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Essentials of Orthopedics for Physiotherapists
John Ebnezar, Rakesh John
SECTION ONE: GENERAL PRINCIPLES OF PHYSIOTHERAPY TREATMENT
1:
General Principles of Physiotherapy
DIAGNOSIS IN ORTHOPEDICS (APPROACH TO A PATIENT WITH ORTHOPEDIC DISORDERS)
At the End of History
Certain Points of Importance in the History
EXAMINATION
Step I
Examination of Gait
Definition
Step II
General Physical Examination
Step III
Clinical Examination
Signs
Movements of Joint
Measurements
Step IV
Investigations
Treatment Methods
Role of a Physiotherapist
Assessment
CARDIOPULMONARY CONDITIONING
Benefits of CPC
2:
Role of Physical Agents in Physiotherapy
HEAT THERAPY
Mode of Action
Benefits
Goal
Time
Types
Superficial Heating Agents
Hydrocollator Packs
Infrared
Paraffin Bath
Other Superficial Heating Methods
Deep Heating Agents
Microwave
Shortwave
Ultrasound (Figs 2.2A to C)
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (Fig. 2.3)
COLD THERAPY
HYDROTHERAPY
Whirlpool Therapy
Therapeutic Pool
Advantages of Pool Therapy
3:
Massage
TYPES
Effleurage
Deep Stroking Massage
Petrissage
Friction
Percussion (Tapotement)
4:
Hydrotherapy
PHYSICAL PROPERTIES OF WATER
Specific Heat/Thermal Conductivity
BOUYANCY
Resistance
Hydrostatic Pressures
Hydrodynamic Pressures
USES OF HYDROTHERAPY/INDICATION
PHYSIOLOGICAL EFFECTS
Cleansing Effects
Musculoskeletal Effects
Cardiovascular Effects
Respiratory Effects
HEMORRHAGE
Adverse Effects
APPLICATION TECHNIQUE (HYDROTHERAPY)
Whirlpool
Procedure
Advantages
Hubbard Tank
5:
Suspension
DEFINITION
USE OF SUSPENSION
APPARATUS USED
Suspension Apparatus
Ropes
Slings
Hooks
TYPE OF SUSPENSION
Axial Fixation
Vertical Fixation
Pendular Fixation
SUSPENSION FOR UPPER EXTREMITY
Abduction and Adduction
Flexion and Extension
Medial/Lateral Rotation
Elbow Joint
LOWER LIMB SUSPENSION
Hip
Abduction and Adduction
Flexion and Extension
Medial/Lateral Rotation of Hip
Knee Joint
Flexion and Extension
DISADVANTAGES OF SUSPENSION
ADVANTAGES
6:
Therapeutic Exercises
GOAL
BASIC PRINCIPLES
COMPREHENSIVE EXERCISE PROGRAM
Range of Motion Exercises
Aim
Benefits
Principles
Types of ROM Exercises
Procedural Norms During ROM Exercises
Strengthening Exercises
Basic Exercises of Strengthening (Table 6.1)
High Performance Strengthening Exercise
Types of Muscle Contraction During Exercise
7:
Ambulation After a Lower Limb Fracture
MAKING AMBULATION POSSIBLE
PREAMBULATION MEASURES
Measures to Obtain Joint Mobility
Measures to Strengthen the Muscles
Measures to Prevent Contractures and Deformities
AMBULATION PHASE
Assistive Devices
Parallel Bars (Fig. 7.2)
Walkers (Fig. 7.3)
Crutches
Cane
ASSISTIVE DEVICES FOR DAILY LIVING ACTIVITIES
Upper Limbs
Lower Limbs
Hip Joint
Knee Joint/Leg/Foot and Ankle
Role of Braces and Splints
Role of Traction
8:
Wheelchairs
WHEELCHAIR ACCESSORIES
Assuming Standing and Seated Position with Walker
Coming to Standing
Return to Sitting
Break Extensions
TYPES OF WHEELCHAIR
Hand Propelled Folding Transit Chair
Standard and Junior Models
Standard Light Weight Chair
Simireclining Back Chair
Transit Chair
Power Drive Chair
Stand-up Chair
Chair with Variable Seat Height
Sports Chair
High Performance Wheelchair
Outdoor Wheelchair/Vehicles
TRANSFERS
Transfers by Therapist
Position of Therapist to Transfer the Patient to Right
Action of Therapist
Cervical Lift Using Two Therapists
Transfer from Bed to Chair
Position of Therapist to Transfer the Patient to Left
Independent Transfer
To Transfer to Plinth (Morning to Right)
To Transfer to the Floor
SECTION TWO: GENERAL PRINCIPLES OF FRACTURES AND DISLOCATIONS
9:
Know Your Skeletal System
HOW I START DEVELOPING?
Osteon
PORTIONS OF BONE
Medulla
Cortex
GENERAL STRUCTURE
Epiphysis
Growth Plate (Physis)
Metaphysis
Diaphysis
ORGANIZATION OF THE BONES
TYPES OF BONES (Figs 9.3A TO C)
JOINTS
Fibrous Joint or Synarthrosis
Cartilaginous Joints or Amphiarthrosis
Synovial Joints or Diarthrosis
Types of Synovial Joints (Figs 9.4A to G)
10:
General Principles of Fractures, Dislocations and their Treatment
DEFINITIONS
TYPES OF FRACTURE
Atypical Fractures (Figs 10.6A to D)
Displacement of Fractures
APPROACH TO ORTHOPEDIC INJURY
Mechanism of Injury
Clinical Features
Clinical Signs
About Crepitus
About Tenderness
Clinical Manifestations Due to Neurovascular Injuries
DEFORMITIES
Definition
Classification
Congenital Deformities (Since Birth)
Acquired Deformities
Clinical Facts (Table 10.5)
Bone Causes
Joint Causes
Deformity due to Soft Tissue Contractures
Treatment Options
Conservative Measures
Surgical Measures
INVESTIGATIONS IN ORTHOTRAUMA
Radiography
CT Scan and MRI
PATHOLOGICAL FRACTURES (Box 10.4)
Clinical Features
Investigation
Treatment
Fatigue or Stress Fractures
Radiograph
Treatment
DISLOCATIONS
Pathology
Types
Congenital or Acquired
Clinical Features
Investigations
Treatment
Rehabilitation in Dislocations
Complications
Subluxation
Sprain
Strain
FRACTURE HEALING
Methods of Fracture Healing
Indirect Fracture Healing
Primary Bone Healing (Direct Bone Healing, Healing by Primary Intention)
Distraction Histogenesis
11:
Open Fractures
CLASSIFICATION
APPROACH IN COMPOUND FRACTURES
INVESTIGATIONS
MANAGEMENT PRINCIPLES
Considerations
Treatment Plan
Debridement
Other Forms of Fracture Immobilization
Definitive Wound Care
REHABILITATION IN COMPOUND FRACTURES
Rehabilitation Protocol in Compound Fractures
APPROACH TO A POLYTRAUMA CASE
Fracture Examination
Investigation
12:
Fracture Treatment Methods: Then, Now and Future
PLASTER BANDAGES
TRACTION
FUNCTIONAL BRACE
OPEN FRACTURES
EARLY FRACTURE SURGERY
External Fixation
Intramedullary Fixation
AO Group
METHODS OF FRACTURE TREATMENT
No Treatment
Strapping
Conservative Methods
Operative Treatment of Fractures
Treatment of Fractures by External Fixators (Figs 12.5A and B)
Functional Cast Bracing
SPLINTS, TRACTION AND IMPLANTS
Plaster of Paris Splint
History
Chemical Formula
Types of POP
Why is Plaster of Paris an Ideal Splint?
Various Forms of POP
Rules of Application of POP Casts
Complications of POP
Rehabilitation Protocol
Functional Cast Brace
Mode of Action
Rehabilitation Protocol
Important Splints in Orthopedics Other than POP
Thomas Splint
Bohler-Braun Splint (Fig. 12.10)
Care of the Splints
Rehabilitation Protocol for Splints
Practical Points
TRACTION IN ORTHOPEDICS
Uses of Traction
Methods of Traction
Skin Traction (Fig. 12.11)
Skeletal Traction
IMPLANTS
Types of Implants
Metallic
Nonmetallic Implants
Commonly Used Implants
Screws
Plates
Intramedullary Nail
Types of Intramedullary Nails (Fig. 12.22)
MANAGEMENT OF FRACTURES
Management of Simple Fractures
Conservative Methods
Management of Fractures by Closed Reduction
Fracture Management by Open Reduction (Operative Management)
Principles of Open Reduction
Retention after Open Reduction
Rehabilitation in Fractures treated by Internal Fixation
RECENT ADVANCES IN FRACTURE TREATMENT
Improvements in Plaster of Paris Splints
Functional Cast Brace
Improvements in AO Technique
Improvements in Intramedullary Nails
Interlocking Nails
Advantages
Principles
Rehabilitation Protocol
Improvements in External Fixation
Ilizarov Technique
13:
Fracture Healing
METHODS OF FRACTURE HEALING
Indirect Fracture Healing
Direct Bone Healing (Healing by Primary Intention)
Distraction Histogenesis
Factors Affecting Fracture Repair (Box 13.1)
14:
Complications of Fracture
ACUTE RESPIRATORY DISTRESS SYNDROME (FAT EMBOLISM)
Etiology
Management
VOLKMANN'S ISCHEMIA OR COMPARTMENTAL SYNDROMES
Definition
Sites
COMPARTMENTAL SYNDROME OF FOREARM
Definition
Incidence and Etiology
Clinical Features
Management
Acute Stage
Established VIC
Late Cases
Serial Splinting in VIC
Aim
Splint
Stages
Adjunctive Measures
Post-surgery Physiotherapy Measures in VIC
During Immobilization
During Mobilization
CHRONIC COMPARTMENTAL SYNDROME
NONUNION
Definition (FDA Panel)
Causes
Compound Fractures
Infection
Segmental Fractures
Distraction of Fracture Fragments
Soft tissue Interposition
III-advised Open Reduction
Insecure and Inadequate Fixation
Clinical Features
History
Symptoms
Signs
Investigation
Radiograph
Management
Principles
Role of Ilizarov in Nonunion
Role of Physiotherapy in Nonunion
AVASCULAR NECROSIS
Causes
Common Sites
Problems
Clinical Features
Investigations
Treatment
TRAUMATIC MYOSITIS OSSIFICANS
Definition
Causes
Trauma
Simple Blow or Repeated Minor Trauma
Dislocations and Avulsion Injuries
III-advised Massage
Clinical Features
Investigations
Radiography
Treatment
Acute Stages
Later Stages
Chronic Stages
Post-surgery Physiotherapy Management
First 2 Weeks
After 2 Weeks
MALUNION
Causes
Closed Reduction
Improper Immobilization Techniques
Treatment by Quacks
Multiple and Multisystem Injuries
Classification
Types
Clinical Features
Treatment
OTHER IMPORTANT COMPLICATIONS OF FRACTURES
Deep Vein Thrombosis and Pulmonary Embolism
Homan's Sign
Treatment
Anticoagulant Therapy
Embolic Facts
Physiotherapy Measures
INJURY TO BLOOD VESSELS
Causes of Injury
Effects of Injury
Clinical Features
Investigations
Treatment
Physiotherapy Measures
INJURY TO NERVES
Incidence
Mechanism of Injury
Types of Nerve Injury
Rehabilitation Nerve Injuries
Crush Syndrome
Post-traumatic Osteoarthritis
15:
Soft Tissue Injuries
MECHANISM OF INJURY
APPROACH TO A PATIENT WITH SOFT TISSUE INJURY
Patient's Story
Observation
Goal Setting
Goals of Soft Tissue Injury Treatment
Execution of Plan
CLASSIFICATION OF SOFT TISSUE INJURY
Strains
Reasons
Types
Severity of Strain
INJURIES TO THE JOINTS
Ligament Injury (Sprain)
Anatomy
Function
Problems of Healing
Types of Sprain
Injury to the Synovium
Relevant Anatomy
Functions
Causes
Types
Acute Synovitis
Chronic Synovitis
Tenosynovitis
Tenovaginitis
Injury to the Bursa
Functions
Types
Causes
Common Sites
Clinical Features
Treatment
SPECIAL TYPES OF MUSCLE INJURIES
Bruise or Contusion
Hematomas
Treatment
IMPORTANT SOFT TISSUE PROBLEMS
Upper Limb
Shoulder
Elbow
Wrist
Lower Limbs
Hip and Pelvis
Knee and Leg
Ankle and Foot
FIBROMYALGIA
Incidence
Causative Factors
Clinical Features
Diagnostic Criteria
Treatment
Alternative Therapies
16:
First Aid and Emergency Care of the Injured
DEFINITION
GOALS OF FIRST AID TREATMENT
INITIAL CARE OF THE INJURED
At the Scene of Accident
MODUS OPERANDI IN FIRST AID
Airway
Cardia
Bleeding
EXAMINING THE VITAL STRUCTURES
Head Injuries
Chest Injuries
Abdominal Injuries
Pelvic Fractures
Injuries to the Genitourinary System
Spine Injuries
Fractures
MANAGEMENT AT THE HOSPITAL
SECTION THREE: TRAUMATOLOGY
17:
Fracture Clavicle and Injuries of Acromioclavicular Joints
FRACTURE CLAVICLE
Mechanism of Injury
Direct
Direct Trauma
Indirect
Sites of Fracture
Clinical Features
Investigation
X-ray Clavicle
Treatment
Principle of Treatment
Goals
Treatment Methods (Figs 17.4A to C)
Complications of Fracture Clavicle
Immediate
Late
Rehabilitation Program
Conservative Treatment (Box 17.1)
Surgery
INJURIES OF THEACROMIOCLAVICULAR JOINT
Mechanism of Injury
Direct Force
Indirect Force
Clinical Features
Investigation
Management
Complications
Physiotherapy Measures
Goal
Conservative Treatment
Surgical Treatment
FRACTURE OF THE SCAPULA
Mechanism of Injury
Clinical Features
Investigation
Treatment
Rehabilitation Program
Aim
Steps
18:
Injuries Around the Shoulder
ANTERIOR DISLOCATION OF SHOULDER
Mechanism of Injury
Types
Clinical Features
Radiograph
Treatment
Physiotherapy Management
Aim
Strengthening Exercises
RECURRENT DISLOCATIONOF THE SHOULDER
Causes
Mechanism of Dislocation
Pathological Anatomy
Triad of Essential Lesion
How does RDS Occur?
Clinical Features
Investigations
Treatment
Physiotherapy Management (Box 18.2)
Approach No. 1 (Health Education)
Approach No. 2 (Muscle Education or Strengthening)
Approach No. 3 (Movement Training)
19:
Injuries of the Upper Arm
PROXIMAL HUMERAL FRACTURES
Mechanism
Classification
Clinical Features
Radiograph
Management
Undisplaced fractures
Displaced Fractures
Complications
Rehabilitation Program
Physiotherapy Methods
Conservative Treatment
Surgery
FRACTURE OF GREATER TUBEROSITY OF HUMERUS
Clinical Features
Radiograph
Treatment
Physiotherapy Measures
FRACTURE SHAFT HUMERUS
Anatomic Considerations
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Conservative Methods
Operative Treatment
Complications
Physiotherapy Treatment
During the 1st Week
During the 2nd Week
During 4–6 Weeks
During 8–12 Weeks
20:
Injuries of the Elbow
CLASSIFICATION OF FRACTURES OF DISTAL HUMERUS IN CHILDREN
SUPRACONDYLAR FRACTURE
Mechanism of Injury
Classification
Gartland's Classification
Clinical Features
Radiograph
Management
Complications
Complications Causing Functional Impairment
Complications that Produce Cosmetic Abnormalities (Figs 20.8A and B)
Flexion Type of Supracondylar Fracture
Mechanism of Injury
Mechanism of Injury
Clinical Features
Radiography
Treatment
Complications
Physiotherapy Management
Rehabilitation Programs
INTERCONDYLARFRACTURES OF THE HUMERUS
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Physiotherapy Management
PHYSEAL FRACTURES
Physiotherapy Measures
POSTERIOR DISLOCATION OF ELBOW JOINT
Mechanism of Injury
Classification (Stimson)
Clinical Features
Radiograph
Treatment
Complications
Physiotherapy Management
During the First 3 Weeks
After 3 Weeks
SIDESWIPE INJURIES
Synonyms
Mechanism
Shorbe's Classification
Clinical Features
Radiograph
Methods of Treatment
Primary Amputation
Physiotherapy Treatment for Sideswipe Injuries
RADIAL HEAD FRACTURE
Mechanism of Injury
Mason's Classification (Figs 20.24A to C)
Clinical Features
Radiograph
Treatment
Complications
Physiotherapy
Treatment Goals
Methods of Treatment
FRACTURE OF THE OLECRANON
Mechanism of Injury
Colton's Classification (Figs 20.28A to C)
Clinical Features
Radiograph
Treatment
Three Methods of Operative Treatment
Complications
Physiotherapy Management
Conservative Management
Surgery (Open Reduction and Internal Fixation/Excision) (Fig. 20.32)
FRACTURE OF THE CAPITULUM
Clinical Features
Radiograph
Treatment
Conservative Treatment
Surgical Management
Physiotherapy Measures
21:
Injuries of the Forearm
FRACTURES OF THE FOREARM BONES
FRACTURE OF BOTH BONES OF FOREARM (FIG. 21.1)
Mechanism of Injury
Clinical Features
Radiograph
Management
Complications in Fracture of Both Bones of Forearm
MONTEGGIA FRACTURE
Mechanism of Injury
Classification
Clinical Features
Radiograph
Treatment
Complications
GALEAZZI FRACTURE
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Complications
ESSEX-LOPRESTI FRACTURE
Treatment Goals in Forearm Fractures
Orthopedic Goals
Rehabilitation Goals
Functional Goals
Methods of Rehabilitation in Forearm Bone Fractures
Conservative Management
Surgical Management
Functional Rehabilitation
22:
Injuries of the Wrist
COLLES’ FRACTURE
Mechanism of Injury
Clinical Features
Radiograph
Treatment Methods
Aim
Classification
Complications
Rehabilitation Program
Orthopedic Goals
Rehabilitation Goals
Functional Goals
Vital Facts
Rehabilitation Methods
1st Week
2nd week
4–6 Weeks
Methods of Wrist Mobilization
6–8 Weeks
Wrist Mobilizer
SMITH'S FRACTURE (Figs 22.12A and B)
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Complications
SCAPHOID FRACTURE
Interesting Features
Anatomical Peculiarities
Mechanism of injury
Clinical Features
Investigation
Conservative Management
Indications
Types
Surgical Management
Indications
Surgical Methods
Complications
Goals of Treatment in Scaphoid Fractures
Orthopedic Goals
Rehabilitation Goals
Functional Goals
Physiotherapy Measures
During First 2 Weeks
During 4–6 Weeks
During 8–12 Weeks
During 12–16 weeks
BARTON'S FRACTURE
Dorsal Barton
Mechanism
Clinical Features
Radiograph
Treatment
Volar Barton (Palmar Rim Dislocation)
Mechanism
Clinical Features
Treatment
RADIAL STYLOID FRACTURE (CHAUFFEUR'S FRACTURE)
Mechanism
Clinical Features
Radiographs
Treatment
23:
Injuries of the Hand
METACARPAL FRACTURES
Mechanism of Injury
Clinical Features
Investigation
Goals of Treatment
Orthopedic Goals
Rehabilitation Goals
Functional Goals
Treatment Methods
Conservative Treatment with Cast or Splints (Stress Sharing)
Closed Reduction and Percutaneous Fixation with K-wire (Figs 23.3 to 23.5)
Open Reduction and Internal Fixation
Rehabilitation Protocol in Metacarpal Fractures
During the 1st Week
During the 2nd Week
During the 4–6 Weeks
FRACTURES OF THE PHALANX
Orthopedic Objective
Rehabilitation Goal
Functional Goals
Methods of Treatment
Conservative Treatment
Closed Reduction and Cast or Splint
Percutaneous Pinning
Open Reduction and Internal Fixation
External Fixators
SPECIAL PHALANGEAL FRACTURES
Mallet Finger
Nail Bed Injury
Boutonnière Deformity
Proximal IP Joint Fracture Dislocation
Physiotherapy Measures in Phalangeal Fractures
During the 1st Week
During the 2nd Week
During 3–6 Weeks
During 4–6 Weeks
Supportive Therapy
24:
Injuries Around the Hip
FRACTURE OF NECK FEMUR
Problems of Healing, Why?
Etiology
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Aims of Treatment
Methods of Internal Fixation
Meyer's Muscle Pedicle Graft
Other Treatment Options
COMPLICATIONS OF FEMORAL NECK FRACTURE
Thromboembolism
Nonunion
Causes
Clinical Features
Radiograph
Treatment
Osteotomy
Hemireplacement Arthroplasty
Total Hip Replacement
Avascular Necrosis
Incidence
Clinical Features
Radiograph
Treatment
Fracture Neck of Femur at a Glance
Physiotherapy Management
SUBTROCHANTERIC FRACTURE
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Physiotherapy Measure
INTERTROCHANTERIC FRACTURE
Salient Features
Mechanism
Clinical Features
Radiograph
Treatment
Complications
Physiotherapy Management
DISLOCATION AND FRACTURE DISLOCATION OF THE HIP
Posterior Dislocation of Hip Joint
Mechanism of Injury
Clinical Features
Radiograph
Treatment
25:
Fracture Femur
FRACTURE SHAFT FEMUR
Mechanism of Injury
Clinical Features
Radiograph
Management
General Principles
Treatment Methods
Children
Adults
Types of Intramedullary Nails
Complications of Fracture Shaft Femur
Physiotherapy Management for Fracture Shaft Femur
Physiotherapy Regimen after Surgery
During the first 10 Days
After 10 days
FRACTURE DISTAL FEMUR
SUPRACONDYLAR FRACTURE OF FEMUR
Mechanism of Injury
Neer's Classification (Figs 25.10A to D)
Clinical Features
Radiograph
Treatment
Conservative Methods
Traction Methods
Operative Methods
Fixation Methods
Complications
PHYSIOTHERAPY MANAGEMENT
FURTHER MANAGEMENT
26:
Proximal Tibial Fracture
CAUSES
TYPES (Fig. 26.1)
CLASSIFICATION
Clinical Features
Investigations
MANAGEMENT
Aim
Plateau Fracture
Split Fracture
COMPLICATIONS
PHYSIOTHERAPY TREATMENT
Goals
Interventions
During the First 2 Weeks
After 2 Weeks
FRACTURE TIBIA AND FIBULA
Features
Mechanism of Injury
Clinical Features
Investigations
Methods of Treatment
Conservative Management
Operative Treatment
Physiotherapy Treatment
27:
Injuries of the Knee Joints
KNEE LIGAMENT INJURIES
General Principles
Etiology
Mechanism of Injury (Palmar)
Goals of Treatment
COLLATERAL LIGAMENT INJURY
Classification
American Medical Association
Medial Collateral Ligament Tear
Clinical Tests
Investigations
Lateral Collateral Ligament Tear
Treatment of Collateral Ligament Injuries
General Principles
Physiotherapy Treatment
CRUCIATE LIGAMENT INJURIES
Anterior Cruciate Ligament (ACL) Tear
Mechanism of Tear
Clinical Features
Investigations
Treatment
Conservative
Surgical
Posterior Cruciate Ligament Tear
Clinical Features
Investigations
Treatment
PHYSIOTHERAPY MEASURES FOR INTERNAL DERANGEMENT OF KNEE
During the Initial Stages
During Postacute Stage
Specific Physiotherapy Measures
After Ligament Repair
SEMILUNAR CARTILAGES
Anatomy
Functions of the Menisci
Smillie's Classification
Medial Meniscus Injury
Mechanism of Injury
Predisposing Factors
Clinical Features
Investigations
Differential Diagnosis
Treatment
Procedures
Physiotherapy Measures After Meniscectomy
PHYSIOTHERAPY MEASURES AFTER ARTHROSCOPY
Preoperative Physiotherapy
Postoperative Physiotherapy
FRACTURE OF PATELLA
Mechanism of Injury
Classification (Figs 27.20A to D)
Clinical Features
Radiograph
Management
Surgical Methods (Figs 27.24 and 27.25)
Complications
Disadvantages of Patellectomy
Extensor Lag (Fig. 27.26)
Physiotherapy Management
Physiotherapy Management for Patella Fractures Treated Conservatively
Physiotherapy Management for Surgically Treated Patellar Fractures
Types of Isometric Quadriceps Exercises
ACUTE DISLOCATION OF PATELLA
Clinical Features
Radiograph
Treatment
Physiotherapy Measures
During the Period of Cast Immobilization
After Removal of the Cast
ACUTE DISLOCATION OF KNEE
Clinical Features
Radiograph
Treatment
Conservative
Surgery
Physiotherapy Measures
SOFT TISSUE INJURIES AROUND THE KNEE AND THE THIGH
Injury to the Extensor Apparatus of Knee
Quadriceps Strain
Patellar Tendonitis (Jumper's Knee)
Clinical Features
Treatment
Prepatellar Bursitis
Plica Syndrome
Other Thigh and Leg Muscle Strains
Hamstrings Strain
Calf Muscle Strain
Achilles Tendon Injury
Treatments
Rupture of Achilles Tendon
Treatment
28:
Injuries of Ankle
ANKLE JOINT SPEAKS
MECHANISM OF INJURY
Force Influencing Ankle Injuries
CLINICAL FEATURES
INVESTIGATION
TREATMENT OF ANKLE INJURIES
Goals
For Stable Injuries
For Unstable Injuries
Fracture due to External Rotation
Fracture Primarily due to Abduction
Fracture Primarily due to Adduction
Fracture Resulting from Primarily Vertical Compression
COMPLICATIONS
PHYSIOTHERAPY MANAGEMENT OF ANKLE INJURIES
Goals
Orthopedic Goals
Rehabilitation Goals
Functional Goals
Physiotherapy for Ankle Injuries
Treated Conservatively
Treated Surgically
ANKLE SPRAIN
TYPES
Lateral Ligament Sprain (Fig. 28.11)
Clinical Features (Fig. 28.12)
Medial Ligament Sprain
Grading of Ankle Sprains
TREATMENT
Grade I Sprain (Rice Regimen)
Grade II Sprain (Partial Tear)
Strapping
Cast Bracing
Long Leg Cast
Grade III
29:
Injuries of the Foot
FRACTURE CALCANEUM
Mechanism of Injury
Clinical Features
Radiology
Treatment
Extra-articular Fractures
Intra-articular Fractures
Management
Orthopedic Goals
Rehabilitation Goals
Functional Goals
Physiotherapy Management for Calcaneal Fractures Treated by Essex–Lopresti Method
Physiotherapy Management for Calcaneal Fractures Treated Conservatively with Short Leg Cast
Complications
FRACTURE TALUS (BOX 29.1)
Blood Supply of Talus
Fracture Neck Talus
Mechanism of Injury
Classification (Table 29.1 and Fig. 29.7)
Clinical Features
Radiology
Treatment
Complications
Physiotherapy Management of Talus Fracture
Physiotherapy Management After Conservative Treatment
Physiotherapy Management After Surgical Treatment
Additional Measures
MIDFOOT FRACTURES
Mechanism of Injury
Clinical Features
Radiology
Treatment Goals
Orthopedic Goal
Rehabilitation Goals
Functional Goals
Methods of Treatment
Lisfranc Injuries (Figs 29.12A and B)
Navicular, Cuboid and Cuneiform Fractures
Physiotherapy Management for Midfoot Fractures
During the First 2 Weeks
After 2 Weeks
After 8–12 Weeks
FRACTURE OF THE FOREFOOT
Mechanism of Injury
Phalangeal Fractures
Clinical Features
Radiology
Metatarsal Fractures
Clinical Features
Sesamoid Bone Fractures (Fig. 29.19)
Treatment Goals in Forefoot Fractures
Orthopedic Goals
Rehabilitation Goals (Fig. 29.20)
Functional Goals
Methods of Treatment
Lesser Phalanx Fracture
Second, Third and Fourth Metatarsal Fractures
Fifth Metatarsal Fracture
Great Toe Phalanx Fractures
First Metatarsal Fracture
Sesamoid Bone Fractures
Physiotherapy Management
During the First 2 Weeks
After 2 Weeks
SECTION FOUR: AXIAL SKELETON INJURIES
30:
Fracture of Pelvis
PELVIC FRACTURES
Stable Pelvic Fracture
Unstable Pelvic Fracture
Mechanism of Injury
Classification
Fractures not Affecting the Integrity of the Pelvic Ring
Fractures Affecting the Integrity of the Pelvic Ring
Clinical Features
Symptoms
Clinical Signs
Clinical Tests
Compression Test
Distraction Test
Direct Pressure Test
Investigations
Radiography
CT Scan
Management
Treatment Methods
Physiotherapy Management for Pelvic Fractures
Physiotherapy Treatment for Fractures not Affecting the Integrity of the Pelvic Ring
Physiotherapy Management for Fractures Affecting the Integrity of Pelvic Ring
COCCYX FRACTURES
Mechanism
Clinical Features
Investigations
Management
Conservative Measures
Injection Therapy
Surgery
Physiotherapy Management
RIB FRACTURES
Mechanism of Injury
Clinical Features
Radiography
Management
Complications
Physiotherapy Management
31:
Injuries of Spine
ABOUT SPINE
INJURIES OF CERVICAL SPINE
Causes
Mechanism of Injury (Figs 31.5A to D)
Allen's Classification [6 Patterns (Figs 31.6A to D)]
Compressive Flexion (5 Stages)
Vertical Compression (3 Stages)
Distractive Flexion (4 stages)
Compression Extension (5 Stages)
Distractive Extension
Lateral Flexion
Clinical Features
Concussion
Nerve Root Involvement
Cord Involvement
Vital Steps
Other Examinations
Investigations
Radiography
Myelography
Computed Tomography Scan
Magnetic Resonance Imaging Evaluates
General Laboratory Investigations
Treatment Facts (Box 31.2)
Treatment Methods
At the Accident Site
At the Hospital
Surgical Treatment
Physiotherapy Management of Cervical Vertebral Fractures
Orthopedic Goals
Rehabilitation Goals
Functional Goals
Individual Cervical Fracture of Interest
Fracture of C1
Clinical Features
Radiology
Treatment
PHYSIOTHERAPY MANAGEMENT OF C1 FRACTURE (JEFFERSON FRACTURE)
During the First 2 Weeks
After 2 Weeks
Rotary Subluxation
Odontoid Process Fracture (Figs 31.23A to C)
Hangman's Fracture
CERVICAL SPINE INJURIES WITH NEUROLOGICAL PROBLEMS
Management of Quadriplegia
Physiotherapy Measures during the Spinal Shock
Measures to Combat Early Spinal Shock Complications
Physiotherapy Measures Post spinal Shock
THORACIC AND LUMBOSACRAL SPINE INJURIES
Mechanism of Injury
McAfee's Classification (3-Column) (Figs 31.25A to F)
Clinical Features
Investigations
Radiography of the Affected Spine (Figs 31.27 and 31.28)
CT Scan and MRI
Management
Management at the Site of Accident
Definitive Treatment at the Hospital
For Stable Fracture Without Neurological Deficit
For Stable Fracture with Neural Deficit
Unstable Fracture without Neurological Deficit
Unstable Fracture with Neurological Deficit
Physiotherapy Management of Thoracic and Thoracolumbar Fractures
Orthopedic Goals
Rehabilitation Goals
Functional Goals
During the First 2 Weeks
After 2 weeks
By 8–12 Weeks
By 12–16 Weeks
SPINAL CORD INJURY
Pathology
Clinical Classification of Neurological Damage
Injury at the Cervical Level
Injuries at the Thoracic Level
Injuries at the Thoracolumbar Region
Injuries below L1
Clinical Assessment
General Examination
Neurological Examination
Return of Reflex Activity
Total Sensory and Motor Paralysis
Investigations
Treatment
Paralyzed Bladder
UMN Type (Automatic Bladder)
LMN Type (Autonomous Bladder)
Bedsore Management (Fig. 31.39)
Nursing Goals (Box 31.3)
Bowel Program
Reflex Emptying
Sex Rehabilitation
Beds
Family Education
Physical Therapy
Physiotherapy for a Paraplegic Patient
Strengthening of Specific Group of Muscles
Gait Training and Ambulation
Additional Measures
Occupational Therapy
Social Therapy
SECTION FIVE: REGIONAL ORTHOPEDICS
32:
General Principles of the Treatment of Orthopedic Disorders
MASTERLY INACTIVITY
CONSERVATIVE METHODS
Rest
Support
Physiotherapy
Active Exercises
Passive Exercises
Electrical Muscle Stimulation
Hydrotherapy
Heat Therapy
Manipulation
Radiotherapy
Massage
Drugs
OPERATIVE METHODS
Osteotomy
Physiotherapy Measures following Osteotomy
Arthrodesis
Methods
Physiotherapy Following Arthrodesis
ARTHROPLASTY
Types of Arthroplasties of Hip
Excision Arthroplasty of Hip
Physiotherapy Measures following Excisional Arthroplasty
Hemireplacement Arthroplasty
Preoperative Regime
Physiotherapy Management after Hemireplacement Arthroplasty of Hip
Total Hip Arthroplasty or Replacement
Physiotherapy Measures Following Total Hip Replacement
Total Knee Replacement
Physiotherapy Measures in TKR
Total Ankle Arthroplasty
Physiotherapy Measures
Arthroplasty of the Upper Limbs
Types of Prosthesis
Physiotherapy Management
Postoperative Management
Elbow Arthroplasty
Types
Total Wrist Arthroplasty
Hand Arthroplasty
ARTHROSCOPY
Bone Graft Operations
Types
Role of a Bone Graft
Tendon Surgeries
Tendon Transfers
Tendon Grafting
Other Important Surgeries
Equalization of Leg Length
Excision of Tumors
Amputations
33:
Regional Conditions of Neck
TORTICOLLIS (WRY NECK)
Causes
Clinical Features
Management
Conservative
Physiotherapy Measures
Surgical Management
THORACIC OUTLET SYNDROME
Sites of Compression
Contributing Factors
Dynamic Factors
Static Factors
Clinical Features
Vascular Problems
Neurogenic Problems
Complications
Investigations
X-ray Neck
Nerve Conduction Studies
Treatment
Physiotherapy Measures
CERVICAL RIB
Developmental Factors
Types
Pathological Anatomy
Clinical Features
Treatment
Physiotherapy Treatment
CERVICAL DISK SYNDROMES
Types
Clinical Features (Figs 33.8A and B)
Investigations
Treatment
Preventive Measures
Cervical Traction
Continuous Traction
Static Traction
Intermittent Traction (Fig. 33.17)
Polyaxial Cervical Traction
34:
Regional Conditions of the Upper Limbs
FROZEN SHOULDER
History
Causes
Primary Shoulder Causes
Secondary Non-Shoulder Causes
Pathogenesis
Clinical Features
Investigations
Treatment
Stage I
Stage II and III
Shoulder Mobilization Techniques
Passive Mobilization Technique after the Initial Thermotherapy
Patient Heal Thyself (Role of the Patient)
Management
What is new?
ROTATOR CUFF LESIONS
Clinical Features
Investigations
Treatment
Physiotherapy in Rotator Cuff Lesions
Preventive Measures
SUBACROMIAL BURSITIS
Clinical Features
Investigations
Treatment
SUBSCAPULARIS TENDINITIS
Clinical Features
Investigations
Treatment
BICIPITAL TENDINITIS
Clinical Features
Diagnostic Test
Treatment Method
INFRASPINATUS TENDINITIS
Clinical Features
Clinical Test
Treatment
Physiotherapy Measures
SUPRASPINATUS TENDINITIS
Impingement Syndrome
Clinical Features
Investigations
Management
TENNIS ELBOW
History
Definition
Lateral Tennis Elbow
Causes
Pathophysiology and Related Symptoms
Clinical Tests
Investigations
Treatment
GOLFER's ELBOW
Definition
Clinical Features
Treatment
DE QUERVAIN's DISEASE AND TRIGGER FINGER
Etiology
Clinical Features
De Quervain's (Refer Fig. 34.28)
Trigger Finger (Figs 34.32A and B)
Treatment/Management
Surgery
Physiotherapy Measures
GANGLIA
Definition
Origin
Sites
Predisposing Factors
Treatment/Management
Physiotherapy Measures
DUPUYTREN's CONTRACTURE
Causes
Pathogenesis
Clinical Features
Treatment/Management
Observation
Radiotherapy
Surgery
Physiotherapy Measures
CARPAL TUNNEL SYNDROME
Anatomy
Causes
General
Local
Clinical Features
Clinical Tests
Wrist Flexion (Phalen's Test)
Tourniquet Test
Median Nerve Percussion Test (Fig. 34.39)
Median Nerve Compression Test (Fig. 34.40)
Other Tests
Treatment/Management
Non-operative Methods
Physiotherapy Measures
Injection Treatment
Surgery
COMPOUND PALMAR GANGLION
Clinical Features
Treatment/Management
Physiotherapy Measures
OLECRANON BURSITIS (STUDENT's ELBOW)
Clinical Features
Investigations
Treatment
35:
Hand Disorders
ANATOMY OF THE HAND
Skin
Muscles and the Nerves
Joints and Ligaments of the Hand
FUNCTIONS OF THE HAND
Power Grip
Precision Grip
Sensory Supply
CONGENITAL ANOMALIES OF THE HAND
Polydactyly
Syndactyly
Macrodactyly
Congenital Trigger Digits
Streeter's Dysplasia
Camptodactyly
Cleft Hand
Mirror Hand (Reduplication of Ulna)
Congenital Radioulnar Synostosis
Madelung's Deformity
Congenital Absence of Radius or Ulna
Kirner's Deformity
INJURIES OF THE HAND
Fractures and Dislocations of the Hand Bones
General Principles
Management of Hand Injuries
Conservative
Surgery
Role of Hand Splints
METACARPAL BONE FRACTURES
Metacarpal Shaft or Neck Fracture
Metacarpal Head Fractures
FRACTURE OF THE PHALANGES
Fracture of Distal Phalanx
Fracture of Middle or Proximal Phalanx
Fracture Dislocations of Proximal IP Joint
Dislocation of Metacarpophalangeal Joints
Complications
TENDON INJURIES
Flexor Tendon Injuries
Tests to Diagnose Flexor Tendon Injuries
Flexor Zones of the Hand
Methods of Treatment
Physiotherapy Measures for Flexors Tendon Injuries
Extensor Tendon Injuries
Test
Treatment
Physiotherapy Management
INTERESTING FINGER INJURIES
SOFT TISSUE INJURIES OF THE HAND
CRUSH INJURIES OF THE HAND AND AMPUTATIONS
Principles of Amputation of Fingers
Treatment Protocol in Crush Injuries
Postoperative Considerations
INFECTIONS OF THE HAND
Paronychia
Clinical Features
Treatment
Distal Pulp Space Infection
Surgical Anatomy
Clinical Features
Treatment
MIDDLE AND PROXIMAL VOLAR SPACE INFECTION
Infection of the Web Spaces
What are these Web Spaces?
Clinical Features
Deep Palmar Abscess
Surgical Anatomy
Clinical Features
Diagnostic Test
Treatment
Tenosynovitis
Surgical Anatomy
Clinical Features
Treatment
Physiotherapy Measures following Hand Infections
ARTHRITIC HAND
PARALYTIC HAND
36:
Regional Conditions of the Lower Limbs
REGIONAL CONDITIONS OF THE HIP
Introduction
COXA VARA
Definition
Classification
Congenital
Acquired (According to the Site of Disturbance)
Disadvantages of Coxa Vara
Clinical Features
Radiography
Treatment
Physiotherapy Measures after Surgery
LEGG-CALVÉ-PERTHES DISEASE
Definition
Clinical Features
Symptoms
Signs
Classification
Radiography
Management (Fig. 36.4)
Goals of Treatment
Prerequisites
Physiotherapy Management in Perthes’ Disease
Physiotherapy Measures Following Surgery
Late Surgical Management for Deformity
SLIPPED CAPITAL FEMORAL EPIPHYSIS
Etiology
Predisposing Factors
Clinical Types (Table 36.1)
Investigations
Radiography
Computed Tomography Scan
Classification of Slipping
Treatment
Principles of Treatment
Physiotherapy Measures
Complications
REGIONAL DISORDERS OF THE KNEE
GENU VALGUM (KNOCK KNEE)
Definition
Incidence
Types
Clinical Features
Genu Valgum Complex
Investigation/Assessment
Clinical Assessment
Radiological Assessment
Treatment of Genu Valgum(Table 36.3 and Box 36.1)
Mild Cases
Severe Cases
Post Surgery Physiotherapy Measures
GENU VARUM (BOW LEGS)
Definition
Types and Causes
Unilateral
Bilateral
Investigation/Clinical Measurements
Child
Adults
Clinical Features
Genu Varum Complex
Treatment
Physiotherapy Measures
GENU RECURVATUM
Definition
Causes
Quadriceps Contracture
Treatment
Methods
Physiotherapy Measures Following Quadricepsplasty
BURSAE AROUND THE KNEE
Problems Related to Bursae Around the Knee
Anterior
Lateral
Medial
Posterior
POPLITEAL CYST (BAKER's CYST)
Baker's Cyst
How is it Produced?
Giant Cyst
Treatment
Clinical Features (Fig. 36.19)
Investigations
Treatment
Role of Physiotherapy after Surgery
RECURRENT DISLOCATION OF PATELLA
Predisposing Factors
Clinical Features
Investigations/Radiography
Treatment
Nonsurgical or Conservative Measure
Surgical Methods (Table 36.6)
Physiotherapy following Surgery in RDP
CHONDROMALACIA PATELLA (Fig. 36.22)
Predisposing Factors
Clinical Features
Investigations
Differential Diagnosis
Treatment
Conservative Methods
Surgery
Physiotherapy Measures
ARCHES OF THE FOOT
Longitudinal Arch (Fig. 36.24A)
Transverse Arches of the Foot (Fig. 36.24B)
PES CAVUS
Definition
Theories of Pathogenesis
Pathologic Anatomy
Classification (Table 36.8)
Clinical Features
Investigations/Radiography
Treatment
Early Stages
Late Stages
Physiotherapy Measures in Cavus Foot
PES PLANUS
Definition
Associated Abnormalities
Types (seeTable 36.9)
Predisposing Factors
Clinical Features
Investigations
Treatment
Plan Based on Age Group
Surgical Correction
Physiotherapy Measures in Flat-Foot
FOOT PAIN
Causes of Pain
Pain in the Forefoot
Pain in the Midfoot
Pain in the Heel
HALLUX VALGUS
Causes
Clinical Features
Investigation
Treatment
Mild Cases
Severe Cases
Physiotherapy Measures after Surgery
HALLUX RIGIDUS
Causes
Clinical Features
Investigation
Treatment
Mild Cases
Severe Cases
Physiotherapy Measures Following Surgery
METATARSALGIA
Types
Clinical Features
Investigation
Treatment
MORTON'S METATARSALGIA
Clinical Features
Investigation
Treatment
Nonoperative Treatment
Surgical Treatment
Physiotherapy Measures
PAINFUL HEEL
Causes
TRAUMATIC DISTURBANCE
Types
Clinical Features
Investigations
Treatment
NON-TRAUMATIC HEEL CONDITIONS
Plantar Fasciitis
Clinical features
Investigation
Treatment
CALCANEAL SPURS
Incidence
Causes
Clinical features
Investigations
Treatments
Traumatic Subtalar Joint Arthritis
EPIPHYSITIS OF THE CALCANEUM
Types
Clinical Features
Investigations
Treatment/Management
37:
Regional Conditions of Spine
SCOLIOSIS
Types of Scoliosis
Structural Scoliosis
Nonstructural Scoliosis
Clinical Features
Importance of the Arm Span
Scoliotic Facts
Investigations
Radiology
Treatment
Nonsurgical Treatment
Surgical Treatment
Facts about Curve Progression
Physiotherapy Measures During the Postoperative Phase
SPONDYLOLISTHESIS
Definition
Classification (Wiltse, Macnab and Newman)
Dysplastic
Isthmic (True)
Degenerative
Traumatic
Pathological
Clinical Features
Investigations
Treatment
Conservative Treatment
Surgical Management
Physiotherapy Measures Following Surgery for Spondylolisthesis
KYPHOSIS
Definition
Causes
Types
Methods of Examination
Inspection
Gibbus
Stages in Kyphosis
Anteriorly
Posteriorly
Preatment/Management
Physiotherapy Management
Surgical Management
Postsurgical Physiotherapy Measures
LUMBAR CANAL STENOSIS
Definition
Classification
Clinical Features
Investigations
Treatment Methods
Conservative
Surgical
Physiotherapy Treatment for Lumbar Canal Stenosis
SECTION SIX: BACKACHE
38:
Low Backache
EPIDEMIOLOGY
Posture
Normal Features
Pathological Physiology
FUNCTIONAL ANATOMY
COMMON LOW BACKACHE (MECHANICAL BACKACHE)
LUMBAR DISK DISEASE AND LOW BACKACHE
General Disk and Spine Anatomy
Disk Physiology
Natural History of Lumbar Disk Disease
Stage of Dysfunction
Stage of Instability
Stage of Stabilization
Classification of Prolapsed Intervertebral Disk (Figs 38.4A to D)
Etiology of Disk Herniation
Risk Factors
Definitive Causes
Clinical Features
Low Backache
Radiculopathy
Nerve Root Compression
Examination of the Back (Table 38.2 and Figs 38.10A to E)
Inspection
Palpation
Evaluation of Neurological System
Clinical Tests
Clinical Facts
Investigations of Low Backache
Radiography (Figs 38.12A and B, 38.13)
Myelography (Fig. 38.14)
Computed Tomography Scan (Fig. 38.15)
Magnetic Resonance Imaging(Figs 38.16, 38.17A and B)
Discography
Other tests
Differential Diagnosis
Extrinsic Causes (Unrelated to Spine)
Intrinsic Causes (Related to Spine)
TREATMENT OF COMMON LOW BACKACHE
Conservative Therapy
Bed rest
Physical Agents
Role of Traction in Low Back pain
Corsets and Braces
Spinal Manipulations
Massage
Exercises for Low Backache
Choice of Exercises
Flexion Exercises
McKenzie's Approach to LBA Treatment
Treatment of Some Specific Low Back Pain
Idiopathic LBA
Later Stages
LBA due to Faulty Postural Habits
Treatment of Chronic LBA
Epidural Steroids
Surgery
Principles of Surgery
Surgical Methods
Physiotherapy Management after Spinal Surgery
Principles
Physiotherapy after Fenestration Technique
Physiotherapy after Laminectomy
Physiotherapy after Spinal Fusion
Chemonucleolysis
Back Ergonomics
Proper Postural Habits (Refer Table 38.3)
Proper Work Environment
Exercises
Modifications in Activities of Daily Living
Ways to Prevent Recurrence
APPROACH TO A PATIENT WITH LOW BACKACHE
Causes of Backache
Presenting Complaints
Factors Influencing
Pain
Neurogenic Claudication
Neurological Symptoms
Facet Syndromes
Other Complaints
Physical Signs
Examination/Investigations
Neurological Examination
Other Examinations
Investigations
Treatment
Other Important Causes of Backache
BACKACHE IN SPECIAL SITUATIONS
Repetitive Stress Injury
Synonyms
Definition
Incidence
Presentation
Stages
Investigations
Treatment
Backache in Children (School Bag Syndrome)
Vital Facts
Features
Prevention
YOGA AND PHYSIOTHERAPY
Physiotherapy vs Yoga
Role of Yoga and Physiotherapy in the Treatment of LBA
SECTION SEVEN: GENERAL ORTHOPEDICS
39:
Congenital Disorders
CONGENITAL TORTICOLLIS (WRYNECK)
Features
Etiology
Clinical Features
Treatment
Principles
CONGENITAL ELEVATION OF SCAPULA (SPRENGEL's DEFORMITY)
Etiology
Clinical Features
Radiograph
Treatment
Physiotherapy Measures
CLEIDOCRANIAL DYSOSTOSIS
Salient Features
Types
Etiology
Clinical Features
Radiograph
Treatment
Physiotherapy Measures
CONGENITAL RADIOULNAR SYNOSTOSIS
Salient Features
Classification
Radiograph
Treatment
MADELUNG's DEFORMITY
Causes
Clinical Features
Other Features
RADIOGRAPHIC ABNORMALITIES
Treatment
CONGENITAL ABSENCE OF RADIUS
Radial Club Hand
CONGENITAL DISORDERS OF LOWER LIMBS
Developmental Dysplasia of Hip (DBH) Earlier Known as Congenital Dislocation of Hip (CDH)
Definition
Risk Factors: (4 F's)
Theories of Etiology
Pathology
Stages of DDH (Fig. 39.13)
Radiographic and Treatment Methods
Clinical Features
Treatment
Physiotherapy Measures in CDH
CONGENITAL TALIPES EQUINOVARUS (CTEV)
Foot
Interesting Features of CTEV
Types of CTEV (Etiology)—Table 39.3
Clinical Features
Radiograph
Management
Manipulation and Physiotherapy Measures in CTEV
Treatment by External Fixators
RETENTION OF CTEV CORRECTION
40:
Developmental Disorders
ACHONDROPLASIA
Introduction
Achondroplasia Dwarfism
Causes
Clinical Features
Treatment
OSTEOGENESIS IMPERFECTA
Definition
Etiology
Clinical Features
Laboratory Investigations
Radiograph
Treatment
Principles
MUCOPOLYSACCHARIDE DISORDERS
Morquio-Brailsford Disease
Hurler's (Gargoylism)
Hunter's Disease
Hereditary Multiple Exostosis (Diaphyseal Aclasia)
Clinical Features
Radiograph
Dyschondroplasia (Ollier's Disease)
Maffucci's Disease
OSTEOPETROSIS
Etiology
Clinical Features
Radiology
Complications
EPIPHYSEAL DYSPLASIAS
Epiphyseal Dysplasia Multiplexa
Epiphyseal Dysplasia Punctata
Conradi's Disease
Epiphyseal Dysplasia Hemimelia
METAPHYSEAL DYSPLASIAS
Metaphyseal Dysplasia (Pyle's Disease)
Craniometaphyseal Dysplasia
Metaphyseal chondrodysplasia
DIAPHYSEAL DYSPLASIA
Progressive Diaphyseal Dysplasia (Canuati's or Engelmann's Disease)
Craniodiaphyseal Dysplasia
FIBROUS DYSPLASIA
Etiology
Clinical Features
Albright's Syndrome
Laboratory Investigation
Radiology
Treatment
Nail-PatellaSyndrome (Onycho-Osteodysplasia)
Marfan's Syndrome
HOMOCYSTINURIA
Acrocephalosyndactyly (Apert's Syndrome)
Carpenter Syndrome
Cleidocranial Dysplasia
CONGENITAL NEUROFIBROMATOSIS
Von Recklinghausen's Disease
Clinical Features
Radiograph
Treatment
PAGET's DISEASE (OSTEITIS DEFORMANS)
Etiology
Clinical Features
Investigations
Radiograph
Treatment
General Management
Specific Management
Indications
41:
Metabolic Bone Disorders
RICKETS
Causes
NUTRITIONAL RICKETS
Clinical Features
Deformities of Rickets (from Head to Toe)
Skull
Chest (Figs 41.2A to C)
Bones
Other Features
Radiologic Findings
Laboratory Investigations
Treatment
Physiotherapy Measures
Differential Diagnosis
RENAL OSTEODYSTROPHY
Why is Renal Rickets Low-grade Rickets?
Causes
Clinical Features
Investigations
Treatment
VITAMIN D-RESISTANT RICKETS
Clinical Features
Tackle Deformity (Fig. 41.6)
Treatment
Prognosis
OSTEOMALACIA
Etiology
Pathogenesis
Clinical Features
Radiograph
Treatment
Hyperparathyroidism
Primary Hyperparathyroidism (Osteitis Fibrosa Cystica, von Recklinghausen's Disease)
Clinical Features
Radiograph
Treatment
Secondary Hyperparathyroidism
Classification
OSTEOPOROSIS
Causes
Clinical Features (Fig. 41.12)
Early Symptoms
Investigations
Management of Osteoporosis
Treatment
Physiotherapy Measures
Recent Trends
SCURVY
History
Etiology
Clinical Features
Radiology
Treatment
42:
Osteomyelitis
DEFINITION
Classification
ACUTE OSTEOMYELITIS
Etiology
Agent Factors
Host Factors
Age
Sex
Economic Status
Environmental Factors
General Factors
Local Factors
Pathophysiology
Clinical Features
Fever
Swelling
Limitation of Movement
Clinical Signs
General Features (Box 42.1 and Table 42.3)
Local Features
Management
General and Physiotherapy Management
Principles of Antibiotic Therapy
Current Trends in Antibiotic Therapy
CHRONIC OSTEOMYELITIS
Clinical Features (Figs 42.7 and 42.8)
Signs
Management of Chronic Osteomyelitis
Goal
Principles of Treatment
Residual Osteomyelitis
Physiotherapy Measures in Osteomyelitis
During Acute Osteomyelitis
Measures for Chronic Osteomyelitis
TUBERCULAR OSTEOMYELITIS
43:
Skeletal Tuberculosis
HISTORY
ETIOLOGY
How does the Osteoarticular Tubercular Lesion Develop (Fig. 43.1)
CLINICAL FEATURES
Monoarticular
Constitutional Symptoms
PRINCIPLES OF TREATMENT
TUBERCULOSIS SPINE
Regional Distribution
Clinical Features
Physical Findings
Investigations
Treatment
Physiotherapy Measures in Conservative Management TB Spine
Surgery in TB Spine
Complications of Tuberculosis Spine
Middle Path Regime in TB
Physiotherapy Measures in Surgical Management
Preoperative Phase
Postoperative Phase
TB SPINE WITH PARAPLEGIA
Classification
Seddon's Classification
Clinical Features
Treatment of Pott's Paraplegia
Conservative Treatment
Physiotherapy and Occupational Therapy
Surgical Treatment
Surgical Techniques
Physiotherapy Measures After Surgery in Pott's Paraplegia
TUBERCULOSIS OF THE HIP JOINT
Clinical Features
Radiograph
Surgical Treatment in Tuberculosis of Hip
Physiotherapy Measures in TB Hip
Treatment Facts: Tuberculosis Hip
TUBERCULOSIS KNEE
Clinical Features
Radiograph
Treatment
Non-operative Treatment
Surgical Treatment
Physiotherapy Measures in TB Knee
TUBERCULOSIS SHOULDER
Clinical Features
Late Stages
Radiograph
Treatment
Physiotherapy Measures in TB Shoulder
TUBERCULOSIS ANKLE
Clinical Features
Radiology
Treatment
Aim
Surgery
Physiotherapy Measures in TB Ankle
TUBERCULAR OSTEOMYELITIS
Tubercular Osteomyelitis without Joint Involvement
Spina Ventosa Type
Treatment
Radiographs
Treatment
44:
Disorders of Joints
INFECTIVE ARTHRITIS
Pyogenic Infection of Joint or Septic Arthritis
Definition
Causative Organisms
Predisposing factors
Sites of Involvement of the Joint
Clinical Features
Investigations
Treatment
Complications
Physiotherapy Management in Infective Arthritis
Gonococcal Arthritis
Clinical Features
Treatment
Physiotherapy Measures
Syphilis of Joints
Physiotherapy Measures
NEUROPATHIC JOINTS (CHARCOT's)
Clinical Features
Radiograph
Treatment
Physiotherapy Measures in Charcot's Joint
HEMOPHILIC ARTHRITIS (BLEEDER's JOINTS) (TABLE 44.2)
Pathology
Clinical Features
Investigations
Treatment
Chronic Hemarthropathy
Physiotherapy Management in Hemophilic Arthritis
45:
Rheumatic Diseases
DEFINITION
Etiology
Current Hypothesis
Antigenic Agents
Pathogenic Spectrum (Fig. 45.1)
Pathology
Clinical Features
Classical Presentation
Other Presentations
Extra-articular Features
ORTHOPEDIC DEFORMITIES IN RHEUMATOID ARTHRITIS
Orthopedic Deformities of the Hand (Rheumatoid Hand)
Rheumatoid Foot
Other Joints
Rheumatoid Knee
Rheumatoid Hip
Investigations
Radiological Features of Rheumatoid Arthritis
Other Common Abnormalities
Synovial Fluid Analysis
Differential diagnosis
Management (Fig. 45.7)
Aims of Treatment
General Measures
Drug Therapy
Surgical Procedures in Rheumatology
Preoperative Considerations
Surgical Methods (Table 45.2)
Postsurgical Physiotherapy in RA
Physiotherapy Measures for Rheumatoid Arthritis
Self-management Techniques for Rheumatoid and Other Forms of Arthritis
Ten Self-help Techniques
Differential Diagnosis in RA
SERONEGATIVE SPONDYLOARTHROPATHIES
Etiology
Clinical Features
Articular Features
Extra-articular Features
Diagnosis
Radiological Diagnosis
Computerized Axial Tomography
HLA-B27
Physiotherapy Measures for Seronegative Spondyloarthropathies
ANKYLOSING SPONDYLITIS (AS)
DEFINITION
Causes
Pathology
Clinical Features
Extra-articular Manifestations
Investigations
Treatment
General Principles
Physiotherapy Management in Ankylosing Spondylitis
46:
Osteoarthritis
PRIMARY OSTEOARTHRITIS
Etiological Causes
Features
Sequence of Pathological Events in Osteoarthritis
Clinical Features (Figs 46.4A to D)
Investigations
Laboratory Investigations
X-ray
Other Investigations
Treatment
Conservative Methods
Surgical Methods
SECONDARY OSTEOARTHRITIS OF KNEE
Ethology
Physiotherapy Management in Osteoarthritis of Knee Joint
Measures to Relieve Pain and Muscle Spasm
Exercise Regimen
Measures to Reduce Compressive Forces on the Knee
Self-help Measures
Physiotherapy Measures after Surgery in Osteoarthritis Knee
PRIMARY OSTEOARTHRITIS OF HIP
Pathology
Clinical Features
Investigation/Radiology
Primary Osteoarthritis
Secondary Osteoarthritis
Treatment
Conservative Measures
Surgical
Physiotherapy Management for Osteoarthritis Hip
SECONDARY OSTEOARTHRITIS OF HIP
OTHER USEFUL APPROACHES IN THE MANAGEMENT OF OSTEOARTHRITIS OF HIP AND KNEE JOINTS (MODIFICATIONS)
Management Measures in Daily Life
General Advice
Role of Exercises in the Management of Osteoarthritis of the Hip
Types of Exercises in Osteoarthritis of Hip and Knee
Exercises Lying on the Back (Figs 46.25A to D)
Exercises Lying on your Side, with the Painful Hip Up (Figs 46.26, 46.27A and B)
Exercises in Sitting Posture (Figs 46.28 and 46.29)
Exercises in Standing Posture (Figs 46.30A and B)
OSTEOARTHRITIS SPINE
Lumbar Spondylosis
Physiotherapy Treatment for Lumbar Spondylosis
Osteoarthritis of Cervical Spine
OSTEOARTHRITIS OF THE HAND
Sites
Clinical Features
Investigation
Treatment
Conservative Measures
Physiotherapy Measures
MONOSODIUM URATE ARTHROPATHY (GOUT)
Sites
Role of Hyperuricemia
Clinical Features
Investigations
Laboratory Studies
Radiology
Treatment
PSEUDOGOUT (CPPD)
Physiotherapy Measures
47:
Neuromuscular Disorders
CEREBRAL PALSY
Lesions
Incidence and Prevalence
Classification
Lesions in the Brain
Causes
Clinical Features (Table 47.3)
Orthopedic Deformities
Upper Limb
Lower Limb
Spine
Knee
Foot
Treatment
Treatment Methods in Brief
Physiotherapy Measures in Cerebral Palsy
Choice of Surgery
Prognosis in Cerebral Palsy
POLIOMYELITIS
Viruses
Pathogenesis
Clinical Features
Orthopedic Deformities
Differential Diagnosis
Treatment
Broad Principles of the Treatment
Treatment Methods
Treatment during Post Polio Paralysis
After Tendon Transfers
ARTHROGRYPOSIS MULTIPLEX CONGENITA (MULTIPLE CONGENITAL CONTRACTURES)
Causes
Classification (Sharrard, Brown and Robson)
Eight Types
Common Orthopedic Deformities in AMC (Figs 47.10A and B)
Investigations
Treatment
Principles of Orthopedic Treatment
LEPROSY IN ORTHOPEDICS
National Leprosy Eradication Program
Problems of Leprosy in India
Classification
Investigations
Tests for Detecting CMI
Tests for Detecting Humoral Antibodies
Treatment
Chemotherapy
Duration of Treatment
Orthopedic Deformities In Leprosy
Ankle and Foot
Foot Drop
Consequence of Paralysis
Treatment
Surgical Methods for Foot-drop
Plantar Ulcers
Treatment of Plantar Ulcers (Table 47.10)
Deformities of the Hand in Leprosy
Surgery for Hand
Physiotherapy Measures
MUSCULAR DYSTROPHIES
Duchenne Muscular Dystrophy
Clinical Features
Investigations
Facioscapulohumeral Muscular Dystrophy
Limb Girdle Muscular Dystrophy
Treatment Measures and Physiotherapy Treatment
SPINA BIFIDA
Incidence
Causes
SPINA BIFIDA OCCULTA
Clinical Presentation
Investigations
Treatment
SPINA BIFIDA APERTA
Clinical Presentation
Investigations
Treatment
Physiotherapy Measures in Spina Bifida
48:
Bone Neoplasias
TUMORS
GENERAL PRINCIPLES
History
Clinical Examination
Investigations
Routine Laboratory Investigation
Special Investigations
Enneking's Staging
Surgical Techniques
Curettage
Resection or Excision
Choice of the Surgical Procedures
Adjunctive Therapy
Radiotherapy
Chemotherapy
Newer Modalities of Treatment
Classification of Bone Tumors
OSTEOCHONDROMA
Clinical Features
Treatment
CHONDROMA (ENCHONDROMA, CHONDROMYXOMA)
Clinical Features
Radiology
Treatment
Prognosis
CHONDROBLASTOMA
Clinical Features
Radiology
Treatment
CHONDROSARCOMA
Classification
Antecedent Lesions
Clinical Features
Investigations
Treatment
CHONDROMYXOID FIBROMA
Clinical Features
Radiology
Treatment
OSTEOMA
OSTEOID OSTEOMA
Clinical Features
Radiology
Treatment
OSTEOGENIC SARCOMA
Secondary Osteosarcoma
Clinical Features
Investigations
Radiological Features
Other Investigations
Treatment
Treatment of Pulmonary Metastasis
Prognosis
ANEURYSMAL BONE CYST
Clinical Features
Investigations
Treatment
UNICAMERAL BONE CYST
Clinical Features
Investigations
Complications
Treatment
Types of Surgery
BENIGN GIANT CELL TUMOR (OSTEOCLASTOMA)
Clinical Features
Radiology
MALIGNANT GIANT CELL TUMOR (FIGS 48.23 AND 48.24)
EWING'S SARCOMA
Clinical Features
Radiology
Recommended Treatment
MULTIPLE MYELOMA (PLASMACYTOMA)
Clinical Features
Findings
Course
Investigations
Treatment
Clinical Settings
Clinical Features
Laboratory Diagnosis
Other Investigations
Treatment
Radiotherapy
Surgery
Hormone Therapy
Radioisotope Therapy
Chemotherapy
Treatment of Hypocalcemia
Amputation
Prophylactic Nailing
SYNOVIOMA (SYNOVIAL SARCOMA)
Clinical Features
Course
Radiology
Treatment
Physiotherapy Management for all Bone Tumors
SECTION EIGHT: SPORTS MEDICINE
49:
Sports Medicine and Sports Injuries
CLASSIFICATION OF SPORTS INJURIES
Among the Consequential Injuries
Primary Extrinsic
Primary Intrinsic
Non-consequential injuries
COMMON SPORTS INJURIES
Lower limbs
Head, Neck, Trunk and Spine
INVESTIGATIONS
TREATMENT OF SPORTS INJURY
Preventive Measures
Treatment
General Principles
Training
Phases of Exercise Training
Exercises to Increase the Cardiopulmonary Capacity
Exercises to Increase the Muscle Strength
Exercises for Free Weight Training
Measures to Improve the Agility
Measures to Improve the Speed-polymetrics
Measures of Relaxation
SECTION NINE: MISCELLANEOUS
50:
Human Gait
WHAT IS GAIT?
Gait Cycle
Definition
Phases of the Gait Cycle (Fig. 50.1)
Terminology of the Gait Cycle
Stance Phase (Fig. 50.2A)
Swing Phase (Fig. 50.2B)
Forces Responsible for Gait
Practical Method of Gait Evaluation
Pathological Gait
GAIT TRAINING
51:
Amputations
AMPUTATION LEVELS (Box 51.1)
Aim
UPPER LIMB AMPUTATIONS (FIG. 51.2)
Forequarter Amputations
Indications
Disarticulation of Shoulder
Above Elbow Amputation
Below Elbow Amputation
Krukenberg Amputation
Amputation Through the Hand
Amputations through the Lower Limb (Fig. 51.4)
Hind Quarter Amputation
Hip Disarticulation
Above Knee Amputation
Knee Disarticulation
Below Knee Amputation
Syme's Amputation
TYPES OF AMPUTATIONS
Closed Amputation
Open Amputation
CLOSED AMPUTATIONS PRINCIPLES (Figs 51.5A TO E)
Open Amputations (Guillotine Operation)
Indications
Types
AFTER TREATMENT FOLLOWING AMPUTATIONS
Rigid Dressing Concept (Pylon)
Soft Dressing Concept
IMPORTANT AMPUTATIONS OF LOWER EXTREMITY
Below Knee Amputation
Non-ischemic Limbs
Ischemic Limb
Knee Disarticulation
Amputation Through the Thigh
Syme's Amputation
PHYSIOTHERAPY MANAGEMENT IN AMPUTATIONS
Management of the Stump
Other Important Aspects of Stump Management
All Important Stages of Mobilizing the Patient
Steps
COMPLICATIONS OF AMPUTATIONS
52:
Prosthetics
INTRODUCTION
CLASSIFICATION
Based on Part
Endoprostheses
Exoprostheses
Based on Period of Use
Temporary Prosthesis
Permanent Prosthesis
PERMANENT PROSTHESIS
Prosthesis for the Lower Limbs
Component of Prosthesis
Prosthesis for ‘Above Knee’ Amputation
Prosthesis for ‘Through Knee’ Amputation
Prosthesis for ‘Below Knee’ Amputations
Patellar Tendon Bearing
Conventional Type Prosthesis
Prosthesis for Syme's Amputation
Prosthesis for Hemipelvectomy and Hip Disarticulation (Fig. 52.4)
Prosthesis of Partial Foot Amputation
Prosthesis for Bilateral Amputations
For Bilateral Above Knee Amputations
For Bilateral Hip Disarticulation
Prosthesis for Upper Limb Amputations
Forequarter Amputations
Shoulder Disarticulation
Above Elbow Amputation
Below Elbow Amputation
Wrist Disarticulation
Physiotherapy Measures
What Does a Patient Wearing the Prosthesis Need to Learn?
How is a Patient Trained to Walk on the Prosthesis?
TEMPORARY PROSTHESIS (Fig. 52.8)
Physiotherapy Measures
How to Construct a Temporary Prosthesis?
Re-educating An Upper Limb Amputee
Goal
Elbow Amputation
For Below Elbow Amputation
Teaching a Patient How to Operate the Prosthesis of the Upper Limb
Ankle Units and Artificial Feet
53:
Orthotics
CLASSIFICATION
Terminology for Orthosis (Box 53.1)
ACTION OF ORTHOSIS
Functions of Spinal Orthosis
SPINAL ORTHOSES
Types
Supportive Spinal Orthosis
Corrective Spinal Orthosis
LOWER LIMB ORTHOSIS
Knee-Ankle-Foot Orthosis (KAFO)
Hip-Knee-Ankle-Foot Orthosis (HKAFO) and Lumbosacral Hip-Knee-Ankle-Foot Orthosis (LSHKAFO)—Figure 53.6
Ankle-Foot Orthosis (Afo)
Footwear and its Modifications
UPPER LIMB ORTHOSIS
54:
Peripheral Nerve Injuries
ABOUT SPINAL NERVE
CLASSIFICATION OF NERVE INJURIES
Seddon's (1943) Classification
Sunderland's Classification
ETIOLOGY
TYPES
Primary
Secondary
Incidence
Clinical Diagnosis
Typical Deformities
Simple Screening Tests
Diagnostic Tests
Electromyography
Nerve Conduction Studies
Tinel Sign
Sweat Test Starch Test
Skin Resistance Test
Electrical Stimulation
MANAGEMENT
General Principles
Conservative Management
Operative Management
Types of Nerve Repair
Techniques
Methods of Nerve Suture (Refer Figs 54.4A to D)
ULNAR NERVE INJURY
Etiology
General Causes
Local Causes
Claw Hand Deformity
Entrapment Sites
Types and Causes
Problems of Claw Hand
Clinical Features
Clinical Tests/Diagnosis
For Ulnar Nerve Injury
What is Ulnar Paradox?
Treatment
For Ulnar Nerve Injury
For Claw Hand Deformity
RADIAL NERVE INJURY
Causes
General Causes
Local Causes
Clinical Features
Investigations
Treatment
Early Cases
Late Cases (>1 Year)
FOOT DROP
Causes
General Causes
Local Causes
Clinical Features
Treatment of Early Foot Drop
Conservative Treatment
Surgery
PHYSIOTHERAPY MANAGEMENT IN PERIPHERAL NERVE LESIONS
Stage of Paralysis
Postparalytic Stage
Delayed Stage
Physiotherapy after Nerve Repair
Physiotherapy after Tendon Transfers
BRACHIAL PLEXUS INJURIES
Types
Supraclavicular Lesion
Assessment of Brachial Plexus Injury
In Preganglionic Lesions
In Postganglionic Lesions
Investigations
Treatment
During the Initial Stages
During the Later Stages
Surgical Measures
ERB'S PALSY
Effects of the Injury
At the Shoulder
At the Elbow
At the Forearm
Management
Splinting
Measures to Prevent Contractures
Electrical
Surgery
KLUMPKE'S PARALYSIS (FIG. 54.29)
55:
Wholistic Orthopedics
IS WHOLISTIC ORTHOPEDICS A BOON FOR GERIATRIC PATIENTS?
STEPS WHOLISTIC ORTHOPEDICS
INDEX
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