Musculoskeletal injuries and conditions: assessment and management

488 Pages·2016·28.51 MB·English

by  Se Won Lee

Musculoskeletal Injuries L
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and Conditions Se Won Lee, MD
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Assessment and Management
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Conditions
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Se Won Lee
Provides a consistent approach to managing common musculoskeletal conditions based s
on location of pain
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• Bulleted format and clear heading structure make it easy to find information n
• More than 30 flowcharts map out differential diagnosis, diagnostic approach, and initial d
management strategy for each complaint
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• Packed with useful tables, lists, and over 150 illustrations of surface anatomy
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• Integrates musculoskeletal ultrasound into the imaging workup, with over 40 normal and n
abnormal scans to aid in recognizing signature pathologies at the point of care
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• Purchase includes access to the fully-searchable downloadable e-book with image bank
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t
i
Recommended Shelving o
Category: Physical Medicine
and Rehabilitation n
s
ISBN 978-1-62070-098-3
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Musculoskeletal Injuries
and Conditions
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Musculoskeletal Injuries
and Conditions
Assessment and Management
Se Won Lee, MD
Associate Professor
Department of Clinical Physical Medicine and Rehabilitation
Albert Einstein College of Medicine
Fellowship Director, Sports Medicine
Director
Electrodiagnostic Laboratory
Department of Rehabilitation Medicine
Montefi ore Medical Center
Bronx, New York
New York
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Visit our website at www.demosmedical.com
ISBN: 9781620700983
e-book ISBN: 9781617052750
Acquisitions Editor: Beth Barry
Compositor: Newgen KnowledgeWorks
Copyright © 2017 Springer Publishing Company.
Demos Medical Publishing is an imprint of Springer Publishing Company, LLC.
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Library of Congress Cataloging-in-Publication Data
Names: Lee, Se Won, author.
Title: Musculoskeletal injuries and conditions: assessment and management / Se Won Lee.
Description: New York: Demos Medical Publishing, [2017] | Includes bibliographical references.
Identifi ers: LCCN 2016025422| ISBN 9781620700983 | ISBN 9781617052750 (e-book)
Subjects: | MESH: Musculoskeletal Diseases—diagnosis | Musculoskeletal Diseases—therapy | Musculoskeletal System—injuries |
Physical Examination | Handbooks | Outlines
Classifi cation: LCC RC925.5 | NLM WE 39 | DDC 617.4/7044—dc23
LC record available at https://lccn.loc.gov/2016025422
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This book is dedicated to my wife (Hyunjoo), my daughter (Jane), and my mentors
(Dr. Dennis D. J. Kim and Dr. Mooyeon Oh-Park). It is also dedicated to the Physical
Medicine and Rehabilitation faculty at Montefi ore Medical Center (Dr. Matthew Bartels,
Dr. Mark Thomas, Dr. Stanley Wainapel, Dr. Sikha Guha, Dr. Eathar Saad, Dr. Yuxi Chen,
Dr. Yumei Wang, Dr. Karen Morice, Dr. Andrew Gitkind, Dr. Emal Wahezi, Dr. Sooyeon Kim,
Dr. Olivera Pekovic, Dr. Jeffrey Nissinoff, Dr. Gary Inwald, Dr. Maria Castro, Dr. Meg Krilov,
Dr. David Prince, Dr. Anna Lasak, Dr. Rani Kathirithamby, Dr. David Cancel,
Dr. Grigory Syrkin, Dr. Huma Naqvi, and Dr. Maria Reyes), and past, present,
and future fellows and residents.
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Contents
Abbreviations xv
2. N ECK 83
Preface xvii
Acknowledgments xix
Epidemiology of Neck Pain 83
Share Musculoskeletal Injuries and Conditions:
Neck Pain in the General Population 83
Assessment and Management
Neck Pain in Athletes 83
Neck Pain at Work 83
1. A PPROACH TO THE PATIENT WITH A
Differential Diagnosis 83
MUSCULOSKELETAL PROBLEM 1
Unusual Causes of Neck Pain 84
Neurological Symptoms Associated
History and Physical Examination 1
With Neck Pain 85
Chief Complaint 1
Neurological Impairment 4
Anatomy 87
Other History 6
Regional Anatomy 87
Past Medical History (Limited to MSK Problems) 8
Spine Complex (Bone and Joint) 87
Review of Systems 8
Ligament 90
Other MSK Symptoms 9
Nerve: Root and Plexus 90
Physical Examination 9
Muscle 92
Provocative Test 11
Fascia 95
Clinically Oriented Anatomy 12 Blood Supply 95
Tendon and Ligament 12
Muscle and Fascia 16 Biomechanics 96
Bursa 20
Bone and Joint 20 Physical Examination 97
Nervous System 26 Inspection 97
Palpation 97
Biomechanics 28
Neurologic Examination
Introduction 28
and Special Examination 97
Clinical Application 29
Gait Cycle 29
Diagnostic Studies 99
Gait Dysfunction 31
Plain Radiographs 99
Workup 33 MRI 100
MSK Imaging 33 Point-of-Care Ultrasonagraphy 100
Radiographs 33 CT Scan 101
Advanced Imaging 36 Electromyography (EMG) 101
Scanning Protocol Modifi ed From AIUM
Protocol 45 Treatment 101
Other Workup: Laboratory Investigation 56 Nonoperative Management 101
Surgery 102
Treatment 57
Patient Education 57
Nerve and Spinal Cord Pathology 103
Pharmacologic Management 57
Cervical Radiculopathy 103
Local Intervention 64
Noncompressive Radiculopathy 104
Physical and Occupational Therapy 69
C5 (Nerve Root) Palsy 104
Orthoses 75
Greater Occipital Neuralgia 105
Treatment Based on Different Anatomical
Supraclavicular Nerve Entrapment Syndrome 106
Pathologies 76
References 78
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viii Contents
Cervical Myelopathy 106 Diagnostic Studies 135
Cervical Cord Neurapraxia 107 Plain Radiographs 135
Ossifi cation of Posterior Longitudinal Point-of-Care Ultrasonography 136
Ligament (OPLL) 107 MRI/MRA 136
Syringomyelia 108 CT Scan 137
Chiari Malformation 108
Drop Head Syndrome 109 Treatment 137
Nonoperative Management 137
Bone and Joint Pathology 109 Surgery 138
Cervical Facet Pathology 109
Whiplash-Associated Injury 110 Tendon and Bursa Pathology 139
Degenerative Disc Disease 110 Impingement Syndrome 139
Rheumatoid Arthritis 111 Rotator Cuff Tendinopathy and Tear 142
Cervical Spine Disorder Calcifi c Tendinopathy 143
in Down Syndrome 111 Biceps Long-Head Tendon
Klippel–Feil Anomaly 112 Pathologies 144
Fracture 112 Pectoralis Muscle Strain and Tear 146
Metastatic Cervical Spine Tumor 114
Joint and Bone Pathology 146
Muscle and Ligament Pathology 114 AC Joint Sprain and Injury 146
Cervical Strain/Sprain 114 AC Osteoarthritis 147
Myofascial Pain Syndrome 115 Distal Clavicle Osteolysis 148
Glenohumeral Joint Pathologies 148
References 115
Shoulder Osteoarthritis 149
Shoulder Instability 150
3. S HOULDER 119 Multidirectional Instability 151
SLAP (Superior Labral Anteroposterior)
Epidemiology of Shoulder Pain 119 Lesion 151
Shoulder Pain in the General Population 119 Bennett Lesion 152
Shoulder Pain in Athletes 119 Rheumatologic Disease 152
Shoulder Pain at Work 119 Infectious Pathology 154
Osteonecrosis of the Humeral Head 155
Differential Diagnosis 119 Little League Shoulder 155
Musculoskeletal (MSK) Causes of Sternoclavicular (SC) Sprain/Injury 156
Shoulder Pain Based on Location 119 SC Osteoarthritis 156
Neuropathic Causes of Shoulder Pain 122 Fracture 156
Extrinsic Causes of Shoulder Pain 122
Neurological Symptoms 122 Neuropathy and Vascular Dysfunction 158
Snapping Shoulder 123 Brachial Amyotrophy (Parsonage Turner
Shoulder Instability 123 Syndrome) 158
Cervical Radiculopathy 159
Anatomy 124
Stinger Syndrome (Burner) 159
Bone, Joint, and Ligament 124
Thoracic Outlet Syndrome (TOS) 159
Nerve 126
Effort Thrombosis (Paget–Schroetter
Bursa 126
Syndrome) 160
Muscle 127
Axillary Artery Occlusion 161
Suprascapular Neuropathy 161
Biomechanics 129
Quadrilateral Space Syndrome 162
Shoulder Movement 129
Subacromial Impingement 130 References 162
Subcoracoid Impingement: Roller Wringer
Effect 130
Suprascapular Nerve Traction With Scapula 4. E LBOW 167
Position 130
Biomechanics of Throwing 131 Epidemiology of Elbow Pain 167
Shoulder Stability 131 Elbow Pain in the General Population 167
Elbow Pain in Athletes 167
Physical Examination 132 Elbow Pain at Work 167
Inspection 132
Palpation 132 Differential Diagnosis 167
Range of Motion 132 Elbow Instability 169
Strength of Rotator Cuff Muscles 133 Snapping Elbow 169
Special Tests 133 Stiffness 169
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Contents ix
Anatomy 170
5. W RIST AND HAND 197
Bone and Joint 170
Ligament 171
Nerve 171 Epidemiology of Wrist and Hand Pain 197
Muscle 172 Wrist and Hand Pain in the General
Population 197
Wrist and Hand Pain in Athletes 197
Biomechanics 174
Wrist and Hand Pain at Work 197
Kinetic and Kinematics 174
Elbow Stability 174
Differential Diagnosis 197
Elbow Function in ADL 174
MSK Causes of Wrist and Hand Pain
Based on Location 197
Physical Examination 175
Neuropathic Causes of Wrist
Inspection 175
and Hand Pain 199
Palpation 175
Differential Diagnosis of
Range of Motion 175
Finger/Wrist Drop 200
Special Tests 176
Snapping 200
Diagnostic Studies 177
Anatomy 200
Plain Radiographs 177
Bone, Joint, and Ligament 200
Point-of-Care Ultrasonography 177
Nerve 204
MRI/MRA 178
Muscle 206
CT Scan 178
No Man’s Land 208
Treatment 178
Biomechanics 208
Nonoperative Management 178
Forearm Movement and RU Joint 208
Surgery 179
ROM of Wrist and Hand 208
Proximal Carpal Movements 208
Tendon, Ligament, and Bursa Pathology 179
Wrist Stability 209
Lateral Epicondylitis 179
Biomechanics of Hand 209
Lateral Collateral Ligament Sprain 180
Medial Epicondylitis 180
Physical Examination 209
Little League Elbow 181
Inspection 209
Ulnar Collateral Ligament (UCL) Injury 181
Palpation 210
Valgus Extension Overload Syndrome
Special Tests of Wrist and Hand 211
(Posteromedial Impingement) 182
Special Examination of Hand (Finger) 213
Distal Biceps Tendinopathy/Tear 182
Bicipitoradial Bursitis 183
Diagnostic Studies 214
Triceps Tendinopathy and Tear 183
Plain Radiographs 214
Olecranon Bursitis 183
Point-of-Care Ultrasonography 214
MRI/MRA 215
Bone and Joint Pathology 184
CT Scan 215
Osteoarthritis 184
Electromyography (EMG) 215
Osteochondritis Dissecans
of the Elbow (Capitellum) 184
Treatment 216
Posterior Impingement of the Elbow 185
Nonoperative Management 216
Rheumatoid Arthritis 185
Surgery 217
Myositis Ossifi cans 186
Fracture 186 Tendon and Ligament Pathology 218
Elbow Dislocation 189 Wrist Extensor Tendon Disorders 218
Wrist Flexor Tendon Disorders 220
Neuropathy 189 Trigger Fingers 221
Ulnar Neuropathy 189 Retinacular Cyst 221
Radial Tunnel Syndrome 192 Dupuytren’s Disease 222
Posterior Antebrachial Cutaneous Gamekeeper’s (Skier’s) Thumb
Neuropathy 193 and Stener’s Lesion 222
Median Neuropathy at Elbow 193 Finger Sprain and Strain 223
Other Nerves 194 Volar Plate Injury 224
References 194 Central Slip Extensor Injury 224
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