Monique Mokha, PhD, ATC, LAT Brady L. Tripp PhD, ATC

Transcription

1 Contributors Monique Mokha, PhD, ATC, LAT Associate Professor Division of Math, Science, and Technology Farquhar College of Arts and Sciences Nova Southeastern University Fort Lauderdale-Davie, FL Brady L. Tripp PhD, ATC Clinical Associate Professor Director of Graduate Athletic Training Dept. Applied Physiology and Kinesiology College of Health and Human Performance University of Florida Gainesville, FL vii

2 Reviewers John W. Burns, MS, ATC, LAT Program Director, Athletic Training Education Kinesiology Washburn University Topeka, KS Erin M. Jordan, MS, ATC Clinical Instructor Health and Kinesiology Georgia Southern University Statesboro, GA Heather Schuyler, MA, AT, MT, KTP Assistant Professor Athletic Training Education Program/ESPE Adrian College Adrian, MI Bret A. Wood, MEd, LAT, ATC Lecturer, Clinical Coordinator Department of Kinesiology University of North Carolina at Charlotte Charlotte, NC Joanne Klossner, PhD, LAT, ATC Clinical Assistant Professor Kinesiology Indiana University Bloomington, IN ix

3 Contents SECTION I FOUNDATIONS OF EXAMINATION 1 Chapter 1 Examination Process 3 Differential Diagnosis 3 Systematic Examination Technique 3 The Examination Model 4 Regional Interdependence 5 The Role of the Uninjured Paired Structure 5 Clinical Assessment 6 History 6 Physical Examination 14 Functional Assessment 14 Inspection 14 Palpation 16 Joint and Muscle Function Assessment 17 Selective Tissue Tests 24 Neurological Screening 24 Vascular Screening 28 Review of Systems 28 The Role of Evidence in the Examination Process 41 Chapter 2 Examination and Management of Acute Conditions 49 Emergency Planning 50 Sport-Specific Rules 50 Critical Findings 50 The On-Field Examination 50 Equipment Considerations 52 Primary Survey 52 Secondary Survey 54 On-Field History 55 On-Field Inspection 55 On-Field Palpation 55 Palpation of Bony Structures 55 On-Field Joint and Muscle Function Assessment 56 On-Field Joint Stability Tests 56 On-Field Neurological Testing 56 On-Field Vascular Assessment 56 Chapter 3 Immediate Management 57 Splinting 57 Transportation 57 Disposition 58 Return-to-Play Decision Making 58 Evidence-Based Practice in the Diagnostic Process 61 The Role of Evidence-Based Practice in Orthopedic Examination and Diagnosis 62 Fundamentals of Interpreting Research 63 Reliability 63 Diagnostic Accuracy 64 Diagnostic Gold Standard 65 Diagnostic Predictive Value 65 Sensitivity and Specificity 65 Likelihood Ratios 67 Positive Likelihood Ratio 67 Negative Likelihood Ratio 68 Interpreting Likelihood Ratios 68 Clinical Decision Rules 69 Clinical Practice Guidelines 70 Outcome Measures 70 Incorporating Evidence-Based Practice into Clinical Diagnosis 71 Use of Evidence in This Text 71 Chapter 4 Injury Pathology Nomenclature 73 Tissue Response to Stress 73 Stress Strain Relationships 74 Mechanisms of Injury 74 Tensile Forces 74 Compression Forces 74 Shear Forces 75 Torsion Forces 75 Direct Blow 75 Soft Tissue Pathology 75 Musculotendinous Injuries 75 Contusions 81 Heterotopic Ossification 81 xiii

4 xiv Contents Chapter 5 Joint Structure Pathology 83 Articular Surface Pathology 86 Bony Pathology 91 Exostosis 91 Apophysitis 91 Fractures 93 Neurological and Vascular Pathologies 95 Peripheral Nerve Injury 95 Complex Regional Pain Syndrome 99 Musculoskeletal Diagnostic Techniques 101 Imaging Techniques 101 Radiography 103 Computed Tomography Scan 104 Magnetic Resonance Imaging 105 Bone Scan 109 Diagnostic Ultrasound 109 Nerve Conduction Study/ Electromyography 110 Chapter 6 Assessment of Posture 113 Clinical Anatomy 113 The Kinetic Chain 113 Muscular Function 116 Muscle Imbalances 117 Noncontractile Soft Tissue Influences 117 Posture 118 History 118 Functional Assessment 119 Inspection 119 Views of Postural Inspection 124 Palpation 127 Muscle-Length Assessment 131 Common Postural Deviations 131 Foot and Ankle 131 The Knee 132 Spine and Pelvis 134 Shoulder and Scapula 142 Head and Cervical Spine 142 Regional Interdependence 143 Documentation of Postural Assessment 144 Chapter 7 Evaluation of Gait 149 Observational Gait Analysis 149 Gait Terminology 151 Walking Gait Phases 151 Stance Phase 154 Swing Phase 156 Running Gait Cycle 156 Stance Phase 158 Swing Phase 158 General Approach to Patient Evaluation 159 History 159 Physical Examination 160 Observational Gait Analysis Findings 160 Compensatory Gait Deviations 163 Quantitative Gait Analysis 163 SECTION 2 LOWER EXTREMITY EXAMINATION 167 Chapter 8 Foot and Toe Pathologies 171 Clinical Anatomy 171 Zones of the Foot 171 Articulations and Ligamentous Support 173 Muscles Acting on the Foot and Toes 175 Arches of the Foot 175 Neurological Anatomy 181 Vascular Anatomy 181 the Foot and Toes 181 History 182 Functional Assessment 185 Inspection 185 Joint and Muscle Function Assessment 200 Joint Stability Tests 202 Neurological Examination 203 Vascular Examination 206 and Selective Tissue Tests 206 Influence of Foot Structure on Pathology 206 Plantar Heel Pain 215 Tarsal Coalition 217 Tarsal Tunnel Syndrome 218 Metatarsal Fractures 220 Lisfranc Injuries 222 Phalangeal Fractures 225 Intermetatarsal Neuroma 226 Hallux Rigidus 227 Hallux Valgus 230 First Metatarsophalangeal Joint Sprains 230 Sesamoiditis 230 On-Field Examination of Foot Injuries 231 Equipment Considerations 232 On-Field History 232 On-Field Inspection 233 On-Field Palpation 233 On-Field Joint Function Tests 233 On-Field Management of Foot Injuries 233 Plantar Fascia Ruptures 233 Fractures and Dislocations 233

5 Contents xv Chapter 9 Ankle and Leg Pathologies 237 Clinical Anatomy 237 Related Bony Structures 239 Articulations and Ligamentous Support 239 Muscles of the Leg and Ankle 241 Bursae 245 Neurological Anatomy 245 Vascular Anatomy 245 the Ankle and Leg 246 History 246 Functional Assessment 246 Inspection 248 Joint and Muscle Function Assessment 255 Joint Stability Tests 260 Neurological Assessment 266 Vascular Assessment 266 and Selective Tissue Tests 269 Ankle Sprains 269 Ankle and Leg Fractures 276 Achilles Tendon Pathology 280 Peroneal Tendon Pathology 286 Medial Tibial Stress Syndrome 288 Stress Fractures 288 Compartment Syndromes 290 On-Field Examination of Leg and Ankle Injuries 295 Equipment Considerations 295 On-Field History 295 On-Field Inspection 296 On-Field Palpation 296 On-Field Range of Motion Tests 296 Initial Management of On-Field Injuries 296 Ankle Dislocations 296 Compartment Syndrome 297 Chapter 10 Knee Pathologies 301 Clinical Anatomy 301 Articulations and Ligamentous Support 302 The Menisci 305 Muscles Acting on the Knee 307 Neurological Anatomy 311 Vascular Anatomy 311 Knee Injuries 311 History 311 Past Medical History 311 History of the Present Condition 311 Functional Assessment 314 Inspection 314 Determination of Intracapsular versus Extracapsular Swelling 320 Joint and Muscle Function Assessment 323 Joint Stability Tests 325 Neurological Assessment 329 Vascular Testing 329 and Selective Tissue Tests 329 Uniplanar Knee Sprains 329 Rotational Knee Instabilities 341 Meniscal Tears 348 Osteochondral Lesions 357 Iliotibial Band Friction Syndrome 358 Popliteus Tendinopathy 361 Knee Osteoarthritis 366 Tibiofemoral Joint Dislocations 366 On-Field Examination of Knee Injuries 371 Equipment Considerations 371 On-Field History 372 On-Field Inspection 372 On-Field Palpation 372 On-Field Range of Motion Tests 372 On-Field Ligamentous Tests 372 On-Field Management of Knee Injuries 376 Tibiofemoral Joint Dislocations 376 Collateral and Cruciate Ligament Sprains 377 Meniscal Tears 377 Chapter 11 Patellofemoral Pathologies 381 Clinical Anatomy 381 Articulations and Ligamentous Support 381 Muscular Anatomy and Related Soft Tissues 383 Bursae of the Extensor Mechanism 384 the Patellofemoral Joint 384 History 386 Functional Assessment 387 Inspection 387 Joint and Muscle Function Assessment 395 Joint Stability Tests 395 Neurological and Vascular Testing 397 and Selective Tissue Tests 397 Patellofemoral Pain Syndrome 399 Patellofemoral Instability 401 Patellofemoral Tendinopathies 404 Traumatic Conditions 411 On-Field Evaluation of Patellofemoral Injuries 414 Equipment Considerations 414 On-Field History 414 On-Field Palpation 416 On-Field Functional Assessment 416 Initial Management of On-Field Injuries 416 Patellar Tendon Rupture and Patellar Fracture 416

6 xvi Contents Chapter 12 Pelvis and Thigh Pathologies 421 Clinical Anatomy 421 Articulations and Ligamentous Support 422 Muscular Anatomy 423 Bursae 427 Neurological Anatomy 427 Vascular Anatomy 427 the Pelvis and Thigh 428 History 428 Functional Assessment 430 Inspection 430 Joint and Muscle Function Assessment 435 Joint Stability Tests 440 Neurological Testing 440 and Selective Tissue Tests 440 Iliac Crest Contusion 440 Muscle Tears 441 Quadriceps Contusion 445 Slipped Capital Femoral Epiphysis 447 Legg-Calvé-Perthes Disease 449 Femoral Stress Fractures 450 Intra-Articular Pathology 452 Femoral Acetabular Impingement 452 Labral Tears 454 Hip Osteoarthritis 458 Hip Subluxation 458 Athletic Pubalgia 458 Osteitis Pubis 460 Piriformis Syndrome 460 Snapping Hip Syndrome (Coxa Saltans) 460 Bursitis 462 On-Field Evaluation of Pelvis and Thigh Injuries 464 Initial Evaluation and Management of On-Field Injuries 466 Hip Dislocation 466 Femoral Fracture 467 SECTION 3 TORSO EXAMINATION 471 Chapter 13 Lumbosacral Pathologies 473 Clinical Anatomy 473 Bony Anatomy 474 Intervertebral Discs 476 Articulations, Ligamentous and Fascial Anatomy 477 Neurological Anatomy 479 Muscular Anatomy 479 the Lumbar Spine 482 History 483 Nonorganic Origin of Pain 486 Functional Assessment 486 Inspection 486 Joint and Muscle Function Assessment 491 Joint Stability Tests 494 Selective Tissue Tests 495 Neurological Testing 495 and Selective Tissue Tests 508 Spinal Stenosis 508 Intervertebral Disc Lesions 508 Segmental Instability 513 Erector Spinae Muscle Tears 513 Spondylopathies 518 Sacroiliac Pathology 521 On-Field Examination of Lumbar Spine Injuries 531 On-Field History 531 On-Field Inspection 531 On-Field Neurological Tests 531 On-Field Palpation 531 On-Field Management of Lumbar Spine Injuries 531 Lumbar Spine 531 Chapter 14 Cervical and Thoracic Spine and Thorax Pathologies 535 Clinical Anatomy 535 Cervical Spine 535 Thoracic Spine 536 Intervertebral Discs 536 Ligamentous Anatomy 537 Neurological Anatomy 537 Thorax 539 Muscular Anatomy 539 the Cervical and Thoracic Spine and Thorax 540 History 545 Functional Assessment 546 Inspection 547 Joint and Muscle Function Assessment 550 Joint Stability Tests 555 Neurological Testing 556 and Selective Tissue Tests 560 Cervical Radiculopathy 563 Clinical Cervical Instability 576 Facet Joint Dysfunction 576 Brachial Plexus Pathology 577 Thoracic Outlet Syndrome 580 Thoracic Spine Pathologies 583 Thorax Pathologies 585 Splenic Injury 589 Kidney Trauma 591 Commotio Cordis 592

7 Contents xvii On-Field Evaluation and Management of Cervical and Thoracic Spine and Thorax Injuries 592 Brachial Plexus Injury 594 Thoracic Spine 594 Rib Fractures 594 Pneumothorax and Hemothorax 594 Respiratory Distress 594 SECTION 4 UPPER EXTREMITY EXAMINATION 599 Chapter 15 Shoulder and Upper Arm Pathologies 601 Clinical Anatomy 601 Bony Anatomy 601 Joints of the Shoulder Complex 604 Muscles of the Shoulder Complex 606 Bursae of the Shoulder Complex 612 Shoulder Injuries 612 History 612 Functional Assessment 614 Inspection 614 Joint and Muscle Function Assessment 620 Joint Stability Tests 639 Neurological Testing 640 Vascular Testing 640 and Selective Tissue Tests 640 Scapulothoracic Articulation Pathology 640 Sternoclavicular Joint Sprains 646 Acromioclavicular Joint Pathology 650 Glenohumeral Instability 656 Anterior Instability 656 Nontraumatic Anterior Instability 656 Traumatic Anterior Instability 656 Posterior Instability 658 Acute Posterior Dislocation 658 Rotator Cuff Pathology 664 Biceps Tendon Pathology 674 Adhesive Capsulitis 678 On-Field Examination of Shoulder Injuries 678 Equipment Considerations 681 On-Field History 681 On-Field Inspection 681 On-Field Palpation 685 On-Field Neurological Tests 685 Initial Management of On-Field Shoulder Injuries 685 Scapular Fractures 685 Clavicular Injuries 685 Chapter 16 Elbow and Forearm Pathologies 689 Clinical Anatomy 689 Articulations and Ligamentous Support 690 Muscular Anatomy 692 Nerves 692 Bursae 692 the Elbow and Forearm 695 History 695 Functional Assessment 697 Inspection 698 Joint and Muscle Function Assessment 702 Active Range of Motion 702 Manual Muscle Testing 703 Passive Range of Motion 703 Joint Stability Tests 705 Neurological Testing 706 Vascular Testing 710 and Selective Tissue Tests 710 Elbow Dislocations 710 Fractures About the Elbow 711 Elbow Sprains 712 Ulnar Collateral Ligament 712 Radial Collateral Ligament 718 Osteochondritis Dissecans of the Capitulum 718 Epicondylalgia 718 Lateral Epicondylalgia 718 Medial Epicondylalgia 720 Distal Biceps Tendon Rupture 721 Nerve Pathology 722 Forearm Compartment Syndrome 726 On-Field Examination of Elbow and Forearm Injuries 726 On-Field History 726 On-Field Inspection 726 On-Field Palpation 727 On-Field Joint and Muscle Function Tests 727 On-Field Neurological Tests 727 On-Field Management of Elbow and Forearm Injuries 727 Elbow Dislocations 727 Fractures About the Elbow 728 Chapter 17 Wrist, Hand, and Finger Pathologies 731 Clinical Anatomy 731 Articulations and Ligamentous Support 732 Muscular Anatomy 734 Nerves 741 The Carpal Tunnel 741

8 xviii Contents Injuries to the Wrist, Hand, and Fingers 741 History 743 Functional Assessment 743 Inspection 744 Joint and Muscle Function Assessment 750 Wrist Joint and Muscle Function Assessment 750 Thumb Joint and Muscle Function Assessment: Carpometacarpal Joint 751 Finger Joint and Muscle Function Assessment 752 Joint Stability Tests 766 Wrist and Hand Joint Play Assessment 767 Neurological Testing 767 Vascular Testing 767 and Selective Tissue Tests 767 Wrist Pathology 767 Hand Pathology 786 Finger Pathology 787 Thumb Pathology 789 On-Field Evaluation and Management of Wrist, Hand, and Finger Injuries 791 Wrist Fractures and Dislocations 792 Interphalangeal Joint Dislocations 792 Hand and Finger Fractures 793 Lacerations 794 SECTION 5 EXAMINATION OF THE HEAD 797 Chapter 18 Eye Pathologies 799 Clinical Anatomy 799 Eye Structures 799 Muscular Anatomy 800 Visual Acuity 800 Eye Injuries 800 History 800 Inspection 803 Functional Assessment 806 Neurological Testing 806 and Selective Tissue Tests 806 Orbital Fractures 806 Corneal Abrasions 807 Corneal Lacerations 811 Traumatic Iritis 811 Hyphema 812 Retinal Detachment 813 Ruptured Globe 813 Conjunctivitis 814 Foreign Body Embedment 815 On-Field Examination and Management of Eye Injuries 816 Contact Lens Removal 816 Orbital Fractures 816 Penetrating Eye Injuries 816 Chemical Burns 816 Chapter 19 Face and Related Structure Pathologies 819 Clinical Anatomy 819 Temporomandibular Joint Anatomy 819 The Ear 820 The Nose 821 The Throat 821 The Mouth 822 The Teeth 822 Muscular Anatomy 822 Facial Injuries 823 History 823 Inspection 826 Functional Assessment 831 Neurological Testing 831 and Selective Tissue Tests 832 Ear Pathology 832 Nasal Injuries 835 Throat Injury 836 Facial Fractures 837 Dental Conditions 839 Temporomandibular Joint Dysfunction 843 On-Field Examination and Management of Injuries to the Face and Related Areas 843 Lacerations 845 Laryngeal Injuries 845 Facial Fractures 845 Temporomandibular Joint Injuries 845 Nasal Fracture and Epistaxis 846 Dental Injuries 846 Chapter 20 Head and Acute Cervical Spine Pathologies 849 Clinical Anatomy 849 The Brain 850 The Meninges 851 Cerebrospinal Fluid 851 Blood Circulation in the Brain 851 Examination Scenarios 852 Evaluation of the Athlete s Position 853 Examination of Head Injuries 853 Determination of Consciousness 854 History 854

9 Contents xix Inspection 855 Palpation 856 Functional Assessment 856 Cranial Nerve Function 856 Neurocognitive Function 857 Vital Signs 863 and Selective Tissue Tests 863 Traumatic Brain Injury 863 Concussion 864 Concussion Assessment Tools 866 Postconcussion Syndrome 871 Diffuse Cerebral Swelling (Second impact syndrome) 872 Intracranial Hemorrhage 872 Home Instructions 873 Skull Fractures 873 Examination of Acute Cervical Spine Injuries 874 History 874 Inspection 877 Functional Assessment 878 Neurological Assessment 879 Acute Cervical Spine Trauma 879 On-Field Examination and Management of Cervical Spine Injuries and the Unconscious Athlete 882 Equipment Considerations 882 Initial Inspection 884 Initial Action 885 History 888 Inspection 889 Neurological Testing 889 Removing the Athlete From the Field 889 Appendix A Diagnostic Evidence References 895 Index 905