Ebook Essentials of musculoskeletal care (4/E): Part 2

Part 2 book “Essentials of musculoskeletal care” has contents: Trochanteric bursitis, collateral ligament tear, collateral ligament tear, gastrocnemius tear, iliotibial band syndrome, iliotibial band syndrome, iliotibial band syndrome, stress fracture, achilles tendon tear, achilles tendon tear,… ang other contents.

Section Hip and Thigh 528 Pain diagram 530 Anatomy 531 overview of the Hip and thigh 555 Fracture of the Femoral Shaft 558 Fracture of the Pelvis 563 Fracture of the Proximal Femur 541 Physical examination of the Hip and thigh 568 Hip impingement 551 Dislocation of the Hip (Acute, traumatic) 573 inflammatory Arthritis 576 Lateral Femoral cutaneous nerve Syndrome 597 Strains of the thigh 579 osteoarthritis of the Hip 607 transient osteoporosis of the Hip 582 osteonecrosis of the Hip 586 Snapping Hip 591 Strains of the Hip 604 Stress Fracture of the Femoral neck 609 trochanteric Bursitis 614 Procedure: trochanteric Bursitis injection Section Editors Craig J Della Valle, MD Kathleen Weber, MD, MS Associate Professor Department of Orthopaedic Surgery Rush University Medical Center Chicago, IL Assistant Professor Department of Orthopaedic and Internal Medicine Rush University Medical Center Chicago, IL Michael Huxford, MEd, ATC, CSCS Sports Medicine Coordinator Rehabilitative Services Institute for Sports Medicine Children’s Memorial Hospital Chicago, IL E s s E n t i a l s o f M u s c u l o s k E l E ta l c a r E  Shane J Nho, MD, MS Assistant Professor Section of Sports Medicine Department of Orthopaedic Surgery Rush University Medical Center Chicago, IL © a M E r i c a n a c a d E M y o f o r t h o pa E d i c s u r g E o n s 529 AnAtomy oF tHe HiP AnD tHigH Origin of psoas major muscle from vertebral bodies, transverse processes, and intervertebral disks (T12-L4) and origin of psoas minor muscle from vertebral bodies (T12, L1) T12 12th rib Quadratus lumborum muscle L1 Transversus abdominis muscle (cut) L2 Iliohypogastric nerve L3 Ilioinguinal nerve Lumbar plexus Psoas minor muscle Lumbosacral trunk Psoas major muscle L4 Genitofemoral nerve L5 Iliac crest Anterior superior iliac spine Lateral cutaneous nerve of thigh Iliacus muscle Femoral nerve Superior pubic ramus Iliopectineal bursa Greater trochanter of femur Iliopsoas muscle passes backward to insertion on lesser trochanter Iliofemoral ligament of hip joint (Y ligament of Bigelow) Shaft (body) of femur Anterior Muscles of the Pelvis Anterior superior iliac spine Iliacus muscle Iliac crest Gluteal aponeurosis over gluteus medius muscle Psoas major muscle Gluteus medius muscle Inguinal ligament Gluteus maximus muscle Pubic tubercle Iliopsoas muscle Tensor fasciae latae muscle Pectineus muscle Greater trochanter Adductor longus muscle Semitendinosus muscle Gracilis muscle Sartorius muscle Biceps femoris muscle (long head) Rectus femoris muscle Adductor minimus part of adductor magnus muscle Vastus lateralis muscle Vastus intermedius muscle Vastus medialis muscle Iliotibial tract Rectus femoris tendon (becoming part of quadriceps femoris tendon) Lateral patellar retinaculum Patella Medial patellar retinaculum Patellar ligament Sartorius tendon Gracilis tendon Semimembranosus muscle Iliotibial tract Gracilis muscle Biceps femoris muscle Short head Long head Semimembranosus muscle Semitendinosus muscle Popliteal vessels and tibial nerve Common fibular (peroneal) nerve Plantaris muscle Gastrocnemius muscle Medial head Lateral head Sartorius muscle Semitendinosus tendon Tibial tuberosity Muscles of the Anterior Thigh 530 E s s E n t i a l s o f M u s c u l o s k E l E ta l c a r E Muscles of the Posterior Thigh and Gluteus  © a M E r i c a n a c a d E M y o f o r t h o pa E d i c s u r g E o n s Overview of the Hip and Thigh SECTION HIP Hip or proximal thigh pain generally comes from one of the following sources: (1) the hip joint itself, (2) the soft tissues around the hip and pelvis, (3) the pelvic bones, or (4) referred pain from the lumbar spine Diagnosing pathology involving the hip joint and pelvis is often possible with a careful history and physical examination combined with plain radiographs; in some cases, however, advanced imaging studies such as MRI, CT, or nuclear medicine scans may be required The hip joint, consisting of the articulation between the cartilaginous surfaces of the femoral head and the pelvic acetabulum, is a diarthroidal, synovial ball-and-socket joint (Figure 1) The acetabulum is formed by the confluence of the ilium, the ischium, and the pubis, and the articular surface that is created is horseshoe shaped The proximal femur consists of the femoral head and neck and the greater and lesser trochanters The greater trochanter is a large bony prominence found at the lateral base of the femoral neck; it serves as the attachment site for the abductor musculature (the gluteus medius and minimus) The lesser trochanter is a smaller bony prominence located on the medial aspect of the proximal femur; Figure Bones of the hip and thigh E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 531 OVERVIEW OF THE HIP AND THIGH it serves as the attachment site for the iliopsoas tendon (a powerful hip flexor) Radiographic examination of the hip should include an AP radiograph of the pelvis and either a frog-lateral view of the pelvis or AP and lateral radiographs of the involved hip Radiographs should be evaluated carefully for displaced or nondisplaced fractures, degenerative changes of the hip joint (including joint space narrowing), hip dysplasia, and changes in bony architecture, such as lytic or blastic lesions that could suggest a primary or metastatic tumor SECTION HIP Type of Pain 532 Pain arising from the hip joint may be secondary to osteoarthritis, osteonecrosis, inflammatory conditions such as rheumatoid arthritis, septic arthritis, fractures of the proximal femur or pelvis, or dislocations of the femoral head Patients with these conditions usually report pain in the groin or the anterior aspect of the proximal thigh, but pain may be present in the buttock or lateral aspect of the thigh or may be referred to the supracondylar region of the knee Hip joint pathology is often associated with a decrease in range of motion that in degenerative conditions is associated with difficulty in activities such as putting on shoes A limp also may be present, and patients with traumatic injuries (such as proximal femoral or pelvic fractures) are typically unable to bear weight on the extremity and are unable to perform a straight-leg raise Problems involving the bony pelvis include traumatic highenergy fractures, insufficiency fractures associated with osteoporosis, avulsion fractures from attached tendons, and primary or metastatic tumors Problems involving both the hip joint and bony pelvis often manifest as pain in the groin, buttock, or lateral thigh Conditions that affect the soft tissues around the hip, such as trochanteric bursitis, lateral femoral cutaneous nerve impingement, and snapping hip syndrome, typically cause pain on the lateral or anterolateral aspect of the proximal thigh Patients with an injury of the adductor muscles will note pain in the groin; hamstring injuries are associated with pain in the buttock or posterior aspect of the thigh The sacroiliac (SI) joint is relatively immobile Some individuals have been found to experience more SI mobility than others and may experience SI pain High-energy injuries such as high-energy pelvic ring disruption can lead to significant SI pain Other conditions that involve the SI joint, such as seronegative arthritides or traumatic arthritis, can cause buttock and posterior thigh pain but are unlikely to restrict function Pathology in the lumbar spine may present as referred pain to the buttock and posterior thigh or as pain that radiates down the E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S ipsilateral extremity in a radicular pattern Patients with degenerative problems of the lumbar spine or strains of the lumbar musculature may have pain limited to the buttock, whereas disorders that cause entrapment of the spinal nerves (such as disk herniations) will cause pain that radiates in a dermatomal pattern With these conditions, patients typically not have symptoms referable to the groin, significant discomfort with rotation of the hip, or limited range of motion of the hip joint, although they often present with what they describe as “pain in the hip.” Nonmusculoskeletal pathology may present as groin or hip pain, and if the source of pain is obviously not the hip joint, these etiologies must be explored Constitutional symptoms such as fever, chills, and weight loss should be explored to rule out malignancy or infection Inguinal or abdominal hernias and rectus abdominus strains may present with pain in the groin or anterior thigh and may be difficult for the patient to distinguish from hip pathology Gastrointestinal disorders such as inflammatory bowel disease, diverticulosis, diverticulitis, or appendicitis may mimic hip pain Pain from abdominal aortic aneurysms may mimic groin pain Urinary tract infections or nephrolithiasis also may cause pain referred to the hip region Pathology of the reproductive system also may present as pain in the groin or hip area Prostatitis, epididymitis, hydroceles, varicoceles, testicular torsions, and testicular neoplasms all have been known to cause groin pain in men Ectopic pregnancy, dysmenorrhea, endometriosis, and pelvic inflammatory disease may cause pain in this location in women Pelvic floor muscles that are weak or too tight can produce hip, buttock, or groin pain If any of these disorders are suspected, a referral should be made to the appropriate specialists Gait A brief examination of the patient’s gait can be very helpful in making a diagnosis Ask the patient to walk briskly up and down the hall several times at a brisk pace An abductor or gluteus medius lurch is manifested by a lateral shift of the body to the weight-bearing side with ambulation This type of gait often occurs in patients who have intra-articular hip pathology (osteoarthritis, inflammatory arthritis, or osteonecrosis of the hip) Pain associated with a limp suggests pathology around the pelvis or hip and requires further investigation SECTION HIP OVERVIEW OF THE HIP AND THIGH Musculoskeletal Conditioning of the Hip A conditioning program consists of three basic phases: stretching exercises, to improve range of motion; strengthening, to improve muscle power; and proprioception, to enhance balance and E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 533 SECTION HIP OVERVIEW OF THE HIP AND THIGH agility In addition, the exercise session should begin with an active warm-up, and plyometric exercises may be added for power after basic strength and flexibility have been achieved Patient handouts are provided here for the stretching and strengthening exercises Advanced proprioceptive exercises and plyometric exercises should be done under the supervision of a rehabilitation specialist or other exercise professional The goal of a conditioning program is to enable people to live a more fit and healthy lifestyle by being more active A well-structured conditioning program also will prepare the individual for participation in sports and recreational activities The greater the intensity of the activity that the individual wishes to engage in, the greater the intensity of the conditioning that will be required If the individual participates in a supervised rehabilitation program that provides instruction in a conditioning routine—instead of using only an exercise handout such as provided here—the focus should be on developing and committing to a home exercise fitness program A conditioning program for the body as a whole that includes exercises for the shoulder, knee, foot, and spine as well as the hip is described in Musculoskeletal Conditioning: Helping Patients Prevent Injury and Stay Fit, beginning on page 183 The muscles of the hip and pelvis are important in walking and running activities Both the shoulder and the hip are balland-socket joints, but because of its anatomy, the hip is more stable than the shoulder An exercise program for conditioning of the hip should include an active warm-up; stretching, strengthening, and proprioceptive exercises; and, once basic stretching and strengthening have been achieved, plyometrics for power Active Warm-Up The hip muscle groups are large and require an adequate warmup, such as riding on a stationary bicycle or jogging for 10 minutes to raise the core body temperature In addition, dynamic stretching exercises such as leg swings can be used to warm up the synovial fluid in the hip joint and actively stretch the muscles before activity Strengthening Exercises Exercises that isolate muscle contraction and not stimulate co-contractions are important for strengthening the hip muscles In general, weight-bearing exercises produce co-contractions, and non–weight-bearing exercises not Co-contractions are important for stabilizing the joint that is being strengthened Strengthening of the large hip muscle groups requires heavier weights and few (6 to 12) repetitions After beginning with a weight that allows the patient to perform to repetitions initially, working up to 12 repetitions should be the goal of the 534 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S OVERVIEW OF THE HIP AND THIGH strengthening phase The exercises described below isolate the gluteus medius (posterior fibers), the gluteus maximus, and the internal and external rotators, which often are weak and therefore contribute to hip pathology Static Stretching Exercises Static stretching should be done to increase the flexibility of the muscles surrounding the hip A static stretch is performed at the end of the available range of painless motion of the muscle and joint In addition to strength, the athlete requires balance and power Neuromuscular training, which improves communication between the muscles and the proprioceptors, includes balance and perturbation exercises as well as plyometrics Balance involves the visual, vestibular, and proprioceptive systems With balance training, the athlete consciously attempts to hold a posture for 30 to 60 seconds These exercises might include balancing on one leg or balancing on one leg while touching the other foot to different points on the ground within reach With perturbation training, the athlete stands on an unstable surface such as a balance board while it is being perturbed by an outside force Jumping exercises, such as jumping forward and backward over a barrier, are a basic form of plyometrics These should be attempted only by individuals with full range of motion and adequate strength in the hip, pelvic and abdominal, and back muscles These types of plyometric and proprioceptive exercises should be supervised by a rehabilitation specialist or other exercise professional E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S SECTION HIP Proprioceptive Conditioning and Plyometrics 535 OVERVIEW OF THE HIP AND THIGH Home Exercise Program for Hip Conditioning ■ ■ ■ Before beginning the conditioning program, warm up the muscles and the hip joint by riding a stationary bicycle or jogging for 10 minutes and performing leg swings as follows: While standing, swing one leg forward and backward 10 times and then side-to-side 10 times Repeat with the opposite leg Place one hand against a wall for balance if needed When performing the stretching exercises, you should stretch slowly to the limit of motion, taking care to avoid pain If you experience pain with the exercises, call your doctor After performing the active warm-up and strengthening exercises, static stretching exercises should be performed to maintaining or increase flexibility Exercise Muscle Group Number of Repetitions/Sets Number of Days per Week SECTION HIP Strengthening 536 Hip extension (prone) Gluteus maximus to repetitions, progressing to 12 repetitions to Side-lying hip abduction Gluteus medius to repetitions, progressing to 12 repetitions to Internal hip rotation Medial hamstrings to repetitions, progressing to 12 repetitions to External hip rotation Piriformis to repetitions, progressing to 12 repetitions to Seat side straddle Adductor muscles Medial hamstrings Semitendinosus Semimembranosus repetitions/2 to sets Daily Modified seat side straddle Hamstrings Adductor muscles repetitions/2 to sets Daily Leg stretch Hamstrings repetitions/2 to sets Daily Sitting rotation stretch Piriformis External rotators Internal rotators repetitions/2 to sets Daily Knee to chest Posterior hip muscles repetitions/2 to sets Daily Leg crossover Hamstrings repetitions/2 to sets Daily Cross overstand Hamstrings repetitions/2 to sets Daily Iliotibial band stretch Tensor fascia repetitions/2 to sets Daily Quadriceps stretch (prone) Quadriceps repetitions/2 to sets Daily Stretching E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S OVERVIEW OF THE HIP AND THIGH Strengthening Exercises Hip Extension (Prone) ■ ■ ■ ■ ■ Lie face down with a pillow under your hips and one knee bent 90° Elevate the leg off the floor, lifting the leg straight up with the knee bent Lower the leg to the floor slowly, to a count of Ankle weights should be used Start with weight light enough to allow to repetitions and work up to 12 repetitions Repeat on the other side Perform the exercise to days per week Once you have worked up to 12 repetitions, add as much weight as can be lifted only times, working up to 12 repetitions again Continue this cycle of adding weight and increasing repetitions ■ ■ ■ ■ ■ Lie on your side while cradling your head in your arm Bend the bottom leg for support Slowly move the top leg up and back to 45°, keeping the knee straight Lower the leg slowly, to a count of 5, and relax it for seconds Ankle weights should be used, starting with weight light enough to allow to repetitions, working up to 12 repetitions Repeat on the other side Perform the exercise to days per week Once you have worked up to 12 repetitions, add as much weight as can be lifted only times, working up to 12 repetitions again Continue this cycle of adding weight and increasing repetitions Internal Hip Rotation ■ ■ ■ ■ ■ ■ Lie on your side on a table with a pillow between your thighs Bend the top leg 90° at the hip and 90° at the knee Start with the foot of the top leg below the level of the top of the table; lift to the finish position, which is rotated as high as possible Lower the leg slowly, to a count of Ankle weights should be used, starting with weight light enough to allow to repetitions, working up to 12 repetitions Repeat on the other side Perform the exercise to days per week Once you have worked up to 12 repetitions, add as much weight as can be lifted only times, working up to 12 repetitions again Continue this cycle of adding weight and increasing repetitions E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S SECTION HIP Side-Lying Hip Abduction 537 OVERVIEW OF THE HIP AND THIGH External Hip Rotation ■ ■ ■ ■ ■ ■ Lie on your side on a table with the bottom leg bent 90° at the hip and 90° at the knee Start with the foot below the level of the top of the table; lift to the finish position, which is rotated as high as possible Lower the leg slowly, to a count of Ankle weights should be used, starting with weight light enough to allow to repetitions, working up to 12 repetitions Repeat on the other side Perform the exercise to days per week Once you have worked up to 12 repetitions, add as much weight as can be lifted only times, working up to 12 repetitions again Continue this cycle of adding weight and increasing repetitions Stretching Exercises Seat Side Straddle ■ ■ ■ SECTION HIP ■ Sit on the floor with your legs spread apart Place both hands on the same ankle and bring your chin as close to your knee as possible Hold the stretch for 30 seconds and then relax for 30 seconds Repeat on the other side Repeat the sequence times, performing to sets daily Modified Seat Side Straddle ■ ■ ■ ■ Sit on the floor with one leg extended to the side and the other leg bent as shown Place both hands on the ankle of the extended leg and bring your chin as close to your knee as possible Hold the stretch for 30 seconds and then relax for 30 seconds Reverse leg positions and repeat on the other side Repeat the sequence times, performing to sets daily Leg Stretch ■ ■ ■ ■ ■ 538 Sit on the floor with your legs straight and your hands grasping the calf of one leg Slowly lift and pull the leg toward your ear, keeping your back straight and the other leg flat on the floor or bent slightly if necessary for comfort Hold the stretch for 30 seconds and then relax for 30 seconds Repeat with the other leg Repeat the sequence times Perform to sets daily E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S INDEX physical examination of, 962 treatment of, 963 Metatarsal anatomic zones of, 806f congenital short first, 1045 fracture of, 806–808 adverse outcomes from, 807 clinical symptoms of, 806 definition of, 806 diagnostic tests of, 807 differential diagnosis of, 807 physical examination of, 806 treatment of, 807–808 Metatarsalgia, 832–833 clinical symptoms of, 832 definition of, 832 development of, 858f diagnostic tests of, 832 differential diagnosis of, 832–833 orthoses for, 838t physical examination of, 832 treatment of, 833 Metatarsal pad, application of, 775–776 aftercare instructions for, 775f placement of, 775f procedure of, 775 Metatarsophalangeal joint (MTP joint) See also Sesamoid, MTP joint anatomic features of, 811 instability of, 753 palpation of, 747 Metatarsus adductus, 1131–1134 adverse outcomes from, 1133 classification of, 1132f clinical appearance of, 1131f clinical symptoms of, 1132 definition of, 1131 diagnostic tests of, 1133 differential diagnosis of, 1133 foot photocopies of, 1133, 1133f physical examination of, 1132– 1133 treatment of, 1133–1134 Metatarsus primus varus, 819 Metatarsus varus, 1131 Methylprednisolone acetate characteristics of, 89t doses of, 91t Methyl sulfonyl methane, 43 Middle-aged patients, shoulder considerations with, 246–247 Midfoot amputation of, 16–17 arthritis of, 769f conditions associated with, 734, 1008 fracture-dislocation of, 797–799, 798f adverse disease outcomes from, 799 definition of, 797 diagnostic tests of, 797–798 differential diagnosis of, 799 physical examination of, 797 treatment of, 799 Milking sign, 353 Miserable malalignment syndrome, 993, 993f, 1110 Monosodium urate crystals, 76f Monteggia injury, 1089–1090 Morton neuroma See Interdigital neuroma MP joint See Metacarpophalangeal joint MRI See Magnetic resonance imaging MTP joint See Metatarsophalangeal joint Mucous cyst, 488, 490f, 523f, 868 Multiple myeloma, incidence by sex of, 894 Munchausen syndrome, 1021 Muscle See also specific body part; specific muscle compartments of anatomy of, 669f arm’s, 59f leg’s, 58f pressure of, 63f, 64t thigh’s, 59f contraction, types of, 179t flexibility loss of, 994f Musculoskeletal conditioning, 183– 184 Musculoskeletal evaluation, 8–14 goniometer use in, 12f inspection in, joint motion measurement in, 10f–11f, 12–13 motor function in, 13 muscle testing in, 13, 13t palpation in, patient history in, 8, 8t peripheral nerves in, 14t physical examination in, point of maximum tenderness localization in, 9f range of motion in, sensory function in, 13 Musculoskeletal oncology, E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ Musculotendinous cuff rupture, 311 Myeloma, multiple myeloma, incidence by sex of, 894 Myofascial pain syndrome, 103t N Nail See also Toenail avulsion of, treatment of, 505–506, 505f fungal infection of, 834–835, 834f clinical symptoms of, 834 definition of, 834 differential diagnosis of, 834 tests of, 834 treatment of, 834–835 plate avulsion of, 825–826 adverse outcomes from, 826 anatomy in, 825 permanent ablation with, 826 procedure of, 825, 826f removal of, paronychia and, 453f Nail bed anatomy of, 504f injuries of, 504–506 definition of, 504 physical examination of, 504 treatment of, 505–506 laceration of, 505 Nancy nails, 1093f Naturopathy, 40t Neck exercise of neck retraction, 338, 338f neck stretch, 337, 337f fracture of, surgical, 283 pain in, 888t, 889 sprain of See Cervical sprain Necrosis, of femoral head, 1122 See also Osteonecrosis Neer impingement sign, 261 Neisseria gonorrhoeae, 1173t Neonatal brachial plexus palsy, 1135–1138 adverse outcomes from, 1137 clinical symptoms of, 1135 definition of, 1135 diagnostic tests of, 1136 differential diagnosis of, 1136 physical examination of, 1136 treatment of, 1137–1138 Neoplasia, pain associated with, 889t Nerve See also specific nerve gliding, 440, 440f injury to, 779 Nerve block See also Digital anesthetic block continuous axillary, 72f © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 1245 INDEX peripheral, in orthopaedic surgery, 25–26 subclavian, 72f Nerve compression syndromes See also Lateral femoral cutaneous nerve syndrome elbow, 384–388 clinical symptoms of, 385 definition of, 384–385 differential diagnosis of, 386–387 physical examination of, 385–386 tests of, 385–386 treatment of, 387–388 median, 436 ulnar, 384, 384ff, 387 Neuritis, ulnar nerve, 384 Neurogenic claudication, 958t See also Lumbar spinal stenosis Neurogenic leg pain See Lumbar disk herniation Neurologic evaluation lower extremity, 892f upper extremity, 890f Neuroma See Interdigital neuroma Neuromuscular disorders, in pediatric orthopaedics, 977 Neuropathic foot See Diabetic foot Neuropathic ulceration, orthotics for, 838t Neurovascular injury, in dislocation reduction maneuver, 359–360 Nodular fasciitis, 868 Nondisplaced fracture, 110f Nonrheumatoid arthritis clinical symptoms of, 355 of elbow, 354 treatment of, 357 Nonsteroidal anti-inflammatory drugs (NSAIDs), 93–95 choice of, 95 definition of, 93 osteoarthritis treatment with, 36–37, 37t side effects of, 94–95 types of, 94t NSAIDs See Nonsteroidal antiinflammatory drugs Nuclear stress test, for orthopaedic patients, 27t Numbness of hand, 402 of wrist, 402 Nursemaid’s elbow, 1004 Nutrition, comorbidities associated with, 172–173 Nutritional supplements 1246 medication interactions with, 42t osteoarthritis therapy with, 29, 41 O OA See Osteoarthritis Ober test, 639 Oblique fracture, 111f Obstetric palsy See Neonatal brachial plexus palsy Occult bony pathology, 779 Occult fractures, of elbow, 1002–1003 OCD See Osteochondritis dissecans Olecranon avulsion of, 1127 bursitis of, 379–381 adverse disease outcomes from, 380 aspiration of, 382–383, 382f clinical symptoms of, 379 definition of, 379 differential diagnosis of, 380 physical examination of, 379–380 tests of, 379–380 treatment of, 380–381 fracture of, 364–366 adverse disease outcomes from, 365 clinical symptoms of, 364 definition of, 364 differential diagnosis of, 365 physical examination of, 365 tests of, 365 treatment of, 365–366 types of, 364f Oligoarthritis, asymmetric, 54t Omega-3 fatty acids, 43 Oncology, musculoskeletal, See also Cancer Onychomycosis, dermatophytic, 834 Open-chain exercise, 180t Opioid analgesics, osteoarthritis treatment with, 37, 37t Orthopaedics See also Pediatric orthopaedics overview of, stress tests in, 27t Orthopaedic surgery anesthesia for, 25–31 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E epidural anesthesia in, 25 general anesthesia in, 25 intravenous regional anesthesia in, 26 outpatient surgery centers and, 27–28, 28t peripheral nerve blocks in, 25–26 preoperative evaluation in, 26–27, 27t spinal anesthesia in, 25 ■ surgical procedures with, 28–31, 29t techniques for, 25–26 classification of, 169t Orthoses application of, 838 custom-made, 836f definition of, 836 foot types and, 836 pad/insert, 836–837, 837f shoe, 837–838, 838f for specific diagnoses, 838t spinal, 967-969 types of, 836–838 Orthovisc See Hyaluronan Ortolani maneuver, 1051, 1051f Osgood-Schlatter disease, 1139–1141 adverse outcomes from, 1140 clinical symptoms of, 1139 definition of, 1139 diagnostic tests of, 1139–1140, 1139f differential diagnosis of, 1140 physical examination of, 1139 treatment of, 1140–1141 Osteoarthritis (OA), 32–38 adverse disease outcomes from, 36 clinical appearance of, 33f, 34f clinical characteristics of, 5t clinical symptoms of, 32, 355 definition of, 32 demographics affected by, 5t diagnostic tests of, 35, 35f differential diagnosis of, 35–36, 372 elbow, 355 hand, 419 hip, 579–581 adverse disease outcomes from, 580 clinical symptoms of, 579 diagnostic tests of, 580, 580f differential diagnosis of, 580 physical examination of, 579 treatment of, 580–581, 581f pathophysiology of, 5t physical examination of, 33–34 rheumatoid arthritis vs., 5t risk factors for, 6t treatment of, 5t, 36–38, 357 CAM therapies for, 39–44 nonpharmacologic, 36 pharmacologic, 36–38, 37t workup for, 5t © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S INDEX Osteochondral lesions, of talus, 1142–1143 adverse outcomes from, 1143 clinical symptoms of, 1142 definition of, 1142 diagnostic tests of, 1142–1143, 1142f differential diagnosis of, 1143 physical examination of, 1142 treatment of, 1143 Osteochondral loose body, differential diagnosis of, 372 Osteochondritis of inferior patella, 1139 of tibial tuberosity, 1139 Osteochondritis dissecans (OCD), 1142, 1144–1146 adverse outcomes from, 1129, 1145 clinical symptoms of, 1145 definition of, 1127–1128, 1144 diagnostic tests of, 1129, 1145 differential diagnosis of, 1145 physical examination of, 1129, 1145 treatment of, 1129, 1145–1146 Osteomyelitis adult, 137–139 adverse disease outcomes from, 139 clinical symptoms of, 137 definition of, 137 differential diagnosis of, 138 tests of, 137–138, 138f treatment of, 139 childhood, 1147–1150 adverse disease outcomes from, 1149 clinical symptoms of, 1147–1148 CRP level in, 1148 definition of, 1147 diagnostic tests of, 1148–1149 differential diagnosis of, 1149 physical examination of, 1148 treatment of, 1149–1150 Osteonecrosis carpal lunate See Kienböck disease femoral condyle, 689–691 clinical symptoms of, 689 definition of, 689 diagnostic tests of, 689–690, 690f differential diagnosis of, 690 physical examination of, 689 treatment of, 691 femoral head, 1122 hip, 582–585 adverse disease outcomes from, 584 clinical symptoms of, 582 definition of, 582 diagnostic tests of, 583, 583f differential diagnosis of, 583 physical examination of, 582–583 treatment of, 584–585 Osteoporosis, 6, 149–157 calcium intake levels and, 155t clinical symptoms of, 149–150 definition of, 149 diagnostic tests of, 152–154 differential diagnosis of, 154 fracture from, risk factors for, 151t fragility associated with, hip, transient, 607–608 clinical symptoms of, 607 definition of, 607 differential diagnosis of, 608 tests of, 607, 607f treatment of, 608 incidence by sex of, 894 interventions for, 155–156 physical examination of, 152 prevention of, 154–156 spinal deformity in, progressive, 150f treatment of, 154–157 Osteotomy, realignment, 580 Os trigonum, 1007 Ottawa rules, for ankle, 232t Outtoeing, 1105–1111 adverse outcomes from, 1109– 1110 clinical symptoms of, 1106 definition of, 1105 diagnostic tests of, 1109 differential diagnosis of, 1109 foot progression angle estimation and, 1107f further evaluation of, 1110–1111 hip rotation measurement and, 1107f–1108f motor development screens and, 1109t physical examination of, 1106, 1108–1109 tibial rotational status assessment and, 1108f–1109f treatment of, 1110 Overhead throwing shoulder adverse disease outcomes from, 309 clinical symptoms of, 307 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ definition of, 303–306 diagnostic tests of, 308 differential diagnosis of, 309 internal impingement mechanisms in, 306f pain in, pathologic, 307 physical examination of, 307–308 range of motion in, 307 stages of, 309–310 throwing phases and, 305f, 310 treatment of, 309 Overuse syndromes, 158–164 adverse disease outcomes from, 162 clinical symptoms of, 159–160 definition of, 158–159 diagnostic tests of, 160–162 differential diagnosis of, 162 factors leading to, 159t patient history and, 160 physical examination of, 160 treatment of, 162–163 P Pain See also Complex regional pain syndrome; Fibromyalgia syndrome; Low back pain; Myofascial pain syndrome ankle, children with, 1006–1010 accessory navicular and, 1008 calcaneal apophysitis and, 1007 clinical symptoms of, 1006 definition of, 1006 diagnostic tests of, 1007 differential diagnosis of, 1007– 1010 enthesitis and, 1009 fractures and, 1009 Freiberg infraction and, 1008– 1009, 1009f hallux valgus and, 1009 infection and, 1009 os trigonum and, 1007 physical examination of, 1006 sprains and, 1009 strains and, 1009 tarsal coalition and, 1008 tumors and, 1009–1010 ankle, chronic lateral, 777–780 clinical symptoms of, 777 definition of, 777 diagnostic tests of, 777–778 differential diagnosis of, 778–780 physical examination of, 777 arm, 888t, 889 back, 888t, 891, 893, 997–1000 See also Low back pain adverse outcomes from, 1000 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 1247 INDEX clinical symptoms of, 997 conditions associated with, 889t definition of, 997 diagnostic tests of, 998 differential diagnosis of, 998, 999t, 1000 etiology of, 999t physical examination of, 997–998 treatment of, 1000 in cauda equina syndrome, 919f in cervical radiculopathy, 922f in cervical spondylosis, 926f in cervical sprain, 929f in DIP joint, 54t, 55 discogenic, 889t in DISH, 87f elbow growing, 1011–1012 adverse outcomes from, 1012 clinical symptoms of, 1011 definition of, 1011 diagnostic tests of, 1011 differential diagnosis of, 1012 physical examination of, 1011 treatment of, 1012 hand dorsal, 400 location of, 399 radial, 399–400 ulnar, 400 volar, 401 heel, plantar See Plantar fasciitis heel, posterior, 849–851 adverse outcomes from, 851 clinical appearance of, 850f clinical symptoms of, 849–850 definition of, 849 diagnostic tests of, 850 differential diagnosis of, 850 exercise program for, 852–853 physical examination of, 850, 850f rehabilitation for, 851 sites of, 849f treatment of, 851 acute, 343–344 anterior, 345 lateral, 344–345 medial, 345 posterior, 345 elbow, childhood, 1001–1005 chronic, 1005 clinical symptoms of, 1001 definition of, 1001 diagnostic tests of, 1001 differential diagnosis of, 1002t dislocation and, 1003 hemarthrosis and, 1004 infection and, 1005 occult fractures around, 1002–1003 physical examination of, 1001 radial head subluxation and, 1004 sprains and, 1004 hip, 531 types of, 532–533 infection-associated, 889t knee acute, 620–621 anterior, 622 causes of, 620t chronic, 621–622 lateral, 622–623 location of, 622–623 medial, 622 posterior, 623 in epicondylitis, 370f foot, 832 foot, children with, 1006–1010 accessory navicular and, 1008 calcaneal apophysitis and, 1007 clinical symptoms of, 1006 definition of, 1006 diagnostic tests of, 1007 differential diagnosis of, 1007– 1010 enthesitis and, 1009 fractures and, 1009 Freiberg infraction and, 1008– 1009, 1009f hallux valgus and, 1009 infection and, 1009 os trigonum and, 1007 physical examination of, 1006 sprains and, 1009 strains and, 1009 tarsal coalition and, 1008 tumors and, 1009–1010 knee, childhood, 993–996 adverse outcomes from, 995 clinical symptoms of, 993 definition of, 993 diagnostic tests of, 994–995 differential diagnosis of, 995 physical examination of, 993–994 treatment of, 995–996 leg, 888t, 891, 893 algorithm for, 164f neurogenic See Lumbar disk herniation in lumbar disk herniation, 953f McGill Pain Questionnaire and, 69 neck, 888t, 889 neoplasia-associated, 889t nonorganic, 165–168 forearm, 344 forefoot, 832 groin, 533 1248 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E clinical symptoms of, 165–166 definition of, 165 differential diagnosis of, 168 physical examination of, 166–167 ■ treatment of, 168 in overhead throwing shoulder, 307 patellofemoral, 704–707 clinical symptoms of, 704 definition of, 704 diagnostic tests of, 705 differential diagnosis of, 705–706 exercise program for, 708–710 physical examination of, 705 rehabilitation for, 706–707 treatment of, 706–707 shoulder, 245 spinal, 888–893 location of, 889, 891, 893 types of, 888–889 spinal stenosis, 889t lumbar, 958f in spondylolisthesis, 1185f sympathetically maintained, 67 thigh, 531 wrist dorsal, 400 location of, 399 radial, 399–400 ulnar, 400 volar, 401 Pain dysfunction syndrome, 67 Palm, inspection of, 405 Palmar fibromatosis, 447 Palsy Erb definition of, 1135 posture in, 1136f treatment of, 1137 Klumpke, 1135 neonatal brachial plexus, 1135– 1138 adverse outcomes from, 1137 clinical symptoms of, 1135 definition of, 1135 diagnostic tests of, 1136 differential diagnosis of, 1136 physical examination of, 1136 treatment of, 1137–1138 panplexus, 1135 tardy ulnar, 384 Panner disease definition of, 1127 physical examination of, 1129 Panplexus palsy, 1135 Paronychia, 450 clinical symptoms of, 451 nail removal for, 453f treatment of, 453–454 Pasteurella multocida, 416 Patella apprehension test of, 635 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S INDEX bipartite, 994f, 996 bursa below, 633 dislocation of infection in, 978 neuromuscular disorders in, 977 physical examination in, 979–992 congenital, 1042 knee, 700f grind test of, 635 inspection of, 633 osteochondritis of, 1139 tracking, 634 Patellar tendinitis, 692–694 clinical symptoms of, 692 definition of, 692 diagnostic tests of, 693 differential diagnosis of, 693 exercise program for, 695–696 physical examination of, 692 rehabilitation for, 694 treatment of, 693–694 Patellar tendon, rupture of, 697–699 adverse disease outcomes from, 698 areas of, 698f clinical symptoms of, 697 definition of, 697 diagnostic tests of, 697 differential diagnosis of, 698 physical examination of, 697 treatment of, 698–699 Patellofemoral instability, 623 Patellofemoral joint instability/malalignment of, 700–703 adverse disease outcomes from, 702 clinical symptoms of, 700–701 definition of, 700 diagnostic tests of, 701–702 differential diagnosis of, 702 physical examination of, 701 treatment of, 702–703 pain in, 704–707 clinical symptoms of, 704 definition of, 704 diagnostic tests of, 705 differential diagnosis of, 705–706 exercise program for, 708–710 physical examination of, 705 rehabilitation for, 706–707 treatment of, 706–707 Patellofemoral syndrome, 993 Pathologic fracture, 111f Pavlik harness, 1053–1054 PCL See Posterior cruciate ligament Pediatric orthopaedics, 976–978 age in, 976 arthritis in, 978 growth in, 977 ankle examination in, 991 elbow examination in, 987 extremities, upper, in, 985 foot examination in, 992 forward bend test in, 982 gait assessment in, 984 hand examination in, 989 hip examination in, 990 inspection in, 979 knee examination in, 990 kyphosis test in, 982 limb-length discrepancy in, 981 musculoskeletal screening examination in, 983 palpation in, 979 range of motion measurements in, 980–981, 986 scoliosis test in, 982 shoulder range of motion in, 986 spine examination in, 984–985 Wilson test in, 983 wrist examination in, 988 sex in, 976 soft-tissue injuries in, 977 symptoms seen in, 976 Pelvis anatomy of, 591f fracture of, 558–562 adverse disease outcomes from, 560–561 clinical symptoms of, 559 definition of, 558 diagnostic tests of, 559–560, 560f differential diagnosis of, 560 energy level of, 559 physical examination of, 559 referrals for, 562 treatment of, 561 unstable, 558f tilt of, 902 Peripheral nerve, in musculoskeletal evaluation, 14t Peripheral nerve block, 25–26 Peripheral vascular disease, amputations due to, 15 Peroneal spastic flatfoot, 1066, 1188 Peroneal tendon inspection of, 745 subluxation of, 779 Peroneal tenosynovitis, 779 Peroneus brevis, test of, 751 Peroneus longus, test of, 751 Pes anserine, tenderness of, 658f Pes cavus, 1017 Pes planovalgus, 1066 Pes planus, 1066 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ Phalanx foot, fracture of, 809–810 buddy taping of, 810f clinical symptoms of, 809 definition of, 809 diagnostic tests of, 809, 809f differential diagnosis of, 809 physical examination of, 809 treatment of, 810 hand, fracture of, 479–483 angulation of, 483f clinical symptoms of, 481 definition of, 480 diagnostic tests of, 481 differential diagnosis of, 481 physical examination of, 481 treatment of, 482 types of, 480f Phalen maneuver, 413 Phantom limb, 23 Philadelphia collar, 967 Physeal bar, 1074f Physeal fracture, 1073f, 1085t Physical therapy for carpal tunnel syndrome, 440 nerve/tendon gliding in, 440, 440f Pigeon-toe, 1105 PIP joint See Proximal interphalangeal joint Piriformis stretch of, 589, 589f, 612, 612f test, 549 Pisiform, 471f Pitching, recommendations/limits for, 1130t See also Throwing Pivot shift test, 637 Plantar fascia, inspection of, 746 Plantar fasciitis, 839–843 anatomy of, 839f clinical symptoms of, 840 definition of, 839–840 diagnostic tests of, 840, 841f differential diagnosis of, 841 exercise program for, 844 injection for, 845–846 adverse outcomes from, 846 aftercare instructions with, 846 needle location for, 846f procedure of, 845 nonresponsive patients with, 843 orthoses for, 838t physical examination of, 840 rehabilitation for, 842 treatment of, 842 Plantar fibroma, 868 Plantar heel pain See Plantar fasciitis © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 1249 INDEX Plantar neuroma See Interdigital neuroma Plantar surface, inspection of, 744 Plantar warts, 847–848, 847f adverse outcomes from, 848 clinical symptoms of, 847 definition of, 847 diagnostic tests of, 847 differential diagnosis of, 847 physical examination of, 847 treatment of, 848 Plica, lateral, differential diagnosis of, 372 Plica syndrome, 711–713 clinical symptoms of, 711 definition of, 711 diagnostic tests of, 711 differential diagnosis of, 712 exercise program for, 714–715 physical examination of, 711 rehabilitation for, 713 treatment of, 712–713 Plyometrics in foot/ankle conditioning, 207, 736 in hip conditioning, 193, 535 in knee conditioning, 200, 627 Podagra, 73 Polyarthritis, symmetric, 54t Polydactyly of foot, 1045, 1045f of hand, 1046–1047, 1047f Popliteal cyst, 716–718 clinical symptoms of, 716 definition of, 716 diagnostic tests of, 717 differential diagnosis of, 717 physical examination of, 716 treatment of, 717–718 Posterior cruciate ligament (PCL), tear of, 719–722 adverse outcomes from, 721 clinical symptoms of, 719 definition of, 719 diagnostic tests of, 720 differential diagnosis of, 721 exercise program for, 723 physical examination of, 719–720 rehabilitation for, 722 treatment of, 721–722 Posterior drawer test, 638 Posterior heel pain, 849–851 adverse outcomes from, 851 clinical appearance of, 850f clinical symptoms of, 849–850 1250 definition of, 849 diagnostic tests of, 850 differential diagnosis of, 850 exercise program for, 852–853 physical examination of, 850, 850f rehabilitation for, 851 sites of, 849f treatment of, 851 Posterior impingement syndrome, as dance injury, 788 Posterior tibialis, test of, 750 Posterior tibial tendon dysfunction, 854–857 adverse outcomes from, 856 clinical appearance of, 855f clinical symptoms of, 854 definition of, 854 diagnostic tests of, 856 differential diagnosis of, 856 evaluation of, 857 physical examination of, 854–855 treatment of, 856 Posttraumatic arthritis of elbow, 354 tests of, 356 treatment of, 357 Postural roundback, 1118 PPE See Preparticipation physical evaluation Prednisolone terbutate, characteristics of, 89t Preparticipation physical evaluation (PPE), 225, 1155–1163 cardiovascular examination in, 1160–1161, 1161t clearance in, 1159f, 1162 components of, 1160–1163 continuity of care and, 1155 definition of, 1155 diagnostic tests in, 1162 forms for, 1156f–1159f further evaluation after, 1162–1163 interval of, 1160 musculoskeletal examination in, 1161 patient history in, 1156f, 1160 special needs in, 1157f, 1162 timing of, 1160 types of, 1155 Pronation of foot, 1066 of forearm, 376 resisted, 350 Pronator syndrome, 384–385 clinical symptoms of, 385 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ treatment of, 387 Proprioception, 180 in foot/ankle conditioning, 206– 207, 736 in hip conditioning, 193, 535 in knee conditioning, 200, 626 in shoulder conditioning, 186–187, 249 Prosthesis fitting principles for, 20–22 joint infection classification with, 140t pistoning in, 21 socket life-span in, 22 Proximal focal femoral deficiency, 1035–1036 Proximal interphalangeal joint (PIP joint) anatomy of, 510f dislocation of, 511f, 513f, 514 injection in, 422–423 adverse outcomes from, 423 aftercare instructions with, 423 location of, 422f procedure of, 423 Pseudogout, 73, 74t Pseudospondylolisthesis See Spondylolisthesis Psoriatic arthritis, 1174 characteristics of, 52t, 54 clinical symptoms of, 1174 patterns of, 54t Psoriatic arthropathy See Seronegative spondyloarthropathies Pulled elbow, 1004 Pulmonary embolism See also Deep vein thrombosis acute, treatment of, 86 death from, 81 Pump bump See Posterior heel pain Pyarthrosis, 1170 Q Qi xiong, osteoarthritis therapy with, 40 Quadriceps exercise of quadriceps strengthening, 668, 668f quadriceps stretch, 198, 198f, 540, 696, 696f test of, 906 Quadriceps tendinitis, 692–694 clinical symptoms of, 692 definition of, 692 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S INDEX diagnostic tests of, 693 differential diagnosis of, 693 exercise program for, 695–696 physical examination of, 692 rehabilitation for, 694 treatment of, 693–694 Quadriceps tendon, of rupture, 697–699 adverse disease outcomes from, 698 areas of, 698f clinical symptoms of, 697 definition of, 697 diagnostic tests of, 697 differential diagnosis of, 698 physical examination of, 697 treatment of, 698–699 Radius, 471f See also specific radial feature distal, fracture of, adult, 474–478 adverse disease outcomes from, 476 clinical symptoms of, 475 definition of, 474–475 diagnostic tests of, 476, 477f differential diagnosis of, 476 neurologic dysfunction with, 478 physical examination of, 475 progressive collapse of, 478 treatment of, 476–477 types of, 474f distal, fracture of, childhood, 1085–1088 clinical symptoms of, 1085 definition of, 1085 diagnostic tests of, 1086 differential diagnosis of, 1086 physical examination of, 1086 treatment of, 1087–1088 types of, 1085t R RA See Rheumatoid arthritis Rabies, 416 Radial deficiency, 1038 Radial head dislocation of, congenital, 1048– 1049 fracture of, 367–369 adverse disease outcomes from, 368 classification of, 367f clinical symptoms of, 367 definition of, 367 differential diagnosis of, 368, 372 physical examination of, 368 tests of, 368 treatment of, 368–369 subluxation of, 1004 Radial nerve capture of, 280f test of, 411 Radial tunnel syndrome clinical symptoms of, 385 differential diagnosis of, 372 exercise program for, 375–376 treatment of, 387 Radiculopathy See Cervical radiculopathy; Lumbar disk herniation Radiography, 128–129 advantages/disadvantages of, 128t indications for, 129 of rheumatoid arthritis (RA), 46f of seronegative spondyloarthropathies, 56 of shoulder arthritis, 269f–270f views with, common, 130t Radioulnar synostosis, congenital, 1047–1048 Rand 36-Item Health Survey, 69 Range of motion ankle exercises for, 760, 760f, 766, 766f measurement of, 748–749 of cervical spine, 914–915 elbow, measurement of, 348–349 of hand, 407 hip, measurement of, 543–546 of knee, measurement of, 634–635 in musculoskeletal evaluation in, in overhead throwing shoulder, 307 in pediatric orthopaedics, 980– 981, 986 restoration of, 176–180 of shoulder, 246, 257–259, 986 thigh, measurement of, 543–546 of toe, great, 750 of wrist, 408 Ray resection, 16 Reactive arthritis, 54 Reduction maneuver incomplete, 360f neurovascular injury from, 359– 360 shoulder E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E adverse outcomes from, 326 aftercare instructions for, 326–327 gravity-assisted, 325–326, 325f longitudinal traction technique for, 326, 326f Stimson technique for, 325–326, 325f ■ Reflex deep tendon, 905 Hoffmann, 918 Reflex sympathetic dystrophy, 67, 1029 Rehabilitation, 175–182 for achilles tendon tear, 759 for ACL tear, 642–643 for acromioclavicular injuries, 265 adverse outcomes from, 182 for ankle sprain, 765 athletic injury guidelines for, 176t canes, crutches, and walkers in, 217 for carpal tunnel syndrome, 439 for cervical sprain, 931 for collateral ligament tear, 665 for CRPS, 71 definition of, 175 for epicondylitis, 373 for fibromyalgia syndrome, 107 for frozen shoulder, 293 for gastrocnemius tear, 681 goals of, 175–176 for hip strains, 593, 593t impingement syndrome treatment with, 297–298 for knee arthritis, 653 for LBP, acute, 942–943 for LBP, chronic, 948 for Legg-Calvé-Perthes disease, 1126 for meniscal tear, 687 for patellar/quadriceps tendinitis, 694 for patellofemoral pain, 706–707 for PCL tear, 722 for plantar fasciitis, 842 for plica syndrome, 713 for posterior heel pain, 851 rotator cuff tear treatment with, 314 for SLAP lesion, 330 for snapping hip, 587–588 therapeutic modalities in, 180– 181, 181t for thigh strains, 599 for toe deformities, 878 for trochanteric bursitis, 611 Reiter syndrome, 52t, 1174 Reproductive system, pathology of, 533 Resisted supination/external rotation test, 328–329 Retrocalcaneal bursitis, as dance injury, 787 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 1251 INDEX Retroversion, femoral, 1105 Rheumatoid arthritis (RA), 45–51 advanced, 420f adverse disease outcomes from, 50 ankle, 858–860 adverse outcomes from, 859 clinical symptoms of, 858 definition of, 858 diagnostic tests of, 858 differential diagnosis of, 859 physical examination of, 858 treatment of, 859–860 clinical appearance of, 47f, 49f clinical characteristics of, 5t clinical symptoms of, 45–48, 355 definition of, 45 demographics affected by, 5t diagnostic tests of, 48–49 differential diagnosis of, 49 disease outcomes of, 356 of elbow, 354–357 extra-articular symptoms of, 46–47, 47t foot, 49f, 858–860 adverse outcomes from, 859 clinical symptoms of, 858 definition of, 858 diagnostic tests of, 858 differential diagnosis of, 859 physical examination of, 858 treatment of, 859–860 of hand, 46f–47f, 419 osteoarthritis vs, 5t pathophysiology of, 5t physical examination of, 48 radiographic appearance of, 46f of spine, 50f tests for, 356 treatment of, 5t, 50–51, 357 workup for, 5t Rhomboid, test of, 260 Rigid cervical orthoses, 967 Rigid flatfoot, 1188 Rigid orthoses, 969 Rolando fracture, 468 Rotator cuff anatomy of, 295f muscles of, 295, 303f stress on, 304 tear of, 311–316, 311f adverse disease outcomes from, 313 clinical symptoms of, 311 diagnostic tests of, 312, 312f differential diagnosis of, 313 exercises for, 315–316 physical examination of, 311 1252 rehabilitation in, 314 treatment of, 313–316 Rotator cuff tendinitis, 295, 303, 305 See also Overhead throwing shoulder Running, return to, 226t S Sacroiliitis, 54t, 55 S-adenosyl-L-methionine (SAM-e), 42t, 43 Saliva, contamination from, 495f Salter-Harris classification, 1073f SAM-e See S-adenosyl-L-methionine Scaphoid, 471f Scaphoid, fracture of, 484–487 clinical symptoms of, 484–485 definition of, 484 diagnostic tests of, 485 differential diagnosis of, 485 evaluation of, 486–487 physical examination of, 485 treatment of, 485–486 types of, 484f Scapula fracture of, 288–290, 289f adverse disease outcomes from, 290 clinical symptoms of, 289 definition of, 288 diagnostic tests of, 289 differential diagnosis of, 289–290 patterns of, 288f physical examination of, 289 treatment of, 290 retraction/protraction of, 268 SCFE See Slipped capital femoral epiphysis Scheuermann disease, 1118, 1121, 1121f Sciatica See Lumbar disk herniation Scoliometer, 1166f Scoliosis adolescent, incidence of, 894 adult, 964–966 adverse outcomes from, 965 clinical symptoms of, 964 definition of, 964 diagnostic tests of, 965 differential diagnosis of, 965 physical examination of, 964–965 treatment of, 965–966 childhood, 1164–1169 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E adverse outcomes from, 1167 clinical symptoms of, 1165 Cobb method for measurement of, 1166f definition of, 1164–1165 ■ diagnostic tests of, 1166–1167, 1166f, 1168f differential diagnosis of, 1167 etiologic classification of, 1164t physical examination of, 1165– 1166 scoliometer use with, 1166f test of, 982 treatment of, 1167–1169 Scotty dog appearance, 1185f Scouring test, 550 Segmental fracture, 111f Sensation, amputation-related, 23–24 Sensitivity test, of foot, 755 Septic arthritis adult, 140–144, 355 adverse disease outcomes from, 143 antibiotic regimens for, 144t clinical symptoms of, 141, 355 definition of, 140 diagnostic tests of, 142 differential diagnosis of, 143 disease outcomes of, 356 of elbow, 355 organisms causing, 144t patient history with, 141t physical examination of, 141–142 treatment of, 143–144, 357 childhood, 1170–1173 adverse outcomes from, 1172 antibiotics for, 1173t clinical symptoms of, 1170 definition of, 1170 diagnostic tests of, 1171 differential diagnosis of, 1171– 1172 laboratory results with, 1171t organisms causing, 1173t physical examination of, 1170 treatment of, 1172 Septic tenosynovitis, 465–467, 465f adverse disease outcome from, 466 clinical symptoms of, 465, 466f definition of, 465 differential diagnosis of, 466 Kanavel signs and, 467f physical examination of, 466 treatment of, 467 Seronegative spondyloarthropathies adult, 52–57 adverse disease outcomes from, 56 clinical symptoms of, 54–55 definition of, 52–53 differential diagnosis of, 56 laboratory tests of, 55 physical examination of, 55 radiographic tests of, 56 treatment of, 56–57 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S INDEX types of, 52t, 53–54 childhood, 1174–1176 adverse outcomes from, 1175 clinical symptoms of, 1174–1175 definition of, 1174 diagnostic tests of, 1175 differential diagnosis of, 1175 physical examination for, 1175 treatment of, 1176 Serratus anterior, test of, 260 Sesamoid, MTP joint bipartite, 811 fracture of, 811–813 adverse outcomes from, 812 clinical symptoms of, 811–812 definition of, 811 diagnostic tests of, 812 differential diagnosis of, 812 physical examination of, 812 treatment of, 813 palpation of, 811f Sesamoid, palpation of, 747 Sesamoiditis, 861–863 anatomy of, 861f clinical symptoms of, 861 as dance injury, 786 definition of, 861 diagnostic tests of, 862 differential diagnosis of, 862 physical examination of, 862 treatment of, 862–863 Sever disease, 1007, 1015 Sex in pediatric orthopaedics, 976 selected disease incidence by, 894 Shaken baby syndrome, 1021 Shin-splints, 724–725 clinical symptoms of, 724 definition of, 724 differential diagnosis of, 724 tests of, 724 treatment of, 724–725 Shoe, 864–867 See also Orthoses adverse outcomes from, 867 analysis of, 866–867 anatomy of, 865f, 866 children’s, 1177–1179 foot contour mismatch with, 867f foot shape affected by, 864f lacing patterns with, 867f lasting techniques of, 864–865 orthotic, 837–838, 838f types of, seven basic, 864 wear pattern of, normal, 866f Shoe splint, 126, 126f Short arm cast, 1087f Shoulder, 245–249 See also Overhead throwing shoulder age-related considerations with, 246–247 anatomy of, 295f arthritis of, 269–272 adverse disease outcomes of, 271 clinical symptoms of, 269–270 definition of, 269 diagnostic tests of, 270 differential diagnosis of, 270–271 physical examination of, 270 radiography of, 269f–270f red flags with, 272 treatment of, 271 bursitis of, 295 conditioning of, 185–191, 247–255 proprioception in, 186–187, 249 strengthening in, 186, 187t, 188– 190, 248 stretching in, 186, 187t, 190–191, 248–249 dislocated, 320, 320f See also Reduction maneuver exercise of external rotation, 188, 188f external rotation, passive, 190, 190f, 254, 294 external rotation with abduction, 190, 190f frozen shoulder-related, 294 internal rotation, 188, 188f internal rotation, passive, 191, 191f, 255 shoulder roll, 338, 338f shoulder rotation, 251–252, 267–268 fracture of, 283 frozen clinical symptoms of, 291 definition of, 291 diagnostic tests of, 292 differential diagnosis of, 292 exercise program for, 294 physical examination of, 291 rehabilitation for, 293 treatment of, 292 appropriate, 1177 characteristics of, 1178 corrective, 1178 foot development and, 1177 problems with, 1178 recommendations for, 1179 design of, 864–865 for diabetic foot, 796 fit of, 866–867 function of, 246 instability of, 246, 320–324 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ adverse disease outcomes from, 323 clinical symptoms of, 321 definition of, 320 diagnostic tests of, 322 differential diagnosis of, 323 physical examination of, 321–322 treatment of, 323–324 muscle strength of, 246 pain in, 245 physical examination of, 256–262 apprehension sign in, 261 cross-body adduction in, 261 Hawkins impingement sign in, 261 inspection in, 256–257 jerk test in, 262 muscle tests in, 259–260 Neer impingement sign in, 261 palpation in, 256–257 pediatric, 986 range of motion testing in, 257– 259 Sulcus sign in, 262 range of motion of, 246, 257–259, 986 separation of See Acromioclavicular injury surgery on, anesthesia for, 29t, 30 Shoulder-hand syndrome, 67 Skin, conditions of, 22–23 SLAP See Superior labrum anteriorto-posterior Slipped capital femoral epiphysis (SCFE), 1180–1183 adverse outcomes from, 1182 clinical symptoms of, 1180 definition of, 1180 diagnostic tests of, 1181–1182, 1181f differential diagnosis of, 1182 physical examination of, 1181 surgical fixation for, 1182, 1182f treatment of, 1182–1183 Slipped epiphysis See Slipped capital femoral epiphysis Slump test of Maitland, 908 Smashed finger See Nail bed Smith fracture, 474 Snapping hip, 586–590 clinical symptoms of, 586 definition of, 586 diagnostic tests of, 587 differential diagnosis of, 587 exercises for, 589–590 physical examination of, 586 rehabilitation for, 587–588 treatment of, 587–588 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 1253 INDEX Sodium hyaluronate (Euflexxa, Hyalgan, Supartz), 44t Soft cervical collar, 967 Soft-tissue injury, in pediatric orthopaedics, 977 Soft-tissue mass, foot/ankle, 868–869 adverse outcomes from, 869 clinical symptoms of, 868 definition of, 868 diagnostic tests of, 869 differential diagnosis of, 869 physical examination of, 868 treatment of, 869 Spica cast, 1092f Spinal anesthesia, in orthopaedic surgery, 25 Spinal stenosis, pain associated with, 889t See also Lumbar spinal stenosis Spine, 887–894 See also Cervical spine; Lumbar spine; Thoracic spine deformity of, 893 progressive, 150f diskitis in, 1056–1058 adverse outcomes from, 1057 clinical symptoms of, 1056 definition of, 1056 diagnostic tests of, 1057 differential diagnosis of, 1057 physical examination of, 1056 treatment of, 1057–1058 metastatic disease of, 961–972 adverse outcomes from, 963 clinical symptoms of, 961–962 definition of, 961 diagnostic tests of, 962 differential diagnosis of, 962–963 physical examination of, 962 treatment of, 963 presentation of, 888t rheumatoid arthritis of, 50f surgery on, anesthesia for, 29t, 31 trauma of, 894 Spinous process, palpation of, 903 Spiral fracture, 111f Splint for claw toe, 878 coaptation, 281–282, 281f dorsal extension block, 514f dynamic extension, 435f for elbow, 122, 123f for extremity, lower, 124–126 for extremity, upper, 121–124 flexor tendon, 464f for foot, 126, 126f for forearm, 122, 123f for fractures, 120–127 for hand, 121–122, 122f for humerus, 123–124, 123f for leg, 124–126, 125f–126f for mallet finger, 502f materials in, 120–121, 121t patient instructions on, 124, 126–127 principles of, 120 shoe, 126, 126f static extension, 435f for wrist, 121–122, 122f Spondylitis See Ankylosing spondylitis Spondyloarthropathies, 228t See also Seronegative spondyloarthropathies Spondylolisthesis childhood, 1184–1187 adverse outcomes from, 1186 clinical symptoms of, 1185 definition of, 1184 diagnostic tests of, 1185–1186 differential diagnosis of, 1186 grade of, 1184 pain diagram for, 1185f physical examination of, 1185 slip percentage in, 1184f treatment of, 1187 orthoses of, 967–969 pain in, 888–893 location of, 889, 891, 893 types of, 888–889 pediatric examination of, 984–985 physical examination of, 901 Babinski sign in, 910 Brudzinski-Kernig test, 911 FABER test in, 910 prone examination in, 911 seated examination in, 905–908 sensory examination in, 910, 914 slump test in, 908 standing examination in, 901–904 supine examination in, 908–911 Trendelenburg test in, 902 Waddell signs in, 912–914 degenerative, 970–971 clinical symptoms of, 970 definition of, 970 diagnostic tests of, 970 differential diagnosis of, 971 physical examination of, 970 treatment of, 971 isthmic, 972–974 problems with adverse outcomes from, 973 clinical symptoms of, 972 definition of, 972 incidence by sex, 894 1254 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ diagnostic tests of, 973 differential diagnosis of, 973 physical examination of, 972–973 treatment of, 973–974 Spondylolysis, 1184–1187 adverse outcomes from, 1186 definition of, 1184 differential diagnosis of, 1186 treatment of, 1186–1187 Spondylosis See Cervical spondylosis Sports medicine, 223–228 for adolescent athletes, 225t clinical symptoms in, 225 definition of, 223 ethical issues in, 227 general issues in, 223–224 liability in, 227 prevention strategies in, 225t running program and, 226t tests in, 225 throwing program in, 227t treatment in, 225–227 Sports participation, childhood, 1151–1154 See also Preparticipation physical evaluation readiness for, 1151–1152, 1154 recommendations for, 1152t–1153t Sprain, 230–234 ankle, 232t, 762–765 adverse disease outcomes from, 764 children with, 1009 clinical symptoms of, 763 definition of, 762 diagnostic tests of, 763 differential diagnosis of, 763–764 exercise program for, 766–767 pain from, children with, 1009 physical examination of, 763 rehabilitation for, 765 squeeze test of, 763, 763f treatment of, 764–765 cervical adverse outcomes from, 931 clinical symptoms of, 929 definition of, 929 diagnostic tests of, 930 differential diagnosis of, 930–931 exercise program for, 933 pain diagram for, 929f physical examination of, 930 rehabilitation for, 931 treatment of, 931–932 classification of, 229t clinical symptoms of, 231 collateral ligament, 514 definition of, 230 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S INDEX diagnostic tests of, 231–232 differential diagnosis of, 232 elbow pain and, 1004 evaluation of, 234 finger, 510 foot, 232t pain and, children with, 1009 differential diagnosis of, 592 exercises for, 595–596 physical examination of, 591–592 rehabilitation for, 593, 593t treatment of, 592–594 physical examination of, 231 thigh, 597–603 adverse disease outcomes from, 598 clinical symptoms of, 597 definition of, 597 diagnostic tests of, 598, 598f differential diagnosis of, 598 exercises for, 601–603 physical examination of, 597 rehabilitation for, 599 treatment of, 599–600 hand, 510–515 clinical symptoms of, 511–512 definition of, 510–511 differential diagnosis of, 513 physical examination of, 512–513 treatment of, 514–515 lumbar, 940 physical examination of, 231 treatment of, 232–233 Spur, heel See Plantar fasciitis Spurling test, 402 Squamous cell carcinoma, clinical appearance of, 523f Squat, observation of, 632 Squeeze test, 763, 763f St John’s wort, 42t Staphylococcus aureus, 416, 450, 453, 1055, 1173t Static extension splint, 435f Stenosing tenosynovitis See de Quervain tenosynovitis; Trigger finger Stenosis, spinal, pain associated with, 889t See also Lumbar spinal stenosis Stiffness of elbow, 345–346 of hand, 401 of knee, 624 of wrist, 401 Still disease, 1112 Stimson technique, 325–326, 325f Stingers, 273–274 Strain, 230–234 back, 940 cervical, 929–932 classification of, 230t clinical symptoms of, 231 definition of, 230 diagnostic tests of, 231–232 differential diagnosis of, 232 evaluation of, 234 foot pain and, 1009 hamstring, treatment protocol for, 233t hip, 591–596 clinical symptoms of, 591 definition of, 591 diagnostic tests of, 592, 592f treatment of, 232–233 Streptococci, 416, 1055, 1173t Stress fracture, 111f, 726–728 adverse disease outcomes from, 727 clinical symptoms of, 726 as dance injury, 786–787 definition of, 726 diagnostic tests of, 726–727, 726f–727f differential diagnosis of, 727 femoral neck, 604–606 adverse disease outcomes from, 606 clinical symptoms of, 604 definition of, 604 diagnostic tests of, 604–605, 605f differential diagnosis of, 605 physical examination of, 604 treatment of, 606 foot/ankle, 870–872 adverse outcomes from, 872 clinical symptoms of, 870 definition of, 870 diagnostic tests of, 871, 871f differential diagnosis of, 872 physical examination of, 870 treatment of, 872 physical examination of, 726 treatment of, 727–728 Stress test dobutamine stress test, 27t elevated arm, 334, 334f eversion, 755 exercise, 27t inversion, 755 nuclear, 27t for orthopaedic patients, 27t valgus, 352–353, 393f, 636 varus, 352, 637, 752 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ Subacromial bursa injection, 301–302, 301f Subclavian nerve block, 72f Subluxation of iliotibial band, 586, 586f of peroneal tendon, 779 of radial head, 1004 of shoulder, 320 Subscapularis muscle, 260, 295 Subtalar impingement lesion, 780 Subtalar instability, 778 Subtalar joint arthritis, 780 Subtalar joint synovitis, 780 Subungual hematoma, treatment of, 505 Sudeck atrophy, 67 Sulcus sign, 262, 322f Supartz See Sodium hyaluronate Superior labrum anterior-to-posterior (SLAP) detachment, 305–306 lesions of, 306, 328–332 clinical symptoms of, 328 definition of, 328 diagnostic tests of, 329 differential diagnosis of, 329 exercises for, 331–332 physical examination of, 328–329 rehabilitation for, 330 treatment of, 330 Supraspinatus muscle, 295 atrophy of, 312f strength testing of, 296f test of, 259 Surgery See also Orthopaedic surgery; specific surgical procedure comorbidity evaluation before, 169–174 cardiac, 170, 170t deep vein thrombosis, 167–174, 173t diabetes, 171 nutritional, 172–173 principles of, 170–174 pulmonary, 170, 171t recommendations for, 171t renal, 170–171 rheumatologic disease, 171–172 for compartment syndrome, 671–672 fracture treatment with, 118–119 for hand arthritis, 421 for hip/proximal femur fracture, 567 for SCFE fixation, 1182, 1182f on shoulder, 29t, 30 on spine, 29t, 31 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 1255 INDEX trauma, 29t Surgical neck fracture, 283 Swelling of hand, 401–402 of knee, 624 of wrist, 401–402 Sympathetically maintained pain, 67 Syndactyly, 1046, 1046f Synostosis, congenital radioulnar, 1047–1048 Synovitis, 429 See also Tenosynovitis differential diagnosis of, 372 physical examination of, 356 subtalar joint, 780 toxic, 1199 transient hip, 1199–1201 adverse outcomes from, 1200 clinical symptoms of, 1199 definition of, 1199 diagnostic tests of, 1199–1200 differential diagnosis of, 1200 further evaluation of, 1201 physical examination of, 1199 treatment of, 1200 differential diagnosis of, 1189 pain and, 1008 physical examination of, 1188 treatment of, 1189–1190 Tarsal tunnel, anatomy of, 873f Tarsal tunnel syndrome, 873–875 adverse outcomes from, 875 clinical symptoms of, 873 definition of, 873 diagnostic tests of, 874 differential diagnosis of, 874 physical examination of, 874, 874f treatment of, 875 Tendinitis biceps, 306 flexor hallucis longus tendon, dance-related, 788–789 locations of, 158t patellar/quadriceps, 692–694 clinical symptoms of, 692 definition of, 692 diagnostic tests of, 693 differential diagnosis of, 693 exercise program for, 695–696 physical examination of, 692 rehabilitation for, 694 treatment of, 693–694 Synvisc See Hylan G-F 20 T Tai chi, osteoarthritis therapy with, 40 Tailor’s bunion See Bunionette Talipes equinovarus, 1025 Talocalcaneal bar, 1188 Talus congenital vertical, 1044 fracture of, 803–805 adverse disease outcomes from, 805 clinical symptoms of, 803 definition of, 803 diagnostic tests of, 803, 804f differential diagnosis of, 805 physical examination of, 803 treatment of, 805 osteochondral lesions of, 1007, 1142–1143 adverse outcomes from, 1143 clinical symptoms of, 1142 definition of, 1142 diagnostic tests of, 1142–1143, 1142f differential diagnosis of, 1143 physical examination of, 1142 treatment of, 1143 Tardy ulnar palsy, 384 Tarsal coalition, 1188–1190 adverse outcomes from, 1189 clinical symptoms of, 1188 definition of, 1188 diagnostic tests of, 1189, 1189f 1256 rotator cuff, 295, 303, 305 See also Overhead throwing shoulder triceps, differential diagnosis of, 372 Tendinosis See Epicondylitis Tendoachilles rupture See Achilles tendon, tear of Tendon See also specific condition; specific tendon chronic problems with, factors leading to, 159t gliding, 440, 440f laceration of, bites causing, 495f reflex, deep, 905 Tennis elbow See Epicondylitis Tennis elbow injection, 377–378, 377f Tenosynovitis, See also de Quervain tenosynovitis; Septic tenosynovitis Kanavel signs in, peroneal, 779 TENS See Transcutaneous electrical nerve stimulation Teres minor muscle, 260, 295 Terminal extensor tendon, rupture of See Mallet finger “Terrible triad,” 358, 358f Tetanus prophylaxis, 418t, 497t E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ Thenar atrophy, 437f Thigh, 531–535 bones of, 531f circumference of, 905 muscle compartments of, 59f pain in, 531 physical examination of, 541–543 range of motion of, 543–546 strains of, 597–603 adverse disease outcomes from, 598 clinical symptoms of, 597 definition of, 597 diagnostic tests of, 598, 598f differential diagnosis of, 598 exercises for, 601–603 physical examination of, 597 rehabilitation for, 599 treatment of, 599–600 Thomas test, 544 Thompson test, 754, 757, 758f Thoracic outlet, anatomy of, 333f Thoracic outlet syndrome, 333–338 adverse disease outcomes from, 335 clinical symptoms of, 333–334 definition of, 333 diagnostic tests of, 334 differential diagnosis of, 334–335 exercises for, 337–338 physical examination of, 334 red flags with, 336 treatment of, 335 Thoracic spine fractures of, 937–939 clinical symptoms of, 937 definition of, 937 diagnostic tests of, 938, 938f differential diagnosis of, 938 physical examination of, 937 treatment of, 938–939 orthoses of, 968 pediatric examination of, 985 Thoracolumbosacral corset, 968 Thrombosis See Deep vein thrombosis Throwing See also Overhead throwing shoulder age-based recommendations/limits for, 1130t biceps tendinitis and, 306 forces from, in elbow, 1128f phases of, 305f program for, basic interval, 227t Thumb absence of, 1037–1038 adduction strength of, 410 © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S INDEX hypoplasia of, 1037–1038 opposition of, 407 ulnar collateral ligament of, test of, 414 Thumb CMC joint arthritis of, 424–426, 424f adverse disease outcomes from, 425 clinical symptoms of, 424 definition of, 424 diagnostic tests of, 425, 425f differential diagnosis of, 425 physical examination of, 424 tests of, 414–415 treatment of, 426 Toe See also Intoeing; Outtoeing; Toenail; Toe walking amputation of, 16 broken, 809 buddy taping of, 810f claw clinical appearance of, 876f definition of, 876 orthoses for, 838t splint for, 878 congenital curly, 1045 dancer’s, 861 deformities of, 876–878 adverse outcomes from, 877 clinical symptoms of, 876 definition of, 876 diagnostic tests of, 877 differential diagnosis of, 877 physical examination of, 877 rehabilitation for, 878 treatment of, 877–878 types of, 876 injection of, 427–428, 428f adverse outcomes from, 428 aftercare instructions with, 428 procedure of, 427 Thumb metacarpal, fracture of, 468– 470, 468f adverse disease outcomes from, 469 clinical symptoms of, 469 definition of, 468 differential diagnosis of, 469 physical examination of, 469 treatment of, 469–470 Thumb MP joint, ligament tear in, 511 Tibia See also Iliotibial band; Posterior tibial tendon dysfunction amputation through, 17–18, 21f bowing of anterolateral, 1042–1043, 1043f posteromedial, 1042, 1043f exercise of big toe pull, 210, 210f, 739 marble pick-up, 210, 210f, 740, 880, 880f strengthening, 879–880 toe pull, 210, 210f, 740, 879–880, 879f–880f toe squeeze, 209, 209f, 739, 879, 879f towel curl, 211, 211f, 740, 880, 880f great arthritis of, 816 range of motion of, 750 hammer clinical appearance of, 876f definition of, 876 orthoses for, 838t deficiency of, 1034–1035 fracture of, 1094–1096, 1095f adverse outcomes from, 1095 clinical symptoms of, 1094 definition of, 1094 diagnostic tests of, 1095 differential diagnosis of, 1095 physical examination of, 1095 treatment of, 1095–1096 types of, 1094t osteochondritis of, 1139 plateau of, fracture of, 676f rotational status of, 1108f–1109f Tibialis, test of, 750 Tibial nerve entrapment See Tarsal tunnel syndrome Tibial torsion, 1105 Tibiofemoral instability, 623 Tick See Deer tick Tinea unguium, 834 Tinel sign, 402, 412 mallet clinical appearance of, 876f definition of, 876 pigeon, 1105 spread of, 744 strengthening of, 206, 208t, 209– 211, 739–740, 879–880 turf, 881–882 adverse outcomes from, 882 clinical symptoms of, 881 definition of, 881 diagnostic tests of, 881 differential diagnosis of, 881 treatment of, 882 Toenail fungal infection of, 834f ingrown, 822–824, 822f E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E adverse outcomes from, 823 clinical symptoms of, 822 ■ definition of, 822 diagnostic tests of, 823 differential diagnosis of, 823 evaluation of, 824 physical examination of, 822 treatment for, 823 Toe walking, 904, 1191–1193 adverse outcomes from, 1192 clinical appearance of, 1191f clinical symptoms of, 1191 definition of, 1191 diagnostic tests of, 1192 differential diagnosis of, 1192 further evaluation of, 1193 idiopathic, 1191f patient history with, 1191 physical examination of, 1191– 1192 treatment of, 1192–1193 Tophi, 73, 74f, 75 Torticollis, 1194–1198 acquired, 1197 adverse outcomes from, 1197 clinical appearance of, 1195f clinical symptoms of, 1194–1195 congenital muscular, 1197–1198 definition of, 1194 diagnostic tests of, 1196 differential diagnosis of, 1196– 1197 physical examination of, 1195 post-birth presentation of, 1196 treatment of, 1197–1198 Torus fracture, 111f, 1085, 1085t Total-contact thoracolumbosacral orthosis, 968 Toxic synovitis, 1199 Traction apophysitis, of medial epicondyle definition of, 1127 physical examination of, 1129 Transcutaneous electrical nerve stimulation (TENS), 180 Transfemoral amputation, 19–20, 21f Transtibial amputation, 17–18, 21f Transverse fracture, 111f Trapezium, 471f Trapezoid, 471f Trauma, 6–7 See also Falls, of elderly nonaccidental, 1021 spinal, 894 surgery, anesthesia for, 29t Trendelenburg test, 548, 902 Triacinolone hexacetonide, characteristics of, 89t © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 1257 INDEX Triamcinolone acetonide, characteristics of, 89t Triceps brachii, test of, 917 Triceps tendinitis, differential diagnosis of, 372 Trigger finger, 516–520, 516f clinical symptoms of, 517 definition of, 516 differential diagnosis of, 517 evaluation with, 518 injection for, 519–520, 520f physical examination of, 517 treatment of, 518 Triquetrum, 471f Trochanteric bursitis, 609–615 clinical symptoms of, 609 definition of, 609 diagnostic tests of, 610 differential diagnosis of, 610–611 exercises for, 612–613 incidence by sex of, 894 injection for, 614–615 location of, 609f physical examination of, 610, 610f rehabilitation for, 611 treatment of, 611 Trunk shift, 953f Tumor See also Metastatic disease bone, 235–240 adverse disease outcomes from, 239 benign, 240t biopsy of, 238 blood tests of, 237 clinical symptoms of, 236 definition of, 235 diagnostic tests of, 237 differential diagnosis of, 239 patient history and, 236 patterns of, 235t physical examination of, 236 treatment of, 239 foot pain and, 1009–1010 giant cell, 523f glomus, 523f hand and wrist, 521–524 See also Ganglion adverse disease outcomes from, 523 clinical appearance of, 523f clinical symptoms of, 521 definition of, 521 differential diagnosis of, 524t locations of, 522f physical examination of, 521–522 treatment of, 524 Turf toe, 881–882 adverse outcomes from, 882 1258 clinical symptoms of, 881 definition of, 881 diagnostic tests of, 881 differential diagnosis of, 881 treatment of, 882 U Ulcer, residual limb, 22 Ulceration, neuropathic, orthotics for, 838t Ulcerative colitis, 1175 Ulna, 471f Ulnar collateral ligament elbow, tear of, 392–394 adverse disease outcomes from, 394 causes of, 511 children with, 1127 clinical symptoms of, 392 definition of, 392 differential diagnosis of, 393 physical examination of, 392–393 tests of, 392–393 treatment of, 394 thumb, test of, 414 Ulnar deficiency, 1038 Ulnar nerve compression of, 384, 384ff, 387 entrapment of, 525–527 adverse disease outcomes from, 526 definition of, 525 diagnostic tests of, 526 differential diagnosis of, 526 physical examination of, 526 treatment of, 527 zones of, 525f neuritis of, 384 test of, 411 Ultrasonography, 136 advantages/disadvantages of, 128t indications for, 136 V Vacuum sign, 947, 947f Valgus angle in genu valgum, 1097, 1097f–1098f in hallux valgus, 820f, 859f Valgus stress test, 352–353, 393f, 636 Varus stress test, 352, 637, 752 Vascular claudication, 958t Verruca vulgaris, 847 Vertebral osteophytosis, 87 Vicosupplementation osteoarthritis therapy with, 43–44 prescribing information for, 44t Viking disease, 447 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ W Waddell signs, 165, 912–914 Waiter’s tip position, 1136, 1136f Walker, 221–222, 221f patient guide to, 221t rehabilitation with, 217 Walking heel, 904 toe, 904, 1191–1193 adverse outcomes from, 1192 clinical appearance of, 1191f clinical symptoms of, 1191 definition of, 1191 diagnostic tests of, 1192 differential diagnosis of, 1192 further evaluation of, 1193 idiopathic, 1191f patient history with, 1191 physical examination of, 1191– 1192 treatment of, 1192–1193 Warfarin, 82 Warts See Plantar warts Weakness of hand, 402 of knee, 624–625 of wrist, 402 Whitesides infusion technique, 63f Whitlow, herpetic, 451f Wilson test, 983 Winking owl sign, 962, 962f Wound management, tetanus prophylaxis in, 418t, 497t Wrist, 399–403 arthritis of, 429–430 clinical symptoms of, 429 diagnostic tests of, 429, 430f differential diagnosis of, 430 physical examination of, 429 treatment of, 430 aspiration/injection, 431–432 aftercare instructions with, 432 procedure of, 431 deviation of, radial/ulnar, 405 exercise for, flexion and extension, 375–376 extension of measurement of, 405 muscle tests of, 409 resisted, 351 flexion of measurement of, 405 muscle test of, 408 resisted, 351 ganglion of adverse disease outcomes from, 491 aspiration of, 493–494, 493f © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S INDEX clinical appearance of, 488f–489f clinical symptoms of, 488–489 differential diagnosis of, 491 physical examination of, 490 treatment of, 491–492 instability of, chronic, 401 masses in, 403 numbness of, 402 pain in dorsal, 400 location of, 399 radial, 399–400 ulnar, 400 volar, 401 physical examination of, 404–415 inspection in, 404–406 muscle tests in, 408–409 palpation in, 404–406 pediatric, 988 range of motion measurement in, 408 sensory tests in, 412 special tests in, 412–414 radial extensors of, test of, 916 splinting of, 121–122, 122f stiffness of, 401 swelling of, 401–402 tumors of, 521–524 adverse disease outcomes from, 523 clinical appearance of, 523f clinical symptoms of, 521 definition of, 521 differential diagnosis of, 524t locations of, 522f physical examination of, 521–522 treatment of, 524 weakness of, 402 Wryneck, 1194 E S S E N T I A L S O F M U S C U L O S K E L E TA L C A R E ■ © A M E R I C A N A C A D E M Y O F O R T H O PA E D I C S U R G E O N S 1259 ... N S 557 Fracture of the Pelvis ICD-9 Codes 808.0 Fracture of the acetabulum, closed 808.1 Fracture of the acetabulum, open 808 .2 Fracture of the pubis, closed 808.3 Fracture of the pubis, open... passes backward to insertion on lesser trochanter Iliofemoral ligament of hip joint (Y ligament of Bigelow) Shaft (body) of femur Anterior Muscles of the Pelvis Anterior superior iliac spine Iliacus... significant discomfort with rotation of the hip, or limited range of motion of the hip joint, although they often present with what they describe as “pain in the hip.” Nonmusculoskeletal pathology may