Pocket Guide to Msukculoskeletal Assessment by RICHARD f. BAXlfR

["mr-----------145 lOWfR fXTRfMIlY AMPUTATION fVAlUATION Subjective oz Evaluation ~ t Pt Hx (amputation specific): age, ::J sex, date and type of amputation, --l present MHx ~ t Motivation, communication abili- ties, family support W t Home specifics (e.g., stairs, type of carpet, bath- oZ room layout) ~ t Lifestyle I- ::J t Pt's goals for therapy 0... 2 <t: >- I- 2 w a: lx- w a: w oS --l M....","146 - - - - - - - - - - - - - Objective Evaluation I. Observation A. Vital signs B. Skin: wound healing, perspiration, check for trophic changes C. Shape: conical, cylindrical, bulbous, ... edematous, dog ears w D. Measurements: girth, length E. Circulation: pulses, coloration or F. Motor function: strength, tone of all ~ extremities m :0 G. Sensation m 1. Light touch, hot\/cold, sharp, proprioception, X -l :0 phantom sensation m ~ 2. Educate Pt about importance of --<l desensitization of residual limb to tapping J> or rubbing ~ IJ H. Pain C -l 1. Bone, vascular, nerve, wound, phantom ~ o pain :;;Z 2. Frequency, intensity, duration, description m r I. ROM for all joints: note any contractu res C 1. Common AKA contractures: hip flex, ER, ~ abd oz 2. Common BKA contractures: hip flex, ER, abd, knee flex J. Function 1. Bed mobility 2. Balance (sitting, standing) 3. Transfers (sit-to-stand and bed-to- wheelchair, each with and without the prosthesis) 4. Gait (amount of weight bearing, assistive devices, tolerance, stairs) K. ADLs","-------------147 1. Bath, dressing, toilet, bandaging of residual limb independently 2. Donning\/doffing of the prosthesis independently Bibliography oz Karacoloff LA, Hammersley CS, Schneider FJ: Lower Extremity ~ Amputation: A Guide to Functional Outcomes in Physical Therapy Management. Gaithersburg, MD, Aspen, 1992 . :=> Skinner HB, Effeney DJ: Gait analysis in amputees. Am J Phys ---.J Med 6482-89, 1985. \u00a7 W Z o ~ f- :=> 0... ~ <t: ~ ~ w 0:: f- X w 0:: w oS ---.J .(.\\\\.'.)","","rnr------------149 uLI NfUROlOGIC fVAlUAlION Subjective z Evaluation o ~ t Pt Hx (neurologic specific): onset => of present condition, diagnosis, test results, precautions :;.-J t Home environment (e.g., barriers). W family support U t Recovery to date, Pt's goals o<.9 .-J o a: =w> Z","150 Objective Evaluation I Observations A. Catheter B. Oxygen C. Intravenous lines D. Ventilator or other assistive devices II Mental status A. State of consciousness (e.g., alert, lethargic, obtunded, stupor, coma) ... B. Score on standardized cognitive function scale C. Orientation (person\/place\/time) xl, 2, 3 ~ D. Memory (short and long term) z E. Attention m c F. Calculation :JJ 0 G. Abstract thinking r 0 III. Communication Gl n A. Aphasia: global or Wernicke's (receptive), m cr~ Broca's (expressive) B. Observe Pt's ability to name objects, write, ~ read aloud, and follow directions 0z C. Establish method of communicating with Pt IV. Cranial ner es (see Specla Te stable) Reflexes A. MSRs B. Pathologic 1. Clonus 2. Babinski's sign or reflex 3. Hoffmann's sign 4. Other superficial or postural reflexes VI Sensation A. Light touch B. Pain C. Proprioception D. Combined sensations","151 1. Stereognosis z 2. Tactile localization 3. Two-point discrimination 0 4. Bilateral, simultaneous stimulation (e.g., ~ vibration) VI S ::J ...J A. Check to ensure no decubiti forming VII Percep ;\u00a3 A. Spatial neglect W B. Apraxia C. Agnosia u Musculosl<e e A. Involuntary movement (e.g., tremor, chorea, (? athetosis) 0 B. Muscle tone (e.g., spasticity, rigidity, flaccidity) C. PROM and AROM ...J X Respiratory A. Airway protection, mechanics, cough a0: XI Coordination A. Finger-to-nose test ::J B. Pronation\/supination (rapid alternating wz movements) C. Alternate nose-to-finger test ~ )<1 Balance po A. Static and dynamic B. Sitting and standing (e.g., Romberg's test, functional reach, perturbation testing) XII ADLs A. Bed mobility B. Sit-to-stand movement C. Transfers D. Gait * Compile a problem list, with short- and long-term goals, and a treatment plan. Educate the family about positioning, bed mooility, transfers, and safety.","~ SPECIAL TESTS FOR NEUROLOGIC EVALUATION Test Detects Test Procedure Cranial nerve function' Which areas of central I: olfactory (sense of s nervous system may be II: optic (visual field) involved by assessing III, IV, VI: pupillary rea functions of cranial nerves muscle func Babinski's reflex\/sign' Upper motor neuron lesion side I V: trigeminal Ibilateral Hoffmann's sign' Upper motor neuron lesion\/ pin or light touch to (pathologic reflex for UE, corticospinal tract lesion of VII: facial Ismile, frow similar to Babinski's sign spinal cord VIII: auditory and vest for LE) IX, X: glossopharyngea XI: accessory (trapeziu XII: hypoglossal Itongu Pt supine. Examiner ru aspect of Pt's foot and med Examiner grasps and s distal phalanx of PI's causing quick stretch Clonus' Upper motor neuron lesion Pt sitting with knees Pupillary light reflex' exam table. Examiner gastrocnemius muscle upward (into OF). Lesion of cranial nerve II or III Examiner shines light Gag reflex' Lesion of cranial nerve IX or X Examiner uses tongue or pharynx (]l W","Positive Sign smell) Loss or asymmetry of any of these functions\/reflexes action to light. extraocular Pt involuntarily extends big toe and abducts (splays) ction (look up, down, and side to other toes l simultaneous stimulation with o face) wn, wrinkle browl tibular (hearing, vertigo) al and vagus (gag reflexl us\/shoulder shrug, SCMI ue protrusion) uns pointed object along plantar d across metatarsal heads lat to stabilizes PI's hand and \\\"flicks\\\" Induced flex of thumb and other fingers middle finger in direction of ext, of finger flexors flexed and hanging over edge of Rapid oscillations of contraction and relaxation occur in r places a quick stretch on response to this quick stretch, causing reverberating e by abruptly moving Pt's foot OF\/PF motion of ankle. There may be several beats or, t into one eye of Pt in some cases, clonus does not cease until stretch is released when examiner passively plantar flexes PI's e depressor to touch soft palate ankle Lesion of cranial nerve Ilion test side: pupil of eye on test side into which light is shined fails to constrict and opposite pupil does constrict when light is shined into opposite side, only that pupil constricts Lesion of cranial nerve lion test side: neither pupil constricts when light is shined into eye on test side, but both pupils constrict when light is shined into opposite eye Asymmetry in retraction of soft palate during gag. Palate retracts to normal side (away from side of central nervous system lesion). Cnnti\/llm\/ ...","I SPECIAL TESTS FOR NEUROLOGIC EVALUATION Continued Test Detects Test Procedure Romberg's test' Vestibular dysfunction\/balance Pt standing with feet deficit Examiner observes and Coordination tests' Cerebellar dysfunction Finger-to-nose: PI's sh elbow extended. PI th finger to tip of nose Alternate nose-to-fing nose and tip of exami Examiner may change to assess PI's ability t and force of movemen Pronation\/supination: with elbows flexed 90 pronate\/supinate forea speed.","Positive Sign together and eyes closed. Excessive postural sway, tendency to fall to one side, nd notes postural reaction. abd of arms more to one side than other, and associated movements of mouth and hands houlder abducted 90 deg with Difficulty or inability to perform on one side compared hen asked to touch tip of index with opposite side ger: Pt alternately touches tip of Difficulty or inability to perform on one side compared iner's finger using index finger. with opposite side e positions of finger in front of PI to change distance, direction, I Inability to coordinate hands so they perform pronation\/ nt. supination alternately, and\/or inability to perform test rapidly have Pt hold arms into sides 0 deg. Then have Pt alternately arms\/hands, gradually increasing 0:0 <c ~3 0\\\"0 CJl :::Y ~~","","mr----------157 INPATlfNT ORTHOPfDIC fVAlUATlON Subjective oz Evaluation ~ t Pt Hx (inpatient orthopedic ::J specific) -l t Surgery\/diagnosis: procedure and \u00a7: date, postsurgical complications, W EBL, expected discharge date U t Presurgical functional level o t Home environment (e.g., carpet, stairs) and living arrangements, if applicable W 0... t Meds, radiograph\/CT\/MRI o I ofer-: f- Z w ~ 0... Z .I.n.","158 - - - - - - - - - - - - - Objective Evaluation I. Vital Signs, temperature, oxygen saturation II. Mental status III. Galt, if applicable IV. AROM and PROM, if applicable V. Strength of upper and lower extremity, as applies VI. Sensation ... A. Light touch CJ'I B. Sharp\/dull z C. Two-point discrimination ~ VII. Reflexes '-l m A. MSRs Z '-l B. Pathologic o :lJ '-l 1. Babinski's reflex present\/not present Io 2. Clonus present\/not present and number \\\\J of beats mo n VIII. Vascular m A. Pulses :\u00a7 r C 1. Radial ~ 2. DP oz 3. PT 4. Capillary refill in finger\/toenail beds 5. Extremity temperature IX. Balance, if applicable A. Romberg's test B. Sitting and standing with perturbation C. Single-leg stance D. Dynamic balance during gait X. Coordination, if applicable A. Finger-nose-finger test B. Heel-to-shin test C. Rapid alternating movements","-------------159 XI. Special tests, if applicable XII. Palpation, if applicable XIII Functional asseSSrT1ent A. Bed mobility B. Transfers C. Ambulation z o ~ =:> -l \u00a7: W U o W Q... o I olc-c I- Z w ~ Q... Z ...It)","160------------- APPENDIX A Dermatomes The dermatomes follow a highly regular pattern on the body. S, sacral; L, lumbar; 1, thoracic; C, cervical. In actuality, the boundaries of the dermatomes are less distinct than shown here because of overlapping innervation. \u00bb \/11\/ I o , ; -. If,'I. :mJJ ' ; ~. '\u00b71 ~ .,- a ~ (f) Ikproduced with permission from Kandel EH: Principles of Neural Scie\/lce, :3rd ed. New York, Elsevier Publishers. 1991.","161 APPENDIX B Sderotomes The sclerotomes are areas of bone or fascia that are supplied by individual nerve roots. ~3 ~ ~~ ~N M .,- \\\"'~'::\\\":':J N (.f) ....J.....I....J ... I ~.., \\\" .'hC;<= w \/ ~~ I g J:! ~ ] ~I '~ r ~ CJ ~ ~ 0 \\\"J I- I- v; c: 0:a:J: 1\\\"' ~ ~UD u ~ ~ . ., ~~'*'..I. ~ ~~=~. .~ cc .,- u u'\\\" .1w2 \u00abC u\\\"- Heproduced with permission from Ilertling D, Kessler HM: Manage- ment of Common Musculoskeletal Disorders: Physical Therapy Princi- ples and Methods, 2nd ed. Philadelphia: JB Lippincott, 1990. lilustra- tions by Elizabetb Kessler.","162 APPENDIX C \\\\ II cultatIon The patient is asked to breathe through his mouth, slowly and easily, deeper than normal. A right-to-Ieft sequence is used, always comparing one side with the other (A. B). New examiners should listen to several \\\"normal\\\" chests to get a baseline for what is abnormal (C, 0). (\\\") \u00bbc (f) n c Cj ~ oz A, Path of auscultation on the anterior chest. B, Path of auscultation on tl1(' posterior chest. C and D, Hclationship of the lung to surf'lce anatomy. The examiner must consider the lung areas being auscultated. (From Frownfelter DL (ed): Chest P!Il\/sica! Therapy and Pulmo\/1ary HI'!wIJilita{io\/1, 2nd eel. St. Louis, Mosby-Year Book, 1978.)","163 APPENDIX D . onl1<ll Hange of lotlOll* oz oi= 2 u.. o w <..9 Z <a:t: -.J <t 2 oa:: Z c","OJ -I>- Wiechec and Dorinson and JAMA' Daniels a Krusen' Wagner' Worthingha Shouldert 180 180 150 90' Flexion 45 45 40 50 Extension 180 180 150 90' Abduction 90 90 40b 90 Internal rotation 90 90 90' 90 External rotation Horizontal abduction 135 145 150 160 Horizontal adduction 90 80 80 90 90 70 80 90 Elbow Flexion 60 80 70 90 Pronation 55 55 60 90 Supination 35 20 20 25 75 40 30 65 Wrist Flexion Extension Radial deviation Ulnar deviation Hip 120 125 100 125 ~ Flexion 45 50 30 15 45 45 40 45 Extension 20 20 0 Abduction 135 30 40 45 Adduction 55 50 50 45 Internal rotation 30 External rotation 140 120 130 Knee 45 40 45 Flexion 20 20 50 30 Ankle 20 20 Plantar flexion Dorsiflexion Inversion Eversion *These \\\"normal\\\" values (in degrees) are associated with manual muscle testing, and the a strated by this table, published normal range of motion values vary. Normal ranges of mot Manual Examination, 5th ed. Philadelphia: W.B. Saunders Co., 1986 tTested with the shoulder in 0 degrees of abduction :tThis IS the only article in which the methodology for obtaining normal values was rep ing in age from 18 months to 54 years. Reproduced with permission from Rothstein JM (ed), Measurement in Phvsical Thera OJ Ul","and Esch and Gerhardt and Boone and AAOS' CMA' Clarke\\\" am \u2022 lepley' Russe' Alen1. t 170 170 167 180 170 130 60 50 62 60 30 80 170 170 184 180 170 180 80 80 69 70 60' 90' 90 90 104 90 80' 40' 45 30 140 135 135 143 150 135 150 150 150 76 80 75 50 90 80 82 80 85 90 90 90 76 80 70 80 90 60 75 70 65 70 70 50 22 20 20 15 20 20 36 30 40 30 30 30 130 125 122 120 110 120 45 15 10 30 30 20 45 45 46 45 50 55 15 15 27 30 30 45 33 45 47 45 35 20 36 45 47 45 50 45 135 130 143 135 135 145 65 45 56 50 50 50 10 20 30 40 13 20 15 15 15 20 37 35 35 26 15 20 authors list only the part of the movement attributable to the deltoid muscle. As demon- ion were derived primanly from Daniels L, Worthingham C. Muscfe Testing: Techniques of ported. The values presented represent the means of measurements taken on 109 men rang- apy. New York, Churchill Livingstone, 1985.","166 1. Wiechec FJ, Krusen FH: A new method of joint measurement and a review of the literature. Am J Surg 43:659, 1939. 2 Dorinson SM, Wagner ML: An exact technic for clinically measuring and recording joint motion. Arch Phys Med 29:468, 1948. 3. A guide to the evaluation of permanent impairment of the extremities and back. JAMA Special ed: 1, 1958. 4. Daniels L, Worthingham C: Muscle testing. Techniques of Manual Examination, 5th ed. Philadelphia, WB Saunders, 1986. 5. Esch D, Lepley M: Evaluation of Joint Motion: Methods of Measurement and Recording. Minneapolis, University of Minnesota Press, 1974. 6. Gerhardt JJ, Russe OA: International SFTR Method of c Measuring and Recording Joint Motion. Bern, Huber, 1975. 7. Boone DC, Azen SP: Normal range of motion of joints in z male subjects. J Bone Joint Surg Am 61 a:756-759, 1979. o 8. American Academy of Orthopaedic Surgeons: Joint :0 ~ Motion: Method of Measuring and Recording. Chicago, American Academy of Orthopaedic Surgeons, 1965. l> r 9. Commission of California Medical Association and The :0 Industrial Accident Commission of the State of California: l> Z Evaluation of Industrial Disability. New York, Oxford University Cl m Press, 1960. o 10. Clarke WA: A system of joint measurement. J Orthop \\\" Surg 2:687, 1920. o~ -1 o Z","---------------167 APPENDIX E Ligament L<L\\\\:it\\\\ Grading Scale Crade I1FiJ'st-De~rec\/\\\"i1dSprain. Tear of a minimum W number of fibers of the ligament and local tenderness but ...J no instability. Joint surfaces separate 5 mm or less during stress testing. <r: GI ,Ide III~econd-Del',reef'l()derale Sp.-ain. Tear of more U fibers and more generalized tenderness but no gross instability. Joint surfaces separate 5-10 mm during stress (\/) testing. l'J C.-ade IIIrrhird-De~re(\/Se,cre Sprain Complete rupture Z of the ligament with gross instability. Joint surfaces separate 10 mm or more. o Data from Committee on the Medical Aspects of Sports of the American a<r:: Medical Association: Standard Nomenclature of Athletic Injunes. Chicago, American Medical Association, 1976. l'J >- f- X <r: ...J f- Z w ~ <r: l'J ...J w","168 - - - - - - - - - - - - - - - APPENDIX F Capsular Pattern and Closed Pack Positions for Selected Joints \\\" \u00bbn Capsular Pattern Closed Pack Position Joints lat flex and ER ext (facet joints) \\\"\\\"U ER, abd, IR (j) C \u00bbr Cervical spine :II Shoulder \\\"\\\"U flex, ext ~ Elbow ---1 Wrist equal all motions full ext m :II Carpometacarpal abd, ext full opposition Z \u00bbz MCP flex, ext 1st MCP. full opposition o 2nd-5th MCP. full ext n or Lumbar spine lat flex and ER ext (facet jointsl (j) Hip flex, abd, IR combined ext, IR, and abd flex, ext full ext mo Knee n~ Ankle (talocrural jointl PF, OF full OF A IP flex, ext full ext o\\\"\\\"U (j) Data from Magee DJ: Orthopedic PhYSical Assessment, 3rd ed. Philadelphia, WB Saun- o---1 ders, 1997, and Maitland GD: Penpheral ManipulatIOn, 3rd ed. Boston, Butterworth- Heinemann, 1991 Z (j) \\\"o :II (j) m r m n ---1 m o 'o- Z ---1 (j)","------------169 APPENDIX G Radiology I. Suggested methodology for evaluating radiographs: observe >- radiographs methodically, looking for abnormalities in the following order (ABes) lo? A: alignment (of bones\/vertebrae; no displacement\/ -l deformity 7) o B: bony changes (changes in density, Fxs, spurring, o sclerosis) <at:: C: cartilage\/disc space (joint space, lack thereof, indicating DJD or DDD) S: soft tissue (some soft tissues such as the psoas major can be seen on radiographs, and abnormalities such as an abscess or hemorrhaging may be identified) II. Radiologic techniques for specific conditions: some techniques are better suited for identifying specific conditions than others Radiography: Fx, OCD\/osteochondral defects, femoral head dislocation\/dysplasia, joint dislocation CT scan: HNP, vertebral body abnormalities, abscess or neoplasm, intraarticular Fx fragments, pelvis fracture, meniscal tears MRI: soft tissue lesions (Iig, tendon, and muscle tears\/ ruptures, soft tissue tumors), meniscus tears, spinal cord anomalies, avascular necrosis of the femoral head, HNP Bone scan: stress Fxs, skeletal metastasis\/bone tumors, osteomyelitis Myelography: visualization of the spinal cord, nerve roots, and thecal sac III. Before ordering a radiologic examination, ask yourself the following questions as put forth by Dr. John R. Thornbury: 1. Is this examination going to affect my diagnostic certainty about the differential diagnosis I am considering, and if so, how much 7 2. Will the information expected to be provided by the examination change my diagnostic thinking enough so that it will significantly affect my choice of treatment?","170 - - - - - - - - - - - - - Bibliography James H. Swain: ABCS of radiology. Presented in a class entitled Radiology for Physical Therapists and adapted from Scheurger SR: Introduction to critical review of roentgenograms. Phys Ther 68:1114-1120,1988. Thornbury JR: Clinical decision making in use of imaging examinations. In Kuhns LR, Thornbury JR, Fryback DG (eds): Decisions in Imaging. Chicago, Year Book Medical Publishers, 1989 Parker MD: Introduction to Radiologv. Philadelphia, JB Lippincott, 1985. G') :JJ l> 0 a Ia G) -<","Jjr - - - - - - - - - - - - 1 7 1 APPENDIX H Physical Agent and Modalities UwJ i= \u00ab---l a0 ~ 0 \u00abZ zf- w <\u00ab..9 \u00ab---l u :>Ur-J: 0- ::I:","Physical Agent Indications Superficial heat (depth of penetration of Pain modulation O various techniques for superficial heat is Reduce joint stiffness s approx 1 cml Alleviate muscle guarding\/ h spasm\\\" T Increase ROM Increase blood flow h Superficial cold Acute musculoskeletal trauma O Reduce spasticity se Pain modulation Increase ROM C Myofascial pain syndrome C S p C .... -..l W","Contraindications Notes Over areas of impaired temperature Methods of superficial heat include sensation, impaired circulation, active Hot packs (hydrocollator). do not have hemorrhage, or acute inflammation Pt lie on hot pack; wrap pack in 6-8 towel thickness Tumor Paraffin: commonly used for hands and feet, also used to moisturize and Pt who cannot verbally tell you that it is too increase pliability of scar from burn or hot injury Fluidotherapy: also used to desensitize Skin infection skin after peripheral nerve injuries or any type of hyperesthesia Radiation (infrared lamp). intensity affected by inverse square and cosine law Hydrotherapy: additional uses include debridement, over painful scars, adhesions, arthritis, as warm-up for exercises, relaxation Over areas of impaired temperature Methods of superficial cold include sensation or impaired circulation Cold pack\/crushed ice pack Ice massage Cold hypersensitivity Ice immersion Cold compression Certain cardiovascular diseases Vapocoolant sprays Superficial nerve trunk, especially applying Types of cold hypersensitivity include cold pressure\/compression urticaria, cryoglobinemia, cold intolerance, vasospastic disease, cold hemoglobinuria Certain rhuematoid conditions Types of cardiovascular disease that could be adversely affected by cold: Raynaud's phenomenon, HTN, coronary artery disease TCOlltllllll'd","Physical Agent Indications Short wave diathermy (heating modality) Pain modulation I Reduce joint stiffness i Alleviate muscle guarding\/spasm Increase ROM O Increase blood flow O M j O m O O O O i O O D Pulsed electromagnetic field Soft tissue injury Cutaneous wound healing Laser Wound healing Pain modulation Scar tissue reduction Edema and inflammation","Contraindications Notes In presence of pacemakers or other Methods of short wave diathermy implanted stimulators Capacitive: depth of penetration approx 1 cm. Tissues with high electrical Over areas of decreased sensation resistance are selectively heated (e.g.. Over eyes (heating of eye fluid) fat. skin. ligament. capsule. cartilageJ. Metal objects in area to be treated (e.g .. Caution: nylon or foam rubber in field may jewelry. metal implantsl burn. Over pelvic area of female Pt during menstruation Inductive: depth of penetration approx 3 cm. Tissues with high magnetic Over moist wound dressings resistance are selectively heated le.g.. muscle. blood. sweat). Over tumors Caution: moisture (sweat or exudate from Over testes of male Pt woundl in field absorbs energy and may Over active hemorrhage or acute burn Pt inflammation Over ischemic tissue Over open growth plate\/epiphysIs in children During pregnancy In presence of pacemakers and implanted HeNe penetrates 2-5 mm stimulators GaAs penetrates 1-2 cm HeNe. indirect effects to 8-10 mm Over tumors GaAs. indirect effects to 5 cm During pregnancy If mean power approaches 80 wans. include contralndicatlons for thermal effects as above for short wave diathermy Into. over. or around eyes During pregnancy In pt who is photosensitive COnlinl\/l'\\\" ...","Physical Agent Indications Co Ultraviolet light Acne Ov Ultrasound Aseptic and septic wounds W Folliculitis ca Pityriasis rosea go Tinea capitum Qu Sinusitis [su ps Po Pe Sa Lu Xe Ac tu Ac Ad G H Thermal effects: joint contracture, Do scar tissue mobilization, chronic bursitis, chronic tendinitis, muscle guarding\/spasm-pain cycle Nonthermal effects: wound\/tissue healing, plantar warts, Fx healing, detecting stress Fxs D -' -..J -..J","ontraindications Notes ver or into the unprotected eye Used mainly for dermatology patients Depth of penetration is epidermis When pt is taking drugs or eating foods that ause hypersensitivity to UV radiation (e,g., old therapy, sulfa drugs, insulin, thyroxine, uinine, tetracycline, eggs Isulfa]. lobster sulfa]. aniline dyes [in coal tar for soriasisll orphyria ellagra arcoidosis upus erythematosus eroderma pigmentosum Active and progressive pulmonary uberculosis Acute psoriasis Advanced arteriosclerosis General dermatitis Hyperthyroidism o not apply over Types of ultrasound Areas of impaired pain\/temperature 1.0 MHz: penetrates approx 4-6 cm sensation 3.0 MHz: penetrates approx 1-2 cm Areas of reduced circulation Thrombophlebitis Pulsed ultrasound eliminates thermal Eyes effect by using 20-50% duty cycle. Testes\/ovaries Heating depends on the temporal Heart Pacemaker average: Malignant tissue Spinal cord du c cle = on ,on +timofef t.ime x 100 Cervical\/stellate ganglia ty Y time Epiphyseal areas of children, abdominal region of females during the reproductive Ultrasound has affinity for tissues years or immediately after menses containing high protein content Do not apply during pregnancy It is recommended that ultrasound be limited to 14 treatments COllflll\/Utl\\",",\"Physical Agent Indications Contra Electrotherapy Analgesia Dema Pulsatile Imono-, bi-, and polyphasicl Muscle re-education Cardia Prevent atrophy Over c Direct current Spasticity reduction Hyper Cutaneous wound healing Pregna Fx healing Patien Scoliosis Adjace Orthotic substitution throm Reduce swelling Over a Increase blood flow Ventilation (phrenic drivingI Same Iontophoresis Wound healing H PHYSICAL AGENT","ra indications Notes If Pt'is able to participate, active and-type cardiac pacemaker therapeutic exercise is often better at ac arrhythmia accomplishing goals of many indications carotid artery listed here rsensitive patients nancy Caution: direct current can burn skin nt with central venous line Aids debridement cent to or distal to area of mbophlebitis area of abnormal skin e as above = T AND MODALITIES","NOIDVtJl ::JO Type of Traction Indications Contra ind Cervical or lumbar traction Disc protrusion Absolute Degenerative disc\/joint Spinal Disease (especially that resulting in Spinal foraminal encroachment) Vertebr Joint hypomobility only) Facet impingement Trauma Muscle spasm\/guarding Relative c Acute s Acute i rheuma Joint in prolong Osteop Hiatal .... C..O..","O S3dAl ~ :x> I'D \\\"\\\"'C VJ \\\"\\\"'C 0 rT'I H-, :::::~ P:l -.(.\\\"..)...t::J ><0' ;::::l ~ ~ dications Notes contraindications: Use precaution in presence of any tumor contraindication labsolute or relativel. infection Sources differ on what is considered an ral artery disease Icervical traction absolute or relative contraindication. Remember, above all else, DO NO HARM! a where Fx has not been excluded contraindications: strains\/sprains inflammatory conditions le.g., atoid arthritisl nstability le.g .. during pregnancy, ged steroid use, Down's syndrome) porosis hernia","182 - - - - - - - - - - - - - Bibliograph) Kisner C, Colby LA: Therapeutic Exercise: Foundations and Techniques, 2nd ed. Philadelphia, FA Davis, 1990. Saunders HD, Saunders R: Evaluation, Treatment, and Prevention of Musculoskeletal Disorders: Spine, 3rd ed, Vol 1. Chaska, MN Educational Opportunities, 1995. --<i ml J (f) o \\\"'Tl -i :0 ol> -i o Z","_______- - - - - - - 1 8 3 APPENDIX J 'onnal Yal11l'<; for Comlllonh EnCollllter('c! Lahoratol) RCSllltS jl Normal Range (f) III Component 31-4.3 g\/dL ~ 22-26 mEq\/L Inonpregnant adultl Blood <200mg\/dL ~ Albumin 44-45 mg\/dL male (f) Bicarbonate (HCO, 55 mg\/dL female Cholesterol Itotal) <130 mg\/dL (desirablel w HDL cholesterol 5-25 fJ.g\/dL a:: <10 fJ.g\/dL >a:-: LDL cholesterol <10 U\/L 0 Cortisol 0.6-1.5 mg\/dL male a~:: 0.6-1.1 mg\/dL female 0 8 AM (client at restl 60-100 U\/L Imale) 8 PM 40-150 U\/L Ifemale) CO CPK (CK II) 4.6-5.9 million\/10m' (malel Creatinine 4.2-54 million\/10m' (femalel <t: 70-11 0 mg\/dL Creatine kinase 0.45-0.52% (malel -.J Total 0.37-0.48% (femalel 13-18 g\/dL (male) 0 Erythrocyte count 12-16 g\/dL (female) w 80-180 fJ.g\/dL Imalel Glucose (fasting) a:: Hematocrit IHctl 60-160 fJ.g\/dL !femaleI w Hemoglobin (Hgbl 4300-10,800\/1010' 7.35-7.45Iarteriall f- Iron 7.30-7.41 Ivenousl Z 75-1001010 Hg Leukocyte count ~ pH of blood ((I'lI\/lucl .... 0 Po, (blood gasI U Z w ~ Z 0 2: 2: 0 U a:: 0 u.. (f) w ~ -.J \u00a7\u00a3 -.J <t: 2: a:: 0 Z ..,","184 - - - - - - - - - - - - - - Component Normal Range Blood Continued Pco, Iblood gas) 35-45 mm Hg larterial) 41-51 mm Hg Ivenous) c.. (slightly lower in femalesl z Platelet count 150,000-350,000\/mm' o :JJ Thyroxine, total IT.I 4.0-11.0 f-Lg\/dL \u00bb~ Triiodothyronine, total IT,) 75-220 ng\/dL r ~ Thyroid-stimulating hormone (TSHI 05-50 f-LUlmL r Triglycerides 40-150 mg\/dL (nonpregnant adult; C females slightly lower) m (f) 130-135 mg\/dL 1>65 y) o\\\"T1 Coagulation Tests :JJ n Prothrombin time (PTI Control 8.8-11.6 sec (\u00b1 2 secl o Partial thromboplastin time (PTT) 24-37 sec for activated PTT ~ ~ 60-90 sec if not activated oz Erythrocyte Sedimentation Rate ~ Westergren method m Adult Z Male 1-13 mm\/h Female 1-20 mm\/h n 44-114 mm\/h o c Pregnancy Z -i Senior adult 1< 50 yl m Male 1-20 mm\/h :JJ Female 1-30 mm\/h m 1-13 mm\/h o Child \u00bbr Wintrobe method oOJ Adult Male 1-9 mm\/h :JJ 1-20 mm\/h ~ Female o :JJ -< Corbett JB: Laboratory Tests and Diagnostic Procedures with Nursing Diagnoses, 4th :JJ ed. Stamford, CT, Appleton & Lange, 1996. m (f) C ~ (f)","_ _ _ _ _ _- - - - - - - - 1 8 5 APPENDIX K Ir 'Abbreviations and Definitions jf, This list contains abbreviations and definitions specific to [f this text. Most facilities or practices have their own lists of approved abbreviations, and the facility's list should take precedence in the event of a conflict. t AAA: abdominal aortic aneurysm AAROM: active assisted range of motion abd: abduction AC: acromioclavicular (f) ACL: anterior cruciate ligament Z add: adduction o [r ADLs: activities of daily living f= AGG: aggravating factors or activities that increase Sx z AKA: above-knee amputation LL AP: anteroposterior (e.g., anteroposterior glides) oW APL: abductor pollicis longus oz <t approx: approximately (f) AROM: active range of motion z ASTS: anterior superior iliac spine o ATFL: anterior talofibular ligament ~ >w ATNH: asymmetric tonic neck reflex cr: ATTL: anterior tibiotalar ligament OJ OJ athetosis: slow, writhing, involuntary movements of limbs and <t facial muscles B\/B: bowel\/bladder (e.g., frequency, urgency, retention) BKA: below-knee amputation BW: birth weight CFL: calcaneofibular ligament chorea: abrupt, involuntary movements of limb and face muscles clonus: alternate involuntary muscular contraction and relaxation of rapid succession in response to quick stretch C\/O: complains of coxa vara: decreased angle between femoral neck and shaft \u00ab120 deg) coxa valga: increased angle between femoral neck and shaft (> 135 deg) crepitus: a grinding\/cracking\/popping sound or sensation in joints associated with active range of motion CT: computed tomography DDD: degenerative disc disease deg: degrees","186-------------- dermatome: area of the skin innervated by a single dorsal nerve root DF: dorsiflexion DIP: distal interphalangeal joint DJD: degenerative joint disease DP: dorsal pedal pulse duration: duration of symptoms Dx: diagnosis EASE: easing factors, activities, or positions that decrease symptoms EBL: estimated blood loss ECG: electrocardiograph EPB: extensor pollicis brevis muscle ER: external rotation ev: eversion exostosis: excess bone deposition ext: extension \u00bb FCU: flexor carpi ulnaris OJ OJ FDP: flexor digitorum profundus :JJ FEV,: forced expiratory volume at 1 second (volume of gas that m < can be forcefully expelled from the lungs in 1 second- ~ normally about 80%) o Rex: flexion z FOOSH: fallon outstretched hand (f) \u00bb FPL: flexor pollicis longus z F'HC: functional residual capacity (volume of air in the lungs at the o resting end-expiratory level) o FWB: full weight bearing m \\\" Fx: fracture Z genu reCllIvatum: excessively hyperextended knee o-i GMMT: gross manual muscle testing Z HNP: herniated nucleus pulposus (f) H\/O: history of HTN: hypertension Hx: history inv: inversion IP: interphalangeal joint IR: internal rotation ITB: iliotibial band lat: lateral LBP: low back pain LCL: lateral collateral ligament LE: lower extremity LT: light touch MCL: medial collateral ligament MCP: metacarpal phalangeal joint MD: medical doctor med: medial","187 Ir Meels: medications patient is taking Mllx: medical history MMT: manual muscle testing\/strength testing MOl: mechanism of injury if symptoms result from trauma ~IP: metacarpal phalangeal joint ~lHI: magnetic resonance imaging MSH: muscle stretch reflex nature of pain: constant or intermittent, ache\/sharp\/burning\/ stabbing, difference in time of day (morning or evening); 24- hour behavior NSATDs: nonsteroidal antiinflammatory drugs IWB: non-weight-bearing n),stagmus: involuntary rapid eye movement OA: osteoarthritis OCD: osteochondritis dissecans onset: onset of symptoms (insidious or trauma) (f) OHlF: open reduction internal fixation PA: posteroanterior (e.g., posteroanterior glide mobilization) z PACVP: posteroanterior central vertebral pressure o PAIVM: passive accessory intervertebral motion PAUVP: posteroanterior unilateral vertebral pressure f= PCL: posterior cruciate ligament Pes cavus: excessively high arched foot z Pes planus: excessively low arched foot PF: plantar flexion LL PFT: pulmonary function test W PIP: proximal interphalangeal plica: remnants of the embryonic synovial membrane that usually o o regress in the adult PM Hx: past medical history Z PPIVM: passive physiologic intervertebral movement <t: (f) oZ ~ :> w a: aJ aJ <t: PQ: pronator quadratus PHE: progressive resistive exercise PHOM: passive range of motion PSllx: past surgical history PSIS: posterior superior iliac spine Pt: patient PT: posterior tibial artery pulse PTFL: posterior talofibular ligament PTS: prone to sit PTIL: posterior tibiotalar ligament P\\\\\\\\'B: partial weight bearing rales: abnormal breath sounds, a bubbling noise heard in the chest while breathing in HCL: radial collateral ligament HElL: repeated extension in lying HEIS: repeated extension in standing HF: rheumatoid factor","188 - - - - - - - - - - - - - RFIL: repeated flexion in lying RFIS: repeated flexion in standing RIO: rule out ROM: range of motion rot: rotation Rx: treatment SAID: specific adaptation to imposed demand SC: sternoclavicular sclerotome: the area of a bone innervated from a single spinal segment SCM: sternocleidomastoid muscle SI: sacroiliac SLR: straight-leg raise spondylosis: vertebral ankylosis; any degenerative changes in the spine spondylolisthesis: forward displacement of a vertebra over a lower segment, usually of the fourth or fifth lumbar vertebra, caused l> by a developmental defect in the pars interarticularis OJ spondylolysis: fracture of the posterior arch of the vertebra at the OJ :JJ pars interarticularis but no translation of the vertebral body <m SQ: special questions, such as about unrelenting night pain, bowel ~ or bladder symptoms, saddle anesthesia, unexplained weight o loss, or history of diabetes\/cancer\/osteoarthritis\/rheumatoid z arthritis\/osteoporosis\/hypertension\/cardiac disorders Ul STNR: symmetric tonic neck reflex lz> Sx: symptom(s) o TCL: tibiocalcaneal ligament o TFL: tensor fascia latae m \\\" TFM: transverse friction massage Z TEL: transverse humeral ligament -i TNL: tibionavicular ligament TOCS: thoracic outlet compression syndrome o Z Ul TTl': tender to palpation UCL: ulnar collateral ligament UE: upper extremity UTI: urinary tract infection VA: vertebral artery (tests for VA insufficiency) VC: vital capacity (maximal volume of air measured on complete expiration after full inspiration) VMO: vastus medialis obliquus VI: tidal volume (volume of air that is inspired or expired in a single breath during regular breathing)","-------------189 INDEX Note: Page numbers followed by the letter t refer to tables. Abbreviations, 185-188 Apley's scratch test, in x Achilles tendinitis, acute, shoulder evaluation, 26t ozw treatment options for, 129t Apophyseal joint, impinge- Achilles tendon, rupture of, ment of, treatment options for,88t treatment options for, 130t-1311 sprain of, treatment options Acromioclavicular joint, for, 88t separation of, treatment options for, 36t Apprehension test, in knee Acromioclavicular joint shear evaluation, 113t test, in shoulder evaluation, 25t Arthritis, rheumatoid, of hand, Adhesive capsulitis, treatment treatment options for, 65t options for, 37t Adson's maneuver, in thoracic Auscultation, 162 outlet syndrome testing, 27t Avascular necrosis, of lunate, Albumin, blood levels of, normal values for, 183t treatment options for, 63t Allen's test, in wrist\/hand of scaphoid, treatment op- evaluation, 611 Amputation, of lower tions for, 63t extremity, evaluation of, 145-147 Babinski's reflex\/sign, in lumbar Ankle, 123-134 See also Foot spine evaluation, 82t and ankle. in neurologic evaluation, 152t range of motion of, 165t Bicarbonate, blood levels of, sprain of, treatment options normal values for, 183t for, 133t Bicipital tendinitis, treatment Ankylosing spondylitis, options for, 30t treatment options for, 89t Blood tests, normal values for, Anterior apprehension test, in 183t-184t shoulder evaluation, 24t Bounce horne test, for Anterior cruciate ligament, meniscal tears, 113t deficiency\/tear of, treatment Brachial plexus tension test, in options for, 115t Anterior drawer test, for cervical spine evaluation, 111-12t anterior knee instability, Brudzinski's sign, in lumbar 110t in foot\/ankle evaluation, 126t spine evaluation, 811 Anterior interosseous in thoracic spine evaluation, syndrome, treatment options for, 50t 73t Anterior shoulder instability, Bryant's triangle, in hip treatment options for, 32t Apley's grinding test, for evaluation, 99t meniscal tears, 113t Bunnel-Littler test, in hand evaluation, 60t Bursitis, iliopectineal, treatment options for, 1011 olecranon, treatment options for,49t pes anserinus, treatment op- tions for, 119t","190 - - - - - - - - - - - - - Bursitis (Continued) Compartment syndrome, prepatellar, treatment options treatment options for, 132t for, 119t Compression fracture, of subacromial, treatment op- thoracic spine, treatment tions for, 31 t options for, 75t subdeltoid, treatment options Compression test, in cervical for, 3lt spine evaluation, lOt trochanteric, treatment op- Contusion, muscle, of cervical tions for, 10It spine, treatment options for, Buttock, sign of, in hip 14t Coordination tests, in evaluation, 98t neurologic evaluation, 154t Cortisol, blood levels of, normal values for, 183t Capital femoral epiphysis, Costoclavicular syndrome test, slipped, treatment options in thoracic outlet syndrome for, 102t testing, 27t Capsulitis, adhesive, treatment Costovertebral joint options for, 37t dysfunction, treatment Cardiac evaluation, objective, options for, 74t 142-143 CPK, blood levels of, normal subjective, 141 values for, 183t Carpal tunnel syndrome, Craig's test, in hip evaluation, treatment options for, 51 t, 99t z 66t Cranial nerve function, in o neurologic evaluation, 152t Cauda equina syndrome, Creatine kinase, blood levels m treatment options for, 90t of, normal values for, 183t X Cervical radiculitis, acute, Creatinine, blood levels of, treatment options for, 13t normal values for, 183t Cervical spine, 7-17 objective examination of, 8-9 Cross-arm adduction test, in shoulder evaluation, 25t special tests for, 10t-12t subjective examination of, 7 Cruciate ligament, anterior, deficiency\/tear of, treatment treatment options for, 13t- options for, 11 5t 16t Cubital tunnel syndrome, Cervical spondylosis, treatment treatment options for, 52t options for, 13t Cyst(s), ganglion, of hand\/wrist, Cervical traction, indications\/ treatment options for, 66t contraindications for, 181 t Cholesterol, blood levels of, normal values for, 183t Clarke's sign, in knee Degenerative joint disease, evaluation, 113t cervical, treatment options for, 14t Clonus, in neurologic of hip, treatment options for, evaluation, 153t 10lt Coagulation tests, normal Dermatomes, 160 values for, 184t Cold, superficial, indications\/ Diathermy, short wave, contraindications for, 173t ind ications\/contra indications Collateral ligament, lateral, for, 174t deficiency\/tear of, treatment Disc bulge, treatment options options for, 116t for, 84t-85t medial, deficiency\/tear of, Dislocation, of elbow, posterior, treatment options for, 115t treatment options for, 47t","--------------191 Dislocation (Continued) External rotation-recurvatum Xw of lunate, treatment options test, for posterior knee o for, 63t instability, 11lt of patella, treatment options z for, 117t Extremity, lower, amputation of,145-147 Distraction test, in cervical spine evaluation, lOt Faber's test, in hip evaluation, 98t Drawer test, anterior, for anterior knee instability, Facet joint, impingement of, 110t treatment options for, 88t in foot\/ankle evaluation, sprain of, treatment options 126t for, 88t posterior, for posterior knee Fasciitis, plantar, treatment instability, 111 t options for, 13lt Drop-arm test, in shoulder Femoral cutaneous nerve, evaluation, 26t lateral, entrapment of, treatment options for, 103t \\\"Dunker's hand\\\" injury, treatment options for, 62t Femoral neck stress fracture, treatment options for, 103t Elbow, 41-52 golfer's, treatment options Femoral nerve test, in lumbar for, 49t spine evaluation, 82t objective examination of, 42-43 Finger, trigger, treatment range of motion of, 164t options for, 66t special tests for, 44t-45t subjective examination of, 41 Finkelstein's test, in wrist\/hand tennis, treatment options for, evaluation, 60t 48t treatment options for, 46t- Flexion-rotation drawer test, for 52t anterior knee instability, 111 t Elbow flexion test, 45t Foot and ankle, 123-134 Electromagnetic field, pulsed, objective examination of, 124-125 indicationslcontraindications special tests for, 126t-128t for, 175t subjective examination of, Electrotherapy, indications\/ 123 contraindications for, 178t treatment options for, 129t- Empty can test, in shoulder 134t evaluation, 26t Epicondylitis, lateral, tests for, Fracture(s), compression, of thoracic spine, treatment 44t options for, 75t treatment options for, 48t medial, tests for, 45t scaphoid, treatment options treatment options for, 49t for, 62t Epiphysis, slipped capital femoral, treatment options stress, femoral neck, treat- for, 102t ment options for, 103t Erythrocyte count, normal values for, 183t pubic ramus, treatment op- Erythrocyte sedimentation rate, tions for, 103t normal values for, 184t External rotation stress test, in treatment options for, 132t foot\/ankle evaluation, 127t Froment's sign, in wrist\/hand evaluation, 59t Gag reflex, in neurologic evaluation, 153t","192 Gamekeeper's thumb, Hyperabduction syndrome test, treatment options for, 64t in thoracic outlet syndrome Ganglion cyst, of hand\/wrist, testing, 27t treatment options for, 66t Hypothenar hammer Glucose, blood levels of, syndrome, treatment options normal values for, 183t for, 62t Godfrey's sign, in posterior knee instability evaluation, 112t Iliopectineal bursitis, treatment Golfer's elbow, treatment options for, 49t options for, 101t Grind test, in knee evaluation, Iliotibial band friction 113t syndrome, treatment options for, 116t Impingement, apophyseal, Halstead's maneuver, in treatment options for, 88t thoracic outlet syndrome Impingement relief test, in testing, 27t shoulder evaluation, 23t Hamstring tightness test, in hip Impingement syndrome, evaluation, 98t treatment options for, 28t Hand, 55-66. See also Wrist Impingement tests, in hip and hand. evaluation, 22t-23t Hawkin's impingement test, in Inversion stress test, in foot\/ shoulder evaluation, 22t ankle evaluation, 126t Heart, evaluation of, objective, z Iron, blood levels of, normal 142-143 values for, 183t 0 m X subjective, 141 Heat, superficial, indications\/ contra indications for, 172t Jerk test of Hughston, for Hematocrit, normal values for, anterior knee instability, 111 t 183t Joint(s), acromioclavicular, Hemoglobin, blood levels of, separation of, treatment options for, 36t normal values for, 183t Herniated nucleus pulposus, apophyseal\/facet, impinge- ment of, treatment-options treatment options for, 84t-85t for, 88t Hip, objective examination of, capsular pattern for, 168t 94-96 closed pack positions for, range of motion of, 165t special tests for, 97t-l00t 168t subjective examination of, 93 costovertebral, dysfunction treatment options for, 101 t- of, treatment options for, 103t 74t Hoffmann's sign, in cervical \\\"Jumper's knee,\\\" treatment options for, 118t spine evaluation, 12t in neurologic evaluation, 152t Homans' sign, in foot\/ankle Juvenile kyphosis, treatment evaluation, 127t options for, 74t Hoover's test, in lumbar spine evaluation, 82t Hormone, thyroid-stimulating, Kienbock's disease, treatment blood levels of, normal values options for, 63t for, 184t Hughston jerk test, for anterior Kleiger's test, in foot\/ankle knee instability, 111 t evaluation, 127t","193 Knee, 107-119 Ligament(sl (Continued) Xw instability of, anterior, tests laxity grading scale for, 167 0 for, 110t-ll1t retinacular, tight, test for, 61t lateral, tests for, 112t ulnar collateral, rupture of, Z medial, tests for, 112t treatment options for, 46t- posterior, tests for, 111 t- 47t 112t \\\"jumper's,\\\" treatment op- Light, ultraviolet, indications\/ tions for, 118t contra indications for, 176t objective examination of, 108-109 Load-shift test, in shoulder range of motion of, 165t evaluation, 25t special tests for, 11 Ot-114t subjective examination of, Ludington's test, in shoulder 107 evaluation, 26t treatment options for, 115t- 119t Lumbar spine, 77-90 objective examination of. Kyphosis, juvenile, treatment 78-80 options for, 74t special tests for, 81 t-83t subjective examination of, 77 Laboratory results, normal treatment options for, 84t- values for, 183t-184t 90t Lachman's test, for anterior Lumbar spondylosis, treatment knee instability, 11 Ot options for, 86t Lasegue's test, in lumbar spine Lumbar traction, indications\/ evaluation, 82t contraindications for, 181t Laser, indications\/ Lunate, avascular necrosis of, contraindications for, 175t treatment options for, 63t dislocation of, treatment op- Lateral collateral ligament, tions for, 63t deficiency\/tear of, treatment osteonecrosis of, treatment options for, 116t options for, 63t Leg length, apparent, in hip Malignant disease, of lumbar evaluation, lOOt spine, treatment options for, in lumbar spine evaluation, 90t 83t McMurray's test, for meniscal true, in hip evaluation, lOOt tears, 113t in lumbar spine evaluation, 83t Medial collateral ligament, deficiency\/tear of, treatment Legg-Calve-Perthes disease, options for, 115t treatment options for, 102t Median nerve bias, in cervical Leg-heel raise, single, in foot\/ spine evaluation, 11 t ankle evaluation, 126t Median nerve neuropathies, Leukocyte count, normal treatment options for, 50t-51t values for, 183t Meniscal tears, tests for, 113t Ligament(s). collateral, lateral, Meralgia paresthetica, deficiency\/tear of, treatment options for, treatment options for, 103t 116t Metatarsal loading test, in foot\/ medial, deficiency\/tear of, treatment options for, ankle evaluation, 128t 115t Morton's neuroma, test for, in cruciate, anterior, deficiency\/ foot\/ankle evaluation, 128t tear of, treatment options treatment options for, 134t for, 115t Multidirectional shoulder instability, treatment options for, 34t","194 Muscle(sl. of cervical spine, Ober's test, in hip evaluation, contusion of, treatment 97t options for, 14t in knee evaluation, 114t strain of, treatment op- Olecranon bursitis, treatment tions for, 14t options for, 49t Orthopedic evaluation, inpatient, objective, Neck, \\\"wry,\\\" treatment options 158-159 for, 15t-16t subjective, 157 Osgood-Schlatter disease\/ Neck extension-rotation test, in syndrome, treatment options cervical spine evaluation, 111 for, 119t Osteonecrosis, of lunate, Neer's impingement test, in treatment options for, 63t shoulder evaluation, 22t treatment options for, 63t Nelaton's line, in hip evaluation, 99t Nerve(sl. cranial, function of, in neurologic evaluation, 152t lateral femoral cutaneous, en- Painful arc test, in shoulder trapment of, treatment op- evaluation, 22t tions for, 103t Palmar cutaneous nerve median, neuropathies involv- compression, treatment ing, treatment options for, options for, 511 50t-511 Partial thromboplastin time, z radial, neuropathies involving, normal values for, 184t o treatment options for, 51 t Patella, subluxation\/dislocation m superficial, compression of, treatment options for, X of, treatment options for, 117t 511 Patellar tendinitis, treatment ulnar, compression of, treat- options for, 118t ment options for, 52t Patellofemoral pain, treatment neuropathies involving, options for, 117t treatment options for, Patrick's test, in hip evaluation, 52t 98t Neurologic evaluation, Pea\\\" blood levels of, normal objective, 150-151 values for, 183t special tests for, 152t-154t Percussion test, in hip subjective, 149-154 evaluation, 98t Neuroma, Morton's, test for, in Pes anserinus bursitis, foot\/ankle evaluation, 128t treatment options for, 119t treatment options for, 134t pH, blood, normal values for, Neuropathy(iesl. median nerve, 183t treatment options for, Phalen's test, in wrist\/hand 50t-511 evaluation, 58t radial nerve, treatment op- Physical agents and modalities, tions for, 51 t 171-178 ulnar nerve, treatment op- Physical therapy cardiac tions for, 52t evaluation, inpatient, Ninhydrin sweat test, in wrist\/ objective, 142-143 hand evaluation, 59t subjective, 141 Noble's compression test, in Pinch test, in wrist\/hand knee evaluation, 114t evaluation, 59t Nucleus pulposus, herniated, Piriformis syndrome, treatment treatment options for, 84t-85t options for, 102t"]