The Art of the Musculoskeletal Physical Exam

Preface
Contents
Part I: Shoulder Reviewer John Lane
1: Shoulder Anatomy
1.1 Shoulder Anatomy
1.1.1 Osseous
1.1.2 Muscles
1.1.3 Ligaments
1.1.4 Nerves
1.1.5 Vascular
References
2: Biomechanics of the Glenohumeral, Acromioclavicular, and Sternoclavicular Joints
2.1 General Principles of Shoulder Biomechanics
2.2 Glenohumeral Joint
2.3 Acromioclavicular Joint
2.4 Sternoclavicular Joint
References
3: Evaluation of the Range of Motion of the Glenohumeral Joint
3.1 Anatomy
3.2 Evaluation of the Shoulder Joint
3.2.1 Resting Position
3.2.2 Abduction
3.2.3 Adduction
3.2.4 Forward Flexion
3.2.5 Extension
3.2.6 Internal Rotation
3.2.7 External Rotation
References
4: Examination of Range of Motion Scapulothoracic, Acromioclavicular, and Scapulothoracic Joints
4.1 Scapulothoracic Joints
4.2 Specific Strength Test for Scapulothoracic Muscles
4.2.1 Serratus Anterior
4.2.2 Lower Trapezius Test
4.2.3 Latissimus Dorsi
4.2.4 Rhomboid Test
4.3 Acromioclavicular Joint
References
5: Clinical Tests for Evaluation of Motor Function of the Shoulder
5.1 Introduction
5.2 History
5.3 Clinical Examination
5.3.1 Inspection
5.3.2 Palpation
5.3.3 Range of Motion
5.3.4 Strength Testing
5.3.4.1 Abduction
5.3.4.2 External Rotation
5.3.4.3 Internal Rotation
5.3.5 Special Tests
5.3.5.1 Rotator Cuff Muscles
Tests for the Supraspinatus Muscle
Empty Can Test/Jobe Test/Supraspinatus Test (Sensitivity 53–89% and Specificity 65–82%, Fig. 5.1a and b) [6]
Drop Arm Test (Sensitivity 10–73% and Specificity 77–98%) [6]
Tests for the Infraspinatus Muscle
Strength
External Rotation Lag Sign (Sensitivity 46–98%, Specificity 72–98%) [6]
Drop Sign
Tests for the Teres Minor Muscle
Hornblower’s Sign (Sensitivity 100% and Specificity 93%) [6]
Tests for the Subscapularis Muscle
Gerber Lift-Off Test (Sensitivity 17–100% and Specificity 60–98%) [6]
Belly Press Test/Napoleon Test (Sensitivity 40–43% and Specificity 93–98%) [6]
Bear Hug Test (Sensitivity 60% and Specificity 92%) [16]
5.3.5.2 Testing for Other Muscles Around Shoulder Girdle
Trapezius Muscle
Rhomboid Muscle
Serratus Anterior
Latissimus Dorsi
Deltoid
5.3.5.3 Impingement Tests
Neer Impingement Sign and Test (Sensitivity 68–89% and Specificity 49–98%) [6]
Hawkins-Kennedy Impingement Test (Sensitivity 72–92% and Specificity 44–78%) [6]
5.3.5.4 Biceps Tendon Examination
Speed’s Test (Sensitivity 32%, Specificity 75%) [21]
Yergason’s Test (Sensitivity 43%, Specificity 79%) [21]
5.3.6 Neurovascular Examination
5.4 Conclusion
References
6: Evaluation of the Stability and Function of the Sternoclavicular and Acromioclavicular Joint
6.1 Acromioclavicular Joint
6.1.1 Introduction
6.1.2 Clinical Evaluation
6.1.3 Imaging of the Acromioclavicular Joint
6.1.3.1 Radiographic Imaging
6.1.3.2 Assessment of Vertical Instability
6.1.3.3 Assessment of Horizontal Instability
6.1.4 Magnetic Tomography Imaging
6.1.5 Computer Tomography
6.2 Sternoclavicular Joint
6.2.1 Clinical Evaluation
6.3 Imaging of the Sternoclavicular Joint
6.3.1 Radiographic Imaging
6.3.2 Magnetic Tomography Imaging
6.3.3 Computer Tomography
References
7: Evaluation of the Stability and Function of the Glenohumeral Joint
7.1 Introduction
7.1.1 The Glenoid and Humeral Head
7.1.2 The Coracoid
7.1.3 The Labrum
7.1.4 Capsuloligamentous Complex
7.2 Coracohumeral Ligament
7.3 Superior Glenohumeral Ligament
7.4 Middle Glenohumeral Ligament
7.5 Inferior Glenohumeral Ligament
7.5.1 Rotator Cuff
7.5.2 Deltoid
7.5.3 Periscapular Muscles
7.5.4 Long Head Biceps Tendon
7.5.5 Testing
References
8: Evaluation of the Stability and Function of the Scapulothoracic Joint
8.1 Biomechanics
8.2 Clinical Examination
8.2.1 Scapular Assistance Test
8.2.2 Scapular Retraction Test
8.2.3 Lateral Scapular Slide Test
8.2.4 Scapular Winging
8.3 Summary
References
9: Nerve Compressions Around the Shoulder
9.1 Suprascapular Nerve
9.1.1 Introduction
9.1.2 Anatomy
9.1.3 Compression Sites and Causes
9.1.4 Physical Examination
9.2 Supraspinatus
9.2.1 Jobe Sign (Empty Can Test)
9.2.2 Other Tests
9.2.3 Yocum Sign (Subacromial Space)
9.3 Infraspinatus
9.3.1 Patte Sign
9.3.2 Infraspinatus Test (External Rotation Against Resistance)
9.3.3 Hornblower Sign
9.3.4 Complementary Studies
9.3.5 Treatment
9.4 Musculocutaneous Nerve
9.4.1 Introduction
9.4.2 Anatomy
9.4.3 Physical Examination
9.4.4 Motor Testing
9.4.5 Speed Sign (Long Head of the Biceps)
9.4.6 Yergason Sign (Long Head of the Biceps)
9.4.7 Sensitivity Testing
9.4.8 Pathology and Diagnosis
9.4.9 Treatment
9.5 Subscapular Nerve
9.5.1 Anatomy
9.5.2 Physical Examination
9.5.2.1 Belly Press Test
9.5.2.2 Gerber Test
9.5.2.3 Bear Hug Test
9.5.3 Pathology and Diagnosis
9.5.4 Treatment
9.6 Axillary Nerve (Circumflex Nerve)
9.6.1 Introduction
9.6.2 Anatomy
9.6.2.1 Branches
9.6.3 Injuries
9.6.4 Physical Examination, Tests, and Diagnosis
9.6.5 Motor Testing
9.6.6 Treatment
References
10: Evaluation of the Stiff Shoulder
10.1 Introduction
10.2 Patient History
10.3 Physical Examination
10.4 Diagnostic Investigations
10.4.1 Laboratory Studies
10.4.2 Radiographs
10.4.3 Arthrogram
10.4.4 Magnetic Resonance Imaging (MRI) and Ultrasound Findings
10.5 Etiology of Stiff Shoulder
References
11: Evaluation of the Thrower’s Shoulder
11.1 Phases of Throwing
11.2 Adaptations to the Throwing Shoulder
11.3 Pathophysiology
11.3.1 Glenohumeral Internal Rotation Deficit (GIRD)
11.3.2 Internal Impingement
11.3.3 Scapular Dyskinesis
11.4 History
11.5 Physical Examination
11.6 Summary
References
Part II: Elbow Reviewer Dr Pederizini
12: Anatomy
12.1 Osseous Anatomy
12.2 Capsular Ligamentous Complex
12.2.1 Ulnar Collateral Complex
12.2.2 Lateral Collateral Ligament Complex
12.3 Muscle Layer
12.3.1 Triceps Brachii Muscle
12.3.2 Anconeus Muscle
12.3.3 Biceps Brachii Muscle
12.3.4 Brachioradialis
12.3.5 Brachialis
12.3.6 Extensor Muscles
12.4 Neuroanatomy
12.4.1 Median Nerve
12.4.2 Radial Nerve
12.4.3 Ulnar Nerve
References
13: Biomechanics of the Elbow
13.1 Kinematics
13.2 Elbow Stability
13.3 Joint Forces
References
14: Evaluation of Range of Motion
14.1 Introduction
14.2 Carrying Angle
14.3 Motion
14.4 Range of Motion in Daily Activities
14.5 Limitation of Motion (LOM)
References
15: Evaluation of Triceps Tendon
15.1 Introduction
15.2 Anatomy
15.2.1 Origin
15.2.2 Insertion
15.2.2.1 Olecranon Footprint
15.3 Pathogenesis
15.3.1 Traumatic Lesions
15.3.2 Spontaneous Ruptures
15.3.3 Overuse Injuries
15.3.4 Following Total Elbow Arthroplasty
15.4 Natural History
15.5 Patient History and Physical Findings
15.6 Imaging and Other Diagnostic Studies
15.7 Differential Diagnosis
15.8 Nonoperative Management
15.9 Surgical Management
References
16: Clinical Evaluation of the Distal Biceps Tendon
16.1 Introduction
16.2 Anatomy
16.3 Clinical Evaluation
16.3.1 Sonography
References
17: Evaluation of Elbow Instability with Clinical Testing
17.1 Introduction
17.2 Anatomy and Biomechanics
17.2.1 Posterolateral Rotatory Instability
17.2.2 Valgus Instability
17.3 History
17.4 Physical Examination
17.4.1 Inspection
17.4.2 Palpation
17.4.3 Range of Motion
17.5 Specific Tests
17.5.1 Physical Examination for the Evaluation of Posterolateral Rotatory Instability
17.5.1.1 Lateral Pivot-Shift Apprehension (Posterolateral Rotatory Apprehension)
17.5.1.2 Lateral Pivot-Shift (Posterolateral Rotatory Instability)
17.5.1.3 Posterolateral Rotatory Drawer Test
17.5.1.4 Chair Push-Up Test (Chair Sign)
17.5.1.5 Active Floor Push-Up Test (Push-Up Sign)
17.5.1.6 Table-Top Relocation Test
17.5.2 Physical Examination for the Evaluation of Valgus Instability
17.5.2.1 Valgus Stress Test
17.5.2.2 Moving Valgus Stress Test
17.5.2.3 The Milking Maneuver
17.6 Summary
References
18: Neurologic Evaluation of the Elbow and Forearm
18.1 Lateral Cutaneous Nerve of Forearm
18.2 Radial Nerve
18.3 Posterior Interosseous Nerve
18.4 Radial Tunnel Syndrome
18.5 Wartenberg Syndrome
18.6 Median Nerve
18.7 Pronator Syndrome
18.8 Anterior Interosseous Nerve
18.9 Ulnar Nerve
References
19: Evaluation of Common Tendinopathies of the Elbow
19.1 Introduction
19.1.1 Medical History
19.1.2 Clinical Examination
19.2 Lateral Epicondylitis (Tennis Elbow)
19.2.1 Clinical Presentation
19.2.2 Physical Examination
19.2.3 Specific Examination Manoeuvres
19.2.4 Possible Associated Symptoms
19.3 Medial Epicondylitis (Golfer’s Elbow)
19.3.1 Clinical Presentation
19.3.2 Physical Examination
19.3.3 Specific Examination Manoeuvres
19.3.4 Possible Associated Symptoms
19.4 Distal Biceps Tendinopathy
19.4.1 Clinical Presentation
19.4.2 Physical Examination
19.4.3 Specific Examination Manoeuvres
19.5 Triceps Tendinopathies
19.5.1 Clinical Presentation
19.5.2 Physical Examination
19.5.3 Specific Examination Manoeuvres
References
20: Evaluation of Sports-Related Elbow Instability
20.1 Introduction
20.2 Instability Tests
20.3 Medial Instability
20.4 Lateral Instability
20.5 Rotatory Instability
20.6 Micro-instability
References
21: Compartment Syndrome in the Upper Limb
21.1 Introduction
21.2 Anatomy
21.3 Pathophysiology
21.4 Physical Examination
21.5 Clinical Decision-Making
21.6 Technique: ICP measurement
21.6.1 Imaging
21.7 Operative Technique: Compartment Fasciotomy in the Upper Limb
21.7.1 Volar Forearm and Anterior Brachium
21.7.2 Dorsal Forearm, Mobile Wad, and Posterior Brachium
21.8 Post-Operative Management: When to Close
References
22: Evaluation of Pediatric Elbow Conditions
22.1 Ossification Centers
22.2 The History
22.2.1 Acute Injury
22.2.2 Chronic Injury
22.3 Physical Examination
22.3.1 Imaging Assessment
22.4 Pathological Conditions
22.4.1 Supracondylar Fracture of the Distal humerus
22.4.2 Lateral Condylar Fracture
22.4.3 Medial Epicondyle Fractures
22.4.4 Proximal Radius Fracture
22.4.5 Olecranon Apophyseal Injury or Olecranon Fracture
22.4.6 Elbow Dislocations, Fracture-Dislocations
22.4.7 Panner’s Disease
22.4.8 Osteochondritis Dissecans (OCD)
References
Part III: Wrist and Hand Reviewer Dr Cage
23: Hand Anatomy
23.1 Skin and Subcutaneous Tissue
23.2 Nail Anatomy
23.3 Muscles and Tendons
23.3.1 Extrinsic Flexors
23.3.2 Intrinsic Muscles
23.3.3 Extrinsic Extensors and the Extensor Retinaculum
23.3.4 Digital Flexor Apparatus
23.3.5 Digital Extensor Mechanism
23.4 Vascular Anatomy
23.5 Bony and Ligamentous Anatomy
23.5.1 Wrist
23.5.2 Extrinsic Ligaments
23.5.3 Intrinsic Ligaments
23.5.4 Metacarpals
23.5.5 Fingers
23.5.6 Thumb
23.6 Nerve Anatomy
23.6.1 Median Nerve
23.6.2 Ulnar Nerve
23.6.3 Radial Nerve
References
24: Biomechanics of the Distal Forearm and Wrist
24.1 Forearm Biomechanics
24.2 Biomechanics of the DRUJ
24.3 Biomechanics of the Wrist
References
25: Evaluation of Range of Motion
25.1 Introduction
25.2 Anatomy of the Joint
25.2.1 Wrist Joint
25.2.1.1 Radiocarpal Joint (RCJ)
25.2.1.2 Mid-Carpal Joint (MCJ)
25.2.1.3 The Distal Radio-Ulnar Joint (DRUJ)
25.2.2 Hand Joints
25.2.2.1 The Carpometacarpal Joint (CMCJ)
25.2.2.2 Metacarpophalangeal Joint (MCPJ)
25.2.2.3 Interphalangeal Joint (IPJ)
25.2.2.4 Proximal Interphalangeal Joint (PIPJ)
25.2.2.5 Distal Interphalangeal Joint (DIPJ)
25.3 Measurement Techniques
25.3.1 Measurement Instruments
25.3.1.1 Wrist Joint
25.3.2 Wrist Flexion-Extension
25.3.3 Wrist Radial Deviation and Ulnar Deviation
25.3.4 Pronation-Supination
25.3.4.1 Hand Joints
Thumb Joints Measurement
First Carpometacarpal Joint (CMCJ)
First CMCJ Abduction
First CMCJ Opposition
25.3.5 Thumb Metacarpophalangeal Joint and Interphalangeal Joint
25.4 Finger Joints Measurement
25.4.1 Metacarpophalangeal Joint (MCPJ)
25.4.2 Proximal Interphalangeal Joint (PIPJ)
25.4.3 Distal Interphalangeal Joint (DIPJ)
25.4.4 Composite Finger Flexion
25.4.4.1 Total Active Motion (TAM)
25.4.4.2 Total Passive Motion (TPM)
25.5 Functional Range of Motion
25.6 Active and Passive Range of Motion
25.7 Fixed Flexion Contracture
25.8 Factors Affecting Hand and Wrist Range of Motion: Gender, Ethnics, Age, Hand Dominance
25.9 Other Measurement Techniques
References
26: Clinical Testing of the Wrist
26.1 Popular Physical Test Commonly Used in Daily Practice
26.1.1 Tenderness Point
26.1.2 Watson Test
26.1.3 Ulnocarpal Stress Test
26.1.4 Ballottement Test
26.1.5 Synergy Test
26.1.6 Fovea Sign
26.2 Popular Image Modalities for Wrist Disorders
26.2.1 X-Ray
26.2.2 Computed Tomography (CT)
26.2.3 MRI
26.2.4 Arthrogram
References
27: Evaluation of the Triangular Fibrocartilage Complex
27.1 Introduction
27.2 Inspection
27.3 Palpation
27.3.1 Fovea Sign
27.4 Range of Motion (ROM)
27.5 Provocative Test
27.5.1 Ballottement Test
27.5.2 Piano Key Test
27.5.3 TFC Grind Test /Ulnocarpal Stress Test
27.5.4 Press Test
27.5.5 Provocative Tests for ECU Tendon Pathology
References
28: Compartment Syndrome of the Hand
28.1 Introduction
28.2 Pathophysiology
28.3 Anatomy
28.4 Diagnosis
28.5 History
28.6 Clinical Examination
28.7 Inspection
28.8 Palpation
28.9 Compartment Pressure Measurement
28.10 Management
28.11 Summary
References
29: Evaluation of the Neurological Conditions of the Elbow, Forearm and Hand
29.1 Introduction
29.2 Median Nerve
29.2.1 Anatomy
29.2.2 Sites of Compression
29.2.3 Evaluation
29.2.3.1 Observation or Inspection
29.2.3.2 Sensory Function Evaluation
29.2.3.3 Motor Evaluation
29.2.3.4 Provocative Tests for Nerve Compression
29.2.3.5 Pitfalls
29.3 Ulnar Nerve
29.3.1 Anatomy
29.3.2 Sites of Compression
29.3.3 Evaluation
29.3.3.1 Observation
29.3.3.2 Sensory Evaluation
29.3.3.3 Motor Evaluation
29.3.3.4 Provocative Tests
29.3.4 Pitfalls
29.4 Radial Nerve
29.4.1 Anatomy
29.4.2 Sites of Injury and Compression
29.4.3 Evaluation
29.4.3.1 Observation
29.4.3.2 Sensory Evaluation
29.4.3.3 Motor Evaluation
29.4.3.4 Provocative Tests
29.4.4 Pitfalls
References
30: Evaluation of Tendinopathies/Tendon Ruptures/Tendon Instability
30.1 Introduction
30.2 Anatomy
30.3 Tendon Ruptures
30.3.1 General Examination
30.3.2 Finger Extensors [1]
30.3.3 Finger Flexors
30.4 Tendon Subluxation/Dislocation
30.4.1 ECU Tendon Subluxation/Dislocation
30.4.2 Extensor Tendon Subluxation
30.5 Chronic Tendon Pathologies
30.5.1 de Quervain’s Disease
30.5.2 ECU Tendonitis
30.5.3 Trigger Finger
30.6 Conclusion
References
31: Evaluation of Hand Infections
31.1 Introduction
31.2 Paronychia
31.3 Felon
31.4 Flexor Tenosynovitis
31.5 Web Space Infection
31.6 Deep Palmar Space and Bursae Infections
31.7 Parona’s Space Infection
31.8 Septic Arthritis of the Wrist
31.9 Conclusion
References
32: Diagnosis and Evaluation of Fractures of the Hand and Wrist
32.1 Fractures of the Phalanges
32.1.1 Fractures of the Distal Phalanx
32.1.2 Dorsal Lip Avulsion Fracture
32.1.3 Volar Lip Avulsion Fracture
32.1.4 Seymour Fractures
32.1.5 Distal Phalanx Tuft Fractures
32.2 Fractures of the Middle Phalanx
32.2.1 Intra-articular Middle Phalanx Fractures
32.2.2 Middle Phalanx Shaft Fractures
32.3 Proximal Phalanx Fractures
32.4 Fractures of the Thumb
32.5 Fractures of the Metacarpals
32.5.1 Bennett Fracture Dislocation
32.5.2 Rolando Fractures
32.6 Second Through Fifth Metacarpal Fractures
32.6.1 Metacarpal Head Fractures
32.6.2 Open Fractures at the Metacarpophalangeal Joint
32.6.3 Metacarpal Neck Fractures
32.6.4 Metacarpal Shaft Fractures
32.6.5 Metacarpal Base Fractures and Fracture Dislocations of the Carpometacarpal Joint
32.7 Fractures of the Carpal Bones
32.7.1 Scaphoid
32.7.1.1 Acute Scaphoid Fractures
32.7.2 Scaphoid Fracture Nonunion
32.7.3 Lunate Fractures
32.7.4 Fractures of the Triquetrum
32.7.5 Pisiform Fractures
32.7.6 Trapezium Fractures
32.7.7 Trapezoid Fractures
32.7.8 Capitate Fractures
32.7.9 Hamate fractures
32.8 Fractures of the Distal Radius
32.8.1 Colles Fractures
32.8.2 Smith Fractures
32.8.3 Barton Fractures
32.8.4 Chauffeur Fractures
32.9 Fractures of the Distal Ulna
32.10 Galeazzi Fractures
32.11 Essex-Lopresti Injuries
32.12 Conclusion
References
33: Evaluation of Instability and Joint Dislocations of the Hand
33.1 Proximal Interphalangeal Joint
33.1.1 Introduction and Relevant Anatomy
33.1.2 History and Presentation
33.1.3 Physical Examination
33.1.4 Radiographic Evaluation
33.2 Metacarpophalangeal Joint
33.2.1 Introduction and Relevant Anatomy
33.2.1.1 History and Examination
33.2.1.2 Radiographic Evaluation
33.3 Thumb Metacarpophalangeal Joint
33.3.1 Introduction and Relevant Anatomy
33.3.2 History and Examination
References
34: Rheumatoid and Other Arthritis of the Wrist and Hand
34.1 Introduction
34.2 Common Features of Wrist and Hand Arthritis
34.3 Rheumatoid Arthritis
34.4 General Considerations
34.4.1 Range of Motion
34.5 Identification of Findings and Deformities
34.6 Functional Assessment
34.6.1 Inspecting the Wrist
34.6.2 Fingers
34.7 Role of the Intrinsic Muscles
34.8 Bunnell Test
34.9 Swan Neck Severity
34.10 Swan Neck Classification
34.11 Boutonniere Deformity
34.12 Rheumatoid Thumb
34.13 Functional Assessment of the Thumb in Rheumatoid Arthritis
34.14 Extensor Tendons
34.14.1 Subluxation of Extensor Tendons
34.15 Flexor Tendon Rupture
34.15.1 Trigger Fingers and Carpal Tunnel Syndrome
34.16 Summary
References
Part IV: Hip/Pelvis Reviewer Dr’s Rath & Hoelmich
35: Hip Anatomy
35.1 Vascularization of the Hip
35.2 The Labrum
35.3 The Ligamentus Teres
35.4 The Capsule Ligaments
References
36: Hip Biomechanics
36.1 Static Analysis
36.2 Dynamic Analysis
36.3 Inverse Dynamic
36.4 Forward Dynamic
36.5 Muscle Action
References
37: Evaluation of Dysplasia of the Hip (Children with DDH, Adolescents, and Adults)
37.1 Clinical Presentation and Diagnosis of DDH in Newborns
37.2 Clinical Presentation and Diagnosis of DDH in Adolescents and Adults
37.3 Etiopathogenesis
37.4 Preluxation
37.5 Subluxation
37.6 Dislocation
37.7 Inveterate Dislocation
37.8 Ortolani Test (Reduction Test)
37.9 Barlow Test (Dislocation Test)
37.10 Trelat Sign
37.11 Savariaud Sign
37.12 The Instrumental Diagnosis (Ultrasound Scan and Radiography)
References
38: Evaluation of Hip Osteoarthritis
References
39: Evaluation of Snapping Hip and Extra-Articular Impingement
39.1 Snapping Hip
39.2 Subspine Impingement
39.3 Avulsion and Ossification of the Rectus Femoris
39.4 Ischiofemoral Impingement
39.5 Greater Trochanteric-Pelvic Impingement
References
40: Evaluation of Athletic Population with Hip/Hamstring/Quad Injuries
40.1 Introduction
40.2 Standing Examination
40.3 Seated Examination
40.4 Prone Examination
40.5 Supine Examination
40.6 Lateral Examination
40.7 Conclusions
References
41: Limping Child
41.1 Children Under 3 Years of Age
41.2 Children Aged 3–10 Years
41.3 Children Aged 10–16 Years
References
42: Evaluation of Chronic Pelvic Pain (Athletic Pubalgia-Sports Hernia and Other Pain Conditions)
42.1 The Long-Standing Groin Pain Syndrome
42.2 Pubic Osteopathy and Adductor Tendinopathy
42.3 The Profile of the Patient Affected by LSGPS
42.4 The Clinical Evaluation
42.5 Conclusions
References
43: Assessment of Outcome Scores of the Hip
References
Part V: Knee Reviewers Dr’s Gobbi, Lane & Espregueira-Mendes
44: Anatomy of the Knee
44.1 The Central Pivot
44.2 Anterior Cruciate Ligament
44.3 Posterior Cruciate Ligament
44.4 Passive and Active Peripheral Rotary Constraints
44.5 The Medial Collateral Ligament
44.6 The Lateral Collateral Ligament
44.7 Condylar Shells
44.8 The Menisci
44.9 Patellofemoral Joint
44.10 Synovial and Neurovascular Anatomy
References
45: Biomechanics of the Tibiofemoral and Tibiofibular Joints
45.1 Introduction
45.2 Tibiofemoral Joint
45.3 Angular Kinematics
45.3.1 Flexion-Extension (Sagittal Plane)
45.3.2 Valgus-Varus (Coronal/Frontal Plane)
45.3.3 Internal-External (Transverse Plane)
45.4 Translational Kinematics
45.4.1 Anterior-Posterior (Sagittal Plane)
45.4.2 Medio-Lateral (Coronal/Frontal Plane)
45.4.3 Compression-Distraction (Transverse Plane)
45.5 Kinetics
45.5.1 Static Kinetics
45.5.2 Dynamic Kinetics
45.6 Proximal Tibiofibular Joint
45.7 Translational Kinematics
45.7.1 Anterior-Posterior (Sagittal Plane)
45.7.2 Medio-Lateral (Coronal/Frontal Plane)
45.7.3 Compression-Distraction (Transverse Plane)
45.8 Angular Kinematics
45.8.1 Flexion-Extension (Sagittal Plane) and Valgus-Varus (Coronal/Frontal Plane) of the PTFJ
45.8.2 Internal-External (Transverse Plane)
45.9 Kinetics
45.9.1 Static Kinetics
45.9.2 Dynamic Kinetics
45.10 Summary
References
46: Evaluation of Range of Motion of the Tibiofemoral Joint
46.1 Visual Estimation of Knee Range of Movement (KROM)
46.2 Universal Goniometer (UG)
46.3 Electrical Digital Inclinometers (EDI)
46.4 Digital Photographic Goniometry (DPG)
46.5 Fluoroscopy and Cross-Sectional Imaging
46.6 Radiostereometric Analysis (RSA)
46.7 Motion Capture Analysis
46.8 Conclusion
References
47: Clinical Tests for Evaluation of Motor Function of the Knee
47.1 Introduction
47.2 Clinical History
47.3 Inspection
47.4 Range of Motion
47.5 Palpation
47.6 Motor Tests of the Knee
47.6.1 Five-Time Sit-to-Stand Test (FTSST)
47.6.2 Five-Meter Walk Test (5mWT)
47.6.3 Ascend/Descend Four Stairs
47.6.4 Maximal Hop for Distance
47.6.5 Maximal Controlled Leap
47.6.6 Single-Legged Drop-Jump Landing Test
47.6.7 Y-Balance
47.6.8 Modified T-Test
47.6.9 Ninety-Degree Medial Rotation Hop for Distance (MRH)
47.7 Conclusion
References
48: The Stability and Function of the Patellofemoral Joint
48.1 Introduction
48.2 Anatomy
48.3 History
48.4 Examination
48.5 General Inspection
48.6 Standing
48.6.1 Static Assessment while Standing
48.6.1.1 Frontal Assessment of the Lower Limbs
48.6.1.2 Q-Angle
48.6.1.3 Sagittal Assessment of the Knee
48.6.1.4 Foot Position
48.6.2 Dynamic Assessment while Standing
48.6.2.1 Gait
48.6.2.2 Single-Leg Squat
48.7 Sitting
48.7.1 Static Assessment while Sitting
48.7.1.1 Patella Position
48.7.1.2 Quadriceps Atrophy
48.7.1.3 Tubercle Sulcus Angle
48.7.2 Dynamic Assessment while Sitting
48.7.2.1 Passive Patellar Tracking
48.8 Supine
48.8.1 Static Assessment while Supine
48.8.1.1 Apprehension Test
48.8.1.2 Medial Glide Test
48.8.1.3 Moving Patellar Apprehension Test
48.8.1.4 Femoral Rotation
48.8.2 Dynamic Assessment while Supine
48.9 Special Tests
48.10 Coarse Crepitus
48.11 PFJ Glide/Compression Test [7]
48.12 Patella Tilt Test
48.13 Conclusion
References
49: Evaluation of the Stability and Function of the Tibiofemoral and Tibiofibular Joints
49.1 Introduction
49.2 Inspection
49.3 Palpation
49.4 Special Tests: Anterior Cruciate Ligament (ACL)
49.4.1 Lachman-Noulis Test
49.4.2 Anterior Drawer Test
49.4.3 Pivot-Shift Test
49.4.4 Jerk Test
49.4.5 Losee Test
49.4.6 Lever Sign Test
49.5 Special Tests: Posterior Cruciate Ligament (PCL)
49.5.1 Posterior Sag Test
49.5.2 Dial Test
49.5.3 Posterior Lachman
49.5.4 Posterior Drawer Test
49.5.5 Posterolateral Drawer Test
49.5.6 Posteromedial Drawer Test
49.5.7 Quadriceps Active Test
49.5.8 Reverse Pivot-Shift Sign
49.5.9 External Rotation Recurvatum
49.6 Special Tests: Medial and Lateral Collateral Ligaments (MCL and LCL)
49.6.1 Valgus and Varus Stress Tests
49.6.2 Figure-of-Four
49.7 Clinical Evaluation: Proximal Tibiofibular Joint (PTFJ)
49.8 Conclusion
References
50: Evaluation of the Menisci
50.1 Introduction
50.2 Clinical History
50.3 Inspection
50.4 Evaluation of the Vascular and Neurological Status
50.5 Range of Motion and Palpation
50.6 Special Tests and Signs
50.6.1 Apley Grinding Test
50.6.2 McMurray Test
50.6.3 Joint-Line Palpation
50.6.4 Bragard Test
50.6.5 Thessaly Test
50.6.6 Ege’s Test
50.6.7 Payr Sign
50.6.8 Steinman Tests
50.6.9 Bohler Test
50.7 Conclusion
References
51: Evaluation of Muscle Injuries
51.1 Introduction
51.2 Epidemiology
51.3 Etiology
51.4 Physical Exam
51.5 Classification
References
52: Evaluation of Neuropathies/Nerve Entrapment Around the Knee Joint
52.1 The Infrapatellar Branch of the Saphenous Nerve Injury
52.1.1 Anatomy
52.1.2 Causes
52.1.3 Examination
52.2 Peroneal Neuropathy
52.2.1 Anatomy
52.2.2 Causes
52.2.3 Examination
References
53: Evaluation of Malalignment of the Knee
53.1 Introduction
53.2 Clinical Evaluation
53.2.1 History
53.2.2 Physical Examination
53.2.2.1 Gait Examination
53.2.2.2 Clinical Alignment
53.2.2.3 Range of Motion (RoM)
53.2.3 Special Tests
53.2.3.1 The Q Angle or Quadriceps Angle
53.2.3.2 The Single-Leg Knee-Bend Test
53.2.3.3 Sitting Position with the Legs Hanging from the Table
53.3 Unicompartmental Osteoarthritis
53.4 Knee Instability
53.5 Case 1
53.6 Case 2
53.7 Conclusion
References
54: Evaluation of Bursitis About the Knee
54.1 Introduction
54.2 Anatomy and Pathophysiology
54.3 Anterior Aspect
54.3.1 Suprapatellar Bursa
54.3.2 Prepatellar Bursa
54.3.3 Superficial Infrapatellar Bursa
54.3.4 Deep Infrapatellar Bursa
54.4 Medial Aspect
54.4.1 Pes Anserine Bursa
54.4.2 Medial Collateral Ligament Bursa
54.4.3 Semimembranosus–Medial Collateral Ligament Bursa
54.5 Lateral
54.5.1 Lateral Collateral Ligament–Biceps Femoris Bursa
54.5.2 Iliotibial Bursa
54.6 Posterior
54.6.1 Gastrocnemius–Semimembranosus Bursa (Popliteal or Baker’s Cyst)
References
55: Evaluation of Patellofemoral Knee Pain
55.1 Physical Examination
55.2 Inspection
55.3 Standing Examination
55.4 The Q-Angle
55.5 Dynamic Evaluation
55.6 Palpation
55.7 Range of Motion
55.8 Special Tests
55.8.1 Patellar Mobility Testing
55.8.1.1 Patella Glide
55.8.1.2 Patellar Tilt Test
55.8.1.3 Patellar Grind Test or Clarke’s Patellofemoral Grind Test
55.8.2 Patellar Apprehension Test
55.8.3 Moving Patellar Apprehension Test
55.9 Examination in Prone Position
55.10 Conclusions
References
Part VI: Ankle Reviewer Dr Canata
56: Foot and Ankle Anatomy
56.1 Introduction
56.2 The Ankle
56.3 Ankle Ligaments
56.4 The Distal Tibiofibular Syndesmosis
56.5 The Talus
56.6 The Calcaneus
56.7 Os Trigonum
56.8 Hindfoot Joints and Stabilizers
56.9 Midfoot Joints and Stabilizers
56.10 Forefoot and Stabilizers
56.11 Plantar Fascia
56.12 Plantar Fat Pad
56.13 The First Ray: Role and Pathological Conditions
56.14 Arch Height
56.15 Foot Functional Model
References
57: Biomechanics of the Ankle Syndesmosis
57.1 Introduction
57.2 Anatomy of the Ankle Syndesmosis
57.3 Biomechanics of the Syndesmosis
57.4 Pathomechanics of Syndesmosis Injury
References
58: Clinical Tests for Assessment of Instability of the Ankle and Syndesmosis
58.1 Introduction
58.2 Anatomy
58.3 Mechanism of Injury
58.4 Clinical Presentation and Diagnosis
58.4.1 Physical Exam and Clinical Tests
58.4.1.1 Lateral Instability
Anterior Drawer Test
Anterolateral Drawer Test
Reverse Anterolateral Drawer Test
Talar Tilt Test
58.4.1.2 Medial Instability
External Rotation Stress Test
Kleiger Test
Eversion Stress Test
58.4.1.3 Clinical Tests for Syndesmosis
Frick Test
Squeeze Test
Cotton Test
Single-Leg Jump Test
The External Rotation Stress Test
Fibula Translation Test
58.5 Conclusion
References
59: Evaluation of the Achilles Tendon
59.1 Introduction and Epidemiology
59.2 Trauma and Medical History
59.3 Clinical Evaluation of the Achilles Tendon
59.4 Imaging of the Achilles Tendon
59.5 Post-treatment Evaluation
59.6 Summary
References
60: Evaluation of Ankle Impingement
60.1 Introduction
60.2 Relevant Anatomy
60.3 Etiology
60.3.1 Anteromedial Ankle Impingement (AMAI)
60.3.2 Anterolateral Ankle Impingement (ALAI)
60.3.3 Syndesmosis Impingement
60.3.4 Lateral Ankle Impingement
60.3.5 Posterior Ankle Impingement (PAI)
60.3.6 Posterolateral Ankle Impingement (PLAI)
60.3.7 Posteromedial Ankle Impingement (PMAI)
60.4 Clinical Presentation and Diagnosis
60.4.1 Anterior Impingement
60.4.1.1 Anteromedial Impingement
60.4.1.2 Anterolateral Impingement
60.4.2 Posterior Impingement
60.4.2.1 Posterolateral Impingement
60.4.2.2 Posteromedial Impingement
60.4.3 Physical Exam and Clinical Tests
60.4.3.1 Anterior Impingement
Palpation of Different Anatomical Locations of Anterior Impingement
Ankle Impingement Sign
Single-Leg Squat Test
60.4.3.2 Posterior Impingement
Palpation of Different Anatomical Locations of Posterior Impingement
Passive Forced Plantar Flexion Test
Big Toe Dorsiflexion Plantar Flexion Motion Test
Resisted Dorsiflexion Test of Big Toe
60.5 Radiological Investigations
60.5.1 Anterior Impingement
60.5.2 Posterior Impingement
60.6 Conclusion
References
61: Stress Syndromes Around the Ankle
61.1 Introduction
61.2 Pathophysiology and Etiology
61.3 Presentation and Physical Evaluation
61.4 Specific Examination
61.5 Summary
References
62: Evaluation of Common Injuries of the Ankle and Calf Areas
62.1 Introduction
62.2 Calf
62.2.1 Calf Anatomy
62.2.2 Calf Injuries
62.2.2.1 Muscle and Tendon Injuries of the Calf Area
62.3 Ankle
62.3.1 Ankle Anatomy
62.3.2 Ankle Ligamentous Injuries
62.3.2.1 Classification
62.3.2.2 Lateral Compartment Injuries
62.3.2.3 Syndesmotic Injuries
62.3.2.4 Medial Compartment Injuries
62.4 Conclusions
References
63: Assessment of Outcome Scores of the Ankle
References
Part VII: Foot and Toes Dr Canata
64: Anatomy of the Foot
64.1 Osteology
64.1.1 Talus
64.1.2 Calcaneus
64.1.3 Navicular
64.1.4 Cuboid
64.1.5 Cuneiforms
64.1.6 Metatarsal Bones
64.1.7 Phalanges
64.1.7.1 Big Toe
64.1.7.2 Lesser Toes
64.2 Arthrology
64.2.1 Foot Joints
64.2.1.1 Subtalar Joint
64.2.1.2 Midtarsal Joint (Chopart Joints)
64.2.1.3 Cuneonavicular Joint
64.2.1.4 Tarsometatarsal Joint (Lisfranc Joint)
64.2.1.5 Metatarsophalangeal Joints
64.2.1.6 Interphalangeal Joints
64.2.2 Ligaments
64.2.2.1 Ligaments of the Talocalcaneonavicular Joints
Cervical Ligament
Ligament of the Tarsal Canal
Lateral Talocalcaneal Ligament
Posterior Talocalcaneal Ligament
Medial Talocalcaneal Ligament
Talonavicular Ligament
64.2.2.2 Ligaments of the Calcaneonavicular Joint and Acetabulum Pedis
Spring Ligament Complex
Superomedial Calcaneonavicular Ligament
Inferior Calcaneonavicular Ligament (Spring Ligament)
Bifurcate Ligament
64.2.2.3 Ligaments of the Calcaneocuboid and Cubonavicular Joints
Medial Calcaneocuboid Ligament
Dorsolateral Calcaneocuboid Ligament
Inferior Calcaneocuboid Ligament
Cubonavicular Ligaments
64.2.2.4 Ligaments of the Cuneonavicular and Cuneocuboid Joints
Cuneonavicular Ligaments
Cuneocuboid Ligaments
Intercuneiform Ligaments
64.2.2.5 Ligaments of the Tarsometatarsal Joint (Lisfranc Joint)
64.2.2.6 Intermetatarsal Ligaments
64.2.2.7 Ligaments of Metatarsophalangeal Joints and Proximal Phalangeal Apparatus
Metatarsophalangeal Ligaments of the Lesser Toes
Interphalangeal Joint Ligaments of the Lesser Toes
Proximal Phalangeal Apparatus of the Big Toe
Metatarsophalangeal Ligaments of the Big Toe
Interphalangeal Joint Ligaments of the Big Toe
64.2.2.8 Plantar Aponeurosis
64.3 Myology
64.3.1 Extrinsic Muscles
64.3.2 Intrinsic Muscles
References
65: The Art of the Musculoskeletal Physical Exam: Foot and Toes Biomechanics of the Foot
65.1 Terminology of the Motion
65.2 Biomechanics of the Foot
65.2.1 Functional Anatomy of Subtalar Joint
65.2.2 Functional Anatomy of Midfoot
65.2.3 Functional Anatomy of Forefoot
65.2.4 Functional Anatomy of Toe
65.2.4.1 Hallux
65.2.4.2 Lesser Toes
References
66: Ankle Joint Range of Motion Evaluation (ROM) Using Smartphone Calculators
66.1 Applications
66.2 Fields of Use
66.3 Ankle
66.4 Results
References
67: Assessment of Instability of the Calcaneus and Lisfranc
67.1 Introduction
67.2 Patho-anatomy for Subtalar Instability and Midfoot/Lisfranc’s Instability
67.3 Clinical Assessment of Subtalar Instability
67.4 Clinical Assessment of Lisfranc’s Instability
67.5 Radiological Assessment of Subtalar Instability
67.6 Radiological Assessment of Lisfranc’s Instability
67.7 Conclusion
References
68: Evaluation of Hindfoot Varus and Valgus Conditions
68.1 Inspection
68.1.1 Shoes
68.1.2 Whole Foot
68.1.3 Hindfoot
68.1.4 Gait
68.2 Palpation
68.3 Range of Motion
References
69: Hindfoot Tendinopathies
69.1 Introduction
69.2 Nomenclature
69.3 Pathophysiology
69.3.1 What Causes Pain in Tendinopathy?
69.4 Patient History and Risk Factors
69.5 General Physical Examination
69.5.1 Inspection
69.5.2 Palpation
69.5.3 Range of Motion and Muscle Strength
69.5.4 Pain Provocation Test
69.6 Physical Examination of Hindfoot Tendinopathy
69.6.1 Posterior Tibial Tendon
69.6.2 Anterior Tibial Tendon
69.6.3 Peroneal Tendons
69.6.4 Flexor Hallucis Longus
69.6.5 Extensor Hallucis Longus
69.7 Conclusion
69.8 Pearls and Pitfalls
References
70: Examination of Common Heel and Forefoot Conditions
70.1 Introduction
70.2 Plantar Heel Pain
70.2.1 Plantar Fasciitis
70.2.2 Calcaneal Bone Stress Injuries
70.2.3 Heel Pad Atrophy
70.3 Forefoot Pain
70.3.1 Hallux Valgus
70.3.2 Metatarsalgia
References
71: Evaluation of Stress Fractures
71.1 Introduction
71.2 Epidemiology
71.3 Etiopathogenesis and Mechanism of Injury
71.4 Diagnosis
71.4.1 Clinical Assessment and Physical Examination
71.4.2 Imaging
71.4.2.1 Radiography
71.4.2.2 Ultrasonography
71.4.2.3 CT Scan
71.4.2.4 MRI
71.4.2.5 Bone Scan (Scintigraphy)
71.5 General Treatment Concepts
71.5.1 Conservative Treatment
71.5.2 Surgical Treatment
71.6 Site-Specific Stress Fractures
71.6.1 Metatarsal Stress Fractures
71.6.1.1 Fifth Metatarsal Stress Fractures
71.6.1.2 Second Metatarsal Stress Fractures
71.6.2 Navicular Stress Fractures
71.6.3 Medial Malleolus Stress Fractures
71.6.4 Other Stress Fractures of the Foot
71.6.4.1 Calcaneus
71.6.4.2 Talus
71.6.4.3 Cuboid
71.6.4.4 Sesamoid
71.7 Return to Play
71.8 Prevention
References
72: Clinical Examination: Evaluation of Neurologic Conditions of the Foot (Interdigital Neuromas, Charcot-Marie-Tooth Disease)
72.1 Introduction
72.2 Charcot-Marie-Tooth Disease
72.3 Interdigital (Morton) Neuroma
References