3918_FM_i-xx 03/01/15 3:29 PM Page i Chad Starkey, PhD, AT, FNATA Professor Division of Athletic Training School of Applied Health Sciences and Wellness College of Health Sciences and Professions Ohio University Athens, OH Sara D. Brown, MS, LAT, ATC Clinical Associate Professor Director, Programs in Athletic Training Boston University College of Health and Rehabilitation Sciences: Sargent College Department of Physical Therapy and Athletic Training Boston, MA 3918_FM_i-xx 03/01/15 3:29 PM Page ii F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2015 by F. A. Davis Company Copyright © 2015 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. 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The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Starkey, Chad, 1959- , author. Examination of orthopedic & athletic injuries / Chad Starkey, Sara D. Brown. — Fourth edition. p. ; cm. Examination of orthopedic and athletic injuries Includes bibliographical references and index. ISBN 978-0-8036-3918-8 — ISBN 0-8036-3918-X I. Brown, Sara D., author. II. Title. III. Title: Examination of orthopedic and athletic injuries. [DNLM: 1. Athletic Injuries—diagnosis. 2. Orthopedic Procedures—methods. QT 261] RD97 617.1’027—dc23 2014041993 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: / + $.25. 3918_FM_i-xx 03/01/15 3:29 PM Page iii Whenever I put my foot in my mouth and you begin to doubt That it's you that I'm dreaming about Do I have to draw you a diagram? Chad Starkey, PhD, AT, FNATA To my colleagues at Boston University, for your relentless curiosity, commitment to improvement, and willingness to laugh every day. Sara D. Brown, MS, LAT, ATC 3918_FM_i-xx 03/01/15 3:29 PM Page iv 3918_FM_i-xx 03/01/15 3:29 PM Page v Preface T Some chapters have been reorganized, with the cervical he continued evolution of health care necessitates care- and thoracic spine now bundled together to reflect clinical ful changes in how we think about and approach the exam- reality. The chapter on environmental conditions has been ination and diagnostic process for patients with orthopedic removed since this content is not typically included in conditions. In this edition, we emphasize a patient-centered courses relating to orthopedic examination. The relevant examination process using the World Health Organization’s content on thoracic, abdominal, and cardiopulmonary International Classification of Functioning, Disability, and pathologies, a stand-alone chapter in the third edition, has Health disablement model. This model reminds us to look been redistributed to the specific systems. for connections between what the patient can and cannot The content is now organized into five discrete sections. do and the involved body structures and functions. Section I presents the foundations of the examination We continue to highlight the practical integration of evi- process. Chapter 1 describes the clinical examination process dence into practice. Updated information regarding the used, and Chapter 2 presents the on-field processes used clinical usefulness of selective tissue tests and other exami- throughout the text. Chapter 3 introduces the elements of di- nation techniques is presented in the associated boxes using agnostic evidence and describes the measures commonly a standardized format. Most notable, perhaps, is how little used for assessing outcomes (which are then presented in the continues to be known about the validity and reliability of relevant Section Openers). Chapter 4 gets the messy vernacu- some of the commonly used techniques. We have added lar used to describe pathology out of the way and presents the multiple new techniques that have promising or established examination findings of common musculoskeletal disorders diagnostic value. The values we present are dynamic and (e.g., sprains, inflammatory conditions, fractures). Chapter 5 are not intended to supplant current systematic reviews or describes diagnostic imaging techniques that are often the meta-analyses. gold standard used to confirm the clinical diagnosis. Chapters 6 The values used to represent the range of scores for (Assessment of Posture) and 7 (Evaluation of Gait) emphasize inter- and intrarater reliability, sensitivity, specificity, and general alignment and function that can contribute to a positive and negative likelihood ratios were obtained from patient’s status. the references cited in the Appendix. Ranges for metrics Section IIcontains those chapters that describe the ex- that had 12 or more data points were calculated using the amination of the lower extremity. Although the content is 95% confidence interval, while those having 5 to 11 data presented in separate chapters, the actual clinical examina- points were calculated using the interquartile range. For tion will most likely require the examination of the sur- those tests having two to four data points, the low value, rounding body parts. Section IIIpresents the examination high value, and median value were reported. Instructors of the torso. Lumbar and sacral examination is presented in and students are encouraged to regularly scan the literature Chapter 13, while Chapter 14 covers the cervical and tho- for the most recent information. racic spine and the thorax. The upper extremity, shoulder Integration of outcome measures into daily practice is be- and upper arm, elbow, wrist, hand, and fingers are covered coming the expectation for high-quality health care. Outcome in Section IV. The text concludes with Section V, involving measures provide a standard approach to understanding the injuries to the eye (Chapter 18), face (Chapter 19), and the patient’s current status, the impact of a condition on the pa- brain and skull (Chapter 20). tient’s life, and the extent to which an intervention is helping The most visually striking change is the new full-color the patient. This text emphasizes the incorporation of out- format, designed to provide still greater clarity of the come measures into the examination process and connects pathologies and diagnostic techniques described in this these outcomes to a brief description of the interventions text. We encourage both instructors and students to contact used. A new opener for each section describes commonly us with questions or comments. Chad’s e-mail address is used patient-rated outcome measures and region-specific [email protected], and Sara’s is [email protected]. We also functional assessments, and clinician-rated outcome meas- invite students and instructors to visit us on Facebook at ures are incorporated into each chapter. facebook.com/EOAI4. v 3918_FM_i-xx 03/01/15 3:29 PM Page vi 3918_FM_i-xx 03/01/15 3:29 PM Page vii Contributors Monique Mokha, PhD, ATC, LAT Brady L. Tripp PhD, ATC Associate Professor Clinical Associate Professor Division of Math, Science, and Technology Director of Graduate Athletic Training Farquhar College of Arts and Sciences Dept. Applied Physiology and Kinesiology Nova Southeastern University College of Health and Human Performance Fort Lauderdale-Davie, FL University of Florida Gainesville, FL vii 3918_FM_i-xx 03/01/15 3:29 PM Page viii 3918_FM_i-xx 03/01/15 3:30 PM Page ix Reviewers John W. Burns, MS, ATC, LAT Heather Schuyler, MA, AT, MT, KTP Program Director, Athletic Training Education Assistant Professor Kinesiology Athletic Training Education Program/ESPE Washburn University Adrian College Topeka, KS Adrian, MI Erin M. Jordan, MS, ATC Bret A. Wood, MEd, LAT, ATC Clinical Instructor Lecturer, Clinical Coordinator Health and Kinesiology Department of Kinesiology Georgia Southern University University of North Carolina at Charlotte Statesboro, GA Charlotte, NC Joanne Klossner, PhD, LAT, ATC Clinical Assistant Professor Kinesiology Indiana University Bloomington, IN ix 3918_FM_i-xx 03/01/15 3:30 PM Page x