Diagnosis and Treatment of the Upper Extremities Nonoperative Orthopaedic and Manual Therapy - DOS WINKEL

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NONOPERATIVE ORTHOPAEDIC MEDICINE AND MANUAL THERAPY DOS WINKEL, PT Instructor, Scientific Society of Flemish General Practitioners Antwerp, Belgium Director, Dutch and German Academy of Orthopaedic Medicine Delft, the Netherlands and Gottingen, Germany President, International Academy of Orthopaedic Medicine OMER MATTHIJS, PT VALERIE PHELPS, PT Instructor, International Academy of Instructor, International Academy of Orthopaedic Medicine Orthopaedic Medicine Instructor, American Academy of Director and Instructor, American Orthopedic Medicine, Inc. Academy of Orthopedic Medicine, Inc. Tucson, Arizona Tucson, Arizona Copyrighted Material

Library of Congress Cataloging-in-Publication Data Winkel, Dos. Diagnosis and treatment of the upper extremities: nonoperative orthopaedic medicine and manual therapy / Dos Winkel with Omer Matthijs, Valerie Phelps. p. cm. \"Translation and adaptation of material previously published in Dutch under the titles: Orthopedische geneeskunde en manuele therapie, Diagnostiek extremiteiten (deel 2b) and Orthopedische geneeskunde en manuele therapie, Therapie extremiteiten (deel 3b) by Dos Winkel with Geert Aufdemkampe and Onno G. Meijer; Weke delen aandoeningen van het bewegingsapparaat, Anatomie in vivo (deel 1) by Andry Vleeming, Dos Winkel, and Onno G. Meijer\"—T.p. verso. Includes bibliographical references and index. ISBN 0-8342-0901-2 1. Shoulder joint—Wounds and injuries. 2. Elbow—Wounds and injuries. 3. Shoulder joint—Diseases. 4. Elbow—Diseases. 5. Shoulder joint—Pathophysiology. 6. Elbow—Pathophysiology. I. Matthijs, Omer. II. Phelps, Valerie. III. Winkel, Dos. Orthopedische geneeskunde en manuele therapie. IV. Vleeming, Andry. Weke delen aandoeningen van het bewegingsapparaat. V. Title. [DNLM: 1. Shoulder Joint—pathology. 2. Arm—pathology. 3. Joint Diseases—diagnosis. 4. Joint Diseases—therapy. WE 810 W773d 1997] RD557.W56 1997 617.57044—dc21 DNLM/DLC for Library of Congress 96-46879 CIP Copyright © 1997 by Aspen Publishers, Inc. All rights reserved. Aspen Publishers, Inc., grants permission for photocopying for limited personal or internal use. This consent does not extend to other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, or for resale. For information, address Aspen Publishers, Inc., Permissions Department, 200 Orchard Ridge Drive, Gaithersburg, Maryland 20878. Orders: (800) 638-8437 Customer Service: (800) 234-1660 About Aspen Publishers • For more than 35 years, Aspen has been a leading professional publisher in a variety of disciplines. Aspen's vast information resources are available in both print and electronic formats. We are com- mitted to providing the highest quality information available in the most appropriate format for our customers. Visit Aspen's Internet site for more information resources, directories, articles, and a searchable version of Aspen's full catalog, including the most recent publications: http://www.aspenpub.com Aspen Publishers, Inc. • The hallmark of quality in publishing Member of the worldwide Wolters Kluwer group. The authors have made every effort to ensure the accuracy of the information herein. However, appropriate information sources should be consulted, especially for new or unfamiliar procedures. It is the responsibility of every practitioner to evaluate the appropriateness of a particular opinion in the context of actual clinical situations and with due consid- eration to new developments. Authors, editors, and the publisher cannot be held responsible for any typographical or other errors found in this book. Editorial Resources: Ruth Bloom Library of Congress Catalog Card Number: 96-46879 ISBN: 0-8342-0901-2 Printed in the United States of America 1 2345 Copyrighted Material

Table of Contents Contributors .. .... ..... ....... . v Part I-References .............. 189 Foreword ... .... ..... ... ... .... Part I-Suggested Reading ........ 191 Preface .. .. . .. .... . .. . . . . . . . . . . vii Acknowledgments ............... ix PART II-THE ELBOW ........... 197 xi Introduction.................... xiii PART I-THE SHOULDER ........ 1 9-Functional Anatomy of the Elbow ..................... 200 I-Functional Anatomy of the 6 10-Surface Anatomy of the Arm, Shoulder ................... Elbow, and Forearm ......... 207 2-Surface Anatomy of the 11-Examination of the Elbow..... 221 Shoulder Region.. ......... .. 12 12-Pathology of the Elbow ....... 234 12.1 Elbow Joint Pathology ... .. . 234 3-Examination of the Shoulder .. 42 12.2 Pathology of the Bursae . .... 24 2 12.3 Pathology of the Muscle- 4-Pathology of the Shoulder..... 68 Tendon Unit . ..... .. . . 243 . 68 4.1 Glenohwneral Joint 88 96 Pathology . ... . .. . .. 99 103 4.2 Acromioclavicular Joint 13-Treatment Teclrniques in 10 5 Lesions of the Elbow ......... 251 Pathology .. . .. . . . . . 116 4.3 Sternoclavicular Joint 14-Peripheral Compression Neuropa­ thies in the Elbow Pathology ... .. Region ..................... 294 4.4 Pathology of the Bursae 4.5 Subacromial Impingement Syndrome .. . . ... ... . .. .. Part II-Elbow Review Questions .............. 302 4.6 Pathology of the Muscle- Part II-Elbow Review Answers ... 303 Tendon Unit-Rotator Cuff Part II-References.............. 304 Part II-Suggested Reading ....... 304 Pathology .. ... ..... 4.7 Neurological Disorders 5- Treatment Techniques in PART III-THE WRIST Lesions of the Shoulder ...... 118 AND HAND 6-Peripheral Compression Neuropa­ 309 thies in the Shoulder Region ..................... 152 15-Functional Anatomy of the Wrist and Hand ............. 315 7-Thoracic Outlet Syndrome .... 157 15.1 Functional Anatomy of the Wrist ..................... 315 8- Treatment-Compression Neuropa­ 15.2 Functional Anatomy of the thies of the Upper Hand ..................... 320 Extremities ................ 178 Part I-Shoulder Review 16-Surface Anatomy of the Wrist Questions .................... 187 and Hand .................. 324 Prurt I-Shoulder Review 17-Examination of the Wrist and Answers...................... 188 Hand ...................... 344 ill Copyrighted Material

iv DLA.GNOSIS AND TREATMENT OF THE UPPER EXTREMlTlES aLl\"VJ'V�i:t of the Wrist ........ 366 for the U'''''!K ''''''''' and Treatment of 18.1 Joint Pathology . . . . . 366 Upper Extremities . . .... . ...... 474 18.2 Pathology of the Muscle- Tendon Unit .... ... ..... 375 18.3 Other 383 Appendix for the 19-Pathology of the Midhand, Diagnosis and Treatment of the Thumb, and Fingers . ......... 389 Upper Extremities-General . . . .. 492 20-Treatment Techniques in 400 Appendix D-Algorithms for the Lesions of the Wrist and Diagnosis and Treatment of the Hand .. . . . . . . . . ..... . ..... . Shoulder . . . . . . . . . . . . .. ...... 498 21-Peripheral Neuropa- Appendix E-Algorithms for the Diagnosis and Treatment of the thies in the Wrist and Elbow . . ... . . . . ... . ...... . . .. 523 Hand . . . ... . . . . . . .. . . 453 Part III-Wrist and Hand Review Questions . .. . .... . . . . . • 457 AlJmt:�n<itix F-Algorithms for ...,...o. ,..v\",.'\" and Treatment of the Part III-Wrist and Hand Review Wrist and Hand ... . ............ 543 Answers .... . ... . . . .. . . 458 Part III-References .... . .. .. . . . . 459 Part Reading . . . . . . 460 Appendix G-Peripheral Neuropathies of the Upper .<e>.1\"l''';U'''LA A-Schematic Topography Extremities ..... . . .. . . .. . .... . 551 Extremity Nerves and Index . . ... . . . . . . . . . . . . . . . . . . . . 557 Blood Vessels . . . . . . . . ... . . . . .. 463 Copyrighted Material

Contributors Geert Aufdernkampe, PT nidi G.H. v an Paridon-Edauw, PT Therapist Therapist/ManipuIative Therapist Central Netherlands School of Professional Education International of of Health Care Education for Therapy Medicine The Netherlands for Therapy Gaby M. van Meerwijk, PT Instructor, American Academy of Orthope- Physical dic Inc, St. Lucas Instmctor Tucson, Arizona Academy of Physical Valerie Phelps, PT The Netherlands Therapist of Orner lYJ..\"\"\",UIJI\" Therapist Instructor, Academy for Orthopaedic Physical of Medicine Orthopaedic Medicine for G6ttingen, Medicine Instructor, Association for Therapy G6ttingen, Germany Instructor, Association for Arizona Dos Winkel, PT Arizona Scientific -.;nt'\":'': ' of Flemish General Practitioners Belgimn Onno G. PhD, MD Director, Dutch and German of Movement Scientist Medicine for the and History of Delft, the Netherlands and Movement Science Free University of Amsterdam International of Ortho- Amsterdam, The Netherlands v Copyrighted Material

Foreword Once again I am pleasantly several volume series ment the and Treat- yu,AoL..Lt '�u. clinician rnent and Di- with an which is evident in agnosis and Treatment of the his approach to clinical problems, his Extremities by Dos WinkeL Practical infor­ and from his many publi- mation has been assembled for the health cations and books. I also a friend in care in an ideal combination of Dos Winkel, for whom the of this extensive but conveniently V'-�;<.U.-\"-''-'U ace is an of thanks for our fascinat­ matter and thorough but discus­ ing, cooperative working relationship with sion of various topics. Basic data regarding the orthopedic patient. functional anatomy and fol­ lowed by thorough Marc Martens, MD, PhD Professor and Chief of Orthopedics examination and thorough discussions of pa- O.L.V. Middelares and make these volumes essential reference books that deserve a place in every medical the most Consultant Orthopedist recent techniques are illustrated in every volume. vti Copyrighted Material