Bilateral Hip & Sacroiliac Support. Devin Laing Eloy Ramos

Transcription

1 Bilateral Hip & Sacroiliac Support Devin Laing Eloy Ramos

2 BACKGROUND INFORMATION Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by varying degrees of skin hyperextensibility, joint hypermobility, and vascular fragility. According Shirley, E, EDS is likely underdiagnosed; therefore, it is difficult to estimate the incidence. The overall incidence may be approximately.02%, or 1,416,014 individuals worldwide. In many cases, EDS is shown to be caused by mutations that result in qualitatively abnormal collagen, with manifestations in collagen-rich tissues such as the skin, ligaments, joints, and vessels.types I, III, and V collagen may be affected, and specific mutations have been described for most types. The classical and hypermobile types account for more than 90% of cases. The hypermobility type is also characterized by hypermobile joints and hyperextensible and/or smooth velvety skin. However, skin hyperextensibility is less prominent and more variable than that in the classical type prominent and more variable than that in the classical type. More than 90% of patients are female. The hypermobility type is associated with the most debilitating musculoskeletal manifestations, and joint pain is reported by 100% of patients

3 The Hip & SI /

4 Problem Statement Ehlers Danlos specialists and the affected community, internationally, report an inability to brace the hip and sacroiliac joints, bilaterally and simultaneously, in order to prevent movement beyond accepted range of motion for the SI (4 degrees rotation, 1.6mm translation) and for the hip (50 degrees abduction, 30 degrees external rotation, 40 degrees internal rotation).

5 Justification Pelvic Belt Effects on Health Outcomes and Functional Parameters of Patients with Sacroiliac Joint Pain

6 Justification Can people with EDS select and adjust their own braces? Only to a limited extent, and there are big barriers to getting this right. One is that braces are not cheap, and the better ones can be very expensive indeed. Health Insurers will usually cover them, but only when the exact right brace is prescribed by a doctor, and often only when there s documentation of the reason for the brace. So, since most braces don t work well for EDSers joints, if they try to find them by trial and error, this will be an expensive and time-consuming exercise and one that is very likely to fail, since the EDSer will not be able to do the adjustments or alterations that are usually necessary. - Dr. Alan Spanos, EDS Specialist

7 Existing Solutions Pros: Can be worn over/under clothing Possibility of bilateral support Cons: Does not properly restrict hip range of motion Does not support the SI Pros: Can be worn over/under clothing Restricts SI range of motion Cons: Does not restrict hip Range of Motion

8 Existing Solutions Pros: Restricts hip range of motion Possibility of bilateral support Cons: Does not support the SI Pros: Restricts hip range of motion Possibility of bilateral support Cons: Does not support the SI

9 Design Requirements 1. The solution must be able to restrict range of motion for both hips and sacroiliac joints simultaneously a. These samples are just a small portion of the Ehlers Danlos Type III community on facebook that experience bilateral hip and SI instability. According to Dr. Alan Spanos, EDS specialist, many of his patients have the same issues of wanting bilateral support for both the sacroiliac and hip joints. There was also much self reported interest from members of the Ehlers Danlos National Society

10 Design Requirements 2. The solution must be able to provide 50N of tension across and just below the anterior superior iliac spines for all users a. Sacroiliac joint laxity was assessed with Doppler imaging of vibrations. The influence of two different positions (low: at the level of the symphysis and high: just below the anterior superior iliac spines) and tensions (50 and 100 N) of a pelvic belt was measured in ten healthy subjects, in the prone position. Mean sacroiliac joint laxity value was 2.2 (SD, 0.2) threshold units nearer to the without-belt values when the belt was applied in low position as compared to the case with the belt in high position. A pelvic belt is most effective in a high position, while a tension of 100 N does not reduce laxity more than 50 N. Does a Pelvic Belt Influence Sacroiliac Joint Laxity?, Clinical Biomechanics Journal

11 Design Requirements 3. The solution must be able to limit the hip range of motion as follows a. External rotation should not exceed 30 degrees b. Internal Rotation should not exceed 40 degrees c. Abduction should not exceed 50 degrees with hip extended i. ii. Dr. Ralph Moore, Orthopaedic Surgeon

12 Design Requirements 4. Sizing at the hip must be adjustable for a range of "ASTM D e1: Standard Tables of Body Measurements for Adult Female Misses Figure Type, Size Range 00 20". Astm.org. ASTM. Retrieved

13 Design Requirements 5. Sizing at the thigh must be adjustable for a range of a. Though this is not pulled from a scholarly source, it provides initial data to work from until a population can be properly surveyed b. Dr. Ralph Moore, an Orthopaedic Surgeon, reported that he believed these measurements to be appropriate based on the populations that he commonly treats and based on our intended hip range design. & Ideal thigh size

14 Design Requirements 6. The solution must be able to be comfortable worn, without chafing or bruising, for 12 consecutive hours a. Dr. Ralph Moore, Orthopaedic Surgeon at Jennings Orthopaedic Associates, gives the recommendation that the longest wear time should not exceed 8-12 hours in one day.

15 Design Requirements 7. The solution must be able to be modified in a way that the user could choose to support a single hip, with or without SI support a. Dr. Ralph Moore, Orthopaedic Surgeon, mentioned that this would be ideal for the user so they would have as much flexibility with their own care as you could give them. Dr. Moore reported, that though this would be ideal, if any of the aforementioned requirements would have to be sacrificed to meet this one, it would be a step in the wrong direction.