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Netter's Orthopaedic Clinical Examination E-Book

Netter's Orthopaedic Clinical Examination E-Book

Joshua Cleland | Shane Koppenhaver | Jonathan Su

(2015)

Additional Information

Book Details

Abstract

With its unique combination of classic Netter artwork, exam photos and videos, and rigorous evidence-based approach, Netter's Orthopaedic Clinical Examination, 3rd Edition, helps you get the most clinically significant information from every orthopaedic examination. This new edition, by Drs. Joshua Cleland, Shane Koppenhaver, and Jonathan Su, allows you to quickly review the reliability and diagnostic utility of musculoskeletal physical exams and make it easier to incorporate evidence into your clinical decision making.

  • Extremely user-friendly and well organized, this unique text walks you through the anatomy and clinical exam, then critically reviews all literature for given diagnostic tests.
  • A tabular format provides quick access to test reliability and diagnostic utility, study quality, anatomy and biomechanics, and summary recommendations for applying evidence in practice.
  • Quality ratings for 269 studies, investigating a test’s reliability using the 11-item Quality Appraisal of Diagnostic Reliability Checklist.
  • Evidence-based approach helps you focus on the effectiveness of the clinical tests available and review recent studies quickly to determine which test will best predict a specific diagnosis.
  • 84 new studies, 34 new photos and 25 new videos on Student Consult.
  • QAREL (Quality Appraisal for Reliability Studies) checklists included for each reliability study.

Table of Contents

Section Title Page Action Price
Front Cover cover
IFC_Student Consult ad IFC1
half-title Evolve i
Marketing AD ii
Netter's Orthopaedic Clinical Examination iii
Copyright Page iv
Dedication v
About the Authors vii
About the Artists viii
Foreword ix
Preface x
Table Of Contents xi
Video Contents xii
1 The Reliability and Diagnostic Utility of the Orthopaedic Clinical Examination 1
Reliability 2
Diagnostic Accuracy 3
2×2 Contingency Table 3
Overall Accuracy 4
Positive and Negative Predictive Values 4
Sensitivity 4
Specificity 5
Likelihood Ratios 6
Confidence Intervals 8
Pretest and Posttest Probability 8
Calculating Posttest Probability 8
Assessment of Study Quality 9
Summary 11
References 12
2 Temporomandibular Joint 13
Clinical Summary and Recommendations 14
Anatomy 15
Osteology 15
Arthrology 18
Ligaments 19
Muscles 20
Muscles Involved in Mastication 20
Muscles of the Floor of the Mouth 22
Nerves 24
Mandibular Nerve 24
Patient History 25
Initial Hypotheses Based on Patient History 25
The Association of Oral Habits with Temporomandibular Disorders 25
Reliability of Patient’s Reports of Pain in Temporomandibular Dysfunction 26
Diagnostic Utility of Patient History in Identifying Anterior Disc Displacement 27
Self-Reported Temporomandibular Pain 29
Reliability of Self-Reported Temporomandibular Pain 29
Diagnostic Utility of Self-Reported Temporomandibular Pain 30
Diagnostic Criteria for TMD 31
Reliability and Diagnostic Criteria for Pain-Related TMD 31
Reliability and Diagnostic Criteria for Intraarticular TMD 33
Physical Examination Tests 35
Palpation 35
Reliability in Determining the Presence of Pain during Muscle Palpation 35
Reliability in Determining the Presence of Pain during Temporomandibular Joint Regional Palpation 36
Diagnostic Utility of Palpation in Identifying Temporomandibular Conditions 38
Diagnostic Utility of Pressure Pain Thresholds in Identifying Temporomandibular Disorder 39
Joint Sounds 40
Reliability of Detecting Joint Sounds during Active Motion 40
Reliability of Detecting Joint Sounds during Joint Play 40
Diagnostic Utility of Clicking in Identifying Temporomandibular Conditions 41
Diagnostic Utility of Crepitus in Identifying Temporomandibular Conditions 42
Range-of-Motion Measurements 43
Reliability of Range-of-Motion Measurements of the Temporomandibular Joint during Mouth Opening 43
Reliability of Range-of-Motion Measurements of the Temporomandibular Joint 44
Reliability of Joint Play and End-Feel Assessment of the Temporomandibular Joint 46
Reliability of Measuring Mandibular Opening with Different Head Positions 46
Diagnostic Utility of Limited Range of Motion in Identifying Anterior Disc Displacement 47
Dynamic Movement Measurements 48
Diagnostic Utility of Deviations in Movement in Identifying Anterior Disc Displacement 48
Reliability of Determining the Presence of Pain during Dynamic Movements 49
Reliability of Detecting Pain during Resistance Tests 50
Reliability of Determining the Presence of Pain during Joint Play 51
Diagnostic Utility of Pain in Identifying Temporomandibular Conditions 52
Other Tests 54
Reliability of the Compression Test 54
Diagnostic Utility of Lower Extremity Measurements 55
Combinations of Tests 56
Diagnostic Utility of Combined Tests for Detecting Anterior Disc Displacement with Reduction 56
Diagnostic Utility of Combined Tests for Detecting Anterior Disc Displacement without Reduction 58
Predicting Treatment Success with Nightly Wear of Occlusal Stabilization Splint 60
Predicting Treatment Failure with Nightly Wear of Occlusal Stabilization Splint 61
Outcome Measures 62
Appendix 63
Quality Appraisal of Reliability Studies for Temporomandibular Disorders Using QAREL 63
Quality Assessment of Diagnostic Studies for Temporomandibular Disorders Using QUADAS 65
References 67
3 Cervical Spine 69
Clinical Summary and Recommendations 70
Anatomy 71
Osteology 71
Arthrology 73
Ligaments 74
Muscles 76
Anterior Muscles of the Neck 76
Suprahyoid and Infrahyoid Muscles 77
Scalene and Prevertebral Muscles 79
Posterior Muscles of the Neck 80
Nerves 82
Patient History 84
Initial Hypotheses Based on Patient History 84
Cervical Zygapophyseal Pain Syndromes 84
Reliability of the Cervical Spine Historical Examination 86
Diagnostic Utility of Patient Complaints for Cervical Radiculopathy 87
Physical Examination Tests 89
Neurologic Examination 89
Reliability of Sensation Testing 89
Diagnostic Utility of Pinprick Sensation Testing for Cervical Radiculopathy 90
Reliability of Manual Muscle Testing 91
Diagnostic Utility of Manual Muscle Testing for Cervical Radiculopathy 92
Diagnostic Utility of Muscle Stretch Reflex Testing for Cervical Radiculopathy 93
Screening for Cervical Spine Injury 94
Diagnostic Utility of the Clinical Examination for Identifying Cervical Spine Injury 95
Range-of-Motion Measurements 97
Reliability of Measuring Range of Motion 98
Reliability of Pain Responses during Active Physiologic Range of Motion 100
Diagnostic Utility of Pain Responses during Active Physiologic Range of Motion 101
Cervical Strength and Endurance 102
Reliability of Cervical Strength and Endurance Testing 102
Passive Intervertebral Motion 103
Reliability of Assessing Limited Passive Intervertebral Motion 103
Reliability of Assessing Limited and Painful Passive Intervertebral Motion 104
Reliability of Assessing Passive Mobility in the Upper Cervical Spine for Detecting Ligament and Membrane Injuries 106
Diagnostic Utility of Assessing Passive Mobility in the Upper Cervical Spine for Detecting Ligament and Membrane Injuries 106
Diagnostic Utility of Assessing Limited and Painful Passive Intervertebral Motion 107
Palpation 108
Reliability of Assessing Pain with Palpation 108
Reliability of Assessing Pain with Palpation with and without a Patient History 109
Reliability of Assessing Pain with Palpation in Patients with Cervicogenic Headache 109
Diagnostic Utility of Assessing Pain with Palpation 109
Postural and Muscle Length Assessment 110
Reliability of Postural Assessment 110
Reliability of Muscle Length Assessment 111
Spurling’s and Neck Compression Tests 112
Reliability of Spurling’s and Neck Compression Tests 112
Diagnostic Utility of Spurling’s Test 113
Neck Distraction and Traction Tests 115
Reliability of Neck Distraction and Traction Tests 115
Cervical Flexion-Rotation Test 116
Reliability of Cervical Flexion-Rotation Test 116
Shoulder Abduction Test 117
Reliability of Shoulder Abduction Test 117
Neural Tension Tests 118
Reliability of Neural Tension Tests 118
Reliability of Neural Tension Tests 119
Diagnostic Utility of Neural Tension Tests for Cervical Radiculopathy 120
Sharp-Purser Test 121
Diagnostic Utility of the Sharp-Purser Test for Cervical Instability 121
Arm Squeeze Test 122
Reliability of the Arm Squeeze Test in Distinguishing Cervical Nerve Root Compression from Shoulder Pain 122
Diagnostic Utility of the Arm Squeeze Test in Distinguishing Cervical Nerve Root Compression from Shoulder Pain 122
Compression of Brachial Plexus 123
Diagnostic Utility of Brachial Plexus Compression for Cervical Cord Compression 123
Cervical Myelopathy Tests 124
Reliability of Tests for Cervical Myelopathy 124
Diagnostic Utility of Tests for Cervical Myelopathy 125
Combinations of Tests 128
Diagnostic Utility of Clusters of Tests for Cervical Myelopathy 128
Diagnostic Utility of Clusters of Tests for Cervical Radiculopathy 129
Interventions 130
Clinical Prediction Rule to Identify Patients with Neck Pain Who Are Likely to Benefit from Cervical Thrust Manipulation 130
Diagnostic Utility of Single Factors and Combinations of Factors for Identifying a Positive Short-Term Clinical Outcome for Cervical Radiculopathy 130
Diagnostic Utility of Historical and Physical Examination Findings for Immediate Improvement with Cervical Manipulation 131
Diagnostic Utility of Historical and Physical Examination Findings for Immediate Improvement with Thoracic Manipulation 132
Diagnostic Utility of a Cluster of Historical and Physical Examination Findings for Immediate Improvement with Thoracic Manipulation 133
Diagnostic Utility of Historical and Physical Examination Findings for Improvement with Three Weeks of Mechanical Cervical Traction 135
Diagnostic Utility of a Cluster of Historical and Physical Examination Findings for Improvement with Three Weeks of Mechanical Cervical Traction 137
Outcome Measures 138
Appendix 139
Quality Appraisal of Reliability Studies Using QAREL 139
Quality Assessment of Diagnostic Studies Using QUADAS 142
References 145
4 Thoracolumbar Spine 147
Clinical Summary and Recommendations 148
Anatomy 149
Osteology 149
Arthrology 150
Joints of the Thoracic Spine 150
Joints of the Lumbar Spine 152
Ligaments 153
Costovertebral Ligaments 153
Thoracolumbar Ligaments 154
Muscles 155
Thoracolumbar Muscles: Superficial Layers 155
Thoracolumbar Muscles: Intermediate Layer 156
Thoracolumbar Muscles: Deep Layer 157
Anterior Abdominal Wall 158
Fascia 159
Nerves 160
Patient History 163
Initial Hypotheses Based on the Patient History 163
Lumbar Zygapophyseal Joint Referral Patterns 164
Thoracic Zygapophyseal Joint Referral Patterns 165
Reliability of the Historical Examination 166
Diagnostic Utility of Patient History in Identifying Lumbar Spinal Stenosis 167
Diagnostic Utility of Patient History in Identifying Lumbar Radiculopathy 168
Diagnostic Utility of Patient History in Identifying Ankylosing Spondylitis 169
Physical Examination Tests 170
Neurologic Examination 170
Diagnostic Utility of Sensation Testing, Manual Muscle Testing, and Reflex Testing for Lumbosacral Radiculopathy 170
Diagnostic Utility of Sensation Testing, Manual Muscle Testing, and Reflex Testing for Lumbar Spinal Stenosis 172
Range-of-Motion Measurements 173
Reliability of Range-of-Motion Measurements 173
Reliability of Pain Provocation during Range-of-Motion Measurements 176
Thoracolumbar Strength and Endurance Tests 177
Reliability of Assessing Thoracolumbar Strength and Endurance 177
Postural Assessment 178
Reliability of Postural Assessment 178
Motor Control Assessment 180
Reliability of Tests for Lumbar Motor Control 180
Passive Intervertebral Motion Assessment 181
Reliability of Assessing Limited or Excessive Passive Intervertebral Motion 181
Reliability of Assessing Painful Passive Intervertebral Motion 183
Diagnostic Utility of Assessing Limited and Painful Passive Intervertebral Motion 184
Association of Limited Passive Intervertebral Motion with Low Back Pain 185
Diagnostic Utility of Assessing Excessive Passive Intervertebral Motion 186
Palpation 187
Reliability of Identifying Segmental Levels 187
Reliability of Identifying Tenderness to Palpation 188
Reliability of Assessing Lumbar Multifidus Muscle Function via Palpation 188
Centralization Phenomenon 189
Reliability of Identifying the Centralization Phenomenon 189
Diagnostic Utility of the Centralization Phenomenon 190
Straight-Leg Raise Test 191
Reliability of the Straight-Leg Raise Test 191
Diagnostic Utility of the Straight-Leg Raise Test for Detecting Disc Bulge or Herniation 192
Crossed Straight-Leg Raise Test 193
Diagnostic Utility of the Crossed Straight-Leg Raise Test for Detecting Disc Bulging or Herniation 193
Slump Test 194
Reliability of the Slump Test 194
Diagnostic Utility of the Slump Test for Detecting Disc Bulging or Herniation 195
Slump Knee Bend Test 197
Reliability of the Slump Knee Bend Test 197
Diagnostic Utility of the Slump Knee Bend Test in Detecting Nerve Root Compression 197
Tests for Lumbar Segmental Instability 198
Reliability of Tests for Lumbar Segmental Instability 198
Tests for Lumbar Spinal Stenosis 200
Diagnostic Utility of Tests for Lumbar Spinal Stenosis 200
Tests for Radiographic Lumbar Instability 201
Diagnostic Utility of Tests for Radiographic Lumbar Instability 201
Tests for Ankylosing Spondylitis 204
Diagnostic Utility of Tests for Ankylosing Spondylitis 204
Classification Methods 205
Reliability of Low Back Pain Classification Systems 205
Treatment-Based Classification Method 206
Interventions 207
Diagnostic Utility of Single Factors for Identifying Patients Likely to Benefit from Spinal Manipulation 207
Diagnostic Utility of Combinations of Factors for Identifying Patients Likely to Benefit from Spinal Manipulation 208
Diagnostic Utility of Single Factors and Combinations of Factors in Identifying Patients Likely to Benefit from Lumbar Stabilization Exercises 209
Clinical Prediction Rule to Identify Patients with Low Back Pain Likely to Benefit from Pilates-Based Exercise 209
Outcome Measures 210
Appendix 211
Quality Appraisal of Reliability Studies for Thoracolumbar Spine Disorders Using QAREL 211
Quality Assessment of Diagnostic Studies for Thoracolumbar Spine Disorders Using QUADAS 216
References 218
5 Sacroiliac Region 223
Clinical Summary and Recommendations 224
Anatomy 225
Osteology 225
Arthrology 229
Ligaments 230
Muscles 232
Nerves 233
Patient History 235
Sacroiliac Pain and Sacroiliac Dysfunction 235
Pain Location and Aggravating Factors 236
Sacroiliac Joint Pain Referral Patterns 237
Physical Examination Tests 238
Palpation 238
Pain Provocation and Patient Identification of Location of Pain 238
Assessment of Symmetry of Bony Landmarks 239
Pain Provocation 241
Patrick Test (FABER Test) 241
Thigh Thrust (or Posterior Shear Test or Posterior Pelvic Provocation Test) 243
Compression Test 245
Sacral Thrust Test 247
Gaenslen Test 249
Distraction Test 250
Mennell Test 251
Other Pain Provocation Tests 252
Motion Assessment 254
Gillet Test (Stork Test) 254
Spring Test (Joint Play Assessment) 256
Long-Sit Test (Supine-to-Sit Test) 257
Standing Flexion Test 258
Sitting Flexion Test 259
Prone Knee Bend Test 260
Other Motion Assessment Tests 260
Combinations of Tests 261
Pregnancy-Related Pelvic Girdle Pain Classification 261
Reliability of Pregnancy-Related Pelvic Girdle Pain Classification 261
Sacroiliac Joint Pain 262
Following the McKenzie Evaluation to Rule Out Discogenic Pain 264
Interventions 265
Identifying Patients Likely to Benefit from Spinal Manipulation 265
Outcome Measures 267
Appendix 268
Quality Appraisal of Reliability Studies for the Sacroiliac Region Using QAREL 268
Quality Assessment of Diagnostic Studies for the Sacroiliac Region Using QUADAS 271
References 273
6 Hip and Pelvis 275
Clinical Summary and Recommendations 276
Anatomy 277
Osteology 277
Arthrology 278
Ligaments 279
Muscles 280
Posterior Muscles of Hip and Thigh 280
Anterior Muscles of Hip and Thigh 282
Nerves 284
Patient History 286
Initial Hypotheses Based on Historical Findings 286
Diagnostic Utility: Hip Pain, Osteoarthritis, and Acetabular Labral Tears 287
Physical Examination Tests 288
Range-of-Motion Measurements 288
Reliability of Range-of-Motion Measurements 288
Reliability of Determining Capsular and Noncapsular End Feels 289
Diagnostic Utility of Cyriax’s Capsular Pattern for Detecting Osteoarthritis 290
Diagnostic Utility of Pain and Limited Range of Motion 291
Diagnostic Utility of Limited Range of Motion for Detecting Avascular Necrosis 293
Diagnostic Utility of Limited Hip Abduction for Detecting Developmental Dysplasia in Infants 294
Assessing Muscle Strength 295
Reliability of Detecting Pain or Weakness during Resisted Tests 295
Diagnostic Utility of Pain or Weakness for Identifying Lateral Hip Tendon Pathologic Conditions 298
Reliability of the Trendelenburg Test 299
Diagnostic Utility of the Trendelenburg Test for Identifying Lateral Hip Tendon Pathology 300
Assessing Muscle Length 301
Reliability of Tests for Iliotibial Band Length 301
Reliability of the Thomas Test for Hip Flexor Contracture 302
Reliability of Assessing Muscle Length 303
Functional Movement Assessments 305
Forward Step-Down Test 305
Reliability of the Forward Step-Down Test 306
Diagnostic Utility of Pain with Functional Movement Assessments 307
Palpation 308
Reliability of Pain with Palpation 308
Diagnostic Utility of Pain with Palpation for Intraarticular Hip Pain 308
Special Tests 309
Reliability of the Patrick (FABER) Test 309
Diagnostic Utility of the Patrick (FABER) Test 310
Reliability of Special Tests for Detecting Intraarticular Pathologic Conditions 311
Diagnostic Utility of Special Tests for Detecting Intraarticular Pathologic Conditions 312
Diagnostic Utility of the Patellar-Pubic-Percussion Test for Detecting Hip Fractures 313
Reliability of Balance Tests 314
Combinations of Tests 315
Diagnostic Utility of Combinations of Tests for Osteoarthritis 315
Interventions 315
Clinical Prediction Rule to Identify Patients with Primary Hip Osteoarthritis Likely to Benefit from Physical Therapy Intervention 315
Outcome Measures 316
Appendix 317
Quality Appraisal of Reliability Studies for the Hip and Pelvis Using QAREL 317
Quality Assessment of Diagnostic Studies for the Hip and Pelvis Using QUADAS 319
References 320
7 Knee 323
Clinical Summary and Recommendations 324
Anatomy 325
Osteology 325
Arthrology 326
Ligaments 327
Muscles 330
Nerves 333
Patient History 336
Initial Hypotheses Based on Historical Findings 336
Assessing Subjective Questions in Patients with Osteoarthritis 337
Reliability of the Meniscal Symptom Index in Patients with Meniscal Tear 338
Diagnostic Utility of Meniscal Symptom Index in Patients with Meniscal Tears 339
Diagnostic Utility of Patient History: Meniscal and MCL Tears and Effusion 340
Physical Examination Tests 341
Screening 341
Reliability of the Ottawa Knee Rule for Radiography 341
Diagnostic Utility of the Ottawa Knee Rule for Radiography 342
Reliability of the Pittsburgh Decision Rule for Radiography 343
Diagnostic Utility of the Pittsburgh Decision Rule for Radiography 343
Reliability of Detecting Inflammation 344
Reliability of the Stroke Test for Identifying Knee Joint Effusion 345
Diagnostic Utility of the Ballottement Test for Identifying Knee Joint Effusion 345
Range-of-Motion Measurements 346
Reliability of Range-of-Motion Measurements 346
Reliability of Determining Capsular and Noncapsular End Feels 348
Reliability of Assessing Pain during Range-of-Motion Movements 349
Assessing Strength 350
Reliability of Strength Assessment 350
Diagnostic Utility of Manual Muscle Testing for Detecting Strength Deficits 350
Assessing Muscle Length 351
Reliability of Assessing Muscle Length 351
Assessing Bony Alignment 352
Reliability of Assessment of Mediolateral Patellar Tilt 352
Reliability of Assessment of Patellar Orientation 353
Reliability of Assessing Superoinferior Patellar Tilt 355
Reliability of Assessing Patellar Rotation 356
Reliability of Patellar Mobility in Patients with Patellofemoral Pain Syndrome 357
Diagnostic Utility of Patellar Mobility in Identifying Patients with Patellofemoral Pain Syndrome 357
Reliability of Assessing Quadriceps Angle Measurements 358
Reliability of Assessing the Angle between the Longitudinal Axis of the Patella and the Patellar Tendon (A Angle) 359
Reliability of the Lateral Pull Test to Assess Patellar Alignment 359
Palpation 360
Reliability of Pain during Palpation 360
Diagnostic Utility of Joint Line Tenderness 361
Diagnostic Utility of Joint Line Fullness 361
Special Tests 362
Reliability of the Lachman Test 362
Diagnostic Utility of the Lachman Test in Identifying Anterior Cruciate Ligament Tears 364
Reliability of the Anterior Drawer Test 365
Diagnostic Utility of the Anterior Drawer Test in Identifying Anterior Cruciate Ligament Tears 365
Diagnostic Utility of the Pivot Shift Test in Identifying Anterior Cruciate Ligament Tears 367
Diagnostic Utility of the Loss-of-Extension Test in Identifying Anterior Cruciate Ligament Tears 368
Reliability of Varus and Valgus Stress Tests 369
Diagnostic Utility of Valgus Stress for Identifying Medial Collateral Ligament Tears 369
Reliability of the McMurray Test 370
Diagnostic Utility of the McMurray Test 370
Diagnostic Utility of the Apley Test 371
Diagnostic Utility of Other Tests for Identifying Meniscal Tears 372
Diagnostic Utility of the Thessaly Test for Identifying Meniscal Tears 373
Diagnostic Utility of the Moving Patellar Apprehension Test for Identifying Patellar Instability 375
Combinations of Tests 376
Diagnostic Utility of Combinations of Tests for Diagnosing Meniscal Tears 376
Diagnostic Utility of Combinations of Tests for Diagnosing Pathologic Conditions of the Knee Other Than Meniscal Tears 379
Interventions 380
Diagnostic Utility of History and Physical Examination Findings for Predicting a Favorable Response to Foot Orthoses and Activity Modification 380
Diagnostic Utility of History and Physical Examination Findings for Predicting a Favorable Short-Term Response to Hip Mobilizations 382
Clinical Prediction Rule to Identify Patients with Patellofemoral Pain Likely to Benefit from Foot Orthoses 383
Outcome Measures 384
Appendix 385
Quality Appraisal of Reliability Studies for the Knee Using QAREL 385
Quality Assessment of Diagnostic Studies for the Knee Using QUADAS 389
References 393
8 Foot and Ankle 397
Clinical Summary and Recommendations 398
Anatomy 399
Osteology 399
Arthrology 401
Ligaments 402
Posterior Ankle Ligaments 402
Lateral Ankle Ligaments 403
Medial Ankle Ligaments 404
Plantar Foot Ligaments 405
Muscles 407
Lateral Muscles of Leg 407
Lateral Muscles of Leg 408
Posterior Muscles of Leg 409
Muscles of Dorsum of Foot 410
First Layer of Muscles: Sole of Foot 412
Second Layer of Muscles: Sole of Foot 413
Third Layer of Muscles: Sole of Foot 414
Deep Interosseous Muscles: Sole of Foot 415
Nerves 416
Patient History 418
Initial Hypotheses Based on Historical Findings 418
Physical Examination Tests 419
Screening 419
Evaluation Following Acute Ankle Trauma 419
Diagnostic Utility of the Ottawa Ankle Rule for Radiography 420
Range-of-Motion Measurements 422
Reliability of Range-of-Motion Measurements 422
Reliability of Range-of-Motion Measurements of Calcaneal Position 423
Assessing Strength 424
Reliability of Strength Assessment 424
Diagnostic Utility of the Paper Grip Test for Detecting Toe Plantarflexion Strength Deficits 424
Assessing Bony Alignment 425
Measurement of Navicular Height 425
Assessment of Medial Arch Height 426
Measuring Forefoot Position 427
Assessing Balance and Dynamic Performance 428
Reliability of Assessing Balance and Proprioception 428
Reliability of Assessing Dynamic Performance 429
Assessing Foot Motion during Gait 430
Reliability of Assessing Hindfoot Motion during Gait 430
Accuracy of the Functional Hallux Limitus Test to Predict Abnormal Excessive Midtarsal Function during Gait 430
Assessing Swelling 431
Reliability of Measuring Ankle Joint Swelling 431
Assessing Sensation 432
Reliability of Assessing Protective Sensation 432
Special Tests 433
Detecting Subcutaneous Tears of the Achilles Tendon 433
Detecting Syndesmotic Injury 434
Detecting Anterolateral Ankle Impingement 436
Detecting Joint Instability after Lateral Ankle Sprain 437
Detecting Tarsal Tunnel Syndrome 439
Reliability of the Windlass Test 440
Outcome Measures 441
Appendix 442
Quality Appraisal of Reliability Studies for the Foot and Ankle Using QAREL 442
Quality Assessment of Diagnostic Accuracy Studies for the Foot and Ankle Using QUADAS 445
References 447
9 Shoulder 449
Clinical Summary and Recommendations 450
Anatomy 451
Osteology 451
Arthrology 452
Scapulohumeral Rhythm 453
Ligaments 454
Muscles 456
Posterior Muscles of Shoulder 456
Anterior Muscles of Shoulder 457
Rotator Cuff Muscles 458
Nerves 459
Patient History 461
Initial Hypotheses Based on Historical Findings 461
Diagnostic Utility of the Patient History for Identifying Labrum and Rotator Cuff Tears 462
Physical Examination Tests 463
Range-of-Motion Measurements 463
Reliability of Range-of-Motion Measurements 463
Reliability of Functional Range-of-Motion Tests 464
Assessing Strength and Proprioception 465
Reliability of Assessing Strength 465
Reliability of Assessing Proprioception 465
Assessing Muscle Length 466
Reliability of Determining Length of Pectoralis Minor Muscle 466
Diagnostic Utility of a Tight Pectoralis Minor Muscle in Identifying Shoulder Pain 467
Reliability of Palpating the Subacromial Space 468
Diagnostic Utility of Palpation in Identifying Subacromial Impingement 469
Diagnostic Utility of Palpation in Identifying Labral Tears 469
Assessing Alignment 470
Reliability of Assessing Scapular Asymmetry during Static and Dynamic Activity 470
Reliability of Assessing Clavicular Tilt Angle 471
Reliability of Assessing Thoracic Kyphosis 471
Classifying Shoulder Disorders 472
Reliability of Classifying Shoulder Disorders 472
Special Tests—Instability 473
Reliability of Tests to Identify Shoulder Instability 473
Diagnostic Utility of the Apprehension Test in Identifying Shoulder Instability 474
Diagnostic Utility of the Apprehension and Relocation Tests in Identifying Shoulder Instability 475
Diagnostic Utility of the Anterior Drawer Test in Identifying Shoulder Instability 476
Special Tests—Labral Tears 477
Reliability of the Crank Test 477
Diagnostic Utility of the Crank Test in Identifying Labral Tears 478
Diagnostic Utility of the Compression Rotation Test in Identifying Labral Tears 479
Diagnostic Utility of the Speed Test in Identifying Superior Labrum Anterior and Posterior Lesions 480
Reliability of the Active Compression/O’Brien Test 481
Diagnostic Utility of the Active Compression/O’Brien Test 482
Diagnostic Utility of the Yergason Test in Identifying Labral Tears 484
Reliability of the Anterior Slide Test/Kibler Test 485
Diagnostic Utility of the Anterior Slide Test/Kibler Test in Identifying Labral Tears 485
Reliability of Various Tests in Identifying Labral Tears 486
Diagnostic Utility of the Kim Test in Identifying Labral Tears 486
Diagnostic Utility of the Biceps Load Test in Identifying Labral Tears 487
Diagnostic Utility of Various Tests in Identifying Labral Tears 488
Special Tests—Subacromial Impingement 490
Reliability of the Hawkins-Kennedy Test 490
Diagnostic Utility of the Hawkins-Kennedy Test in Identifying Subacromial Impingement 491
Reliability of the Neer Test 492
Diagnostic Utility of the Neer Test in Identifying Subacromial Impingement 492
Reliability of the Painful Arc Test in Identifying Subacromial Impingement 494
Diagnostic Utility of the Painful Arc Test in Identifying Subacromial Impingement 494
Reliability of the Drop-Arm Test in Identifying Subacromial Impingement 494
Diagnostic Utility of the Drop-Arm Test in Identifying Subacromial Impingement 495
Reliability of the Empty Can Test in Identifying Subacromial Impingement 495
Diagnostic Utility of the Empty Can Test in Identifying Subacromial Impingement 496
Diagnostic Utility of the Lift-Off Test in Identifying Subacromial Impingement 497
Reliability of Various Tests in Identifying Subacromial Impingement 497
Diagnostic Utility of Various Tests in Identifying Subacromial Impingement 498
Diagnostic Utility of the Internal Rotation Resistance Strength Test in Differentiating Subacromial Impingement from Intraarticular Pathologic Conditions 499
Special Tests—Rotator Cuff Tears 500
Reliability of Special Tests for Identifying Supraspinatus and/or Infraspinatus Tears 500
Diagnostic Utility of Special Tests for Identifying Supraspinatus and/or Infraspinatus Tears 501
Reliability of Special Tests for Identifying Subscapularis Tears 505
Diagnostic Utility of Special Tests for Identifying Subscapularis Tears 505
Special Tests—Brachial Plexus Palsy 509
Diagnostic Utility of Special Tests for Identifying Nerve Root Avulsion in People with Brachial Plexus Palsy 509
Special Tests—Acromioclavicular Lesions 510
Diagnostic Utility of Special Tests for Identifying Acromioclavicular Lesions 510
Special Tests—Adhesive Capsulitis 511
Diagnostic Utility of Special Tests for Identifying Adhesive Capsulitis 511
Combinations of Tests 512
Diagnostic Utility of Combinations of Tests for Identifying Glenoid Labral Tears 512
Diagnostic Utility of Combinations of Tests for Identifying SLAP Lesions 513
Diagnostic Utility of Combinations of Tests for Identifying Type II to IV SLAP Lesions 513
Diagnostic Utility of Combinations of Tests for Identifying Subacromial Impingement 514
Outcome Measures 515
Appendix 516
Quality Appraisal of Reliability Studies for the Shoulder Using QAREL 516
Quality Assessment of Diagnostic Studies for the Shoulder Using QUADAS 519
References 523
10 Elbow and Forearm 527
Clinical Summary and Recommendations 528
Anatomy 529
Osteology 529
Arthrology 530
Ligaments 531
Elbow 531
Forearm 532
Muscles 533
Anterior and Posterior Muscles of Arm 533
Anterior and Posterior Muscles of Arm 534
Supinators and Pronators of the Forearm 535
Nerves 536
Patient History 537
Initial Hypotheses Based on Historical Findings 537
Physical Examination Tests 538
Range-of-Motion Measurements 538
Reliability of Elbow Flexion and Extension Measurements 538
Reliability of Forearm Supination and Pronation Measurements 539
End-Feel Classification 540
Reliability of Classification According to End Feel for Elbow Flexion and Extension 540
Assessing Strength 540
Reliability of Grip Strength Testing in Patients with Lateral Epicondylalgia 540
Special Tests 541
Indication of Bony or Joint Injury 541
Detecting Cubital Tunnel Syndrome 542
Detecting Medial Collateral Tears 544
Detecting Complete Distal Biceps Tendon Rupture 545
Interventions 548
Diagnostic Utility of History and Physical Examination Findings for Predicting a Favorable Short-Term Response to Mobilization with Movement and Exercise in Patients with Lateral Epicondylalgia 548
Outcome Measures 549
Appendix 550
Quality Appraisal of Reliability Studies for the Elbow and Forearm Using QAREL 550
Quality Assessment of Diagnostic Studies for the Elbow and Forearm Using QUADAS 551
References 552
11 Hand 555
Clinical Summary and Recommendations 556
Anatomy 557
Osteology 557
Arthrology 559
Ligaments 560
Palmar Ligaments of the Wrist 560
Posterior Ligaments of the Wrist 561
Metacarpophalangeal and Interphalangeal Ligaments 562
Muscles 563
Extensor Muscles of the Wrist and Digits 563
Flexor Muscles of the Wrist and Digits 565
Intrinsic Muscles of the Hand 567
Nerves 569
Median Nerve 569
Ulnar Nerve 570
Radial Nerve 571
Patient History 572
Initial Hypotheses Based on the Patient History 572
Reliability of the Historical Examination 572
Diagnostic Utility of Patient History in Identifying Carpal Tunnel Syndrome 573
Physical Examination Tests 575
Screening 575
Diagnostic Utility of Tests in Identifying Scaphoid Fractures (see Fig. 11-15) 575
Diagnostic Utility of Hand Symptom Diagrams in Identifying Carpal Tunnel Syndrome 576
Diagnostic Utility of Tests in Identifying Scaphoid Fractures 577
Reliability of Hand Symptom Diagrams in Identifying Carpal Tunnel Syndrome 577
Acute Pediatric Wrist Fractures: Clinical Prediction Rule 578
Range-of-Motion Measurements 579
Reliability of Wrist Range-of-Motion Measurements 579
Reliability of Finger and Thumb Range-of-Motion Measurements 581
Assessing Strength 582
Intraexaminer Reliability of Assessing Strength 582
Intraexaminer Reliability of Assessing Strength 583
Diagnostic Utility of Weakness in Identifying Carpal Tunnel Syndrome 584
Assessing Wrist Anthropometry 585
Reliability of Measuring Wrist Anthropometry 585
Diagnostic Utility of Wrist Anthropometry in Identifying Carpal Tunnel Syndrome 585
Assessing Swelling 586
Reliability of Assessing Swelling 586
Testing Sensation 587
Reliability of Sensory Testing 587
Diagnostic Utility of Diminished Sensation in Identifying Carpal Tunnel Syndrome 587
Diagnostic Utility of Diminished Sensation in Identifying Carpal Tunnel Syndrome 588
Special Tests 589
Reliability of the Tinel Sign 589
Diagnostic Utility of the Tinel Sign in Identifying Carpal Tunnel Syndrome 590
Reliability of the Phalen Test 592
Diagnostic Utility of the Phalen Test in Identifying Carpal Tunnel Syndrome 593
Reliability of the Carpal Compression Test 595
Diagnostic Utility of the Carpal Compression Test in Identifying Carpal Tunnel Syndrome 595
Diagnostic Utility of the Hand Elevation Test in Identifying Carpal Tunnel Syndrome 596
Diagnostic Utility of Using a Questionnaire in Predicting the Results of Nerve Conduction Tests for Carpal Tunnel Syndrome 597
Reliability of Upper Limb Tension Tests 597
Diagnostic Utility of Upper Limb Tension Tests in Identifying Carpal Tunnel Syndrome 598
Diagnostic Utility of Special Tests in Identifying Carpal Instability 599
Diagnostic Utility of Special Tests in Identifying de Quervain Tenosynovitis 601
Reliability of Miscellaneous Special Tests 601
Diagnostic Utility of Miscellaneous Special Tests 602
Combinations of Tests 603
Carpal Tunnel Syndrome: Clinical Prediction Rule 603
Scaphoid Fracture: Clinical Prediction Rule 603
Outcome Measures 604
Appendix 605
Quality Appraisal of Reliability Studies for the Hand Using QAREL 605
Quality Assessment of Diagnostic Studies for the Hand Using QUADAS 607
References 609
Index 611
A 611
B 613
C 614
D 618
E 619
F 620
G 623
H 623
I 625
J 626
K 627
L 628
M 630
N 632
O 633
P 634
Q 638
R 638
S 640
T 645
U 649
V 649
W 650
X 650
Y 650
Z 650
Inside Back Cover ibc1
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