Orthopaedic physical therapy secrets 2nd ed

11830 Westline Industrial Drive St Louis, Missouri 63146 ORTHOPAEDIC PHYSICAL THERAPY SECRETS ISBN-13: 978-1-56053-708-3 Copyright © 2006, 2001 by Elsevier Inc ISBN-10: 1-56053-708-6 All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail: healthpermissions@elsevier.com You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’ Notice Knowledge and best practice in this field are constantly changing As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the Editors assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book Previous edition copyrighted 2001 ISBN-13: 978-1-56053-708-3 ISBN-10: 1-56053-708-6 Acquisition Editor: Kathy Falk Publishing Services Manager: Patricia Tannian Project Manager: Jonathan M Taylor Design Direction: Bill Drone Printed in the United States of America Last digit is the print number: To my wife, Laura, my best friend, my soul mate, my rock, my inspiration To my three angels, Alexis, Bailey, and Lily, my life’s true joy, my deepest love, my serenity, my peace JDP To my mother and father, for instilling in me a strong work ethic To my wife, Marcia Boyce, and my children, Elizabeth, Emily, and Cole, for your constant love and support Finally, to my students and patients—thank you for teaching me so much over the years DAB In loving memory of Dr Edward G Tracy (November 2, 1941 March 3, 2004) who devoted himself to educating health professionals for three decades It is hoped that the presentation of his contribution to this book provides a window into his humor, kindness, compassion, and enthusiasm Dr Tracy brought joy into his classroom and made a heavy burden seem light Generations of students remember him in the same way they remember the material he taught—with affection Contributors JEFFREY E BALAZSY, MD Attending Trauma Surgeon Department of Orthopaedic Surgery William Beaumont Hospital Royal Oak, Michigan KATHLEEN A BRINDLE, MD Chief, Musculoskeletal Radiology Assistant Professor of Radiology George Washington University Washington, D.C JUDITH L BATEMAN, MD Oakland Arthritis Center Bingham Farms, Michigan TIMOTHY J BRINDLE, PT, PHD, ATC Post Doctoral Research Physical Therapist Physical Disabilities Branch National Institutes of Health Bethesda, Maryland TURNER A “TAB” BLACKBURN, JR., PT, MED, ATC Vice President, Corporate Development Clemson Sports Medicine and Rehabilitation Seneca, South Carolina Clinical Director SportsPlus Physical Therapy of Manchester Manchester, Georgia Adjunct Assistant Professor Physical Therapy School Belmont University Nashville, Tennessee DAVID A BOYCE, PT, EDD, OCS, ECS Assistant Professor Bellarmine University Physical Therapy Program Owner, Physical Therapy Plus Louisville, Kentucky DOUGLAS BOYCE, MD, RPH Associate Clinical Professor Wayne State University Detroit, Michigan JOSEPH A BROSKY, JR., PT, MS, SCS Associate Professor Bellarmine University Physical Therapy Program Louisville, Kentucky JUDITH M BURNFIELD, PT, PHD Director, Movement Sciences Center Clifton Chair in Physical Therapy and Movement Science Institute for Rehabilitation Science and Engineering Madonna Rehabilitation Hospital Lincoln, Nebraska MARK A CACKO, PT, MPT, OCS Physical Therapy Specialists, PC Troy, Michigan CHARLES D CICCONE, PT, PHD Professor Department of Physical Therapy Ithaca College Ithaca, New York vii viii Contributors GEORGE J DAVIES, PT, DPT, MED, SCS, ATC, LAT, CSCS, FAPTA Professor Armstrong Atlantic State University Department of Physical Therapy Savannah, Georgia MICHAEL DOHM, MD, FAAOS Rocky Mountain Orthopaedic Associates Grand Junction, Colorado SUSAN DUNN, PT Dunn & Associates Physical Therapy, PLLC Lecturer, Bellarmine University Louisville, Kentucky CHRISTOPHER J DURALL, PT, DPT, MS, LAT, SCS, CSCS Clinical Research Director Director of Physical Therapy Student Health Center University of Wisconsin–La Crosse La Crosse, Wisconsin BETH ENNIS, PT, EDD, PCS Assistant Professor Bellarmine University Physical Therapy Program Louisville, Kentucky JOHN L ECHTERNACH, PT, DPT, EDD, ECS, FAPTA Professor and Eminent Scholar School of Community Health Professions and Physical Therapy Old Dominion University Norfolk, Virginia RICHARD ERHARD, PT, DC Assistant Professor Department of Physical Therapy University of Pittsburgh Pittsburgh, Pennsylvania SEAN P FLANAGAN, PHD, ATC, CSCS Assistant Professor Department of Kinesiology California State University Northridge Northridge, California TRACEY M FLECK, PT, MPT Instructional Assistant Department of Physical Therapy Wayne State University Detroit, Michigan Physical Therapist Maines and Dean Physical Therapy Howell, Michigan TIMOTHY W FLYNN, PT, PHD, OCS, FAAOMPT Associate Professor Department of Physical Therapy Regis University Denver, Colorado JULIE M FRITZ, PT, PHD, ATC Assistant Professor Division of Physical Therapy University of Utah Salt Lake City, Utah KATHLEEN GALLOWAY, PT, MPT, DSC, ECS Assistant Professor Department of Physical Therapy Oakland University Rochester, Michigan TERI L GIBBONS, PT, MPT, OCS Physical Therapy Specialists, PC Troy, Michigan PATRICIA DOUGLAS GILLETTE, PT, PHD Associate Professor Bellarmine University Physical Therapy Program Louisville, Kentucky DAVID G GREATHOUSE, PT, PHD, ECS Director, Clinical Electrophysiology Services Texas Physical Therapy Specialists New Braunfels, Texas Adjunct Professor U.S Army–Baylor University Doctoral Program in Physical Therapy Fort Sam Houston, Texas Contributors DARREN GUSTITUS, OTR, CHT Director of Rehabilitation Services Michigan Hand and Wrist Rehabilitation Center Novi, Michigan TODD R HOCKENBURY, MD Assistant Clinical Professor of Orthopedic Surgery University of Louisville Bluegrass Orthopedic Group Louisville, Kentucky ROBERT “CLIFF” HALL, PT, MS, SCS, ATC Deputy Director of Health and Fitness National Defense University Washington, D.C SUSAN J ISERNHAGEN, PT DSI Work Solutions Duluth, Minnesota JOHN S HALLE, PT, PHD Associate Professor School of Physical Therapy Belmont University Nashville, Tennessee JAY D KEENER, MD, PT Assistant Professor Department of Orthopaedic Surgery University of North Carolina Chapel Hill, North Carolina CRAIG T HARTRICK, MD, DABPM Director, Anesthesiology Research Department of Anesthesiology and Perioperative Medicine William Beaumont Hospital Royal Oak, Michigan MATTHEW A KIPPE, MD Department of Orthopedic Surgery William Beaumont Hospital Royal Oak, Michigan HARRY N HERKOWITZ, MD Chairman, Department of Orthopaedic Surgery William Beaumont Hospital Royal Oak, Michigan JAMES ROBIN HINKEBEIN, PT, OCS, ATC Director, Bardstown Rehab Services Kentucky Orthopedic Rehab Team Bardstown, Kentucky SALLY HO, PT, DPT, MS Adjunct Assistant Professor Department of Biokinesiology and Physical Therapy University of Southern California Los Angeles, California Owner and Director Ho Physical Therapy Beverly Hills, California ix PATRICK H KITZMAN, PT, PHD Department of Rehabilitation Sciences Division of Physical Therapy and the Rehabilitation Sciences Doctoral Program University of Kentucky Lexington, Kentucky JOHN R KRAUSS, PT, PHD, OCS, FAAOMPT Assistant Professor School of Health Sciences Program in Physical Therapy Assistant Professor OMPT Program Coordinator Oakland University Rochester, Michigan KORNELIA KULIG, PT, PHD Associate Professor of Clinical Physical Therapy Department of Biokinesiology and Physical Therapy University of Southern California Los Angeles, California x Contributors EDWARD M LICHTEN, MD, FACS, FACOG Department of Obstetrics and Gynecology Providence Hospital Southfield, Michigan (Retired) M ELAINE LONNEMANN, PT, DPT, MSC, OCS, MTC, FAAOMPT Assistant Professor Bellarmine University Physical Therapy Program Louisville, Kentucky Instructor University of St Augustine St Augustine, Florida JANICE K LOUDON, PT, PHD, ATC Department of Physical Therapy Education and Rehabilitation Sciences University of Kansas Kansas City, Kansas TERRY R MALONE, PT, EDD, ATC, FAPTA Professor and Director Division of Physical Therapy University of Kentucky Lexington, Kentucky JAMES W MATHESON, PT, MS, SCS, CSCS Clinical Research Director Therapy Partners, Inc Maplewood, Minnesota Staff Physical Therapist Minnesota Sport and Spine Rehabilitation Burnsville, Minnesota JOSEPH M MCCULLOCH, PT, PHD, CWS, FAPTA, FCCWS Dean, School of Allied Health Professions Louisiana State University Health Sciences Center Shreveport, Louisiana ANDREA LYNN MILAM, PT, MSED Assistant Professor Division of Physical Therapy University of Kentucky Lexington, Kentucky ARTHUR J NITZ, PT, PHD, ECS, OCS Professor Division of Physical Therapy Department of Rehabilitation Sciences College of Health Sciences University of Kentucky Lexington, Kentucky JOHN NYLAND, PT, EDD, SCS, ATC, CSCS, FACSM Assistant Professor Division of Sports Medicine Department of Orthopaedic Surgery University of Louisville Adjunct Professor School of Physical Therapy Bellarmine University Louisville, Kentucky BRIAN T PAGETT, PT, MPT Physical Therapy Specialists, PC Troy, Michigan JOHN J PALAZZO, PT, DSC, ECS Director, Neurolabs Waterford, Michigan STANLEY V PARIS, PT, PHD President and Professor Department of Physical Therapy University of St Augustine St Augustine, Florida SARA R PIVA, PT, MS, OCS, FAAOMPT Department of Physical Therapy School of Health and Rehabilitation Sciences University of Pittsburgh Pittsburgh, Pennsylvania JEFFREY D PLACZEK, MD, PT Hand and Upper Extremity Surgery Michigan Hand & Wrist, PC Novi, Michigan Providence Park Medical Center Novi, Michigan Associate Clinical Professor Department of Physical Therapy Oakland University Rochester, Michigan Contributors FREDRICK D POCIASK, PT, PHD, OCS, FAAOMPT Assistant Professor Physical Therapy Program College of Pharmacy and Health Sciences Wayne State University Detroit, Michigan CHRISTOPHER M POWERS, PT, PHD Associate Professor Department of Biokinesiology and Physical Therapy Co-Director Musculoskeletal Biomechanics Research Laboratory University of Southern California Los Angeles, California MICHAEL QUINN, MD Bloomfield Hand Specialists Bloomfield Hills, Michigan STEPHEN F REISCHL, PT, DPT, OCS Adjunct Assistant Professor of Clinical Physical Therapy Department of Biokinesiology and Physical Therapy University of Southern California Los Angeles, California SUSAN MAIS REQUEJO, PT, DPT Department of Physical Therapy Mount St Mary’s College Assistant Adjunct Professor of Clinical Physical Therapy University of Southern California Los Angeles, California ROBERT C RINKE, PT, DC, FAAOMPT Puget Orthopedic Rehabilitation Everett, Washington T KEVIN ROBINSON, PT, DSC, OCS Associate Professor School of Physical Therapy Belmont University Nashville, Tennessee xi MATTHEW G ROMAN, PT, OMPT Senior Physical Therapist, Department of Physical and Occupational Therapy Duke University Medical Center Durham, North Carolina PAUL J ROUBAL, PT, PHD Owner and Director Physical Therapy Specialists, PC Troy, Michigan ROBIN SAUNDERS RYAN, PT, MS Chief Operating Officer The Saunders Group, Inc Chaska, Minnesota H DUANE SAUNDERS, PT, MS Chief Executive Officer and President The Saunders Group, Inc Chaska, Minnesota EDWARD SCHRANK, MPT, DSC, ECS Assistant Professor of Physical Therapy Shenandoah University Winchester, Virginia Physical Therapist in Private Practice Colorado Springs, Colorado ROBERT A SELLIN, PT, DSC, ECS Director Electrophysiologic Testing Professional Rehabilitation Associates Lexington, Kentucky AMANDA L SIMIC, MS, OTR, CHT Milliken Hand Center Barnes-Jewish Hospital St Louis, Missouri PAUL SIMIC, MD Southern California Orthopedic Institute Van Nuys, California BRITT SMITH PT, MSPT, OCS, FAAOMPT S.O.A.R Physical Therapy Grand Junction, Colorado xii Contributors LEANN SNOW, MD, PHD Assistant Professor Department of Physical Medicine and Rehabilitation University of Minnesota Minneapolis, Minnesota TRACY SPIGELMAN, MED, ATC Division of Athletic Training University of Kentucky Lexington, Kentucky SUSAN W STRALKA, PT, MS Baptist Rehabilitation Hospital Germantown, Tennessee LADORA V THOMPSON, PT, PHD Associate Professor Program in Physical Therapy Department of Physical Medicine and Rehabilitation University of Minnesota Minneapolis, Minnesota DAVID TIBERIO, PT, PHD, OCS Associate Professor Department of Physical Therapy University of Connecticut Storrs, Connecticut † EDWARD G TRACY, PHD EERIC TRUUMEES, MD Attending Spine Surgeon Department of Orthopaedic Surgery William Beaumont Hospital Royal Oak, Michigan Orthopaedic Director Harold W Gehring Center for Biomechanical Research Adjunct Faculty Bioengineering Center Wayne State University Detroit, Michigan † Deceased TIM L UHL, PT, PHD, ATC Associate Professor Division of Athletic Training Director of Musculoskeletal Laboratory College of Health Sciences University of Kentucky Lexington, Kentucky FRANK B UNDERWOOD, PT, PHD, ECS Professor of Physical Therapy Department of Physical Therapy University of Evansville Evansville, Indiana VICTORIA L VEIGL, PT, PHD Assistant Professor Division of Natural Science and Math Jefferson Community and Technical College, Downtown Campus Louisville, Kentucky BRADY VIBERT, MD Fellow in Spine Surgery UCSD Medical Center University of California–San Diego San Diego, California MICHAEL L VOIGHT, PT, DHSC, OCS, SCS, ATC Associate Professor School of Physical Therapy Belmont University Nashville, Tennessee BARRY L WHITE, PT, MS, ECS, CNIM, DABNM Director of Neurophysiological Services Human Performance and Rehabilitation Centers, Inc Columbus, Georgia (Retired) J MICHAEL WIATER, MD Attending Shoulder and Elbow Surgeon Department of Orthopaedic Surgery William Beaumont Hospital Royal Oak, Michigan Beverly Hills Orthopaedic Surgery Beverly Hills, Michigan Contributors MARK WIEGAND, PT, PHD Program Director/Department Chairperson Bellarmine University Physical Therapy Program Louisville, Kentucky PATRICIA WILDER, PT, PHD Professor Emeritus Department of Health Professions Program in Physical Therapy University of Wisconsin–La Crosse La Crosse, Wisconsin xiii ERIC WINT, PT, OCS Regional Director Physical Therapy Plus Orthopedic Clinic Prospect, Kentucky Lecturer in Orthopedics Bellarmine University Louisville, Kentucky Index Pancoast’s tumor, 380 Pancreatic amylase, 142 Pancreatic disorders, 208 Pancreatic lipase, 142 Pancreatitis, 142 Panner’s disease, 390 Pannus formation, 50 Panoramic radiography of temporomandibular joint, 499 Parafunctional habits, 498 Parallel-fiber muscle, Parametric statistical procedures, 173 Paratenonitis, 27 Paresthesia, 164 Paronychia, 426 Paroxetine, 132 Parrot-beak meniscal tear, 565 Partial meniscectomy, 566 Partial-thickness rotator cuff tear, 331-332 Partial thromboplastin time, 59, 144 Passive elevation in total shoulder arthroplasty, 357 Patella bipartite, 556, 582 chondroplasty and, 28-29 dislocation of, 558, 588-589 fracture of, 582-584, 587 lateral tracking of, 552-553 sulcus angle and, 306-307 tendinitis of, 550 total knee arthroplasty and, 576 Patella alta, 306, 550, 553 Patella baja, 548 Patellar instability, 549-550 Patellar taping, 562 Patellar tendon autograft, 579 Patellar tendon rupture, 584 Patellar tendon strap, 562 Patella-trochlear groove contact, 547 Patellectomy, 583 Patellofemoral disorders, 552-563 bipartite patella in, 556 bracing for, 562 chondromalacia in, 553 distal realignment surgery for, 562-563 Hoffa’s disease in, 557 housemaid’s knee in, 557-558 lateral pressure syndrome in, 556 lateral tracking of patella and, 552-553 patella alta in, 553 patellar dislocation in, 558 patellofemoral pain in, 554-555, 557 plica syndrome in, 557 quadriceps strengthening for, 559-560 radiologic studies in, 558-559 tubercle-sulcus angle and, 552, 553 weight-bearing exercises for, 560-561 Patellofemoral pain, 18 bracing for, 562 classification of, 554-556 electromyographic biofeedback strength training for, 560 foot orthotics for, 633 hip weakness and, 558 Patellofemoral pain, 18 leg length discrepancy and, 557 magnetic resonance imaging in, 559 non–weight-bearing exercises for, 560 open kinetic chain exercises for, 290 plica syndrome versus, 547 quadriceps strengthening exercises for, 559-560, 561 weight-bearing exercises for, 560-561 Pathologic fracture, 31 Pathologic spondylolisthesis, 468, 469 Patient position in cervical traction, 116 in lumbar traction, 117 Patient-controlled analgesia, 130 Paxil See Paroxetine Peabody II test, 224 Peak torque, 285 Pearson correlation, 170 Pearson correlation coefficient, 173 Pectoralis major tendon, 328-329 Pectoralis minor muscle, 322 Pectus excavatum, 229 PEDI test, 224 Pediatric physical therapy, 223-230 in brachial plexus palsy, 226-227 in cerebral palsy, 227 in clubfoot, 226 in deformational plagiocephaly, 225 in developmental dysplasia of hip, 225-226 developmental milestones and, 223 Gower’s maneuver in, 225 growing pains and, 229 in growth plate fractures, 229-230 in Legg-Calvé-Perthes disease, 228 in Osgood-Schlatter disease, 228 in osteochondritis dissecans, 227-228 in pectus excavatum, 229 in slipped capital femoral epiphysis, 229 in Sprengel’s deformity, 228 standardized tests in, 224 in torticollis, 225 wheelchair and, 223-224 PEDro database, 181 Pelvic floor dysfunction, 234 Pelvic floor exercises after pregnancy, 232 for urinary incontinence, 235 Pelvic girdle disorders, 510-516 Pelvic organ prolapse, 234-235 Pelvic ring, 505 Pelvic ring disruption, 536 Pelvic traction in lumbar spinal stenosis, 464 Pelvis, 517-544 fractures and dislocations of, 534-538 functional anatomy of, 519-522 innervation of, 507 male versus female, 507 radiography of, 315 Penicillamine, 136 Pennation, Pentazocine, 127 Perforating fracture, 31 665 666 Index Periactin See Cyproheptadine Pericarditis, 200 Perimysium, Perineural steroids, 253 Peripheral innervation of scapula, 368 Peripheral nerve compression, 591 Peripheral neuropathic pain, 64 Peripheral quantitative computed tomography in osteoporosis, 237 Peripheral vascular disorders, 196 Perkin’s line, 314 Peroneal nerve palsy following total knee arthroplasty, 578 tension neuropathy of, 612 Peroneal tendon subluxation, 609-610 Peroneus longus tendon, 599 Pes cavus, 601 Pes planus, 601 PET See Positron emission tomography Pflüger’s law, 84 Phagocytosis, 26 Phalen’s test, 439-440 Pharmacology, 126-139 acetaminophen and, 131-132 anticoagulants and, 137 antispasm medications and, 135 for arthritis, 49 cardiovascular medications and, 138 for chronic pain, 253 for complex regional pain syndromes, 62 COX-2 inhibitors and, 131 deep venous thrombosis and, 137 effects of physical agents on drug disposition, 139 fluoroquinolones and, 134 glucocorticoids and, 133-134 for heterotopic ossification, 138 increased risk of falling and, 294 lipid-lowering medications and, 138 local anesthetics and, 136 for migraine, 262-263 nonsteroidal antiinflammatory drugs and, 128-131 opioid analgesics and, 126-127, 129-130 for osteoarthritis, 135-136 for osteoporosis, 137-138 for rheumatoid arthritis, 136 for spasticity, 227 topical and transdermal analgesics and, 132 Phase duration of waveform, 80-81 Phenelzine sulfate, 263 Phenobarbital, 262 Phenylbutazone, 128 Phonophoresis, 94-95, 134 Physical dependence on opioid analgesics, 129 Physiologic barrier, 103 Physiologic changes with aging, 188-189 Physiologic overflow with isokinetic exercise, 290 Piezoelectric effect, 92 Pilon ankle fracture, 619, 620 PIP See Proximal interphalangeal joint Piriformis muscle, 521 Piriformis syndrome, 531-532, 591 Piroxicam, 128 Pisiform, 415 Pivot-shift test of knee, 549 Plain film radiography in adhesive capsulitis, 350 in lumbar spinal stenosis, 463 in rotator cuff tear, 337 in spondylolysis, 307 in stress fracture, 305-306 in temporomandibular joint dysfunction, 499 Plantar fasciitis, 122, 610-611 Plantar flexion contracture, 122 Plantar interossei muscles, 605 Plantar ulcer, 242 Plantaris tendon, 603 Plasma membrane, Plasma volume, endurance training and, 40 Plastic range, 19, 20 Platelet, 146, 150 Platelet disorders, 213 Platelet-derived growth factor, bone healing and, 36 Platelet-rich plasma, 29 Pleuritis, 203 Plica, 547 Plica syndrome, 557 Pneumatic foot pump, 58 Pneumothorax, 202, 204 PO[sub]2 See Oxygen partial pressure POEM mnemonic, 181 Polycythemia, 214 Ponseti’s technique, 226 Popliteal artery disruption after knee dislocation, 587 Popliteus musculotendinous complex, 551 Popping of joint, 104 Population, statistical, 173 Porta pedis, 603 Positioning in cervical traction, 116 in lumbar traction, 117 Positive likelihood ratio, 182 Positive predictive value, 140, 175-176, 183 Positron emission tomography, 305 Posterior cord lesion, 378 Posterior cruciate ligament, 549 injury of, 569, 574 Posterior cruciate retaining knee replacement, 578 Posterior cruciate substituting, 578 Posterior heel pain, 610 Posterior impingement of shoulder, 333-334 Posterior interosseous nerve, 389 Posterior longitudinal ligament, 446 Posterior medial rotary instability, 572 Posterior medial tibial stress syndrome, 613 Posterior oblique ligament, 548 Posterior shear test, 512 Posterior shoulder dislocation, 342, 344-345, 346 Posterior tarsal tunnel, 593 Posterior tarsal tunnel syndrome, 594 Posterior tibialis tendon dysfunction, 608-609 Posterolateral elbow dislocation, 401 Posterolateral rotary instability, 386, 572 Postherpetic neuralgia, 483-484 Index Postmenopausal women calcium supplementation for, 276 osteoporosis in, 237 Postoperative hip dislocation, 539 Postoperative pain cold treatment for, 70-71 in disk herniation surgery, 459 Postpartum period, carpal tunnel syndrome and de Quervain tenosynovitis in, 233 Posttraumatic compartment syndrome, 247-248 Postural receptor, 454 Postural syndrome, 280 Posture cervical headache and, 258 changes during pregnancy, 231 disk herniation and, 459 lumbar pressures in, 450 spinal loads and, 448 temporomandibular joint dysfunction and, 498 Potassium, 146-147 Power, 15 Predental space, 309 Prednisolone, 133 Prednisone, 133, 262 Preemptive analgesia, 247 Pregnancy, 230-234 physiologic changes during, 230 cardiovascular, 231 effects on collagen and, 22 effects on exercise and, 42 respiratory, 231 Prelone See Prednisolone Premarin, 237 Prempro, 237 Prepatellar bursitis, 557-558 Pressure, 15, 18 stress versus, 19 Pressure therapy for burned hand, 428 Pressure ulcer, 18, 241-242 Pretendinous band, 423 Pretest probability, 181-182 Prevalence, statistical, 176-177 Prevertebral soft tissue in cervical spine, 309 PRICEMMS acronym, 186 Primary adhesive capsulitis, 349 Primary bone healing, 34 Primary rotator cuff impingement, 333 Procuren, 245-246 Programmed cell death, 11 Progressive resistance exercises, 9-10, 41 Prolapse lumbar disk, 455 pelvic organ, 234-235 Prolotherapy, 515 Pronation elbow, 387, 388 foot, 627 rear foot, 600 wrist, 416 Pronation-dorsiflexion fracture, 619 Pronator quadratus muscle, 388 Pronator teres muscle, 388 667 Pronator teres syndrome, 404-405 Prone extension with external rotation of teres minor, 333 Prone knee flexion test, 512 Propoxyphene, 127 Propranolol, 260, 263 Proprioception, 188 disk herniation and, 459 gait and, 123 surgical repair of shoulder instability and, 347 Proprioceptive training, 188 Prostaglandins inflammatory response and, 26 nonsteroidal antiinflammatory drugs and, 130 Protein athlete need for, 190-191, 277 daily-recommended percentages during heavy training, 277 Prothrombin time, 59, 144 Protrusion of temporomandibular joint, 497 Provocation elevation test, 379 Provocative maneuvers for chronic pain, 251-252 in sacroiliac joint pain, 511-512 Proximal femoral fracture, 293-294 Proximal humeral replacement, 373, 374 Proximal humerus, 323-324 average articular version of, 329 fracture of, 371-375 Proximal interphalangeal joint, 419 boutonniére deformity of, 424 lateral collateral ligament injury of, 431 swan neck deformity of, 424 testing extension at, 421 Proximal phalanx fracture, 425, 430 Proximal radioulnar joint, 110, 385 Proximal tibial fracture, 586-587 Proximal tibial osteotomy, 579-580 Proximal transverse arch, 601 Pseudoanginal pain, 482 Pseudo-boutonniére deformity, 424 Pseudogout, 53-54 Psoriatic arthritis, 52, 219 Psoriatic spondylitis, 514 Psychiatric disorders, 196 Psychologic system, 295 PT See Prothrombin time Ptosis in Horner syndrome, 165, 380 PTT See Partial thromboplastin time PTTD See Posterior tibialis tendon dysfunction Pubic symphysis changes during pregnancy, 231 instability of, 515 Pubofemoral ligament, 520 Pudendal nerve, 507 Pulley system of hand, 413, 428 Pulmonary disorders, 202-205 chronic obstructive pulmonary disease in, 44 exercise in older adult and, 299-300 Pulmonary embolism, 57 Pulsatile lavage, 244 Pump, 630 Putti-Platt procedure, 346 668 Index Q Q-angle, 552 Q10 effect, 11 Quadrangular space, 325 Quadriceps avoidance, 122 Quadriceps femoris reflex, 161 Quadriceps muscle anterior cruciate ligament rehabilitation and, 88 contusion of, 529 hip fracture and, 537 L3-4 radiculopathy and, 160 strain of, 525 strengthening in patellofemoral disorders, 559-560, 561 Quadriceps tendon rupture, 583 Quadriga, 422 Qualitative variable, 169 Quantitative computed tomography in osteoporosis, 237 Quantitative variable, 169 R Radial artery, Allen test and, 422 Radial collateral ligament, 386 Radial deviation of wrist, 416 Radial head dislocation of, 310 fracture of, 34, 400, 401 osteochondritis dissecans of, 390 radial nerve compression and, 406 Radial inclination, 311, 313 Radial neck fracture, 34 Radial nerve, 411 compression of, 403-404 elbow and, 388 humeral shaft fracture and, 374, 375 injury of, 158 Saturday night palsy and, 405-406 splinting for injury of, 422 superficial branch of, 420 Radial tunnel syndrome, 392, 403-404 Radicular disorders, 195-196 Radicular pain, 164, 195 in spondylolisthesis, 470 Radiculopathy, 455-456 Radiocapitellar joint, 385 closed-chain upper extremity exercise and, 387 Radiocapitellar line, 310 Radiocarpal joint, 419 Radiofrequency neurotomy, 515 Radiography in acromioclavicular injuries, 360-361 in adhesive capsulitis, 350 in ankle fracture, 618 in ankle sprain, 611-612 in anterior shoulder dislocation, 316 arthrography versus, 302 in calcaneal fracture, 619 in cervical headache, 258 in complex regional pain syndromes, 61 in developmental dysplasia of hip, 314-315 in lumbar spinal stenosis, 463 in osteoporosis, 307 in patellar malalignment, 589 Radiography—cont’d pelvic, 315 reading of radiograph, 303 in rotator cuff tear, 337 of sacroiliac joint, 509 safety of, 302 in spinal cord injury, 487-488 in spondylolysis, 307 in sternoclavicular injury, 364 in stress fracture, 305-306 in temporomandibular joint dysfunction, 499 of wrist, 310-313, 431-432 Radiologic studies, 302-318 of anterior cruciate ligament, 317 anterior humeral line and, 310 of anterior shoulder dislocation, 316 of basilar invagination, 309 bone scan in, 305 in cervical headache, 258 of cervical spine, 307, 308, 309 in complex regional pain syndromes, 61 computed tomography in, 303 in developmental dysplasia of hip, 314-315 diagnostic ultrasound in, 303-304 femoral neck-shaft angle and, 315 of greater tuberosity fracture, 318 in Hill-Sachs lesion, 344 magnetic resonance imaging in, 304-305 of osteochondral lesion of femoral condyle, 316 in osteoporosis, 307 in patella alta, 306 in patellofemoral disorders, 558-559 positron emission tomography in, 305 predental space and, 309 radiocapitellar line and, 310 reading of radiograph in, 303 in rotator cuff tear, 337 in sacroiliac joint pain, 515 safety of x-rays and, 302 in scoliosis, 307 in shoulder instability, 344 in spondylolisthesis, 471 in spondylolysis, 307 in stress fracture, 305-306 sulcus angle and, 306 in temporomandibular joint dysfunction, 499-500 of thoracolumbar spine, 308 ulnar variance and, 310 in whiplash, 492 of wrist, 310-314 x-ray versus arthrogram in, 302 Radioulnar joint, 110 Radius distal, 416 radiocapitellar line and, 310 Raloxifene, 237 Random error, 169 Randomized controlled trial, 180 Rang classification, 230 Range of motion active insufficiency and, cervical spine, 450 Index Range of motion—cont’d elbow, 387 electrotherapy protocols and, 87-88 following total knee arthroplasty, 577 foot and ankle, 600 hip, 522, 523, 540 lumbar spinal stenosis and, 463 manual therapy and, 107 of mouth opening, 496-497 neuromuscular electrical stimulation and, 86 shoulder acromioclavicular joint injuries and, 361 adhesive capsulitis and, 350 in rotator cuff rehabilitation, 334-335, 338 spinal, 445 thoracic spine, 479 wrist, 416 Rapidly alternating movements test, 166 Raynaud’s disease, 95 Raynaud’s phenomenon, 429 Rear foot lateral collateral ligaments of, 602 pronation and supination of, 600 Rear-foot varus posting, 629 Reciprocal innervation time, 285 Rectoris femoris contracture test, 525-526 Recurrence of patellar dislocation, 558 of shoulder instability, 345 Red blood cell, 150 Reduction of acromioclavicular joint injury, 362 of anterior shoulder dislocation, 345 of humeral shaft fracture, 374 of sternoclavicular injury, 365 Reference standard, 181 Referred pain, 164 from sacroiliac joint, 511 in thoracic region, 484 Reflex incontinence, 235 Reflex sympathetic dystrophy, 60-65, 248 Reflex testing, 161 Refractory period, 75 Regan and Morrey classification of coronoid fractures, 399 Regional anesthesia, 251 Regranex See Becaplermin gel Regression analysis, 173 Regulatory proteins, Rehabilitation in disk herniation, 457 in extensor tendon injury, 427 in hip fracture, 535, 536-537 isokinetic testing and, 289-290 knee after lateral retinacular release, 589 after meniscal repair, 566-567 in anterior cruciate ligament injury, 573 in patellar fracture, 583 in patellofemoral pain syndrome, 561 in total knee arthroplasty, 578 in proximal phalanx fracture, 425 shoulder 669 Rehabilitation—cont’d shoulder—cont’d in anterior shoulder dislocation, 345-346 in long thoracic nerve palsy, 369 in rotator cuff tear, 334-335, 338 in total shoulder arthroplasty, 356-357 in spondylolisthesis, 471-472 Reiter syndrome, 52, 219, 514 Relafen See Nabumetone Relative joint angle, 14 Relative refractory period, 75 Relative risk reduction, 178 Relaxin, 231, 507-508 Reliability of measurement, 169 Relocation test, 343 Remodeling of bone, 32 of soft tissue, 25 Renal disorders, 210-212 Repeated measure design, 170 Repositioning splint, 499 Reproductive disorders, 196 Research, 168-178 definitions of, 168-169 descriptive statistics in, 170 design of, 170 identification of best clinical tests in, 174-175 inferential statistics in, 172-173 judging effectiveness of treatment in, 178 measurement accuracy and reliability in, 160 measurement validity in, 170 normal distribution, bell curve, and gaussian distribution in, 171 parametric versus nonparametric statistical procedures in, 174 prevalence and incidence in, 176-177 risk ratios and odds ratios in, 177 selection of statistical test in, 173-174 sensitivity, specificity, positive predictive value, and negative predictive value in, 175-176 skewed distribution in, 171-172 statistical procedures in, 169-170 variable and, 160 Research design, 170 Resistance exercises adaptation of muscle structure in, 9-10, 41 catabolic side effects of glucocorticoids and, 134 older adult and, 296 Respiratory depression, opioid-induced, 129 Respiratory system physiologic changes during pregnancy, 231 physiologic changes with aging, 188 Resting splint, 499 Restrictive pulmonary disorders, 203 Retinacular ligaments, 415 Retrodiskal pad pain, 497-498 Return-to-work information, 266 Reverse curl, 450 Reverse Hill-Sachs lesion, 344 Reverse impingement sign, 335 Reverse Martin-Gruber anastomosis, 403 Reverse prosthesis total shoulder arthroplasty, 353-354, 358 670 Index Reverse-staging of pressure ulcer, 241 RF See Rheumatoid factor Rhabdomyolysis, 138 Rheumatoid arthritis, 50-51 drug therapy for, 136 of hand and wrist, 426, 428-429 signs and symptoms of, 219 Rheumatoid factor, 50, 147, 150 Rheumatrex See Methotrexate Rhomboids, 322 Rib cage motion of, 480 positional dysfunction of, 481 RICE regimen for hip pointer, 529 for muscle strain, 526 for quadriceps contusion, 529 Riche-Cannieu interconnection, 419 Right lower quadrant, 209 Right posterior rotation pelvic torsion provocation test, 512 Right upper quadrant, 209 Rigid external fixation, 33, 34 Rigid plantar-flexed first ray, 627 Rise time of waveform, 81 Risedronate, 237 Risk ratio, 177 Risser classification of scoliosis, 475 Risser sign, 475 Rocker bar, 630 Rocker sole, 632 Rofecoxib, 131 Roland disability index, 282 Rolando’s fracture, 431 Romberg’s sign, 166 Roos test, 379 Root cord syndrome, 487 Rotating platform total knee arthroplasty, 580-581 Rotator cuff, 324 exercises for, 333 glenoid inclination and, 329 impingement of, 33, 366 pain in, 339 Rotator cuff tear, 330-340 acromioplasty for, 339 after total shoulder arthroplasty, 355 age, gender, and occupation in, 334 full-thickness, 334 healing time for, 285 magnetic resonance imaging in, 337-338 Neer’s classification of, 331 outcomes of repair of, 338 partial-thickness, 331-332 physical therapy after repair of, 334-335 prevalence and natural history of, 330 shoulder instability and, 345 subacromial decompression in, 332 testing for, 336-337 undersurface, 332 Rotator interval, 323 Rotatory cuff arthropathy, 332 Roxicodone See Oxycodone Rucksack palsy, 377 Ruedi-Allgower classification of pilon ankle fractures, 620 Ruffini’s corpuscle, 454 Rupture Achilles tendon, 607-608 anterior cruciate ligament, 570 patellar tendon, 584 quadriceps tendon, 583 Ryder’s method, 519 S S curve, 498 Sacral inclination, 467, 468 Sacral spinal curve, 445 Sacral spine, range of motion of, 445 Sacral tilt, 467, 468 Sacral torsion dysfunction, 513 Sacralization, 509 Sacroiliac brace, 515 Sacroiliac hypermobility, 513-514 Sacroiliac joint, 503-516 dysfunction of, 510-516 functional anatomy of, 505-510 Sacrospinous ligament, 506 Sacrotuberous ligament, 506 Safety of x-rays, 302 SALSAP mnemonic, 268 Salt intake, blood pressure and, 275 Saltatory conduction, 75-76 Salter-Harris classification, 230 Salter-Harris fractures, 34 Sample, statistical, 173 Sandal, 630 Sander’s classification of calcaneal fractures, 620-621 Sansert See Methysergide Saphenous nerve entrapment, 591, 592 Sarcolemma, Sarcomere, 3, Satellite cell, 5, Saturday night palsy, 405-406 SCALP mnemonic, 270 Scaphoid, 415 fracture of, 432-433 Scaphoid shift test, 421 Scapholunate angle, 310, 311 Scapholunate dissociation, 434 Scaption of supraspinatus muscle, 333 Scapula, 366-370 Sprengel’s deformity of, 228, 367 Scapular dyskinesia, 366-368 Scapular winging, 327, 368 Scapulohumeral rhythm, 322-323 Scapulothoracic dissociation, 369 Scar contracture of hand, 428 Scheuermann’s disease, 482-483 Schmorl’s node, 482-483 Sciatic nerve, hamstring syndrome and, 532 Sciatic notch, 522 Sciatica, leg length discrepancy and, 458 Scintigraphy, 305 SCIWORA, 487 Scoliosis, 307, 446, 474-478 Index Scoliosometer, 474 Screening, 196-198 for scoliosis, 474, 477 Screw, biomechanics and, 24 Seat-belt injury, 493 Secondary adhesive capsulitis, 349 Secondary bone healing, 34 Secondary rotator cuff impingement, 333 Second-degree sprain, 20 Sedation, opioid-induced, 129 Sedatives, increased risk of falling and, 294 Segmental instrumentation with multihook systems for scoliosis, 477 Segond fracture, 570 Seizure, shoulder dislocation and, 342 Selective estrogen receptor modulators, 237 Semiconstrained total shoulder arthroplasty, 354 Semmes-Weinstein monofilament test, 167, 616 Sensitivity of diagnostic test, 182-183 of laboratory test, 140 statistical, 175-176 Sensory abnormalities in carpal tunnel syndrome, 439 in complex regional pain syndromes, 61 Sensory testing, 161 in tarsal tunnel syndrome, 608 Seronegative arthropathies, 52 Serotonin, inflammatory response and, 26 Serratus anterior muscle, 321 inhibition of, 484 Serum albumin, 140 Serum calcium, 143 Serum uric acid, 53 Sesamoiditis, 615 Sesamoids, 604 fracture of, 619 Sever’s disease, 611 Sexual intercourse after total hip arthroplasty, 541 Shankpiece, 632 Sharp pinwheel test, 440-441 Shea scale, 241 Shear forces, 18 Shenton’s line, 314, 315 Shin splints, 613 Shingles, 207 Shivering, exercise in cold environment and, 45 Shock absorption, gait and, 120-121 Shoe design, 630-633 Short posterior sacroiliac ligaments, 506 Short-arc spectrum isokinetic rehabilitation program, 290 Shortness of breath, 204 Shoulder, 319-381 acromioclavicular joint injuries and, 359-363 adhesive capsulitis of, 349-352 calcific tendonitis of, 93 dislocation of anterior, 316, 342, 345-346, 377 posterior, 342, 344-345, 346 rotator cuff tears and, 334 functional anatomy of, 321-330 axillary nerve and, 326-327 671 Shoulder—cont’d functional anatomy of—cont’d brachial plexus and, 327-328 clavicle and, 326 deltoid and, 329 glenohumeral joint and, 325, 328 long head of biceps and, 324 muscles in, 321-322 musculocutaneous nerve and, 327 pectoralis major tendon and, 328-329 proximal humerus and, 323-324 rotator cuff and, 324 rotator interval and, 323 scapulohumeral rhythm and, 322-323 suprascapular nerve and, 326 impingement tests of, 335 instability of, 341-349 acronyms for, 343 anterior shoulder dislocation and, 342, 345-346 Bankart lesion and, 344 glenohumeral joint and, 341-342 Hill-Sachs lesion and, 344 multidirectional, 342, 346 posterior shoulder dislocation and, 342, 344-345, 346 radiologic studies in, 344 recurrence of, 345 rotator cuff tears and, 345 SLAP lesions and, 347-348 surgical management of, 346-347 tests for, 343 lag signs of, 336 manual therapy of, 106 nerve entrapments of, 376-381 neuromuscular electrical stimulation of, 86 normative isokinetic data for, 286-287 posterior impingement of, 333-334 rehabilitation of in anterior shoulder dislocation, 345-346 in long thoracic nerve palsy, 369 in rotator cuff tear, 334-335, 338 in total shoulder arthroplasty, 356-357 rotator cuff exercises and, 333 rotator cuff impingement and, 333 rotator cuff tears and, 330-340 acromioplasty in, 339 age, gender, and occupation in, 334 full-thickness, 334 magnetic resonance imaging in, 337-338 Neer’s classification of, 331 outcomes of repair of, 338 partial-thickness, 331-332 physical therapy after repair of, 334-335 prevalence and natural history of, 330 subacromial decompression in, 332 testing for, 336-337 undersurface, 332 sternoclavicular injuries and, 363-365 total shoulder arthroplasty and, 353-358 Shoulder girdle passive elevation test, 379 Shoulder separation, 359 Shunt muscle, 23 Side-step cut maneuver, 570 672 Index Sign of buttock, 528 Silent heart attack, 299 Simvastatin, 138 Sinding-Larsen-Johansson syndrome, 228, 556 Single contrast arthrogram in rotator cuff tear, 337 Single limb support in gait, 120-121 Single malleolar fracture, 617 Single-energy x-ray absorptiometry, 237 Single-leg hop for distance, 188 Single-leg vertical jump, 188 Sinus tarsi syndrome, 603, 614 Sitting posterior-superior iliac spine palpation, 512 Sjögren syndrome, 147 Skeletal muscle, 3-12 actions of, 16-17 active insufficiency of, 7-8 characteristics of muscle fiber, 6-7 consequences of disuse, 10 contraction of, endurance exercises and, 10 excitation-contraction coupling and, force-velocity relationship and, Golgi tendon organs and, immobilization in shortened position, 11 length-tension relationship of, 21, 22 myosin and, 4-5 progressive resistance exercises and, 9-10 sarcomere of, 3, satellite cells and, 5-6 structural proteins of, 3-4 Skewed distribution, 171-172 Ski boot syndrome, 591, 593-594 Skin complex regional pain syndromes and, 60 ice application and, 71 physiologic effects of immobility on, 295 resistance to electrical currents, 77, 79 Skull, deformational plagiocephaly of, 225 SLAP lesions, 347-348 SLAP test, 347 SLIC mnemonic, 271 Sliding filament theory of muscle contraction, Sling for acromioclavicular joint injuries, 361 for anterior shoulder dislocation, 345 for sternoclavicular injury, 364 Slip angle, 467-468 Slip-lasting athletic shoes, 632 Slipped capital femoral epiphysis, 229 Slow twitch muscle fiber, 40-41 Small intestine disorders, 208 Small motor unit potentials, 152 Smith’s fracture, 432 Smoking complex regional pain syndromes and, 64 healing process and, 32 SMP See Sympathetically maintained pain Snapping hip syndrome, 530 Snapping scapula, 369-370 SnNouts, 182 Sodium, 149 Sodium hypochlorite solution, delayed healing and, 241 Soft callus, 32 Soft tissue in cervical spine, 309 reading radiograph and, 303 Soft tissue injury, 25-30 in flexion injury of spine, 458 healing of, 26-29, 131 inflammatory response and, 25-26 magnetic resonance imaging in, 305 Soft tissue manual therapy, 103 Soft tissue mobilization, 112-114 Sole of shoe, 632 Sole wedge, 629 Solifenacin succinate, 236 Somatic disorders, 195 Somatic referred pain, 196 Somatosensory-evoked potential study, 155-156 limitations of, 152-153 spinal traction and, 117 Soy protein, 275 Space of Poirier, 415 Spasticity in cerebral palsy, 227 Spearman correlation, 170 Spearman ratio, 173 Specific manual therapy techniques, 104 Specificity of diagnostic test, 182-183 of laboratory test, 140 statistical, 175-176 Spectrin, Speed’s test, 336 Spina bifida occulta, 471 Spinal accessory nerve, 327 cervical lymph node resection and, 369 injury of, 376 Spinal canal, 448 Spinal cord injury, 486-495 burst fracture in, 493 in child, 487 compression injuries and, 488, 490, 493 distractive flexion injuries and, 490 exercise and, 45 Ferguson-Allen classification of, 489 flexion teardrop fracture in, 490 hangman’s fracture in, 491 Jefferson fracture in, 491 odontoid fracture in, 490-491 radiography in, 487-488 seat-belt injury and, 493 surgical management of, 494-495 thoracolumbar injuries and, 492-493 whiplash and, 491-492 Spinal curves, 445 Spinal exercise programs, 279-283 Spinal fusion in spondylolisthesis, 472 Spinal instability, 457 Spinal loading, 450 Spinal manipulation, 105-106, 107 Spinal nerve, 448 Spinal traction, 115-118 Spine, 443-502 articular receptor distribution in, 454 Index Spine—cont’d back pain and, 452-460 See also Back pain cervical basilar invagination of, 309 of child, 487 compression injuries of, 488, 490, 493 disk herniation of, 456 distractive flexion injuries of, 490 dural movement with flexion and extension, 450 facet joints of, 447 Ferguson-Allen classification of trauma to, 489 functional anatomy of, 445-451 ligaments of, 446 loose-packed versus close-packed position of, 109 radiologic evaluation of, 307, 308, 487-488 range of motion of, 445 ratio of disk height to vertebral body height of, 449 referred pain in thoracic region and, 484 spinal nerve roots and, 448 dermatomes and, 160-161 disk herniation and, 454-457 classification of, 455 effects on proprioception and postural control, 459 thoracic, 479 at various spinal levels, 456 fractures and dislocations of, 486-495 burst fracture in, 493 compression injuries and, 488, 490, 493 distractive flexion injuries and, 490 Ferguson-Allen classification of, 489 flexion teardrop fracture in, 490 hangman’s fracture in, 491 Jefferson fracture in, 491 odontoid fracture in, 490-491 pediatric spine and, 487 radiography in, 487 seat-belt injury and, 493 surgical management of, 494-495 thoracolumbar injuries and, 492-493 whiplash and, 491-492 functional anatomy of, 445-451 lumbar disk herniation of, 456 facet joints of, 447 ligaments of, 446 loose-packed versus close-packed position of, 110 lumbar spinal stenosis and, 461-467 McKenzie’s classification of disorders of, 280 muscles in flexion and extension of, 449 muscular stabilization of, 458 nerve root movement during straight leg test, 450 range of motion of, 445 ratio of disk height to vertebral body height of, 449 spinal nerve roots and, 448 spondylolysis and, 307 myotomes and, 159-160 osteoporosis and, 238 scoliosis and, 307, 474-478 spondylolysis and spondylolisthesis of, 467-473 673 Spine—cont’d temporomandibular joint and, 496-502 thoracic ankylosing spondylitis of, 482 complex regional pain syndrome and, 484 costochondritis of, 484 disk disease in, 479 disk herniation of, 456 facet joints of, 447 injuries of, 492-493 loose-packed versus close-packed position of, 110 low back pain and, 483 osteoporosis of, 481-482 positional dysfunction of, 481 postherpetic neuralgia and, 483-484 range of motion of, 445 ratio of disk height to vertebral body height of, 449 Scheuermann’s disease and, 482-483 T4 syndrome and, 483 thoracic outlet syndrome and, 480 Spiral fracture, 31 Splinting for carpal tunnel syndrome, 441-442 for temporomandibular joint dysfunction, 499 of wrist and hand, 422 Spondyloarthropathy, 219 Spondylolisthesis, 307, 467-473 Spondylolysis, 307, 467-473 Spondylosis, cervical, 455 Spontaneous disk resorption, 455 Sports hernia, 524 Sports medicine, 185-194 acromioclavicular joint injuries and, 362 acute sports injury in, 186 anabolic-androgenic steroid use and, 189-190 ankle injuries and, 188 ankle sprain and, 612 anterior cruciate ligament injuries and, 188 athlete collapse and, 191-192 athlete protein needs and, 190-191 athletic tape and, 189 brachial plexus lesion and, 185 burners and stingers and, 380 chronic compartment syndrome and, 191 concussion and, 192 contusion and, 187 exercise-induced asthma and, 192-193 female anterior cruciate ligament injuries and, 186-187 female athlete triad and, 189 femoral neck stress fracture and, 187-188 glucosamine and chondroitin supplements and, 191 heat exhaustion and heat stroke and, 190 hepatitis and HIV transmission and, 187 injuries in older athlete and, 301 malalignment of lower extremity and, 186 physiologic changes with aging and, 188-189 pitching sequence recommendations and, 390 sprain and, 185 sternoclavicular injuries and, 363-365 weight lifting and, 185 youth strength training program and, 185-186 674 Index Sport-specific testing, 289 SpPins, 182 Sprain, 185 ankle, 188, 611-613, 620 sternoclavicular joint, 364 Sprengel’s deformity, 228, 367 Spring ligament, 602 Spurt muscle, 23 Sputum, 204 SSEP See Somatosensory-evoked potential study Stability of elbow, 385 of glenohumeral joint, 341 of hip, 520 joint implant and, 23 of pelvic fracture, 536 of sacroiliac joint, 505, 506 Stabilization in spinal exercise programs, 281 Stadol See Butorphanol Stance phase of gait, 121 Standard deviation, 170 Standing flexion test, 512 Staple capsulorrhaphy, 346 Stasis, 55 Static cervical traction, 116 Static stretching, 99 Statins, 138 Statistics, 169-170 descriptive, 170 inferential, 172-173 parametric versus nonparametric, 174 Steinmann point tenderness test, 566 Stener lesion, 431 Stenosing tenosynovitis of first dorsal compartment of wrist, 425 Step length, 119 Stereognosis, 167 Sternoclavicular joint injury of, 363-365 loose-packed versus close-packed position of, 110 Sternohyoid muscle, 501 Steroids for adhesive capsulitis, 351 anabolic-androgenic, 189-190 for carpal tunnel syndrome, 441-442 delay in healing and, 249 epidural, 253 for lateral epicondylitis, 391-392 physiologic effects on collagen, 22 Stiff back, 453 Stinger, 164, 380 Stomach disorders, 208 Straight lateral knee ligament instability, 572 Straight-leg raise test, 449, 451, 525 Straight medial knee ligament instability, 572 Strain, 15, 19, 20 of hamstring, 524-525 hysteresis and, 21 of quadriceps muscle, 535 treatment of, 526 Strap muscle, Strength of allograft, 29 biomechanical, 14 of soft tissue after injury, 28 Strength exercises after anterior cruciate ligament reconstruction, 86 for cervicogenic headache, 258-259 for chronic pain, 251-252 following total knee arthroplasty, 577 for groin pull, 524 older adult and, 296-297 youth athlete and, 185-186 Strength testing in lumbar radiculopathy, 160 Strength-duration curve, 84 Stress, 15 connective tissue repair and, 27-28 internal fixation and, 34 pressure versus, 19 tissue response to, 18-20 Stress fracture, 31, 35 femoral neck, 187-188 foot, 620 radiology in, 305-306 Stress incontinence, 235 Stress relaxation, 99 Stress shielding, 23 Stress-strain curve, 19-20 Stretching, 99-102 for adhesive capsulitis, 350 after trigger point injection, 250-251 for cervical headache, 258-259 for groin pull, 524 heat application during, 72 for muscle strain, 526 Stride length, 119 Stroke, postmenopausal, 238-239 Stroke volume, athlete versus sedentary individual and, 38 Structural proteins, Structural scoliosis, 474-478 Stylohyoid muscle, 497, 501 Subacromial decompression, 332 Subacute injury, cold application for, 71 Subchondral bone, 557 Subclavius muscle, 326 Subcoracoid anterior dislocation, 342 Subjective status, 289 Subluxation cuboid, 613 distal radioulnar joint, 435 patellar, 588-589 peroneal tendon, 609-610 sternoclavicular joint, 364 Subscapularis muscle, 321 internal rotation of, 333 rotator interval and, 323 Subtalar joint eversion, 121 Subtalar joint inversion, 121 Subtalar neutral position, 625 Subtalar range of motion, 600 Subtarsal joint, 110 Subtrochanteric femur fracture, 535 Sulcus angle, 306-307 Index Sulcus sign, 343 Sulfasalazine, 49 Sulindac, 128 Sumatriptan, 260, 263 Superficial branch of radial nerve, 420 Superficial deltoid ligament, 602 Superficial peroneal nerve, 612 Superficial radial nerve compression, 405, 436 Superficial sensory fibular nerve compression, 593 Superior glenohumeral ligament, 323 Superior glenoid labrum, 325 Superior gluteal nerve, 507 entrapment of, 532 Superior labrum anterior and posterior lesions, 347-348 Superior transverse ligament, 423 Supination elbow, 387-388 rear foot, 600 wrist, 416 Supinator muscle, 388 Supine long-sitting test, 512 Supine sit-up, 450 Supracondylar distal femoral fracture, 584-586 Supracondylar fracture, 395-396 Supraglenoid tubercle, 325 Suprahyoid muscles, 501 Suprascapular nerve, 326 entrapment of, 370, 376-377 injury in proximal humerus fracture, 372 Supraspinatus manual muscle test, 335, 336 Supraspinatus muscle, 321 internal impingement of shoulder and, 333-334 rotator interval and, 323 scaption of, 333 Supraspinatus tendon, 324 Supraspinous ligament, 446 Sural nerve compression, 591, 594 Surgical management of Achilles tendon rupture, 607-608 of acromioclavicular joint injuries, 361-362 of ankle fracture, 618 of anterior cruciate ligament teat, 573 of capitellar fracture, 398 of cervical stenosis, 466 of clavicle fracture, 361 of cubital tunnel syndrome, 406 of distal femoral fracture, 584-585 of distal radius fracture, 432 of groin pull, 524 healing times and, 285 of humeral shaft fracture, 374-375 of intercondylar fracture, 398 of lateral epicondylitis, 392 of long thoracic nerve palsy, 377 of lumbar spinal stenosis, 463-464 of meniscal injury, 566 of patellar dislocation, 588 of patellar fracture, 583 of pediatric supracondylar fracture, 396 of proximal humerus fracture, 373-374 of radial head fracture, 400-401 of scoliosis, 475, 476-477 Surgical management—cont’d of shoulder instability, 346-347 of spinal cord injury, 494-495 of spondylolisthesis, 472-473 of sternoclavicular injury, 365 Swan neck deformity, 415, 424 Sweating, exercise in hot environment and, 45-46 Swelling in ankle sprain, 612 cold treatment for, 70-71 in complex regional pain syndromes, 60 electrotherapeutic control of, 88 in integumentary disorders, 205-206 in posterior tibialis tendon dysfunction, 609 in prepatellar bursitis, 557-558 Swing limb advancement in gait, 120-121 SXA See Single-energy x-ray absorptiometry Sympathetic block, 251 Sympathetic hyperactivity, 249 Sympathetically independent pain, 248 Sympathetically maintained pain, 248, 251 Symphysis pubis inflammation, 530 Syndesmotic ankle sprain, 602, 613 Syndrome of inappropriate antidiuretic hormone, 215 Synovial plicae, 547 Syringomyelia, 165 Syrinx, 165 Systematic error, 169 Systematic review, 180 Systemic lupus erythematosus, 51 signs and symptoms of, 219 wrist and hand and, 428-429 Systemic scleroderma, 219 T t-test, 173 T1 image, 304 T2 image, 304 T4 syndrome, 483 Talar fracture, 619, 622-623 Talar tilt stress radiograph, 611 Talipes equinovarus, 226 Talipes varus, 24 Talocrural joint loose-packed versus close-packed position of, 110 range of motion of, 600 Talwin See Pentazocine Taping, patellar, 562 Tarsal coalition, 614 Tarsal tunnel, 593, 603 Tarsal tunnel syndrome, 591, 608 Tarsometatarsal joint loose-packed versus close-packed position of, 111 range of motion of, 600 Tear acetabular labral, 530-531 anterior cruciate ligament, 569-575 electrotherapy for, 85-86, 88 epidemiology of, 571-572 in female athlete, 188 healing time in, 285 isokinetic testing and exercise for, 290-291 675 676 Index Tear—cont’d anterior cruciate ligament—cont’d magnetic resonance imaging of, 317 rotator cuff, 330-340 acromioplasty for, 339 after total shoulder arthroplasty, 355 age, gender, and occupation in, 334 full-thickness, 334 healing time for, 285 magnetic resonance imaging in, 337-338 Neer’s classification of, 331 outcomes of repair of, 338 partial-thickness, 331-332 physical therapy after repair of, 334-335 prevalence and natural history of, 330 shoulder instability and, 345 subacromial decompression in, 332 testing for, 336-337 undersurface, 332 Tegretol See Carbamazepine Temporal arteritis, 259 Temporalis muscle, 497, 501 Temporomandibular joint, 496-502 loose-packed versus close-packed position of, 109 manual therapy of, 106 Tendinitis, 27 Achilles, 606-607 patellar, 550 Tendon age influence on extensibility of, 101 biomechanical properties of, 21-22 of foot, 599 of hand, 411 healing of, 28 magnetic resonance imaging of, 305 Tendon transfer, 428 Tendonosis, 27 Tendonosis, Achilles, 606-607 Tennis after total hip arthroplasty, 541 after total knee arthroplasty, 580 Tennis elbow, 391 TENS See Transcutaneous electrical nerve stimulation Tensile failure of rotator cuff, 331-332 Tension, 18 length-tension relationship of muscle and, 21 Tension headache, 256 Tension neuropathy of superficial peroneal nerve, 612 Tension-banding technique for patellar fracture, 583 Teres major muscle, 321 Teres minor muscle, 321, 333 Teriparatide, 238 Terry Thomas sign, 434 Testosterone, muscle growth and, 277 Tetany, 144 Thenar atrophy, 440 Therapeutic ultrasound, 303 Thermal capsulorrhaphy, 346 Thigh thrust test, 512 Third-degree sprain, 20 Thomas heel, 629 Thomas test, 525-526 Thompson test, 607 Thoracic outlet syndrome, 378-380, 480 Thoracic pain, manual therapy for, 105 Thoracic spinal curve, 445 Thoracic spine ankylosing spondylitis of, 482 Thoracic spine—cont’d complex regional pain syndrome and, 484 costochondritis of, 484 disk herniation of, 456, 479 facet joints of, 447 injuries of, 492-493 loose-packed versus close-packed position of, 110 low back pain and, 483 osteoporosis of, 481-482 positional dysfunction of, 481 postherpetic neuralgia and, 483-484 range of motion of, 445 ratio of disk height to vertebral body height of, 449 Scheuermann’s disease and, 482-483 T4 syndrome and, 483 thoracic outlet syndrome and, 480 Thoracolumbar spine injuries of, 492-493 radiology of, 308 Thrombocytopenia, 146 Thrombocytosis, 146 Thromboembolic disease, 137 Thrust techniques, 103, 108-109 Thumb, 419 avulsion fracture of, 434 gamekeeper’s, 431 motions of, 416 osteoarthritis of, 425 Thyrohyoid muscle, 501 Thyroid cancer, 216 Tibial fracture, proximal, 586-587 Tibial nerve, 507 Tibial overuse syndromes, 613 Tibial torsion, 551 Tibialis anterior muscle, 122 Tibialis posterior tendon, 599 Tibiofemoral joint, 110 Tic douloureux, 259 Tillaux-Chaput fracture, 618 Tilt angle of glenoid, 329 Time rate of torque development, 285 TIME test, 224 Tinel’s sign in carpal tunnel syndrome, 439, 440 in meralgia paresthetica, 532 Tissue electrical stimulation of, 83-84 ice application-induced damage of, 70 iontophoresis and, 91 rate of adaptation to change, 23 response to immobilization, 27 response to stress, 18-20 Tissue perfusion, maximal oxygen uptake and, 38 Tissue temperature, massage and, 112 Titin, Tizanidine, 135 Index Tolectin See Tolmetin Tolerance to opioid analgesics, 129 Tolmetin, 129 Tolterodine, 236 Tongue, resting position of, 499 Topical agents, delayed healing and, 241 Topical analgesics, 132 Topical growth factors, 245-246 Toradol See Ketoprofen Torque, 16 Torque acceleration energy, 285 Torque to body weight, 286 Torsional loading, 19 Torticollis, 225 TOS See Thoracic outlet syndrome Total excursion of flexor and extensor tendons, 426 Total hip fusion, gait and, 124 Total hip precautions, 539 Total joint arthroplasty deep venous thrombosis after, 56 elbow, 406-407 hip, 539-543 in femoral neck fracture, 534 gait and, 124 knee, 576-581 prosthetic infection in, 54 shoulder, 353-358 Total leg/total arm strength, 286 Total meniscectomy, 566 Total radial/ulnar deviation arc, 416 Total work, 285 Total-contact casting, 242 Tourniquet test, 440 Toygar’s triangle, 604 Traction in lumbar spinal stenosis, 464 Transcondylar humerus fracture, 397 Transcutaneous electrical nerve stimulation, 87 Transdermal analgesics, 132 Transducer, effective radiating area of, 92 Transepicondylar axis of distal humerus, 329 Transforming growth factor-[beta], bone healing and, 36 Translational manipulation for adhesive capsulitis, 351 Transplantation bone, 36 heart, 44 meniscal, 567 Transtibial amputation, 124-125 Transverse arches of foot, 601 Transverse carpal ligament, 418 Transverse fracture, 31 Transverse friction massage, 113-114 Transverse ligament, 446 Trapeziometacarpal joint, 110 Trapezium, 415 Trapezius muscle, 322 inhibition of, 484 Trapezoid, 415 Trauma in anterior shoulder dislocation, 345 in elbow fractures and dislocations, 394-402 capitellar, 398 coronoid process, 399-400 677 Trauma—cont’d in elbow fractures and dislocations—cont’d distal humerus and, 394-395 epicondylar, 397 intercondylar, 397-398 olecranon, 399 radial head, 400-401 supracondylar, 395-396 trochlear, 398-399 in foot and ankle fractures and dislocations, 617-624 avascular necrosis and, 621 calcaneal, 619, 620-621 Charcot neuroarthropathy and, 622 classification of, 617-618 compartment syndrome and, 623-624 Jones, 622 Lisfranc joint injury and, 621-622 pilon, 620 radiography of, 618 stress, 620 surgical management of, 618 talar, 619, 622-623 in knee fractures and dislocations, 582-587 distal femoral, 584-586 patellar, 582-584 proximal tibial, 586-587 spinal cord, 486-495 burst fracture in, 493 child and, 487 compression injuries and, 488, 490, 493 distractive flexion injuries and, 490 Ferguson-Allen classification of, 489 flexion teardrop fracture in, 490 hangman’s fracture in, 491 Jefferson fracture in, 491 odontoid fracture in, 490-491 radiography in, 487-488 seat-belt injury and, 493 surgical management of, 494-495 thoracolumbar injuries and, 492-493 whiplash and, 491-492 Traumatic spondylolisthesis, 469 Treadmill ambulation in lumbar spinal stenosis, 464 Trendelenburg gait, 123 Triamcinolone, 133 Triangular fibrocartilage complex, 426 Triangular space, 325 Triceps muscle, 322, 388 Triceps reflex, 161 Tricyclic antidepressants for chronic pain, 253 Trigeminal nerve, 162 Trigeminal neuralgia, 259 Trigeminocervical nucleus, 257 Trigger finger, 423 Trigger point, 248-249 Trigger point injection, 250-251 Trimalleolar fracture, 617 Triple arthrodesis, 122 Triple-phase scintigraphy, 61 Tripod sign, 525 Triptans, 260 Triquetral, 415 678 Index Trochanteric bursa, 522 Trochanteric bursitis, 526-527 Trochlear fracture, 398-399 Trochlear nerve, 162 Tropomyosin, 3, Troponin, 3, True score, 169 Trunk curl, 450 Tubercle-sulcus angle, 552, 553 TUBS acronym, 343 Tumor, Pancoast’s, 380 Tunnel of Guyon compression, 437-438 Turf toe, 191 Two-point discrimination test, 167-168, 441 Tylenol See Acetaminophen Type diabetes mellitus, exercise recommendations in, 300 Type IIx myosin heavy chain, U UKA See Unicompartmental knee arthroplasty Ulcer plantar, 242 venous versus arterial, 241 Ulcerative colitis, 514 Ulnar artery, Allen test and, 422 Ulnar deviation of wrist, 416 Ulnar nerve, 420 compression of, 402-403, 437 elbow and, 388 injury in clavicle fracture, 371 loss of function following total elbow joint arthroplasty, 406-407 splinting for injury of, 422 Ulnar variance, 310 Ulnohumeral joint, 385, 387 Ultrasound, 92-94 in adhesive capsulitis, 350 diagnostic versus therapeutic, 303 in rotator cuff tear, 337 in treatment of acute fracture, 34-35 Uncinate process, 449 Unconstrained total shoulder arthroplasty, 353-354 Uncovertebral joint, 457-458 Undersurface rotator cuff tear, 332 Unfused acromial epiphysis, 331 Unicompartmental knee arthroplasty, 579 Unipennate muscle, Unipolar hemiarthroplasty, 534 Unipolar neuromuscular electrical stimulation, 83 Upper cervical manipulation, drug contraindications in, 137 Upper extremity exercise-induced changes in physiology of, 39 joint disease in, 425 manual therapy of, 106 splinting techniques for nerve injury of, 422 Upper limb nerve conduction, 152 Upper respiratory tract infection, 44 Ureteral disorders, 210-211 Urethral disorders, 210 Urge incontinence, 235 Urinary incontinence, 235-236 Urinary tract infections, 210 V Vagus nerve, 163 Valdecoxib, 131 Valgus stress at elbow, 386 at knee, 570 Valgus stress test, 575 Valium See Diazepam Variables, 169 Variance, 170 Varus stress at elbow, 386 Vasoconstriction cold application and, 70 exercise in cold environment and, 45 Vasodilation cold application and, 70 heat application and, 72 Vastus medialis oblique muscle, 553, 561 Vegetarian diet, 273 Velocity, 15 Venlafaxine, 132 Venography in deep venous thrombosis, 58 Venous thrombosis, 55-59 Venous ulcer, 241 Ventilatory threshold, 38 Vertebral fracture compression, 495 older adult and, 293-294 Vertebral landmarks, 450 Vertebroplasty, 495 Vertical compression injury, 490 Vesicare See Solifenacin succinate Vestibulocochlear nerve, 163 Vibration sensibility testing, 167 Vincula, 427 Vioxx See Rofecoxib Virchow’s triad, 55 Visceral organs, manual therapy and, 107 Visceral symptoms, 194-195 Viscosupplementation for sacroiliac pain, 515 Vitamin B6 supplementation, 275 Vitamin B12 supplementation, 275, 276 Vitamin D calcium absorption and, 33 for osteoporosis, 238 VO2max See Maximal oxygen uptake Volar intercalated segment instability, 433 Volar plating of distal radius fracture, 432 Volar proximal interphalangeal joint dislocation, 431 Volar tilt of distal radius, 313 Voltage, nerve cell membrane depolarization and, 77 Voltaren See Diclofenac Vomiting in cardiovascular disorders, 201 W Waddell signs, 252 Wagner grading system for plantar ulcers, 242 Walker, gait and, 123-124 Walking velocity, 119 Warfarin, 144 for deep venous thrombosis, 59 for thromboembolic disease, 137 Index Warfarin—cont’d for venous thrombosis prevention, 58 Warming-up period beneficial effects of, 11 oxygen deficit and, 38 Wartenberg’s disease, 425, 436 Watson’s test, 434 Waveform characteristics of, 80-82 type used in electrical stimulation, 87 Wear debris, 23 Weber/AO classification of ankle fractures, 617 WeeFIM test, 224 Weight-bearing after fracture, 34 after total hip arthroplasty, 542 after total knee arthroplasty, 576 alignment of femur and tibia during, 550 knee fracture and, 587 lumbar spinal stenosis and, 462 Weight-bearing exercises for patellofemoral pain, 560-561 Weight control, 273-278 Atkins diet and, 274 creatine supplementation and, 277-278 dietary guidelines of American Heart Association, 276-277 guidelines for exercise program for, 43 heart disease and, 275-276 Ornish low-fat diet and, 273, 274 protein supplementation in athlete and, 277 Weight Watchers diet and, 274 Zone diet and, 273, 274 Weight lifting, 185 acromioclavicular joint injury and, 362 Weight Watchers diet, 274 Wet-to-dry gauze dressing, 240 Wheelchair, child and, 223-224 Whiplash, 491-492 Whirlpool, 244-245 White blood cell count, 145, 150 Wiberg’s center-edge angle, 315 Wide dynamic range neuron, 248 Wigraine See Ergotamine tartrate Wilk classification of patellofemoral pain, 554-556 Williams’ flexion exercises, 279 Wilson test, 227 Wind-up of wide dynamic range neuron, 248 Windlass mechanism of foot, 601, 614-615 Within-subjects factorial design, 170 Wolff ’s law, 33 Women’s health issues, 230-239 anterior cruciate ligament injuries in, 186-187 heart attack and stroke in, 238-239 lymphedema in, 236 oligomenorrhea and amenorrhea in, 236 osteoporosis in, 236-238 pelvic floor dysfunction in, 234 pelvic organ prolapse in, 234-235 pregnancy and, 230-234 sacroiliac dysfunction in, 510-516 Women’s health issues—cont’d urinary incontinence in, 235-236 Work conditioning, 265, 266 Work hardening, 265, 266 Work rehabilitation, 266 Wound healing, 239-246 debridement and, 240-241 diabetes mellitus and, 242 electrical stimulation for, 245 hydrotherapy for, 244-245 isokinetic testing and exercise after, 285 moist wound, 239-240 negative pressure wound therapy for, 245 pressure ulcer and, 241-242 topical growth factors for, 245-246 wound care dressings for, 242-244 Wright test, 379 Wrist, 409-442 de Quervain’s disease and, 424-425 Dupuytren’s contracture and, 423 extensor tendon injuries of, 426-427 flexor tendon injuries of, 427-428 fractures and dislocations of, 430-435 functional anatomy of, 411-420 ganglion cyst of, 423-424 nerve entrapments of, 436-442 carpal tunnel syndrome in, 438-442 tunnel of Guyon and, 437-438 ulnar nerve compression in, 437 Wartenberg’s disease in, 436 oblique retinacular ligament contracture and, 421 osteoarthritis of, 425 quadriga and, 422 radiology of, 310-314 Raynaud’s phenomenon and, 429 rheumatoid arthritis of, 50, 428-429 scaphoid shift test and, 421 splinting of, 422 systemic lupus erythematosus of, 428-429 triangular fibrocartilage complex of, 426 Wrist extension test, 440 Wrist flexion test, 439-440 Writer’s cramp, 426 X X-ray See Radiography Y Yergason’s test, 336 Yield point, 19, 20 Young’s modulus, 19 Youth strength training program, 185-186 Z Z disk, 3, Zanaflex See Tizanidine Zocor See Simvastatin Zone diet, 273, 274 Zostrix See Capsaicin 679 [...]...Preface We are pleased that the first edition of Orthopaedic Physical Therapy Secrets has become a standard study guide for the orthopaedic certification specialty examination This text provides condensed, high-quality, preprocessed information that gets to the heart of orthopaedic examination, intervention, and outcomes Orthopaedic Physical Therapy Secrets promotes the concept of efficient... medical laboratory tests As always, we have emphasized questions founded on sound outcome-based and evidence-based research Orthopaedic Physical Therapy Secrets has gathered experts from a wide variety of disciplines, including orthopaedic physical therapy, occupational therapy, orthopaedic surgery, radiology, rheumatology, spine surgery, sports medicine, exercise physiology, anesthesiology, and obstetrics/gynecology... used, quick, and well-organized clinical resource guide We have included new, extremely detailed chapters covering differential diagnosis and radiology These chapters are a direct reflection of the direction in which contemporary physical therapy practice is moving Likewise, we have added significant detail to the chapters covering anatomy, orthopaedic neurology, pharmacology, and the evaluation of medical... exercise • • • • • • • • • • Improved ability to obtain ATP from oxidative phosphorylation Increased size and number of mitochondria Less lactic acid produced per given amount of exercise Increased myoglobin content Increased intramuscular triglyceride content Increased lipoprotein lipase (enzyme needed to use lipids from blood) Increased proportion of energy derived from fat; less from carbohydrates... Aerobic Many Intermediate (wide) Low Low High High Low Fast Intermediate High (intermediate) Intermediate Dark High Rich Aerobic Many Wide (intermediate) High (intermediate) High Low Medium-high High Fast Large Low Large Pale Low Poor Anaerobic Few Narrow High High Moderate Low High 10 Basic Science 36 List the effects of progressive resistance exercise • Increased mass and strength • Increased cross-sectional... load placed on the muscle As the load is increased, the velocity decreases When the load exceeds the maximal force capable of being developed by the muscle, a lengthening contraction ensues The force developed during a shortening contraction is less than the isometric force The force developed during a lengthening contraction exceeds the isometric force by 50% to 100% because of the increased extension... cross-sectional area of muscle (increased number of myofibrils, leading to hypertrophy) • Increased type I and type II fiber area • Decreased mitochondrial density per fiber and oxidative capacity • Increased intracellular lipids and capacity to use lipids as fuel • Increased intracellular glycogen and glycolytic capacity • Increased intramuscular high-energy phosphate pool and improved phosphagen metabolism 37... the changes that result from muscles being immobilized in a shortened position • Altered strength • Increased stiffness to passive stretch • Increased fatigability 42 What occurs as a result of lengthening the muscles? Sarcomeres are added 43 Does muscle splitting occur, or can there be an increase in the number of cells (hyperplasia)? Hyperplasia, defined as an increase in fiber number, generally does... neuromuscular diseases 44 Define disease-associated muscle atrophy, such as cachexia Disease-associated muscle atrophy is due to accelerated proteolysis This form of skeletal muscle atrophy is systemic and associated with metabolic and/or inflammatory factors 45 Differentiate apoptosis from necrosis as applied to skeletal muscle Apoptosis, or programmed cell death, is a regulated physiologic process critical to... poorly vascularized foot, in association with connective tissue changes, is vulnerable to increases in pressure and consequently the development of pressure sores If the body weight transmitted to the foot can be dispersed over a larger surface area of the foot, the magnitude of pressure is decreased as is the chance for ulceration The same factors apply to a person confined to prolonged bed rest; pressure