe proximal end off the upper support plate can also be called the near edge ie the edge through which the idealized rotational motion passes. The finger tip side of the upper plate is the distal end. A neutral position is when the plate lies parallel to the ground. If the distal end moves downward this is called plate-flexion. Upward motion of the distal end is called plate extension. Lateral tilt of the plate accommodates pronation-supination motion of the hand-wrist. Combinations of lateral tilt, plate flexion, and plate extension provide a wide range of possible positional opportunities for the hand and wrist.

[0114] Plate Extensionrefers to the distal end of the plate elevating relative to the proximal edge of the plate from a neutral position with the proximal edge of the plate being the support end close to the wrist

[0115] Plate Flexionrefers to the distal end of the plate lowering relative to the proximal edge of the plate from a neutral position with the proximal edge of the plate being the support end close to the wrist

[0116] Positionthe description of an object in 3-dimensional space relative to a qualified reference point For the pivotal edge hand table the reference point is called neutral position. Change in position of an object should not be confused with movement by the object, for example, a wrist that has a surgical fusion (ie, where the joints cannot move) can be said to have changed positions in space by motions of the elbow.

[0117] Repositioninga change of position for the hand-wrist on the pivotal edge hand table wherein the elbow position is fixed. Repositioning of the hand-wrist without the pivotal edge hand table often involves the inefficient task of having to move the elbow which effectively becomes a repositioning of the entire upper extremity

[0118] Starting positionalso called initial position refers to the point of reference of the upper extremity in space at the beginning of a procedure. This is not to be confused with neutral position (see neutral position and zero degrees)

[0119] TranslationThis term refers to the common position of placing an upper extremity on a supportive apparatus with the elbow in contact a supporting surface. There can be motion of the upper extremity with a force applied to the hand which is transmitted along the extremity causing motion of the olecranon by the surrounding elbow anatomy that glides over the relatively loose skin covering the region. A simple illustrative test is for a person to place the tip (olecranon) of the elbow on a hard surface and move the shoulder in small increments; it can be noted that there is movement of the elbow through the elastic surrounding soli tissues to produce about 3 cm of translational movement on average in any direction from the starting point. Once the limit of elasticity is reached the friction (drag) substantially increases making additional positioning of the hand more difficult by the requirement of substantially increased force

[0120] Uncoupled Movementwhen motion of a joint is performed with negligible contribution from another joint

[0121] Upper Armreferring to an extremity above the condyles of the elbow

[0122] Upper Support PlateA support structure for the wrist and hand

[0123] WristThe proximal extent lies distal to the end of the radius and the ulna, or to end of whichever of the two (radius or tuna) is more proximal. The distal extent lies at the articulations with: the metacarpals.

[0124] Zero (0) degreesalso called neutral position. 0 degrees describes the upper support table in a position parallel to the floor. Descriptions of the angular position of the pivotal edge hand table are in reference to this starting position. Zero degrees is not to be confused with a starting (or initial) position where the angular reference is the surface of the upper plate in neutral position.