Additional Information
Book Details
Abstract
Whether you’re preparing for the OCS or just want to brush up on your orthopedic knowledge, you don’t want to be without Placzek and Boyce’s new third edition of Orthopaedic Physical Therapy SECRETS. As with previous editions, SECRETS covers a variety of different physical therapy concepts, healing modalities, specialties, and orthopedic procedures to ensure you are well-prepared to pass the OCS and provide the best orthopedic therapy options for today’s patients. Common diseases are included as well as more innovative diagnostic tools. Each chapter features thoroughly updated content that’s entirely evidence-based and outcome-based. This ebook also features insightful anecdotes — including clinical tips, memory aids, and secrets — and helpful review tools — such as bulleted lists, algorithms and illustrations — to help you thoroughly master all aspects of orthopedic physical therapy practice.
- Coverage of topics found on the orthopedic specialty exam makes this a useful review resource for those studying for the exam.
- Clinical tips provide insightful guidance on a variety of clinical situations and tasks.
- Charts, tables, and algorithims simplify information into logical frameworks.
- Evidence-based content supports the latest orthopedic research.
- Strong chapter on the shoulder and hand succinctly presents important information on this complex topic.
- Annotated references provide a useful tool for research.
- NEW! Completely updated content reflects the latest physical therapy guidelines.
- NEW! Electronic-only format makes this study tool completely portable and accessible on a variety of devices such as the Kindle, Nook, iPad, and more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Orthopaedic Physical Therapy | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xiii | ||
| Contents | xv | ||
| Section I: Basic Science | 1 | ||
| Chapter 1: Muscle Structure and Function | 1 | ||
| 1. What is the organizational hierarchy of skeletal muscle, and how is it achieved? | 1 | ||
| 2. Describe the characteristics of the sarcomere. | 1 | ||
| 3. What are the contractile and regulatory proteins? | 1 | ||
| 4. Name the structural proteins in skeletal muscle. | 1 | ||
| 5. What are the characteristics of myosin? | 1 | ||
| 6. Describe the components of myosin. | 2 | ||
| 7. Explain the role of the enzyme myosin adenosinetriphosphatase (ATPase). | 3 | ||
| 8. What are the characteristics of actin? | 3 | ||
| 9. Explain the sliding filament theory of muscle contraction. | 3 | ||
| 10. What are the functions of muscle? | 3 | ||
| 11. List the functions of myonuclei and satellite cells, and identify the number of nuclei found in the skeletal muscle f... | 3 | ||
| 12. List the energy production systems in skeletal muscle. | 3 | ||
| 13. What are the major steps of fatty acid metabolism in muscle that result in the release of energy? | 3 | ||
| 14. What is the range of muscle fiber lengths? | 3 | ||
| 15. Discuss the role of satellite cells in the formation of a new muscle fiber. | 4 | ||
| 16. Identify and define or describe muscle growth factors. | 4 | ||
| 17. What are the characteristics of myofibrils? | 4 | ||
| 18. Describe the characteristics of individual muscle fibers. | 4 | ||
| 19. What are the factors that upregulate protein synthesis in skeletal muscle? | 4 | ||
| 20. What is a strap or fusiform muscle? List examples of fusiform muscles. | 4 | ||
| 21. What are the factors that upregulate protein degradation in skeletal muscle? | 4 | ||
| 22. Explain the role of pennation in force production. | 4 | ||
| 23. Describe the differences among unipennate, bipennate, and multipennate muscles. | 5 | ||
| 24. Define the force-velocity relationship. | 5 | ||
| 25. Describe additional factors influencing muscle strength. | 5 | ||
| 26. What is active insufficiency at the sarcomere level? | 5 | ||
| 27. Define the all-or-none principle of muscle contraction. | 5 | ||
| 28. What is active insufficiency at the muscle level? | 5 | ||
| 29. Define excitation-contraction coupling. | 5 | ||
| 30. Summarize how excitation-contraction coupling occurs in skeletal muscle. | 5 | ||
| 31. What are the characteristics of the different skeletal muscle fiber types? | 6 | ||
| 32. Define the type IIx myosin heavy chain in human fibers. | 6 | ||
| 33. Define the function of muscle spindles, and describe their appearance. | 6 | ||
| 34. What is the size principle of motor unit recruitment? | 6 | ||
| 35. Discuss the function of the Golgi tendon organs. | 6 | ||
| 36. Describe the adaptations in muscle structure that occur with progressive resistance exercises. | 7 | ||
| 37. List the effects of progressive resistance exercise. | 7 | ||
| 38. Describe the adaptations in muscle structure that occur with endurance exercises. | 7 | ||
| 39. List the effects of endurance exercise. | 7 | ||
| 40. What are the consequences of muscle disuse? | 7 | ||
| 41. What adaptations occur if muscles are immobilized in a shortened position? | 8 | ||
| 42. Define the term sarcopenia. | 8 | ||
| 43. What occurs as a result of lengthening the muscles? | 8 | ||
| 44. What are the changes in skeletal muscles that occur with aging? | 8 | ||
| 45. Define disease-associated muscle atrophy, such as cachexia. | 8 | ||
| 46. Differentiate apoptosis from necrosis as applied to skeletal muscle. | 8 | ||
| 47. What are the hallmarks of muscles undergoing degeneration-regeneration? | 8 | ||
| Bibliography | 8 | ||
| Chapter 2: Biomechanics | 10 | ||
| 1. Does kinematic similarity ensure kinetic similarity? | 10 | ||
| 2. Explain how impulse can be manipulated to prevent injury. | 10 | ||
| 3. What are some considerations to keep in mind when using elastic resistance? | 10 | ||
| 4. Define commonly used biomechanical terms and equations. | 10 | ||
| 5. What is the relation between the linear motion at the joint surface and the angular motion of a bone around the joint ... | 11 | ||
| 6. Has the convex-concave rule been experimentally verified? | 11 | ||
| 7. Is the axis of rotation for a joint fixed? | 12 | ||
| 8. What is the difference between an absolute and relative joint angle? | 12 | ||
| 9. Are the terms valgus and varus used unambiguously? | 12 | ||
| 10. Provide examples of the concept of moment. | 13 | ||
| 11. What is the effect of a muscles force on a joint system? | 13 | ||
| 12. Explain how torque-producing capabilities of a muscle vary over a joints range of motion. | 13 | ||
| 13. Can a muscles action at a joint change? | 13 | ||
| 14. When a study refers to a net joint moment, what does that mean and what are the assumptions behind it? | 13 | ||
| 15. What is joint instability, and how does it differ from hypermobility? | 14 | ||
| 16. How are force and strength related? | 14 | ||
| 17. Does the amplitude of the electromyography (EMG) signal quantify a muscles force-producing (absorbing) capability? | 14 | ||
| 18. What are the benefits of having three different types of muscle actions? | 14 | ||
| 19. What information can be obtained from studying the force-velocity curve? | 14 | ||
| 20. Is there a mechanical variable that can identify the types of muscle actions? | 15 | ||
| 21. Why is eccentric strength important in the prevention of injury? | 15 | ||
| 22. Explain the length-tension relationship of muscle. | 15 | ||
| 23. What is the stretch-shortening cycle? | 16 | ||
| 24. Is excessive force the cause of pain and injury? | 16 | ||
| 25. What is the tissue response to a force (stress), and how is it measured? | 16 | ||
| 26. What information can be ascertained from studying force-deformation curves? | 17 | ||
| 27. Do human tissues respond to all stresses in the same way? | 17 | ||
| 28. When the force is applied to the tissue externally, does the tissue return to its original state after the force is r... | 17 | ||
| 29. Give an example of the clinical implications of the force-deformation curve. | 18 | ||
| 30. Discuss some factors that affect the biomechanical properties of tendons and ligaments. | 18 | ||
| 31. Is cartilage the same in all joints? | 19 | ||
| 32. Do all tissues adapt to change at the same rate? | 19 | ||
| 33. What does it mean that a tendon is more compliant? | 19 | ||
| 34. Are tissue responses to a submaximal stress time dependent? | 19 | ||
| 35. What is hysteresis? | 19 | ||
| 36. What is the role of cartilage in joint lubrication, and how might pathology affect it? | 20 | ||
| 37. What is friction, and is it good or bad? | 20 | ||
| 38. List biomechanical factors that affect a joint implant | 21 | ||
| 39. List factors that affect the stability of an external fixator. | 21 | ||
| 40. What happens to the strength of an intramedullary rod when its diameter is increased? | 21 | ||
| 41. What happens biomechanically with improper fixation size? | 21 | ||
| 42. How do holes in the bone (ie, missing screw or following removal of plate) affect its strength? | 21 | ||
| 43. How long does it take for strength to return to normal levels after the removal of a screw? | 22 | ||
| 44. List the types of metals that are closest biomechanically to bone. | 22 | ||
| 45. How much strength does a well-placed lag screw add to fracture fixation? | 22 | ||
| 46. Do movement screens have diagnostic value? | 22 | ||
| Bibliography | 22 | ||
| Chapter 3: Soft Tissue Injury and Repair | 23 | ||
| 1. What is the bodys initial response to soft tissue injury? How is it identified? | 23 | ||
| 2. Describe the phases of soft tissue healing. | 23 | ||
| 3. Describe the basic vascular and cellular activities associated with the inflammatory reaction and the primary function... | 23 | ||
| 4. Identify the key chemical mediators of the inflammatory response. | 23 | ||
| 5. Which cell type is especially prominent in the proliferative and matrix formation phases of connective tissue healing? | 23 | ||
| 6. Describe the elements that comprise the connective tissue matrix. | 23 | ||
| 7. What general factors affect connective tissue repair after tissue injury? | 24 | ||
| 8. What is the association of antibiotic medicines and acute tendinopathy and tendon ruptures? | 24 | ||
| 9. What risk factors are associated with FQ antibiotic-induced tendon rupture? | 24 | ||
| 10. What influence does nutrition play in the soft tissue repair process? | 24 | ||
| 11. What role does aging play in altering the soft tissue injury healing process? | 24 | ||
| 12. How does tendinitis differ from tendinosis? | 24 | ||
| 13. What is the appropriate treatment for tendinosis? | 25 | ||
| 14. What tissue changes occur in response to a period of immobilization after soft tissue injury? | 25 | ||
| 15. What is the effect of immobilization on stiffness and strength of injured soft tissue? | 25 | ||
| 16. How do stress and motion affect connective tissue repair after injury? | 25 | ||
| 17. After ligament and tendon repair or reconstruction, when is the soft tissue the strongest and when is it the weakest? | 25 | ||
| 18. What is the response of articular cartilage to chondroplasty (microfracture technique, abrasion, and drilling) of the... | 25 | ||
| 19. Describe the scientific evidence supporting articular cartilage repair. | 26 | ||
| 20. What growth factors are involved with soft tissue healing? | 26 | ||
| 21. What is the effect of NSAIDs on muscle recovery? | 26 | ||
| 22. What factors affect allograft strength? | 26 | ||
| 23. What growth factors may aid in soft tissue repair? | 26 | ||
| Bibliography | 26 | ||
| Chapter 4: Bone Injury and Repair | 28 | ||
| 1. What are the components that make up bone? | 28 | ||
| 2. Describe the effects of aging on bone structure. | 28 | ||
| 3. How does Wolffs law apply to bone healing? | 28 | ||
| 4. List the different types of bone fractures. | 28 | ||
| 5. What is a bone bruise and how does it relate to bone fractures? | 29 | ||
| 6. How are bone bruises identified? | 29 | ||
| 7. Discuss the stages of bone healing. | 29 | ||
| 8. Name some conditions that have a negative effect on the bone healing process. | 29 | ||
| 9. Discuss the effect that smoking has on the bone healing process. | 30 | ||
| 10. What steps may be taken by a patient to promote accelerated fracture healing? | 30 | ||
| 11. Discuss the effect calcium nutrition has on bone healing. | 30 | ||
| 12. What other factors affect calcium absorption? | 30 | ||
| 13. Define closed reduction, open reduction, and rigid external fixation in fracture treatment. | 31 | ||
| 14. What are the advantages of closed reduction? | 31 | ||
| 15. List advantages and disadvantages of open reduction. | 31 | ||
| 16. How does rigid fixation affect bone healing? | 31 | ||
| 17. What effects can internal fixation have on bone healing? | 31 | ||
| 18. List some advantages of weight-bearing activities after sustaining a fracture. | 31 | ||
| 19. Describe a radiologic sign of a fracture of the radial head/neck. | 31 | ||
| 20. What is the most commonly overlooked fracture in adults at the time of injury? | 31 | ||
| 21. Discuss the role of ultrasound in the treatment of acute fractures. | 31 | ||
| 22. What effect does bioelectric stimulation have on fracture healing? | 32 | ||
| 23. What is the effect of NSAIDs on bone healing? | 32 | ||
| 24. What are stress fractures, and how do they occur? | 32 | ||
| 25. What is the best imaging method for detecting stress fractures? | 32 | ||
| 26. What is bone transplantation (replacement), and why is it used? | 32 | ||
| 27. What treatments are available for nonunions? | 32 | ||
| 28. How do Salter-Harris fractures influence the pediatric population? | 33 | ||
| 29. What are the roles of various growth factors on bone healing? | 33 | ||
| Bibliography | 33 | ||
| Chapter 5: Exercise Physiology | 35 | ||
| 1. What factor is considered to be the best indicator of an individuals level of aerobic capacity? | 35 | ||
| 2. How is VO2max determined? | 35 | ||
| 3. How is VO2max measured? | 35 | ||
| 4. Why is VO2max considered the best indicator of aerobic fitness? | 35 | ||
| 5. What are limiting factors in determining VO2max? | 35 | ||
| 6. Are the VO2max values the same in an individual performing various exercises (eg, treadmill, cycling, arm ergometry)? | 35 | ||
| 7. Why is the cardiac output and arteriovenous oxygen difference larger in individuals who engage in regular physical act... | 35 | ||
| 8. How does the VO2max of a well-trained man compare with the VO2max of a well-trained woman? | 35 | ||
| 9. Define other common indicators of physical fitness. | 35 | ||
| 10. Differentiate between physical activity, exercise, and physical fitness. | 36 | ||
| 11. What are the five components of physical fitness? | 36 | ||
| 12. What is the effect of regular exercise on cardiometabolic parameters? | 36 | ||
| 13. What is the effect of regular exercise on neurologic parameters? | 36 | ||
| 14. What is oxygen deficit? | 36 | ||
| 15. What effect does warming up have on the oxygen deficit? | 36 | ||
| 16. How do the resting stroke volume, heart rate, and cardiac output of a well-trained athlete compare with those of a se... | 36 | ||
| 17. How does the stroke volume response to exercise in the upright position differ between individuals who are physically... | 36 | ||
| 18. How do heart rate, stroke volume, mean total peripheral resistance, mean arterial blood pressure, and respiratory rat... | 37 | ||
| 19. What is the acute response of systolic and diastolic blood pressure to aerobic exercise? | 37 | ||
| 20. Describe the normal interaction of inotropes and chronotropes during exercise. | 37 | ||
| 21. What effect does a low partial pressure of oxygen (Po2) have on blood vessel diameter in the lung and in the systemic... | 37 | ||
| 22. Discuss the effect long-term endurance training has on the heart and on blood volume. | 37 | ||
| 23. Describe the contributions of stored adenosine triphosphate (ATP), creatine phosphate, glycolysis, and aerobic metabo... | 37 | ||
| 24. What can be done to improve the systems for providing ATP during intense exercise? | 38 | ||
| 25. What are the main muscle fiber types and their characteristics? | 38 | ||
| 26. Which type of muscle fiber is activated during moderate-intensity, long-duration exercise, such as jogging? | 38 | ||
| 27. Which type of muscle fiber is activated during high-intensity, short-term exercise, such as sprinting? | 38 | ||
| 28. Why are specific muscle fiber types activated during different kinds of exercise? | 38 | ||
| 29. Explain why movements become less precise and refined as low-intensity exercise is continued for a prolonged period o... | 38 | ||
| 30. Can the three muscle fiber types be changed as a result of exercise? | 38 | ||
| 31. What changes occur in muscle with endurance training? | 38 | ||
| 32. What changes occur in muscle with resistance training, and how long does it take for those changes to occur? | 39 | ||
| 33. What causes improvements in strength with resistance training? | 39 | ||
| 34. What is the cause of athletic amenorrhea? | 39 | ||
| 35. Is it true that pregnant women who are physically fit deliver more easily? | 39 | ||
| 36. Summarize some physiologic changes that occur during pregnancy that affect exercise. | 39 | ||
| 37. What are the American College of Sports Medicine (ACSM) guidelines for physical activity? | 39 | ||
| 38. What are the American College of Sports Medicine (ACSM) guidelines for muscular fitness? | 39 | ||
| 39. List the general American College of Sports Medicine (ACSM) guidelines for an exercise program to decrease body weight. | 40 | ||
| 40. What are the American College of Sports Medicine (ACSM) guidelines for sustaining weight loss? | 40 | ||
| 41. Describe the ``fit-but-fat´´ paradigm. | 40 | ||
| 42. What are the American College of Sports Medicine (ACSM) guidelines for an exercise program to preserve bone health? | 40 | ||
| 43. How do exercise and training affect the endocrine system and the resting levels of hormones? | 40 | ||
| 44. Discuss prolonged, moderate-intensity exercise training and blood glucose levels in individuals with type 1 and type ... | 40 | ||
| 45. Does exercise affect the prevalence of upper respiratory tract infections (URTI)? | 40 | ||
| 46. Should patients with chronic obstructive pulmonary disease (COPD) be encouraged to exercise? | 41 | ||
| 47. How does the heart rate response to exercise differ between normal individuals and individuals who have had heart tra... | 41 | ||
| 48. How does resting heart rate differ between normal individuals and individuals who have had heart transplants? | 41 | ||
| 49. Why are individuals with thoracic-level spinal cord injuries at risk for fainting after exercising in the upright pos... | 41 | ||
| 50. What is the most common problem associated with exercising in cold environments? | 41 | ||
| 51. List strategies to avoid hypothermia and hyperthermia when exercising in a cold environment. | 41 | ||
| 52. Describe the physiologic changes that occur with exercising in the cold. | 41 | ||
| 53. List possible causes for decreased maximal muscle strength and power with hypothermia. | 41 | ||
| 54. What are the two most common problems associated with exercising in hot environments? | 41 | ||
| 55. How can dehydration and hyperthermia be avoided? | 41 | ||
| 56. Describe the physiologic changes that occur with exercising in the heat. | 41 | ||
| 57. Does living at high altitude improve exercise tolerance at high altitude? | 42 | ||
| Bibliography | 42 | ||
| Section II: Disease Processes | 44 | ||
| Chapter 6: Arthritis | 44 | ||
| 1. List uses and potential side effects of medications commonly used to treat types of arthritis. | 44 | ||
| 2. Describe characteristic signs and symptoms of rheumatoid arthritis (RA). | 44 | ||
| 3. Who gets RA? | 44 | ||
| 4. Why is it important to diagnose RA? | 44 | ||
| 5. What x-ray changes are typical of rheumatoid arthritis? | 45 | ||
| 6. Describe joint pathology in RA. | 45 | ||
| 7. List the most common hand and wrist deformities associated with rheumatoid arthritis. | 45 | ||
| 8. How do children present with juvenile inflammatory arthritis? | 45 | ||
| 9. What labs help in the diagnosis of RA? | 45 | ||
| 10. Does RA affect the spine? | 45 | ||
| 11. What are the possible medical emergencies associated with RA that physical therapists should keep in mind? | 45 | ||
| 12. What are signs and symptoms of carpal tunnel syndrome? | 45 | ||
| 13. Is carpal tunnel associated with systemic disease? | 46 | ||
| 14. What is systemic lupus erythematosus (SLE)? | 46 | ||
| 15. Is lupus diagnosed by the presence of antinuclear antibodies (ANA)? | 46 | ||
| 16. List musculoskeletal problems that patients with SLE can develop. | 46 | ||
| 17. Describe typical lupus arthritis. | 46 | ||
| 18. Name the seronegative arthropathies. | 46 | ||
| 19. List the clinical features that the seronegative arthropathies share. | 46 | ||
| 20. List clinical features of psoriatic arthritis. | 46 | ||
| 21. What is reactive arthritis? | 46 | ||
| 22. How does the back pain of ankylosing spondylitis differ from mechanical back pain clinically? | 46 | ||
| 23. What treatments are available for ankylosing spondylitis? | 47 | ||
| 24. Describe x-ray changes in ankylosing spondylitis. | 47 | ||
| 25. Are there red flags for a PT treating a patient with ankylosing spondylitis? | 47 | ||
| 26. What causes gout? | 47 | ||
| 27. What causes pseudogout? | 47 | ||
| 28. How can the crystal types in gout and pseudogout be distinguished? | 47 | ||
| 29. Describe a typical episode of acute gout. | 47 | ||
| 30. What joints other than the first MTP may be affected in gout? | 47 | ||
| 31. How is acute gout treated? | 47 | ||
| 32. Can gout be diagnosed by an elevated serum uric acid level? | 47 | ||
| 33. How does pseudogout differ from gout? | 47 | ||
| 34. What is the differential diagnosis of a single red, hot joint? | 48 | ||
| 35. Describe the clinical signs of infected total joint prostheses. | 48 | ||
| 36. How are infected total joint arthroplasties treated? | 48 | ||
| 37. How common is OA? | 48 | ||
| 38. What are common types of inflammatory muscle disease? | 48 | ||
| 39. Is it safe to exercise with myositis? | 48 | ||
| Bibliography | 48 | ||
| Chapter 7: Deep Venous Thrombosis | 49 | ||
| 1. Define Virchows triad. | 49 | ||
| 2. List states that are associated with hypercoagulability. | 49 | ||
| 3. What is the most common inherited thrombophilia? | 50 | ||
| 4. In the general population, how frequent does DVT occur? | 50 | ||
| 5. How common are genetic factors in association with hypercoagulability? | 50 | ||
| 6. When do venous thrombi develop? | 50 | ||
| 7. Describe the incidence of DVT after total joint arthroplasty. | 50 | ||
| 8. Does the type of anesthetic used during surgery affect the incidence of DVT? | 50 | ||
| 9. List the clinical signs and symptoms of DVT. | 50 | ||
| 10. Is DVT easily clinically diagnosed? | 50 | ||
| 11. What is Homans sign? | 50 | ||
| 12. List differential diagnoses of DVT. | 50 | ||
| 13. Name the most dreaded complication from DVT. | 51 | ||
| 14. Describe the signs and symptoms of PE. | 51 | ||
| 15. What are the electrocardiogram (ECG) findings of pulmonary embolism? | 51 | ||
| 16. What long-term complications are associated with DVT? | 51 | ||
| 17. Discuss the modalities that are available to prevent the formation of a DVT. | 51 | ||
| 18. What actions should a therapist take if a DVT is suspected? | 51 | ||
| 19. Discuss the sensitivity and specificity of diagnostic tests for DVT. | 52 | ||
| 20. If the presence of a DVT is confirmed, what treatments are available? | 52 | ||
| 21. What are the mechanisms of action of heparin, LMWH, warfarin, aspirin, and fondaparinux? | 52 | ||
| 22. Define PTT, PT, and INR. | 52 | ||
| Bibliography | 53 | ||
| Section III: Electrotherapy and Modalities | 54 | ||
| Chapter 8: Cryotherapy and Moist Heat | 54 | ||
| 1. At what depth have tissue temperature changes been recorded after treatment with superficial ice? | 54 | ||
| 2. Which method is more effective in lowering tissue temperature: ice massage or ice pack? | 54 | ||
| 3. What is the effect of ice application on metabolic rate? | 54 | ||
| 4. What is the physiologic effect of cold application on the muscle spindle? | 54 | ||
| 5. How may the physiologic effect of cold application be successful in reducing a muscle spasm or cramp? | 54 | ||
| 6. Describe the effect of therapeutic ice on local blood flow. | 54 | ||
| 7. At what temperature does local tissue damage occur with ice application? | 55 | ||
| 8. What is the ideal tissue temperature to achieve the optimal physiologic effects of cryotherapy? | 55 | ||
| 9. How long do tissue blood flow and tissue temperature remain decreased after application of an ice pack? | 55 | ||
| 10. Which form of cold treatment is the most effective at relieving postoperative pain and swelling? | 55 | ||
| 11. Explain the impact of cold application on the diabetic patient. | 55 | ||
| 12. Should ice be used in the treatment of a subacute or chronic injury? | 55 | ||
| 13. What is the hunting response? | 56 | ||
| 14. What is hyperbaric gaseous cryotherapy, and what are the proposed benefits? | 56 | ||
| 15. What skin temperature can be achieved with hyperbaric cryotherapy? | 56 | ||
| 16. At what depth have tissue temperature changes been recorded after treatment with superficial heat? | 56 | ||
| 17. What is the desired therapeutic tissue temperature produced by heat? | 56 | ||
| 18. What is the oxygen-hemoglobin dissociation curve? | 56 | ||
| 19. What does a shift in the oxygen-hemoglobin dissociation curve to either the right or the left signify? | 56 | ||
| 20. Explain the mechanism by which heat reduces muscle spasm or cramp. | 56 | ||
| 21. Describe the effect of heat on a tight or shortened muscle, capsule, or tendon during stretching. | 57 | ||
| 22. What is the effect of heat application on local blood flow? | 57 | ||
| 23. Describe the physiologic effect of heat on muscle performance during exercise. | 57 | ||
| 24. What is the effect of heat and ice on nerve conduction velocity? | 57 | ||
| 25. How do the superficial heat and ice modalities act to reduce pain? | 57 | ||
| 26. Are home heat wraps effective in treating low back pain? | 57 | ||
| 27. Are low-level heating wraps effective when used in the extremities? | 58 | ||
| 28. Is a contrast bath effective at reducing pain and edema? | 58 | ||
| 29. Should an athlete return to performance immediately after local treatment with cryotherapy? | 58 | ||
| 30. How is hand dexterity effected by cold? | 58 | ||
| Bibliography | 58 | ||
| Chapter 9: Electrotherapy | 60 | ||
| Muscle and nerve anatomy and physiology | 60 | ||
| 1. Define cellular membrane potentials. | 60 | ||
| 2. Define refractory period. | 60 | ||
| 3. What is saltatory, or jumping, conduction? | 60 | ||
| 4. What are the average conduction velocities for myelinated and unmyelinated nerve fibers? | 61 | ||
| Physics of electrical forces | 61 | ||
| 5. What is an electrical current? | 61 | ||
| 6. Clinically, therapeutic intensities should not exceed what amperage? | 61 | ||
| 7. What is electromotive force? | 61 | ||
| 8. What role does voltage play in nerve cell membrane depolarization? | 61 | ||
| 9. How does Ohms law express the relationship between current (I), voltage (V), and resistance (R)? | 61 | ||
| 10. What properties of a material tend to make it resist electrical currents? | 61 | ||
| 11. What factors typically alter skin impedance? | 61 | ||
| Principles of alternating and direct current | 62 | ||
| 12. What criteria are used to describe direct current (DC)? | 62 | ||
| 13. Direct currents produce polar effects. What polar effects are produced by the anode and the cathode? | 62 | ||
| 14. What are the criteria used to describe alternating current (AC)? | 62 | ||
| 15. List the typical frequencies (ranges of currents, if applicable) used in therapeutic applications. | 63 | ||
| 16. Does medium-frequency stimulation (MFS) differ from low-frequency stimulation in terms of skin resistance (capacitive... | 63 | ||
| 17. Describe the key attributes of interferential currents. | 63 | ||
| Waveform characteristics | 64 | ||
| 18. Draw and label the following waveform characteristics: (1) pulse duration, (2) phase duration, and (3) amplitude. | 64 | ||
| 19. What is the typical nomenclature and the appropriate units of measurement used to describe waveform characteristics? | 64 | ||
| 20. Discuss the practical and clinical implications for frequency, phase duration, and amplitude. | 64 | ||
| 21. What is the clinical relevance of the pulse characteristics that are labeled in the diagram? | 65 | ||
| 22. Define rise time, fall time, and duty cycle. | 65 | ||
| 23. Describe the key attributes of high-volt current and the unique characteristics of high-volt units. | 65 | ||
| 24. Discuss how high-volt currents differ from direct currents. | 66 | ||
| Electrodes and electrode placement | 66 | ||
| 25. What is the relationship between interelectrode distance and depth of penetration? | 66 | ||
| 26. Name three common electrode placement strategies for neuromuscular electrical stimulation (NMES). | 66 | ||
| Stimulation of healthy and denervated tissues | 66 | ||
| 27. List electrically excitable and nonexcitable tissues. | 66 | ||
| 28. Discuss Pflügers law and its implications in the stimulation of human tissues. | 67 | ||
| 29. What is accommodation? | 67 | ||
| 30. What is the strength-duration curve? | 67 | ||
| 31. What are common contraindications and precautions for electrotherapy application? | 68 | ||
| Application | 68 | ||
| 32. List common indications for electrical stimulation. | 68 | ||
| 33. Is there a difference between the use of NMES or voluntary exercise or the use of combined NMES and voluntary exercis... | 68 | ||
| 34. Outline a suitable protocol for neuromuscular facilitation and reeducation including purpose, rationale, indications,... | 68 | ||
| 35. When is NMES indicated after knee surgery and immobilization? | 69 | ||
| 36. Is there a difference between the use of high-intensity electrical stimulators and low-intensity or battery-powered s... | 69 | ||
| 37. Outline a suitable protocol for muscle strengthening in terms of purpose, rationale, indications, parameters, and spe... | 69 | ||
| 38. Is microcurrent electrical nerve stimulation (MENS) effective in the treatment of temporomandibular joint pain? | 69 | ||
| 39. What are the benefits and limitations of NMES after ACL reconstruction? | 69 | ||
| 40. Is NMES more effective for strength training after ACL reconstruction when performed against isometric resistance? | 69 | ||
| 41. Should the presence or absence of a knee extensor lag be a criterion for using or not using NMES after ACL reconstruc... | 69 | ||
| 42. Is there a relationship between the number of NMES training sessions per week and strength outcomes? | 69 | ||
| 43. Is NMES effective in the treatment of elderly patients with knee osteoarthritis? | 69 | ||
| 44. Is there a relationship between muscle contraction strength or fatigue and type of waveform used with electrical stim... | 70 | ||
| 45. What are the suitable parameters and rationale for conventional, low-rate, and brief intense transcutaneous electrica... | 70 | ||
| 46. Are there differences between the effects of low-frequency transcutaneous electrical nerve stimulation (TENS) and int... | 70 | ||
| 47. Discuss important considerations and treatment parameters for maintaining joint range of motion. | 70 | ||
| 48. Discuss key considerations and treatment parameters for edema control. | 70 | ||
| 49. Can electromyographic biofeedback aid in the recovery of quadriceps femoris muscle function after ACL reconstruction? | 70 | ||
| Bibliography | 71 | ||
| Chapter 10: Iontophoresis, Ultrasound, Phonophoresis, and Laser and Light Therapy | 73 | ||
| Iontophoresis | 73 | ||
| 1. Are iontophoresis and phonophoresis interchangeable clinically? | 73 | ||
| 2. Describe Leducs classic experiment. | 73 | ||
| 3. Describe the potato experiment. | 73 | ||
| 4. Define direct current. | 73 | ||
| 5. List some commonly used ionic solutions and their proposed indications. | 73 | ||
| 6. Why are the effects of iontophoresis often longer lasting than those of phonophoresis? | 74 | ||
| 7. Does increasing the concentration of the drug increase the amount delivered to the target tissue? | 74 | ||
| 8. Are there concerns with using direct current? | 74 | ||
| 9. Ion transfer depends on what factors? | 74 | ||
| 10. Why do burns occur with iontophoresis? | 74 | ||
| 11. Where should the iontophoresis electrodes be placed? | 74 | ||
| 12. What are advantages of iontophoresis compared with injection? | 74 | ||
| 13. What are the disadvantages of iontophoresis? | 74 | ||
| 14. Is corticosteroid delivery by iontophoresis an effective treatment for lateral epicondylitis? | 74 | ||
| 15. What is the preferred treatment duration for iontophoresis in the treatment of medial or lateral epicondylitis? | 74 | ||
| 16. How many serial iontophoresis treatments are safe? | 75 | ||
| 17. Does the magnitude of iontophoresis current determine the depth of penetration? | 75 | ||
| 18. Do buffered electrodes stabilize skin pH under the cathode? | 75 | ||
| 19. Is there evidence showing the benefits of iontophoresis with specific pathologies? | 75 | ||
| Ultrasound | 75 | ||
| 20. How is ultrasound generated, and what is a piezoelectric effect? | 75 | ||
| 21. What is the beam nonuniformity ratio (BNR)? | 75 | ||
| 22. What is the effective radiating area (ERA) of a transducer? | 75 | ||
| 23. What are nonthermal and thermal ranges of therapeutic ultrasound? | 75 | ||
| 24. What are the reported and theorized nonthermal effects of ultrasound? | 75 | ||
| 25. What are the reported and theorized thermal effects of ultrasound? | 75 | ||
| 26. How does ultrasound frequency relate to depth of penetration? | 76 | ||
| 27. Does the ultrasound transducer speed affect the intramuscular tissue temperature? | 76 | ||
| 28. Will tissue temperature increases in human muscle vary between pulsed and continuous ultrasound application when admi... | 76 | ||
| 29. Is a metal implant an absolute contraindication for the use of ultrasound? | 76 | ||
| 30. Is ultrasound effective in treating calcific tendinitis of the shoulder? | 76 | ||
| 31. Is there evidence supporting the use of static ultrasound application over conventional ultrasound application? | 76 | ||
| 32. Is there evidence supporting the use of low-intensity pulsed ultrasound? | 76 | ||
| 33. Is ultrasound effective in treating carpal tunnel syndrome? | 76 | ||
| 34. Is there sufficient support for the use of ultrasound in a physical therapy treatment program? | 76 | ||
| Ultrasound and phonophoresis | 77 | ||
| 35. How does phonophoresis work? | 77 | ||
| 36. When performing phonophoresis, what dosage is preferred? | 77 | ||
| 37. When performing phonophoresis, what concentrations of hydrocortisone are most effective? | 77 | ||
| 38. How many serial phonophoresis treatments are safe? | 77 | ||
| 39. What are examples of drugs that can be administered by phonophoresis? | 77 | ||
| 40. Provide an example of a topical nonsteroidal antiinflammatory drug (NSAID) that may be administered by phonophoresis. | 77 | ||
| 41. What is the most efficiently transmitted topical antiinflammatory media used in phonophoresis? | 77 | ||
| 42. Is phonophoresis effective in treating lateral epicondylitis? | 77 | ||
| Laser and light therapy | 77 | ||
| 43. What is laser and light therapy? | 77 | ||
| 44. What is the relationship between wavelength and depth of penetration? | 78 | ||
| 45. What are the proposed benefits, strengths, and limitations of laser and light therapy? | 78 | ||
| 46. What is multiwave locked system (MLS) laser therapy? | 78 | ||
| 47. Is the use of MLS laser therapy supported by the literature? | 78 | ||
| Bibliography | 78 | ||
| Section IV: Special Topics | 81 | ||
| Chapter 11: Stretching | 81 | ||
| 1. What is stress relaxation? | 81 | ||
| 2. Define creep. | 81 | ||
| 3. When stretching a muscle joint complex, what structures are influenced? | 81 | ||
| 4. What is ballistic (dynamic) stretching? | 81 | ||
| 5. Define static stretching. | 81 | ||
| 6. Describe some commonly used proprioceptive neuromuscular facilitation (or active inhibition) stretching techniques. | 81 | ||
| 7. What is the optimal number of static stretch repetitions? | 82 | ||
| 8. What is the optimal amount of time that a static stretch should be held? | 82 | ||
| 9. What is the optimal intensity of a static stretch? | 82 | ||
| 10. How often must static stretching be performed to maintain gains experienced during a static stretch session? | 82 | ||
| 11. If an individual statically stretches on a regular basis, how long will the gains be retained? | 82 | ||
| 12. Does static muscle stretching alter performance? | 82 | ||
| 13. Does dynamic stretching alter performance? | 82 | ||
| 14. Does static stretching decrease the chance of injury? | 82 | ||
| 15. Does static stretching decrease muscle soreness? | 82 | ||
| 16. Is static stretching effective at reducing the effects of spasticity? | 83 | ||
| 17. Does static stretching reduce joint contracture? | 83 | ||
| 18. Should a muscle joint complex be warmed up to optimize the effects of a stretch? | 83 | ||
| 19. What stretching technique results in the greatest flexibility gain? | 83 | ||
| 20. Does age influence the extensibility of muscle and tendon? | 83 | ||
| 21. Does stretching the gastrocnemius muscle in subtalar supination result in greater ankle dorsiflexion range of motion? | 83 | ||
| 22. Does stretching alter joint position sense? | 83 | ||
| 23. Is stretching effective at reducing neck pain? | 83 | ||
| 24. Is stretching effective at reducing hamstring injuries? | 83 | ||
| 25. Is stretching effective at reducing patellofemoral pain syndrome (anterior knee pain)? | 83 | ||
| 26. Is stretching effective at reducing heel pain? | 83 | ||
| Bibliography | 84 | ||
| Chapter 12: Manual Therapy | 85 | ||
| 1. What is manual therapy? | 85 | ||
| 2. When is manual therapy treatment indicated? | 85 | ||
| 3. What is joint play? | 85 | ||
| 4. Is manual therapy always passive? | 85 | ||
| 5. Describe the basic types of manipulations. | 85 | ||
| 6. What is a physiologic and anatomic barrier? | 86 | ||
| 7. Define direct and indirect manual therapy techniques. | 86 | ||
| 8. What is the difference between general and specific manual therapy techniques? | 86 | ||
| 9. Is there evidence that specific thrust manipulation techniques are delivered accurately to the targeted segment? | 86 | ||
| 10. What is the pop? | 86 | ||
| 11. Describe the grading systems for joint mobilization. | 86 | ||
| 12. Is there evidence that manual therapy is effective in the treatment of spinal conditions? | 87 | ||
| 13. Is there evidence that manual therapy is effective in treating cervicogenic headache? | 88 | ||
| 14. Is there evidence that manual therapy is effective in treating conditions of the extremities? | 88 | ||
| 15. Is there evidence that manual therapy is effective for other conditions? | 89 | ||
| 16. What are the expected side effects of spinal manipulation? | 89 | ||
| 17. Is there any evidence to support the use of craniosacral therapy? | 89 | ||
| 18. Does manual therapy affect the visceral organs? | 89 | ||
| 19. Can manual therapy straighten a spinal deformity? | 89 | ||
| 20. Can manual therapy restore spinal curvatures? | 89 | ||
| 21. How does manual therapy help to increase range of motion and decrease pain and disability? | 90 | ||
| 22. Should joint hypomobility be treated in the absence of symptoms? | 90 | ||
| 23. What is end-feel and how is it classified? | 90 | ||
| 24. What are the general contraindications to manual therapy? | 90 | ||
| 25. List specific contraindications for thrust manipulation. | 90 | ||
| 26. Describe the convex-concave rule, and explain how it influences manual therapy. | 91 | ||
| 27. Describe loose-packed and close-packed positions. | 91 | ||
| 28. How do the loose-packed and close-packed positions influence manual therapy treatment? | 91 | ||
| 29. Define capsular pattern. | 91 | ||
| 30. Compare loose-packed position, close-packed position, and capsular pattern for all joints. | 91 | ||
| Bibliography | 92 | ||
| Chapter 13: Massage and Soft Tissue Mobilization | 95 | ||
| 1. Discuss briefly the common approaches to massage. | 95 | ||
| 2. Does massage boost the immune system and reduce inflammation? | 95 | ||
| 3. Does massage improve lymphatic drainage? | 95 | ||
| 4. Does massage increase tissue temperature? | 95 | ||
| 5. Does massage decrease depression? | 95 | ||
| 6. How does massage generate pain relief? | 96 | ||
| 7. Does massage aid in recovery from exercise and competition? | 96 | ||
| 8. Does massage improve muscle flexibility? | 96 | ||
| 9. Does massage increase blood flow? | 96 | ||
| 10. Does massage decrease blood pressure? | 97 | ||
| 11. Does massage decrease the frequency of chronic tension headaches? | 97 | ||
| 12. Does massage increase range of motion in patients with cervicogenic headache? | 97 | ||
| 13. Does massage improve adverse neural tension signs and symptoms? | 97 | ||
| 14. What is the origin, nature, and purpose of functional massage? | 97 | ||
| 15. What is the purpose of Cyriax transverse friction massage? | 98 | ||
| 16. What are the basic principles of transverse friction massage? | 98 | ||
| 17. Does transverse friction massage induce healing? | 98 | ||
| 18. How long should transverse friction massage be performed? | 98 | ||
| Bibliography | 98 | ||
| Chapter 14: Spinal Traction | 101 | ||
| 1. What are the theoretical effects of spinal traction? | 101 | ||
| 2. What are the indications for spinal traction? | 101 | ||
| 3. What are the contraindications for spinal traction? | 101 | ||
| 4. How much force is optimal for cervical traction? | 101 | ||
| 5. Is cervical traction effective for the treatment of cervical radiculopathy? | 101 | ||
| 6. Is cervical traction effective for treatment of cervicogenic headache? | 101 | ||
| 7. What are the important treatment variables for cervical traction? | 102 | ||
| 8. How much force is optimal for lumbar traction? | 102 | ||
| 9. Is lumbar traction effective for lumbar radiculopathy? | 102 | ||
| 10. What are the most important treatment variables for lumbar traction? | 103 | ||
| 11. Does spinal traction change somatosensory evoked potentials (SSEPs)? | 103 | ||
| Bibliography | 103 | ||
| Chapter 15: Normal and Pathologic Gait | 105 | ||
| 1. What is the average adult walking velocity? | 105 | ||
| 2. Does walking velocity decline with age? | 105 | ||
| 3. Name contributors to an individuals walking velocity. | 105 | ||
| 4. What is considered normal stride and step length? | 105 | ||
| 5. What is normal cadence? | 105 | ||
| 6. Define gait cycle. | 105 | ||
| 7. Describe the functional tasks associated with normal gait. | 105 | ||
| 8. Describe the key motions and muscular activity patterns at the ankle, knee, and hip during weight acceptance. | 105 | ||
| 9. Describe the key motions and muscular activity patterns at the ankle, knee, and hip during single limb support. | 106 | ||
| 10. Describe the key motions and muscular activity patterns at the ankle, knee, and hip during swing limb advancement. | 106 | ||
| 11. What factors contribute to shock absorption during weight acceptance? | 106 | ||
| 12. What allows for stance stability during single limb support? | 106 | ||
| 13. What allows for foot clearance during swing limb advancement? | 106 | ||
| 14. Name the key factors that are essential to ensure forward progression during the gait cycle. | 106 | ||
| 15. Describe the role of the heel, ankle, forefoot, and toe ``rockers´´ during gait. | 107 | ||
| 16. What is the functional significance of normal subtalar joint eversion/inversion during the stance phase of gait? | 107 | ||
| 17. What effects would a weak tibialis anterior have on gait? | 107 | ||
| 18. Describe gait deviations that likely would be evident in a patient with plantar fasciitis or a heel spur. | 107 | ||
| 19. What are the consequences of a triple arthrodesis on gait function? | 107 | ||
| 20. Describe the effect of calf weakness on ankle function during gait. | 107 | ||
| 21. Describe the effect of a plantar flexion contracture on ankle function during gait. | 107 | ||
| 22. What are the characteristics of quadriceps avoidance? | 108 | ||
| 23. With what orthopedic conditions could quadriceps avoidance be associated? | 108 | ||
| 24. Discuss the penalty associated with a knee flexion contracture. | 108 | ||
| 25. Name typical compensatory strategies associated with reduced knee flexion range of motion. | 108 | ||
| 26. What is the penalty associated with reduced knee flexion range of motion? | 108 | ||
| 27. What is a Trendelenburg gait pattern? | 108 | ||
| 28. Describe a typical compensation associated with Trendelenburg gait. | 108 | ||
| 29. Discuss the penalty associated with a hip flexion contracture. | 108 | ||
| 30. Explain the effect of hip extensor weakness on gait function. | 108 | ||
| 31. How does decreased proprioception influence gait? | 108 | ||
| 32. How does an ankle fusion alter gait and energy consumption? | 108 | ||
| 33. What are the energy costs of using various assistive devices (eg, crutches, standard walker, wheeled walker, cane) co... | 109 | ||
| 34. How are energy costs of assistive devices affected by the presence of significant gait pathology? | 109 | ||
| 35. How does osteoarthritis of the knee influence gait? | 109 | ||
| 36. How does the energy cost of walking with a total hip fusion compare with that of walking with a total hip arthroplasty? | 109 | ||
| 37. What influences do various levels of amputation have on walking velocity and energy cost? | 109 | ||
| 38. What are common gait deviations in a person with a transtibial amputation? | 109 | ||
| 39. List the pros and cons of using an ankle-foot orthosis (AFO) for the treatment of footdrop. | 110 | ||
| 40. Compared with traditional nonmicroprocessor-controlled knee units, what impact do microprocessor-controlled knees hav... | 110 | ||
| 41. Describe the effect of hip abductor weakness on pelvis, hip, and knee motion during gait. | 110 | ||
| Bibliography | 110 | ||
| Chapter 16: Pharmacology in Orthopedic Physical Therapy | 112 | ||
| 1. Summarize the properties of common opioid analgesics. | 112 | ||
| 2. List the common NSAIDs and compare them. | 113 | ||
| 3. How do opioid analgesics decrease pain? | 114 | ||
| 4. Discuss side effects of opioids that can be especially troublesome in patients receiving physical therapy. | 115 | ||
| 5. Does long-term opioid use always result in addiction? | 115 | ||
| 6. Can opioids increase pain in certain patients? | 115 | ||
| 7. List advantages of using a patient-activated electronic drug delivery system, known commonly as patient-controlled ana... | 115 | ||
| 8. Describe the disadvantages of using PCA to administer opioids. | 115 | ||
| 9. List the primary effects of NSAIDs. | 116 | ||
| 10. How do NSAIDs exert their primary beneficial effects? | 116 | ||
| 11. How do prescription NSAIDs differ from nonprescription (over-the-counter) NSAIDs? | 116 | ||
| 12. Discuss potential problems associated with the long-term use of NSAIDs. | 116 | ||
| 13. Can NSAIDs inhibit healing of bone and soft tissues? | 116 | ||
| 14. What are the COX-2 inhibitors? | 116 | ||
| 15. Give an example of a COX-2 inhibitor and its benefits. | 117 | ||
| 16. Are COX-2 inhibitors safe? | 117 | ||
| 17. How is acetaminophen different from the NSAIDs? | 117 | ||
| 18. Does acetaminophen have any side effects? | 117 | ||
| 19. Can analgesics be applied topically or transdermally to decrease pain? | 117 | ||
| 20. Are medications from other drug categories effective in treating chronic pain? | 117 | ||
| 21. What are the two primary categories of antiinflammatory medications? | 118 | ||
| 22. List the common glucocorticoids and their antiinflammatory activity. | 118 | ||
| 23. How do glucocorticoids decrease inflammation? | 118 | ||
| 24. How do glucocorticoids compare with NSAIDs in terms of efficacy and safety? | 118 | ||
| 25. Discuss the serious side effects of glucocorticoids. | 119 | ||
| 26. Can delivery of antiinflammatory steroids via iontophoresis or phonophoresis cause adrenocortical suppression? | 119 | ||
| 27. Which side effect of glucocorticoids can be especially troublesome in patients receiving physical therapy? | 119 | ||
| 28. How can the catabolic side effects of glucocorticoids be managed? | 119 | ||
| 29. Is there a critical dosage or frequency of administration that contraindicates further intraarticular injections of g... | 119 | ||
| 30. What are the fluoroquinolones? | 119 | ||
| 31. Why are fluoroquinolones potentially harmful to patients with orthopedic conditions? | 119 | ||
| 32. What medications are available to treat skeletal muscle spasms associated with orthopedic impairments (eg, nerve root... | 119 | ||
| 33. Discuss the efficacy of the drugs commonly used to treat skeletal muscle spasm. | 120 | ||
| 34. How do antispasm medications differ from drugs used to treat spasticity? | 120 | ||
| 35. What are the primary medications used to treat osteoarthritis? | 120 | ||
| 36. Is there evidence that dietary supplements (eg, glucosamine, chondroitin) can improve joint function in people with o... | 120 | ||
| 37. Discuss the primary pharmacologic strategies available for treating rheumatoid arthritis. | 120 | ||
| 38. Why are local anesthetics used to treat acute and chronic pain? | 121 | ||
| 39. How are local anesthetics used to manage pain during and after surgery? | 121 | ||
| 40. How can medications decrease the risk of thromboembolic disease in patients recovering from hip arthroplasty and othe... | 121 | ||
| 41. Is aspirin effective in preventing deep venous thrombosis? | 122 | ||
| 42. Is ambulation safe for a patient newly diagnosed with deep vein thrombosis (DVT)? | 122 | ||
| 43. What drugs are contraindicated for upper cervical manipulation? | 122 | ||
| 44. Discuss medications that are currently available to treat osteoporosis. | 122 | ||
| 45. What is heterotopic ossification? | 122 | ||
| 46. Discuss drugs that are effective in treating heterotopic ossification. | 122 | ||
| 47. Discuss how cardiovascular medications affect exercise responses. | 122 | ||
| 48. List specific concerns for physical therapists regarding cardiac medications and exercise. | 123 | ||
| 49. Can lipid-lowering medications cause skeletal muscle damage? | 123 | ||
| 50. Can physical agents affect drug absorption, distribution, and metabolism? | 123 | ||
| Bibliography | 123 | ||
| Chapter 17: Evaluation of Medical Laboratory Tests | 125 | ||
| 1. List various nondisease states that can result in an abnormal laboratory test result. | 125 | ||
| 2. What two characteristics are important for diagnostic laboratory testing? | 125 | ||
| 3. Explain the concepts of positive predictive value (PPV) and negative predictive value (NPV). | 125 | ||
| 4. Where is albumin produced and what are its functions? | 125 | ||
| 5. What is the normal range for serum albumin levels? | 125 | ||
| 6. What conditions result in decreased albumin levels (hypoalbuminemia)? | 125 | ||
| 7. Where does alkaline phosphatase originate? | 125 | ||
| 8. Explain alkaline phosphatase elevation as it relates to bone. | 126 | ||
| 9. What are the two hepatic conditions that result in elevation of alkaline phosphatase concentration? | 126 | ||
| 10. How can liver- versus bone-related elevations in alkaline phosphatase levels be differentiated? | 126 | ||
| 11. What is the normal range for alkaline phosphatase? | 126 | ||
| 12. What are aminotransferases? | 126 | ||
| 13. What are nonhepatic sources of AST and causes for its elevation? | 126 | ||
| 14. List the common pancreatic causes for elevated amylase and lipase levels. | 126 | ||
| 15. List some of the nonpancreatic causes for elevated amylase and lipase levels. | 126 | ||
| 16. What are antinuclear antibodies (ANAs)? | 126 | ||
| 17. List diseases associated with a positive ANA (conditions associated with the disease or specific laboratory abnormali... | 127 | ||
| 18. What is bilirubin and what are its two forms? | 127 | ||
| 19. Why does jaundice occur with hyperbilirubinemia? | 127 | ||
| 20. What conditions are associated with hyperbilirubinemia? | 127 | ||
| 21. What is blood urea nitrogen (BUN)? | 127 | ||
| 22. What are the causes of elevated BUN levels? | 127 | ||
| 23. What is the normal range for BUN levels? | 127 | ||
| 24. Where is the majority of calcium stored in the body? | 127 | ||
| 25. What factors affect serum calcium levels? | 127 | ||
| 26. What conditions are associated with hypercalcemia? | 127 | ||
| 27. What are the signs and symptoms of hypercalcemia? | 128 | ||
| 28. What are the signs and symptoms of hypocalcemia? | 128 | ||
| 29. What causes the neuromuscular irritability (tetany) seen with hypocalcemia? | 128 | ||
| 30. What is the prothrombin time (PT), and what does its value signify? | 128 | ||
| 31. How does warfarin function as an anticoagulant? | 128 | ||
| 32. What conditions can lead to an increased PT? | 128 | ||
| 33. What medical therapy requires monitoring of the PTT (partial thromboplastin time)? | 128 | ||
| 34. What is the INR (international normalized ratio)? | 128 | ||
| 35. What components constitute the CBC (complete blood count)? | 128 | ||
| 36. What are the causes of leukocytosis (elevated WBC count)? | 128 | ||
| 37. Within the differential white cell count (Diff), name the five white blood cell types, their percentages, and what th... | 128 | ||
| 38. List the causes of neutrophilia. | 129 | ||
| 39. List the causes of neutropenia. | 129 | ||
| 40. List the causes of eosinophilia. | 129 | ||
| 41. What is the ESR (erythrocyte sedimentation rate), and what does its value signify? | 129 | ||
| 42. What are some common conditions that lead to an increased ESR? | 129 | ||
| 43. What are the clinical applications of the ESR? | 129 | ||
| 44. What are the symptoms of hypoglycemia, and what is the most common cause of this condition? | 129 | ||
| 45. What three criteria must be met to diagnose hypoglycemia? | 129 | ||
| 46. What are the symptoms of hyperglycemia? | 129 | ||
| 47. What are some of the complications of hyperglycemia and long-standing diabetes? | 129 | ||
| 48. What is the average life span of platelets, and where are they produced? | 129 | ||
| 49. What are the symptoms of thrombocytopenia? | 129 | ||
| 50. What are the three major causes of thrombocytopenia? | 129 | ||
| 51. What specific clinical conditions cause thrombocytopenia? | 130 | ||
| 52. What is thrombocytosis? | 130 | ||
| 53. What are some basic facts about potassium? | 130 | ||
| 54. What factors influence K+ levels? | 130 | ||
| 55. What are the common causes of hypokalemia? | 130 | ||
| 56. What is a normal K+ level? | 130 | ||
| 57. What are common causes of hyperkalemia? | 130 | ||
| 58. What are the symptoms of hypokalemia and hyperkalemia? | 130 | ||
| 59. What is rheumatoid factor (RF)? | 130 | ||
| 60. How is RF reported? | 130 | ||
| 61. What is the human leukocyte antigen (HLA) test? | 131 | ||
| 62. What is the purpose of HLA testing? | 131 | ||
| 63. What are other functions of HLA testing? | 131 | ||
| 64. List the disease and corresponding HLA antigen. | 131 | ||
| 65. What percentage of patients with ankylosing spondylitis are HLA-B27 positive? | 131 | ||
| 66. What is C-reactive protein (CRP)? | 131 | ||
| 67. What is a normal value for CRP? | 131 | ||
| 68. What is the importance of creatine phosphokinase/creatine kinase (CPK/CK)? | 131 | ||
| 69. List some of the more common causes of CK-MM (skeletal) elevation. | 131 | ||
| 70. What are the causes of CK-MB elevation? | 131 | ||
| 71. What are the causes of CK-BB elevation? | 131 | ||
| 72. What are the general functions of sodium? | 131 | ||
| 73. What factors play a role in sodium homeostasis? | 132 | ||
| 74. What are the symptoms of hyponatremia? | 132 | ||
| 75. What are the causes of hyponatremia? | 132 | ||
| 76. How are hyponatremia and hypernatremia similar? | 132 | ||
| 77. A patient with low serum sodium levels, tachycardia, hypotension, vomiting, diarrhea, and diuretic use has what form ... | 132 | ||
| 78. A patient with low serum sodium levels, edema, CHF, cirrhosis, and renal failure has what form of hyponatremia? | 132 | ||
| 79. What are the causes of hypernatremia? | 132 | ||
| 80. List some normal laboratory values. | 132 | ||
| 81. What do these figures represent? | 133 | ||
| Bibliography | 133 | ||
| Chapter 18: Nerve Conduction Studies and Needle Electromyography | 135 | ||
| 1. What are nerve conduction studies (NCS) and needle electromyography (EMG)? | 135 | ||
| 2. What is the usefulness of NCS and needle EMG? | 135 | ||
| 3. When is it most appropriate to refer for an NCS/EMG test? | 135 | ||
| 4. What are examples of compression neuropathies and diseases of nerve and muscle that NCS/EMG studies can help identify? | 135 | ||
| 5. Define NCS terminology. | 136 | ||
| 6. Define needle EMG terminology. | 136 | ||
| 7. Define the NCS/EMG pathologic process terminology. | 136 | ||
| 8. List the normal values for nerve conduction studies. | 137 | ||
| 9. What are the limitations of NCS/EMG studies? | 137 | ||
| 10. What are the sensitivity and specificity values for NCS/EMG studies? | 137 | ||
| 11. Can myopathies as well as neuropathies be determined by an NCS/EMG study? | 138 | ||
| 12. Can neuromuscular junction disorders be determined by an NCS/EMG study? | 138 | ||
| 13. What is a somatosensory evoked potential (SSEP) study? When is SSEP appropriate? | 138 | ||
| 14. Is there any value in requesting an NCS/EMG study for a patient with a suspected nerve injury during the first 3 week... | 138 | ||
| 15. What is wallerian degeneration, and how long does it take a peripheral nerve lesion of this type to recover? | 138 | ||
| Case study | 138 | ||
| 16. From the information given previously, can you locate and describe this nerve injury and give a prognosis? | 139 | ||
| Bibliography | 139 | ||
| Chapter 19: Orthopedic Neurology | 140 | ||
| 1. What are the common myotomes tested in an upper and lower quarter screening examination? | 140 | ||
| 2. What are the common dermatomes tested in an upper and lower quarter screening examination? | 140 | ||
| 3. What are the commonly tested deep tendon reflexes? | 140 | ||
| 4. Classify the cranial nerves, their functions, and how they are tested. | 141 | ||
| 5. Define terminology describing common sensory impairments. | 143 | ||
| 6. Define the terms light touch, two-point discrimination, and stereognosis. | 143 | ||
| 7. What is the interrater and intrarater reliability of the following? | 143 | ||
| 8. Define kinesthesia versus proprioception. | 144 | ||
| 9. List some of the special neurologic tests, and explain their clinical importance. | 144 | ||
| 10. Who was Babinski? | 145 | ||
| 11. Define referred pain and radicular pain. | 145 | ||
| 12. What is a burner or a stinger? | 145 | ||
| 13. How accurate is reflex, sensory, and muscle strength testing in the diagnosis of cervical radiculopathy? | 146 | ||
| 14. What is the prognosis for individuals with cervical radiculopathy? | 146 | ||
| 15. What is the minimal clinically important difference (MCID) and minimal detectable change (MDC) for common outcome mea... | 146 | ||
| 16. What signs and symptoms are the most useful in diagnosing lumbosacral radiculopathy? | 146 | ||
| 17. What is the best strength test to determine weakness of the quadriceps in patients with known L3-L4 radiculopathy? | 146 | ||
| 18. How valuable are the Achilles tendon reflex and the Hoffmann reflex in detecting L5/S1 root compression? | 146 | ||
| 19. What is a syrinx? | 146 | ||
| 20. What is Horner syndrome? | 147 | ||
| 21. Differentiate the following common symptoms associated with vestibular disorders: dizziness, vertigo, lightheadedness... | 147 | ||
| 22. What is benign paroxysmal positional vertigo (BPPV)? What is the most common positional test to examine it, and what ... | 147 | ||
| 23. What are the diagnostic criteria, common symptoms, and prognosis for individuals with concussion or mild traumatic br... | 147 | ||
| Bibliography | 148 | ||
| Chapter 20: Clinical Research and Data Analysis | 150 | ||
| 1. What is research? | 150 | ||
| 2. What are variables? | 150 | ||
| 3. Define independent variable and dependent variable. | 150 | ||
| 4. Describe other types of variables. | 150 | ||
| 5. How accurate are measurements? | 150 | ||
| 6. Define measurement reliability. | 151 | ||
| 7. Describe statistical procedures used to estimate reliability. | 151 | ||
| 8. Define measurement validity. | 151 | ||
| 9. What is a research design? | 151 | ||
| 10. Which descriptive statistics are most useful for describing a set of data? | 151 | ||
| 11. Are the terms normal distribution, bell curve, and Gaussian distribution equivalent? | 152 | ||
| 12. Are there distributions other than a normal distribution? | 152 | ||
| 13. Can the same concepts be used with a skewed distribution; that is, are 68% of the scores within one standard deviatio... | 153 | ||
| 14. What are inferential statistics? | 153 | ||
| 15. Describe the fundamental concept of inferential statistics. | 153 | ||
| 16. How is the correct statistical test chosen? | 154 | ||
| 17. Differentiate between parametric and nonparametric statistical procedures. | 155 | ||
| 18. How is the appropriate type of statistical analysis determined? | 155 | ||
| 19. Other than intuition and clinical experience, how can the best clinical tests be identified? | 155 | ||
| 20. What is meant by sensitivity, specificity, positive predictive value, and negative predictive value? | 156 | ||
| 21. Do other performance characteristics depend on a knowledge of reality? | 156 | ||
| 22. What is the principal drawback to the PPV and NPV? | 156 | ||
| 23. Is there a way to combine the best characteristics of sensitivity, specificity, PPV, and NPV? | 157 | ||
| 24. Define the terms prevalence and incidence. | 157 | ||
| 25. Discuss risk ratios and odds ratios. | 157 | ||
| 26. Discuss how a clinician can judge the effectiveness of a treatment or prevention program. | 158 | ||
| 27. What is this type of plot called? | 159 | ||
| 28. Of the 10 studies that met the inclusion criteria for the study, how many resulted in a statistically significant dif... | 159 | ||
| 29. Was the overall analysis statistically significant? How do you know the answer from the figure alone? | 159 | ||
| 30. Which study had the most subjects? How can you tell? | 159 | ||
| 31. What is the difference between linear regression and logistic regression? | 159 | ||
| 32. Describe a situation where linear regression would be helpful. | 159 | ||
| 33. What does a linear regression equation include? | 160 | ||
| 34. How can you multiply 3.55 times the litigation variable? | 160 | ||
| 35. Describe a situation where logistic regression would be helpful. | 160 | ||
| 36. Is this how logistic regression equations are typically used? | 160 | ||
| 37. Does the same process hold true for continuous predictor variables? | 160 | ||
| 38. Describe the approach to probability proposed by Thomas Bayes. | 160 | ||
| 39. What is Bayess Theorem? | 161 | ||
| 40. How can Bayess Theorem be applied to clinical practice? | 161 | ||
| 41. Are there other uses for a Bayesian approach? | 161 | ||
| Bibliography | 161 | ||
| Chapter 21: Evidence-Based Practice | 163 | ||
| 1. Define the terms evidence-based medicine (EBM) and evidence-based practice (EBP). | 163 | ||
| 2. What does it mean to practice EBP? | 163 | ||
| 3. Define the different study types in a hierarchical manner. | 163 | ||
| 4. Why are randomized controlled trials considered the `high-level evidence in studies of treatment effectiveness? | 164 | ||
| 5. What is a systematic review? | 164 | ||
| 6. What is a meta-analysis? | 164 | ||
| 7. What are common databases used to access evidence related to clinically generated questions? | 164 | ||
| 8. What does it mean to `push the evidence? | 165 | ||
| 9. What is a gold standard versus a reference standard in a study of a diagnostic test? | 165 | ||
| 10. How is the pretest probability determined? | 165 | ||
| 11. What is the difference between a positive likelihood ratio (+LR) and a negative likelihood ratio (-LR)? | 165 | ||
| 12. What is meant by the terms ``SnNouts´´ and ``SpPins´´? | 165 | ||
| 13. What are the advantages of sensitivity, specificity, and likelihood ratios over the concept of predictive values (pos... | 165 | ||
| 14. What is a clinical prediction rule (CPR) or clinical decision rule CPD? | 166 | ||
| 15. What are some examples of clinical prediction rules (CPRs) for diagnosis? | 166 | ||
| 16. What is an example of a clinical prediction rule (CPR) for determining the likely response to treatment in an individ... | 166 | ||
| 17. When should we accept a clinical prediction rule (CPR) or clinical decision rule (CDR) as validated? | 166 | ||
| 18. What is comparative effectiveness (CE)? | 166 | ||
| 19. What is a clinical practice guideline (CPG)? | 167 | ||
| 20. What are levels of evidence for primary research questions? | 167 | ||
| 21. What is a grade of recommendation? | 168 | ||
| 22. What are registries? | 169 | ||
| 23. What are levels of data? | 169 | ||
| Bibliography | 169 | ||
| Chapter 22: Sports Medicine and Concussion Management | 172 | ||
| 1. How are different degrees of sprains classified? | 172 | ||
| 2. How are brachial plexus lesions classified? | 172 | ||
| 3. Is it dangerous for children and adolescents to lift weights? | 172 | ||
| 4. Describe a good youth strength training program. | 172 | ||
| 5. What is the appropriate initial treatment for someone with an acute sports injury? | 172 | ||
| 6. List general criteria for return to sport activity. | 172 | ||
| 7. Describe the miserable malalignment of the lower extremity. | 173 | ||
| 8. Why do females sustain so many noncontact ACL injuries? | 173 | ||
| 9. How are contusions treated? | 173 | ||
| 10. Name the most common mechanisms of injury in football resulting in permanent cervical quadriplegia. | 173 | ||
| 11. How is the transmission of pathogens such as HIV and hepatitis prevented? | 173 | ||
| 12. List injuries that may occur from a fall on an outstretched hand. | 174 | ||
| 13. How can a stress fracture of the femoral neck be identified? | 174 | ||
| 14. What is the most common athletic injury to the ankle, and what structures are involved? | 174 | ||
| 15. Describe three functional tests that can be used to decide return to sport after anterior cruciate ligament injury. | 174 | ||
| 16. What is the limb symmetry index (LSI)? | 174 | ||
| 17. List some physiologic changes that occur to the aging athlete. | 174 | ||
| 18. Are the aforementioned physiologic changes a natural part of aging? | 175 | ||
| 19. What value does athletic tape provide to a joint? | 175 | ||
| 20. What is kinesiology tape and what is its use? | 175 | ||
| 21. Describe the female athlete triad. | 175 | ||
| 22. List potential side effects of anabolic-androgenic steroid use. | 175 | ||
| 23. List the symptoms, presentation, and treatment of heat exhaustion and heat stroke. | 176 | ||
| 24. What actions can be taken to prevent heat exhaustion and heat stroke? | 176 | ||
| 25. Is extra protein needed when participating in athletics? | 176 | ||
| 26. List examples of foods that contain 10g of protein. | 176 | ||
| 27. What is glucosamine, and what is it used for? | 176 | ||
| 28. What is chronic compartment syndrome? | 177 | ||
| 29. List treatment options for chronic compartment syndrome. | 177 | ||
| 30. Why might an athlete collapse on the field? | 177 | ||
| 31. What is exercise-induced asthma (EIA)? | 177 | ||
| 32. What is a concussion? | 178 | ||
| 33. How does a concussion occur? | 178 | ||
| 34. What are the signs and symptoms of a concussion? | 178 | ||
| 35. What is the incidence of concussion for males and females in the United States? | 179 | ||
| 36. What is the concussion incidence in various sports? | 179 | ||
| 37. Do helmets and mouth guards decrease concussions? | 179 | ||
| 38. What type of quick ``on the field´´ testing can be done by a trained professional to determine the presence of concus... | 179 | ||
| 39. If a concussion is suspected, what are the guidelines regarding immediate and long-term return to play? | 180 | ||
| 40. What are the recommendations related to cognitive rest after a concussion? | 180 | ||
| 41. What types of advanced assessments or neuropsychological testing can be administered to identify concussion? | 181 | ||
| 42. Should neuroimaging be used to diagnose a concussion? | 181 | ||
| 43. What is the standard of care regarding return to play for an individual who has suffered multiple concussions? | 181 | ||
| 44. Should medications be administered to individuals suffering from a concussion? | 181 | ||
| 45. Is headache common after a concussion, and how is it treated? | 181 | ||
| Bibliography | 182 | ||
| Chapter 23: Differential Diagnosis and Clinical Reasoning | 183 | ||
| 1. What is a diagnosis, and what is a differential diagnosis? | 183 | ||
| 2. What are examples of impairments that a physical therapist might diagnose? | 183 | ||
| 3. What are characteristics of visceral symptoms? | 183 | ||
| 4. What are somatic disorders? | 183 | ||
| 5. What are characteristics of somatic symptoms? | 184 | ||
| 6. What are radicular disorders? | 184 | ||
| 7. What is a key characteristic of radicular symptoms? | 184 | ||
| 8. What is the difference between radicular referred symptoms and somatic referred pain accompanying a radicular disorder? | 184 | ||
| Screening for systemic involvement | 184 | ||
| 9. Why do physical therapists need to screen for systemic involvement? | 184 | ||
| 10. List common body systems and aggregates of signs/symptoms that may indicate systemic involvement. | 185 | ||
| 11. What are examples of common ``red flags´´ that typically require physician referral and further investigation? | 186 | ||
| Cardiovascular | 186 | ||
| 12. True or false: Pain referral patterns associated with myocardial infarction (MI) are the same for men and women. | 186 | ||
| 13. What are silent heart attacks, and who do they commonly affect? | 186 | ||
| 14. For myocardial infarctions associated with a blood clot, what time frame for the administration of medications that d... | 186 | ||
| 15. What are typical pain referral patterns for the heart? | 187 | ||
| 16. What signs and symptoms are commonly associated with cardiac pathology? | 189 | ||
| 17. What are cardiac red flags? | 189 | ||
| 18. What subjective questions should be asked when cardiac dysfunction is suspected? | 189 | ||
| 19. List common musculoskeletal disorders that mimic cardiovascular pain patterns. | 189 | ||
| Pulmonary | 189 | ||
| 20. Describe the clinical signs and symptoms of acute pleuritis. | 189 | ||
| 21. How does pulmonary function change with obstructive and restrictive pulmonary disorders? | 189 | ||
| 22. What are typical pain referral patterns for the lungs? | 189 | ||
| 23. What signs and symptoms are commonly associated with pulmonary pathology? | 191 | ||
| 24. What are pulmonary red flags? | 191 | ||
| 25. What subjective questions should be asked when pulmonary dysfunction is suspected? | 191 | ||
| 26. List common musculoskeletal disorders that mimic pulmonary pain patterns. | 191 | ||
| Integumentary | 192 | ||
| 27. What signs and symptoms are commonly associated with integumentary system pathology? | 192 | ||
| 28. List common nail abnormalities and probable causes. | 192 | ||
| 29. What are integumentary system red flags? | 192 | ||
| 30. What subjective questions should be asked when integumentary system pathology is suspected? | 192 | ||
| 31. True or false: Malignant melanomas arise from melanocytes in moles. | 193 | ||
| 32. What is the integumentary presentation of herpes zoster (shingles)? | 193 | ||
| 33. Describe the signs and symptoms of dysvascular and neuropathic foot ulcer. | 193 | ||
| 34. What are the key characteristics of cellulitis? | 193 | ||
| Gastrointestinal | 193 | ||
| 35. What is the most common intraabdominal disease referring pain to the musculoskeletal system? | 193 | ||
| 36. How quickly do drug-induced symptoms occur in the GI tract? | 193 | ||
| 37. What are typical pain patterns for GI pathologies? | 193 | ||
| 38. What signs and symptoms are commonly associated with esophageal pathologies? | 193 | ||
| 39. What signs and symptoms are commonly associated with stomach and duodenal pathologies? | 193 | ||
| 40. What signs and symptoms are commonly associated with small intestine pathologies? | 194 | ||
| 41. What signs and symptoms are commonly associated with large intestine and colon pathologies? | 194 | ||
| 42. What signs and symptoms are commonly associated with pancreatic pathologies? | 194 | ||
| 43. What subjective questions should be asked when GI pathology is suspected? | 194 | ||
| 44. What are GI red flags? | 194 | ||
| 45. List common musculoskeletal disorders that mimic GI disorders. | 194 | ||
| 46. What is the McBurney point, and what is its significance? | 194 | ||
| 47. List the structures contained in each of the four abdominal quadrants. | 194 | ||
| RENAL | 195 | ||
| 48. List the common signs and symptoms associated with chronic renal failure. | 195 | ||
| 49. What is the costovertebral angle, and what is its significance? | 195 | ||
| 50. What are the two most common urinary tract infections? | 195 | ||
| 51. What is a key feature that typically distinguishes a radicular disorder from renal pain? | 195 | ||
| 52. List common clinically observable signs and symptoms of chronic renal disease. | 195 | ||
| 53. What are typical pain patterns for renal pathologies? | 195 | ||
| 54. What signs and symptoms are commonly associated with renal pathologies? | 195 | ||
| 55. What are renal red flags? | 195 | ||
| 56. What subjective questions should be asked when renal pathology is suspected? | 196 | ||
| 57. List common musculoskeletal disorders that mimic renal disorders. | 196 | ||
| Hepatic and Biliary | 196 | ||
| 58. What musculoskeletal signs or symptoms may be associated with hepatic and biliary dysfunction? | 196 | ||
| 59. What are typical pain patterns of the hepatic and biliary systems? | 196 | ||
| 60. What signs and symptoms are commonly associated with hepatic and biliary system pathologies? | 197 | ||
| 61. What are hepatic and biliary system red flags? | 197 | ||
| 62. What subjective questions should be asked when hepatic and biliary system pathology is suspected? | 198 | ||
| 63. List common musculoskeletal disorders that mimic hepatic and biliary disorders. | 198 | ||
| Hematology | 198 | ||
| 64. List the common disorders of erythrocytes, leukocytes, and platelets. | 198 | ||
| 65. List the signs and symptoms of polycythemia (increased red blood cell mass). | 198 | ||
| 66. List the common disorders or conditions that elevate red blood cell levels. | 198 | ||
| 67. List the signs and symptoms of leukocytosis (increased white blood cell count). | 198 | ||
| 68. List the common disorders or conditions that elevate white blood cell levels. | 198 | ||
| 69. List the signs and symptoms of anemia (decreased red blood cell levels). | 198 | ||
| 70. List the common disorders or conditions that lower red blood cell levels. | 198 | ||
| 71. List the signs and symptoms of leukopenia (decreased white blood cell levels). | 198 | ||
| 72. List the common disorders or conditions that lower white blood cell levels. | 199 | ||
| 73. What are the hematologic red flags? | 199 | ||
| 74. What subjective information should be obtained when hematologic pathologies are suspected? | 199 | ||
| 75. List three early signs and symptoms of anemia. | 199 | ||
| Endocrine and metabolic disorders | 199 | ||
| 76. What are two primary life-threatening metabolic conditions that can develop if uncontrolled or untreated diabetes mel... | 199 | ||
| 77. What two patient types may exhibit orthostatic hypotension because of slight dehydration, especially when intense exe... | 199 | ||
| 78. What signs and symptoms are commonly associated with endocrine system pathologies? | 199 | ||
| 79. What are the endocrine system red flags? | 199 | ||
| 80. What red flags are associated with metabolic disorders? | 200 | ||
| 81. What subjective information should be obtained when endocrine system pathology is suspected? | 201 | ||
| 82. List common musculoskeletal disorders that mimic endocrine system disorders. | 201 | ||
| 83. What are the four principal classifications of immunologic disorders? | 201 | ||
| 84. Name the only disease known to directly attack the human immune system. | 201 | ||
| 85. How are hypersensitivity disorders classified? | 201 | ||
| 86. What neurologic disorders may be associated with immune system dysfunction? | 201 | ||
| 87. List examples of autoimmune disorders. | 201 | ||
| 88. What signs and symptoms are commonly associated with pathologies of the immunologic system? | 202 | ||
| 89. What are the immunologic red flags? | 203 | ||
| 90. What are other musculoskeletal causes of pain that must be differentially diagnosed from an immunologic disorder? | 203 | ||
| Clinical reasoning | 203 | ||
| 91. Do knowledge, efficiency of data collection, and data interpretation improve with experience? | 203 | ||
| 92. Why do errors in clinical reasoning occur? | 203 | ||
| 93. What is deductive reasoning? | 203 | ||
| 94. What are examples of deductive reasoning errors? | 203 | ||
| 95. What is inductive reasoning? | 203 | ||
| 96. What are examples of inductive reasoning errors? | 203 | ||
| 97. What is iterative hypothesis testing? | 203 | ||
| 98. Give an example of iterative hypothesis testing based on a patients perception of illness. | 204 | ||
| 99. List common errors or biases in clinical reasoning and a potential consequence of the error or bias. | 204 | ||
| 100. What are the ultimate consequences of clinical decision-making errors? | 205 | ||
| 101. What are some examples from within the literature of evidence-based practices that may lead to errors in clinical re... | 205 | ||
| 102. What is an example of a clinical prediction rule? | 205 | ||
| 103. Why does the previous example provide a context for a potential error in clinical reasoning? | 205 | ||
| Bibliography | 206 | ||
| Chapter 24: Special Tests for Medical Screening | 208 | ||
| 1. Why is medical screening necessary? | 208 | ||
| 2. When positive screening results are found, what are the red flags versus the yellow flags? | 208 | ||
| 3. A therapist screens systemic origins of a patients signs and symptoms by considering pain referral, patient history, a... | 208 | ||
| 4. Therapists must be aware of certain pathologies and their associated sites of pain referral. List the sites of referra... | 208 | ||
| 5. List the organs and their respective locations in the abdominal quadrants. | 210 | ||
| 6. What are the components of the physical examination in the abdominal region when screening for visceral disorders? | 211 | ||
| 7. What types of percussive sounds can be heard in the body? | 211 | ||
| 8. What are the specific qualities elicited by palpation? | 212 | ||
| 9. Describe the special tests for palpation and percussion of the liver in an adult. | 212 | ||
| 10. How strong is the evidence to support the tests for palpation and percussion of the liver? | 213 | ||
| 11. What is Murphys sign and how is it performed? | 213 | ||
| 12. Name and describe palpation and percussion tests to assess for splenomegaly. | 213 | ||
| 13. In isolation, palpation and percussion tests for splenomegaly have minimal evidence to support their use and predicti... | 214 | ||
| 14. Name and describe palpation and percussion tests to assess for the kidney. | 214 | ||
| 15. What structure(s) would be involved if a patient has a positive Murphys percussion test, and how confident can a ther... | 215 | ||
| 16. What are the clinical findings related to appendicitis and the medical screens that would be utilized? | 215 | ||
| 17. Where is McBurneys point and what does tenderness to palpation of this area indicate? | 216 | ||
| 18. What is Alvarados score and what diagnostic utility does it have? | 216 | ||
| 19. What are the clinical signs and causes of an iliopsoas (liacus or psoas) abscess, and what tests can be used to scree... | 216 | ||
| 20. In addition to the iliopsoas muscle, what muscle test might be painful in the presence of appendicitis or peritonitis... | 216 | ||
| 21. What is the normal size of the aorta? | 217 | ||
| 22. Describe the palpation and auscultation techniques to assess for an abdominal aortic aneurysm, and discuss the findin... | 217 | ||
| 23. What are Wells criteria for a pulmonary embolism? How confident are you in using this test? | 217 | ||
| 24. List the Framingham criteria for heart failure. | 217 | ||
| 25. When should a therapist auscultate for bowel sounds, and what are the normal findings? | 218 | ||
| 26. Which test uses a tuning fork to assess for fractures, and how confident can you be that they are accurate? | 218 | ||
| Bibliography | 218 | ||
| Chapter 25: Pediatric Orthopaedic Physical Therapy | 220 | ||
| 1. List the common developmental milestones. | 220 | ||
| 2. Describe the normal progression of lower extremity alignment in children. | 220 | ||
| 3. When do children develop an adult gait pattern? | 220 | ||
| 4. What lower extremity changes normally occur with growth? | 220 | ||
| 5. What are growing pains? | 220 | ||
| 6. Name the standardized tests commonly used in pediatric physical therapy. When are they useful? | 220 | ||
| 7. How early can children benefit from using a wheelchair or powered mobility? | 221 | ||
| 8. What is the role of physical therapy for children with torticollis? | 221 | ||
| 9. What is deformational plagiocephaly? | 222 | ||
| 10. Is developmental dysplasia of the hip (DDH) the same as congenital dislocation of the hip (CDH)? | 222 | ||
| 11. Describe the classic tests used to evaluate DDH. | 222 | ||
| 12. How is DDH treated? | 222 | ||
| 13. What is the role of physical therapy in the treatment of DDH? | 223 | ||
| 14. What are the various types and causes of clubfoot? | 223 | ||
| 15. What are the components of a clubfoot (talipes equinovarus)? | 223 | ||
| 16. How are physical therapists involved in treating children with congenital clubfoot? | 223 | ||
| 17. What is brachial plexus palsy (BPP) in infants? | 223 | ||
| 18. How is BPP treated? | 223 | ||
| 19. What actions can be taken to make a baby move its arms to test for BPP? | 224 | ||
| 20. Can physical therapy to reduce spasticity improve function in children with cerebral palsy? | 224 | ||
| 21. What are some methods of addressing spasticity medically? | 224 | ||
| 22. What is Gowers sign or maneuver? | 224 | ||
| 23. Define osteochondritis dissecans (OCD). | 224 | ||
| 24. What tests are useful for the diagnosis of OCD? | 224 | ||
| 25. How is OCD treated? | 225 | ||
| 26. What is Osgood-Schlatter disease? | 225 | ||
| 27. How is Osgood-Schlatter disease treated? | 225 | ||
| 28. What is Legg-Calvé-Perthes (LCP) disease? | 225 | ||
| 29. How is LCP disease treated? | 225 | ||
| 30. What type of individual is most likely to suffer from a slipped capital femoral epiphysis (SCFE)? | 225 | ||
| 31. Describe the treatment for SCFE. | 226 | ||
| 32. What conditions can affect the young baseball pitcher? | 226 | ||
| 33. What is a pectus excavatum (funnel chest) indicative of in a child? | 226 | ||
| 34. What is nursemaids elbow? | 226 | ||
| 35. How do growth plate injuries in children occur? | 226 | ||
| 36. What is the occurrence of scoliosis in youth? | 227 | ||
| 37. What is Severs disease? | 227 | ||
| 38. What is Blounts disease (tibia varum)? | 227 | ||
| 39. What is metatarsus adductus? | 227 | ||
| 40. What is flexible pes planus? | 227 | ||
| 41. What are two common causes of rigid pes planus? | 227 | ||
| 42. Are orthotics useful for the correction of foot/gait deviations in children? | 228 | ||
| 43. What are the considerations for prosthetic use in children with limb deformities or amputation? | 228 | ||
| 44. What is arthrogryposis multiplex congenita (AMC)? | 228 | ||
| 45. What is osteogenesis imperfecta (OI)? | 228 | ||
| Bibliography | 228 | ||
| Chapter 26: Womens Health and Pelvic Floor Physical Therapy | 231 | ||
| 1. What musculoskeletal changes occur as a result of pregnancy? | 231 | ||
| 2. What cardiovascular changes occur as a result of pregnancy? | 231 | ||
| 3. How long after delivery do these values remain changed? | 231 | ||
| 4. What respiratory changes occur during pregnancy? | 231 | ||
| 5. What physical therapy techniques and positions are contraindicated in pregnant clients? | 231 | ||
| 6. What modalities can be applied and what contraindications and precautions must be considered? | 232 | ||
| 7. What guidelines should be followed for exercise during pregnancy? | 232 | ||
| 8. Can a woman participate in aerobic exercise during pregnancy? | 232 | ||
| 9. What are some characteristics of pregnancy-related back pain? | 232 | ||
| 10. What is diastasis rectus abdominis (DRA), and what causes it? | 232 | ||
| 11. How is DRA diagnosed or measured? | 233 | ||
| 12. Why is DRA significant, and what problems can it cause? | 233 | ||
| 13. What can be done to treat DRA? | 233 | ||
| 14. What causes symphyseal pain, and what signs and symptoms may be noted? | 233 | ||
| 15. What is the most effective treatment for pubic symphysis pain? | 233 | ||
| 16. What is meralgia paresthetica? | 233 | ||
| 17. How is meralgia paresthetica treated? | 233 | ||
| 18. Describe the structure and function of the pelvic floor. | 234 | ||
| 19. What causes pelvic floor dysfunction? | 234 | ||
| 20. How is pelvic floor muscle function assessed? | 234 | ||
| 21. Define pelvic organ prolapse. | 234 | ||
| 22. How is physical therapy involved in treating pelvic organ prolapse? | 234 | ||
| 23. What patient population is most at risk for pelvic organ prolapse? | 234 | ||
| 24. Describe the five types of incontinence. | 235 | ||
| 25. Describe physical therapy treatment for incontinence. | 235 | ||
| 26. Is urinary incontinence common in the nulliparous female athlete? | 235 | ||
| 27. What are the expected outcomes of physical therapy for incontinence? | 235 | ||
| 28. What interventions can physical therapists use to address pelvic pain? | 235 | ||
| 29. Define delayed menarche and why this is relevant to physical therapy. | 235 | ||
| 30. Define oligomenorrhea and amenorrhea. | 235 | ||
| 31. What are some of the causes of oligomenorrhea and amenorrhea? | 235 | ||
| 32. Define lymphedema. | 235 | ||
| 33. Describe the treatment for lymphedema. | 236 | ||
| 34. What is the female athletic triad? | 236 | ||
| 35. How can the female athletic triad be addressed? | 236 | ||
| 36. What specific nutritional deficiencies should be considered in cases of female athletic triad? | 236 | ||
| 37. Define osteoporosis. | 236 | ||
| 38. How can a female athlete develop osteoporosis? | 236 | ||
| 39. Describe the common causes of osteoporosis. | 236 | ||
| 40. What methods are used for the diagnosis of osteoporosis? | 236 | ||
| 41. What are the three types of osteoporosis? | 237 | ||
| 42. Are radiographs useful in the diagnosis of osteoporosis? | 237 | ||
| 43. Why is exercise important in the treatment of osteoporosis? | 237 | ||
| 44. Which bones are most commonly affected? | 237 | ||
| 45. What type exercise is ideal for individuals with osteoporosis? | 237 | ||
| 46. What other types of activities are effective for individuals with osteoporosis? | 237 | ||
| 47. Why does the risk of heart attack and stroke begin to increase after menopause? | 237 | ||
| 48. What is postprostatectomy incontinence? | 237 | ||
| 49. What physical therapy interventions can address postprostatectomy incontinence? | 238 | ||
| 50. What is male pelvic pain? | 238 | ||
| 51. What physical therapy interventions can address male pelvic pain? | 238 | ||
| Bibliography | 238 | ||
| Chapter 27: Functional Movement Screening and Selective Functional Movement Assessment | 241 | ||
| 1. What is the functional movement screen (FMS)? | 241 | ||
| 2. Are there any additional tests associated with the FMS? | 241 | ||
| 3. When should you use the FMS? | 241 | ||
| 4. What is the most important test in the FMS? | 242 | ||
| 5. How reliable is the FMS? | 242 | ||
| 6. Is the FMS able to predict injury? | 242 | ||
| 7. Can a guided rehabilitation that is influenced by the findings of the FMS reduce injuries? | 242 | ||
| 8. What is the selective functional movement screen (SFMA)? | 242 | ||
| 9. What is the theory behind the SFMA? | 243 | ||
| 10. What is the difference between the SFMA and FMS? | 243 | ||
| 11. What are the key concepts of the SFMA? | 243 | ||
| 12. Provide an example of an SFMA breakout. | 243 | ||
| 13. How is the SFMA scored? | 244 | ||
| 14. What is the SMFA philosophy regarding the treatment of painful movements? | 244 | ||
| 15. What is mobility-based impairment? | 244 | ||
| 16. What is a stability-based impairment? | 244 | ||
| 17. What is the purpose of the fundamental rolling assessments used in the SFMA? | 244 | ||
| 18. What are the fundamental rolling assessments used in the SFMA? | 245 | ||
| 19. What is the intra- and interrater reliability of the SFMA? | 245 | ||
| Bibliography | 245 | ||
| Chapter 28: Management of Chronic Pain | 247 | ||
| 1. What is the cost of chronic pain? | 247 | ||
| 2. Can chronic pain be prevented? | 247 | ||
| 3. Define preemptive analgesia. | 247 | ||
| 4. How does the response of the central nervous system contribute to the genesis of chronic pain? | 247 | ||
| 5. Do continuous analgesic infusions prevent early recognition of posttraumatic compartment syndromes? | 247 | ||
| 6. If no pain relief is obtained by sympathetic block, can the diagnosis still be sympathetically maintained pain? | 247 | ||
| 7. Is chronic neuropathic pain peripheral or central in origin? | 248 | ||
| 8. Why do muscles ache? | 248 | ||
| 9. How do trigger points differ from chronic muscle tenderness secondary to fibromyalgia? | 248 | ||
| 10. What causes trigger points? | 248 | ||
| 11. Why are trigger points painful? | 248 | ||
| 12. Can physical manipulation affect the healing process after muscle injury? | 248 | ||
| 13. How can trigger points induce sympathetic overactivity? | 249 | ||
| 14. When does the inflammatory cascade cease to be useful after musculoskeletal injury? | 249 | ||
| 15. Can corticosteroids interfere with healing? | 249 | ||
| 16. Can exercise targeted at specific defects be effective in the treatment of chronic low back pain? | 249 | ||
| 17. Which patients with low back pain derive the greatest long-term benefits from physical therapy? | 249 | ||
| 18. Does evidence support physical therapy for acute low back pain? | 249 | ||
| 19. Are exercise programs helpful? | 249 | ||
| 20. Should nerve blocks be used to facilitate physical therapy in patients with chronic pain? | 249 | ||
| 21. When are physical measures needed after trigger point injections? | 250 | ||
| 22. Why does stretching promote healing of trigger points? | 250 | ||
| 23. What measures effectively facilitate trigger point stretching? | 250 | ||
| 24. How can trigger point injections abolish pain at sites distal to the injection? | 250 | ||
| 25. What circumstances require the application of regional local anesthetic blockade? | 250 | ||
| 26. Discuss the role of sympathetic blocks. | 250 | ||
| 27. What physical therapy treatments are helpful in conjunction with invasive therapy for chronic pain? | 250 | ||
| 28. Is physical therapy important after intradiscal electrothermal therapy? | 251 | ||
| 29. What exercise programs are effective in chronic pain patients? | 251 | ||
| 30. What are the essential elements in the physical therapists evaluation of patients with chronic pain? | 251 | ||
| 31. Can a disparity between self-report and objective measures be documented? | 251 | ||
| 32. Which medications are appropriate for chronic pain? | 251 | ||
| 33. Discuss the role of perineural steroids in pain management. | 252 | ||
| 34. What is chronic regional pain syndrome (CRPS)? | 252 | ||
| 35. What is the difference between CRPS types I and II? | 252 | ||
| 36. What is the treatment for CRPS II? | 252 | ||
| 37. What is the treatment for CRPS type I? | 252 | ||
| 38. What radiographic changes are seen with CRPS? | 252 | ||
| Bibliography | 252 | ||
| Chapter 29: Cervical Headache | 254 | ||
| 1. Describe the basic categories of headache and their clinical presentation. | 254 | ||
| 2. What is the epidemiology of cervicogenic headache? | 255 | ||
| 3. Describe the symptoms of cervical headache. | 255 | ||
| 4. How are cervical headaches precipitated? | 256 | ||
| 5. Discuss the neuroanatomic basis for cervicogenic headache. | 256 | ||
| 6. Which structures facilitate synapsis of afferent information to the trigeminocervical nucleus? | 257 | ||
| 7. Describe the anatomy of the posterior neck musculature, C2 sensory nerve root, and occipital notch. | 257 | ||
| 8. What do cervical radiographs show in patients with headache? | 257 | ||
| 9. What is the gold standard for diagnosis of cervical headache? | 257 | ||
| 10. List important differential diagnoses of cervicogenic headache. | 257 | ||
| 11. How do poor posture and muscle impairment contribute to cervical headache? | 257 | ||
| 12. What types of physical therapy are useful in reduction of cervical headache? | 257 | ||
| 13. What exercises are believed to be of most benefit for the headache patient? | 258 | ||
| 14. What does the evidence illustrate regarding manipulative therapy and/or therapeutic exercise for cervicogenic headache? | 258 | ||
| 15. Are there predictors of responsiveness to physical therapy treatment on cervicogenic headache? | 258 | ||
| 16. What other nontherapy treatments are there for cervicogenic headache? | 258 | ||
| 17. What do systematic reviews reveal in management of cervicogenic headache with physical therapy and/or manual therapies? | 258 | ||
| 18. List similarities/differences in distinguishing cervicogenic headache from migraine with aura. | 258 | ||
| Bibliography | 258 | ||
| Chapter 30: Functional Capacity Testing and Industrial Injury Treatment | 260 | ||
| 1. What are the types of functional evaluations used for assessing work capacity? | 260 | ||
| 2. When should FCEs be performed? | 260 | ||
| 3. How is a functional capacity examination (FCE) used? | 260 | ||
| 4. What are the typical components of an FCE? | 260 | ||
| 5. What other areas are covered? | 260 | ||
| 6. Does an FCE have a role in legal disability cases? | 260 | ||
| 7. How should pain be reported in an FCE? | 261 | ||
| 8. Could a client stop performing in an FCE if he or she did not want to participate? | 261 | ||
| 9. Are FCEs and JSTs medical tests? | 261 | ||
| 10. What reliability and validity measures should be applied to functional evaluations? | 261 | ||
| 11. What type of functional evaluation is best for hiring and placing workers at their job? | 261 | ||
| 12. Can a JST be used in return to work? | 261 | ||
| 13. What are the therapeutic interventions that either keep the injured/ill worker at work or can move the worker toward ... | 261 | ||
| 14. What are the eligibility requirements for work conditioning or work hardening? | 262 | ||
| 15. How does a therapist obtain cooperation from a client who is not working toward the program goals? | 262 | ||
| 16. If a worker cannot meet the physical demands of work after an FCE or work rehabilitation program, what are the options? | 262 | ||
| 17. What are the major outcome measures for work rehabilitation? | 262 | ||
| 18. How should a therapist evaluate the advantages and disadvantages of proprietary FCEs and JSTs? | 262 | ||
| Bibliography | 263 | ||
| Chapter 31: Anatomy Mnemonics | 265 | ||
| 1. What is a mnemonic? | 265 | ||
| 2. Can I make up my own mnemonics? | 265 | ||
| 3. What is the military saying for shoulder muscles? | 265 | ||
| 4. What is SALSAP? | 265 | ||
| 5. How do elephants serve as a memory tool? | 265 | ||
| 6. What does B+B=A mean? | 265 | ||
| 7. How can the arrangement of structures in the cubital fossa be remembered? | 266 | ||
| 8. What is the area code for carpal country? | 266 | ||
| 9. Is it true that the most risqué mnemonics relate to the carpal bones? | 266 | ||
| 10. Moving on to the thorax, if I go cruising in my VAN, where would I be? | 266 | ||
| 11. Is LARP a radio station in California? | 266 | ||
| 12. How many birds reside in the (thoracic) cage? | 266 | ||
| 13. What does the formula S+S=P mean? | 267 | ||
| 14. What does SCALP tell you about the head and neck? | 267 | ||
| 15. Is there an easy way to remember the terminal branches of the facial nerve? | 267 | ||
| 16. What can help me remember the cranial nerves? | 267 | ||
| 17. What is the formula for remembering the nerve supply to the seven muscles of the orbit? | 267 | ||
| 18. Are there any slick mnemonics for the back and lower limbs? | 267 | ||
| 19. Is poetry ever used to assist in recall of anatomic facts? | 268 | ||
| 20. What does the phrase ``say grace before tea´´ stand for? | 268 | ||
| 21. Who are Tom, Dick, and A Very Nervous Harry? | 268 | ||
| 22. What are the branches of the brachial plexus from lateral to medial? Remember, ``My Aunt Ravaged My Uncle.´´ | 268 | ||
| 23. What nerve roots comprise the long thoracic nerve that innervates the serratus anterior? | 268 | ||
| 24. What is the innervation of the pectoral muscles? Remember, ``lateral is less and medial is more.´´ | 268 | ||
| 25. How do you remember the results of peroneal and tibial nerve injury? Remember ``PED and TIP.´´ | 268 | ||
| 26. What is the relationship of the suprascapular artery and nerve at the suprascapular notch? | 268 | ||
| 27. Remembering the formation of the brachial plexus: | 268 | ||
| 28. Remembering the infraclavicular branches arising off the brachial plexus: | 269 | ||
| 29. Remembering nerve supply to sternocleidomastoid and trapezius: | 269 | ||
| 30. You would rather eat lamb before mutton. | 269 | ||
| 31. Remembering the actions of palmer and dorsal interossei: | 269 | ||
| 32. Remembering the segmental innervation of sciatic, tibial, and common fibular (peroneal) nerves: | 269 | ||
| 33. Remember AchilleS only had one weak spot. | 269 | ||
| Chapter 32: Nutrition | 271 | ||
| 1. What are the dietary guidelines for Americans? | 271 | ||
| 2. Describe the Ornish low-fat diet. What does it claim to do? | 271 | ||
| 3. What are the possible problems that may result from being on a very low-fat diet? | 271 | ||
| 4. Briefly describe the Atkins diet. What does it claim to do? | 271 | ||
| 5. According to most traditional nutritional professionals, why do high-protein and high fat diets cause weight loss? | 271 | ||
| 6. What are the possible side effects of a high protein, high fat diet? | 272 | ||
| 7. Is there a difference in the adherence rates between the Atkins, Ornish, and Weight Watchers? | 272 | ||
| 8. When would the recommendation for bariatric surgery be appropriate? | 272 | ||
| 9. What does a typical American diet consist of? | 272 | ||
| 10. What type of diet is most effective for long-term weight loss? | 272 | ||
| 11. Why lower sodium intake? | 272 | ||
| 12. Does soy protein decrease the risk of developing cardiovascular disease? | 272 | ||
| 13. Do antioxidant supplements decrease the risk of developing cardiovascular disease? | 273 | ||
| 14. Do folic acid, vitamin B6, and vitamin B12 decrease the risk of developing cardiovascular disease? | 273 | ||
| 15. Do omega-3 fatty acids alter mortality rate, incidence of a cardiovascular events, or cancer? | 273 | ||
| 16. Do folate supplements decrease the incidence of neural tube defects? | 273 | ||
| 17. Do folic acid supplements with or without vitamin B12 supplements improve cognitive function or mood? | 273 | ||
| 18. What are the health benefits of adding fiber to the diet? | 273 | ||
| 19. Do calcium supplements increase bone density in postmenopausal women? | 273 | ||
| 20. A Mediterranean diet may be helpful in managing which medical condition? | 273 | ||
| 21. How should the daily recommended percentages of carbohydrate, fat, and protein intake be altered during heavy training? | 274 | ||
| 22. Should athletes consume additional protein when they are in training? | 274 | ||
| 23. Does carbohydrate consumption affect the amount of muscle growth? | 274 | ||
| 24. What is the primary factor that determines whether carbohydrates, fats, or proteins are metabolized during a bout of ... | 274 | ||
| 25. Do creatine supplements improve an athletes performance? | 274 | ||
| 26. What are the side effects of creatine supplementation? | 274 | ||
| Bibliography | 274 | ||
| Chapter 33: Dry Needling | 277 | ||
| 1. What is dry needling (DN)? | 277 | ||
| 2. How does DN differ from wet needling? | 277 | ||
| 3. What is the difference between DN and acupuncture? | 277 | ||
| 4. What are the proposed theories of how DN works? | 277 | ||
| 5. What is the current evidence regarding the effectiveness of DN? | 278 | ||
| 6. What is a trigger point? | 278 | ||
| 7. What is a local twitch response (LTR)? | 278 | ||
| 8. What is the reliability of finding a TP? | 278 | ||
| 9. What are the current practice requirements for a physical therapist to perform DN? | 278 | ||
| 10. What is the incidence of adverse events (AEs) when performing DN? | 278 | ||
| 11. What are the precautions to TDN? | 278 | ||
| 12. What are the absolute contraindications to TDN? | 279 | ||
| 13. Describe a general protocol when performing TDN. | 279 | ||
| 14. What types of needles/supplies are required to perform TDN? | 279 | ||
| Bibliography | 279 | ||
| Chapter 34: Isokinetic Testing and Exercise | 283 | ||
| 1. What do isokinetic devices do? | 283 | ||
| 2. What are the advantages of isokinetic devices? | 283 | ||
| 3. What are the contraindications to isokinetic testing or exercising? | 283 | ||
| 4. When is it safe to perform isokinetic testing after surgical repair? | 283 | ||
| 5. What parameters are commonly used for the assessment of isokinetic data? | 284 | ||
| 6. How are isokinetic data commonly interpreted and analyzed? | 284 | ||
| 7. Describe the evaluation of isokinetic data relative to normative data. | 285 | ||
| 8. Is there value in using isokinetic testing to document strength and power in patients with ACL injuries before surgery? | 286 | ||
| 9. Discuss the correlation between isokinetic testing and manual muscle testing. | 286 | ||
| 10. What is the correlation between isokinetic testing and functional performance? | 287 | ||
| 11. How can isokinetic testing be integrated in a rehabilitation functional testing algorithm? | 287 | ||
| 12. Is isokinetic exercise beneficial? | 288 | ||
| 13. Discuss the use of a short-arc spectrum isokinetic rehabilitation program. | 288 | ||
| 14. How can the principle of physiologic overflow with isokinetic exercise be applied in rehabilitation? | 289 | ||
| 15. Does isolated OKC isokinetic training improve functional performance? | 289 | ||
| 16. What does the evidence show regarding the use of open kinetic chain (isolated joint exercises) or isokinetics in rega... | 289 | ||
| 17. What does the evidence demonstrate regarding the use of open kinetic chain (isolated joint exercises) or isokinetics ... | 289 | ||
| 18. What does the recent evidence demonstrate in regard to the use of open kinetic chain (OKC) (isolated joint exercises)... | 289 | ||
| 19. Do OKC exercises actually stress the graft where it could compromise long-term healing and maturation? | 289 | ||
| 20. Because of the regional interdependency concept, does isokinetic testing of the lower kinematic chain demonstrate par... | 290 | ||
| Bibliography | 290 | ||
| Chapter 35: Orthopedic Secrets: Exercise in Aging and Disease | 293 | ||
| 1. Summarize the critical demographics of aging in America and the effects on health care. | 293 | ||
| 2. Summarize the health status of older adults. | 293 | ||
| 3. What is the importance of fall risk assessment in older adults? What factors are associated with an increased incidenc... | 293 | ||
| 4. Can exercise reduce the risk of falling? | 293 | ||
| 5. What medications are associated with increased risk of falling? | 293 | ||
| 6. What is orthostatic (postural) hypotension, and what are common signs and symptoms? | 294 | ||
| 7. Describe physical therapy interventions for orthostatic hypotension. | 294 | ||
| 8. Describe the musculoskeletal effects of aging. | 294 | ||
| 9. What causes frailty in older adults? | 294 | ||
| 10. What muscle groups are often weak in older adults? | 294 | ||
| 11. What musculoskeletal effects of aging can be reversed or attenuated with exercise? | 294 | ||
| 12. Summarize the recommended protocol for strength and power training in older adults. | 294 | ||
| 13. When is exercise or exercise testing not recommended in older adults? | 295 | ||
| 14. When is heavy resistance training not recommended in older adults? | 295 | ||
| 15. Summarize the recommendations for strength training in older adults with hypertension. | 295 | ||
| 16. Summarize the recommendations for aerobic exercise in older adults. | 295 | ||
| 17. Can older adults improve aerobic capacity with endurance training? | 295 | ||
| 18. Can exercise improve functional outcomes in older adults? | 295 | ||
| 19. Can exercise reduce mortality and increase life expectancy? | 295 | ||
| 20. What are the primary risk factors for cardiovascular disease? Why is this information important to orthopedic special... | 296 | ||
| 21. What are appropriate cardiovascular responses to aerobic or dynamic exercise? | 296 | ||
| 22. How should a person taking β-blocker medications be monitored during exercise? | 296 | ||
| 23. How should a person with a pacemaker or implantable cardioverter defibrillator (ICD) be monitored during exercise? | 296 | ||
| 24. How can general musculoskeletal chest pain be distinguished from cardiac ischemic pain? | 296 | ||
| 25. Can a patient experience a heart attack without the usual symptoms? | 296 | ||
| 26. What are the exercise recommendations for patients with heart failure (HF)? | 296 | ||
| 27. What types of exercises are recommended for patients with chronic primary or secondary pulmonary disease? | 297 | ||
| 28. What types of exercises are recommended for people with osteoporosis? | 297 | ||
| 29. What are the most common causes of sport injuries in the older athlete? | 297 | ||
| 30. Is exercise recommended for patients with cancer? | 297 | ||
| 31. List the three most common fractures that older adults sustain: | 297 | ||
| Bibliography | 297 | ||
| Chapter 36: Orthopaedic Radiology | 300 | ||
| 1. Is x-ray imaging dangerous? | 300 | ||
| 2. How is an x-ray different from an arthrogram? | 300 | ||
| 3. What are the ABCs of reading a radiograph? | 300 | ||
| 4. How many views are typically ordered to diagnose injuries? | 300 | ||
| 5. What is computed axial tomography (CAT/CT) scanning? | 300 | ||
| 6. What is diagnostic ultrasound? | 300 | ||
| 7. What is rehabilitation ultrasound imaging (RUI)? | 301 | ||
| 8. How is diagnostic ultrasound different from therapeutic ultrasound? | 301 | ||
| 9. What are the advantages and disadvantages of ultrasound as an imaging modality? | 301 | ||
| 10. How does magnetic resonance imaging (MRI) work? | 301 | ||
| 11. What are the characteristics of the T1 image? | 301 | ||
| 12. What are the characteristics of a T2 image? | 301 | ||
| 13. Is exposure to the magnetic fields during MRI dangerous? | 301 | ||
| 14. Should people with metal implants or electronic implants be excluded from MRI? | 301 | ||
| 15. What is an MRI arthrogram? | 301 | ||
| 16. What is the most valuable MRI sequence for assessing pathology? | 301 | ||
| 17. Is MRI best for evaluating soft tissue injuries? | 301 | ||
| 18. What is the appearance of a normal ligament or tendon on MRI? | 302 | ||
| 19. What is positron emission tomography (PET) scanning? | 302 | ||
| 20. What is a bone scan? | 302 | ||
| 21. When will a stress fracture become visible on a plain film? | 302 | ||
| 22. What is the x-ray appearance of a stress fracture? | 303 | ||
| 23. What is the appearance of a stress fracture on MRI? | 303 | ||
| 24. What is patella alta and how is it diagnosed on radiographs? | 303 | ||
| 25. What is a sulcus angle? | 303 | ||
| 26. Is osteoporosis detectable by x-ray imaging, and if so, what is its appearance? | 303 | ||
| 27. What are a delayed union and a nonunion? | 303 | ||
| 28. What is spondylolysis and how is it diagnosed radiographically? | 303 | ||
| 29. How is scoliosis measured radiographically? | 304 | ||
| 30. How is alignment of the cervical spine evaluated? | 304 | ||
| 31. When is the predental space considered abnormal? | 305 | ||
| 32. What is the normal thickness of the prevertebral soft tissues in the cervical spine? | 305 | ||
| 33. What is ulnar variance? | 305 | ||
| 34. What are some of the common radiographic measurements made on wrist x-rays? | 305 | ||
| 35. What radiographic lines and angles can be used in the diagnosis of developmental dysplasia of the hip (DDH)? | 309 | ||
| 36. What is the femoral neck-shaft angle? | 309 | ||
| 37. How does an osteochondral lesion of the lateral femoral condyle appear on a radiograph? | 310 | ||
| 38. How does an anterior dislocation of the shoulder appear on a radiograph? | 311 | ||
| 39. How does a normal ACL appear on MRI? | 311 | ||
| 40. How does a ruptured ACL appear on MRI? | 312 | ||
| 41. How does a greater tuberosity fracture appear on MRI? | 312 | ||
| 42. What are the MRI findings of a shoulder dislocation? | 313 | ||
| 43. What is the radiographic appearance of an acomioclavicular separation? | 313 | ||
| 44. What is the radiographic appearance of proper and improper total hip arthroplasty component positioning? | 314 | ||
| 45. Compare the appearance of a rotator cuff as viewed with ultrasound compared to MRI. | 314 | ||
| 46. What is the radiographic appearance of a pars interarticularis fracture? | 315 | ||
| 47. What is the radiographic appearance of a Jones fracture? | 315 | ||
| 48. What is the MRI appearance of a Triangle Fibrocartilage Complex (TFCC) tear? | 316 | ||
| 49. What are the radiographic and MR appearances of avasuclar necrosis of the hip? | 316 | ||
| Bibliography | 317 | ||
| Section V: The Shoulder | 318 | ||
| Chapter 37: Functional Anatomy of the Shoulder? | 318 | ||
| 1. Name the origins, insertions, innervation, and actions of all muscles that attach to the scapula. | 318 | ||
| 2. What is the normal scapulohumeral rhythm? | 319 | ||
| 3. Describe the gliding movements at the shoulder. | 319 | ||
| 4. How is glenohumeral joint stability maintained? | 319 | ||
| 5. Which structure is the most important static restraint to anterior glenohumeral translation in the 90-degree abducted-... | 320 | ||
| 6. What are the normal strength ratios of the shoulder? | 320 | ||
| 7. What are the four parts of the proximal humerus? | 320 | ||
| 8. What is the normal shape of the human glenoid? | 320 | ||
| 9. What is the rotator interval? | 320 | ||
| 10. What are the basic biomechanical functions of the rotator cuff? | 320 | ||
| 11. Describe the anatomy of the supraspinatus tendon and its clinical significance. | 321 | ||
| 12. Describe the role of the long head of the biceps. | 321 | ||
| 13. What is the role of the bicipital groove in anterosuperior shoulder pain? | 321 | ||
| 14. Describe the most common variations of the labral origin of the biceps anchor. | 321 | ||
| 15. Define the borders of the quadrangular space, triangular space, and triangular interval. Which structures pass throug... | 321 | ||
| 16. Describe the three most common normal variations in anterior labral anatomy. | 322 | ||
| 17. What is a Bankart lesion? | 322 | ||
| 18. What is an HAGL lesion? | 322 | ||
| 19. What is a Hill-Sachs lesion and how does it relate to recurrent anterior shoulder instability? | 322 | ||
| 20. What is the biomechanical function of the clavicle? | 322 | ||
| 21. What are the normal motions of the clavicle? | 322 | ||
| 22. Describe the origin, insertion, innervation, and function of the subclavius muscle. | 322 | ||
| 23. Name the primary arterial supply to the humeral head. | 322 | ||
| 24. What is the average proximal humerus articular version relative to the transepicondylar axis of the distal humerus? | 323 | ||
| 25. Describe the course of the suprascapular nerve. | 323 | ||
| 26. Which neurovascular structure is at greatest risk during anterior shoulder surgery? Describe the course and branches ... | 323 | ||
| 27. Which nerve lies superficial in the posterior cervical triangle and is susceptible to injury? | 323 | ||
| 28. Which nerve injury leads to primary medial scapular winging? | 323 | ||
| 29. Which nerve injuries lead to lateral scapular winging? | 323 | ||
| 30. Describe the course of the musculocutaneous nerve. | 323 | ||
| 31. Describe the basic structure of the brachial plexus. | 324 | ||
| 32. Is there a relationship between glenoid inclination and rotator cuff tears/instability? | 324 | ||
| 33. Where is the center of rotation of the normal glenohumeral joint? Where is the center of rotation in the severely cuf... | 324 | ||
| 34. What are the glenoid erosion patterns typically seen in osteoarthritis and rotator cuff arthropathy? | 324 | ||
| 35. What are the most frequently occurring anatomic variations of the coracoacromial (CA) ligament? | 325 | ||
| 36. Are the acromial attachments of the coracoacromial ligament and anterior deltoid preserved during arthroscopic acromi... | 325 | ||
| 37. Describe the anatomy of the pectoralis major tendon including the insertion and anatomy of the medial and lateral pec... | 325 | ||
| 38. Describe the anatomy of the deltoid insertion. | 325 | ||
| 39. What are the main stabilizers of the AC joint, and in which direction do they resist displacement? | 325 | ||
| 40. What direction is the most common with traumatic sternoclavicular dislocation? What direction is the most dangerous? | 325 | ||
| Bibliography | 325 | ||
| Chapter 38: Shoulder Impingement and Rotator Cuff Tears | 327 | ||
| 1. What are the prevalence and natural history of rotator cuff disease? | 327 | ||
| 2. Define os acromiale. | 327 | ||
| 3. What are the three morphologic types of the acromion? | 327 | ||
| 4. Are types II and III acromia acquired or developmental? | 327 | ||
| 5. Describe Neers classification of rotator cuff pathology. | 327 | ||
| 6. Describe the coracoacromial arch and its clinical importance. | 327 | ||
| 7. What is a partial-thickness rotator cuff tear (tensile failure of the rotator cuff)? | 328 | ||
| 8. Do partial-thickness tears heal or progress to full-thickness tears? | 328 | ||
| 9. What is an undersurface rotator cuff tear? | 328 | ||
| 10. What is rotator cuff arthropathy? | 328 | ||
| 11. When are acromioplasty and subacromial decompression required? What are the two types? | 328 | ||
| 12. Should the coracoacromial ligament be released during subacromial decompression? | 328 | ||
| 13. What is the Mumford procedure? | 328 | ||
| 14. What are the primary rotator cuff exercises? | 329 | ||
| 15. What rotator cuff exercises result in the greatest electromyographic (EMG) activity of the supraspinatus, infraspinat... | 329 | ||
| 16. What is primary rotator cuff impingement? | 329 | ||
| 17. What is secondary rotator cuff impingement? | 329 | ||
| 18. What is posterior (internal) impingement? | 329 | ||
| 19. What are the typical age, gender, and occupation of patients with rotator cuff tears? | 329 | ||
| 20. Do shoulder dislocations lead to rotator cuff tears? | 330 | ||
| 21. What classification system is used to describe the extent or size of a rotator cuff tear? | 330 | ||
| 22. Do full-thickness rotator cuff tears heal? | 330 | ||
| 23. Describe the typical physical therapy protocol for patients with rotator cuff repair. | 330 | ||
| 24. How is the Neer impingement test performed? | 330 | ||
| 25. How is the Hawkins-Kennedy impingement test performed? | 330 | ||
| 26. Describe the reverse impingement sign. | 330 | ||
| 27. Describe the cross-over impingement test. | 330 | ||
| 28. What is the painful arc sign? | 330 | ||
| 29. How is the supraspinatus or empty can test performed? | 331 | ||
| 30. Describe the drop-arm test. | 331 | ||
| 31. What is the lift-off sign? | 331 | ||
| 32. Describe the drop sign. | 331 | ||
| 33. What are the lag signs of the shoulder? | 331 | ||
| 34. Describe the sensitivity and specificity of the various tests used in rotator cuff pathology. | 331 | ||
| 35. Can the supraspinatus manual muscle test predict the size of a rotator cuff tear? | 331 | ||
| 36. How accurate is a clinical examination of the shoulder in predicting rotator cuff pathology? | 332 | ||
| 37. What clinical tests are most predictive for a rotator cuff tear? | 332 | ||
| 38. Which imaging modality-plain radiographs, arthrography, or ultrasonography-is most accurate in diagnosing a rotator c... | 332 | ||
| 39. Are there radiographic findings associated with symptomatic rotator cuff tears? | 332 | ||
| 40. How accurate is MRI in determining a rotator cuff tear? | 332 | ||
| 41. What are the outcomes of rehabilitation for rotator cuff disease? | 332 | ||
| 42. What are the expected ROM, strength, pain, and function of a patient with rotator cuff repair at 1 and 5 years? | 333 | ||
| 43. What percentage of patients undergoing rotator cuff repair has a favorable outcome? | 333 | ||
| 44. What is the clinical outcome of a patient suffering structural failure of a rotator cuff repair? | 333 | ||
| 45. Does open or arthroscopic acromioplasty provide a better result? | 333 | ||
| 46. Should a patient with a confirmed rotator cuff tear undergo physical therapy? Can physical therapy make a rotator cuf... | 333 | ||
| 47. What are the options for management of an irreparable rotator cuff tear secondary to arthropathy? | 333 | ||
| 48. When developing an outcome measure for shoulder function, is the evaluation of strength of the opposite shoulder impo... | 333 | ||
| 49. What are some of the common physical therapy interventions for shoulder (rotator cuff) pain, and are they effective? | 334 | ||
| 50. If a patient cannot attend formal physical therapy programs after surgical repair of the rotator cuff, is a standardi... | 334 | ||
| Bibliography | 334 | ||
| Chapter 39: Shoulder Instability | 335 | ||
| 1. How do the size, shape, and orientation of the glenoid fossa affect glenohumeral joint stability? | 335 | ||
| 2. Describe the passive stabilizing mechanisms for the glenohumeral joint. | 335 | ||
| 3. What are the primary static stabilizers of the glenohumeral joint? | 335 | ||
| 4. Describe the mechanisms for achieving dynamic stability at the glenohumeral joint. | 335 | ||
| 5. What is the most common direction and mechanism of injury causing shoulder instability? | 335 | ||
| 6. What is the most common nerve injury after anterior shoulder dislocation? | 336 | ||
| 7. Describe the most common mechanism of posterior shoulder dislocation. | 336 | ||
| 8. Why is posterior shoulder dislocation more likely than anterior dislocation after electric shock or convulsive seizures? | 336 | ||
| 9. What is multidirectional instability with atraumatic onset? | 336 | ||
| 10. In describing shoulder instability, what is meant by the acronym TUBS? | 336 | ||
| 11. What is meant by the acronym AMBRI in describing shoulder instability? | 336 | ||
| 12. What type of lesion is characterized by the acronym ALPSA? | 336 | ||
| 13. What type of lesion is characterized by the acronym HAGL? | 336 | ||
| 14. Describe the load-shift test. | 336 | ||
| 15. Describe the anterior release test. | 336 | ||
| 16. What are the sensitivity and specificity values of commonly performed shoulder instability tests? | 337 | ||
| 17. What type of grading scheme is used to assess increased glenohumeral translation? | 337 | ||
| 18. Describe the clinical tests for posterior shoulder instability. | 337 | ||
| 19. What radiologic studies and views are best suited for confirming or evaluating shoulder instability? | 337 | ||
| 20. Describe the Hill-Sachs and reverse Hill-Sachs lesions. | 337 | ||
| 21. What is the suggested radiologic view to visualize a Hill-Sachs lesion? | 337 | ||
| 22. What is a Bankart lesion? What is its significance? | 337 | ||
| 23. Describe the clinical presentation of a posterior shoulder dislocation. | 337 | ||
| 24. What is the suggested initial medical treatment for anterior shoulder dislocation? Why is early relocation important? | 338 | ||
| 25. Following reduction for an anterior dislocation, should the arm be immobilized in IR or ER? | 338 | ||
| 26. What is the most common complication in managing a traumatic anterior dislocation? | 338 | ||
| 27. What accounts for the high incidence of recurrent dislocation? | 338 | ||
| 28. What is the incidence of associated rotator cuff tears in patients older than 40 years? Why is the rate increased? | 338 | ||
| 29. What nonoperative management is appropriate after anterior shoulder dislocation? | 338 | ||
| 30. What nonoperative management is appropriate after posterior shoulder dislocation? | 339 | ||
| 31. What nonoperative management is appropriate for multidirectional instability? | 339 | ||
| 32. Describe the modern surgical management of patients for whom operative treatment is advisable. | 339 | ||
| 33. How does the outcome of immediate surgical stabilization compare to the nonoperative management of shoulder instabili... | 339 | ||
| 34. What are superior labrum anterior and posterior (SLAP) lesions? | 339 | ||
| 35. What are the types of SLAP lesions? | 339 | ||
| Bibliography | 340 | ||
| Chapter 40: Adhesive Capsulitis | 342 | ||
| 1. Describe the epidemiology of adhesive capsulitis. | 342 | ||
| 2. What are the predominant cell types in adhesive capsulitis? What growth factors are present? | 342 | ||
| 3. Are other cell types present in the capsule of adhesive capsulitis? | 342 | ||
| 4. Is there a role for the use of hyaluronan in the treatment of adhesive capsulitis? | 342 | ||
| 5. Define primary and secondary adhesive capsulitis. | 342 | ||
| 6. What imaging techniques are useful for the diagnosis of adhesive capsulitis? | 342 | ||
| 7. What MRI findings are associated with adhesive capsulitis? | 342 | ||
| 8. Describe the natural resolution of adhesive capsulitis. | 342 | ||
| 9. What outcomes are associated with the natural resolution of adhesive capsulitis? | 342 | ||
| 10. What are the outcomes associated with a home stretching program for adhesive capsulitis? | 343 | ||
| 11. What factors have been proposed in the pathogenesis of adhesive capsulitis? | 343 | ||
| 12. What is the role of physical therapy for the treatment of capsulitis? | 343 | ||
| 13. Do end range mobilization techniques improve range of motion in patients with adhesive capsulitis? | 343 | ||
| 14. Does translational mobilization increase glenohumeral abduction? | 343 | ||
| 15. Does the direction of the mobilization matter? | 343 | ||
| 16. What outcomes are associated with steroid injections for capsulitis? | 343 | ||
| 17. How does translational manipulation differ from traditional long lever manipulation? | 343 | ||
| 18. What outcomes are associated with traditional long lever manipulation under anesthesia for capsulitis? | 343 | ||
| 19. Does manipulation tear the rotator cuff? | 343 | ||
| 20. What outcomes are associated with translational manipulation under anesthesia for capsulitis? | 343 | ||
| 21. What outcomes are associated with the brisement technique (arthrographic distention)? | 344 | ||
| 22. What outcomes are associated with arthroscopic release for capsulitis? | 344 | ||
| 23. Is traditional long lever manipulation under anesthesia associated with intraarticular lesions? | 344 | ||
| Bibliography | 344 | ||
| Chapter 41: Total Shoulder Arthroplasty | 346 | ||
| 1. Who is the typical patient who might undergo total shoulder arthroplasty (TSA)? | 346 | ||
| 2. How many TSAs, reverse TSAs, and hemiarthroplasties are performed each year? | 346 | ||
| 3. What are the typical indications for TSA? | 346 | ||
| 4. What are the typical contraindications for TSA? | 346 | ||
| 5. What is the difference between unconstrained, constrained, and a reverse TSA? | 346 | ||
| 6. What is the difference between hemiarthroplasty and TSA? | 347 | ||
| 7. Is there a benefit for choosing HHR versus TSA? | 348 | ||
| 8. What factors and conditions should be present for a person to consider undergoing a TSA or HHR? | 348 | ||
| 9. Can an HHR be converted to a TSA if the HHR fails? | 348 | ||
| 10. What postoperative complications are associated with TSA and reverse TSA? | 348 | ||
| 11. What causes components to loosen? | 348 | ||
| 12. What are the postoperative goals after TSA? | 348 | ||
| 13. How long does a TSA last? | 349 | ||
| 14. How much pain, function, and motion improvement is expected after hemiarthroplasty, TSA, or reverse TSA? | 349 | ||
| 15. Can a patient participate in sports after TSA? | 349 | ||
| 16. What is meant by limited-goal rehabilitation? To what type of patient is it applied? | 349 | ||
| 17. When should postoperative rehabilitation begin for TSA and hemiarthroplasty? | 349 | ||
| 18. Describe the technique of early passive motion (EPM). | 349 | ||
| 19. Is all passive elevation the same? | 350 | ||
| 20. What is the Neer-phased rehabilitation program? | 350 | ||
| 21. Why do some patients need abduction pillows and others do not? | 350 | ||
| 22. What are the standard precautions after TSA and reverse TSA? | 350 | ||
| 23. What are typical outcomes for reverse total shoulder prosthesis? | 350 | ||
| Bibliography | 351 | ||
| Chapter 42: Acromioclavicular and Sternoclavicular Injuries | 353 | ||
| Acromioclavicular Injuries | 353 | ||
| 1. What are the typical mechanisms of acromioclavicular (AC) injury? | 353 | ||
| 2. Who is at risk for AC injury? | 353 | ||
| 3. What is the common name for AC joint injury? | 353 | ||
| 4. Describe the structure and function of the AC joint. | 353 | ||
| 5. What are the ligaments of the AC joint? | 353 | ||
| 6. Describe the acute presentation of a patient with an AC injury. | 353 | ||
| 7. What radiographs are taken to diagnose/classify AC injuries? | 354 | ||
| 8. How are AC injuries classified? | 354 | ||
| 9. How are type I AC injuries treated? | 356 | ||
| 10. Describe the treatment for type II AC injuries. | 356 | ||
| 11. Describe the operative and nonoperative approaches to type III AC injuries. | 356 | ||
| Operative Management | 356 | ||
| Nonoperative Management | 356 | ||
| 12. Describe the initial treatment for significant (type III or greater) AC injuries. | 356 | ||
| 13. What can be done to minimize or prevent AC injuries? | 357 | ||
| 14. What are the long-term consequences of AC injury? | 357 | ||
| 15. What can be done for the patient whose pain is associated with weight lifting? | 357 | ||
| 16. What other athletes are prone to AC problems? | 357 | ||
| 17. What is the surgical procedure of choice for arthritic AC disability? | 357 | ||
| 18. Discuss briefly the role of AC joint mobilization. | 357 | ||
| Sternoclavicular injuries | 357 | ||
| 19. What is the typical mechanism of sternoclavicular (SC) injury? | 357 | ||
| 20. Who is at risk for SC injuries? | 358 | ||
| 21. Describe the structure and function of the SC joint. | 358 | ||
| 22. What ligaments support and control the SC joint? | 358 | ||
| 23. Which radiographic views are used to assess SC injuries? | 358 | ||
| 24. How are SC injuries classified? | 358 | ||
| 25. Describe the treatment for a mild sprain of the SC joint. | 358 | ||
| 26. Describe the treatment for a moderate sprain (subluxation) of the SC joint. | 358 | ||
| 27. What is the initial treatment for an anterior severe sprain (dislocation) of the SC joint? | 358 | ||
| 28. What is the initial treatment for a posterior severe sprain (dislocation) of the SC joint? | 359 | ||
| 29. What are the long-term consequences of SC injuries? | 359 | ||
| 30. What types of surgical procedures are performed on patients with SC instability and disability? | 359 | ||
| Bibliography | 359 | ||
| Chapter 43: Scapulothoracic Pathology | 360 | ||
| 1. What is the role of the scapula in glenohumeral movement? | 360 | ||
| 2. What is the 3-D kinematics of the scapula with respect to the humerus and trunk in arm elevation? | 360 | ||
| 3. What muscular force couples act on the scapula during arm elevation? | 360 | ||
| 4. Does the scapular musculature activation pattern change when the glenohumeral joint is injured? | 360 | ||
| 5. Can abnormal scapular movement be associated with rotator cuff impingement? | 360 | ||
| 6. Define scapular dyskinesia. | 360 | ||
| 7. How common is scapular dyskinesia? | 360 | ||
| 8. What populations need to be watched for scapula pathology? | 360 | ||
| 9. What causes scapular dyskinesis? | 361 | ||
| 10. What is Sprengels deformity? | 361 | ||
| 11. What is SICK scapula syndrome? | 361 | ||
| 12. How do you assess abnormal scapular movement? | 361 | ||
| 13. How do you treat scapular dyskinesis? | 361 | ||
| 14. Which scapular muscles should be targeted for rehabilitation? | 361 | ||
| 15. Which exercises target the scapula muscles? | 362 | ||
| 16. How does dyskinesis differ from scapular winging? | 362 | ||
| 17. What are the peripheral nerves and their corresponding root levels that innervate the muscles that attach to the scapula? | 362 | ||
| 18. What causes long thoracic nerve palsy? | 362 | ||
| 19. What is the standard treatment for long thoracic nerve palsy? | 362 | ||
| 20. What are alternative treatments for long thoracic nerve palsy? | 362 | ||
| 21. What is scapulothoracic dissociation? | 363 | ||
| 22. A patient presents with severe shoulder and neck pain and a drooped shoulder after cervical lymph node resection. Wha... | 363 | ||
| 23. Define snapping scapula. | 363 | ||
| 24. What is the differential diagnosis of snapping scapula? | 363 | ||
| 25. How is snapping scapula treated? | 363 | ||
| Bibliography | 363 | ||
| Chapter 44: Fractures of the Clavicle, Proximal Humerus, and Humeral Shaft | 366 | ||
| 1. How are clavicle fractures classified? | 366 | ||
| 2. Describe the subclass of distal-third clavicle fractures. | 366 | ||
| 3. What nerve is most frequently injured with a fracture of the clavicle? | 366 | ||
| 4. How are middle-third clavicle fractures usually treated? | 366 | ||
| 5. What are the indications for operative treatment of clavicle fractures? | 366 | ||
| 6. What are the risks of fracture nonunion for displaced midshaft clavicle fractures treated conservatively? | 366 | ||
| 7. What are the results of operative treatment of displaced midshaft clavicle fractures? | 366 | ||
| 8. When should shoulder motion be initiated in closed treatment of clavicle fractures? | 366 | ||
| 9. What is the incidence of proximal humerus fractures? | 367 | ||
| 10. Describe the Neer classification of proximal humerus fractures. | 367 | ||
| 11. What are the deforming muscular forces responsible for the pattern of fracture displacement encountered with proximal... | 367 | ||
| 12. How often do nerve injuries accompany proximal humerus fractures? | 367 | ||
| 13. What percentage of proximal humerus fractures can be treated nonoperatively? | 367 | ||
| 14. When is the treatment of conservatively managed proximal humerus fractures initiated? | 367 | ||
| 15. What are the outcomes of conservatively treated proximal humerus fractures? | 367 | ||
| 16. What are the indications for surgical management of proximal humerus fractures? | 368 | ||
| 17. When is proximal humeral replacement (hemiarthroplasty) preferred over fracture fixation for the management of proxim... | 368 | ||
| 18. What are the final outcomes of surgical fixation of proximal humerus fractures? | 368 | ||
| 19. What are the potential complications of surgical fixation of proximal humerus fractures? | 368 | ||
| 20. What are the outcomes of hemiarthroplasty for the treatment of proximal humerus fractures? | 368 | ||
| 21. Is there a role for reverse shoulder arthroplasty in patients with displaced proximal humerus fractures? | 368 | ||
| 22. How often do nerve injuries accompany humeral shaft fractures? | 369 | ||
| 23. What is the usual treatment for fracture of the humeral shaft? | 369 | ||
| 24. What are the outcomes of conservative management of humeral shaft fractures? | 369 | ||
| 25. What are the indications for surgical management of humeral shaft fractures? | 369 | ||
| 26. What is the recommended treatment for radial nerve palsies associated with humeral shaft fractures? | 369 | ||
| 27. What are the outcomes of surgical management of humeral shaft fractures? | 369 | ||
| Bibliography | 369 | ||
| Chapter 45: Nerve Entrapments of the Shoulder Region | 371 | ||
| 1. How is the spinal accessory nerve usually injured? | 371 | ||
| 2. Describe the typical presentation of a patient with a spinal accessory nerve injury. | 371 | ||
| 3. How the is the diagnosis of spinal accessory nerve injury made? | 371 | ||
| 4. What are the expected outcomes after a spinal accessory nerve injury? | 371 | ||
| 5. What are the common sites of entrapment of the suprascapular nerve? | 371 | ||
| 6. What are common causes of injury to the suprascapular nerve? | 371 | ||
| 7. What diagnostic tests are available to help confirm suprascapular nerve injury? | 372 | ||
| 8. What is the ``Unhappy or Terrible Triad´´ in regard to the shoulder? | 372 | ||
| 9. What nerve is most commonly injured after anterior shoulder dislocation? | 372 | ||
| 10. Describe the motor and sensory distributions of the musculocutaneous nerve. | 372 | ||
| 11. What are the common mechanisms of injury to the musculocutaneous nerve? | 372 | ||
| 12. What are common causes for long thoracic nerve injuries? | 372 | ||
| 13. What are expected outcomes for someone with a long thoracic nerve palsy? | 373 | ||
| 14. What are the common causes of brachial plexus injuries? | 373 | ||
| 15. What are the clinical signs and symptoms of typical brachial plexus injuries? | 373 | ||
| 16. What key muscle tests help differentiate a C5-C6 root injury from a lateral cord lesion? | 373 | ||
| 17. What is thoracic outlet syndrome (TOS)? | 373 | ||
| 18. Describe the various tests used to evaluate a patient suspected of having TOS. | 374 | ||
| 19. What diagnostic tests are helpful in diagnosing TOS? | 374 | ||
| 20. How many TOS tests should be performed in a clinical examination? | 374 | ||
| 21. What outcomes are associated with physical therapy treatment of TOS? | 374 | ||
| 22. What outcomes are associated with surgical treatment of TOS? | 375 | ||
| 23. What causes ``dead arm syndrome´´? | 375 | ||
| 24. What is a ``burner´´? | 375 | ||
| 25. Describe the clinical findings of a patient with Pancoasts tumor. | 375 | ||
| 26. What is a ``burner´´ or ``stinger´´? | 375 | ||
| 27. What are effective management/prevention strategies for burners and stingers? | 375 | ||
| Bibliography | 375 | ||
| Section VI: The Elbow and Forearm | 378 | ||
| Chapter 46: Functional Anatomy of the Elbow | 378 | ||
| 1. Describe the joints of the elbow. | 378 | ||
| 2. What is the normal carrying angle of the elbow? | 378 | ||
| 3. Describe the articular geometry of the distal humerus. | 378 | ||
| 4. Describe the interosseous membrane (IOM) of the forearm. | 378 | ||
| 5. What portion of the longitudinal growth of the upper arm does the elbow contribute? | 378 | ||
| 6. What structures contribute to elbow stability? | 378 | ||
| 7. Describe the medial ligamentous complex. | 378 | ||
| 8. Describe the lateral ligamentous complex. | 378 | ||
| 9. Describe the most important varus and valgus stabilizers of the elbow at 0 and 90 degrees of flexion. | 379 | ||
| 10. What provides the most dynamic stabilization of the medial elbow? | 379 | ||
| 11. Describe posterolateral rotatory instability. | 379 | ||
| 12. What is the Morrey elbow instability scale? | 379 | ||
| 13. During closed-chain upper extremity exercise, how much weight is transmitted through the radiocapitellar and ulnohume... | 379 | ||
| 14. Describe normal arthrokinematics at the elbow. | 379 | ||
| 15. Differentiate ``normal´´ from ``functional´´ elbow ROM. | 379 | ||
| 16. Where is the axis of flexion and extension in the elbow? Where is the axis during pronation and supination? | 379 | ||
| 17. Which muscle is considered the ``workhorse´´ of elbow flexion? | 380 | ||
| 18. What is the primary function of the brachioradialis? | 380 | ||
| 19. Describe the effect of speed on muscle recruitment during supination. | 380 | ||
| 20. Describe the effects of speed and joint angle on pronation activity. | 380 | ||
| 21. What is the effect of changing forearm position on muscle testing of elbow flexion strength? | 380 | ||
| 22. At what position are elbow flexion strength and supination strength maximal? | 380 | ||
| 23. Describe the innervation of the various muscles controlling movement at the elbow. | 380 | ||
| 24. Which arteries supply blood to the elbow? | 380 | ||
| 25. What is the order (and approximate age) of ossification of structures around the elbow? | 380 | ||
| 26. Describe the anatomy of the ulnar nerve at the elbow. | 380 | ||
| 27. Does the ulnar nerve really innervate the medial triceps? | 381 | ||
| 28. The medial antebrachial cutaneous nerve is subject to painful neuromas if disrupted during surgery. Where do branches... | 381 | ||
| 29. What is the blood supply to the extensor carpi radialis brevis (ECRB) tendon? | 381 | ||
| 30. Describe the anatomy of the lateral joint capsule. | 381 | ||
| 31. What is the relationship of the posterior interosseous nerve (PIN) near the lateral elbow? | 381 | ||
| 32. What is the innervation pattern of the radial nerve in the forearm? | 381 | ||
| 33. What distal bicep tendon repair technique is at greatest risk for radioulnar impingement? | 381 | ||
| 34. What are the differences in function regarding the long and short head of the biceps at the elbow? | 381 | ||
| 35. What advantage does a two-incision technique have over a one-incision technique for distal biceps repairs? | 381 | ||
| 36. How is elbow flexion strength affected after release of the brachioradialis tendon during repair of distal radius fra... | 381 | ||
| Bibliography | 381 | ||
| Chapter 47: Common Orthopedic Elbow Dysfunction | 383 | ||
| 1. What are patient-reported outcome questionnaires, and which is best when working with patients with elbow pathologies? | 383 | ||
| 2. Describe an elbow with joint effusion. | 383 | ||
| 3. What is ``little league elbow´´? | 383 | ||
| 4. How is little league elbow treated? | 383 | ||
| 5. Describe the recommended sequence of pitches for adolescent athletes. | 383 | ||
| 6. What functional tests help confirm the diagnosis of little league elbow? | 384 | ||
| 7. What is lateral epicondylitis? | 384 | ||
| 8. Which structure is most commonly involved in lateral epicondylitis (tennis elbow)? | 384 | ||
| 9. What are the differential diagnoses for lateral epicondylitis? | 384 | ||
| 10. Are forearm support bands (counterforce braces) an effective orthosis for lateral epicondylitis? | 384 | ||
| 11. Describe the incidence and demographics of lateral epicondylitis. | 384 | ||
| 12. What is the best treatment for lateral epicondylitis? | 384 | ||
| 13. What is the Mills maneuver? Is it an effective treatment for lateral epicondylitis? | 385 | ||
| 14. What are the common surgical treatments of lateral epicondylitis? | 385 | ||
| 15. What other treatments are available for lateral epicondylitis? | 385 | ||
| 16. What is radial tunnel syndrome? Why is it confused with lateral epicondylitis? | 385 | ||
| 17. What is ``nursemaids elbow´´? | 385 | ||
| 18. Describe medial epicondylitis. | 385 | ||
| 19. What are the differential diagnoses for medial epicondylitis? How are they ruled out? | 385 | ||
| 20. What is olecranon bursitis? | 386 | ||
| 21. Describe the management of olecranon bursitis. | 386 | ||
| 22. How common is a rupture of the distal biceps tendon, and what is the etiology of injury? | 386 | ||
| 23. What is the clinical presentation for a patient with a distal biceps tendon rupture? | 386 | ||
| 24. What clinical tests can be used to assess for a distal biceps tendon rupture? | 386 | ||
| 25. What are the outcomes for untreated, complete distal biceps tendon tears? | 387 | ||
| 26. What are the outcomes for surgically repaired acute distal biceps ruptures? | 387 | ||
| 27. What are potential complications of distal bicep tendon repairs? | 387 | ||
| 28. What is the clinical presentation of osteoarthritis of the elbow? | 387 | ||
| Bibliography | 387 | ||
| Chapter 48: Elbow Fractures and Dislocation: Patterns, Classifications, and Management | 389 | ||
| 1. How are fractures of the distal humerus classified? | 389 | ||
| 2. Define Malgaigne (supracondylar) fractures. | 389 | ||
| 3. Describe two classification systems for Malgaigne fractures. | 390 | ||
| 4. How are supracondylar fractures managed in adults? | 390 | ||
| 5. Describe the classification and management of supracondylar fractures in children. | 390 | ||
| 6. How are Granger (epicondylar) fractures classified and managed? | 391 | ||
| 7. Which age group is most susceptible to transcondylar humerus fractures? | 391 | ||
| 8. How are condylar fractures classified in adults? | 391 | ||
| 9. How are condylar fractures classified in children? | 391 | ||
| 10. Define intercondylar fractures. | 391 | ||
| 11. Describe three classification systems for intercondylar fractures in adults. | 392 | ||
| 12. How are intercondylar fractures managed? | 392 | ||
| 13. What are typical functional outcomes after an intraarticular distal humerus fracture? | 392 | ||
| 14. Describe the three types of capitellar fractures. | 392 | ||
| 15. How are capitellar fractures managed? | 392 | ||
| 16. Define Laugier (trochlear) fractures. | 392 | ||
| 17. How are trochlear fractures managed? | 392 | ||
| 18. Describe the Colton classification of olecranon fractures. | 392 | ||
| 19. How are undisplaced olecranon fractures treated? | 393 | ||
| 20. How are displaced olecranon fractures treated? | 393 | ||
| 21. What outcomes are associated with olecranon fractures? | 393 | ||
| 22. Describe the Regan and Morrey classification of coronoid fractures. | 393 | ||
| 23. Do type I fractures represent true avulsions of the coronoid? | 393 | ||
| 24. Summarize the mechanisms of injury and general management of radial head fractures. | 393 | ||
| 25. How are radial head fractures classified in adults? | 394 | ||
| 26. How are radial head fractures classified in children? | 394 | ||
| 27. How are elbow dislocations classified? | 394 | ||
| 28. What are the most and least common types of elbow dislocations? | 394 | ||
| 29. Which fractures are commonly associated with elbow dislocations? | 394 | ||
| 30. What complications are associated with elbow dislocations? | 395 | ||
| 31. What are typical outcomes for triad injuries of the elbow (radial head fracture, coronoid fracture, and ligament inst... | 395 | ||
| 32. What are the types of coronoid fractures? | 395 | ||
| 33. What is the treatment of coronoid fractures? | 395 | ||
| 34. What surgical approach gives the best view of anteromedial fractures? | 395 | ||
| 35. What other structure is often injured with anteromedial coronoid fractures? | 395 | ||
| Bibliography | 395 | ||
| Chapter 49: Nerve Entrapments of the Elbow and Forearm | 397 | ||
| 1. What anatomic structures could compress the ulnar nerve at the elbow, and why would elbow flexion increase pressure on... | 397 | ||
| 2. Dislocation or subluxation of the ulnar nerve at the elbow is due to the absence of what anatomic structure? | 397 | ||
| 3. What are the sensitivity or provocation tests for cubital tunnel syndrome? | 397 | ||
| 4. Focal demyelination of motor and sensory axons of the ulnar nerve at the elbow could result in what finding during an ... | 397 | ||
| 5. What is a Martin-Gruber anastomosis? Explain its clinical significance. | 397 | ||
| 6. What are the clinical differences (sensory changes and muscle weakness) that would help distinguish a motor and sensor... | 397 | ||
| 7. At what site above the elbow may the median nerve be compressed? | 398 | ||
| 8. Define radial tunnel syndrome. | 398 | ||
| 9. What five tests are commonly used for the diagnosis of radial tunnel syndrome? | 398 | ||
| 10. Which test for radial tunnel syndrome has the highest sensitivity? | 398 | ||
| 11. What are the possible sites of compression in radial tunnel syndrome? | 398 | ||
| 12. The pronator teres is typically innervated by a motor branch from the median nerve before the nerve passes through th... | 398 | ||
| 13. Could a compromise of the anterior interosseous nerve (AIN) result in wrist pain and numbness and tingling of the thumb? | 398 | ||
| 14. How can pronator teres syndrome be clinically differentiated from anterior interosseous syndrome? | 398 | ||
| 15. What are the common signs, symptoms, and EMG/NSC changes noted in carpal tunnel syndrome, anterior interosseous syndr... | 399 | ||
| 16. At what sites may the superficial radial nerve be compressed? | 399 | ||
| 17. What is Saturday night palsy? | 400 | ||
| 18. Describe the symptoms and signs of Saturday night palsy. | 400 | ||
| 19. Can the radial nerve be compressed by fibrous bands at the level of the radial head? | 400 | ||
| 20. Discuss the relative frequency of the ulnar and median nerve entrapments of the elbow and forearm. | 400 | ||
| 21. What are the surgical options and outcomes for cubital tunnel syndrome? | 400 | ||
| 22. How frequently is there loss of ulnar nerve function after a total elbow joint arthroplasty? | 400 | ||
| Bibliography | 400 | ||
| Section VII: The Wrist and Hand | 402 | ||
| Chapter 50: Functional Anatomy of the Wrist and Hand | 402 | ||
| 1. Describe the anatomy of the carpal tunnel. | 402 | ||
| 2. What is the average pressure (in mm Hg) in the carpal tunnel at different wrist positions? | 402 | ||
| 3. Name the 10 structures that pass through the carpal tunnel. | 402 | ||
| 4. Describe the relationship of the contents of Guyons canal. | 403 | ||
| 5. What is the relationship between the digital nerves and arteries? | 403 | ||
| 6. Where are the vincula located and what is their purpose? | 403 | ||
| 7. Describe the anatomy of the flexor sheath. | 404 | ||
| 8. What are the pulleys of the thumb, and which thumb pulley is the most responsible for prevention of bowstringing of th... | 404 | ||
| 9. Compare the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) of the fingers. | 404 | ||
| 10. What is the total excursion of normal flexor and extensor tendons? | 405 | ||
| 11. Where is Campers chiasm and what is its function? | 405 | ||
| 12. What are the anatomic landmarks for the zones of flexor tendon injury in the hand? | 405 | ||
| 13. What are the zones of injury of the extensor tendon? | 405 | ||
| 14. Name the tendons in the six dorsal compartments of the hand. | 406 | ||
| 15. Describe the tension in the collateral ligaments in relation to joint position. | 406 | ||
| 16. Describe the structure of the carpal ligaments. | 406 | ||
| 17. What is the significance of the palmaris longus tendon? | 407 | ||
| 18. Where is the most immobile part of the wrist and hand located? | 407 | ||
| 19. What is the triangular fibrocartilage complex (TFCC)? | 407 | ||
| 20. What is the normal range of motion of the wrist? | 407 | ||
| 21. What is the functional range of motion of the wrist? | 407 | ||
| 22. Describe the kinematics of the wrist. | 407 | ||
| 23. Describe the motion of the fingers and thumb. | 408 | ||
| 24. Describe the blood supply of the scaphoid. | 408 | ||
| 25. Describe the normal anatomy of the distal radius. | 408 | ||
| 26. What position of the wrist allows maximal grip strength? | 408 | ||
| 27. Describe the force transmission across the radiocarpal joint with axial wrist loading. | 408 | ||
| 28. Describe the musculature of the hand. | 408 | ||
| 29. What innervates each of the extrinsic wrist and digit muscles? | 409 | ||
| 30. What nerve innervates the intrinsic muscles? | 409 | ||
| 31. What are the two possible communications (anastomosis or interconnection) between the median and ulnar nerves? | 409 | ||
| 32. Describe the bony anatomy of the metacarpophalangeal joint. | 409 | ||
| 33. Explain the cam effect of the metacarpophalangeal joint. | 410 | ||
| 34. Describe the anatomy of the proximal interphalangeal joint (PIP). | 410 | ||
| 35. What is the clinical and anatomic significance of the thumb interphalangeal joints active extension versus hyperexten... | 410 | ||
| 36. Where is the extensor indicis proprius (EIP) tendon in relation to the extensor digitorum communis (EDC) tendon? | 410 | ||
| 37. Describe the insertion of the dorsal interossei (DI) tendons. | 410 | ||
| 38. What is the extensor mechanism of the digit? | 410 | ||
| 39. Define the following components of the extensor mechanism: | 410 | ||
| 40. What is the function of the retinacular ligaments? | 411 | ||
| 41. Describe the cross section of the median and ulnar nerves. | 411 | ||
| 42. Describe the anatomy of the superficial branch of the radial nerve (SBRN). | 411 | ||
| Bibliography | 411 | ||
| Chapter 51: Common Orthopedic Dysfunction of the Wrist and Hand | 413 | ||
| 1. Describe clinical assessment of contracture of the oblique retinacular ligament. | 413 | ||
| 2. How is the flexor digitorum superficialis clinically isolated when testing flexion at the PIP joint? | 413 | ||
| 3. What occurs anatomically during a positive scaphoid shift test? | 413 | ||
| 4. List common provocative maneuvers/diagnostic tests for ulnar-sided wrist pain. | 413 | ||
| 5. Describe the Bunnell-Littler test. | 413 | ||
| 6. How can the intrinsics be clinically isolated when testing extension at the PIP joint? | 414 | ||
| 7. Describe the test for vascular integrity of the radial and ulnar arteries. | 414 | ||
| 8. Describe splinting techniques for various upper extremity nerve injuries. | 414 | ||
| 9. In general, what is the appropriate position of the MCP joints in splinting? Why? | 414 | ||
| 10. What is the best position to splint the hand after injury or surgery to prevent ligament shortening and possible fixe... | 414 | ||
| 11. What is currently thought to be the most important factor in increasing a stiff joint passive range of motion with re... | 414 | ||
| 12. Define the syndrome of the quadriga. | 414 | ||
| 13. Explain extrinsic tightness with respect to the extensor tendons. | 414 | ||
| 14. What is a mallet finger? How does it develop? | 414 | ||
| 15. How are mallet fingers currently treated? | 415 | ||
| 16. What is a trigger finger? | 415 | ||
| 17. What is Dupuytrens contracture? Which structures in the hand usually are involved? | 415 | ||
| 18. When is collagenase clostridium histolyticum (Xiaflex) performed with Dupuytrens contracture patients? | 416 | ||
| 19. What is the current therapy regimen post Xiaflex injection and manipulation with Dupuytrens contracture patients? | 416 | ||
| 20. What is Kienböcks disease? | 416 | ||
| 21. What is a ganglion cyst? | 416 | ||
| 22. Define swan neck deformity. | 416 | ||
| 23. What is a boutonnière deformity? | 416 | ||
| 24. What is a pseudoboutonnière deformity? | 417 | ||
| 25. What is de Quervains disease? How is it treated? | 417 | ||
| 26. Compare the success rates of splinting, splinting with injection, injection, and operative management for the treatme... | 417 | ||
| 27. What type of resistive exercise has been found most effective in decreasing lateral epicondylitis rehabilitation? Wha... | 417 | ||
| 28. What long-standing rehabilitation problem may occur when proximal phalanx fractures do not allow for rigid fixation a... | 417 | ||
| 29. Describe the ``lumbrical plus´´ finger. What causes it? | 417 | ||
| 30. What changes in the hand are commonly associated with rheumatoid arthritis? | 418 | ||
| 31. What structures compose the triangular fibrocartilage complex (TFCC)? | 418 | ||
| 32. How are TFCC tears diagnosed? | 418 | ||
| 33. What is the total excursion of normal flexor and extensor tendons? | 418 | ||
| 34. What extensor tendon injuries should be repaired? | 418 | ||
| 35. When are extensor tendon repairs weakest? | 418 | ||
| 36. How long should extensor tendon repairs be protected? | 418 | ||
| 37. Describe the rehabilitation of an extensor tendon injury. | 418 | ||
| 38. How are flexor tendons nourished in the synovial sheaths of the fingers? | 418 | ||
| 39. When should a flexor tendon be repaired? | 418 | ||
| 40. When are flexor tendon repairs weakest? | 418 | ||
| 41. How much gliding of flexor tendons does joint motion produce? | 418 | ||
| 42. List and briefly describe the three rehabilitative approaches to the treatment of flexor tendons. | 418 | ||
| 43. In general, what are the expected outcomes after flexor tendon repair? | 419 | ||
| 44. Name the risks and benefits of early active tendon mobilization post flexor tendon repair. | 419 | ||
| 45. Describe the pyramid of progressive force exercises and how they apply to the treatment of flexor tendon repairs. | 419 | ||
| 46. Describe the difference between the congenital anomalies camptodactyly and clinodactyly. | 419 | ||
| 47. Describe the benefits of pressure therapy in the therapeutic management of a burned hand. | 419 | ||
| 48. What scar contractures can potentially occur after a burn to the dorsum of the hand? What scar contractures can occur... | 420 | ||
| 49. Transfer of a muscle-tendon unit will result in what change in muscle grade, using a 0 to 5 muscle grading scale? | 420 | ||
| 50. How does systemic lupus erythematosus (SLE) differ from rheumatoid arthritis (RA) with regard to arthritis and pathod... | 420 | ||
| 51. What are common wrist and hand deformities developed by patients with a diagnosis of systemic lupus erythematosus? | 420 | ||
| 52. What is Graded Motor Imagery (GMI), and how is it effective in the treatment of CRPS? | 420 | ||
| 53. Define Raynauds phenomenon and discuss its etiology, clinical presentation, and treatment. | 420 | ||
| Bibliography | 421 | ||
| Chapter 52: Fractures and Dislocations of the Wrist and Hand | 423 | ||
| 1. Define boxers fracture. | 423 | ||
| 2. What is a baseball finger? | 423 | ||
| 3. What is a jersey finger? | 423 | ||
| 4. Describe the usual angulation of proximal phalanx fractures. | 423 | ||
| 5. What is the usual or ideal position of immobilization of phalanx fractures? | 423 | ||
| 6. Describe Bennetts fracture and Rolandos fracture. | 423 | ||
| 7. Describe the diagnosis and treatment of lateral collateral ligament injuries of the PIP joint. | 424 | ||
| 8. What are the differences between a dorsal and a volar PIP dislocation? | 424 | ||
| 9. Define gamekeepers thumb. | 424 | ||
| 10. What is a Stener lesion? | 424 | ||
| 11. How is gamekeepers thumb treated? | 424 | ||
| 12. How are metacarpophalangeal radial collateral ligament tears of the thumb treated? | 424 | ||
| 13. Describe the radiographic evaluation of the wrist. | 424 | ||
| 14. Describe Colles, Bartons, and Smiths fractures. | 425 | ||
| 15. What are chauffeurs and die-punch fractures? | 425 | ||
| 16. When is surgery indicated for distal radius fractures? | 425 | ||
| 17. Name the five factors that may contribute to instability of a distal radius fracture after closed reduction. | 425 | ||
| 18. What are the outcomes from volar plating of distal radius fractures? | 425 | ||
| 19. What is the second most common fracture of the wrist? | 425 | ||
| 20. Where is the scaphoid most commonly fractured? | 425 | ||
| 21. What are the treatment guidelines for scaphoid fractures? | 425 | ||
| 22. When is surgery indicated for ulnar styloid fractures? | 425 | ||
| 23. Define Kienböcks disease. | 425 | ||
| 24. What are the four stages of Kienböcks disease? | 426 | ||
| 25. What are the treatment options for Kienböcks disease? | 426 | ||
| 26. Describe the classification of carpal instabilities. | 426 | ||
| 27. What is scapholunate dissociation? | 426 | ||
| 28. Describe Watsons test. | 426 | ||
| 29. What is the Terry Thomas sign? | 426 | ||
| 30. How is SLD treated? | 426 | ||
| 31. How are thumb UCL avulsion fractures best treated? | 427 | ||
| 32. Describe the Galeazzi fracture-dislocation. | 427 | ||
| 33. Describe the Essex-Lopresti injury. | 427 | ||
| Bibliography | 427 | ||
| Chapter 53: Nerve Entrapments of the Wrist and Hand | 429 | ||
| 1. What is Wartenbergs disease? | 429 | ||
| 2. How is de Quervains disease clinically differentiated from superficial radial nerve entrapment? | 429 | ||
| 3. How is median nerve entrapment at the wrist clinically differentiated from a C8 root level compromise? | 429 | ||
| 4. Describe the clinical manifestations of compression of the deep motor branch of the ulnar nerve. | 429 | ||
| 5. A complete ulnar nerve lesion at the wrist may produce motor paralysis of which muscles in the hand? | 430 | ||
| 6. What is the significance of a positive Froments sign? | 430 | ||
| 7. Describe the tunnel of Guyon and a related nerve entrapment. | 430 | ||
| 8. What is the significance of the palmaris brevis sign? | 430 | ||
| 9. Name underlying systemic pathologies that may present with carpal tunnel syndrome. | 430 | ||
| 10. What are important factors to consider when reading an electromyograph (EMG) and nerve conduction velocity (NCV) repo... | 430 | ||
| 11. Describe the classic findings of median nerve compression at the wrist. | 431 | ||
| 12. Are clinical examination tests valid for evaluating carpal tunnel syndrome? | 431 | ||
| 13. What are the most sensitive electromyographic indicators for carpal tunnel syndrome when reading an EMG report? | 433 | ||
| 14. What is the clinical difference between an anterior interosseous nerve injury and median nerve injury at the wrist? | 434 | ||
| 15. What are the normative EMG and nerve conduction values used to define pathology in carpal tunnel syndrome, and how ar... | 434 | ||
| 16. What are the common risk factors associated with carpal tunnel syndrome? | 434 | ||
| 17. What may produce carpal tunnel syndrome in children? | 434 | ||
| 18. Are there different classifications or degrees of carpal tunnel syndrome, and, if so, how would an electromyographer ... | 435 | ||
| 19. A patient complains of numbness and tingling in the small and ring fingers on only the palmar side of the hand with n... | 435 | ||
| Bibliography | 435 | ||
| Section VIII: The Spine | 437 | ||
| Chapter 54: Functional Anatomy of the Spine | 437 | ||
| 1. Describe the blood supply to the spinal cord. | 437 | ||
| 2. Describe the cross-sectional location and function of the lateral corticospinal tracts, the spinothalamic tracts, and ... | 437 | ||
| 3. Describe the 6 major incomplete spinal cord injury syndromes and their characteristics. | 437 | ||
| 4. Describe Fryettes laws of spinal biomechanics. | 437 | ||
| 5. Describe the normal ranges of motion of each section of the spine. | 438 | ||
| 6. List the important ligaments of the cervical and lumbar spine. Specify their origin, insertion, attachment, and function. | 438 | ||
| 7. Describe the anatomy of the intervertebral disc. | 439 | ||
| 8. How does the disc obtain its nutrition? | 439 | ||
| 9. What is the effect of exercise on disc nutrition? | 439 | ||
| 10. What changes occur in the disc with aging? | 439 | ||
| 11. Describe the facet articulations of the spine. | 439 | ||
| 12. How does the spine receive loads in different postures? What is the effect of a backrest or lumbar support? | 439 | ||
| 13. What are the dimensions of the spinal canal? How does the canal size change in different areas of the spine? | 440 | ||
| 14. How are the facet joints innervated? | 440 | ||
| 15. Where is the nerve root in relation to the pedicle and disc in the cervical and lumbar portions of the spine? | 440 | ||
| 16. How does spinal movement affect the size of the intervertebral foramen? | 440 | ||
| 17. What is Spurlings sign? | 440 | ||
| 18. Describe the function of the facet joints and their role in load bearing. | 440 | ||
| 19. Describe the form and function of the uncinate processes. | 440 | ||
| 20. What happens during the straight-leg raise test? | 440 | ||
| 21. Which muscles are recruited to initiate and complete lumbar flexion and extension? | 441 | ||
| 22. How effective are lumbosacral corsets for relief of spinal disc pressure? | 441 | ||
| 23. What changes in lumbar spine intervertebral flexion and extension can be expected after lumbar disc replacement surgery? | 441 | ||
| 24. List the ratios of disc height to vertebral body height in the cervical, lumbar, and thoracic areas of the spine. | 441 | ||
| 25. What active range of motion in the cervical spine is required to perform activities of daily living? | 441 | ||
| 26. Describe the effect on spinal loading of the double SLR, supine sit-up, trunk curl, and reverse curl. | 441 | ||
| 27. What lumbar pressures are involved in commonly used exercises and postures? | 441 | ||
| 28. What are the differences in lumbar spine muscle kinematics between patients with chronic low back pain and normal sub... | 441 | ||
| 29. What is the effect of age on cervical spine range of motion? | 442 | ||
| 30. What are the effects of lumbar discectomy on trunk musculature? | 442 | ||
| 31. What is the effect of leg length discrepancy on spinal motion during gait? | 442 | ||
| 32. How much nerve root movement occurs in the lumbar spine with SLR? | 442 | ||
| 33. How much nerve root movement occurs in the lumbar spine with forward flexion while standing? | 442 | ||
| 34. How much dural movement occurs in the cervical spine with flexion and extension? | 442 | ||
| 35. Describe key vertebral landmarks. | 442 | ||
| 36. Discuss the 3-column model of the spine. | 442 | ||
| 37. Describe the sacroiliac joint. | 442 | ||
| 38. What is Patricks test, and how is it used to assess the sacroiliac joint? | 442 | ||
| Bibliography | 443 | ||
| Chapter 55: Mechanical and Discogenic Back Pain | 444 | ||
| 1. What is the role of bed rest in acute back pain? | 444 | ||
| 2. Describe the structure of the intervertebral disc. | 444 | ||
| 3. Describe the functions of the intervertebral disc. | 444 | ||
| 4. What position facilitates disc nutrition? | 444 | ||
| 5. Describe the innervation of the disc. | 444 | ||
| 6. What is the source of discogenic low back pain? | 444 | ||
| 7. What are some of the anatomic structures associated with mechanical dysfunction of the facet joint, and how might they... | 445 | ||
| 8. Describe the articular receptor distribution in the spine. | 445 | ||
| 9. Which structure is most commonly involved in the patient with low back pain? | 445 | ||
| 10. Describe the outcomes of physical therapy for acute low back dysfunction. | 445 | ||
| 11. How does a therapist determine when manipulation of the spine for mechanical low back pain is indicated? | 446 | ||
| 12. Discuss the potential sources of pain associated with dysfunction of the disc. | 446 | ||
| 13. Does disc herniation result from weakness and damage to the annulus (outside in) or from pressure pushing the disc ou... | 446 | ||
| 14. At what levels do cervical spondylosis most typically occur? | 446 | ||
| 15. At what levels do lumbar disc prolapse most commonly occur? | 446 | ||
| 16. In the thoracic spine, what are the most common levels of dysfunction that present with clinical symptoms? | 446 | ||
| 17. Describe a classification of disc herniations. | 447 | ||
| 18. Does spontaneous disc resorption occur? What are the proposed mechanisms? | 447 | ||
| 19. What is the effect of facet angle on disc herniation? | 447 | ||
| 20. What is the incidence of disc herniation? | 447 | ||
| 21. What are the common causes of radiculopathy? | 447 | ||
| 22. Describe the classic presentation of disc herniations at various spinal levels. | 447 | ||
| 23. Describe the natural history of disc disease. | 448 | ||
| 24. Which is more successful for acute disc herniation-surgery or conservative care? | 448 | ||
| 25. Is disc degeneration associated with low back pain? | 448 | ||
| 26. Describe the Impairment-Based Classification System (IBCS) and International Classification of Functioning (ICF) and ... | 448 | ||
| 27. Discuss the role of manipulation and manual therapy in the treatment of disc herniation. | 449 | ||
| 28. What is the effect of rehabilitation after disc surgery? | 449 | ||
| 29. How does exercise relieve back pain? | 449 | ||
| 30. What is the definition of spinal instability? | 449 | ||
| 31. Describe the innervation of the facet joints and types of afferent nerve fibers. | 449 | ||
| 32. What muscles increase abdominal tone and pressure for stabilization of the lumbar spine? | 450 | ||
| 33. Discuss the significance of the multifidus muscle. | 450 | ||
| 34. What are the effects of dynamic lumbar stabilization exercise programs after discectomy? | 450 | ||
| 35. What are the effects of disc herniation and surgery on proprioception and postural control? | 450 | ||
| 36. What are the functional results and risk factors for reoperation after disc surgery? | 450 | ||
| 37. What are the effects of surgery on pain, spine mobility, and disability? | 450 | ||
| 38. What are the effects of low back pain, disc herniation, and surgery on the lumbar multifidus? | 451 | ||
| Bibliography | 451 | ||
| Chapter 56: Lumbar Spinal Stenosis | 454 | ||
| 1. What is lumbar spinal stenosis (LSS)? | 454 | ||
| 2. How is LSS classified? | 454 | ||
| 3. What are the most common structural changes associated with LSS? | 454 | ||
| 4. Is lumbar stenosis a common problem? | 454 | ||
| 5. How will the typical patient with lumbar stenosis present clinically? | 454 | ||
| 6. Why do patients with LSS feel worse when standing than when sitting? | 455 | ||
| 7. Are there other factors that exacerbate symptoms for patients with LSS? | 455 | ||
| 8. What is neurogenic claudication? | 456 | ||
| 9. Are there other conditions that might be confused with lumbar stenosis? | 456 | ||
| 10. How can LSS be differentiated from other conditions with a similar presentation in the clinic? | 456 | ||
| 11. Are diagnostic imaging studies or electrodiagnostic studies helpful in confirming a diagnosis of LSS? | 456 | ||
| 12. Are plain film x-rays helpful in the diagnosis of LSS? | 457 | ||
| 13. What are the most common impairments and functional limitations found in patients with LSS? | 457 | ||
| 14. Describe the surgical procedure for a patient with LSS. | 457 | ||
| 15. Should a patient with LSS have surgery? | 457 | ||
| 16. Will the symptoms of lumbar stenosis continue to worsen over time? | 457 | ||
| 17. Will epidural steroid injections help patients with lumbar stenosis? | 457 | ||
| 18. What is the best physical therapy treatment for patients with lumbar stenosis? | 457 | ||
| 19. Should traction be used in the treatment of patients with LSS? | 458 | ||
| 20. Can deweighted treadmill ambulation help patients with LSS? | 458 | ||
| 21. Is it possible to identify patient-centered factors that predict better versus worse outcomes from surgery for lumbar... | 458 | ||
| 22. Are there published studies documenting patient outcomes with defined physical therapy treatment approaches? | 458 | ||
| 23. Should patients with lumbar stenosis wear a brace or corset? | 459 | ||
| 24. How should the outcomes of treatment for patients with lumbar stenosis be measured? | 459 | ||
| 25. Does stenosis occur in the cervical spine as well? | 459 | ||
| 26. What symptoms will a patient with cervical stenosis exhibit? | 459 | ||
| 27. What is the typical clinical presentation for patients with central cervical stenosis? | 460 | ||
| 28. Is treatment by a physical therapist helpful for cervical myelopathy? | 460 | ||
| 29. Is surgery recommended for patients with cervical myelopathy? | 460 | ||
| Bibliography | 460 | ||
| Chapter 57: Spondylolysis and Spondylolisthesis | 463 | ||
| 1. How is spondylolisthesis measured and graded? | 463 | ||
| 2. What is sacral inclination? | 463 | ||
| 3. What is the slip angle? | 463 | ||
| 4. What are the types (classifications) of spondylolistheses and the etiologies of each? | 464 | ||
| 5. What is the rate of occurrence of isthmic spondylolisthesis? | 464 | ||
| 6. Does spondylolysis always progress to spondylolisthesis? | 464 | ||
| 7. Should neurologic compromise be anticipated with spondylolisthesis? | 464 | ||
| 8. Does the isthmic pars defect heal when treated? | 466 | ||
| 9. What associated morbidity is seen with spondylolisthesis? | 466 | ||
| 10. How is spondylolisthesis diagnosed radiologically? | 466 | ||
| 11. What are the basic principles of conservative management of spondylolisthesis? | 466 | ||
| 12. What is the role of flexibility exercises in conservative treatment of spondylolisthesis? | 467 | ||
| 13. What are the surgical indications in the child or adolescent with spondylolisthesis? | 467 | ||
| 14. List the surgical indications for adults with spondylolisthesis. | 467 | ||
| 15. What types of surgical interventions are available for treatment of spondylolisthesis? | 468 | ||
| 16. Are athletes more prone to spondylosis than others? | 468 | ||
| 17. By what criteria can an athlete or nonathlete return to activity after being diagnosed with spondylolisthesis? | 468 | ||
| Bibliography | 468 | ||
| Chapter 58: Scoliosis | 470 | ||
| 1. What are the major types of scoliosis? | 470 | ||
| 2. What is the incidence of idiopathic structural scoliosis? | 470 | ||
| 3. What are the possible causes of idiopathic scoliosis? | 470 | ||
| 4. Describe the clinical presentation of idiopathic scoliosis. | 470 | ||
| 5. What types of initial screening processes appear as most effective in determining whether aggressive active treatment,... | 470 | ||
| 6. When is further evaluation of idiopathic scoliosis advisable? | 470 | ||
| 7. Describe the Risser classification. | 470 | ||
| 8. Describe the King classification system. | 470 | ||
| 9. Describe the rate of progression of idiopathic scoliosis. | 471 | ||
| 10. What treatment options are available for progressive idiopathic scoliosis? | 471 | ||
| 11. When should bracing be considered? | 471 | ||
| 12. Describe the bracing used for scoliosis. How long should the brace be worn? | 471 | ||
| 13. What forces in braces reduce progression of scoliotic curves? | 471 | ||
| 14. What are the outcomes of major brace types in treating idiopathic scoliosis? | 471 | ||
| 15. What curves respond best to bracing? | 471 | ||
| 16. How effective is bracing? | 471 | ||
| 17. What are the indications for surgical intervention? | 472 | ||
| 18. Define ``crankshaft phenomenon.´´ | 472 | ||
| 19. What type of correction can be expected with surgical intervention? | 472 | ||
| 20. What is the most common form of surgical intervention in idiopathic scoliosis? | 472 | ||
| 21. List the complications of surgical intervention for idiopathic scoliosis. | 472 | ||
| 22. What types of treatments other than surgery or bracing have been shown to be effective? | 472 | ||
| 23. Describe the role of the physical therapist in screening and treating scoliosis. | 472 | ||
| 24. Compare the costs of bracing and surgery. | 472 | ||
| 25. What are the long-term curve progressions for surgical-treated versus brace-treated curves? | 472 | ||
| 26. What are the long-term (20 years or more) quality-of-life outcomes for surgery versus bracing treatment? | 473 | ||
| 27. What is the natural history of patients with untreated idiopathic scoliosis? | 473 | ||
| Bibliography | 473 | ||
| Chapter 59: Thoracic Spine and Rib Cage Dysfunction | 474 | ||
| 1. What is the prevalence of thoracic spine pain and disability in children and adolescents? | 474 | ||
| 2. Describe the normal range of motion (ROM) of the thoracic spine. | 474 | ||
| 3. Describe the preferred side-bending and rotation-coupling pattern of the thoracic spine. | 474 | ||
| 4. How accurate can we be with manual examination of the thoracic spine? | 474 | ||
| 5. What effects has thoracic spine manipulation been found to have? | 474 | ||
| 6. How many articulations are present on the typical thoracic vertebra? | 475 | ||
| 7. Describe the typical pattern of rib cage motion. | 475 | ||
| 8. Describe the cervical rotation lateral flexion (CRLF) test. | 475 | ||
| 9. Define thoracic outlet syndrome. | 475 | ||
| 10. Describe the typical pattern of movement and positional dysfunction of the thoracic spine and rib cage. | 475 | ||
| 11. Describe a classification system for thoracic spine and rib cage dysfunction. | 476 | ||
| 12. Does osteoporosis frequently involve the thoracic spine? | 476 | ||
| 13. What are the symptoms of thoracic osteoporosis? How are they treated? | 476 | ||
| 14. What is the incidence of musculoskeletal dysfunction mimicking cardiac disease in the emergency department (ED)? | 476 | ||
| 15. A 35-year-old man presents with pain and stiffness in the thoracic region, which is worse in the morning. On physical... | 476 | ||
| 16. A 44-year-old man presents with pain in the right T7-T9 region just below the inferior lateral angle of the scapula. ... | 476 | ||
| 17. Can thoracic spine and rib cage musculoskeletal dysfunction mimic anginal pain? | 477 | ||
| 18. What is Scheuermanns disease? Is it safe to use manual therapy in affected patients? | 477 | ||
| 19. Do postural abnormalities of the cervical and thoracic spine contribute to pain? | 477 | ||
| 20. Define T4 syndrome. | 477 | ||
| 21. What role can the thoracic spine play in headaches? | 477 | ||
| 22. What symptoms may arise from or at least be affected by treatment directed at the thoracolumbar region? | 477 | ||
| 23. During the history portion of the examination of patients over 50 years of age with thoracic spine pain that is not a... | 477 | ||
| 24. Describe the clinical presentation of postherpetic neuralgia. | 478 | ||
| 25. Define costochondritis. What can the physical therapist do about it? | 478 | ||
| 26. If the patient demonstrates inhibition or difficulty in activating the lower trapezius muscle, what should the therap... | 478 | ||
| 27. If the patient demonstrates inhibition of the serratus anterior muscle or has difficulty in stabilizing the scapula d... | 478 | ||
| 28. What areas of the cervical spine typically refer pain to the thoracic region? | 478 | ||
| Bibliography | 478 | ||
| Chapter 60: Spine Fractures and Dislocations: Patterns, Classifications, and Management | 480 | ||
| 1. How common is trauma to the spinal column? | 480 | ||
| 2. How many spinal cord injuries occur per year in the United States? | 480 | ||
| 3. What are the most common modes of spinal column injury? | 480 | ||
| 4. In what scenarios are spinal column injuries most likely to be missed? | 480 | ||
| 5. What is the long-term prognosis of a spinal cord-injured patient? | 480 | ||
| 6. What are incomplete cord syndromes, and how do they affect rehabilitation? | 481 | ||
| 7. How is the pediatric spine differently susceptible to trauma? | 481 | ||
| 8. What is SCIWORA? | 481 | ||
| 9. How are gunshot wounds to the spine treated? | 481 | ||
| 10. Describe appropriate steps in the early evaluation of spinal column injury. | 481 | ||
| 11. Describe appropriate steps in the early management of spinal column injury. | 481 | ||
| 12. How is the level determined in spinal cord injury? | 482 | ||
| 13. Are there any radiographic clues that an injury might be unstable? | 482 | ||
| 14. Why is the level of injury important? | 482 | ||
| 15. How are spinal column injuries classified? | 482 | ||
| 16. What common force vectors cause spinal column injury? | 482 | ||
| 17. What types of injuries are caused by compression-flexion moments? | 482 | ||
| 18. What is a flexion teardrop fracture? | 483 | ||
| 19. How are vertical compression injuries differentiated from compression-flexion injuries? | 484 | ||
| 20. What is the most common type of cervical spine injury? | 484 | ||
| 21. How are distractive flexion injuries treated? | 484 | ||
| 22. What are the characteristics of compressive extension injuries? | 484 | ||
| 23. What is an odontoid fracture? | 484 | ||
| 24. What is a hangmans fracture? | 484 | ||
| 25. What is a Jefferson fracture? | 484 | ||
| 26. What is whiplash? | 485 | ||
| 27. How is whiplash different from other cervical spine trauma? | 485 | ||
| 28. Who tends to be susceptible to whiplash? | 485 | ||
| 29. What are the typical symptoms of whiplash? | 485 | ||
| 30. Describe the physical examination and radiologic signs of whiplash. | 485 | ||
| 31. What is the natural history of whiplash? | 485 | ||
| 32. How is whiplash treated? | 485 | ||
| 33. How are injuries to the thoracolumbar spine classified? | 485 | ||
| 34. What might be considered a minor injury of the thoracolumbar spine? | 485 | ||
| 35. How are these minor injuries evaluated? | 486 | ||
| 36. What are the broad types of major injuries of the thoracolumbar spine? | 486 | ||
| 37. What are compression fractures, and how are they treated? | 486 | ||
| 38. How is a burst fracture different from a compression fracture? | 486 | ||
| 39. What is a seat-belt injury? | 486 | ||
| 40. How are fracture dislocations different from other types of thoracolumbar traumas? | 487 | ||
| 41. What are some complications associated with the surgical treatment of spinal trauma? | 487 | ||
| 42. When may a spinal trauma patient be safely mobilized? | 487 | ||
| 43. Name other common postoperative medical problems to which spinal trauma patients are prone. | 487 | ||
| 44. What percentage of patients experience pain relief or functional improvement after kyphoplasty or vertebroplasty? | 487 | ||
| 45. What is the role of physical therapy in the status of osteoporotic patients after a vertebral compression fracture? | 488 | ||
| 46. How can therapy help prevent osteoporotic fractures? | 488 | ||
| Bibliography | 488 | ||
| Chapter 61: Temporomandibular Joint | 490 | ||
| 1. What are the unique features of the temporomandibular joint (TMJ)? | 490 | ||
| 2. What is the incidence of TMJ dysfunction? | 490 | ||
| 3. How does TMD manifest clinically? | 490 | ||
| 4. What are the causes of TMD? | 490 | ||
| 5. What is the anatomic attachment and function of the disc? | 490 | ||
| 6. Describe the innervation of the TMJ. | 490 | ||
| 7. What are the kinematic movements of mouth opening? | 490 | ||
| 8. Describe the functional and normal range of mouth opening. | 490 | ||
| 9. What is the normal range of motion for lateral excursion, protrusion, and retrusion? | 490 | ||
| 10. Where are the center and axis of rotation of the TMJ? | 491 | ||
| 11. What are the major elevators of the mandible? | 491 | ||
| 12. What are the depressors of the mandible? | 491 | ||
| 13. Describe the muscle function and kinematics of lateral deviation. | 491 | ||
| 14. What is the role of the lateral pterygoid in oral function? | 491 | ||
| 15. How is pain arising from the retrodiscal pad differentiated from pain arising from muscular contraction? | 491 | ||
| 16. Define parafunctional habits. | 491 | ||
| 17. What are the three categories of TMD as defined by the American Academy of Orofacial Pain? | 491 | ||
| 18. How does an anteriorly displaced disc present clinically? | 491 | ||
| 19. What is an open lock? | 492 | ||
| 20. Explain the significance of opening with a C curve or S curve. | 492 | ||
| 21. What is the ideal resting position of the tongue? | 492 | ||
| 22. Describe the connection between TMD and forward-headed posture. | 492 | ||
| 23. How can TMJ problems cause dizziness, headache, and ear symptoms? | 492 | ||
| 24. What are the differential diagnoses of facial and TMJ pain? | 492 | ||
| 25. Describe current evidence-based physical therapy management for patients with TMD. | 492 | ||
| 26. Discuss the roles of splints. | 492 | ||
| 27. What imaging modalities are used to diagnose TMD? | 493 | ||
| 28. What evidence exists in the literature regarding the efficacy of physical therapy for TMD? | 493 | ||
| Bibliography | 493 | ||
| Section IX: The Sacroiliac Joint | 495 | ||
| Chapter 62: Functional Anatomy of the Sacroiliac Joint | 495 | ||
| 1. Name the osseous structures of the pelvic ring. | 495 | ||
| 2. How is the sacroiliac joint (SIJ) classified? | 495 | ||
| 3. Within which sacral segments does the SIJ form? | 495 | ||
| 4. Is the sacrum fully fused at birth? | 495 | ||
| 5. Which surface of the SIJ is concave? | 495 | ||
| 6. Describe the composition of the articular surfaces of the sacroiliac joint. | 495 | ||
| 7. What is the function of the sacroiliac joint? | 495 | ||
| 8. How does the orientation of the SIJ make it difficult to establish a specific axis of motion using conventional planes? | 496 | ||
| 9. Describe the mechanisms of stability in the SIJ in terms of form and force closure. | 496 | ||
| 10. Name and label the ligaments of the SIJ, and explain their function in limiting joint movement. | 496 | ||
| 11. Describe the attachments of the anterior sacroiliac and sacrospinous and sacrotuberous ligaments. | 496 | ||
| 12. Describe the attachments and function of the interosseous sacroiliac ligaments. | 496 | ||
| 13. Which muscles contribute to the stability of the SIJ? | 497 | ||
| 14. Describe the innervation of the SIJ. | 497 | ||
| 15. What neurologic structures emerging from the sacrum innervate the pelvic region and lower limbs? | 497 | ||
| 16. What are the anatomic differences between the male and female pelvis? | 497 | ||
| 17. What are the functional differences between the male and female pelvis? How do they affect the SIJ? | 497 | ||
| 18. Describe the influence of hormones on the SIJ. | 497 | ||
| 19. Describe the amount of potential movement at the SIJ. | 498 | ||
| 20. Describe the possible movements of the sacrum and innominate/ilium (based on the osteopathic model) | 498 | ||
| 21. Discuss the theoretic movements of the ilium and sacrum that may occur during trunk forward bending, backward bending... | 498 | ||
| 22. Describe the age-related changes in the SIJ. | 498 | ||
| 23. Why does the SIJ begin as a mobile joint and progress toward a stable joint? | 498 | ||
| 24. Explain the standard views for radiographic evaluation of the SIJ, and discuss the anatomic structures that are best ... | 498 | ||
| 25. What is the incidence of sacralization in the United States, and how is the presence of a cervical rib associated wit... | 499 | ||
| 26. What is lumbarization? | 499 | ||
| Bibliography | 499 | ||
| Chapter 63: Sacroiliac Dysfunction | 501 | ||
| 1. How are pelvic girdle disorders classified from an impairment-based model? | 501 | ||
| 2. What are the typical mechanisms of injury of the sacroiliac joint (SIJ)? | 501 | ||
| 3. When a patients symptoms include sacroiliac dysfunction, are there certain activities that either aggravate or relieve... | 501 | ||
| 4. Do age and gender play a role in the development of SIJ pathology? | 501 | ||
| 5. Describe the pattern of pain referral from the SIJ, as mapped by injection. | 501 | ||
| 6. Has limitation in lumbar range of motion been determined to be a predictor of SIJ dysfunction? | 502 | ||
| 7. Based on current literature, which appears to be more useful for evaluating the SIJ-assessment of anatomic symmetry or... | 502 | ||
| 8. Which provocation tests have been found to be the most useful in terms of reliability, sensitivity, specificity, and v... | 502 | ||
| 9. Why is the Patricks/FABER test used to assess for SIJ dysfunction? | 502 | ||
| 10. How could SIJ dysfunction cause acetabular retroversion? And why might this be important to the clinician? | 502 | ||
| 11. Describe the posterior shear or thigh thrust test. | 502 | ||
| 12. Describe the right posterior rotation pelvic torsion provocation test. | 502 | ||
| 13. Discuss the method and benefits of using injections to diagnose the SIJ as a cause of low back pain. | 502 | ||
| 14. Describe the osteopathic classifications of sacroiliac dysfunction as presented in clinical practice along with the a... | 503 | ||
| 15. According to the evidence in the current literature, why is it erroneous to consider hypomobility as a clinical syndr... | 503 | ||
| 16. Describe the clinical signs and treatment of sacroiliac hypermobility. | 503 | ||
| 17. What special test is good for determining sacroiliac laxity in postpartum patients? | 504 | ||
| 18. What may cause sacroiliac pain when mobility of the SIJ is normal? | 504 | ||
| 19. How can excellent diagnostic accuracy be achieved in the prediction of sacroiliac dysfunction? | 504 | ||
| 20. What percentage of patients will develop significant SIJ degeneration 5 years after a lumbar fusion? | 504 | ||
| 21. What common medical conditions affect the SIJ? | 504 | ||
| 22. What are the best imaging modalities for diagnosing the cause of SIJ pain? | 504 | ||
| 23. What are the radiologic signs of pubic symphysis instability? | 504 | ||
| 24. Do sacroiliac braces provide pain relief? | 504 | ||
| 25. Do osseous positional changes occur following a high-velocity manipulation to the SIJ? | 505 | ||
| 26. What is prolotherapy, and is it effective in the treatment of SIJ pain? | 505 | ||
| 27. What are some other forms of medical treatments for SIJ pain? | 505 | ||
| 28. What motor control strategies should a physical therapist assess when considering force closure mechanisms of the SIJ... | 505 | ||
| Bibliography | 505 | ||
| Section X: The Hip and Pelvis | 507 | ||
| Chapter 64: Functional Anatomy of the Hip and Pelvis | 507 | ||
| 1. Describe the articular surfaces of the hip joint. | 507 | ||
| 2. How is the hip joint classified? | 507 | ||
| 3. What is the angle of inclination of the femur? | 507 | ||
| 4. What is the angle of torsion of the femur? | 507 | ||
| 5. How is the angle of torsion assessed clinically? | 507 | ||
| 6. What gender differences exist in the anatomy of the hip? | 507 | ||
| 7. Describe the joint capsule of the hip. | 508 | ||
| 8. Which ligaments contribute to the stability of the hip? | 508 | ||
| 9. Describe the arthrokinematics of the hip joint. | 508 | ||
| 10. Describe the osteokinematics of the hip joint. | 508 | ||
| 11. Name the muscles that cross the hip joint. | 508 | ||
| 12. What is inversion of muscle action? | 508 | ||
| 13. Describe inversion of the flexor component of the adductor muscles. | 508 | ||
| 14. Describe inversion of muscle action for the piriformis. | 508 | ||
| 15. What is the iliocapsularis muscle? | 509 | ||
| 16. What changes occur to the hip musculature following an above-knee amputation? | 509 | ||
| 17. Are there differences in the strength of hip musculature, with versus without, osteoarthritis (OA) of the hip? | 509 | ||
| 18. Describe hip range of motion needed for common daily activities. | 509 | ||
| 19. Which muscles are active during two-legged erect stance? | 509 | ||
| 20. How much force is unloaded from the hip when a cane is used in the opposite hand? | 509 | ||
| 21. What structures pass through the sciatic notch? | 509 | ||
| 22. Describe the blood supply to the femoral head. | 509 | ||
| 23. Describe the anatomy of the trochanteric bursa. | 510 | ||
| 24. What is the ideal position for hip arthrodesis? | 510 | ||
| 25. What is the functional range of motion (ROM) of the hip? | 510 | ||
| 26. What force acts on the hip joint with active abduction in sidelying? | 510 | ||
| 27. Describe the function of the acetabular labrum: | 510 | ||
| 28. What is the maximal loose or open packed position of the hip? | 510 | ||
| 29. What is the maximal close packed position of the hip? | 510 | ||
| Bibliography | 510 | ||
| Chapter 65: Common Orthopedic Hip Dysfunction | 511 | ||
| 1. How are muscle strains classified? | 511 | ||
| 2. How do gluteus medius strains occur? | 511 | ||
| 3. What is ``bald trochanter´´? | 511 | ||
| 4. How do groin pulls occur? | 511 | ||
| 5. What treatment is effective in treating groin pulls? | 511 | ||
| 6. When is surgery necessary to treat a groin pull? | 511 | ||
| 7. What is a ``sports hernia´´? | 511 | ||
| 8. How is a sports hernia treated? | 512 | ||
| 9. What is the most frequently strained muscle in the body? | 512 | ||
| 10. How is hamstring length assessed? | 512 | ||
| 11. Are quadriceps strains common? | 512 | ||
| 12. How is rectus femoris length measured? | 513 | ||
| 13. How are the oblique muscles injured? | 513 | ||
| 14. Describe the treatment for muscle strain. | 513 | ||
| 15. Describe trochanteric bursitis. | 513 | ||
| 16. What are the symptoms of trochanteric bursitis? | 514 | ||
| 17. How is trochanteric bursitis treated? | 514 | ||
| 18. What is Obers test? | 514 | ||
| 19. How does iliopectineal/iliopsoas bursitis develop? | 514 | ||
| 20. Describe the clinical findings in iliopectineal bursitis. | 514 | ||
| 21. Describe the treatment for iliopectineal bursitis. | 514 | ||
| 22. How does ischial tuberosity bursitis present? What is its treatment? | 514 | ||
| 23. What is the sign of the buttock? | 515 | ||
| 24. How are contusions in athletes classified? | 515 | ||
| 25. What is a hip pointer? | 515 | ||
| 26. Describe the clinical findings of a hip pointer. | 515 | ||
| 27. How are hip pointers treated? | 515 | ||
| 28. What tests are useful in the diagnosis of hip pointers? | 515 | ||
| 29. What is the mechanism for a quadriceps contusion? What are the clinical findings? | 515 | ||
| 30. How does treatment for a quadriceps contusion progress? | 515 | ||
| 31. What causes myositis ossificans? | 516 | ||
| 32. How is myositis ossificans treated? | 516 | ||
| 33. Is surgery indicated for myositis ossificans? | 516 | ||
| 34. What is ``snapping hip´´ syndrome? How is it treated? | 516 | ||
| 35. Define osteitis pubis. | 516 | ||
| 36. How is osteitis pubis diagnosed and treated? | 516 | ||
| 37. How does damage occur to the acetabular labrum? | 517 | ||
| 38. How can acetabular labral tears be identified? | 517 | ||
| 39. How are acetabular labral tears treated? | 517 | ||
| 40. What are the two types of femoral acetabular impingements (FAIss)? | 517 | ||
| 41. How do you test for FAI? | 517 | ||
| 42. How do you test for ligamentous laxity of the hip joint? | 517 | ||
| 43. Define piriformis syndrome. | 517 | ||
| 44. How is piriformis syndrome assessed? | 518 | ||
| 45. How is piriformis syndrome treated? | 518 | ||
| 46. Define meralgia paresthetica. | 518 | ||
| 47. How is meralgia paresthetica diagnosed and treated? | 518 | ||
| 48. What is hamstring syndrome? | 518 | ||
| 49. How does the superior gluteal nerve become entrapped? | 518 | ||
| 50. What outcome measures are validated for orthopedic hip conditions? | 518 | ||
| Bibliography | 519 | ||
| Chapter 66: Fractures and Dislocations of the Hip and Pelvis | 520 | ||
| 1. Describe the Garden classification of femoral neck fractures. | 520 | ||
| 2. Where is the pain from femoral neck fractures typically felt? | 520 | ||
| 3. What are the treatment options for femoral neck fractures? | 520 | ||
| 4. What is the difference between unipolar and bipolar hemiarthroplasties? | 520 | ||
| 5. What preventive measures can elderly people take to avoid hip fractures? | 520 | ||
| 6. Describe the Evans classification of intertrochanteric (IT) hip fractures. | 520 | ||
| 7. What are the treatment options for IT fractures? | 520 | ||
| 8. How successful are MRI and bone scans in detecting nondisplaced hip fractures? | 520 | ||
| 9. Describe the mortality and morbidity rates associated with hip fractures. | 521 | ||
| 10. Describe the treatment for isolated avulsion fracture of the greater and lesser tuberosities. | 521 | ||
| 11. Define subtrochanteric (ST) femur fractures. | 521 | ||
| 12. What is the recommended treatment for femoral shaft and ST femur fractures? | 521 | ||
| 13. Should THA be considered in patients with displaced femoral neck fractures? | 521 | ||
| 14. What is one predictive measure of outcome after hip fracture? | 521 | ||
| 15. What is one of the main predictors of morbidity, length of hospital stay, and complications after hip fracture? | 521 | ||
| 16. What rehabilitation considerations are important after hip fracture? | 521 | ||
| 17. Define the Morel-Lavallee lesion. | 521 | ||
| 18. What features distinguish a stable pelvis fracture from an unstable one? | 521 | ||
| 19. What is a Malgaigne fracture? | 522 | ||
| 20. What is the usual mechanism of injury for pelvis fracture? | 522 | ||
| 21. Describe the usual mechanism of injury for acetabular fractures. | 522 | ||
| 22. What are the long-term complications of unstable pelvic ring disruptions? | 522 | ||
| 23. Is physical therapy useful after hip fracture? | 522 | ||
| 24. Does the rehabilitation site have an effect on recovery of function after hip fracture? | 522 | ||
| 25. What are the effects of extended outpatient rehabilitation after hip fracture? | 522 | ||
| 26. What are the differences in rehabilitation between men and women following hip fracture? | 522 | ||
| 27. Does early mobility after hip fracture influence mortality? | 522 | ||
| 28. Does neuromuscular stimulation to the quadriceps hasten return to mobility after hip fracture? | 523 | ||
| 29. Is there a difference in home physical therapy versus institutional treatment? | 523 | ||
| 30. What are the presenting symptoms of a patient with a hip dislocation? | 523 | ||
| 31. What is the postreduction treatment of traumatic hip dislocation? | 523 | ||
| 32. What complications are associated with hip dislocation? | 523 | ||
| Bibliography | 523 | ||
| Chapter 67: Total Hip Arthroplasty | 525 | ||
| 1. How much force is placed across the hip during routine activities of daily living? | 525 | ||
| 2. What are total hip precautions? | 525 | ||
| 3. What are the different types of surgical approaches used for hip arthroplasty, and how do they affect rehabilitation? | 525 | ||
| 4. What are typical hip range of motion goals following total hip arthroplasty (THA)? | 525 | ||
| 5. You notice that a patient you are treating following THA has developed increased calf swelling and localized tendernes... | 526 | ||
| 6. What are other typical complications associated with THA? | 526 | ||
| 7. What are the outcomes following THA? | 526 | ||
| 8. When can patients with THA resume sexual intercourse? | 526 | ||
| 9. Can patients with total hip arthroplasties return to play tennis effectively? Do physicians recommend this? | 526 | ||
| 10. Can patients with total hip arthroplasties return to play golf effectively? Do physicians recommend this? | 527 | ||
| 11. Does exercise before THA improve outcomes? | 527 | ||
| 12. What is the postoperative weight-bearing status of a THA patient? | 527 | ||
| 13. What types of patients are candidates for minimally invasive THA? What are the outcomes with this procedure? | 527 | ||
| 14. What are the pros and cons of the different types of arthroplasty surfaces: metal-on-metal, ceramic-on-ceramic, and m... | 527 | ||
| 15. Are hip precautions necessary following THA with an anterior approach? | 528 | ||
| 16. How does having a THA affect a patient going through airport security? | 528 | ||
| 17. Do high-impact sports affect survivorship after THA? | 528 | ||
| 18. Which type of THA provides better results, cemented or cementless? | 528 | ||
| 19. Is there an advantage to a minimally invasive THA versus conventional THA? | 528 | ||
| 20. When do patients following THA see the greatest results? | 528 | ||
| 21. Is highly cross-linked polyethylene superior to conventional polyethylene? | 529 | ||
| 22. Is direct anterior THA superior to THA done from the posterior approach? | 529 | ||
| Bibliography | 529 | ||
| Section XI: The Knee | 531 | ||
| Chapter 68: Functional Anatomy of the Knee | 531 | ||
| 1. What is a plica? | 531 | ||
| 2. Describe the symptoms of an irritated plica. | 531 | ||
| 3. Describe patella-trochlear groove contact as the knee moves from full extension to full flexion. | 531 | ||
| 4. Patella baja may result from adhesions caused by disruption of what bursa? | 531 | ||
| 5. What portion of the capsular ligament holds the menisci to the tibia? | 532 | ||
| 6. Describe the ``lateral blow-out´´ sign of the knee. | 532 | ||
| 7. Discuss the role of the posterior oblique (POL) ligament. | 532 | ||
| 8. What is the importance of the ``anterolateral ligament´´ (ALL)? | 532 | ||
| 9. What important function does the arcuate complex provide? | 532 | ||
| 10. How does the anatomic arrangement of the ACL dictate its function? | 532 | ||
| 11. Can anatomic or ``footprint´´ ACL reconstruction provide improved rotational knee control kinematics and clinical out... | 533 | ||
| 12. What is the function of the PCL? | 533 | ||
| 13. What is the function of the iliotibial band? How does it contribute to the integrity of the knee? | 533 | ||
| 14. How does the ITB affect the pivot-shift test of the knee? | 533 | ||
| 15. Describe the anatomic reasons for patellar instability. | 533 | ||
| 16. Describe how patella alta can lead to patellar tendinitis. | 533 | ||
| 17. Describe the anatomy of articular cartilage. | 533 | ||
| 18. Describe the arterial blood vessels of the knee. | 534 | ||
| 19. Do the cruciate ligaments really cross? | 534 | ||
| 20. Describe the alignment of the femur and tibia during weight bearing. | 534 | ||
| 21. Are there differences between female and male knee joint anatomy and biomechanics? | 534 | ||
| 22. What is the normal amount of tibial torsion, and how does the physical therapist measure it clinically? | 534 | ||
| 23. Which meniscus is most commonly injured and why? | 534 | ||
| 24. What is the function of the popliteus musculotendinous complex? | 534 | ||
| Bibliography | 535 | ||
| Chapter 69: Patellofemoral Disorders | 536 | ||
| 1. What is the Q-angle? | 536 | ||
| 2. What is the tubercle-sulcus angle? | 536 | ||
| 3. What may cause an increase in the Q-angle? | 536 | ||
| 4. What anatomic structures encourage lateral tracking of the patella? | 536 | ||
| 5. Define patella alta. | 537 | ||
| 6. What is the function of the vastus medialis oblique (VMO) muscle? | 537 | ||
| 7. How is chondromalacia classified? | 537 | ||
| 8. How is PF pain classified? | 537 | ||
| 9. Describe treatment based on the classification scheme of Holmes and Clancy. | 537 | ||
| 10. Describe the classification scheme of Wilk et al. | 538 | ||
| 11. How can the system of Wilk et al. be applied to common anterior knee pain disorders? | 539 | ||
| 12. What is lateral pressure syndrome? | 539 | ||
| 13. Define bipartite patella. | 539 | ||
| 14. What is Sinding-Larsen-Johansson disease? | 539 | ||
| 15. Can a leg length discrepancy contribute to PF pain? | 540 | ||
| 16. Because articular cartilage is aneural, what tissues around the PF joint cause PF pain? | 540 | ||
| 17. Define Hoffas disease. | 540 | ||
| 18. How is Hoffas disease treated? | 540 | ||
| 19. Describe the mechanism of pain stemming from the medial plica. | 540 | ||
| 20. How is plica syndrome diagnosed? | 540 | ||
| 21. Define housemaids knee. | 540 | ||
| 22. Describe the mechanism for patellar dislocation. | 540 | ||
| 23. What population is more susceptible to patellar dislocations? | 540 | ||
| 24. What is the rate of repeat dislocation? | 541 | ||
| 25. Can hip weakness contribute to PF pain? | 541 | ||
| 26. What criteria are used to assess patellar instability? | 541 | ||
| 27. Are radiologic studies useful? | 541 | ||
| 28. What views are best to examine the PF joint? | 541 | ||
| 29. Define the congruence angle. | 541 | ||
| 30. Is MRI a useful tool to assess patients with PF pain? | 541 | ||
| 31. Does strengthening of the quadriceps help patients with PF pain? | 541 | ||
| 32. Do all patients need to perform aggressive quadriceps strengthening exercises? | 542 | ||
| 33. Does electromyographic (EMG) biofeedback strength training help patients with PF pain? | 542 | ||
| 34. What are the advantages of nonweight-bearing exercises for patients with PF pain? | 542 | ||
| 35. What are the disadvantages of nonweight-bearing exercises? | 543 | ||
| 36. What are the advantages of weight-bearing exercises for patients with PF pain? | 543 | ||
| 37. What is the main disadvantage of weight-bearing exercises? | 543 | ||
| 38. Are open-chain or closed-chain exercises better for a patient with PF pain? | 543 | ||
| 39. Can the VMO be strengthened in isolation? | 543 | ||
| 40. Is it better to perform quadriceps strengthening in a specific part of the knees range of motion? | 543 | ||
| 41. Tightness of which muscles can contribute to PF pain? | 543 | ||
| 42. Should physical modalities be a part of the rehabilitation program? | 543 | ||
| 43. Is patellar taping (McConnell taping) an effective intervention for patients with PF pain syndrome? | 544 | ||
| 44. Is kinesio taping an effective intervention for patients with PF pain syndrome? | 544 | ||
| 45. Is bracing beneficial for the patient with PF pain? | 544 | ||
| 46. How is a patellar tendon strap supposed to alleviate PF pain? | 544 | ||
| 47. What is the relationship between foot mechanics and PF pain? | 544 | ||
| 48. Are foot orthotics beneficial for patients with PF pain? | 544 | ||
| 49. When are distal realignment surgical procedures indicated? | 544 | ||
| 50. What are the long-term results of nonsurgical management of PF disorders? | 545 | ||
| Bibliography | 545 | ||
| Chapter 70: Meniscal Injuries | 547 | ||
| 1. How common are meniscal injuries in the United States? | 547 | ||
| 2. Describe the anatomy of the meniscus. | 547 | ||
| 3. What structures attach to the medial meniscus? | 547 | ||
| 4. Is the meniscus avascular? | 547 | ||
| 5. List the functions of the meniscus. | 547 | ||
| 6. How important are the menisci in transmitting loads across the knee joint? | 547 | ||
| 7. Do the menisci move with knee joint motion? | 547 | ||
| 8. What is a discoid meniscus? | 547 | ||
| 9. What is a meniscal cyst? Where is it likely to occur? | 548 | ||
| 10. What is the most common mechanism of meniscal injury? | 548 | ||
| 11. Which meniscus is more commonly injured? | 548 | ||
| 12. What are the signs and symptoms of a meniscal tear? | 548 | ||
| 13. Describe the most common meniscal tears. | 548 | ||
| 14. How accurate is magnetic resonance imaging (MRI) in detecting a meniscal tear? | 548 | ||
| 15. Describe the McMurray test. | 548 | ||
| 16. What other special tests are used to test for a meniscal tears? Do they have high sensitivity or specificity? | 548 | ||
| 17. Describe the Steinmann point tenderness test. | 548 | ||
| 18. What is the typical management strategy for a meniscal tear? | 548 | ||
| 19. How effective is nonoperative treatment for meniscal tears? | 549 | ||
| 20. What is the most common surgical management of meniscal injury? | 549 | ||
| 21. When is a partial meniscectomy indicated? | 549 | ||
| 22. What are the predictors of a poor outcome following partial arthroscopic meniscectomy? | 549 | ||
| 23. What is the usual time frame for return to function after partial meniscectomy? | 549 | ||
| 24. When is a meniscal repair indicated? | 549 | ||
| 25. What are the common forms of meniscal repair, and is one better than the other? | 549 | ||
| 26. What is the clinical success rate following meniscal repair? | 549 | ||
| 27. What are contraindications for meniscal repair? | 550 | ||
| 28. Does bleeding stimulate the reparative process of a torn meniscus? | 550 | ||
| 29. Can stem cells be used to treat a meniscal tear? | 550 | ||
| 30. What are the typical rehabilitation guidelines following meniscal repair? | 550 | ||
| 31. Do surgically repaired menisci appear normal on MRI after 10 years? | 550 | ||
| 32. What is meniscal repair using a bioabsorbable screw or arrow? | 550 | ||
| 33. What are the outcomes of meniscal repair using a bioabsorbable screw or arrow? | 550 | ||
| 34. If a meniscal repair fails, can it be repaired a second time? | 550 | ||
| 35. What is a meniscal transplant? | 550 | ||
| 36. What are the typical rehabilitation guidelines following meniscal transplantation? | 551 | ||
| 37. What are the outcomes associated with meniscal transplantation? | 551 | ||
| Bibliography | 551 | ||
| Chapter 71: Ligamentous Injuries of the Knee | 553 | ||
| 1. What ligaments of the knee can be disrupted by a hyperextensive force? | 553 | ||
| 2. Which ligament of the knee is the most likely to be disrupted by a motor vehicle accident in which the tibial tuberosi... | 553 | ||
| 3. Which ligament is likeliest to be injured by a crossover cut maneuver? | 553 | ||
| 4. Which structures of the knee can be injured during a side-step cut maneuver with valgus force? | 553 | ||
| 5. How might an occult osteochondral lesion be associated with an ACL rupture, and where is it commonly found? | 553 | ||
| 6. How might an occult osteochondral lesion associated with an ACL rupture affect long-term outcomes? | 553 | ||
| 7. What is a Segond fracture? | 554 | ||
| 8. Does research consistently support the use of bone-patellar tendon-bone graft versus hamstring tendon graft for ACL re... | 554 | ||
| 9. Which ACL graft is better-allograft or autograft? | 554 | ||
| 10. What is the incidence of ACL injury in females versus males, and what are the anatomic, physiologic, and neuromuscula... | 554 | ||
| 11. What is the effectiveness, if any, of ACL prevention programs for female athletes? | 555 | ||
| 12. What is the epidemiology of ACL tears in the United States? | 555 | ||
| 13. Define anteromedial rotary instability. Which clinical tests are positive for this type of instability? | 555 | ||
| 14. Define anterolateral rotary instability. Which clinical tests are positive? | 555 | ||
| 15. Define posterolateral rotary instability. Which clinical tests are positive? | 555 | ||
| 16. Define straight medial knee ligament instability. Which clinical tests are positive? | 555 | ||
| 17. Define straight lateral knee ligament instability. Which clinical tests are positive? | 555 | ||
| 18. Why is there no such thing as posterior medial rotary instability? | 555 | ||
| 19. How accurate is a clinical examination for ACL injury? | 556 | ||
| 20. What is the incidence for reinjury following ACL reconstruction in athletes? | 556 | ||
| 21. Do all ACL tears require surgery? | 556 | ||
| 22. In an open-chain active extension motion, where does maximal stress fall on the ACL? | 556 | ||
| 23. Do open- and closed-chain exercises put equal amounts of stress on the ACL? | 556 | ||
| 24. Can an independent, home-based rehabilitation program be successful for the postsurgical ACL reconstruction patient w... | 556 | ||
| 25. What criteria are used for the diagnosis of ACL tears with joint arthrometry? | 557 | ||
| 26. How accurate is magnetic resonance imaging (MRI) in detecting ACL and PCL tears? | 557 | ||
| 27. How strong are the most common ACL grafts? | 557 | ||
| 28. What are some common guidelines for activities after ACL reconstruction? | 557 | ||
| 29. What are the outcomes of ACL repair? | 557 | ||
| 30. Describe the grading system for collateral ligament injuries. | 557 | ||
| 31. Compare third-degree injury of the ACL with third-degree injury of the medial compartment ligaments of the knee. | 557 | ||
| 32. What is the most commonly used graft for a PCL reconstruction? | 557 | ||
| 33. Describe the general treatment strategy for MCL injuries. | 557 | ||
| 34. Testing for medial knee instability in a 10-year-old boy after a valgus injury demonstrates a pathologic opening of t... | 557 | ||
| 35. Describe the signs and symptoms of a lateral collateral ligament (LCL) injury. | 558 | ||
| 36. Describe the typical surgical procedures used to repair/reconstruct the lateral knee. | 558 | ||
| 37. Describe the role that platelet-rich plasma (PRP) plays in the management of ACL tears. | 558 | ||
| Bibliography | 558 | ||
| Chapter 72: Total Knee Arthroplasty | 560 | ||
| 1. Is the patella typically resurfaced at the time of total knee arthroplasty (TKA)? What are the outcome differences? | 560 | ||
| 2. What is the weight-bearing status of most patients following total knee arthroplasty? | 560 | ||
| 3. What are the common knee range of motion goals following total knee arthroplasty? | 560 | ||
| 4. You notice that a patient you are treating following knee arthroplasty has developed increased calf swelling and local... | 560 | ||
| 5. What is the difference between a posterior cruciate substituting and a posterior cruciate retaining knee replacement? ... | 560 | ||
| 6. What complications are associated with total knee arthroplasty? | 561 | ||
| 7. What are the outcomes of total knee arthroplasty? | 561 | ||
| 8. What are the indications for unicompartmental knee arthroplasty (UKA)? | 561 | ||
| 9. What are the outcomes of UKA? | 561 | ||
| 10. What are the indications for proximal tibial osteotomy? | 562 | ||
| 11. What are the outcomes of proximal tibial osteotomy? | 562 | ||
| 12. Can a patient kneel after total knee arthroplasty? | 562 | ||
| 13. Can patients with total knee arthroplasty return to playing tennis? Do doctors recommend this? | 562 | ||
| 14. Can patients with total knee arthroplasty return to playing golf? Do doctors recommend this? | 562 | ||
| 15. Does following an exercise program before total knee replacement surgery improve outcome? | 562 | ||
| 16. What is a rotating platform total knee arthroplasty? | 563 | ||
| 17. What are preoperative predictors for return to work following TKA? | 563 | ||
| 18. Is there an advantage of having a mini-invasive or computer-navigated total knee arthroplasty versus conventional TKA? | 563 | ||
| 19. What are indications for manipulation under anesthesia for a total knee arthroplasty? What are expected gains? When i... | 563 | ||
| 20. What characteristics are commonly found in patients with knee flexion contractures following TKA? Are there surgical ... | 563 | ||
| 21. What are the risks and benefits of simultaneous TKA? | 563 | ||
| 22. Does preoperative osteoarthritis affect pain and dissatisfaction after TKA? | 563 | ||
| 23. Does obesity affect outcomes after TKA? | 564 | ||
| 24. Can TKA be done in an outpatient setting? | 564 | ||
| Bibliography | 564 | ||
| Chapter 73: Knee Fractures and Dislocations | 566 | ||
| Patellar fractures | 566 | ||
| 1. List, in order of frequency of occurrence, the five types of patellar fractures. | 566 | ||
| 2. List the two major mechanisms of injury that result in patellar fractures. | 566 | ||
| 3. When is nonsurgical treatment indicated for a patellar fracture? | 566 | ||
| 4. Describe the course of conservative treatment for patellar fractures. | 566 | ||
| 5. What are the common sequelae of patellar fractures? | 566 | ||
| 6. How is a bipartite patellar differentiated from a fracture? | 566 | ||
| 7. Describe the outcomes for nonoperative treatment of nondisplaced patellar fractures. | 566 | ||
| 8. What are the outcomes for open reduction and internal fixation (ORIF) of patellar fractures? | 566 | ||
| 9. By what mechanism does the tension-banding technique stabilize patellar fractures? | 566 | ||
| 10. How does rehabilitation differ between patients with nondisplaced fractures and patients with severely comminuted fra... | 567 | ||
| 11. What are the outcomes for patellectomy? | 567 | ||
| 12. At what age does a quadriceps tendon rupture typically occur? How do patients present? | 567 | ||
| 13. How is a quadriceps tendon rupture treated? What is the expected outcome? | 567 | ||
| 14. At what age does a patellar tendon rupture typically occur? How do patients present? | 567 | ||
| 15. What is the incidence of repeat patellar tendon rupture following surgical repair? | 567 | ||
| 16. How are patellar tendon ruptures repaired? What is the expected outcome? | 567 | ||
| Distal femoral fractures | 567 | ||
| 17. What is the typical direction of displacement for a supracondylar distal femoral fracture? Why? | 567 | ||
| 18. How are closed supracondylar fractures treated after reduction? | 567 | ||
| 19. What are the primary goals of operative treatment of distal femoral fractures? | 567 | ||
| 20. What injuries are commonly associated with distal femoral fractures? | 568 | ||
| 21. Describe the age distribution of distal femoral fractures. | 568 | ||
| 22. What are the indications and contraindications for operative and nonoperative treatment of distal femoral fractures? | 568 | ||
| 23. Why is fat embolism such a concern with femoral fractures? | 568 | ||
| 24. What are the outcomes for low profile minimally invasive plating for distal femoral fractures? | 568 | ||
| 25. How do distal femoral fractures present in children? What is the incidence of distal femoral fractures in children? W... | 568 | ||
| 26. Describe the nonoperative treatment of nondisplaced and displaced distal femoral fractures in children. | 568 | ||
| 27. What are the indications for ORIF of distal femoral fractures in children? | 568 | ||
| 28. What complications are associated with distal femoral fractures in children? | 568 | ||
| Proximal tibial fractures | 569 | ||
| 29. What are the general types of proximal tibial fractures? | 569 | ||
| 30. What kinds of condylar fractures are often seen in the elderly? | 569 | ||
| 31. What injuries are associated with condylar fractures? | 569 | ||
| 32. Which tibial condyle is fractured more frequently? Why? | 569 | ||
| 33. Describe conservative treatment of nondisplaced condylar fractures. | 569 | ||
| 34. Describe the outcomes of low-profile minimally invasive plating for proximal tibia fractures. | 569 | ||
| 35. Traumatic avulsions of the tibial tubercle are seen most often in what age group? Describe the mechanism and rate of ... | 569 | ||
| 36. How are proximal tibial physeal fractures in children treated? | 569 | ||
| 37. What complications are associated with proximal tibial physeal fractures? | 569 | ||
| 38. Describe the weight bearing progression for the various fractures about the knee. | 570 | ||
| Knee dislocations | 570 | ||
| 39. What is the frequency of vascular and nerve injury following knee dislocation? | 570 | ||
| 40. How does disruption of a popliteal artery after knee dislocation present? Describe the emergent treatment. | 570 | ||
| 41. Should repair of ligament tears be acute or delayed in knee dislocations? | 570 | ||
| 42. Does the use of a hinged external fixator provide for better outcomes in knee dislocations? | 570 | ||
| Patellar dislocations and subluxations | 570 | ||
| 43. What are the anatomic characteristics of typical patients with patellar dislocations? | 570 | ||
| 44. What type of fracture is frequently associated with acute patellar dislocations? | 571 | ||
| 45. What are the two main mechanisms of patellar dislocation and subluxation? | 571 | ||
| 46. Describe the typical conservative course of treatment for a first-time patellar dislocation. | 571 | ||
| 47. What factors contribute to recurrent instability after acute patellar dislocation? | 571 | ||
| 48. What are the indications for surgery with a patellar dislocation? | 571 | ||
| 49. What are the indications and contraindications for lateral retinacular release? | 571 | ||
| 50. How effective is reconstruction of the medial patellofemoral ligament (MPFL) for the treatment of instability? | 571 | ||
| 51. What is the typical progression of rehabilitation following a lateral retinacular release? | 571 | ||
| 52. When is a tibial tubercle osteotomy indicated, and what kind of outcomes can be expected? | 571 | ||
| 53. What is the average recurrence rate after lateral retinacular release for recurrent patellar dislocation? | 571 | ||
| 54. What degree of tubercle-sulcus angle (Q-angle at 90 degrees) indicates potential patellar instability? | 572 | ||
| 55. What radiographic view is used to assess patellar malalignment? | 572 | ||
| 56. What are the outcomes of medial retinacular repair with lateral retinacular release for acute patellar dislocation? | 572 | ||
| Bibliography | 572 | ||
| Chapter 74: Nerve Entrapments of the Lower Extremity | 574 | ||
| 1. In what order are sensory fibers normally lost after nerve injury? | 574 | ||
| 2. Are motor fibers or sensory fibers the first to show electrophysiologically measurable signs of entrapment? | 574 | ||
| 3. What constitutes compression of a peripheral nerve? | 574 | ||
| 4. Describe the negative effects of compression on nerve function. | 574 | ||
| 5. What nerve entrapments are found in the lower extremity? | 574 | ||
| 6. How does lateral cutaneous nerve of the thigh mononeuropathy (meralgia paresthetica) present clinically? Describe its ... | 575 | ||
| 7. Describe the cause and prognosis of lateral cutaneous nerve of the thigh mononeuropathy (meralgia paresthetica). | 575 | ||
| 8. What causes femoral nerve entrapment? | 575 | ||
| 9. How does an obturator nerve entrapment present? | 575 | ||
| 10. What clinical manifestations are associated with entrapment of the saphenous nerve? | 576 | ||
| 11. List four sites of potential fibular (peroneal) nerve entrapment. | 576 | ||
| 12. Describe the clinical presentation of compression of the superficial sensory fibular nerve. | 576 | ||
| 13. Describe the clinical presentation of a deep fibular nerve injury. | 576 | ||
| 14. Describe the tarsal tunnel. | 576 | ||
| 15. What is anterior tarsal tunnel syndrome? | 577 | ||
| 16. What is PTT syndrome? | 577 | ||
| 17. Is tarsal tunnel syndrome a common problem? What branch of the plantar nerve is preferentially involved? | 577 | ||
| 18. What causes entrapment of the sural nerve? | 577 | ||
| 19. How sensitive and specific is electrophysiologic testing? | 578 | ||
| 20. Are there regions of the lower extremity that have a tendency to generate electrophysiologic false positives? | 578 | ||
| 21. What neurologic conditions should be considered in patients with bilateral lower limb numbness, tingling, and pain? | 578 | ||
| 22. What are the various causes of lower limb peripheral neuropathy? | 578 | ||
| 23. How does a sciatic nerve injury present? | 578 | ||
| 24. What are the most common causes of sciatic nerve injury? | 579 | ||
| 25. What are common nerve conduction and electromyography findings in patients with sciatic nerve injury? | 579 | ||
| 26. What is the prognosis for patients who have sustained a sciatic nerve injury? | 579 | ||
| Bibliography | 579 | ||
| Section XII: The Foot and Ankle | 581 | ||
| Chapter 75: Functional Anatomy of the Foot and Ankle | 581 | ||
| 1. What are the major anatomic divisions of the bones of the foot? | 581 | ||
| 2. What are the four muscular layers, from superficial to deep, from the plantar aspect of the foot? | 581 | ||
| 3. Describe the axis of movement and range of motion (ROM) of the foot and ankle. | 581 | ||
| 4. How much talocrural ROM is typically required for normal gait? | 582 | ||
| 5. How much subtalar ROM is required for normal gait? | 582 | ||
| 6. What is the correct terminology to use when referring to or describing foot and ankle motion? | 582 | ||
| 7. Define pronation and supination in relation to the rear foot. | 582 | ||
| 8. Explain the windlass mechanism of the foot. | 582 | ||
| 9. What are the common arches of the normal foot? | 582 | ||
| 10. What are the main noncontractile or passive supports of the longitudinal arches? | 582 | ||
| 11. What are the main dynamic support structures of the longitudinal arches of the foot? | 582 | ||
| 12. What is pes planus? | 582 | ||
| 13. What is pes cavus? | 583 | ||
| 14. What is the ideal position for ankle fusion (eg, arthrodesis)? | 583 | ||
| 15. What percentage of weight does the fibula bear? | 583 | ||
| 16. What is Ficks angle? | 583 | ||
| 17. Describe the function of the deltoid ligament. | 583 | ||
| 18. What are the lateral collateral ligaments of the ankle and rear foot? | 583 | ||
| 19. Define Lisfranc ligament. | 583 | ||
| 20. What is the spring ligament? | 583 | ||
| 21. What is the bifurcate ligament? | 584 | ||
| 22. Define Chopart and Lisfranc joints. | 584 | ||
| 23. How does the weight bearing surface of the ankle change after syndesmotic injury of the ankle? | 584 | ||
| 24. Why is the anterior talus subject to impingement? | 584 | ||
| 25. What is the sinus tarsi? | 584 | ||
| 26. What are the contents of the tarsal tunnel? | 584 | ||
| 27. Describe the structure of the tarsal tunnel. | 584 | ||
| 28. List the five nerves that cross into and supply the motor and sensory fibers to the foot. | 584 | ||
| 29. Define porta pedis. | 584 | ||
| 30. What structure is referred to as ``freshmans nerve´´? | 584 | ||
| 31. What is meant by an accessory bone of the foot? | 585 | ||
| 32. Describe the function of the sesamoids. | 585 | ||
| 33. What is the master knot of Henry? | 585 | ||
| 34. What is the effect of an increasing hallux valgus on plantar flexion force at push-off? | 585 | ||
| 35. What is Toygars triangle? | 585 | ||
| 36. What are the normal forces (relative to body weight) acting on the ankle joint during functional activities, such as ... | 585 | ||
| 37. How many muscles attach to the talus? | 585 | ||
| 38. What is metatarsus adductus? | 585 | ||
| 39. What is the function of the interossei and lumbrical muscles? | 585 | ||
| 40. Describe the functional anatomy of the anterior talofibular ligament. | 585 | ||
| 41. What is the relationship between metatarsal length and midfoot arthrosis? | 586 | ||
| Bibliography | 586 | ||
| Chapter 76: Common Orthopedic Foot and Ankle Dysfunctions | 587 | ||
| 1. What is the difference between Achilles tendinitis, tendinosis, and tendinopathy? | 587 | ||
| 2. What is the difference between midsubstance tendinopathy and insertional tendinopathy, and what are the treatment impl... | 587 | ||
| 3. What are the risk factors for developing Achilles tendinopathy? | 587 | ||
| 4. What should be considered when evaluating Achilles tendinopathy? | 587 | ||
| 5. What is the best treatment for midsubstance Achilles tendinopathy? | 588 | ||
| 6. What is the eccentric protocol for Achilles tendinopathy? | 588 | ||
| 7. What is the differential diagnosis for those with heel and posterior lower leg pain? | 588 | ||
| 8. What are the common rupture sites of the Achilles tendon complex? | 588 | ||
| 9. Describe the typical patient with Achilles tendon rupture. | 588 | ||
| 10. How is an Achilles tendon rupture diagnosed? | 588 | ||
| 11. Is operative treatment necessary for acute Achilles tendon ruptures? | 589 | ||
| 12. What is a recommended nonoperative and operative rehabilitation protocol after Achilles tendon rupture? | 589 | ||
| 13. What is the goal for functional outcome after Achilles tendon rupture with appropriate rehabilitation? | 589 | ||
| 14. What are the most important considerations with rehabilitation of the Achilles tendon rupture? | 589 | ||
| 15. Describe symptoms for tarsal tunnel syndrome. | 589 | ||
| 16. What factors may contribute to tarsal tunnel syndrome? | 590 | ||
| 17. What is posterior tibialis tendon dysfunction (PTTD)? | 590 | ||
| 18. What are the different stages of PTTD? | 590 | ||
| 19. What causes PTTD? | 590 | ||
| 20. What should be considered when evaluating PTTD? | 590 | ||
| 21. What is the best evidence-based treatment for PTTD? | 591 | ||
| 22. What causes peroneal tendon subluxation? | 591 | ||
| 23. How is peroneal tendon subluxation diagnosed? | 591 | ||
| 24. Summarize the differential diagnosis for heel pain. | 591 | ||
| 25. What is plantar fasciitis? | 591 | ||
| 26. Besides the plantar fascia, what other structures can be involved with this syndrome? | 592 | ||
| 27. What tests and measures are useful in the diagnosis of plantar fasciitis? | 592 | ||
| 28. What are the risk factors associated with plantar fasciitis? | 592 | ||
| 29. What is the best treatment for plantar heel pain? | 592 | ||
| 30. What nerves are involved with plantar heel pain? | 592 | ||
| 31. How can adverse neurodynamics cause plantar heel pain, and why do patients feel better with neural mobilization? | 592 | ||
| 32. Describe the common cause and usual management of heel pain in children. | 592 | ||
| 33. What are some clinically useful outcome measures that can be used for patients with heel pain or plantar fasciitis? | 593 | ||
| 34. Summarize the differential diagnosis for pain in the lateral aspect of the ankle after inversion sprain. | 593 | ||
| 35. How common are the various ankle sprains? | 593 | ||
| 36. When are radiographs warranted for ankle and foot injuries? | 593 | ||
| 37. What is the best method for measuring ankle swelling? | 593 | ||
| 38. What are the guidelines for return to activities and sports after ankle sprains, and what is the best evidence to pre... | 593 | ||
| 39. What disorders may cause chronic pain after an ankle sprain? | 594 | ||
| 40. What is a syndesmotic ankle sprain? | 594 | ||
| 41. What are shin splints? | 594 | ||
| 42. What is the most common cause of tibial overuse syndromes? | 594 | ||
| 43. Why is anterior tibial stress syndrome (shin splints) often associated with runners? | 594 | ||
| 44. What is the cause of posterior medial tibial stress syndrome? | 594 | ||
| 45. What is the best treatment for shin splints? | 595 | ||
| 46. Define sinus tarsi syndrome. | 595 | ||
| 47. Define tarsal coalition. | 595 | ||
| 48. Describe the normal mobility of the first ray. How is it assessed clinically? | 595 | ||
| 49. What are hallux rigidus and hallux limitus, and what is the best treatment? | 595 | ||
| 50. What is the consequence of a hypomobile first ray? | 595 | ||
| 51. Describe bunions and hallux abducto valgus (HAV) deformity and discuss risk factors. | 595 | ||
| 52. Should you treat asymptomatic HAV? | 596 | ||
| 53. What interventions are helpful in those with painful HAV? | 596 | ||
| 54. What is the typical surgery for a bunion or hallux abductus valgus (HAV)? | 596 | ||
| 55. What should be considered with rehabilitation after HAV? | 596 | ||
| 56. Describe the windlass mechanism. How can abnormal mechanics lead to pathology? | 596 | ||
| 57. Describe hammer toes and mallet toes. How are they treated? | 597 | ||
| 58. Define claw toes. How are they treated? | 597 | ||
| 59. What is sesamoiditis? | 597 | ||
| 60. What is metatarsalgia? | 597 | ||
| 61. In general, what is the best conservative treatment for forefoot disorders? | 597 | ||
| 62. Where is the most common site of a neuroma? Describe the symptoms of a neuroma. | 597 | ||
| 63. How is a neuroma diagnosed? | 598 | ||
| 64. What is the suggested treatment for neuromas? | 598 | ||
| 65. How is the level of protective sensation tested? | 598 | ||
| Bibliography | 598 | ||
| Chapter 77: Fractures and Dislocations of the Foot and Ankle | 601 | ||
| 1. How are ankle fractures classified? | 601 | ||
| 2. What are the indications for surgical treatment of an ankle fracture? | 601 | ||
| 3. Describe the radiographic views and alignment guides used in assessing ankle fractures. | 601 | ||
| 4. Describe the complications and outcomes of ankle fractures. | 602 | ||
| 5. Describe other fracture patterns around the ankle. | 602 | ||
| 6. What is the Hawkins classification of talar neck fractures? | 602 | ||
| 7. Describe the treatment and outcomes for talus fractures. | 602 | ||
| 8. What is Canales view? | 602 | ||
| 9. What radiographic views and lines are used to evaluate calcaneal fractures? | 602 | ||
| 10. What are the outcomes of calcaneal fractures? | 602 | ||
| 11. How is a bipartite sesamoid distinguished from a sesamoid fracture? | 603 | ||
| 12. What is a pilon ankle fracture and how is it treated? | 603 | ||
| 13. What complications can occur after pilon fractures? | 603 | ||
| 14. What common fractures are frequently misdiagnosed as ankle sprains? | 603 | ||
| 15. What is the pathophysiology of stress fractures of the foot? | 603 | ||
| 16. What are common locations for stress fractures of the foot? | 603 | ||
| 17. Describe the Sanders classification of calcaneal fractures. | 603 | ||
| 18. What injuries are commonly associated with calcaneal fractures? | 604 | ||
| 19. How are calcaneal fractures treated? | 604 | ||
| 20. What are expected outcomes after calcaneal fractures? | 604 | ||
| 21. What fractures of the foot are at risk for avascular necrosis and why? | 604 | ||
| 22. What is a Lisfranc joint injury? | 604 | ||
| 23. What are the classification patterns and treatments for Lisfranc injuries? | 605 | ||
| 24. What are the classification and treatment of a fifth metatarsal base fracture (Jones fracture)? | 605 | ||
| 25. What is a Charcot arthropathy or neuropathic arthropathy, and how is it classified? | 605 | ||
| 26. How is a Charcot arthropathy/neuropathic arthropathy diagnosed and treated? | 605 | ||
| 27. How are talar fractures classified? | 606 | ||
| 28. How are talar fractures treated? | 606 | ||
| 29. What is the Hawkins sign? | 606 | ||
| 30. How are osteochondral talar dome fractures classified? | 606 | ||
| 31. How are osteochondral talar dome fractures treated? | 606 | ||
| 32. What is compartment syndrome of the foot, and how is it diagnosed? | 607 | ||
| 33. How does the presence of diabetes affect ankle fracture outcomes? | 607 | ||
| Bibliography | 607 | ||
| Chapter 78: Foot Orthoses and Shoe Design | 609 | ||
| 1. Define the subtalar neutral position. Why is it important? | 609 | ||
| 2. How is subtalar neutral position determined? | 609 | ||
| 3. How reliable and valid are these methods? | 609 | ||
| 4. What is the primary goal of a foot orthosis? | 609 | ||
| 5. Does the subtalar joint function around neutral position? | 609 | ||
| 6. Do orthotics actually control motion? | 610 | ||
| 7. Why do orthotics function better in the clinical setting? | 610 | ||
| 8. How do foot orthoses control motion? | 610 | ||
| 9. When can a foot orthosis be utilized to ``increase´´ motion? | 610 | ||
| 10. Does exercise prescription provide an added benefit to foot orthosis application? | 610 | ||
| 11. Are there any clinical tests that, if positive, suggest that a patient requires a foot orthosis? | 610 | ||
| 12. What is the significance of heel eversion in a relaxed standing position? | 610 | ||
| 13. Why do some patients stand with most of the weight on the outside of the feet? | 611 | ||
| 14. What types of symptoms can be caused by a rigid plantar-flexed first ray? | 611 | ||
| 15. In what situation does the heel evert very little while the STJ pronates excessively? | 611 | ||
| 16. Why does a rear foot with a varus position fail to pronate at the STJ during weight bearing? | 611 | ||
| 17. With restricted calcaneal motion caused by limited STJ pronation, would there ever be a case for posting the heel med... | 611 | ||
| 18. Can a foot that pronates excessively still lack enough pronation? | 611 | ||
| 19. Can a foot that relaxes close to STJ neutral be abnormal and require orthotic intervention? | 611 | ||
| 20. What is the difference between forefoot varus and forefoot supinatus? | 611 | ||
| 21. Are posting strategies different in children? | 612 | ||
| 22. What is the role of the arch of the orthotic shell? | 612 | ||
| 23. What is an extended forefoot post, and when is it indicated? | 612 | ||
| 24. How does function improve with a first ray cut-out? | 612 | ||
| 25. What is more important in orthotic fabrication: material selection, posting, or specific contouring of the device? | 612 | ||
| 26. What problems may be associated with insufficient rearfoot varus posting with a substantial forefoot varus post? | 612 | ||
| 27. Why would a patient with a large rear foot and forefoot varus complain that he or she is sliding off the lateral side... | 612 | ||
| 28. How does the forefoot adjust to a large degree of rear foot posting? | 612 | ||
| 29. Why should the midtarsal joint be considered when designing an orthosis? | 613 | ||
| 30. How many miles can a running shoe sustain? | 613 | ||
| 31. How can orthotics relieve symptoms of a Mortons neuroma? | 613 | ||
| 32. What is the function of an external metatarsal or rocker bar? | 613 | ||
| 33. List common problems with foot orthotics and their possible causes. | 613 | ||
| 34. Are injury rates reduced with minimalist shoes? | 613 | ||
| 35. What are the effects on the foot and body of wearing high-heeled shoes? | 614 | ||
| 36. How should the shoe be checked for improper wear? | 614 | ||
| 37. How can the patient ensure a proper shoe fit? | 614 | ||
| 38. What is the leading cause of diabetic foot ulcers? What are the appropriate recommendations for therapeutic footwear? | 614 | ||
| 39. What is a last? | 615 | ||
| 40. Describe the anatomy and construction of the shoe. | 615 | ||
| 41. What are the three basic types of athletic shoe constructions? | 616 | ||
| 42. What is a rocker sole? | 616 | ||
| 43. What mechanisms can be used to capture a patients foot in which to fabricate an orthotic? | 616 | ||
| 44. What are the proposed mechanisms by which a foot orthotic has a positive effect on pain and function in patients with... | 616 | ||
| 45. Does the use of a foot orthotic reduce the incidence of lower limb stress reactions in younger, active adults? | 616 | ||
| 46. Does the type of prophylactic foot orthosis have any effect on the incidence of lower limb overuse injuries? | 616 | ||
| 47. Are laterally wedged orthotics helpful to patients with medial knee osteoarthritis? | 616 | ||
| Bibliography | 617 | ||
| Answers to Study Questions | 619 | ||
| Chapter 1 Answers: | 619 | ||
| Chapter 2 Answers: | 619 | ||
| Chapter 3 Answers: | 619 | ||
| Chapter 4 Answers: | 619 | ||
| Chapter 5 Answers: | 619 | ||
| Chapter 6 Answers: | 619 | ||
| Chapter 7 Answers: | 619 | ||
| Chapter 8 Answers: | 619 | ||
| Chapter 9 Answers: | 620 | ||
| Chapter 10 Answers: | 620 | ||
| Chapter 11 Answers: | 620 | ||
| Chapter 12 Answers: | 620 | ||
| Chapter 13 Answers: | 620 | ||
| Chapter 14 Answers: | 620 | ||
| Chapter 15 Answers: | 620 | ||
| Chapter 16 Answers: | 620 | ||
| Chapter 17 Answers: | 620 | ||
| Chapter 18 Answers: | 621 | ||
| Chapter 19 Answers: | 621 | ||
| Chapter 20 Answers: | 621 | ||
| Chapter 21 Answers: | 621 | ||
| Chapter 22 Answers: | 621 | ||
| Chapter 23 Answers: | 621 | ||
| Chapter 24 Answers: | 621 | ||
| Chapter 25 Answers: | 621 | ||
| Chapter 26 Answers: | 622 | ||
| Chapter 27 Answers: | 622 | ||
| Chapter 28 Answers: | 622 | ||
| Chapter 29 Answers: | 622 | ||
| Chapter 30 Answers: | 622 | ||
| Chapter 31 Answers: | 622 | ||
| Chapter 32 Answers: | 622 | ||
| Chapter 33 Answers: | 622 | ||
| Chapter 34 Answers: | 622 | ||
| Chapter 35 Answers: | 623 | ||
| Chapter 36 Answers: | 623 | ||
| Chapter 37 Answers: | 623 | ||
| Chapter 38 Answers: | 623 | ||
| Chapter 39 Answers: | 623 | ||
| Chapter 40 Answers: | 623 | ||
| Chapter 41 Answers: | 623 | ||
| Chapter 42 Answers: | 623 | ||
| Chapter 43 Answers: | 623 | ||
| Chapter 44 Answers: | 624 | ||
| Chapter 45 Answers: | 624 | ||
| Chapter 46 Answers: | 624 | ||
| Chapter 47 Answers: | 624 | ||
| Chapter 48 Answers: | 624 | ||
| Chapter 49 Answers: | 624 | ||
| Chapter 50 Answers: | 624 | ||
| Chapter 51 Answers: | 624 | ||
| Chapter 52 Answers: | 624 | ||
| Chapter 53 Answers: | 625 | ||
| Chapter 54 Answers: | 625 | ||
| Chapter 55 Answers: | 625 | ||
| Chapter 56 Answers: | 625 | ||
| Chapter 57 Answers: | 625 | ||
| Chapter 58 Answers: | 625 | ||
| Chapter 59 Answers: | 625 | ||
| Chapter 60 Answers: | 625 | ||
| Chapter 61 Answers: | 625 | ||
| Chapter 62 Answers: | 625 | ||
| Chapter 63 Answers: | 626 | ||
| Chapter 64 Answers: | 626 | ||
| Chapter 65 Answers: | 626 | ||
| Chapter 66 Answers: | 626 | ||
| Chapter 67 Answers: | 626 | ||
| Chapter 68 Answers: | 626 | ||
| Chapter 69 Answers: | 626 | ||
| Chapter 70 Answers: | 626 | ||
| Chapter 71 Answers: | 626 | ||
| Chapter 72 Answers: | 626 | ||
| Chapter 73 Answers: | 627 | ||
| Chapter 74 Answers: | 627 | ||
| Chapter 75 Answers: | 627 | ||
| Chapter 76 Answers: | 627 | ||
| Chapter 77 Answers: | 627 | ||
| Chapter 78 Answers: | 627 | ||
| Index | 628 |