Download Orthopedic Manual PDF

TitleOrthopedic Manual
File Size60.7 MB
Total Pages439
Table of Contents
Table of Contents
	Table of Contents
	PhysMed DDx Overview
	Clinical Encounter Flow
	Basic Treatment Protocol
	Muscle Injury Grading
	Muscle Injury Healing
	Ligament Injury Grading
	Ligament Injury Healing
	Cartilage Injury Grading
	Cartilage Injury Healing
	Bone Injury
	Bone Injury Healing
	Nerve Injury & Healing
	Visceral Pain Referral
Head & Neck
	Table of Contents
	Cervical Spine Exam Flow
	Cervical Spine Exam Form
	Head & Neck Kinematics
	Posterior Muscles
	Lateral & Anterior Muscles
	Cervical Sprain/Strain
	Bell’s Palsy
	Trigeminal Neuralgia
	Benign Positional Vertigo
	BPV - Semmont’s & Epley’s
	C1-C2 Instability
	Cervical Spondylosis
	Cervical Facet Syndrome
	Cervical Meniscoid
	Cervical Radiculopathy
	Discogenic Pain Syndrome
	Headache, Cervicogenic
	Cluster Headache (CH)
	Migraine Headache
	Pathologic Headache
	Tension Headache
	TMJ Syndrome
	Transient Ischemic Attack
	Vertebrobasilar Ischemia (VBI)
	Table of Contents
	Thoracic Exam Flow
	Thoracic Kinesiology
	Vertebral Epiphysitis
	Postural Syndrome
	Thoracic Outlet Syndrome
	Rib Subluxation
	Myocardial Infarction
L-Spine & Pelvis
	Table of Contents
	Lumbosacral Exam Flow
	Lumbosacral Exam Form
	Lumbar Anatomy
	Lumbar Kinesiology
	Sacroiliac (SI) Assessment
	Lumbopelvic Kinematics
	Pelvis Position & Leg Length
	Leg Length Inequality (LLI)
	Leg Length Inequality
	SI Joint Syndrome
	Lumbar Sprain Strain
	Lumbar Facet Syndrome
	Lumbar Instability
	Spondylolisthesis (lumbar)
	Lumbar Disc Herniation
	Lumbar Stenosis
	Cauda Equina Syndrome
	Lumbar DJD
	Lumbar DJD
Shoulder & Arm
	Table of Contents
	Shoulder Exam Flow
	Shoulder Exam Form
	Shoulder Kinematics
	Shoulder Anatomy Review
	Scapulocostal Syndrome
	Rotator Cuff Strain
	Subscapularis Tendinopathy
	Supraspinatus Tendinopathy
	Impingement Syndrome
	Bicipital Tendinopathy
	Calcific Tendinopathy
	AC Sprain
	Frozen Shoulder
	GH Instability
	Glenoid Labral Tear
	Glenohumeral Arthritis
Elbow & Forearm
	Table of Contents
	Elbow Exam Flow
	Elbow Kinematic Review
	Lateral Epicondylitis
	Medial Epicondylitis
	Pulled Elbow
	Olecranon Bursitis
	Elbow Osteochondritis Dessicans
	Cubital Tunnel Syndrome
	Elbow Sprain (UCL)
Wrist & Hand
	Table of Conntents
	Wrist & Hand Exam Flow
	Wrist & Hand Exam Form
	Wrist & Hand Kinematics
	Forearm & Hand Anatomy Review
	Carpal Tunnel Syndrome (CTS)
	Carpal Instability
	Wrist Sprain
	De Quervain’s Tenosynovitis
	Game Keeper’s Thumb
	Game Keeper’s Thumb
	Scaphoid Fracture
	Lunate Dislocation
	Keinböck’s Disease (lunate AVN)
	Triangular Fibrocartilage Tear
	Ganglion Cyst
Hip & Thigh
	Table of Contents
	Hip Exam Flow
	Hip Exam Form
	Hip Kinematics
	Hip Muscle Review
	Piriformis Syndrome
	Groin Strain
	Hamstring Strain
	Hip Bursitis
	Hip Osteoarthritis
	Hip Avascular Necrosis (AVN)
	Myositis Ossificans
	Septic Arthritis of Hip
	Slipped Femoral Epiphysis (SCFE)
	Snapping Hip Syndrome
	Transient Hip Synovitis
	Acetabular Labral Tear
	Inguinal & Femoral Hernia
	Congenital Hip Dysplasia
	Coxa Vara & Coxa Valga
	Table of Content
	Knee Exam Flow
	Knee Exam Form
	Knee Bone & Ligament Review
	Knee Muscle Review
	ACL Sprain/Tear
	ACL Sprain
	PCL Sprain/Tear
	PCL Sprain
	MCL Sprain
	LCL Sprain
	Meniscus Tear
	Chondromalacia Patella
	Genu Varum/Valgum/Recurvatum
	Jumper’s Knee (patellar tendinopathy)
	Iliotibial Band Tendinopathy
	Knee Bursitis
	Osteochondritis Dessicans
	Osgood Schlatter’s
	Patellar Dislocation
Leg, Ankle & Foot
	Table of Contents
	Ankle & Foot Exam Flow
	Ankle & Foot Exam Form
	Ankle & Foot Kinematic Review
	Ankle Muscle Review
	Foot & Toe Anomalies
	Inversion Ankle Sprain
	Inversion Sprain
	Eversion Sprain
	Shin Splints
	Compartment Syndrome
	Compartment Syndrome
	Tibial Stress Fracture
	Gastroc Strain (Tennis Leg)
	Gastrocnemius Strain
	Thrombophlebitis & DVT
	Deep Vein Thrombosis
	Varicose Veins
	Achilles Tendonopathy & Rupture
	Morton’s Neuroma
	Metatarsal Stress Fracture
	Plantar Fascitis
	Pronation Syndrome
	Table of Contents
	Systemic Exam Flow
	Abdominal Aortic Aneurysm
	Ankylosisng Spondylitis
	Bipolar Disorder
	Chronic Fatigue Syndrome
	Complex Regional Pain Syndrome
	Diabetes Mellitus
	Psoriatic Arthritis (PA)
	Reactive Arthritis
	Rheumatoid Arthritis
	Rheumatoid Arthritis
	Systemic Lupus Erythmatosis
Peripheral Neuro
	Table of Contents
	Neurologic Exam Flow
	Neurologic Exam Form
	Neuroanatomy Review
	Cutaneous Innervation (posterior)
	(anterior) Cutaneous Innervation
	Sensory Lesion Patterns
	CNS Lesion Patterns
	Motor Nerves Upper Extremity
	Motor Nerves Lower Extremity
	Brachial Plexus
	Lumbar & Sacral Plexus
	Radial Nerve
	Musculocut. & Axillary Nerves
	Median Nerve
	Ulnar Nerve
	Sciatic Nerve
	Femoral & Obturator Nerves
	Cranial Nerve Exam
Rehab. Protocols
	Table of Contents
	Brügger’s Exercise
	Protecting Your Back
	Dead Bug Track
	Prone Track
	Side-Lying Track
	Quadriped Track
	Neutral Pelvis Track
	Bridge Track
	Torso Rotation Track
	Core Leg Curl Track
	Shoulder Stretches
	Shoulder Strengthening
	Elbow Stretch & Strengthen
	Wrist & Hand Strengthening
	Wrist & Hand Stretch
	Hip Stretching
	Hip Strengthening
	Knee Stretch & Strengthen
	Ankle & Foot Strengthening
	Ankle & Foot Stretching
	Rocker & Wobble Board
	Advanced Wobble Board
	Computer Desk Ergonmics
	Table of Contents
	Musculoskeletal Nutrition
	Head & Neck Rapid DDx
	Chest Pain Rapid DDx
	Abdominal Rapid DDx
	Lumbar Sacroilliac Rapid DDx
	Shoulder & Arm Rapid DDx
	Elbow, Wrist & Hand Rapid DDx
	Hip & Thigh Rapid DDx
	Knee Rapid DDx
	Ankle & Foot Rapid DDx
	Key Movement Patterns (KMP)
	KMP: Shoulder ROM
	KMP: Trunk Flexion
	KMP: Neck Flexion
	KMP: Hip Extension
	KMP: Hip Abduction
	Blood Draw
	Complete Blood Count
	Endocrine Review
	ROM & End Feel
	Spinal Joint Listings
	Extremity Practical
	Spinal Practical
Back Cover
Document Text Contents
Page 219





Vizniak Hip & Thigh | 207

Hip Osteoarthritis
Diagnostic Imaging
• X-ray: best diagnostic tool - Kellgren-Lawrence

Grading System, uses 4 radiographic features:
• Joint space narrowing (= loss of cartilage)
• Osteophyte formation
• Subchondral sclerosis
• Subchondral cysts

• Usually WNL, possible elevated ESR
• May be used to rule out other pathologies


General Measures
• Acute: rest, NSAIDs, mild activity (water aerobics,

• Chronic: find a balance between rest & use, basic

ROM exercises & strengthening, weight loss if
obese, consider heat therapy to ↓ pain

Massage Therapy
• Swedish massage, pin & stretch, myofascial

release of tight or spasm tissue

Osseous Mobes/Manipulation
• Mobilization/manipulation of lower back, SI joints

hip & knees as indicated
• Avoid compressive maneuvers into hip

• Consider pulsed ultrasound, IFC or TENS

• Local points, LI4 GB30, GB34, ST35, ST36, GB39

Diet & Botanicals
• Decrease calorie intake if obese, osteoarthritis

exclusion diet (Hoffmann, 2003)
• Glucosamine & chondroitin sulfate
• Vitamin A, E, D, C, B6, Zn, Cu, pantothenic acid
• Harpagophytum procumbens (Devil’s claw)

• NSAIDs, Ibuprofen
• Intra-articular steriod injections (result in pain

reduction that lasts ~4-6 week only)
• Viscosupplementation - intra-articular injection of

hyaluronic acid

• Hip resurfacing - complications especially in

women (osteoporosis after menopause?)
• Total hip arthroplasty

• 95% improvement of joint function
• New joint lasts ~10-15 years depending on

patient activity level & other factors


Rehabilitation Program
• Consider orthotics or cane if indicated
• Many patients experience benefit from magnetic

bracelets (reduced pain)
• Tai chi, Yoga
• Music therapy associated with less acute

confusion in older persons following hip surgery

Prevention/Patient Education
• Weight reduction in obese patients
• Evaluation & modification of work environment
• Postmenopausal hormone replacement therapy

(HRT) potentially protective (controversial)

• Pain & disability often progresses over years but

may improve for 1 in 3 patients (Guyton & Brand,

• About 22% of patients ≥ 50 years old with incident
hip pain may have total hip replacement within
6 years

Hip DJD - note reactive sclerosis, joint
space loss & osteophyte formation

7-Hip & thigh NMS.indd 207 2014-01-16 6:24:22 AM

Page 220




h Vizniak208 | Orthopedic Conditions

Hip Avascular Necrosis (AVN)

Definition: death of the femoral head cortical bone
& marrow secondary to a disruption of blood
supply, bone structure then collapses causing
deformation, joint degeneration & pain - early
diagnosis is key to improved prognosis

Synonyms: AVN, osteonecrosis, aseptic (bone)
necrosis, ischemic bone necrosis, Chandler
disease, osteonecrosis of the femoral head
(ONF), Legg-Calve-Perthes disease in children

Pathophysiology: two main types both result in
ischemic loss of blood supply & cell death

• Local: secondary to acute trauma where the main
blood supply is damaged (fracture, dislocation)

• Systemic: none traumatic AVN that may appear
as multifocal epiphyseal necrosis, secondary to -
• Microscopic fat emboli, sickle cells, nitrogen

bubbles (caisson disease), focal clotting
(procoagulant abnormalities), elevated marrow
pressure or increased marrow fat (Gaucher
disease - lipid storage disorder)

• Use of high-dose corticosteroids carries a
reported 3-20% incidence of AVN

Incidence: ~15,000 cases/yr in US (accounts for

~10% of hip replacement surgery in US
Age: 40-50 yrs peak incidence (bilateral in 55%)
Gender: male > female (4-8:1)
Genetics: some genetic predisposition in families
Risk factors: systemic steroid use (both medical

& recreational), alcoholism, intravascular
coagulation, hypertension, sickle cell anemia,
vasculitis, radiation damage, iatrogenic (surgery,
organ transplant)


• Look for potential risk factors
• Gradual onset of dull achy hip or groin pain is

the most common presenting symptom, usually
worse with weight bearing & impact activities

• Pain may refer down to knee
• Initially may be asymptomatic, possible incidental

finding seen on diagnostic imaging
• Remember occurs bilateral ~55% of the time

Inspection: possible antalgic gait, (+) trendelenberg
• No bruising or swelling
• Possible short leg with femoral head collapse
• Possible tenderness around hip with associated

muscle spasm
• AROM & PROM: may be restricted & painful, with

possible crepitus with motion
• RROM: usually WNL
Neurovascular: usually WNL, in advanced disease

muscle wasting maybe noted secondary to disuse

Differential Diagnosis
• Osteoarthritis, Rheumatoid arthritis
• Septic arthritis (usually sudden onset)
• Hip synovitis/capsulitis, Groin strain, Hip bursitis
• Neoplasm
• Pain referral (pyelonephritis, Renal colic, Regional

ileitis, Appendicitis, Salpingitis)

Special Test
• (+) Scour (quadrant) test
• (+) Anvil test
• (+) Patrick’s (FABERE)
• (+) Laguerre

Femoral Head Blood Supply

Femoral artery
or deep femoral a.

Lateral circumflex a.
Medial circumflex a.

Artery of round
ligament of

femoral head
(from obturator a.)


Scour Test

7-Hip & thigh NMS.indd 208 2014-01-16 6:24:22 AM

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