Musculoskeletal ex aMination 4th edition JeFFrey M. Gross Joseph Fetto elaine rosen Musculoskeletal Examination Thistitleisalsoavailableasane-book. Formoredetails,pleasesee www.wiley.com/buy/9781118962763 orscanthisQRcode: Musculoskeletal Examination Fourth Edition Jeffrey M. Gross, MD ClinicalAssistantProfessorofRehabilitationMedicine Weill-CornellMedicalCollege AdjunctClinicalAssociateProfessorofRehabilitationMedicine NewYorkUniversitySchoolofMedicine MedicalDirector UnionSquareRehabilitationandSportsMedicine NewYork Joseph Fetto, MD AssociateProfessorofOrthopedicSurgery NewYorkUniversitySchoolofMedicine AssociateProfessorandConsultant ManhattanV.A.MedicalCenter NewYork Elaine Rosen, PT,DHSc,OCS AssociateProfessorofPhysicalTherapy HunterCollege CityUniversityofNewYork Partner QueensPhysicalTherapyAssociates ForestHills,NewYork Thiseditionfirstpublished2016©2016byJohnWiley&Sons,Ltd Previouseditions:1996,2009byJeffreyGross,JosephFetto,ElaineRosen Registeredoffice: JohnWiley&Sons,Ltd,TheAtrium,SouthernGate,Chichester,WestSussex, PO198SQ,UK Editorialoffices: 9600GarsingtonRoad,Oxford,OX42DQ,UK TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK 111RiverStreet,Hoboken,NJ07030-5774,USA Fordetailsofourglobaleditorialoffices,forcustomerservicesandforinformationabouthowtoapplyfor permissiontoreusethecopyrightmaterialinthisbookpleaseseeourwebsiteat www.wiley.com/wiley-blackwell Therightoftheauthortobeidentifiedastheauthorofthisworkhasbeenassertedinaccordancewiththe UKCopyright,DesignsandPatentsAct1988. 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LibraryofCongressCataloging-in-PublicationData Gross,JeffreyM.,1957–,author. Musculoskeletalexamination/JeffreyM.Gross,JosephFetto,ElaineRosen.–4thedition. p. ; cm. Includesbibliographicalreferencesandindex. ISBN978-1-118-96276-3(pbk.) I.Fetto,Joseph,author. II.Rosen,Elaine,author. III.Title. [DNLM:1.MusculoskeletalDiseases–diagnosis. 2.MusculoskeletalPhysiologicalPhenomena. 3.MusculoskeletalSystem–anatomy&histology. 4.PhysicalExamination–methods.WE141] RC925.7 616.70076–dc23 2015000697 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynot beavailableinelectronicbooks. Coverimage:istock(photo/muscles-of-the-arm-34748034)02-09-14(c)Eraxion Setin10/12ptSabonLTStdbyAptaraInc.,NewDelhi,India 1 2016 Contents HowtoUseThisBookvi Acknowledgmentsvii AbouttheCompanionWebsiteviii 1 Introduction1 2 BasicConceptsofPhysicalExamination14 3 OverviewoftheSpineandPelvis31 4 TheCervicalSpineandThoracicSpine34 5 TheTemporomandibularJoint81 6 TheLumbosacralSpine94 7 OverviewoftheUpperExtremity136 8 TheShoulder138 9 TheElbow195 10 TheWristandHand229 11 TheHip286 12 TheKnee327 13 TheAnkleandFoot369 14 Gait420 Appendices432 Bibliography435 Index439 v How to Use This Book Musculoskeletal Examination is to be used as both InChapter2,Basicconceptsofthephysicalexam- a teaching text and a general reference on the tech- ination, we provide you with a framework for per- niques of physical examination. This volume rep- formingtheexamination,beginningwithobservation resents the joint authoring efforts of a physiatrist, andendingwithpalpation.However,ineachregional an orthopedic surgeon, and a physical therapist and anatomy chapter, palpation follows observation and presents the information in a clear and concise for- subjective examination and precedes all other sec- mat, free of any professional biases that reflect one tions.Thisisdeliberate.Forreasonsoflength,wefelt specialty’s preferences. The importance of this will itimportanttodiscusseachanatomicalregionandits be seen as we take you through each anatomical ownspecialanatomicalstructuresassoonaspossible regionanddelineatethebasicexamination.Included in each chapter.This avoids repetition,gives you the in each chapter are the abnormalities most fre- anatomy early in each chapter, and then allows you quently encountered or noted while performing an tovisualizeeachstructureasyoureadthesubsequent examination. sections on testing. Hopefully, this will reinforce the Thebookisorganizedintoregionalanatomicalsec- anatomyandhelpyouapplyanatomytofunctionand tionsincludingthespineandpelvis,theupperextrem- functiontothefindingsofyourexamination. ity, and the lower extremity. The book opens with Each chapter includes a generous number of orig- twochaptersthatdefinethestructuresofthemuscu- inal line drawings, many of which are two-color. loskeletal system and discuss the basic concepts and These provide clear snapshots of how to perform parts of the musculoskeletal exam. A final chapter each examination technique. Thirty-two X-rays and describestheexaminationofgait. MRIshavebeenincludedtohelpyouwithradiologi- Eachmainchapterisorganizedinanidenticalman- calanatomy.Paradigmsandtablesprovideadditional ner: information that will help you understand the how (cid:2) overviewoftheanatomicalregion andwhyofeachexaminationtechnique. (cid:2) observationofthepatient By using Musculoskeletal Examination as a guide (cid:2) subjectiveexamination and reference,the reader will be able to perform the (cid:2) gentlepalpation completebasicexaminationandunderstandcommon (cid:2) triggerpoints(whereapplicable) abnormalitiesandtheirpathologicalsignificance.We (cid:2) activemovementtesting hopethatourreaderswillgainanappreciationforthe (cid:2) passivemovementtesting intimaterelationshipbetweenthestructureandfunc- (cid:2) physiologicalmovements tionofthecomponentsofthemusculoskeletalsystem. (cid:2) mobilitytesting Thisunderstandingshouldthenenableanyreaderto (cid:2) resistivetesting make a correct diagnosis and a successful treatment (cid:2) neurologicalexamination planforeachpatient. (cid:2) referredpainpatterns (cid:2) specialtests (cid:2) radiologicalviews vi Acknowledgments The writing of Musculoskeletal Examination would To my husband, Jed, for his unlimited patience, not have been possible without the overwhelming understanding,andencouragement. supportandunderstandingofmywife,Elizabeth,and Tomybusinesspartnerandfriend,Sandy,forbeing my sons,Tyler and Preston.I also want to thank my therewheneverIneededher. parents,MalcolmandZeldaGross,fortheirguidance To my family for their support, and to my many andeffortsonmybehalf. patients,colleagues,andfriendswhohavehelpedme J.G. grow. Thank you to my wife and family for their under- E.R. standing,patience,support,andlove. J.F. vii About the Companion Website Don’tforgettovisitthecompanionwebsiteforthisbook: www.wiley.com/go/musculoskeletalexam Thereyouwillfind: Hundredinteractivemultiple-choicequestionstotestyourlearning. Linkstotheexaminationvideosmentionedinthebook. ScanthisQRcodetovisitthecompanionwebsite viii