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Orthopaedic Physical Therapy Secrets - E-Book

Orthopaedic Physical Therapy Secrets - E-Book

Jeffrey D. Placzek | David A. Boyce


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Book Details


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
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