Essentials of Physical Medicine and Rehabilitation, 2nd Edition

847 Pages·2008·10.58 MB·English

by  Walter R. Frontera MD PhD

Contributors
Venu Akuthota, MD Sarah S. Banerjee, MD William L. Bockenek, MD
Associate Professor of Physical Medicine Clinical Instructor, Department of Adjunct Clinical Professor, University of North
and Rehabilitation, University of Colorado Orthopaedic Surgery, Texas Tech University Carolina at Chapel Hill, Chapel Hill, North
School of Medicine, Denver, Colorado Health Sciences Center; Private Practice, Carolina; Medical Director, Carolinas Reha-
El Paso, Texas bilitation, Chairman, Department of Physical
Joseph T. Alleva, MD Medicine and Rehabilitation, Carolinas
Assistant Professor, Northwestern University Moon Suk Bang, MD, PhD Medical Center, Charlotte, North Carolina
Medical School, Chicago, Illinois; Medical Professor, Department of Rehabilitation
Director, Outpatient Services, Division of Medicine, Seoul National University, Kath Bogie, DPhil
Physical Medicine and Rehabilitation, College of Medicine; Professor, Senior Research Associate, Department of
Evanston Northwestern Healthcare, Department of Rehabilitation Medicine, Orthopaedics, Case Western Reserve
Evanston, Illinois Seoul National University Hospital, Seoul, University, School of Medicine; Senior
South Korea Research Scientist, Louis Stokes Cleveland
Eduardo Amy, MD Department of Veterans Aff airs
Assistant Professor, Department of Norman L. Banks, MD, MS Medical Center, Cleveland, Ohio
Physical Medicine, Rehabilitation, and Adjunct Clinical Professor, University of
Sports Medicine, University of Puerto Rico Southern California School of Biokinesiol- Kristian Borg, MD, PhD
School of Medicine, San Juan, Puerto Rico; ogy and Physical Therapy, Los Angeles, Professor, Karolinska Institute; Director, Re-
Orthopedic Surgeon, University Hospital, California; Physician, Director of Chronic habilitation Medicine, Department of Clinical
Ponce, Puerto Rico Pain Clinic, Palo Alto Medical Foundation, Sciences, Danderyd Hospital; Senior Consul-
Department of Physical Medicine and tant, Department of Rehabilitation Medicine,
Karen Atkinson, MD, MPH Rehabilitation, Palo Alto, California Danderyd Hospital, Stockholm, Sweden
Assistant Professor, Department of
Medicine/Rheumatology, Emory University Karen P. Barr, MD Joanne Borg-Stein, MD
School of Medicine, Atlanta, Georgia; Chief Associate Professor, Rehabilitation Medicine, Assistant Professor, Harvard Department of
of Rheumatology, Atlanta Veterans Aff airs University of Washington, Seattle, Washington Physical Medicine and Rehabilitation,
Medical Center, Decatur, Georgia Harvard Medical School; Chief, Physical Medi-
Heather G. Belanger, PhD cine and Rehabilitation, Newton-Wellesley
Joseph F. Audette, MA, MD Assistant Professor, Psychology Department, Hospital, Medical Director, Spaulding-
Assistant Professor, Harvard Medical University of South Florida; Staff Psychologist, Wellesley Rehabilitation Center, Medical Direc-
School; Staff Physiatrist, Spaulding James A. Haley Veterans’ Hospital, Tampa, tor, Newton-Wellesley Hospital Spine Center,
Rehabilitation Hospital, Boston, Florida Spaulding Rehabilitation Hospital, Harvard
Massachusetts Medical School, Boston, Massachusetts
Peter Bienkowski, MD
John R. Bach, MD Resident, Department of Orthopedics, Jay E. Bowen, DO
Professor, Physical Medicine and Children’s Hospital, Boston, Massachusetts Clinical Assistant Professor, Department
Rehabilitation, Professor of Neurosciences, of Physical Medicine and Rehabilitation,
Department of Physical Medicine and Randie M. Black-Schaff er, MD, MA University of Medicine and Dentistry, New
Rehabilitation, University of Medicine and Assistant Professor, Department of Physi- Jersey: New Jersey School of Medicine,
Dentistry of New Jersey–New Jersey cal Medicine and Rehabilitation, Harvard Newark, New Jersey
Medical School; Associate Medical Medical School; Lecturer, Department of
Director, Department of Physical Medicine Rehabilitation Medicine, Tufts University Jeff rey S. Brault, DO, PT
and Rehabilitation, University Hospital, School of Medicine; Interim Director, Stroke Assistant Professor, Mayo Medical School;
Newark, New Jersey Program, Medical Director, Young Adult Consultant, Mayo Clinic, Rochester,
Stroke Service, Spaulding Rehabilitation Minnesota
Allison Bailey, MD Hospital, Boston, Massachusetts
Instructor, Harvard Medical School; Staff Steven E. Braverman, MD, MS
Physiatrist, Spaulding Rehabilitation Philip J. Blount, MD Assistant Professor, Uniformed University
Hospital, Boston, Massachusetts Assistant Professor of Medicine, Department of the Health Sciences, Bethesda, Maryland;
of Orthopedics and Rehabilitation, Deputy Director, Health Policy and Services,
Jennifer Baima, MD University of Mississippi; Physiatrist, Chief Consultant to the Army Surgeon
Clinical Instructor, Harvard Medical University of Mississippi Medical Center, General, United States Army Medical
School; Staff Physiatrist, Brigham and Jackson, Mississippi Command, Houston, Texas
Women’s Hospital; Staff Physiatrist,
Spaulding Rehabilitation Hospital, Boston,
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CONTRIBUTORS
Diane W. Braza, MD Victor Chung, BS Susan J. Dreyer, MD
Associate Professor, Department of Medical Student, Tufts University School of Associate Professor, Physical Medicine and
Physical Medicine and Rehabilitation, Medicine, Boston, Massachusetts Rehabilitation, Associate Professor, Ortho-
Medical College of Wisconsin; Physiatrist paedic Surgery, Emory University, School of
and Interist, Froedtert Memorial Lutheran Daniel M. Clinchot, MD Medicine; Physiatrist, Emory Orthopaedic
Hospital, Milwaukee, Wisconsin Residency Program Director, Department of and Spine Center, Atlanta, Georgia
Physical Medicine and Rehabilitation; Director,
Patrick Brennan, MD Medical Humanities, Ohio State University Nancy Dudek, MD, MEd
Instructor, Department of Physical Medicine College of Medicine, Columbus, Ohio Assistant Professor, University of Ottawa;
and Rehabilitation, Harvard Medical School; Associate Staff , Ottawa Hospital, Ottawa,
Physician, Spaulding Rehabilitation Hospital, Isaac Cohen, MD Ontario, Canada
Boston, Massachusetts Physiatrist, The Orthopaedic and Sports
Medicine Center, Trumbull, Connecticut Sheila Dugan, MD
Jeff rey T. Brodie, MD Assistant Professor, Department of Physical
Attending Physician, Division of Orthopaedic Earl J. Craig, MD Medicine and Rehabilitation, Rush Medical
Surgery, St. Joseph Medical Center, Associate Professor, Department of College; Medical Director, Department of
Baltimore, Maryland Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation, Rush
Indiana University School of Medicine, University Medical Center, Chicago, Illinois
David Burke, MD, MA Indianapolis, Indiana
Professor, Emory University School of Gerold R. Ebenbichler, MD
Medicine; Chairman, Department of Christine Curtis, BS Research Associate Professor, Vienna Medical
Rehabilitation Medicine, Atlanta, Georgia Research Coordinator, Children’s Hospital of University; Senior Medical Specialist, Universi-
Boston, Division of Sports Medicine, Depart- ty Clinics of Physical Medicine and Rehabilita-
Mabel E. Caban, MD ment of Orthopedics, Boston, Massachusetts tion, Vienna General Hospital, Vienna, Austria
Assistant Professor, University of Texas
Medical Branch, Galveston, Texas Jatin Dave, MD, MPH Omar El Abd, MD
Instructor, Department of Medicine, Instructor, Harvard Medical School, Boston,
Alexios Carayannopoulos, DO, MPH Harvard Medical School, Boston, Massachusetts; Interventional Spine Director,
Medical Director, Spine Center, Department Massachusetts; Director of Education, Newton-Wellesley Hospital, Newton,
of Neurosurgery, Lahey Clinic, Burlington, Division of Aging, Brigham and Women’s Massachusetts; Attending Physician,
Massachusetts Hospital, Boston, Massachusetts; Medical Spaulding Rehabilitation Hospital, Boston,
Director, Evercare Hospice and Palliative Massachusetts
Charles Cassidy, MD Care, Waltham, Massachusetts
Henry H. Banks Associate Professor and Maury Ellenberg, MD
Chairman, Department of Orthopaedic Alan M. Davis, MD, PhD Clinical Professor, Department of Physical
Surgery, Tufts University School of Assistant Professor, Division of Physical Medicine and Rehabilitation; Wayne State
Medicine; Chairman, Department of Medicine and Rehabilitation, University of University-School of Medicine; Chief, Depart-
Orthopaedic Surgery, Tufts-New England Utah School of Medicine; Medical Director, ment of Physical Medicine and Rehabilitation,
Medical Center, Boston, Massachusetts Salt Lake Regional Medical Center Sinai Grace Hospital, Detroit, Michigan
Rehabilitation; Chief of Staff , Promise
David A. Cassius, MD Specialty Hospital, Salt Lake City, Utah Erik Ensrud, MD
Private Practice, Broadway Sports and Assistant Professor, Medicine/Neurology,
Internal Medicine, Seattle, Washington David R. Del Toro, MD University of Texas Health Science Center
Associate Professor, Department of at San Antonio; Staff Physician, Neurology,
Andrea Cheville, MD Physical Medicine and Rehabilitation, University Health System, San Antonio, Texas
Associate Professor, Physical Medicine and Medical College of Wisconsin; Medical
Rehabilitation, Mayo Clinic, Rochester, Director, Comprehensive Inpatient Avital Fast, MD
Minnesota Rehabilitation Unit, Froedtert Memorial Professor and Chairman, Department of
Lutheran Hospital, Milwaukee, Wisconsin Physical Medicine and Rehabilitation, Albert
Kelvin Chew, MD Einstein College of Medicine, Bronx, New
Director, Sports Medicine Center, Jennifer Devine, MD York; Professor and Chairman, Department
Department of Orthopedics, Alexandria Resident Physician, Spaulding Rehabilita- of Physical Medicine and Rehabilitation,
Hospital, Singapore tion Hospital and Harvard Medical School, Montefi ore Medical Center, Bronx, New York
Boston, Massachusetts
Martin K. Childers, DO, PhD Jeff ery B. Feldman, PhD
Associate Professor, Wake Forest University Timothy R. Dillingham, MD Assistant Professor, Director of Occupational
Health Sciences, Department of Neurology; Professor and Chairman, Department of Rehabilitation Programs, Wake Forest Uni-
Associate Professor, Wake Forest Institute Physical Medicine and Rehabilitation, versity School of Medicine, Winston-Salem,
for Regenerative Medicine, Winston-Salem, Froedtert Memorial Lutheran Hospital and North Carolina
North Carolina the Medical College of
Wisconsin, Milwaukee, Wisconsin Brian T. Fitzgerald, MD
Chien Chow, MD Staff Orthopaedic Hand Surgeon, Naval
Associate Instructor of Surgery, Harvard Medical Center, San Diego, California
School of Medicine; Surgical Intern, Beth
Israel Deaconess Medical Center, Boston, Leslie S. Foster, DO
Massachusetts Assistant Chief, Physical Medicine and
Rehabilitation, Walter Reed Army Medical
Center, Washington, DC
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CONTRIBUTORS
Patrick M. Foye, MD Ed Hanada, MD Faiza Humayun, MD
Associate Professor of Physical Medicine Assistant Professor, Faculty of Medicine, Staff Physician, James A. Haley Veterans’
and Rehabilitation, Co-Director, Dalhousie University; Staff Physiatrist, Hospital, Tampa, Florida
Musculoskeletal/Sports/Spine Fellowship, Capital District Health Authority, Halifax,
University of Medicine and Dentistry of Nova Scotia, Canada Marta Imamura, MD
New Jersey, New Jersey Medical School; Collaborative Professor, University of São
Director, Coccyx Pain Service, Co-Director, Toni J. Hanson, MD Paulo School of Medicine; Attending Physi-
Osteoarthritis and Back Pain Clinic, Assistant Professor, Physical Medicine and cian, Division of Physical Medicine and
University Hospital, Newark, New Jersey Rehabilitation, Staff Physician, Department Rehabilitation, Department of Orthopaedics
of Physical Medicine and Rehabilitation, and Traumatology, University of São Paulo
Michael Fredericson, MD Mayo Clinic, Rochester, Minnesota School of Medicine, São Paulo, Brazil
Associate Professor, Stanford University;
Chief, Physical Medicine and Rehabilitation Amanda L. Harrington, MD Satiko Tomikawa Imamura, MD, PhD
Clinics, Stanford Hospital, Stanford, California Resident Physician, Department of Physical Professor, University of São Paulo School of
Medicine and Rehabilitation, Carolinas Medicine; Coordinator, Pain Clinic, Division
Michelle Gittler, MD Rehabilitation, Carolinas Medical Center, of Rehabilitation Medicine, University of São
Clinical Associate Professor, Department Charlotte, North Carolina Paulo School of Medicine, São Paulo, Brazil
of Orthopedic Surgery and Rehabilitation
Medicine, University of Chicago; Program Sandra S. Hatch, MD Zacharia Isaac, MD
Director, Associate Medical Director for Professor, Vice-Chairman, Department of Instructor, Physical Medicine and
Academic Aff airs, Schwab Rehabilitation Radiation Oncology, Residency Director, Rehabilitation, Harvard Medical School;
Hospital, Chicago, Illinois Radiation Oncology, University of Texas Director, Interventional Physiatry, Medical
Medical Branch, Galveston, Texas Director, Brigham and Women’s Hospital,
Mel B. Glenn, MD Comprehensive Spine Care Center,
Associate Professor, Department of Physi- Melvyn L. Hecht, MD Spaulding Rehabilitation Hospital, Brigham
cal Medicine and Rehabilitation, Harvard Clinical Instructor, Department of Medicine, and Women’s Hospital, Boston,
Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
Director of Outpatient and Community Massachusetts; Beth Israel Deaconess
Brain Injury Rehabilitation, Spaulding Medical Center, Boston, Massachusetts; Cristin Jouve, MD
Rehabilitation Hospital, Boston, Chief Medical Offi cer, Youville Hospital Clinical Instructor, Physical Medicine and
Massachusetts; Medical Director, MEN- and Rehabilitation Center, Cambridge, Rehabilitation, Harvard Medical School;
TOR ABI, Braintree, Massachusetts; Clinical Massachusetts; Department of Medicine, Physiatrist, New England Baptist Spine
Medical Director, Community Rehabilita- Cambridge Hospital, Cambridge, Massa- Center, Boston, Massachusetts
tion Care, Newton, Massachusetts chusetts; Spaulding Rehabilitation Hospital,
Boston, Massachusetts Se Hee Jung, MD, MS
Peter Gonzalez, MD Instructor, Department of Rehabilitation
Assistant Professor of Physical Medicine Chester H. Ho, MD Medicine, Seoul National University
and Rehabilitation, University of Colorado Assistant Professor, Department of Physical College of Medicine; Clinical Assistant
School of Medicine, Denver, Colorado Medicine and Rehabilitation, Case Western Professor, Department of Physical
Reserve University School of Medicine; Medicine and Rehabilitation, Seoul
Dawn M. Grosser, MD Chief, Spinal Cord Injury, Louis Stokes Cleve- Metropolitan Boramae Medical Center,
Orthopaedic Surgery, Christus Spohn land Department of Veterans Aff airs Medical Seoul, South Korea
Hospital, Corpus Christi Medical Center; Center, Cleveland, Ohio
Orthopaedic Associates of Corpus Christi, Robert J. Kaplan, MD
Corpus Christi, Texas Anne Z. Hoch, DO, PT Associate Professor, Rehabilitation
Associate Professor, Physical Medicine Medicine, University of Kansas School of
H. Michael Guo, MD, PhD and Rehabilitation; Associate Professor, Medicine; Staff Physician, Kansas University
Assistant Professor, Wake Forest University Orthopedic Surgery; Director, Women’s Medical Center, Department of Rehabilita-
Health Sciences; Assistant Professor, Wake Sports Medicine Program, Medical College tion Medicine, Kansas City, Kansas
Forest University Baptist Medical Center, of Wisconsin, Milwaukee, Wisconsin
Winston-Salem, North Carolina Jonathan Kay, MD
Joseph C. Honet, MD Associate Clinical Professor of Medicine,
Navneet Gupta, MD Professor, Wayne State University, School of Harvard Medical School; Director of Clinical
Physician, Pain Medicine Associates, Medicine; Professor Emeritus, Department Trials, Rheumatology Unit, Massachusetts
Johnson City, Tennessee of Physical Medicine and Rehabilitation, General Hospital, Boston, Massachusetts
Sinai Grace Hospital, Detroit Medical
Hope S. Hacker, MD Center, Detroit, Michigan Ayal M. Kaynan, MD
Assistant Professor, University of Texas Director, Minimally Invasive and Robotic
Health Science Center, San Antonio; Thomas H. Hudgins, MD Surgery, Morristown Memorial Hospital,
Director, Electrodiagnostic Medicine, Assistant Professor, Northwestern University Morristown, New Jersey
Rehabilitation Medicine Service, South Medical School, Chicago, Illinois; Medical
Texas Veterans Health Care System, San Director; Center for Sports and Spine Care, Florian S. Keplinger, MD
Antonio, Texas Division of Physical Medicine and Rehabili- Assistant Professor, Department of Physical
tation, Evanston Northwestern Healthcare, Medicine and Rehabilitation, University of
Evanston, Illinois Arkansas for Medical Sciences, Little Rock,
Arkansas
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CONTRIBUTORS
Todd A. Kile, MD Shi-Uk Lee, MD, PhD Katherine Mashey, DPM
Associate Professor of Orthopedic Surgery, Assistant Professor, Department of Rehabili- Assistant Director of the Podiatric Surgical
Mayo Graduate School of Medicine; Chair, tation Medicine, Seoul National University Residency, Saint Francis Hospital and
Division of Foot and Ankle Surgery, Consul- College of Medicine; Chairman, Department Medical Center, Hartford, Connecticut
tant, Department of Orthopedic Surgery, of Physical Medicine and Rehabilitation,
Mayo Clinic, Scottsdale, Arizona Seoul Metropolitan Boramae Medical Koichiro Matsuo, DDS, PhD
Center, Seoul, South Korea Assistant Professor, Department of Physical
John C. King, MD Medicine and Rehabilitation, Johns Hopkins
Professor, The University of Texas Health Yong-Tae Lee, MD University School of Medicine, Baltimore,
Science Center at San Antonio; Director of Instructor, Harvard Medical School; Attend- Maryland
Reeves Rehabilitation Center at University ing Physician, Spaulding Rehabilitation
Hospital, San Antonio, Texas Hospital, Boston, Massachusetts Kelly McInnis, DO
Sports Medicine Fellow, Spaulding Reha-
Ricardo Knight, MD, PT Ted A. Lennard, MD bilitation Hospital, Massachusetts General
Instructor, Department of Physical Medicine Clinical Assistant Professor, Department Hospital, Boston, Massachusetts
and Rehabilitation, Harvard Medical School; of Physical Medicine and Rehabilitation,
Spaulding Rehabilitation Hospital and University of Arkansas for Medical Sciences, Peter M. McIntosh, MD
Massachusetts General Hospital, Boston, Little Rock, Arkansas; Department of Clinical Instructor, Mayo Graduate School
Massachusetts Physical Medicine and Rehabilitation, of Medicine; Consultant, Mayo Clinic,
Springfi eld Neurological and Spine Institute, Jacksonville, Florida
Jason H. Kortte, MS, CCC-SLP Springfi eld, Missouri
Senior Speech-Language Pathologist, Good Alec L. Meleger, MD
Samaritan Hospital, Baltimore, Maryland Paul Lento, MD Clinical Instructor, Department of Physical
Assistant Professor, Northwestern University Medicine and Rehabilitation, Harvard
Brian J. Krabak, MD, MBA School of Medicine; Attending Physician, Medical School, Boston, Massachusetts;
Clinical Associate Professor, University of Rehabilitation Institute of Chicago, Spine Director, Pain Medicine Fellowship, Spauld-
Washington Medicine Sports and Spine and Sports Rehabilitation Center, Chicago, ing Rehabilitation Hospital, Medford,
Physicians, Rehabilitation, Orthopaedics, Illinois Massachusetts; Interventional Physiatrist,
and Sports Medicine, University of Spine Center, Newton-Wellesley Hospital,
Washington, Seattle, Washington; Team Peter A.C. Lim, MD Newton, Massachusetts
Physician, University of Washington, Clinical Associate Professor, Department
Medical Director, 4 Deserts Races of Physical Medicine and Rehabilitation, Lyle J. Micheli, MD
Baylor College of Medicine, Houston, Texas; Clinical Professor of Orthopedic Surgery at
Lisa S. Krivickas, MD Head and Senior Consultant, Department of Harvard Medical School; Director, Division
Associate Professor, Physical Medicine and Rehabilitation Medicine, Singapore General of Sports Medicine Department of Orthope-
Rehabilitation, Harvard Medical School; Hospital, Singapore dics, Children’s Hospital of Boston, Boston,
Director, Electromyography, Spaulding Massachusetts
Rehabilitation Hospital, Associate Chief, Karl-August Lindgren, MD, PhD
Physical Medicine and Rehabilitation, Physician in Chief, Rehabilitation ORTON, William Micheo, MD
Massachusetts General Hospital, Boston, Invalid Foundation, Helsinki, Finland Professor and Chairman, Department of
Massachusetts Physical Medicine, Rehabilitation and Sports
Elizabeth Loder, MD, MPH Medicine, University of Puerto Rico, School
Robert J. Krug, MD Associate Professor of Neurology, Harvard of Medicine, San Juan, Puerto Rico; Program
Chairman and Director, Department of Re- Medical School, Boston, Massachusetts; Director, Physical Medicine and Rehabilitation,
habilitation Medicine, Saint Francis Hospital Chief, Division of Headache and Pain, University Hospital, San Juan, Puerto Rico;
and Medical Center, Avon, Connecticut; Department of Neurology, Brigham and Chief, Section of Physical Medicine and Reha-
Medical Director and Director of the Neu- Women’s Hospital, Boston, Massachusetts; bilitation, Department of Medicine, Hospital
romuscular-Skeletal Program, Mount Sinai Clinical Editor, British Medical Journal, San Pablo, Bayamón, Puerto Rico; Chief, Sec-
Rehabilitation Hospital, Hartford, London, United Kingdom tion of Physical Medicine and Rehabilitation,
Connecticut Auxilio Mutuo Hospital, Hato Rey, Puerto Rico
Sandra Maguire, MD
Gail A. Latlief, DO Attending Physician, Physical Medicine and William Moore, MD
Assistant Professor, Internal Medicine, Rehabilitation, Compass Medical PC, East Physician, Sports Medicine Department,
University of South Florida; Medical Bridgewater, Massachusetts Kaiser Permanente, Union City, California
Director, Comprehensive Integrated
Inpatient Rehabilitation Program, James A. Gerard A. Malanga, MD S. Ali Mostoufi , MD
Haley Veterans’ Hospital, Tampa, Florida Clinical Professor, Physical Medicine and Interventional Physiatrist, Assistant
Rehabilitation, University of Medicine and Professor of Rehabilitation Medicine, Tufts
Elise H. Lee, MD Dentistry of New Jersey: New Jersey School University School of Medicine, Boston,
Physical Medicine and Rehabilitation, of Medicine, Newark, New Jersey; Director, Massachusetts; Medical Director,
Harvard Medical School; Spaulding Pain Management, Department of Neuro- Cambridge Spine Center, Cambridge,
Rehabilitation Hospital, Boston, science, Overlook Hospital, Summit, New Massachusetts
Massachusetts Jersey; Director, Sports Medicine Fellow-
ship, Physical Medicine and Rehabilitation,
Sammy M. Lee, DPM Mountainside Hospital, Montclair, New
Attending Staff , Podiatry Service, Jersey; Physician, Atlantic Sports Health and
Massachusetts General Hospital, Boston, Morristown Memorial Hospital,
Massachusetts Morristown, New Jersey
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CONTRIBUTORS
Chaitanya S. Mudgal, MD, MS (Orth), MCh Atul Patel, MD David Ring, MD, PhD
(Orth) Physician, Physical Medicine and Rehabili- Assistant Professor of Orthopaedic Sur-
Instructor, Department of Orthopaedic tation, Kansas City Bone and Joint Clinic, gery, Harvard Medical School; Medical
Surgery, Attending Staff , Orthopaedic Hand Overland Park, Kansas; Medical Director, Director and Director of Research, Ortho-
Service, Co-Director, Hand Surgery Fellow- Outpatient Rehabilitation, Research Brook- paedic Hand and Upper Extremity Service,
ship, Harvard Medical School; Attending Staff , side Campus, Kansas City, Missouri Massachusetts General Hospital, Boston,
Orthopaedic Hand Service, Massachusetts Massachusetts
General Hospital, Boston, Massachusetts Inder Perkash, MD
Professor of Urology, Stanford University Darren Rosenberg, DO
Gregory J. Mulford, MD School of Medicine, Stanford, California; Instructor, Harvard Medical School, Boston,
Clinical Associate Professor, Department Director, Regional Center for Spinal Cord Massachusetts; Clinical Assistant Profes-
of Physical Medicine and Rehabilitation, Injuries, Veterans Aff airs Palo Alto Health sor, University of New England College of
University of Medicine and Dentistry of Care System, Palo Alto, California Osteopathic Medicine, Biddeford, Maine;
New Jersey: New Jersey School of Medicine, Medical Director, Department of Physical
Newark, New Jersey; Chairman, Department Edward M. Phillips, MD Medicine and Rehabilitation, Spaulding-
of Rehabilitation Medicine, Morristown Instructor, Department of Physical Medicine Framingham Outpatient Center,
Memorial Hospital; Medical Director, and Rehabilitation, Harvard Medical School; Framingham, Massachusetts; Director,
Atlantic Rehabilitation Services, Atlantic Director, Outpatient Medical Services, Osteopathic Manipulative Medicine,
Health, Morristown, New Jersey Spaulding Rehabilitation Hospital Network, Spaulding Rehabilitation Hospital; Clinical
Boston, Massachusetts Associate, Massachusetts General Hospital;
Shanker Nesathurai, MD Clinical Associate, Brigham and Women’s
Assistant Professor, Physical Medicine and Thomas E. Pobre, MD Hospital, Boston, Massachusetts
Rehabilitation, Harvard Medical School; Clinical Assistant Professor, Physical Medi-
Researcher, Spaulding Rehabilitation Hos- cine and Rehabilitation, State University of Justin Riutta, MD
pital and Massachusetts General Hospital, New York, Stony Brook, New York; Adjunct Director, Breast Cancer Rehabilitation;
Boston, Massachusetts Clinical Assistant Professor, New York Director, Lymphedema Program, William
College of Osteopathic Medicine, Old Beaumont Hospital, Royal Oak, Michigan
José M. Nolla, MD Westbury, New York; Attending Physician,
Attending Orthopaedic/Hand Surgeon, Physical Medicine and Rehabilitation, Thomas D. Rizzo, Jr., MD
St. Luke’s Episcopal Hospital, Houston, Texas Nassau University Medical Center, East Assistant Professor, Physical Medicine and
Meadow, New York Rehabilitation, College of Medicine, Mayo
Carina J. O’Neill, DO Clinic; Consultant and Chair, Department of
Clinical Associate, Harvard Medical School, Elliot Pollack, DPM Physical Medicine and Rehabilitation, Mayo
Boston, Massachusetts, Medical Director, Chief, Section of Podiatric Surgery, Saint Clinic, Jacksonville, Florida
Spaulding Rehabilitation Hospital, Braintree Francis Hospital and Medical Center,
Massachusetts Outpatient Clinic, Braintree, Hartford, Connecticut; Private Practice, Seward B. Rutkove, MD
Massachusetts Hartford and East Granby, Connecticut Associate Professor of Neurology, Harvard
Medical School; Chief, Division of Neuro-
Michael D. Osborne, MD Mahboob U. Rahman, MD, PhD muscular Disease, Department of Neurol-
Assistant Professor in Physical Medicine Associate Professor (Adjunct), University of ogy, Beth Israel Deaconess Medical Center,
and Rehabilitation, Assistant Professor in Pennsylvania School of Medicine, Boston, Massachusetts
Anesthesiology, Mayo Clinic; Consultant, Philadelphia, Pennsylvania; Senior Director,
Department of Physical Medicine and Reha- Clinical Research and Development, John- Sunil Sabharwal, MD
bilitation, Consultant, Department of Pain son & Johnson Centocor, Inc., Horsham, Assistant Professor, Department of Physi-
Medicine, Mayo Clinic, Jacksonville, Florida Pennsylvania cal Medicine and Rehabilitation, Harvard
Medical School; Chief of Spinal Cord Injury,
Lora Beth Packel, PT, MS James Rainville, MD Veterans Aff airs Boston Healthcare System,
Assistant Professor in Physical Therapy, Assistant Clinical Professor, Department of Boston, Massachusetts
University of the Sciences in Philadelphia, Physical Medicine, Harvard Medical School;
Philadelphia, Pennsylvania Chief, Physical Medicine and Rehabilitation, Francisco H. Santiago, MD
New England Baptist Hospital, Boston, Attending Physician, Rehabilitation Medicine,
Jeff rey B. Palmer, MD Massachusetts Bronx Lebanon Hospital, Bronx, New York
Lawrence Cardinal Sheham Professor and
Director, Department of Physical Medicine Edwardo Ramos, MD Robert J. Scardina, DPM
and Rehabilitation, Professor, Otolaryngol- Department of Physical Medicine, Rehabil- Clinical Instructor in Orthopaedic Surgery,
ogy–Head and Neck Surgery, Professor, itation and Sports Medicine, University of Harvard Medical School; Chief, Podiatry Ser-
Functional Anatomy and Evolution, Johns Puerto Rico School of Medicine, San Juan, vice, Residency Program Director, Podiatry
Hopkins University, School of Medicine; Puerto Rico; Physical Medicine and Re- Service, Massachusetts General Hospital,
Physiatrist-in-Chief, Department of Physical habilitation Residency Program Director, Boston, Massachusetts
Medicine and Rehabilitation, Johns Hopkins University Hospital and Pediatric Hospital,
Hospital, Baltimore, Maryland Chief, Section of Physical Medicine and Michael K. Schaufele, MD
Rehabilitation, Department of Medicine, Assistant Professor, Emory University,
Paul F. Pasquina, MD Hospital San Pablo, Bayamón, Puerto Rico School of Medicine, Department of Or-
Chairman, Physical Medicine and Rehabilita- thopaedics, Department of Rehabilitation
tion, Walter Reed Army Medical Center and Medicine; Attending Physiatrist, Emory
National Naval Medical Center; Department Spine Center, Atlanta, Georgia
of Orthopaedics and Rehabilitation, Walter
Reed Army Medical Center, Washington, DC
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CONTRIBUTORS
Jeff rey C. Schneider, MD Aneesh Singla, MD, MPH Michael F. Stretanski, DO
Instructor, Department of Physical Medi- Instructor, Harvard Medical School; As- Clinical Assistant Professor, Ohio University
cine and Rehabilitation, Harvard Medical sistant Anesthetist, Massachusetts General College of Osteopathic Medicine, Columbus,
School; Medical Director, Burn Rehabilita- Hospital, Boston, Massachusetts Ohio; Fellowship Director, Interventional
tion, Spaulding Rehabilitation Hospital, Spine and Pain Rehabilitation; President,
Massachusetts General Hospital, Boston, Daniel Sipple, DO Neurosciences Committee, MedCentral,
Massachusetts Attending Physiatrist, Rehabilitation Mansfi eld, Ohio; Fisher-Titus Medical Center,
Institute of Chicago Chronic Pain Care Norwalk, Ohio
Joel D. Scholten, MD Center, Chicago, Illinois
Assistant Professor, Internal Medicine, Uni- Ann-Marie Thomas, MD, PT
versity of South Florida; Medical Director, Robert S. Skerker, MD Instructor, Harvard Medical School; Staff
Polytrauma Rehabilitation Center, James A. Associate Clinical Professor of Rehabilita- Physiatrist, Spaulding Rehabilitation
Haley Veterans’ Hospital, Tampa, Florida tion Medicine, University of Medicine and Hospital; Clinical Associate, Massachusetts
Dentistry of New Jersey: New Jersey School General Hospital; Associate Physiatrist in
Steven G. Scott, DO of Medicine, Newark, New Jersey; Attending Medicine, Brigham and Women’s Hospital,
Assistant Professor, Internal Medicine, Physiatrist, Atlantic Rehabilitation Institute, Boston, Massachusetts
University of South Florida; Chief, Physi- Morristown, New Jersey
cal Medicine and Rehabilitation, Director, Mark A. Thomas, MD
Polytrauma Rehabilitation Center, James A. David M. Slovik, MD Associate Professor, Physical Medicine and
Haley Veterans’ Hospital, Tampa, Florida Associate Professor of Medicine, Harvard Rehabilitation, Albert Einstein College of
Medical School; Physician, Endocrine Unit, Medicine; Program Director, Physical
Miriam Segal, MD Massachusetts General Hospital, Boston, Medicine and Rehabilitation, Associate
Attending Physician, Department of Massachusetts Chairman, Department of Physical Medicine
Physical Medicine and Rehabilitation, and Rehabilitation, Montefi ore Medical
Albert Einstein College of Medicine, Bronx, Jonas Sokolof, DO Center, Bronx, New York
New York; Attending Physician, Department Clinical Fellow, Physical Medicine and Reha-
of Physical Medicine and Rehabilitation, bilitation, Harvard Medical School; Resident Anita Thompson, PT
Montefi ore Medical Center, Bronx, Physician, Spaulding Rehabilitation Hospi- Massachusetts General Hospital Institute for
New York tal, Boston, Massachusetts Health Professions, Charlestown, Massachu-
setts; Physical Therapy Supervisor, Spauld-
Vivek M. Shah MD James Spinelli, DO ing Rehabilitation Hospital, Wellesley,
Clinical Associate, Tufts University School of Pain Management Fellow, Spaulding Reha- Massachusetts
Medicine; Orthopaedic Resident, Tufts-New bilitation Hospital, Harvard Medical School,
England Medical Center, Boston, Massachu- Boston, Massachusetts Guy Trudel, MD
setts Professor of Medicine and Surgery,
Joel Stein, MD University of Ottawa, Ottawa, Ontario,
Lena Shahban, MD Associate Professor, Department of Physical Canada
Physiatrist, Interventional Pain Consultants, Medicine and Rehabilitation, Harvard
Oak Brook, Illinois Medical School; Chief Medical Offi cer, Gregory L. Umphrey, MD
Spaulding Rehabilitation Hospital, Boston, Physician, Department of Physical Medicine
Nutan Sharma, MD, PhD Massachusetts and Rehabilitation, Mayo Clinic, Rochester,
Assistant Professor of Neurology, Harvard Minnesota
Medical School, Cambridge, Massachusetts; Meryl Stein, MD
Assistant Neurologist, Massachusetts Resident Physician, Department of Physi- Roman Vallarino, Jr., MD
General Hospital, Boston, Massachusetts; cal Medicine and Rehabilitation, Harvard Assistant Clinical Professor, Physical
Associate Neurologist, Brigham and Medical School, Spaulding Rehabilitation Medicine and Rehabilitation, Albert
Women’s Hospital, Boston, Massachusetts Hospital, Boston, Massachusetts Einstein School of Medicine, Bronx,
New York; Attending Physician,
Julie K. Silver, MD Sonja K. Stilp, MD Department of Neurosciences, New York
Assistant Professor, Department of Physical Attending Physiatrist, Boulder Orthopedics, Methodist Hospital, Brooklyn, New York
Medicine and Rehabilitation, Harvard Medi- Boulder, Colorado
cal School; Associate in Physiatry, Brigham Rodney D. Vanderploeg, PhD
and Women’s Hospital and Spaulding Reha- Todd P. Stitik, MD Associate Professor, Department of
bilitation Hospital, Boston, Massachusetts Professor and Acting Director, Department Psychology, University of South Florida;
of Physical Medicine and Rehabilitation- Staff Psychologist, Clinical Director of
Kenneth H. Silver, MD Sports Medicine, University of Medicine and the Brain Injury Rehabilitation Program,
Associate Professor, Department of Physical Dentistry of New Jersey: New Jersey School James A. Haley Veterans’ Hospital, Tampa,
Medicine and Rehabilitation, John Hopkins of Medicine, Newark, New Jersey Florida
University School of Medicine; Chief, Reha-
bilitation Medicine Service, Good Samaritan Seneca A. Storm, MD Carole S. Vetter, MD
Hospital, Baltimore, Maryland Clinical Assistant Professor, Department Assistant Professor, Orthopaedic Surgery
of Physical Medicine and Rehabilita- Associate Program; Director, Orthopaedic
Ajay K. Singh, MD tion, Michigan State University, College Surgery Residency, Medical College of
Associate Professor of Medicine, Harvard of Osteopathic Medicine, East Lansing, Wisconsin, Milwaukee, Wisconsin
Medical School; Clinical Director, Renal Michigan; Private Practice, Lansing Spine
Division, Brigham and Women’s Hospital, and Extremity Rehabilitation, Lansing,
Boston, Massachusetts Michigan
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xvii
CONTRIBUTORS
Ariana Vora, MD Jay M. Weiss, MD J. Michael Wieting, DO
Instructor, Harvard Medical School; Staff Assistant Professor of Clinical Physical Professor of Physical Medicine and Reha-
Physiatrist, Massachusetts General Hospital; Medicine and Rehabilitation, SUNY bilitation and Osteopathic Principles and
Staff Physiatrist, Spaulding Rehabilitation Stony Brook, Stony Brook, New York; Practices, Medical Director of Sports Medi-
Hospital, Boston, Massachusetts Medical Director, Long Island Physical cine, Lincoln Memorial University–De Busk
Medicine and Rehabilitation, Levittown, College of Osteopathic Medicine, Harrogate,
Aimee H. Walsh, MD New York Tennessee
Assistant Professor, University of Alabama
at Birmingham, Department of Anesthe- Lyn D. Weiss, MD Allen N. Wilkins, MD
sia; Medical Director, Pain Treatment Professor of Clinical Physical Medicine Chief Resident, Harvard Medical School;
Center, University of Alabama, Highlands and Rehabilitation, SUNY Stony Brook, Chief Resident, Spaulding Rehabilitation
Pain Treatment Clinic, Birmingham, Stony Brook, New York; Chairman and Hospital, Boston, Massachusetts
Alabama Program Director, Department of
Physical Medicine and Rehabilitation, Meijuan Zhao, MD
David Wang, DO Director, Electrodiagnostic Medicine, Instructor, Department of Physical
Instructor, Harvard Medical School; Staff Nassau University Medical Center, East Medicine and Rehabilitation, Harvard
Physiatrist, Spaulding Rehabilitation Meadow, New York Medical School; Staff Physiatrist, Physical
Hospital, Boston, Massachusetts Medicine and Rehabilitation, Spaulding
David Wexler, MD, FRCS (Tr, Orth) Rehabilitation Hospital, Boston,
Yumei Wang, MD Orthopaedic Surgeon, Millinocket Regional Massachusetts
Assistant Professor, Physical Medicine Hospital, Millinocket, Maine
and Rehabilitation, Albert Einstein
College of Medicine; Attending Physician, Jane Wierbicky, RN, BSN
Montefi ore Medical Center, Bronx, Health Services Coordinator, Department
New York of Rehabilitation Medicine, Boston Medical
Center, Boston, Massachusetts
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Preface
From the beginning, it was our idea to create a book the same order (Synonyms, ICD-9 Codes, Defi nition,
that covers a variety of medical conditions that the aver- Symptoms, Physical Examination, Functional Limita-
age internist/family practitioner, physiatrist, orthope- tions, Diagnostic Studies, Differential Diagnosis, Treat-
dist, rheumatologist, and neurologist encounters in his ment [Initial, Rehabilitation, Procedures, and Surgery],
or her medical practice. We particularly wanted to em- Potential Disease Complications, Potential Treatment
phasize the outpatient aspects of both musculoskeletal Complications, and References). It is our hope that phy-
injuries and chronic medical conditions requiring reha- sicians in all specialties and allied health care providers
bilitation from the perspective of a practitioner in an will fi nd that this book complements the excellent exist-
ambulatory setting. In this new edition, we have added ing rehabilitation textbooks and that it will be an effi -
an entirely new section on the ambulatory management cient and useful tool in the offi ce setting.
of pain conditions.
We are extremely grateful for the hard work of our col-
Essentials of Physical Medicine and Rehabilitation covers leagues who authored these chapters and who represent
many diagnoses in a deliberately succinct and specifi c many different specialties and come from excellent in-
format. This book is now divided into three sections. stitutions. Their generous support of our work has made
The fi rst section contains chapters on specifi c musculo- this book possible.
skeletal diagnoses, organized anatomically. The second
Finally, we would like to thank our editorial team at
section describes the management of pain conditions.
Elsevier. Their assistance was invaluable in bringing this
The third section covers common medical conditions
book to publication.
that are typically chronic and benefi t from rehabilitative
Walter R. Frontera, MD, PhD
as well as other interventions. Although some of these
Julie K. Silver, MD
conditions require hospitalization, we have tried to fo-
Thomas D. Rizzo, Jr., MD
cus on the rehabilitation that takes place in an ambula-
tory setting. Each chapter includes the same sections in
xix
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MUSCULOSKELETAL DISORDERS: HEAD AND NECK
Cervical Spondylotic
1
Myelopathy
Avital Fast, MD, and Miriam Segal, MD
Synonyms subaxial cervical spinal canal measures 17 to 18 mm,
whereas the spinal cord diameter in the same dimension
Cervical radiculitis is about 10 mm. Severe CSM gradually decreases the
Degeneration of cervical intervertebral disc space available for the cord and brings about cord com-
Cervical spondylosis without myelopathy pression in the anterior-posterior axis. Cord compression
Cervical pain usually occurs at the discal levels.4-6
ICD-9 Codes The encroaching structures may also compress the an-
721.0 Cervical spondylosis without myelopathy terior spinal artery, resulting in spinal cord ischemia
722.4 Degeneration of cervical intervertebral disc that usually involves several cord segments beyond the
723.3 Cervical pain actual compression site. Spinal cord changes in the
723.4 Cervical radiculitis form of demyelination, gliosis, myelomalacia, and
eventually severe atrophy may develop.4,7-9 Dynamic
instability, which can be diagnosed in fl exion or exten-
DEFINITION sion lateral x-ray views, further complicates matters.
Disc degeneration leads to laxity of the supporting liga-
Cervical spondylotic myelopathy (CSM) is a frequently ments, bringing about anterolisthesis or retrolisthesis
encountered entity in middle-aged and elderly patients. in fl exion and extension, respectively. This may further
The condition affects both men and women. Progres - compromise the spinal cord and intensify the present-
sive degeneration of the cervical spine involves the ing symptoms.2,4
discs, facet joints, joints of Luschka, ligamenta fl ava,
and laminae, leading to gradual encroachment on the
SYMPTOMS
spinal canal and spinal cord compromise. CSM has a
fairly typical clinical presentation and, frequently, a
CSM develops gradually during a lengthy period of
progressive and disabling course.
months to years. Not infrequently, the patient is unaware
As a consequence of aging, the spinal column goes of any functional compromise, and the fi rst person to
through a cascade of degenerative changes that tend to notice that something is amiss may be a close family
affect selective regions of the spine. The cervical spine is member. Whereas pain appears rather early in cervical
affected in most adults, most frequently at the C4-7 radiculopathy and alerts the patient to the presence
region.1,2 Degeneration of the intervertebral discs triggers of a problem, this is usually not the case in CSM. A long
a cascade of biochemical and biomechanical changes, history of neck discomfort and intermittent pain may
leading to decreased disc height among other changes. As frequently be obtained, but these are not prominent at
a result, abnormal load distribution in the motion seg- the time of CSM presentation.
ments causes cervical spondylosis (i.e., facet arthropathy)
Most patients have a combination of upper motor neu-
and neural foraminal narrowing. Disc degeneration also
ron symptoms in the lower extremities and lower motor
leads to the development of herniations (soft discs), disc
neuron symptoms in the upper extremities.4 Patients
calcifi cation, posteriorly directed bone ridges (hard discs),
frequently present with gait dysfunction resulting from a
hypertrophy of the facet and the uncinate joints, and
combination of factors, including ataxia due to impaired
ligamenta fl ava thickening. On occasion, more frequently
joint proprioception, hypertonicity, weakness, and mus-
in Asians but not infrequently in white individuals, the
cle control defi ciencies.
posterior longitudinal ligament and the ligamenta fl ava
ossify.3 These degenerative changes narrow the dimen- Studies have demonstrated that severely myelopathic
sions and change the shape of the cervical spinal canal. patients display abnormalities of deep sensation,
In normal adults, the anteroposterior diameter of the including vibration and joint position sense, which is 3
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