In an attempt to achieve this, the ICF has replaced handicap with the term participation restriction. The WHO essentially does not see handicap as entirely separate from disability. Unfortunately, though widely recognized and referenced, there is no WHO international standard. Physicians, and particularly physiatrists, are often burdened with the task of being the key interpreter.
Impairment, disability, and handicap continue to remain the primary terms used in both the medical and legal arenas, despite the inherent confusion of definitions. The WHO proposes new terms, definitions, and algorithms to function as a universal, international standard as published in the ICF. Physical Medicine and Rehabilitation, 3rd ed. Philadelphia: Saunders. Guides to the Evaluation of Permanent Impairment, 5th ed. Chicago: American Medical Association Press. Cocchiarella L, Lord SJ eds. Master the AMA Guides, 5th ed.
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Rehabilitation Medicine: Principles and Practices, 3rd ed. Philadephia: Lippincott-Raven. Disability Evaluation. Geneva: World Health Organization. Chapter 2 Head and neck Jay M. Neck pain can be associated with arm or shoulder pain and can radiate from the neck to the trapezius area unilateral or bilateral , the upper extremities, or the head cervicogenic headaches. The compression is usually caused by cervical disc herniation or boney hypertrophy of the zygoapophyseal or facet joint, vertebral body, or uncovertebral joint, resulting in narrowing of the neural foramen.
Noncompressive radiculopathies can be related to diabetes mellitus, neoplasm, or infection. In the cervical spine there are seven vertebrae. The nerve roots are numbered according to the vertebra below it with C8 arising between C7 and T1. In contrast, in the thoracic spine and lumbar spine, the nerve roots are numbered on the basis of vertebra above so the T1 nerve root exits below T1. Clinical manifestations Cervical radiculopathy typically presents as neck pain radiating to the upper extremity.
There may be associated sensory symptoms in a specific dermatomal distribution see Fig. Although weakness or sensory loss can occur, pain and paresthesia are usually the reasons for presentation. The spinal level involved determines the manifestation see Table 2. Copyright Elsevier Reprinted with permission.
Sensory: Decreased sensation digit 3, or 2 and 3. Reflex: Triceps may be decreased. C6 Neck pain radiating to the shoulder, lateral arm and thumb, or thumb and second digit Motor: Weakness in elbow flexion, wrist extension, and forearm pronation. Sensory: decreased in first 2 digits. Reflexes: Biceps, brachioradialis may be decreased. C8 Neck pain radiating to the shoulder, medial side of arm, and ulnar side of hand Motor: Weakness in hand intrinsics finger abduction and adduction , thumb abduction and thumb and finger flexion.
Sensory: Decreased in fourth and fifth digits. Reflexes: No abnormalities. C5 Neck pain radiating to the shoulder Motor: Weakness in shoulder abduction and external rotation, and elbow flexion. Sensory: Decreased lateral shoulder. Reflexes: Biceps and brachioradialis may be decreased. Differential diagnosis The primary differential diagnosis includes spondylosis, cervical sprain, myofascial pain, and brachial plexopathy. Pain that radiates to bilateral upper extremities usually indicates a myofascial etiology. History Most cases occur spontaneously without previous trauma.
Patients complain primarily of pain in the neck and into an extremity generally in a specific distribution. The C7 nerve root is the most commonly involved nerve root, followed by C6, C8, and C5. Less commonly, patients may report weakness in an involved extremity. Physical The physical examination should adequately assess motor and sensory function in both upper extremities. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, through Brain Pt 2 — Frequently patients with cervical radiculopathies are not aware of subtle weaknesses, as patients are usually preoccupied with the pain or sensory complaints.
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Reflexes should be tested, and may be decreased asymmetrical if a radiculopathy is present. Gait and lower extremity reflexes should be assessed to look for signs of myelopathy scissoring gait or increased reflexes. Diagnostic testing Magnetic resonance imaging MRI is useful for evaluation of the spinal canal, intervertebral disc, nerve root, and foramen. Electrodiagnostic studies may be performed to establish the diagnosis, rule out peripheral neuropathy or peripheral nerve entrapment, and provide assessment as to the degree of nerve damage.
Electromyography EMG is particularly helpful in distinguishing between C8 radiculopathies and ulnar neuropathies, but can also be helpful at higher levels. Special considerations In elderly patients, MRI findings are usually present, even in asymptomatic patients. The high sensitivity of MRI may yield findings that are not of clinical significance.
In addition, patients may have multiple etiologies for their pain. Management treatment Depending on the level of pain and neurological involvement, treatments may include physical therapy cervical traction , nonsteroidal anti-inflammatory drugs NSAIDs , pain medications, oral steroids, or membrane-stabilizing medication gabapentin or pregabalin.
Epidural steroid injections may be performed for cases that do not respond to these treatments. Because most cases of cervical radiculopathy resolve over time, it is difficult to definitively determine the value of any interventions. Surgical discectomy is generally reserved for intractable pain or progressive or significant neurological dysfunction.
Complications and red flags Progressive or significant neurological deficits should lead to more aggressive treatment, including an evaluation for spine surgery. Always assess for myelopathic lesions upper motor neuron signs in the lower extremities, such as increased reflexes or spasticity. Myelopathy can occur as a result of extradural, intradural, or intramedullary processes.
In general, myelopathy is clinically divided into categories based on the presence or absence of significant trauma, presence or absence of pain, and the mode of onset slowly progressive or insidious onset vs. Other causes include extradural or intradural masses carcinomatous metastasis and trauma. Myelopathy may result from primary carcinomas, inflammatory, infectious, or vascular processes, radiation, HIV, transverse myelitis, or nutritional or neurodegenerative changes. Intradural causes include cysts or syrinx, progressive posttraumatic myelomalacic myelopathy, and benign neoplasms meningiomas, arachnoid cysts, epidermoid cysts, and nerve sheath tumors.
Clinical manifestations The clinical manifestations will depend on the level of the lesion, the rapidity of progression, and the type of insult see Table 2. History When trying to determine the etiology of myelopathy, it is important to elicit whether there is a history of spinal trauma, the onset and progression of symptoms, and if pain, weakness, numbness, incontinence, or gait disturbance are present. Physical The physical findings will depend on the location of the insult to the spinal cord.
Usually, there are upper motor neuron findings below the level of the lesion i. Depending on the lesion, there may be lower motor neuron findings at the level of the lesion i. Diagnostic testing The appropriate tests for the diagnosis of myelopathy depend on whether the patient presents with trauma or pain, and the mode of onset. CT may be more useful if trauma or bony injury is suspected.
Depending on the presentation, some of these studies may need to be done urgently or emergently. Myelopathy [online publication]. In these neurological emergencies, urgent spine surgery or another intervention radiation therapy, or intrathecal, epidural, or systemic medications is required.
Table 2. Pain and temperature preserved. Spondylosis changes are ubiquitous with age and are frequently asymptomatic. Spondylosis can affect the vertebral bodies, the intervertebral disks e. Degenerative changes can also involve the facet joints, longitudinal ligaments, or ligamentum flavum. Chronic cervical degeneration is the most common cause of progressive spinal cord and nerve root compression. Spondylitic changes can result in spinal canal, lateral recess, and foraminal stenosis. Spinal canal stenosis can result in myelopathy.
The pain may be perceived locally, or it may radiate to the occiput, shoulder, scapula, or arm. The pain can interfere with sleep. If the spinal canal or intervertebral foramen is sufficiently compromised, nerve involvement can be present see Myelopathy and Radiculopathy sections, pp.
History Symptoms are usually of insidious onset, as this is a chronic degenerative process. Acute injury, strain, or abnormal positioning may precipitate the onset or realization of symptoms. Physical On examination, cervical motion is frequently decreased. Crepitus, tenderness, spasm, or guarding may be present.
The cervical examination should include a neurological assessment of the upper extremities for neurological compromise. Gait and lower extremity reflexes should be assessed to rule out myelopathy. Differential diagnosis Adhesive capsulitis, cervical disc disease, cervical sprain and strain, myofascial pain, multiple sclerosis MS , and rheumatoid arthritis are included in the differential diagnosis.
Diagnostic testing No specific lab testing is diagnostic of cervical spondylosis. Plain radiographs are most commonly used to assess spondylosis and will show degenerative changes. CT or MRI can be used to evaluate for spinal cord compression. CT myelography is commonly used prior to surgical decompression. Somatosensory evoked potential SSEP can provide a functional evaluation of the spinal cord primarily used if myelopathy is suspected but is not useful if radiculopathy or peripheral nerve entrapment is being considered.
Modalities including electric stimulation, ultrasound, and heat frequently provide symptomatic relief and restore motion, allowing normal movement and exercise. Mechanical or manual traction is a widely used technique. The use of cervical exercises has been advocated in patients with cervical spondylosis. Isometric exercises often are beneficial to maintain strength of the neck muscles. Manual therapy e. If transcutaneous electrical nerve stimulation TENS provides relief in therapy, a home unit should be considered.
When pharmacological therapies are used, the potential risk especially of long-term use must be weighed. Topical treatments counterirritant gels and creams, lidocaine, or diclofenac patches can be helpful and are generally safest. Other medications include tramadol and, less frequently, opioid analgesics. Trigger point injections can also provide symptomatic relief. Surgical intervention is generally reserved for cases with neurological involvement. Complications Cervical myelopathy is the most serious consequence. Nerve root impingement may also occur. Because there may not be any specific radiographically detectable lesion, the specific diagnosis for the same condition can vary by practitioner.
In whiplash-associated disorders WAD , the mechanism of injury is a rapid extension of the neck followed by a rapid flexion. Anterior neck muscles such as the sternocleidomastoid can also be disrupted. The initial evaluation of these disorders involves assessment of neurological involvement or spinal instability especially in the case of whiplash or other trauma. Barring neurological involvement or spinal instability, conservative treatment can be initiated. Clinical manifestations Cervical sprain or strain and WAD present primarily with pain in the cervical region and upper back, head, and upper extremities.
If pain radiates, it is typically diffuse and not in a dermatomal distribution. A dermatomal distribution should lead to consideration of radiculopathy or other nerve entrapment. Differential diagnosis While the etiology in WAD or a strain or fall may be obvious, the exact type and location of the injury and its mechanism may not be. Commonly implicated structures are paraspinal muscles, trapezius, sternocleidomastoid muscle, scalenes muscle, spinal ligaments, facet joints, vertebrae, and intervertebral discs.
Fractures, nerve injury, or headache related pain syndromes should be included in the differential diagnosis. History In cases of strain or sprain, there is usually a history of an event that caused the symptoms. In WAD, the etiology is obvious. Patients may complain of associated headaches. Physical As with most cervical disorders, the neurological status of the extremities should be assessed to rule out other disorders.
The primary findings are generally tenderness to palpation and decreased or abnormal cervical motion due to pain or guarding. Muscle spasm may be present.
Diagnostic testing In the absence of nerve compromise or spinal instability, imaging is generally not helpful in the early stages. CT may show subtle fractures that plain X-rays can miss. MRI can evaluate the spinal cord and the intervertebral disc for herniations. Special considerations There is a great deal of controversy about and variability in reported outcomes in soft tissue cervical injuries. Mechanical or manual traction are widely used techniques.
Isometric exercises are often beneficial to maintain strength of the neck muscles. Cervical collars are generally not recommended as their use may delay recovery. Trigger point injections may be used as an adjunct as well. Complications and red flags Appropriate imaging should be performed if there is evidence of instability or progressive neurological involvement, as this may require surgical intervention.
Muscular pain not responding to conservative treatment should be further evaluated. In general, treatments that are not beneficial should be discontinued. Whiplash: pathophysiology, diagnosis, treatment, and prognosis, Muscle Nerve — Spine 20 8 Suppl : The primary muscle involved is the trapezius.
The cause of this pain can be acute an injury or strain or chronic tension, posture.
The clinical picture can overlap with cervical sprain or whiplash; however, myofascial pain is characterized by diffuse tender areas in the muscle. These tender areas will refer pain on pressure and are termed trigger points. While this clinical phenomenon has been described by many, it cannot be objectively verified by pathological, laboratory, or radiological findings. This has led to some controversy.
Fibromyalgia has a similar presentation and symptoms may overlap with those of myofascial pain. However, in fibromyalgia among other differences, the tender points are more diffuse see Chapter 6, Fibromyalgia, p. Clinical manifestations Cervical myofascial pain involves primarily the trapezius in the cervical and upper thoracic region. Pressure on trigger points will typically radiate pain in a characteristic distribution that is not dermatomal. A dermatomal distribution should lead the clinician to consider radiculopathy or other nerve entrapment. Differential diagnosis Cervical spondylosis, radiculopathy, and sprain may all present similarly.
There may be myofascial components in these disorders. The presence of trigger points indicates a myofascial component. History There may be a history of trauma, repetitive use, or overuse. Stress may precipitate and perpetuate myofascial pain. Some acute injuries may develop into myofascial pain.
Physical As with most cervical disorders, the neurological status of extremities should be assessed. There should be no neurological findings if the diagnosis is only myofascial i. The primary findings are generally tenderness to palpation, and decreased or abnormal cervical motion due to pain or guarding. Tight bands in the muscle may be palpated in addition to trigger and tender points. Diagnostic testing There are no specific radiological, pathological, or blood findings in myofascial pain. Lab tests to rule out arthritides may be indicated. With persistent cervical pain, MRI can evaluate the spinal cord and the intervertebral discs for herniations.
Management treatment Trigger point injections are commonly employed. Physical therapy of the cervical spine is usually beneficial. Stretch and spray technique with vapocoolant spray can be helpful. The use of cervical exercises has been advocated for patients with cervical spondylosis. Cervical collars are generally not recommended. Antidepressants are sometimes very helpful. If there is an abnormal sleep pattern, this should be addressed.
Complications and red flags Positive neurological findings should lead to consideration of another diagnosis. If the patient is not responding to treatment, testing should be performed to rule out other diagnoses. Essentials of Physical Medicine and Rehabilitation, 2nd ed. Philadelphia: Saunders—Elsevier, pp. Myofascial Pain and Dysfunction. Philadelphia: Williams and Wilkins, pp. The pain is not confined to the distribution of a nerve.
Headache is among the most common pain problems encountered in practice. Do you have headaches on a regular basis? What symptoms do you have during the headache? What symptoms do you have right now? How did it start gradually, suddenly, other? What were you doing or do you do that triggered the headache? Does the pain seem to spread to any other area? If so, where? If so, what? Physical The primary purpose of the physical examination is to identify causes of secondary headaches. The examination should target areas identified as abnormal during the headache history.
The general physical examination should include vital signs, funduscopic and cardiovascular assessment, and palpation of the head and face. A complete neurological examination is essential, and the findings must be documented. The examination should include mental status testing, level of consciousness, cranial nerve testing, pupillary responses, motor and strength testing, deep tendon reflexes, sensation, pathological reflexes e. Particular attention should be given to detecting problems related to the optic, oculomotor, trochlear, and abducens nerves cranial nerves II, III, IV, and VI, respectively.
Tests for Lyme disease, HIV, and infectious mononucleosis may be performed if clinically suspicious. Differential diagnosis Tension muscle spasm , cluster histamine , and migraine headaches are the usual causes of headaches not associated with structural lesions see Table 2. Headache with serious underlying causes includes brain tumor, intracranial hemorrhages, meningitis, temporal arteritis, and glaucoma.
Management treatment see Table 2. Prophylactic treatments of migraine Table 2. Aura is classic. No aura is common. Botulinum toxin has been used fully success in tension headaches. The underlying cause of secondary headaches should be addressed. Other symptoms that deserve serious attention include abnormal neurological findings, headaches worsening over days or weeks, fever, vomiting preceding the headache, and onset after age 55 see Table 2.
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Evaluation of acute headaches in adults. Weiss Walter J. Gaudino Christopher Burrei Thomas A. Riolo Thomas Pobre Compression fractures 34 Osteoporosis 36 Scoliosis 42 Thoracic radiculopathy and thoracic intervertebral disc herniations 48 Lumbar sprain, strain 50 Lumbar radiculopathy 54 Lumbar spinal stenosis 58 Cauda equina and conus medullaris syndrome 60 Lumbar spondylosis 62 Spondylolisthesis 64 Spondylolysis 68 33 34 CHAPTER 3 Spine Compression fractures General description Compression fractures are fractures of the vertebrae, most commonly due to osteoporosis, but they can also occur with trauma or tumors.
Clinical manifestations Severe pain in the area of the fracture usually the lower thoracic or upper lumbar vertebrae is the most common manifestation. The pain is usually sharp and relieved with rest. Activity often increases the pain. The pain is worse for the first 2—3 weeks after fracture, but generally remains severe until about 6—8 weeks. Pain may be due to the compression fracture itself or associated paraspinal muscle spasm. Chronic pain may develop. Although rare, compression fractures can be asymptomatic.
Differential diagnosis The differential diagnosis includes neoplasm especially if pain is worse at night , abdominal visceral disorders especially pancreatic , or abdominal aortic aneurysm. History Pain in the area of compression is the most common symptom. Compression fractures are most commonly associated with osteoporosis, although they may be secondary to trauma. Risk factors for osteoporosis and subsequent compression fracture include smoking, alcohol use, low body mass, Caucasian, sedentary lifestyle, glucocorticoid use, rheumatoid arthritis, and decreased vitamin D and calcium intake.
Patients may complain of gastrointestinal discomfort due to abdominal protuberance. Decreased lung volume may lead to shortness of breath. Increased pain with lateral rotation and bending may indicate costal iliac impingement. Bone scanning may show increased activity at the site of the fracture. Special considerations Patients with compression fractures suffer significant morbidity. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing, p.
Both procedures help to increase structural stability and reduce pain. Opioid analgesics are frequently necessary for pain relief and occasionally bed rest may be required. Orthoses may be used if tolerated for pain relief and to prevent flexion; the orthoses generally promote extension. The aim is to load the posterior elements and unload the vertebral bodies.
Prolonged use of an orthotic should be avoided as it can lead to weakened trunk muscles and decreased mobility. Spinal extension exercises should be initiated as soon as pain is manageable. Therapy may also include pectoral stretching, isometric abdominal strengthening, deep-breathing exercises, and weight-bearing exercises. Treatment should also be directed at the cause of compression fracture. Osteoporosis, if present, should be treated see Management in Osteoporosis section, p. Complications and red flags Retropulsion of fragments may lead to spinal cord injury.
Complications of vertebroplasty and kyphoplasty can also occur. Musculoskeletal Medicine. Osteoporosis Int ; 8 Suppl 4 :S7—S Osteoporosis is caused by an increase in bone resorption without an increase in bone formation, leading to decreased bone mass, disrupted trabecular connectivity, loss of architecture, and increased cortical porosity. There is a normal ratio of organic and mineral components. Clinical manifestation Osteoporosis is a silent disease—fracture is commonly the first presentation. Thin, white females with advanced age are at highest risk.
The most common sites of fractures are the vertebral spine mid-thoracic and upper lumbar , hip, and wrist in descending order. Compression fractures of the vertebra may present with acute back pain that is worse on weight bearing. Half of these fractures are subclinical and patients might not seek medical attention. History Fractures can occur with a history of minimal or no trauma, such as after an affectionate hug1 or a fall from sitting or standing position. Risk factors include white female, advanced age, low body weight, smoking, excess alcohol use, certain medications see Boxes 3.
Physical Multilevel vertebral fractures can lead to kyphosis, abdominal protrusion, and loss of height. As a consequence of kyphosis, decreased pulmonary function and changes in the abdominal cavity can lead to shortness of breath and esophagitis, respectively. Kyphosis can also lead to iliocostal friction syndrome.
An X-ray of the thoracolumbar spine may show increased lucency of vertebral bodies, loss of horizontal trabecula, increased prominence of cortical end plates and anterior wedging, or loss in both anterior and posterior height of vertebral bodies as in the case of complete compression fractures.
Philadelphia: WB Saunders, pp. Essentials of Physical Medicine and Rehabilitation. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: edition, with selected updates for Endocr Pract 9 6 — Long-term proton pump inhibitor therapy and risk of hip fracture.
JAMA 24 — Comparison DEXA scans must be done in the same laboratory when used to assess response to treatment. Treatment depends on the extent of osteoporosis see Table 3. For pharmacological treatment see Table 3. Physical therapy and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 2 — Osteoporosis prevention, diagnosis and therapy. JAMA 6 ;— JAMA 3 — A normal spine viewed from behind the patient posteroanterior [PA] view on radiograph appears straight from the neck down to the buttocks.
A scoliotic spine viewed from behind will resemble the shape of an S or C curve. To study the biomechanics behind scoliosis, visualization of the spine in the three-dimensional 3-D planes is required. To simplify the issue, one can imagine that as the spine curves to either the right or the left, the involved vertebrae must rotate to compensate for the curve to keep the body in balance. If scoliosis occurs in the thoracic spine, the thoracic vertebrae, which are attached to the thoracic ribs, will rotate and result in rib prominence on the opposite side of the curve.
If the scoliosis in the thoracic spine is very severe, it can lead to abnormal function of visceral organs within the thoracic cage, such as the heart and lungs. Clinical manifestations Most authors believe that most patients with scoliosis never present with pain. As the spine curves laterally, the affected vertebrae rotate, affecting bone, ligament, and muscle connections to the spine. Rib prominence on the opposite side of the curve as well as leg length discrepancies are commonly seen with scoliosis. Because structure and function are highly integrated, these dysfunctional areas will ultimately lead to abnormal posture and strain on muscles, leading to pain and stiffness.
Differential diagnosis The differential diagnosis in a patient with scoliosis includes tumors, embryological defects failure of segmentation of vertebrae or ribs , trauma, spinal stenosis, ankylosing spondylitis, and spondylolysis. Etiologies The etiologies of scoliosis can be divided into three major categories: idiopathic, congenital vertebral, and neuromuscular defects see Fig.
Each of these categories has many other subgroups, but idiopathic and congenital vertebral defects comprise the majority of presentations. Diagnosis is usually made based on the upright PA and lateral views on radiograph. The treatment differs based on the degree of curvature. The Cobb angle is used to measure the amount of scoliosis. The Cobb angle is determined by drawing a perpendicular line on the X-ray from the top most deviated vertebrae and the bottom most deviated vertebra see Fig.
The two perpendicular lines meet to form the Cobb angle. Treatment On the first visit, treatment is usually not initiated. Treatment options include bracing or casting. If signs of scoliosis persist, an orthotic device must be worn 23 hours a day. Fusing the vertebra is usually not an option at this stage, although some physicians will insert a supporting rod if there is rapid progression. Juvenile idiopathic scoliosis 3—10 years of age History This group of patients manifests with signs beginning after age 3 but before age Patients in this group are usually asymptomatic.
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Females make up most of these patients. Some authors believe that pain can be a symptom early on due to defects in walking habits. Unlike the infantile group, there seems to be a rapid progression of the deformity if not corrected early. Physical During the examination, the physician should assess the symmetry among different body limbs, including shoulders, leg lengths, anterior superior iliac spine, posterior superior iliac spine, ischial tuberosities, and pubic symphysis.
Skin texture and discoloration should be examined as well to rule out any neuromuscular defects. Neurological exams should be conducted to assess for any deficits. The Adams test assesses the paravertebral region of the patient. Extreme paravertebral rotation and other irritant anomalies can become apparent during examination.
Diagnosis Diagnosis should be made with radiographs of the lateral and PA views. Patients in this age group should also have radiographs of the brain to exclude other spinal pathologies. Treatment in this patient population involves bracing the individual. If the patient progresses rapidly, surgery can be considered although not done in most cases. Surgery consists of fusing the vertebra together. The onset is usually manifested by puberty but before maturity.
History Most of these individuals do not have any symptoms and their deformities are recognized by an examiner, be it a parent, a primary care physician, or a school nurse. Most of these patients have a convex curve to the right in the thoracic region. Neurological deficits should be considered, especially in left-sided convex curves.
Further imaging studies should be performed on these patients to check for intraspinal pathologies neurofibroma, astrocytoma. Physical and diagnosis The physician should conduct all of the tests used to assess juvenile idiopathic scoliosis for examination and diagnosis. Treatment Treatment for this cohort has to be based on the level of skeletal maturity and the expected progression of the curve.
Females have a much greater tendency to have curve progression than males Most patients with adolescent idiopathic scoliosis do not require treatment. The brace has to be worn for most of the day 23 hours; it may be removed for bathing only. Electrical stimulation has been used as an adjuvant. Oxford Textbook of Orthopedics and Trauma, Vol. New York: Oxford University Press, pp. Imaging in scoliosis: what, why and how? Clin Radiol — Miller NH Cause and natural history of adolescent idiopathic scoliosis.
Orthop Clin North Am — Idiopathic and congenital scoliosis. Roach JW Adolescent idiopathic scoliosis. Tunnessen, WW In Signs and Symptoms in Pediatrics, 3rd ed. Weinstein S, Buckwalter J Fundamentals of Musculoskeletal Imaging by Lynn N. Imaging Skeletal Trauma by Lee F. Rogers; O. West ISBN: Netter's correlative imaging : musculoskeletal anatomy by Michael D. Rehabilitation in Orthopedic Surgery by Andreas B. Clinical orthopaedic rehabilitation by S. Brent Brotzman; Robert C. Human anatomy : color atlas and textbook by John A. Gosling; Philip F.
Harris; John R. Humpherson; Ian Whitmore; Peter L. Neuroanatomy : an illustrated colour text by Alan R. Gray's atlas of anatomy by Richard Drake; A. Wayne Vogl; Adam W. Atlas of Human Anatomy by Frank H. Netter ISBN: ISBN: Abrahams; Jonathan D. Grant's Atlas of Anatomy by Anne M. Agur; Arthur F. Dalley ISBN: Anatomy and Physiology by Michael P. McMinn and Abrahams' clinical atlas of human anatomy by Peter H. Fehrenbach; Susan W. Herring ISBN: Human Anatomy and Physiology by Elaine N.
Marieb; Katja N. Hoehn ISBN: Orthopaedic surgeons are increasingly involved in the planning of post-surgical rehabilitation of patients as evidence mounts that the quality of postoperative rehabilitation directly correlates to the effectiveness of that surgery. With the emergence of evidence based medicine in orthopaedic surgery and its effect on healthcare reimbursement, rehabilitation plans are increasing in importance.
What's more, the need for rehabilitation increases as an aging population participates in more activities and sustains more injuries. Differential diagnosis included at the beginning of each chapter for quick and accurate diagnosis of musculoskeletal conditionsAssess a body joint's range quickly with the regional assessment boxes in every chapterFind information easily with new portrait oriented rehabilitation protocols. Seller Inventory EOD More information about this seller Contact this seller.
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