Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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25.3.6 INNOVATIONS IN PRACTICE,
6-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:​

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EVALUATION AND TREATMENT OF THE PATIENT WITH LOW BONE MASS AND OSTEOPOROSIS

Abstract:

CONTENT: How to effectively manage patients with osteoporosis is the primary focus of this monograph. The inclusion of various tools in terms of functional measures, online resources, and informative tables makes this a complete and informative read. The monograph first presents an overview of osteoporosis by providing a formal definition and delineating osteoporosis from osteopenia. Detection methods such as DXA scan, bone mineral density testing, and plain film radiography are then reviewed. Coverage of epidemiology of osteoporosis aids the reader in gaining perspective on the prevalence and incidence of osteoporosis and its impact on the health care system. The next section covers risk factors for osteoporosis and fractures risk with an accompanying discussion of the FRAX World Health Organization Fracture Risk Assessment Tool. Bone physiology is reviewed in detail. Subtopics include bone changes with aging, exercise effects, the role of calcium and vitamin D, and commonly used pharmacologic agents. Two well-written sections on examination and evaluation will guide the reader through these procedures by highlighting history and specific evaluation tools that can be used. Physical therapy interventions cover the role of weight bearing and strength training, safe postures, individualized exercise programming, balance exercise, and fall prevention home safety. CASE ANALYSES: Two cases are organized and detailed from the beginning evaluation to formulation of a treatment plan. The first case describes a 55-year-old Caucasian woman who was self-referred to physical therapy with primary postmenopausal osteoporosis. The second case describes a 90-year-old woman, referred to physical therapy two weeks after falling and suffering a contusion and experiencing an exacerbation of osteoarthritis.

Keywords:​

osteopenia, epidemiology, Fracture Risk Assessment Tool

References:​

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ORTHOPAEDIC MANAGEMENT OF THE PATIENT WITH OBESITY

Abstract:

This monograph will address the current evidence, practical considerations, and future directions of innovative approaches for telehealth and virtual reality applications in musculoskeletal practice in physical therapy. The overall purpose of this monograph is to inform musculoskeletal physical therapy practitioners on advances in telehealth and virtual reality innovations that may enhance clinical practice in the digital age. Three cases are presented at the end of this monograph. The first case describes a 65-year-old man who has undergone a knee arthroplasty and desires to travel during his rehabilitation. Specific telehealth practice needs and considerations for this patient are highlighted. The second case involves a 10-year-old female from Mexico previously diagnosed as having infant cerebral paralysis spastic dystrophy. A telehealth consultation visit with a physical therapist pediatric certified specialist from the United States is described. The third case is a 25-year-old woman with status post left grade 2 talofibular ankle sprain who desires to add the Wii Fit and Kinect gaming systems to her plan of care.

Keywords:​

body mass index, gait, kinematics

References:​

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MUSCULOSKELETAL ULTRASOUND: ITS USE IN EVALUATION AND TREATMENT

Abstract:

CONTENT: The unique role of musculoskeletal ultrasound in assessment and rehabilitation programs is the sole topic of this monograph. This information will prepare clinicians in understanding the role this technology plays in patient care. The basics underlying ultrasound as it pertains to physics and image optimization are thoroughly reviewed. Basic scanning and normal regional sonographic anatomy are covered. Clinical indications for musculoskeletal and therapeutic ultrasound interventions in orthopaedic physical therapy, including exercise and biofeedback, are discussed. Ultrasound appearances of common pathologies present in each major anatomical region are highlighted. A succinct review of the use of ultrasound-guided interventions during various procedures such as cortisone injection, platelet rich plasma, prolotherapy, and dry needling is also presented. CASE ANALYSES: Two case studies apply the use of musculoskeletal ultrasound in physical therapy care. The first case involves a 22-year-old paraplegic skier complaining of right shoulder pain, weakness, and limited active range of motion after suffering a fall while skiing. The second case describes a 25-year-old Olympic modern pentathlon athlete with a past diagnosis of a spondylolytic spondylolisthesis and previous abdominal surgeries who has ongoing low back pelvic pain.

Keywords:​

assessment, rehabilitation, image optimization

References:​

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Innovations in Practice, 6 Monographs

This unique 6-monograph series contains updated and timely topics on areas of practice influenced by changes in health care and new technologies.

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