FR3060971A1 - ORTHESE OF WRIST AND HAND - Google Patents

Abstract

The orthosis comprises a rigid support (2) comprising: a gutter-shaped proximal portion (3) receiving the forearm (104) and having a distal tongue (34) forming a support for the wrist and a proximal portion palm; - a distal portion (4) placed under the long fingers and under a distal portion of the palm; - An intermediate portion (5) having a support (51) for the thumb and a palmar support (52). The intermediate portion (5) is pivotally mounted relative to the distal portion (4) about a first pivot axis (21), and relative to the proximal portion (3) about a second pivot axis (22). ). The pivot axes are oriented in the anteroposterior direction (Z) of the wearer and pass through the palm, the second axis being offset in the proximal direction (P) relative to the first axis.

Description

© Agent (s): CABINET GERMAIN ET MAUREAU.

FR 3 060 971 - A1 © WRIST AND HAND ORTHESIS.

©) The orthosis includes a rigid support (2) comprising:

- A proximal part (3) in the shape of a gutter receiving the forearm (104) and having a tongue (34) distal forming a support for the wrist and a proximal portion of the palm;

- a distal part (4) placed under the long fingers and under a distal portion of the palm;

- An intermediate part (5) comprising a support (51) for the thumb and a palm support (52).

The intermediate part (5) is pivotally mounted relative to the distal part (4) around a first pivot axis (21), and relative to the proximal part (3) around a second pivot axis (22 ).

The pivot axes are oriented in the anteroposterior direction (Z) of the wearer and pass through the palm, the second axis being offset in the proximal direction (P) relative to the first axis.

The present invention relates to a wrist and hand orthosis, in particular intended for a wearer suffering from rheumatoid arthritis.

Rheumatoid arthritis is an inflammatory disease of the joints. It causes swelling and pain in the affected joints, especially at night, and can cause deformation of these joints. The disease can also, after a certain number of years, prevent the person affected from ensuring their daily actions and / or their professional activity.

At the level of the hand and the wrist, rheumatoid arthritis leads to the fact that the wrist is found off-center with respect to the forearm. In order to limit the deformations caused by this pathology, and to reduce pain, wrist and hand orthoses have been developed, in particular for night wear.

Conventionally, an orthosis of this type comprises a support made of rigid material, which is held against the patient by straps, and which comprises: a proximal part having a shape of gutter receiving the forearm, and a distal part placed under the palm and fingers of the hand. In addition, the distal part is configured to be able to pivot relative to the proximal part around a pivot axis oriented in the anteroposterior direction of the wearer. In this way, it is possible to maintain the wrist in a certain position, corresponding to the deformation at the beginning of the wearing of the orthosis, then gradually to bring the wrist to a more focused position relative to the forearm.

The known orthoses, if they bring a certain relief and limit the evolution of deformations, do not however give full satisfaction.

The present invention aims to provide a wrist and hand orthosis, in particular intended for a wearer suffering from rheumatoid arthritis, which has increased efficiency and improved comfort.

To this end, the orthosis according to the invention comprises a support made of rigid material which comprises: a proximal part having a shape of gutter intended to receive the forearm; and a distal part intended to be placed under the hand and configured to be able to pivot relative to the proximal part.

In addition, according to a general definition, the orthosis has the following characteristics:

- The distal part includes a distal portion intended to form a support for the long fingers and a proximal portion intended to form a palmar support for a distal portion of the palm;

- The proximal part includes a tongue which extends in the distal direction, substantially up to the palmar support of the distal part, and which is intended to form a support for the wrist and for a proximal portion of the palm;

- and the support also comprises an intermediate part comprising a portion intended to form a support for the thumb and a portion intended to form a palmar support, the intermediate part being pivotally mounted:

- relative to the distal part around a first pivot axis which, in the position of use, is oriented in the anteroposterior direction of the wearer and passes substantially to the center of the palm;

- And relative to the proximal part around a second pivot axis which is substantially parallel to the first pivot axis, which is located substantially in the same longitudinal plane as the first pivot axis, when the orthosis is in physiological position normal, and which, in the position of use, passes through the palm and is offset in the proximal direction relative to the first pivot axis.

Thus, the orthosis according to the invention has a double degree of freedom in pivoting, which allows a better adaptation of the orthosis to a deformed hand, and more precisely:

- a pivoting around the second axis, corresponding to an inclination of the carpus in the direction of the radius (radial inclination of the carpus) relative to the normal physiological position;

- And a pivoting around the first axis, corresponding to an inclination of the long fingers in the direction of the ulna (ulnar inclination or "ulnar gust" of the fingers) compared to the normal physiological position.

This better adaptation of the orthosis allows on the one hand to obtain increased wearing comfort, hence better compliance by the wearer, favoring the reduction of pain. On the other hand, during the treatment, the orthosis can gradually be brought closer to the normal physiological position, by pivoting the distal part around the first axis and / or the intermediate part around the second axis, following as best as possible the evolution of different deformations of the hand and wrist.

The normal physiological position is the position occupied by the hand and the wrist, i.e. by their constituent bones, on a person not affected by this pathology, in the absence of any deformation, and when this person is in the reference position, or standard anatomical position.

The anteroposterior direction, defined with reference to the standard anatomical position, and which is substantially orthogonal to the palm, is therefore substantially orthogonal to the mean plane of the orthosis. Furthermore, the longitudinal direction of the orthosis corresponds to the proximal / distal direction defined with reference to the standard anatomical position.

In the orthosis according to the invention:

- the distal part constitutes a metacarpophalangeal support and has no support for the thumb. In the position of use, that is to say when the orthosis is placed on a carrier, the proximal portion of the distal portion can extend substantially to the middle of the palm, that is to say that the distal portion of the palm corresponds to about the distal half of the palm;

- the intermediate part constitutes a metacarpal carpo support. It preferably includes palm support for substantially the entire palm. The intermediate part can also extend over a proximal portion of the long fingers, for example over a part of the first phalanges;

- The tongue of the proximal part forms a carpal support, and extends, in the position of use, under the wrist and substantially to the middle of the palm. There may be a space between the proximal edge of the distal portion and the distal edge of the proximal portion; or there may be an overlap, limited to the middle area of the palm, between the distal part and the proximal part.

In other words, the first pivot axis can be located in the vicinity of the proximal edge of the distal part. It is advantageously located in the physiological zone of convergence of the rays of the long fingers. As for the second pivot axis, it can be located in the vicinity of the distal edge of the proximal part. The second pivot axis can pass substantially at the level of the carpus. It can for example be located in the vicinity of the point of convergence of the axes of the metacarpals of the long fingers.

The orthosis according to the invention may include means for maintaining the desired angular position of the intermediate part with respect to the distal part and with respect to the proximal part, and means for adjusting each of said angular positions.

According to one possible embodiment, the orthosis comprises stops limiting the pivoting around the first and second pivot axes, said stops being arranged so that, seen in a frontal plane:

the angle (a) formed between the longitudinal axis of the forearm and the straight line joining the first and second pivot axes is between 0 and 20 °, preferably between 0 and 15 °, or even between 0 and 10 °, in the direction of a radial inclination of the carp with respect to the normal physiological position;

- and the angle (β) formed between (i) the straight line joining the first and second pivot axes and (ii) the straight line passing through the first pivot axis and between the ring finger and the middle finger is between -10 and 40 °, preferably between 0 and 30 °, in the direction of a cubital inclination of the long fingers relative to the normal physiological position.

A value of 0 ° of the angle β corresponds to an alignment of the lines mentioned in the previous paragraph. A positive value of the angle β corresponds to a cubital inclination of the fingers, while a negative value of the angle β corresponds to a radial inclination of the fingers.

The presence of these stops is a safety measure preventing excessive pivoting which would be painful and / or harmful to the wearer. Concretely, the limitation of pivoting can be obtained by blocking one against the other surfaces provided on the proximal, distal and intermediate parts of the support. The stops may include raised pins, typically projecting in the anterior direction.

According to one possible embodiment, the intermediate part is in contact with the posterior face of the proximal part and in contact with the anterior face of the distal part. With this configuration, the distal part and the proximal part are not in mutual contact.

The thumb rest in the middle can be configured to hold the thumb in antepulsion, in abduction, and in opposition. This makes it possible to adapt to the deformations present in the wearer when the orthosis is put in place.

The tongue of the proximal part can be curved in palmar flexion or in dorsal flexion in the posterior direction, towards the distal end of the proximal part. This configuration allows a better adaptation of the orthosis to the hollow shape of the palm. In addition, this makes it possible to immobilize the wrist in slight dorsiflexion (around 20 °), in order to avoid dislocation of the wrist (radio-carpal joint in particular), in particular when a strap ensures the tightening of the rigid support against the wearer's wrist, noticeably opposite the radio-carpal joint.

In addition, the palmar support of the intermediate part can have a domed shape, with the concavity directed in the anterior direction, so as to be adapted to the hollow shape of the palm.

According to one possible embodiment, the distal portion of the distal part, intended to form a support for the long fingers, is curved in the anterior direction, in the direction of the distal end. In this way, the long fingers, when in contact with the rigid support, and in particular when they are tightened against the rigid support by a strap, are bent in flexion. For example, the metacarpophalangeal joints can be flexed from 0 ° to around 30 °. Such maintenance of the long fingers in flexion makes it possible to avoid a tensile stress on the tendons of the flexor muscles and in fact to avoid the so-called “swan neck” deformation.

The support for the long fingers of the distal part may include a receiving channel for each finger, separated from the or each adjacent channel by a partition. This allows the proximal phalanges of the long fingers to be trapped, to combat deformations of each metacarpophalangeal joint. Each channel receives at least the first phalanx - or proximal phalanx - from the finger concerned, and preferably does not receive the third phalanx, or at least not in its entirety. The purpose of clearing the pulp of the long fingers is to maintain cutaneous sensitivity and therefore to preserve the possibility of distal grasping.

Furthermore, the support for the long fingers of the distal part may have a rim along its medial edge. This contributes to limiting the deformation in ulnar gust of the fingers.

According to a possible embodiment, the orthosis further comprises a cover which envelops the support and which has a palm window allowing access to the first and second pivot axes. This window can provide access to the means for adjusting the relative angular positions of the different parts of the rigid support.

The cover may include a sleeve in which the forearm is housed. The cover may further include a strip coming to be placed against the medial side of the hand, in order to limit the deformation in ulnar gust of the fingers.

In one possible embodiment, the orthosis further comprises a proximal strap configured to clamp the proximal portion of the support against the anterior face of the forearm, and a distal strap configured to sandwich the long fingers with the distal portion. The term "strap" should not be limited to "one strap". Thus, a strap may include several straps, reduction rings, and / or an easier gripping and traction system.

For example, each of the proximal and distal straps has one end fixed to the cover and a free end intended to be pulled to ensure the tightening of the orthosis on the wearer, each of the straps being configured so that the traction on the end free is done in the lateral direction - that is to say in the direction of the thumb. Thus, a pull on a strap tends to return the fingers and the wrist to the normal physiological position.

Provision may be made for the proximal strap to be situated substantially opposite the radio-carpal joint, in the position of use, in order to avoid dislocation of the wrist.

It can also be provided that the distal strap is located substantially opposite the metacarpophalangeal joint, in the position of use, in order to avoid dislocation of the phalanges.

A possible embodiment of the invention is now described, by way of nonlimiting example, with reference to the appended figures:

FIG. 1 is a view of the front face of a hand and of a wrist of a person suffering from rheumatoid arthritis, showing the deformations of the joints;

2 shows a rigid support of an orthosis according to the invention fitted to the deformed hand of Figure 1, in anterior view;

Figure 3 is a schematic representation, in rear view, of the support of the orthosis of Figure 2;

Figure 4 is a representation similar to Figure 2, in rear view;

5 shows the support of Figure 2, in the longitudinal direction of the orthosis, seen from the distal end;

Figure 6 is a representation similar to Figure 2, in side view;

Figures 6a and 6b are views similar to Figure 2, showing an embodiment of stops limiting the relative pivoting of the proximal, distal and intermediate parts of the support;

Figures 7 to 9 show an orthosis comprising a rigid support, a cover and straps, placed on the deformed hand and wrist of a wearer, respectively in anterior view, in posterior view and in lateral view;

Figure 10 illustrates a step of fitting the orthosis;

Figures 11 and 12 illustrate the effect of the traction of the straps of the orthosis on the deformations of the wearer;

Figures 13 and 14 are views similar to Figure 4, Figure 14 corresponding to the normal physiological position and Figure 13 corresponding to an intermediate position between Figures 4 and 14;

Figure 15 is an anterior view of a hand equipped with the rigid support of the orthosis, in normal physiological position;

Figure 15a shows a person's hand and forearm in the normal physiological position;

Figures 16 and 17 show a hand in normal physiological position, equipped with an orthosis according to the invention, respectively in anterior view and in posterior view.

Figure 1 shows the front side of a right hand and a wrist of a person suffering from rheumatoid arthritis. In FIG. 1, the palm 101 of the hand 100, the thumb 102, the long fingers 103 and part of the forearm 104 are visible. The ulna 105, the radius 106, the carpus 107, the metacarpals are also represented. 108 and the phalanges 109.

The standard anatomical position corresponds to that where the person is standing, facing the observer, the arms hanging along the body, the forearms and hands in supination (open hands, palm forward, thumb in the lateral direction, the other fingers pointing downwards).

With reference to this standard anatomical position, in normal physiological position, and as illustrated in FIGS. 1 and 6, the following terms are defined:

- the frontal plane PI is the plane which separates the body into an anterior part and a posterior part;

the longitudinal direction X is the general direction of the forearm 104 and, in this longitudinal direction X, the term “distal” designates an element situated on the side of the end of the arm, as opposed to the term “proximal” which indicates an element located on the side of the elbow. The distal direction D and the proximal direction P are illustrated in FIG. 1;

the transverse direction Y is the direction situated in the frontal plane PI and orthogonal to the longitudinal direction X. According to this transverse direction Y, the term "medial" designates an element situated on the side of the median plane P2 of the body (that is, ie the plane which separates the left half from the right half of the body), as opposed to the term "lateral" which designates an element located on the external side.

- the anteroposterior direction Z, orthogonal to directions X and Y, is substantially orthogonal to palm 101. In this direction Z, the term "anterior" designates an element which is situated or oriented towards the front, while the term "Posterior" means an element which is situated or oriented towards the rear.

As can be seen in FIG. 1, the hand 100 suffering from rheumatoid arthritis is doubly deformed relative to the normal physiological position: radial inclination of the carpus 107 (that is to say inclination of the carpus 107 towards the radius 106) , and cubital inclination or "cubital gust" of the fingers 102.103 (that is to say inclination of the fingers in the direction of the ulna 105).

To alleviate the pain associated with these deformations and gradually replace the hand towards the normal physiological position, the invention proposes an orthosis 1 of hand and wrist. Orthosis 1 is mainly intended for night wear, for resting the hand and correcting deformities, but can be worn temporarily during the day in the event of painful inflammatory attacks.

The orthosis 1 firstly comprises a support 2 made of rigid material, for example polyamide 6. The support 2 can be obtained by molding.

The support 2 has a mean plane substantially coincident with the frontal plane PI, and extends generally in the longitudinal direction X. The support 2 comprises a proximal part 3, a distal part 4 and an intermediate part 5.

The proximal part 3 is intended to be placed against the anterior face of the forearm 104 and of a part of the hand 100. The proximal part 3 comprises a proximal portion in the form of a gutter intended to receive the forearm 104. It thus comprises an anterior wall 31 and two wings 32, 33, respectively lateral (that is to say on the side of the thumb), and medial.

The proximal part 3 further comprises a tongue 34 which extends from the proximal portion in the distal direction D, in extension of the anterior wall 31. The tongue 34 has a distal end 35. In the position of use, it is that is to say when the orthosis 1 is worn by a person, the tongue 34 extends under the wrist and substantially as far as the middle of the palm 101, thus forming a support for the wrist and for a proximal portion - for example substantially half - of the palm 101.

The tongue 34 may be curved in the posterior direction, towards its distal end 35. In other words, the tongue 34 may have a concavity directed towards the palm 101, to adapt to the hollow morphology of the palm . A metal insert 36 can be provided in the proximal part to allow deformation of the proximal part, for a better adaptation of the dorsiflexion / palmar flexion according to the needs of the patient. The insert 36 extends substantially longitudinally, in the tongue 34 and in at least the distal part of the anterior wall 31.

The distal part 4 is intended to be placed under the hand 100, that is to say against the anterior face thereof. The distal part 4 comprises a distal portion 41 intended to form a support for the long fingers 103 and a proximal portion 42 intended to form a palmar support for a distal portion of the palm 101. The distal part 4 has a distal edge 43 and a proximal edge 44. It has no support for the thumb 102.

In the position of use, the proximal portion 42 extends substantially to the middle of the palm 101. Thus, the tongue 34 extends substantially to the palmar support 42 of the distal part 4.

There may be a space between the proximal edge 44 of the distal part 4 and the distal edge 35 of the proximal part 3, as illustrated in FIG. 3. Alternatively, there may be an overlap between the proximal parts 3 and distal 4 , limited to the middle zone of the palm 101, as illustrated in FIG. 4.

As seen more particularly in FIG. 5, the distal portion 41 of the distal part 4, intended to form a support for the long fingers 103, can be bent in the anterior direction, in the direction of the distal end 43, so that the fingers 103 are bent in flexion. In this way, as also seen in FIG. 9, the distal interphalangeal joints 110 can be flexed between 10 and 30 °, and the proximal interphalangeal joints 111 can be flexed between 0 and 30 °.

In addition, this distal portion 41 may include a receiving channel 45 for each finger 103, separated from or from each adjacent channel 45 by a partition 46, and / or a flange 47 along its medial edge.

The intermediate part 5 comprises a portion 51 intended to form a support for the thumb 102 and a portion 52 intended to form a palm support, preferably for substantially the entire palm 101. A notch 56 can be formed between the portion 51 and the portion 52. It is also possible to provide that the intermediate part 5 extends over a proximal portion of the long fingers 103, for example over a part of the first phalanges as illustrated in FIG. 4. The intermediate part 5 has a distal edge 53 and an edge proximal 54.

In direction Z, the intermediate part 5 is disposed between the proximal part 3 and the distal part 4. More specifically, the intermediate part 5 is in contact with the posterior face of the proximal part 3 and in contact with the anterior face of the distal part 4.

The support 51 for the thumb of the intermediate part 5 is configured to keep the thumb in antepulsion (that is to say in front of the plane of the other metacarpals 108), in abduction (that is to say moved away from palm 101), and in opposition (that is to say turned inward).

The intermediate part 5 is pivotally mounted relative to the distal part 4 around a first pivot axis 21 which is oriented in the anteroposterior direction Z and which passes substantially in the center of the palm 101. The first pivot axis 21 can thus be located in the vicinity of the proximal edge 44 of the distal part 4.

The intermediate part 5 is also pivotally mounted relative to the proximal part 3 around a second pivot axis 22 substantially parallel to the first pivot axis 21 and passing through the palm 101. In addition, the second pivot axis 22 is arranged so that, when the support 2 is in the normal physiological position, as in FIG. 15, it is located substantially in the same longitudinal plane as the first pivot axis 21 and offset in the proximal direction P relative to the first axis of pivoting 21. The second pivoting axis 22 can thus be located in the vicinity of the distal edge 35 of the proximal part 3.

The orthosis 1 also comprises a cover 6 enveloping the support 2. The cover 6 contributes to the stability of the orthosis 1 but is flexible enough to allow the double pivoting movement of the support 2 around the first and second pivot axes 21 , 22. It can be made of a textile material, a 3D mesh, etc., and have breathability properties for more comfort. At the level of the long fingers 103, the cover 6 is either sufficiently flexible, extensible and / or fine so that the long fingers 103 can be accommodated each in a channel 45.

The cover 6 has a palm window 61 allowing access to the first and second pivot axes 21, 22. The cover 6 may also include a sleeve 62 in which the forearm 104 is housed, and / or a band 63 coming to be placed against the medial side of the hand 100.

The orthosis 1 also comprises a proximal strap 71 configured to tighten the proximal part 3 of the support 2 against the anterior face of the forearm 104, and a distal strap 72 configured to take the long fingers 103 sandwiched with the distal part 4. Muscle tone is generally sufficient to maintain the thumb 102 in support 51, a strap is therefore not necessary in this area.

In practice, for the installation of the orthosis 1, the user slides his hand in the sleeve 62, in the distal direction D, until his thumb 102 comes to be positioned in the support 51 for the thumb of the intermediate part 5 and that each of its long fingers 103 comes to be housed in one of the channels 45 of the distal part 4, the forearm 104 then being received in the proximal part 3 and located in the sleeve 62. The orthosis 1 is thus easily put on, like a glove, with little tightening. The user can then tighten the straps 71, 72 to ensure good support of the orthosis 1, as explained below.

Orthosis 1 has been previously configured appropriately, by a practitioner or by the patient himself. More specifically, the proximal 3, distal 4 and intermediate 5 parts of the support 2 have been positioned with respect to each other, by pivoting around the first and second pivot axes 21, 22, so that the support 2 is adapted to the patient's morphology and the evolution of his pathology.

We define the following angles, seen in a frontal plane:

the angle a formed between the longitudinal axis X of the forearm 104 and the straight line 23 joining the first and second pivot axes 21, 22

- The angle β, formed between (i) the straight line 23 joining the first and second pivot axes 21, 22 and (ii) the straight line 24 passing through the first pivot axis 21 and between the ring finger and the middle finger.

The orthosis 1 comprises means for adjusting the angles a and β, that is to say the angular position of the intermediate part 5 relative to the distal part 4 and relative to the proximal part 3. The orthosis 1 also comprises means for maintaining each of said desired angular positions. These means can typically be located in the vicinity of the pivot axes 21, 22, and thus be accessible to the practitioner via the palmar window 61 of the cover 6. It can be, for example, a thumbwheel, for example a notched thumbwheel. , or a progressive adjustment screw, actuated by means of a screwdriver, ensuring both adjustment and maintenance in the desired position.

The orthosis 1 may include stops limiting the pivoting around the first and second pivot axes 21, 22. For example, the stops are arranged so that the angle a can vary between 0 and 20 °, preferably between 0 and 15 °, in the direction of a radial inclination of the carpus 107 relative to the normal physiological position, and that the angle β can vary between 0 and 40 °, preferably between 0 and 30 °, in the direction of an inclination cubital long fingers 103 relative to normal physiological position.

An exemplary embodiment of such stops is illustrated in Figures 6a and 6b. The stops may have the shape of pins projecting in the anterior direction, and be shaped to cooperate with an edge of part of the orthosis. We can thus foresee:

- On the distal part 4, a stop 4a placed under the index, and which can come into abutment against the medial edge of the notch 56 of the intermediate part 5 (see FIG. 6b);

- On the intermediate part 5, a lateral stop 5a and a medial stop 5b. The lateral stop 5a can come into abutment against the lateral edge 34a of the tongue 34 of the proximal part 3 (FIG. 6a), while the medial stop 5b can come into abutment against the medial edge 34b of the tongue 34 of the proximal part 3 (Figure 6b).

At the start of patient management, support 2 is placed in a deformed position corresponding to the deformation of the patient's hand and wrist, as illustrated in Figures 2 and 4. A slight correction, in the direction of return at normal physiological position, can be applied from the start. The hand 100 fitted with the complete orthosis 1 - including the cover 6 and the straps 71, 72 - in this same position, is illustrated in FIGS. 7 to 9.

As seen in Figure 9, the proximal strap 71 is located substantially opposite the radio-carpal joint, which avoids dislocation of the wrist. This effect is accentuated when the tightening at the level of the proximal strap 71 is significant, in particular thanks to the presence of a reduction system. The distal strap 72 is located substantially opposite the metacarpophalangeal joint, which makes it possible to maintain each of the long fingers 103 in the corresponding channel 45 and to avoid dislocation of the phalanx 109.

Each of the straps 71, 72 may have one end fixed to the cover 6 and a free end 73 intended to be pulled to ensure the clamping of the orthosis 1 on the wearer, generally via a reduction system comprising a ring 74. The free end 73 may be provided with a device 75 facilitating its gripping, such as a finger pass, so that the patient can pull the strap 71, 72 himself, with his other hand, generally also painful and deformed, as can be seen in FIG. 10. It should be noted that, in the embodiment shown, the distal strap 72 comprises a single strap, while the proximal strap 71 comprises two straps wound around the forearm 104 and spaced apart 'from each other along the longitudinal direction X. This is not, however, limiting.

According to an advantageous characteristic of the invention, each of the straps 71, 72 of the orthosis 1 can also be configured so that the traction on the free end 73 takes place in the lateral direction - that is to say toward thumb 102, as shown in Figure 11.

When the arrows Fl representing the direction of traction of the proximal strap 71 and F2 representing the direction of traction of the distal strap 72 are superimposed by the bare hand deformed in FIG. 12, it can be seen that the straps 71, 72 tend , when tightening, to bring the wearer's hand and wrist back to their normal physiological position. Indeed :

the arrow F1 tends to rotate the forearm 104 in the lateral direction relative to the hand 100, that is to say to rotate the hand in the medial direction relative to the forearm, which opposes the radial inclination of the carpus 107 (shown in dotted lines in FIG. 12);

- The arrow F2 tends to rotate the long fingers 103 in the lateral direction relative to the hand 100, which is opposed to the radial inclination of the carp 107 (shown in dotted lines in Figure 12).

Gradually, the angles a and β can be reduced by the practitioner, depending on the condition of the patient, with a view to returning to the normal physiological position. The practitioner can indeed rotate the intermediate part 5 relative to the proximal part 3, around the second pivot axis 22, to vary the angle a, and / or rotate the distal part 4 relative to the intermediate part 5, around the first pivot axis 21, to vary the angle β.

FIG. 13 illustrates an intermediate position of the support 2, where the value of the angles a and β has decreased compared to FIG. 2, without however canceling out. Hand 100 is less distorted.

Figures 14 and 15 illustrate the support 2 - and therefore the hand 100 - in the normal physiological position, where the angles a and β are substantially detrimental, respectively in anterior view and in posterior view. Figures 16 and 17 show the hand 100 equipped with the complete orthosis 1 - including the cover 6 and the straps 71, 72 - in the normal physiological position, respectively in anterior view and in posterior view. As illustrated in FIG. 15a, in the normal physiological position, there is a neutral inclination, that is to say that the wrist is then stabilized in the axis of the middle finger.

The orthosis 1 according to the invention is thus progressive, which allows a personalized adaptation to the deformations present as well as a progressive correction depending on the treatment. The adjustment of the angles a and β can be done independently by the patient himself, especially if the adjustment means implemented are simple to handle (thumb wheel, etc.).

In addition to its effectiveness against pain and deformation, the orthosis 1 according to the invention is light and airy, easy to put on and take off by the patient himself. It is designed to be comfortable and aesthetic, so as to be better accepted by patients.

It goes without saying that the invention is not limited to the embodiment described above by way of example but that it includes all the technical equivalents and variants of the means described as well as their combinations.

Claims (16)

1. Wrist and hand orthosis, in particular intended for a wearer suffering from rheumatoid arthritis, the orthosis comprising a support (2) made of rigid material which comprises: a proximal part (3) having a shape of gutter intended to receive the forearm (104); a distal part (4) intended to be placed under the hand (100) and configured to be able to pivot relative to the proximal part (3); characterized in that: the distal part (4) comprises a distal portion (41) intended to form a support for the long fingers (103) and a proximal portion (42) intended to form a palmar support for a distal portion of the palm (101); the proximal part (3) comprises a tongue (34) which extends in the distal direction (D), substantially up to the palmar support (42) of the distal part (4), and which is intended to form a support for the wrist and for a proximal portion of the palm (101); and the support (2) further comprises an intermediate portion (5) comprising a portion (51) intended to form a support for the thumb and a portion (52) intended to form a palmar support, the intermediate portion (5) being mounted swivel: - relative to the distal part (4) around a first pivot axis (21) which, in the use position, is oriented in the anteroposterior direction (Z) of the wearer and passes substantially to the center of the palm (101); - And relative to the proximal part (3) around a second pivot axis (22) which is substantially parallel to the first pivot axis (21), which is located substantially in the same longitudinal plane (X, Z) as the first pivot axis (21), when the orthosis (1) is in the normal physiological position, and which, in the use position, passes through the palm (101) and is offset in the proximal direction (P) relative to the first pivot axis (21). 2. Orthosis according to claim 1, characterized in that it comprises means for maintaining the desired angular position of the intermediate part (5) relative to the distal part (4) and relative to the proximal part (3) , and means for adjusting each of said angular positions. 3. Orthosis according to claim 1 or 2, characterized in that it comprises stops limiting the pivoting around the first and second pivot axes (21, 22), said stops being arranged so that, seen in a frontal plane: the angle (a) formed between the longitudinal axis (X) of the forearm (104) and the straight line (23) joining the first and second pivot axes (21, 22) is between 0 and 20 ° , preferably between 0 and 15 °, in the direction of a radial inclination of the carp (107) relative to the normal physiological position; and the angle (β) formed between (i) the straight line (23) joining the first and second pivot axes (21, 22) and (ii) the straight line (24) passing through the first pivot axis (21) and between the ring finger and the middle finger is between -10 and 40 °, preferably between 0 and 30 °, in the direction of a cubital inclination of the long fingers (103) relative to the normal physiological position. 4. Orthosis according to one of claims 1 to 3, characterized in that the intermediate part (5) is in contact with the posterior face of the proximal part (3) and in contact with the anterior face of the distal part (4 ). 5. Orthosis according to one of claims 1 to 4, characterized in that the support (51) for the thumb of the intermediate part (5) is configured to maintain the thumb (102) in antepulsion, in abduction, and in opposition. 6. Orthosis according to one of claims 1 to 5, characterized in that the tongue (34) of the proximal part (3) is curved in the posterior direction, towards the distal end (35) of the proximal part (3). 7. Orthosis according to one of claims 1 to 6, characterized in that the distal portion (41) of the distal portion (4), intended to form a support for the long fingers (103), is curved in the anterior direction , towards the distal end (43). 8. Orthosis according to one of claims 1 to 7, characterized in that the support (41) for the long fingers of the distal part (4) comprises a channel (45) for receiving each finger (103), separate or each channel (45) adjacent by a partition (46). 9. Orthosis according to one of claims 1 to 8, characterized in that the support (41) for the long fingers of the distal part (4) has a flange (47) along its medial edge. 10. Orthosis according to one of claims 1 to 9, characterized in that it further comprises a cover (6) which envelops the support (2) and which has a palm window (61) allowing access to the first and second pivot axes (21, 22). 11. Orthosis according to claim 10, characterized in that the cover (6) further comprises a sleeve (62) in which is housed the forearm (104). 12. Orthosis according to claim 10 or 11, characterized in that the cover (6) further comprises a strip (63) coming to be placed against the medial side of the hand (100). 13. Orthosis according to one of claims 1 to 12, characterized in that it further comprises a proximal strap (71) configured to tighten the proximal part (3) of the support (2) against the front face of the front -arm (104), and a distal strap (72) configured to take the long fingers (103) sandwiched with the distal part (4). 14. Orthosis according to claim 13, when it depends on claim 10, characterized in that each of the proximal (71) and distal (72) straps has one end fixed to the cover (6) and one free end (73) intended to be pulled to ensure the clamping of the orthosis (1) on the carrier, each of the straps (71, 72) being configured so that the traction on the free end (73) takes place in the lateral direction. 15. Orthosis according to claim 13 or 14, characterized in that the proximal strap (71) is arranged on the orthosis (1) so as to be located substantially opposite the radio-carpal joint, in the position of use . 16. Orthosis according to one of claims 13 to 15, characterized in that the distal strap (72) is arranged on the orthosis (1) so as to be located substantially opposite the metacarpophalangeal joint, in position of use. P 2/6 3/6