The present invention relates to an apparatus used for assisting with the relocation of a dislocated shoulder and relates particularly, but not exclusively, to a medical apparatus used for the reduction of anterior shoulder dislocations by experienced doctors and physicians .

Shoulder dislocations account for a substantial amount of all maj or j oint dislocations entering accident and emergency departments of hospitals , with anterior displacements being the most common seen by emergency medical staff .

In a patient with a dislocated shoulder any movement associated with the arm, upper body or lower body can cause pain and discomfort . In this instance a patient would be adverse to any sudden or strenuous effort and would move cautiously to try and mitigate any further irritation .

Many shoulder reduction techniques can be used to relocate the head of the humorous back into the glenoid cavity of the scapula . However, many of these techniques can cause a high amount of pain for the patient . To perform a successful reduction is to overcome the resistance of the shoulder muscle , yet with increased pain in the patient comes increased muscle resistance and muscle spasm . It is therefore important to control the level of pain in a patient . This helps with the comfort of the patient and therefore the ease in which the physician can perform the technique . This pain can be managed with the use of an analgesia or intra-articular anaesthesia if sedation is required .

However, with the inclusion of pain management the time taken for a patient to be successfully treated and then discharged is increased . This also increases the number of people needed to help the patient throughout their procedure by

SUBSTITUTE SHEET (RULE 26) having to include a nurse or doctor to administer the pain medication and monitor the patient .

A known technique for the reduction of anterior shoulder dislocations utilises an apparatus known as an Oxford chair which allows gentle manipulation of the arm with the body in a supported position to relocate the humeral head (ball ) with the glenoid cavity ( socket ) . The present invention is an improvement on the so-called Oxford chair .

Preferred embodiments of the present invention seek to overcome or alleviate the above described disadvantages of the prior art .

According to an aspect of the present invention there is provided an apparatus for assisting with the relocation of a dislocated shoulder, the apparatus comprising : a base ; at least one first leg and at least one second leg attached to said base ; a chest rest connected to said first leg; and a seat connected to said second leg wherein the height of at least one of said chest rest and said seat relative to said base is adj ustable , and said seat has a seating portion for the patient to sit on wherein said seating portion has a substantially uniform cross section .

With this arrangement the patient is able to position themselves on the seat comfortably ready for any height or width adj ustments . The patient can move along the length of the seat ( forwards or backwards ) using small slow movements to achieve the correct angle needed to lean onto the chest rest relative to the length of their back .

The seat and chest rest are adj usted to the patient ' s height to enable the patient to sit comfortably and hang their affected

SUBSTITUTE SHEET (RULE 26) arm down on the other side of the chest rest , with the axilla over the top of the chest rest . Whilst in this position the patient ' s muscle groups are more relaxed making it easier and less painful to manoeuvre . This enables the medical staff to perform a successful reduction without greatly increasing pain in the patient ' s shoulder and therefore, reducing the need for strong analgesia or sedation , only requiring gas and air for pain management . This greatly reduces the time it takes for the patient to be discharged and the number of staff required to help with the procedure .

This apparatus also allows physicians to perform basic techniques to relocate the shoulder safely and comfortably back into place , therefore reducing the need for complex fractional and counter fractional direction manoeuvres . As this technique is easier to perform on a patient more physicians and nurses can be quickly trained, increasing the number of people capable of shoulder reduction .

In a preferred embodiment the seat is adj usted by using a pneumatic gas cylinder .

Having a pneumatic gas cylinder enables the height of chair to be adj usted whilst the patient is sat on the seat . Using this mechanism, the patient can control the height of the seat in a smooth and controlled motion, further reducing the chances of any further pain or discomfort .

In a further preferred embodiment the chest rest is adj ustable using a mechanical height adj ustment mechanism .

In another preferred embodiment the cross-section of the seat is formed such that an upper surface is substantially part circular .

This shape increases the patient ' s comfort and ease for maneuvering along the seat to the required position .

SUBSTITUTE SHEET (RULE 26) In a preferred embodiment the base further comprises a plurality of support beams forming a T-shape .

This greatly reduces the risk of further inj ury caused by the patient tripping over a crossbar located at the back of the seat .

The patient is able to locate and walk towards the seat without the need for caution or sudden movements .

In a further preferred embodiment the base further comprises a plurality of wheels located on a crossbar of said T-shaped base .

This increases the ease of relocating the apparatus to another room for storage or manoeuvring closer to a patient .

In another preferred embodiment the base further comprises a support bar connected between the first and second leg .

Having a support bar increases the durability and stability of the apparatus whilst a patient is seated reducing the chances further inj ury or increased pain .

According to an aspect of the present invention there is provided an apparatus for assisting with the relocation of a dislocated shoulder, the apparatus comprising : a base having a plurality of support beams forming a T-shape ; at least one first leg and at least one second leg attached to said base ; a chest rest connected to said first leg; and a seat connected to said second leg .

In a preferred embodiment the base further comprises a plurality of wheels located on a crossbar of said T-shaped base .

SUBSTITUTE SHEET (RULE 26) Preferred embodiments of the present invention will now be described, by way of example only, and not in any limitative sense with reference to the accompanying drawings in which

Figure 1 is an isometric view of an apparatus of the present invention;

Figure 2 is an isometric view of a seat forming part of the apparatus of figure 1 ;

Figure 3 is an isometric view of a chest rest forming part of the apparatus of figure 1 ;

Figure 4 is an isometric view of a base and legs of the apparatus of figure 1 ; and

Figure 5 is a side view of the apparatus of figure 1 in use .

Referring initially to figures 1 to 4 , an apparatus 10 is shown which is used for assisting in the relocation of a dislocated shoulder of a human patient . The apparatus 10 includes a base 12 which is formed from two square cross-section and metal tubes 14 and 16 which together form a T-shape . The tube 14 forms the upright of the T with the tube 16 forming the crossbar . Attached to the base 12 , and more specifically to tube 14 , are a pair of upright legs 18 and 20 which are connected together by a support bar 22 to provide structural strength . Of the two legs , the leg 18 , which is closer to the crossbar tube 16 , is the taller and is connected to a chest rest 24 via an adj ustable connecting tube 26 . The chest rest 24 is fixed to the connecting tube 26 at an angle of between 30 ° and 60 ° and most preferably at 45 ° .

In order to provide the chest rest 24 with a simple mechanical height adj ustment mechanism, the connecting tube 26 has a series of holes 28 ( shown most clearly in figure 3 ) which work in cooperation with a hole 30 in upright leg 18 to receive a locking pin which allows the height of the chest rest 24 relative to the base 12 to be adj usted . The shorter of the

SUBSTITUTE SHEET (RULE 26) upright legs 20 is connected to a seat 32 via a pneumatic height adj ustment mechanism 34 .

The seat 32 is shown in more detail in figure 2 and is divided into a seating portion 36 which directly contacts the patient when the apparatus is in use and a seat frame 38 which is located between the seating portion 36 and the pneumatic height adj ustment mechanism 34 . The seating portion 36 has a uniform cross section which means that the upper surface of the seating portion 36 is uniform in shape along its length having parallel edges 40 and 42 . As a result , when viewed from above , the seating portion 36 is substantially rectangular . The uniform cross section of the upper surface of the seating portion 36 is substantially part circular in shape , that is , it forms an arc .

The seat frame 38 of seat 32 has a recess 44 into which one end of the pneumatic height adj ustment mechanism 34 extends . The other end of the pneumatic height adj ustment mechanism 34 is connected to the upright leg 20 . The pneumatic height adj ustment mechanism 34 is of the type commonly used in office chairs and is familiar to persons skilled in that art , no further detailed description of this mechanism is provided .

The frame 12 is provided with feet 46 which engage the floor surface when the apparatus is in use and are provided to substantially prevent the apparatus 10 from moving when in use . Attached to a vertical surface adj acent the ends of the crossbar tube 16 of base 12 are a pair of caster wheels 48 which, together with a handle 50 attached to the leg 20 , which is furthest away from the crossbar tube 16 of the T-shaped base 12 , allow the easy manoeuvring of the apparatus when not in use .

Operation of the apparatus 10 will now be described with additional reference to figure 5 . A patient with a shoulder dislocation is generally in significant pain and finds movement , both of the arm in which the shoulder is dislocated and more

SUBSTITUTE SHEET (RULE 26) general movement of the whole body, difficult due to pain and the fear of pain .

The first stage of the treatment process is to position the patient on the apparatus 10 . Using the pair of wheels 48 and the handle 50 the apparatus 10 can be easily manoeuvred to a location close to the patient . This reduces the patient ' s need to move to the apparatus . I f the patient is sitting in a seat waiting for treatment the apparatus 10 can be brought to them and placed in front of them with the seat 32 closest to them and the upper angled surface of the chest plate 24 , against which they are going to rest their chest , facing towards them . Because the crossbar tube 16 of the T-shaped base 12 is furthest away from patient they are able to stand up and shuffle themselves forwards taking small steps and without having to step over any part of the apparatus . They are also able to straddle the seat 32 therefore requiring very little body movement in order to get from a seat into the required position in order to have the reduction of anterior shoulder dislocation procedure undertaken on . Prior to sitting on the apparatus 10 , the height of the chest rest 24 and seat 32 are adj usted to suit the patient .

As described above , the height of the chest rest 24 and seat 32 can be adj usted dependent on the leg length of the patient and the length of their torso . In the embodiment shown in figure 5 the height of the uppermost surface of the seat above the ground ranges from 472mm to 599mm and the height of the uppermost surface of the chest rest 24 above the ground ranges from 685mm to 914mm . This range will accommodate body sizes of 95% of the adult population .

The height of the seat 32 above the base 12 is adj usted depending upon the leg length of the patient using the pneumatic height adj ustment mechanism 34 which has a control lever (not shown) . The height of the chest rest 24 relative to the seat 32 (and above the base 12 ) is adj usted depending upon the torso

SUBSTITUTE SHEET (RULE 26) length of the patient using the pin and holes 28 and 30 . Although it is possible to adj ust the height of the chest rest 24 and seat 32 with the patient in position this is not desirable since it can lead to pain for the patient . Because the seating portion 36 of the seat 32 has a uniform cross section the patient is able to place their buttocks on the seat at a position which enables them to comfortably lay their chest against the chest rest 24 with their arm extending over the uppermost edge of the chest rest . In the left-hand image of figure 5 the schematically represented patient is sitting with their buttocks at the rear of the seat 32 whereas in the right-hand image the schematically represented patient is sitting with their buttocks at the front of the seat . Since the positioning of the buttocks on the seat 32 provides in situ adj ustment of the patient position of the apparatus the initial positioning of the adj ustable components ( chest rest 24 and seat 32 ) need only be approximate .

The procedure for reduction of an anterior shoulder dislocation using the apparatus 10 is substantially the same as that undertaken for the so-called Oxford chair and is briefly described as follows . The patient is positioned on the chair resting their chest on the chest rest 24 and allowing their affected arm to hang down with their axilla over the top chest rest . When the patient is in position vertical traction is applied in line with gravity and the arm may become relaxed and drop down . While maintaining this vertical traction the arm is slowly externally rotated (that is clockwise rotation of the left arm when viewed from above and anti-clockwise rotation of the right arm also when viewed from above ) . This slow rotation should result in the reduction of the anterior shoulder dislocation with the humeral head (ball ) re-engaging with the glenoid cavity ( socket ) . Once back in the correct position the arm can be supported back across the body and then suspended in a sling .

SUBSTITUTE SHEET (RULE 26) It will be appreciated by persons skilled in the art that the above embodiments have been described by way of example only and not in any limitative sense , and that various alterations and modifications are possible without departure from the scope of the protection which is defined by the appended claims . For example , although in the embodiment of the invention described above the hole seat 32 has a uniform cross section it is only the portion of the seat on which the patient sets , that is the seating portion 36 , which should be of uniform cross section . Although not in line with the embodiment described above and not preferable , the seat 32 could be a T-shape aligned similarly to the base with the crossbar part of the T closest to the chest rest . In this example the stem of the T would have uniform cross section to provide the advantages of the invention set out above .

SUBSTITUTE SHEET (RULE 26)