Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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25.3.3 INNOVATIONS IN PRACTICE,
3-MONOGRAPH BUNDLE
Table of Contents

SHOULDER INSTABILITY: A REVIEW OF ANATOMICAL AND BIOMECHANICAL CONSIDERATIONS, PREVALENCE, AND DIAGNOSIS AS WELL AS NONOPERATIVE AND OPERATIVE MANAGEMENT

Abstract:

CONTENT: The literature for shoulder instability is reviewed. Shoulder function is related to impairments and disabilities that occur when stability is lost. The authors formally define instability and distinguish this condition from joint laxity. The anatomy and biomechanics associated with shoulder stability and pathomechanics underlying types of instability are covered in detail. Traumatic and atraumatic etiologies are distinguished. Common classifications of shoulder instability are reviewed. A major section focuses on examination using appropriate clinical measures to distinguish normal and abnormal findings. A detailed section on rehabilitation is divided into nonoperative and operative management. Nonoperative management of shoulder instability and the implementation of an evidence-based rehabilitation program are addressed. Operative management and common surgical techniques, possible complications, postoperative precautions, and rehabilitation goals for primary types of shoulder instability are reviewed. Recommendations for safe return of postsurgical and nonsurgical patients to their prior level of function, occupation, and sport for varied types of shoulder instability are highlighted. Currently used outcome measures for shoulder instability are reviewed. CASE ANALYSES: Two case studies are presented. The first case involves the nonoperative management of a 12-year-old female swimmer who complains of gradual onset of bilateral shoulder pain with swimming. The second case involves operative management for a 21-year-old Division I hockey player who sustained an acute dislocation while playing. Both cases address evaluation, treatment and outcomes.

Keywords:​

shoulder function, rehabilitation, precautions

References:​

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ADVANCES IN ANTERIOR CRUCIATE LIGAMENT SURGERY AND REHABILITATION

Abstract:

CONTENT: The monograph provides a strong foundation of knowledge in understanding the current evidence regarding prevention, evaluation, and management of ACL injury. In the monograph, Dr Campanella provides a much needed comprehensive review of the current state of ACL prevention injury and treatment. A detailed review regarding ACL anatomy and biomechanics provides a nice introduction to understanding ACL injury. Mechanisms of injury are discussed in detail including the effect of gender on injury. The diagnosis of an ACL tear and confirming clinical tests are then reviewed. Surgical methods to restore the ACL are covered along with possible complications following repair of the ACL. A separate section on ACL injury for the pre-adolescent and adolescent age groups is included. Postsurgical protocols and factors to consider when choosing a rehabilitation approach are deliberated by the author along with specific functional therapeutic exercise recommendations. Bracing, return to sport, and outcome measures are also covered. CASE ANALYSES: Two case studies integrate the concepts covered in the monograph. The first is 35-year-old female who sustained an ACL tear of her left knee when she was tackled while playing in an all-female football league. The second case describes a 57-year-old female who suffered an ACL tear from a fall but was unable to pursue surgery until a few years later due to extenuating circumstances.

Keywords:​

prevention, evaluation, management

References:​

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PATELLOFEMORAL PAIN AND REHABILITATION

Abstract:

CONTENT: The reader is introduced to the International Classification of Functioning, Disability, and Health (ICF) for the evaluation and treatment of patellofemoral pain. This model is used by the author as the framework throughout the monograph. A review of the anatomy, biomechanics, and pathomechanics of the patellofemoral region as they relate as potential contributors to the generation of patellofemoral pain are emphasized. Factors associated with patellofemoral pain and instability with an emphasis on understanding regional interdependence and its effect on patellofemoral pain are then presented. The Physical Stress Theory is described. Patellar alignment and tracking and the impact of patellofemoral joint reaction force on pain are reviewed. A major section of the monograph covers patient management and outlines the evaluation scheme for classifying patellofemoral pain. Several functional demonstration tests for the lower extremity are reviewed along with common tests and measures that assist in identifying pain generators in the patellofemoral region. Common imaging techniques and a brief section on surgical interventions are covered as well. Physical therapy treatments are discussed including taping, mobilization, and orthotics, along with specific functional therapeutic exercises recommendations. CASE ANALYSES: Two case studies address patellofemoral pain. The first case describes a 17-year-old male with anterior knee pain. The second case describes a 32-year-old female with bilateral anterior knee pain who reports pain over the last two years. Both cases are presented in detail from evaluation to treatment and then to outcomes.

Keywords:​

instability, joint reaction force, evaluation scheme

References:​

Click here.

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