Brukner & Khan'S Clinical Sports Medicine: Injuries Vol. 1
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EBOOK CLINICAL SPORTS MEDICINE, 5TH EDITION, Volume 1 INJURIES “A striking feature of Clinical Sports Medicine has always been the authors’ relentless commitment to ‘clinical’. This is a unique book. ” Dr Emma K Stokes, President, World Confederation for Physical Therapy EDITORS PETER BRUKNER, BEN CLARSEN, JILL COOK, ANN COOLS, KAY CROSSLEY, MARK HUTCHINSON, PAUL McCRORY, ROALD BAHR, KARIM KHAN Brukner & Khan’s Clinical Sports Medicine, the world-leading title in sport and exercise medicine, is an authoritative and practical guide to physiotherapy and musculoskeletal medicine for clinicians and students.
To accommodate the rapid advances in the professions, the fifth edition has been expanded into two volumes. This first volume, Clinical Sports Medicine: Injuries, is the essential guide to all aspects of preventing, diagnosing and treating sports-related injuries. It serves physiotherapists, team clinicians, athletic trainers, sports therapists, sports rehabilitators and trainers, as well as students in the health professions and in Human Movement Studies.
All chapters have been updated and rewritten by an international team of sports physiotherapists and sports physicians at the top of their fields. More than 550 new figures have been added to bring the total number of illustrations to 1300. There are 15 new chapters, including: • Shoulder pain • Acute knee injuries • Posterior thigh pain • Low back pain • Return to play • Sport-specific biomechanics The second volume, Clinical Sports Medicine: Exercise Medicine, is scheduled for release in 2018 and will focus on the health benefits of exercise and the medical issues in sport.
It will serve general practitioners and other clinicians who prescribe exercise to promote health and to treat medical conditions such as heart disease and diabetes. This ebook of Clinical Sports Medicine: Injuries is enhanced with up to 50 instructional videos demonstrating procedures. ABOUT THE AUTHORS PETER BRUKNER OAM, MBBS, FACSEP, FACSM, FFSEM Peter Brukner is a Sport and Exercise Physician and currently the Australian cricket team doctor.
He was previously Head of Sports Medicine and Sports Science at the Liverpool Football Club in the UK. Peter is the founding partner of the Olympic Park Sports Medicine Centre, a past president of the Australasian College of Sport and Exercise Physicians, and Professor of Sports Medicine at La Trobe University. Peter has been an Olympic team physician and was the Socceroos team doctor at the 2010 World Cup.
In 2005 he was awarded the Order of Australia medal (OAM) for services to sports medicine. KARIM KHAN MD, PhD, MBA, FACSEP, FACSM, FFSEM Karim Khan is a Sport and Exercise Physician and Professor of Sports Medicine at the Department of Family Practice at the University of British Columbia, Vancouver, Canada. He is Editor in Chief of the British Journal of Sports Medicine (BJSM) and has published more than 300 peer-reviewed research articles.
Annað
- Höfundar: Peter Brukner, Karim Khan, Jill Cook, Ann Cools, Kay Crossley, Mark Hutchinson, Paul McCrory, Roald
- Útgáfa:5
- Útgáfudagur: 2017-01-01
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- Format:ePub
- ISBN 13: 9781743769263
- Print ISBN: 9781743761380
- ISBN 10: 1743769261
Efnisyfirlit
- Frontmatter
- Clinical Sports Medicine
- Dedication
- Title Page
- Copyright and More Information
- Foreword to the first edition
- Foreword to the fifth edition
- Brief contents
- Contents
- Preface
- About the authors
- Editors
- Co-authors
- Other contributors
- Acknowledgments
- Guided tour of your book
- Part A: Fundamental principles
- Introduction
- Chapter 1: Sport and exercise medicine: the team approach
- Introduction
- The SEM team
- Multiskilling, roles, responsibilities and communication
- The sport and exercise medicine model
- The challenges of management
- Diagnosis
- Treatment
- Meeting individual needs
- The coach, the athlete and the clinician
- ‘Love thy sport’ (and physical activity!)
- References
- Chapter 2: Integrating evidence into shared decision making with patients
- Introduction
- What is evidence-based practice?
- Why is the evidence-based practice concept controversial?
- Challenges to EBP
- Implementing EBP
- Accessing research
- Retrieving articles
- Published appraisals
- Interpreting research about treatment effects
- Risk of bias
- Research about other types of clinical questions
- References
- Chapter 3: Sports injuries: acute
- Introduction
- Pathophysiology and initial management
- Bone
- Fracture
- Periosteal contusion
- Hyaline cartilage
- Chondral and osteochondral injuries
- Fibrocartilage
- Acute tear
- Herniation of nucleus pulposus from intervertebral disc
- Joint
- Dislocation/subluxation
- Ligament
- Sprain/tear
- Muscle
- Strain/tear
- Contusion
- Myositis ossificans
- Acute compartment syndrome
- Cramp
- Tendon
- Tear/rupture
- Fascia
- Tear/rupture
- Bursa
- Traumatic bursitis
- Nerve
- Neuropraxia
- Fat Pad
- Bruise/contusion
- Skin
- References
- Chapter 4: Sports injuries: overuse
- Introduction
- Bone stress injury
- Pathophysiology
- Epidemiology
- Risk factors
- Factors modifying the load applied to a bone
- Factors influencing the ability of the bone to resist load without damage accumulation
- Diagnosis
- History
- Examination
- Imaging
- Classification of bone stress injuries
- Management
- Phase 1. Initial management
- Phase 2. Return to running
- Healing of bone stress injuries
- Osteitis and periostitis
- Apophysitis
- Articular cartilage
- Joint
- Ligament
- Muscle
- Myofascial pain: trigger points or just sore spots of unknown origin?
- The trigger point model
- Chronic compartment syndrome
- Exercise-induced muscle soreness
- Signs and symptoms
- Management
- Prevention of exercise-induced muscle soreness and delayed onset muscle soreness
- Myofascial pain: trigger points or just sore spots of unknown origin?
- Tendon
- Tendon overuse injury (tendinopathy)
- A contemporary model of a continuum of tendon pathology
- Other terms associated with overuse tendon injuries
- Principles of rehabilitating lower limb tendinopathy
- Before starting
- Decide the start and end of the program
- Stages of rehabilitation
- Enthesopathy
- Tendon overuse injury (tendinopathy)
- Bursa
- Nerve
- Skin
- Blisters
- Skin infections
- Dermatitis
- Skin cancers
- But it’s not that simple
- Pain: where is it coming from?
- Masquerades
- The kinetic chain
- References
- Introduction
- What is pain?
- What is nociception? Clue—nociception is NOT pain!
- Sensitisation of primary nociceptors (‘peripheral sensitisation’)
- Sensitisation of spinal nociceptors (‘central sensitisation’)
- The brain decides
- The brain corrects the spinal cord
- The brain is different in those with persistent pain
- Treating someone in pain: a complex system requires a comprehensive approach
- References
- Introduction
- Input-dominated pain
- Pain and musculoskeletal tissues
- Less well characterised input-dominated pain—referred pain
- Radicular pain
- Somatic pain
- Neuropathic pain
- Centrally dominated pain
- Central sensitisation
- Motor adaptation to pain
- Treatment options for patients with pain
- Education
- Manual therapy
- Medications
- Exercise/progressive loading
- Graded motor imagery/explain pain/cognitive therapy/sensory discrimination training
- Language
- Treatment options for patients with pain
- Summary
- References
- Introduction
- How to recognise a condition masquerading as a sports injury
- Conditions masquerading as sports injuries
- Bone and soft tissue tumours
- Rheumatological conditions
- Muscle disorders
- Endocrine disorders
- Vascular disorders
- Genetic disorders
- Granulomatous diseases
- Infection
- Pain syndromes
- Conditions masquerading as sports injuries
- Introduction
- ‘Ideal’ lower limb biomechanics—the basics
- Lower limb joint motion
- Ideal neutral stance position
- ‘Ideal’ biomechanics with movement—running
- Loading (heel strike to foot flat)
- Midstance (foot flat to heel off)
- Propulsion (heel off to toe off)
- Initial swing
- Terminal swing
- Angle and base of gait
- Landing point relative to centre of mass
- Influence of gait velocity
- Comparing heel and forefoot strike patterns
- Influence of fatigue on running biomechanics
- Lower limb biomechanical assessment in the clinical setting
- Structural (‘static’) biomechanical assessment
- Foot
- Ankle dorsiflexion
- Assessment of tibiofemoral alignment at the knee
- Leg length assessment
- Summary of static assessment
- Functional lower limb tests
- Single-leg stance with progressions
- Single-leg heel raise (with a focus on tibialis posterior function)
- Single-leg squat to assess knee, hip and trunk muscle function
- Landing—specific considerations
- Dynamic movement assessment (e.g. running biomechanics)
- Sport-specific assessment
- Summary of the lower limb biomechanical assessment
- Structural (‘static’) biomechanical assessment
- Clinical assessment of footwear—the Footwear Assessment Tool
- Conditions related to suboptimal lower limb biomechanics
- Management of lower limb biomechanical abnormalities
- Biofeedback and movement pattern retraining
- Foot orthoses
- Types of foot orthoses
- Mechanism of action—an unfinished story
- Orthoses are effective—high quality evidence is accumulating
- Three contemporary approaches for fitting an orthosis
- Footwear as a therapy rather than as a cause of injury!
- Taping
- Upper limb biomechanics
- The biomechanics of throwing
- Wind-up
- Cocking
- Acceleration
- Deceleration/follow-through
- The kinetic chain
- Normal biomechanics of the scapula in throwing
- The scapula provides a stable socket for the humerus
- The scapula must retract and protract along the thoracic wall
- The scapula rotates to elevate the acromion
- The scapula provides a base for muscle attachment
- The scapula provides a key link in the kinetic chain
- Abnormal scapular biomechanics and physiology
- Clinical significance of scapular biomechanics in shoulder injuries
- Changes in throwing arm with repeated throwing
- Common biomechanical abnormalities specific to throwing
- The biomechanics of throwing
- References
- Introduction
- Cycling
- Relationship between risk factors and loading
- Knee pain
- Three biomechanical factors to assess in patellofemoral pain
- Iliotibial band syndrome
- Low back pain
- Cricket fast bowling
- Age and risk of bowling injury
- Bowling workload and injury
- Fast bowling technique and injury
- Golf
- Wrist pain
- The leading wrist
- The trailing wrist
- Shoulder pain
- Hip pain
- Low back pain
- Wrist pain
- Rowing
- Low back pain
- Chest wall pain
- Risk factors for rib stress fracture
- Clinical features
- Management
- Wrist and forearm pain
- Knee pain
- Swimming
- Swimming biomechanics
- Freestyle technique
- Shoulder pain
- Management of shoulder pain in swimmers
- Medial knee pain
- Swimming biomechanics
- Tennis
- Lateral elbow pain
- Shoulder injuries
- References
- Introduction
- Principles of training
- Periodisation
- Overload
- Specificity
- Individualisation
- Conditioning training
- Endurance training
- Endurance training methods
- Speed training
- Speed training methods
- Agility training
- Agility training methods
- Resistance training
- Types of resistance exercises
- Classification of resistance exercises
- Qualities of resistance training
- Flexibility training
- Types of stretching
- Flexibility in the rehabilitation process
- Endurance training
- Introduction
- Rationale for motor control training for lumbopelvic dysfunction
- Motor control training to optimise core stability— key principles and common misconceptions
- Optimal motor control requires a balance between movement and stiffness
- Optimal lumbopelvic control involves three main neural strategies
- Optimal motor control requires a whole system, not a single muscle
- Motor control training involves rehabilitation of whole system
- Motor control training involves a motor learning approach
- Interplay between motor control and biology of pain
- Implications of the role of trunk muscles in respiration and bladder and bowel function
- Is motor control training effective for everyone or is it more effective when targeted to specific individuals?
- Principles of the clinical application of motor control training
- Assessment of motor control for core stability
- Assessment of muscle activation
- Assessment of posture or alignment
- Assessment of movement
- Consider subgrouping patients
- Training of motor control for core stability
- Training of motor control for core stability for prevention of pain and injury
- Considerations for training of motor control for core stability in athletes
- Assessment of motor control for core stability
- Conclusion
- References
- Introduction
- A conceptual approach to injury prevention
- The inciting event
- Risk management: applying prevention models to your team
- Reviewing the literature—risk identification and assessment
- Developing an injury surveillance program within the team
- Season analysis—risk profiling the training and competition program
- The periodic medical assessment—mapping current problems and intrinsic risk factors
- 1. Identify athletes with risk factors
- 2. Plan to follow up risk factors
- 3. Medical and coaching staff of the team must be involved in screening and follow-up
- Developing and initiating a targeted prevention program
- Preventing hamstring strains
- Injury mechanisms
- Risk factors
- Prevention programs
- Preventing ankle sprains
- Injury mechanisms
- Risk factors
- Prevention programs
- Preventing acute knee injuries
- Injury mechanisms
- Risk factors
- Prevention programs
- Preventing overuse injuries
- Stretching
- Structured training programs
- Technique modification
- Nutritional strategies to prevent stress fractures
- Modifying extrinsic risk factors
- Shoe selection
- Barefoot/minimalist running
- Orthotic insoles
- Sports equipment
- The relationship between load and injury
- Monitoring the rate of load increase
- Monitoring the acute:chronic load ratio
- Monitoring athletes’ response to load—the traffic-light approach
- Natural grass versus artificial turf
- Introduction
- Assessing recovery
- Active recovery
- After high-intensity short-duration exercise
- After longer-duration exercise—active recovery and metabolite clearance
- Psychological effects of active recovery
- Massage
- Massage and blood flow
- Massage, muscle tone and viscoelasticity
- Massage and delayed onset muscle soreness (DOMS)
- Cellular and structural effects of massage
- Psychological effects of massage
- Neuromuscular electrical stimulation
- NMES and blood flow
- NMES and performance
- NMES and muscle soreness
- Stretching
- Sleep
- Water immersion
- Compression
- Nutrition
- Replacing fluids
- Replacing fuel
- Repair
- Pulling the different threads together—practical considerations for the clinician
- Summary
- References
- Introduction
- Why is differential diagnosis important?
- Differential diagnosis: a three-step process
- How to calculate an accurate diagnosis
- Reliability
- Sensitivity and specificity
- Positive and negative predictive values
- Likelihood ratio
- Clinical utility
- The formal diagnostic assessment
- The role of bias in influencing diagnostic metrics
- Challenges to making a diagnosis
- Final thoughts and guidance
- References
- Introduction
- Does diagnosis mean tissue diagnosis?
- Keys to accurate diagnosis
- History
- Allow enough time
- Be a good listener
- Know the sport
- Discover the exact circumstances of the injury
- Obtain an accurate description of symptoms, both at the time of injury and at the initial consultation
- Pain
- Swelling
- Instability
- Function
- History of a previous similar injury
- Other injuries
- General health
- Work and leisure activities
- Consider why the problem has occurred
- Training/activity history
- Equipment
- Technique
- Overtraining
- Psychological factors
- Nutritional factors
- Drugs: prescription and others
- History of exercise-induced anaphylaxis
- Determine the importance of the sport to the athlete
- Differential diagnosis
- Physical examination
- Develop a routine
- Where relevant, examine the other side
- Consider possible causes of the injury
- Attempt to reproduce the patient’s symptoms
- Assess local tissues
- Assess for referred pain
- Assess neural mechanosensitivity
- Examine the spine
- Biomechanical examination
- Functional testing
- The examination routine
- Inspection
- Range of motion testing (active)
- Range of motion testing (passive)
- Palpation
- Ligament testing
- Strength testing
- Testing neural mechanosensitivity
- Spinal examination
- Biomechanical examination
- Technique
- Equipment
- Differential diagnosis
- Diagnostic imaging
- The five imaging-related habits of highly effective sports medicine clinicians
- 1. Understand imaging results
- 2. Only order imaging that will influence management
- 3. Explain the imaging to the patient
- 4. Provide relevant clinical findings on the requisition
- 5. Develop a close working relationship with investigators
- The five imaging-related habits of highly effective sports medicine clinicians
- Conventional radiography
- MRI: massive blessing for active patients
- Specific features and patient benefits of MRI
- Difference added by MRI sequences
- Other clinical points about MRI
- Ultrasound scan (for diagnosis)
- The role of colour Doppler
- The role of ultrasound tissue characterisation
- CT scanning
- Radioisotopic bone scan
- Introduction
- What are proms?
- Why is it important to use appropriate proms in sports medicine?
- Considerations for what constitutes a ‘good’ prom for use in sports medicine
- Is the PROM easy to use in a sports medicine setting?
- Does the PROM evaluate dimensions that are relevant for the patient?
- Do all items within a PROM measure the same construct?
- Can the PROM be trusted to detect true change in the patient and be free from error?
- Is the PROM sensitive enough to detect real change in the patient’s condition?
- Summary
- References
- Introduction
- Therapeutic exercise
- Stimulation of repair and remodelling: mechanotherapy
- Muscle
- Tendon
- Articular cartilage
- Bone
- Altering biomechanics: motor-control training
- Exercise-induced hypoalgesia
- Exercise type and dose to maximise hypoalgesia
- Stimulation of repair and remodelling: mechanotherapy
- Protection
- Optimal loading
- Ice
- Compression
- Elevation
- Do no HARM!
- Joint techniques: mobilisation and manipulation
- Safety of manipulation techniques
- Soft tissue therapy
- Treatment position
- Digital ischaemic pressure
- Sustained myofascial tension
- Friction
- Depth of treatment
- Combination treatment
- Lubricants
- Vacuum cupping
- Self-treatment
- Dry needling
- Risks of adverse events during dry needling
- Neurodynamic techniques
- Proposed mechanisms of taping
- Evidence of efficacy
- Patellofemoral pain
- Ankle sprains
- Other conditions
- Practical considerations
- Therapeutic ultrasound
- Ultrasound as a stimulator of bone repair
- Transcutaneous electrical nerve stimulation
- Neuromuscular stimulators
- Interferential stimulation
- Laser
- Electromagnetic therapy
- Extracorporeal shockwave therapy
- Analgesics
- Paracetamol
- Codeine
- Emergency analgesia
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- NSAID use in sport
- NSAID use in the treatment of musculoskeletal injury
- Adverse effects of NSAIDs
- Medications for neuropathic pain and central sensitisation
- Tricyclic antidepressants
- Serotonin reuptake inhibitors
- Gabapentin and pregabalin
- Local anaesthetic patches
- Counterirritants
- Local anaesthetic injections
- Local anaesthetic in competition
- Local anaesthetic in routine musculoskeletal injections
- Traumeel
- Actovegin
- Sclerosant
- Prolotherapy
- Mechanical and high-volume injections
- Hyaluronic acid
- Hyaluronic acid in tendons
- Corticosteroids
- Other adverse effects of corticosteroids
- Choice of corticosteroid
- Other medications
- Sleep medication
- Quinolone antibiotics
- Glyceryl trinitrate patches
- Bisphosphonates
- Glucosamine, chondroitin and omega-3 fatty acids
- Vitamin D
- Green tea/polyphenols
- Autologous blood injections
- Platelet-rich plasma
- Cell therapy
- Arthroscopic surgery
- Open surgery
- Introduction
- General principles
- An essential element—effective planning
- Goal setting and targeted interventions
- Phases of rehabilitation
- Phase 1: Acute
- Phase 2: Restore activities of daily living
- Phase 3: Returning to sports activities
- Phase 4: Prevention of re-injury
- When rehabilitation does not go according to plan
- References
- Introduction
- Strategic assessment of risk and risk tolerance framework for RTP decision making
- Step 1—Tissue health
- Step 2—Tissue stresses
- Step 3—Risk tolerance modifiers
- Return-to-play decision making—beyond risk for injury
- Applying the stARRT framework
- Assessing across outcomes and probabilities
- Additional perspectives
- Who should be the decision Maker?
- Clinicians
- Athletes
- The coach
- Family, friends, agents
- Management
- A multidisciplinary approach
- Summary
- References
- Introduction
- Chapter 20: Sports concussion
- Introduction
- Definition
- Prevention of concussion
- The initial impact: applied pathophysiology
- Management of the concussed athlete
- On-field management
- Confirming the diagnosis
- Does amnesia associate with injury severity?
- Does an acutely concussed athlete need to go to hospital or have urgent neuroimaging?
- How should acute concussion be graded?
- Determining when the player can return safely to competition
- Return to play on the day of injury
- Return to play during the subsequent week(s)
- The risk of premature return to play and concussion sequelae
- Risk of further injury
- Second impact syndrome
- Concussive convulsions
- Prolongation of symptoms
- Chronic traumatic encephalopathy (CTE)
- Mental health issues
- The ‘difficult’ concussion
- Clinical assessment
- Role of investigations
- Treatment
- Clinical assessment
- Children and concussion in sport
- References
- Introduction
- Headache in sport
- Clinical approach to the patient with headache
- History
- Clinical measurement of headache
- Examination
- Primary headache
- Migraine
- Clinical features
- Precipitating factors in migraine
- Treatment
- Primary exercise headache
- Migraine
- Secondary headache
- Cervicogenic headache
- Mechanism
- Clinical features
- Post-traumatic headache
- Post-traumatic migraine
- External compression headache
- High-altitude headache
- Hypercapnia headache
- Cervicogenic headache
- References
- Introduction
- Functional anatomy
- Clinical assessment
- Lacerations and contusions
- Immediate management of lacerations
- Management of larger lacerations
- Additional considerations
- Nose
- Epistaxis (nosebleed)
- Nasal fractures
- Septal haematoma
- Ear
- Auricular haematoma
- Perforated eardrum
- Otitis externa
- Eyes
- Assessment of the injured eye
- History
- Examination
- Corneal injuries: abrasions and foreign body
- Subconjunctival haemorrhage
- Eyelid injuries
- Hyphaema
- Lens dislocation
- Vitreous haemorrhage
- Retinal haemorrhage
- Retinal detachment
- Prevention of eye injuries
- Assessment of the injured eye
- Teeth
- Nature of injuries
- Emergency management
- Dental management and follow-up
- Prevention
- Fractures of facial bones
- Orbital fracture with and without globe trauma
- Fractures of the zygomaticomaxillary complex
- Maxillary fractures
- Mandibular fractures
- Undisplaced fractures
- Displaced mandibular fractures
- Temporomandibular injuries
- Chronic temporomandibular pain
- Introduction
- Anatomical considerations
- Clinical perspective
- History
- Symptoms and their behaviour
- Psychological features
- Social/sport factors
- Patient-reported outcome measures
- Imaging
- Physical examination
- Postural analysis
- Active movement tests
- Quantitative sensory testing
- Passive tests
- Tests of the nervous system
- Tests of muscle function
- Tests of cervical sensorimotor function
- Additional tests
- Performance-based outcome measures
- History
- Management of mechanical neck pain
- Sport and functional modifications
- Education
- Pain management
- Manual therapy
- Range of motion exercises to accompany manual therapy
- Neural tissue mobilisation
- Training motor function
- Stage 1. Motor control
- Stage 2. Resistance training
- Training sensorimotor control
- Maintenance program
- Neck pain conditions
- Cervicogenic headache
- Acute wry neck
- Cervical nerve injury
- Cervical radiculopathy
- Brachial plexus injuries (‘stingers/burners’)
- Acceleration/deceleration injury (‘whiplash’)
- Introduction
- Functional anatomy and biomechanics
- Static stabilisers
- Dynamic stabilisers
- The role of the scapula in normal shoulder function
- Causes of shoulder pain—overview
- Acute versus overuse shoulder pain
- Impingement
- Clinical approach
- History
- Physical examination
- Active movements
- Passive examination
- Resistance examination
- Special tests—diagnostic testing and symptom modification tests
- Impingement tests
- Rotator cuff tests
- Scapular involvement tests
- Instability tests
- Biceps pathology and SLAP lesion tests
- Clinical evaluation of GIRD
- Shoulder symptom modification procedure
- Additional shoulder tests
- Screening of the kinetic chain
- Key outcome measures
- Investigations
- Radiography
- Arthrography
- Ultrasound
- Magnetic resonance imaging
- Diagnostic arthroscopy
- General treatment and rehabilitation guidelines for the most common shoulder injuries in athletes
- Rotator cuff injuries
- Rotator cuff tendinopathy
- Clinical features
- Treatment of rotator cuff tendinopathy
- Rotator cuff tears
- Rotator cuff tendinopathy
- Shoulder instability
- Traumatic shoulder instability—TUBS
- Management of anterior dislocation
- Recurrent dislocation and Bankart repair
- Posterior dislocation of the glenohumeral joint
- Acquired sport-specific instability—AIOS
- Atraumatic multidirectional instability—AMBRI
- Rehabilitation guidelines for shoulder instability—overview
- Open versus closed chain shoulder exercises
- Local neuromuscular control of stabilising muscles
- Progression in closed chain exercise program—practice
- Progression in open chain program—practice
- Traumatic shoulder instability—TUBS
- Pathomechanics of biceps-related shoulder pain
- Clinical features
- Treatment of SLAP lesions
- Pathomechanics of GIRD
- Treatment of GIRD
- Rehabilitation of scapular dyskinesis—a scapular rehabilitation algorithm
- Rehabilitation of flexibility deficits
- Rehabilitation of muscle performance deficits
- Special note—immature skeleton
- Acute acromioclavicular joint injuries
- Chronic acromioclavicular joint pain
- Other muscle tears around the shoulder
- Rupture of the long head of the biceps
- Pectoralis major tears
- Subscapularis muscle tears
- Adhesive capsulitis—‘frozen shoulder’
- Neurovascular injuries
- Suprascapular nerve entrapment
- Long thoracic nerve injury
- Axillary nerve injury
- Thoracic outlet syndrome
- Axillary vein thrombosis (‘effort’ thrombosis)
- Less common fractures around the shoulder
- Snapping scapula
- Kinetic chain integration
- The thrower’s program
- Return to play following shoulder injury
- Introduction
- Anatomy
- Ligaments
- Muscles
- Lateral elbow pain
- History
- Examination
- Investigations
- Lateral elbow tendinopathy
- Clinically relevant pathology
- Clinical features
- Treatment
- Exercises for strengthening and coordination
- Electrotherapeutic modalities
- Manual therapy
- Bracing and taping
- Iontophoresis
- Corticosteroid injection
- Nitric oxide donor therapy
- Botulinum toxin
- Autologous blood, platelet-rich plasma and autologous cell injections
- Correct predisposing factors
- Surgery
- Graduated return to activity
- Other causes of lateral elbow pain
- Medial elbow pain
- Flexor/pronator tendinopathy
- Medial collateral ligament sprain
- Ulnar nerve entrapment/neuritis
- Olecranon bursitis
- Triceps tendinopathy
- Posterior impingement
- Fractures
- Supracondylar fractures
- Olecranon fractures
- Radial head fracture
- Coronoid fractures
- Posterior dislocation
- Instability post-dislocation
- Acute rupture of the medial collateral ligament
- Tendon ruptures
- Hyperextension injuries
- Fracture of the radius and ulna
- Stress fractures
- Entrapment of the posterior interosseous nerve (radial tunnel syndrome)
- Pronator teres syndrome (median nerve entrapment)
- Forearm compartment pressure syndrome
- Myofascial pain
- Stress reaction of the humerus
- Introduction
- Clinical approach
- History
- Physical examination
- Key outcome measures
- Special imaging studies
- Fracture of the distal radius
- Fracture of the scaphoid
- Traditional treatment of stable and unstable scaphoid fractures
- Complications of scaphoid fracture
- Contemporary management of scaphoid non-union
- Post-immobilisation wrist rehabilitation
- Fracture of the trapezium
- Radial epiphyseal injury (gymnast’s wrist)
- De Quervain’s tenosynovitis
- Intersection syndrome
- Radial sensory nerve compression
- Ganglions
- Dislocation of the carpal bones
- Anterior dislocation of the lunate
- Perilunar dislocation of the lunate
- Scapholunate dissociation
- Kienböck’s disease
- Impingement syndromes
- Ulnar styloid fracture
- Fracture of the hook of hamate
- Triquetral fracture
- Lunotriquetral dissociation
- Triangular fibrocartilage complex tear
- Distal radio-ulnar joint instability
- Extensor carpi ulnaris tendon injuries
- Other tendinopathies around the wrist
- Carpal tunnel syndrome
- Ulnar nerve compression
- Wrist splinting
- Post-immobilisation wrist rehabilitation
- Introduction
- Clinical approach
- History
- Physical examination
- Key outcome measures
- Investigations
- Principles of treatment
- Oedema control
- Exercises
- Taping and splinting
- Metacarpal fractures
- Fracture of the base of the first metacarpal
- Fractures of the other metacarpals
- Fractures of phalanges
- Proximal phalanx fractures
- Middle phalanx fractures
- Distal phalanx fractures
- Dislocations of the carpo-metacarpal joints
- Dislocations of the finger joints
- Dislocations of the PIP joint
- Dislocations of the DIP joint
- Ligament and tendon injuries
- Sprain of the ulnar collateral ligament of the first MCP joint
- Sprain of the radial collateral ligament of the first MCP joint
- Capsular sprain of the first MCP joint
- PIP joint sprains
- Mallet finger
- Chronic swan neck deformity
- Boutonnière deformity
- Avulsion of the flexor digitorum profundus tendon (‘jersey finger’)
- Lacerations and infections of the hand
- Overuse conditions of the hand and fingers
- Surgical referrals following hand and finger injury
- Exercises for the hand
- References
- Introduction
- Assessment
- History
- Physical examination
- Investigations
- Thoracic intervertebral joint disorders
- Costovertebral and costotransverse joint disorders
- Scheuermann’s disease
- Thoracic intervertebral disc prolapse
- T4 syndrome
- Postural imbalance of the neck, shoulder and upper thoracic spine
- Assessment
- Chest pain
- Clinical assessment
- History
- Examination
- Investigations
- Rib trauma
- Referred pain from the thoracic spine
- Sternoclavicular joint problems
- Costochondritis
- Stress fracture of the ribs
- Side strain
- Clinical features
- Pathology and epidemiology
- Management
- Conclusion
- Clinical assessment
- References
- Introduction
- Epidemiology
- The multidimensional nature of low back pain
- Triage
- Serious pathology
- Specific pathoanatomical diagnoses
- Low back pain without a pathoanatomical diagnosis
- Factors contributing to low back pain
- Physical factors
- Extrinsic factors
- Intrinsic factors
- Lifestyle factors
- Psychosocial factors
- Cognitive factors
- Emotional factors
- Social stressors
- Neurophysiological factors
- Proportionate pain responses to mechanical loading
- Disproportionate pain responses to mechanical loading
- Individual considerations
- Physical factors
- Clinical approach
- History
- Physical examination
- Investigations
- Management of specific LBP disorders
- Stress fracture of the pars interarticularis/lumbar spondylolysis
- Terminology
- Clinical presentation
- Imaging
- Pathogenesis
- Management of lumbar spondylolysis
- Summary
- Spondylolisthesis
- Clinical features
- Treatment
- Acute radiculopathy +/− nerve root compression
- Clinical features
- Treatment
- Vertebral endplate oedema (Modic type 1 changes)
- Treatment
- Stress fracture of the pars interarticularis/lumbar spondylolysis
- Clinical approach
- Effective patient education
- Pain relief
- Functional restoration
- Addressing lifestyle aspects
- Multidisciplinary care
- Acute severe low back pain
- Clinical features
- Management
- Subacute low back pain
- Recurrent/persistent low back pain: a clinical sub-grouping approach
- Low-complexity profile
- Medium-complexity profile
- High-complexity profile
- Sporting technique
- Optimal motor control
- Flexibility
- Introduction
- Clinical approach
- History
- Physical examination
- Sensitivity and specificity of tests for buttock pain
- Key outcome measures
- Investigations
- Myofascial buttock pain
- Examination
- Treatment of myofascial buttock pain
- Referred pain from the lumbar spine
- Examination
- Treatment
- Proximal hamstring tendinopathy
- Functional anatomy
- Examination
- Treatment
- Initial treatment
- Intermediate stage treatment
- Final stage of treatment
- Functional anatomy
- Clinical features
- Treatment
- Piriformis syndrome
- Ischiofemoral impingement
- Treatment
- Posterior thigh compartment syndrome
- Proximal hamstring tendon rupture
- Treatment
- Avulsion fracture of ischial tuberosity
- Spondyloarthropathies
- Stress fracture of the sacrum
- Introduction
- Epidemiology
- Functional anatomy and biomechanics
- Morphology
- Acetabular labrum
- Ligaments of the hip
- Chondral surfaces
- Muscle function
- Short hip stabilising muscles
- Clinical biomechanics
- History
- Physical examination
- Key outcome measures
- Investigations
- Local factors
- Remote factors
- Proximal factors
- Distal factors
- Systemic factors
- Types of FAI—cam and pincer impingement
- Prevalence of FAI
- Aetiology
- Association with pain and pathology
- Osteoarthritis
- Pathology
- Principles of rehabilitation of the injured hip
- Nine principles of rehabilitation for hip pain patients
- 1. Restore hip range of motion
- 2. Restore hip muscle strength
- 3. Improve balance and proprioception
- 4. Improve hip control in functional task performance
- 5. Improve trunk muscle strength
- 6. Optimise gait biomechanics
- 7. Optimise functional task performance
- 8. Address adverse loading
- 9. Address other remote factors that may be altering the function of the kinetic chain
- Surgical management of the injured hip
- Rehabilitation following hip arthroscopy
- Greater trochanteric pain
- Relevant anatomy
- Role of compression in pathology
- Iliac crest pain
- Examination of the patient with lateral hip pain
- Treatment of the patient with lateral hip pain
- Managing pain
- Managing load: First line treatment
- Introduction
- Anatomy
- Pubic symphysis
- Hip adductors
- Hip flexors
- Inguinal region
- Summary of anatomy
- Epidemiology
- Incidence—soccer
- Incidence—elite sports other than soccer
- Prevalence
- Distribution of acute injuries
- Risk factors
- Terminology and definitions
- Classification
- Acute groin injuries
- Longstanding groin pain
- Classification
- History
- Pain pattern
- Where is the pain located?
- Clinical examination
- Assessment of severity
- Imaging
- Radiography
- Magnetic resonance imaging
- Ultrasonography
- Computed tomography scan
- Radioisotopic bone scan
- Diagnosis
- Adductor-related groin pain
- Diagnostic criteria
- Iliopsoas-related groin pain
- Diagnostic criteria
- Treatment
- Inguinal-related groin pain
- Diagnostic criteria
- Treatment
- Pubic-related groin pain
- Diagnostic criteria
- Treatment
- Obturator neuropathy
- Other nerve entrapments
- Stress fractures of the neck of the femur
- Stress fracture of the inferior pubic ramus
- Referred pain to the groin
- Possible prevention strategies
- Introduction
- Epidemiology
- Functional anatomy and biomechanics
- Clinical approach
- History
- Physical examination
- Key outcome measures
- Investigations
- Quadriceps contusion
- Treatment of quadriceps contusion
- Complications related to contusion
- Quadriceps strain
- Distal quadriceps muscle strain
- Proximal rectus femoris strain
- Complete rectus femoris tear
- Avulsion injury
- Prevention
- Less common causes
- Stress fracture of the femur
- Lateral femoral cutaneous nerve injury (‘meralgia paraesthetica’)
- Femoral nerve injury
- Referred pain
- References
- Introduction
- Functional anatomy
- Clinical approach
- History
- Physical examination
- Investigations
- Integrating the clinical assessment and investigation to make a diagnosis
- Acute hamstring muscle strains
- Epidemiology
- Type I and type II acute hamstring strains-not all acute hamstring injuries are the same!
- Type I acute hamstring strain: sprinting–related
- Type II acute hamstring strain: stretch-related (dancers)
- Prognosis of hamstring injuries
- Management of hamstring injuries
- Risk factors for acute hamstring strain
- Intrinsic risk factors
- Extrinsic risk factors
- Prevention of hamstring strains
- Eccentric hamstring strength training
- Balance exercises/proprioception training
- Sport-specific training
- A promising clinical approach for the high-risk athlete
- Referred pain to posterior thigh
- Trigger points
- Lumbar spine
- Sacroiliac complex
- Other hamstring injuries
- Avulsion of the hamstring from the ischial tuberosity
- Upper hamstring tendinopathy
- Less common causes
- Nerve entrapments
- Ischial bursitis
- Adductor magnus strains
- Compartment syndrome of the posterior thigh
- Vascular
- References
- Introduction
- Functional anatomy
- Clinical approach
- ‘Does this patient have a significant knee injury?’
- History
- Physical examination
- Key outcome measures
- Investigations
- Meniscal injuries
- Clinical features
- Treatment
- Rehabilitation after meniscal surgery
- Medial (tibial) collateral ligament injury
- Treatment
- Anterior cruciate ligament injuries
- Anatomy of the ACL
- Mechanism of ACL injury
- Clinical features
- Surgical or conservative treatment of the torn ACL?
- Surgical treatment
- Combined injuries
- Rehabilitation after ACL injury
- Problems encountered during ACL rehabilitation
- Outcomes after ACL treatment
- Partial ACL tear
- Prevention of ACL injuries
- ACL rupture in children with open physes
- Posterior cruciate ligament injuries
- Clinical features
- Treatment
- Lateral collateral ligament tears
- Posterolateral corner injuries
- Articular cartilage damage
- Epidemiology
- Quantifying chondral injury
- Management
- Acute patellar trauma
- Fracture of the patella
- Patella dislocation
- Less common causes
- Patellar tendon rupture
- Bursal haematoma
- Fat pad impingement
- Fracture of the tibial plateau
- Superior tibiofibular joint injury
- Ruptured hamstring tendon
- References
- Introduction
- Clinical approach
- History
- Physical examination
- Patient-reported outcome measures
- Investigations
- Patellofemoral pain
- What is patellofemoral pain?
- What is patellofemoral osteoarthritis?
- Functional anatomy
- Factors that may contribute to patellofemoral pain
- Treatment of PFP
- Patellofemoral instability
- Primary patellofemoral instability
- Secondary patellofemoral instability
- Patellar tendinopathy
- Nomenclature
- Clinical features
- Investigations
- Management: is the athlete still competing?
- Sudden, acute patellar tendon pain
- Less common causes of anterior knee pain
- Fat pad irritation/impingement
- Osgood–Schlatter lesion
- Sinding-Larsen–Johansson lesion
- Quadriceps tendinopathy
- Bursitis
- Synovial plica
- References
- Introduction
- Lateral knee pain
- Clinical approach
- Iliotibial band friction syndrome
- Lateral meniscus abnormality
- Less common causes of lateral knee pain
- Medial knee pain
- Patellofemoral syndrome
- Medial meniscus abnormality
- Osteoarthritis and chondral injuries of the medial compartment of the knee
- Less common causes of medial knee pain
- Posterior knee pain
- Clinical evaluation
- Baker’s cyst
- Biceps femoris tendinopathy
- Popliteus tendinopathy
- Other causes of posterior knee pain
- References
- Introduction
- Clinical approach
- Role of biomechanics
- History
- Physical examination
- Key outcome measures
- Investigations
- Medial tibial stress fracture of the tibia
- Assessment
- Treatment
- Prevention of recurrence
- Stress fracture of the anterior cortex of the tibia
- Treatment
- Medial tibial stress syndrome
- Risk factors
- Treatment
- Chronic exertional compartment syndrome
- Pathogenesis
- Clinical features
- Deep posterior compartment syndrome
- Anterior and lateral exertional compartment syndromes
- Outcomes of exertional compartment syndrome surgery
- Rehabilitation following compartment syndrome surgery
- Less common causes
- Stress fracture of the fibula
- Referred pain
- Nerve entrapments
- Vascular entrapments
- Developmental issues
- Periosteal contusion
- Fractured tibia and fibula
- References
- Introduction
- Anatomy
- Clinical approach
- History
- Physical examination
- Key outcome measures
- Investigations
- Gastrocnemius muscle strains
- Acute strain
- Soleus muscle strains
- Accessory soleus
- Claudicant-type calf pain
- Vascular causes
- Less common causes
- Neuromyofascial causes
- Nerve entrapments
- Superficial compartment syndrome
- Conditions not to be missed
- References
- Introduction
- Clinical perspective
- History
- Physical examination
- Key outcome measures (PROMs)
- Investigations
- Midportion Achilles tendinopathy
- Pathology
- Predisposing factors for Achilles tendinopathy
- Treatment of midportion Achilles tendinopathy
- Medications
- Electrophysical agents
- Surgical treatment
- Insertional Achilles tendinopathy including retrocalcaneal bursitis—the ‘enthesis organ’
- Anatomy and the key role of compression
- Clinical assessment
- Treatment
- Retrocalcaneal bursitis
- Achilles (superficial calcaneal) bursitis
- Posterior impingement syndrome
- Sever’s disease
- Other causes of pain in the Achilles region (gradual onset)
- Accessory soleus
- Referred pain
- Acute Achilles tendon rupture (complete)
- Clinical approach
- History
- Physical examination
- Key outcome measures
- Investigations
- Rehabilitation of Achilles tendon ruptures
- References
- Introduction
- Functional anatomy
- Clinical perspective
- History
- Examination
- Investigations
- Lateral ligament injuries
- Treatment and rehabilitation of lateral ligament injuries
- Initial management
- Treatment of grade III injuries
- Less common causes
- Medial (deltoid) ligament injuries
- Significant ankle fractures
- Lateral malleolar fracture with syndesmotic injury (Maisonneuve fracture)
- Persistent pain after ankle sprain—‘the difficult ankle’
- Clinical approach to the difficult ankle
- Osteochondral lesions of the talar dome
- Avulsion fracture of the base of the fifth metatarsal
- Other fractures
- Impingement syndromes
- Tendon dislocation or rupture
- Other causes of the difficult ankle
- Sinus tarsi syndrome
- Complex regional pain syndrome type 1
- References
- Introduction
- Medial ankle pain
- History
- Examination
- Key outcome measures
- Investigations
- Tibialis posterior tendinopathy
- Flexor hallucis longus tendinopathy
- Tarsal tunnel syndrome
- Medial malleolar stress fracture
- Medial calcaneal nerve entrapment
- Other causes of medial ankle pain
- Lateral ankle pain
- Examination
- Peroneal tendinopathy
- Sinus tarsi syndrome
- Anterolateral impingement
- Posterior impingement syndrome
- Stress fracture of the talus
- Referred pain
- Anterior ankle pain
- Anterior impingement of the ankle
- Tibialis anterior tendinopathy
- Anterior inferior tibiofibular ligament (AITFL) injury
- References
- Introduction
- Rearfoot pain
- History
- Examination
- Investigations
- Patient-reported outcome measures
- Plantar fasciopathy (formerly called ‘plantar fasciitis’)
- Fat pad contusion
- Calcaneal stress fracture
- First branch of lateral plantar nerve (Baxter’s nerve) entrapment
- Midfoot pain
- Clinical approach to midfoot pain
- Investigations
- Navicular stress fracture
- Midtarsal joint sprains
- Lisfranc joint injuries
- Tibialis posterior tendinopathy (distal pain presentation)
- Less common causes of midfoot pain
- Forefoot pain
- Clinical perspective
- Stress fractures of the neck of metatarsals I–IV
- Special metatarsal stress fracture: base of the second MT
- Fractures of the fifth metatarsal
- MTP joint synovitis
- First MTP joint sprain (‘turf toe’)
- Hallux limitus
- Hallux valgus
- Sesamoid injuries
- Plantar plate tear—with Kent Sweeting
- Corns and calluses
- Morton’s interdigital neuroma
- Plantar warts
- Onychocryptosis
- Less common causes of forefoot pain
- References
- Chapter 44: The younger athlete
- Introduction
- The young athlete is unique
- Nonlinearity of growth
- Maturity-associated variation
- Unique response to skeletal injury
- Management of musculoskeletal conditions
- Acute fractures
- Overuse injuries of the physis
- Shoulder pain
- Elbow pain
- Wrist pain
- Back pain and postural abnormalities
- Hip pain
- Knee pain
- Painless abnormalities of gait
- Foot pain
- References
- Chapter 45: Military personnel
- Introduction
- Special military culture
- Epidemiology of military injuries
- Common military injuries
- Overuse injuries of the lower limb
- Blister injuries
- Parachuting injuries
- The ageing defence forces
- Injury prevention in the military
- Injury surveillance
- Sex as a risk factor for injury
- Body composition
- Previous injury
- Weekly running distance
- Running experience
- Competitive behaviours
- Warm-up/stretching
- Conclusion
- References
- Chapter 46: Periodic medical assessment of athletes
- Introduction
- Why perform the medical assessment?
- Identification of medical conditions that contraindicate participation in sport
- Assessment of known injuries and illnesses
- Review of current medications and supplements
- Education
- Baseline testing
- Development of athlete rapport
- Screening
- Who is being assessed?
- Sport and position
- Geographical location
- Age
- Sex
- Available resources
- When to perform a PMA
- What to include in the template
- Other issues to consider
- Consent
- Clearance or restriction from play
- Who should perform the PMA?
- Pre-employment medical assessment
- Insurance medical assessment
- Action points from the PMA
- Summary
- References
- Chapter 47: Working and travelling with teams
- Introduction
- The medical support team
- Key attributes of a successful medical team
- Medical indemnity and trauma training
- Where does the medical team work?
- Medical equipment
- Team care throughout the season
- Core principles providing care for a team
- Emergency action plans
- Preparing to travel
- 1. Before travel
- 2. During travel
- 3. On arrival
- 4. Journey home
- Jet lag
- Air travel and jet lag
- Pathophysiology
- Prevention of jet lag
- Symptomatic treatment for jet lag
- References
- Chapter 48: Career development
- Introduction
- Development of sport and exercise medicine
- The adoption of exercise medicine in the sports medicine movement
- Increased resources in sport
- Proficiency in a second or third language
- Widening the scope of practice—dual qualifications and subspecialist courses
- Sports therapy, sports and exercise science and sports rehabilitation
- Men and women have a place in sport and exercise medicine
- Key behaviours for a successful and interesting career
- Lessons from around the world
- Ummukulthoum Bakare—football medicine enthusiast and sports injury prevention strategist, West Africa
- Dr Liam West—the rookie doctor, Northern Europe and Australia
- Hans-Wilhelm Müller-Wohlfahrt—the team and celebrity doctor, Bavaria, Central Europe
- Rod Whiteley—sports physiotherapist who has moved across continents for his career, Middle East via Australasia and Major League Baseball
- Roald Bahr—Professor of Sports Medicine, the Nordic countries
- References
- Child SCAT5
- Credit
- Index
- References
UM RAFBÆKUR Á HEIMKAUP.IS
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