Specialists

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Treatment

Many treatment methods have been described through the years. In general, the choice of the treatment for a proximal humerus fracture should be based on the type of the fracture, presence of concurrent injuries, age and activity level of the patient, the presence and nature of comorbid medical conditions, and potential outcomes of specific treatment […]

The Rotator Cuff

Key Points The majority of symptomatic rotator cuff disease patients respond to a nonoperative program emphasizing the restoration of normal biomechanics, unrestricted motion, and functional force couples.Early surgical management should be considered for acute rotator cuff tears in physiologically young and very active individuals.

The ability to recognize the complex layered anatomy in addition to […]

Operative Treatment

For patients who fail nonoperative treatment, the procedure of choice is arthroscopic subacromial decompression (ASAD). The advantages of the arthroscopic approach include minimally invasive surgery without detachment of the deltoid.

This leads to a more comfortable postoperative recovery and the capability to accelerate rehabilitation. Arthroscopy also allows complete evaluation of the glenohumeral joint and the […]

Protocol for Positioning and Helmet Removal-The Prone Athlete

If an athlete is found in the prone position after an injury, cervical spine injury should be assumed. The team physician and the training staff should complete their initial evaluation (i.e., primary survey) without moving the athlete. The team physician and athletic trainer position themselves by the patient. The trainer stabilizes the cervical spine […]

Management of Protective Equipment

Collision sports, such as football and ice hockey, further complicate the risk of cervical spine injury because of the protective equipment associated with each athlete. Helmets and shoulder pads aim to protect athletes from contact, but they often provide little additional support for motion of the spine and, quite frankly, make it difficult to assess […]

Strong varus movement at the ankle

Significance.

This movement tests the integrity of the strong distal tibiofibular ligaments.

Positioning.

The ankle is in neutral position and the knee extended. The examiner is distal to the foot. The ipSilateral hand fixes the leg at the inner side, just above the ankle. The contralateral hand grasps the foot at the heel.

Procedure.

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Combined dorsiflexion-eversion

Significance.

This is a specific test to demonstrate anterior periostitis of the fibula.

Positioning.

The knee is slightly flexed and the ankle in neutral position. The examiner is distal to the foot. His ipsilateral hand supports the heel and the contralateral hand is placed against the plantar and lateral side of the foot. […]

SPECIFIC TESTS

Combined plantar flexion-inversion Significance.

This movement brings all the lateral structures of ankle and foot under stretch and is therefore an extremely important test in sprained ankles.

Positioning.

The heel rests on the couch, the knee is slightly flexed and the ankle is in neutral position. The examiner is distal to the foot. […]

Resisted inversion of the foot

Positioning.

The patient lies supine with the knee extended and the foot in neutral position. The examiner is distal to the foot. The contralateral hand is placed at the lateral and distal end of the leg just above the lateral malleolus. The ipsilateral hand is placed against the medial border of the foot.

Procedure. […]

MAXIMAL ISOMETRIC CONTRACTIONS OF THE FOOT

Resisted dorsiflexion of the foot

Positioning.

The subject lies supine with the knee extended and the foot in neutral position. The examiner is distal to the foot. Both hands are placed at the dorsum of the forefoot.

Procedure.

Ask the patient to extend the foot.

Common mistakes.

None. Anatomical structures tested:

Muscle function:

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