CH01 Sample

Normal Values
and Assessments
ASIA Classification of Spinal Cord Injury
The American Spinal Injury Association (ASIA) has developed a spinal
injury classification system based on specific motor and sensory
assessments as depicted in the figure on page 2.
Motor function is determined by manual muscle testing of 10 key
muscles. Results of manual muscle tests are expressed numerically.
Dermatomal sensation assessment for pinprick and light touch is
performed and scored numerically.
The ASIA Impairment Scale, using letters A to E, represents the
overall classification of the spinal injury.
1
1
c h A p T E r
53415_CH01_FINAL.indd 1 4/23/12 12:28:49 PM
ASIA Standard Neurological Classification of Spinal Cord Injury Chart
Jones and Bartlett Publishers
Elizabeth Morales Illustration Services
Figure 38115_CH01_0101.eps Date 05-31-06
C2
C3
C4
C2
C3
C4
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
C5
C6 C6
C7 C7
C8 C8
C6 C6
C5
T2 T2
T1 T1
L1
L2 L2
L3
L4
L5 L5
L4
L3
L1
S1 S1
S1
S3
S2
L5 L5
S1 S1
S2
L2 L2
L3 L3
S3
S4-5
L4
C2
R L
C3
C4
C5
C6
C7
C8
T1
Elbow flexors
Wrist extensors
Elbow extensors
Finger flexors (distal phalanx of middle finger)
Finger abductors (little finger)
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L5
S1
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe extensors
Ankle plantar flexors
Voluntary anal contraction (Yes/No)
(Maximum 50 50 100)
The most
caudal segment
with normal
function
S2
S3
S4-5
+ =
=
Totals Motor score
STANDARD NEUROLOGICAL CLASSIFICATION OF
SPINAL CORD INJURY
NEUROLOGICAL
LEVEL
Complete or
incomplete?
ZONE OF PARTIAL
PRESERVATION
ASIA IMPAIRMENT
SCALE
Sensory
Motor
Light touch score
Pin prick score (Max 112)
(Max 112)
Any anal sensation (Yes/No)
C2
R L
C3
C4
C5
C6
C7
C8
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L5
S1
(Maximum 56 56 56 56)
Incomplete = Any sensory or
motor function in S4-S5 Caudal extent of partially
innervated segments
S2
S3
S4-5
+
Totals
=
+
0 = total paralysis
1 = palpable or visible contraction
2 = active movement,
gravity eliminated
against gravity
against some resistance
against full resistance
NT = not testable
LIGHT
TOUCH
R L
PIN
PRICK
R L
Sensory
Motor
R L
0 = absent
1 = impaired
2 = normal
NT = not testable
MOTOR
Key muscles
SENSORY
Key sensory points
= Key
sensory
point
Palm
Palm
Dorsum
Dorsum
Figure 1.1 Standard Neurological Classification of Spinal Cord Injury
Source: Reproduced with permission of the American Spinal Injury Association
(2005). This form may be copied freely but should not be altered without permis-
sion from the American Spinal Injury Association.
2 Chapter 1 Normal Values and Assessments
53415_CH01_FINAL.indd 2 4/23/12 12:28:50 PM
C2
C3
C4
C2
C3
C4
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
C5
C6 C6
C7 C7
C8 C8
C6 C6
C5
T2 T2
T1 T1
L1
L2 L2
L3
L4
L5 L5
L4
L3
L1
S1 S1
S1
S3
S2
L5 L5
S1 S1
S2
L2 L2
L3 L3
S3
S4-5
L4
C2
R L
C3
C4
C5
C6
C7
C8
T1
Elbow flexors
Wrist extensors
Elbow extensors
Finger flexors (distal phalanx of middle finger)
Finger abductors (little finger)
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L5
S1
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe extensors
Ankle plantar flexors
Voluntary anal contraction (Yes/No)
(Maximum 50 50 100)
The most
caudal segment
with normal
function
S2
S3
S4-5
+ =
=
Totals Motor score
STANDARD NEUROLOGICAL CLASSIFICATION OF
SPINAL CORD INJURY
NEUROLOGICAL
LEVEL
Complete or
incomplete?
ZONE OF PARTIAL
PRESERVATION
ASIA IMPAIRMENT
SCALE
Sensory
Motor
Light touch score
Pin prick score (Max 112)
(Max 112)
Any anal sensation (Yes/No)
C2
R L
C3
C4
C5
C6
C7
C8
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L5
S1
(Maximum 56 56 56 56)
Incomplete = Any sensory or
motor function in S4-S5 Caudal extent of partially
innervated segments
S2
S3
S4-5
+
Totals
=
+
0 = total paralysis
1 = palpable or visible contraction
gravity eliminated
against gravity
against some resistance
against full resistance
NT = not testable
LIGHT
TOUCH
R L
PIN
PRICK
R L
Sensory
Motor
R L
0 = absent
1 = impaired
2 = normal
NT = not testable
MOTOR
Key muscles
SENSORY
Key sensory points
= Key
sensory
point
Palm
Palm
Dorsum
Dorsum
Figure 1.1 continued
ASIA Classification of Spinal Cord Injury 3
53415_CH01_FINAL.indd 3 4/23/12 12:28:50 PM
A = Complete: No motor or sensory function is preserved in the
sacral segments S4S5.
B = Incomplete: Sensory but not motor function is preserved
below the neurological level and includes the sacral
segments S4S5.
C = Incomplete: Motor function is preserved below the
neurological level, and more than half of key muscles below
the neurological level have a muscle grade less than 3.
D = Incomplete: Motor function is preserved below the
neurological level, and at least half of key muscles below the
neurological level have a muscle grade of 3 or more.
E = Normal: Motor and sensory function are normal.
Clinical Syndromes
Central Cord
Brown-Squard
Anterior Cord
Conus Medullaris
cauda Equina
Figure 1.2 ASIA Impairment Scale
(2005).
53415_CH01_FINAL.indd 4 4/23/12 12:28:50 PM
c
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.
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5
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1

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h
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3

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m
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:

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1
7

m
m
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:

1
2
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m
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(
H
C
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)
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n
f
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t
s
:

3
0
6
0
%

C
h
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l
d
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n
:

3
0
4
9
%

M
e
n
:

3
7
4
9
%

W
o
m
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n
:

3
6
4
6
%
H
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2
5
%
.
Table 1.1 BloodComplete Blood Count (CBC) 5
53415_CH01_FINAL.indd 5 4/23/12 12:28:50 PM
H
e
m
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(
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)
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s
:

1
7
1
9

g
/
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c
h
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d
r
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n
:

1
4
1
7

g
/
d
L

M
e
n
:

1
3
1
8

g
/
d
L

W
o
m
e
n
:

1
2
1
6

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/
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3

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n
f
a
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t
s
:

2
0
0
,
0
0
0
4
7
5
,
0
0
0

c
h
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d
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n
:

1
5
0
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0
0
0
4
0
0
,
0
0
0
A
d
u
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t
s
:

1
5
0
,
0
0
0
4
0
0
,
0
0
0
P
l
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s

p
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2
1
,
0
0
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0
,
0
0
0

c
e
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l
s
/
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3
.
E
x
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2
0
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0
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0

c
e
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l
s
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m
m
3
.

W
h
i
t
e

B
l
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d

C
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l
l
s

(
W
B
C
s
)
U
n
i
t
s
:

c
e
l
l
s
/
m
m
3

c
h
i
l
d
r
e
n
:

4
,
5
0
0
1
4
,
5
0
0
A
d
u
l
t
s
:

4
,
5
0
0
1
1
,
0
0
0

W
h
i
t
e

b
l
o
o
d

c
e
l
l
s

p
l
a
y

a

c
r
u
c
i
a
l

r
o
l
e

i
n

t
h
e

b
o
d
y
s

i
m
m
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e

r
e
a
c
t
i
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n
.
E
x
e
r
c
i
s
e

m
a
y

n
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t

b
e

p
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r
m
i
t
t
e
d

a
t

v
a
l
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e
s

o
f

5
,
0
0
0

c
e
l
l
s
/
m
m
3
.
T
a
b
l
e

1
.
1

B
l
o
o
d
C
o
m
p
l
e
t
e

B
l
o
o
d

C
o
u
n
t

(
C
B
C
)
,

c
o
n
t
i
n
u
e
d
N
o
t
e
:

N
o
r
m
a
l

v
a
l
u
e
s

m
a
y

v
a
r
y

f
r
o
m

o
n
e

l
a
b
o
r
a
t
o
r
y

t
o

a
n
o
t
h
e
r
.

T
h
e

v
a
l
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e
s

p
r
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s
e
n
t
e
d

i
n

t
h
e
s
e

c
h
a
r
t
s

s
h
o
u
l
d

n
o
t

b
e

c
o
n
s
i
d
e
r
e
d

a
b
s
o
l
u
t
e
.
A
s
s
e
s
s
m
e
n
t

C
o
m
p
o
n
e
n
t
V
a
l
u
e
s
D
e
s
c
r
i
p
t
i
o
n
/
I
m
p
l
i
c
a
t
i
o
n
s
/
r
e
d

F
l
a
g

V
a
l
u
e
s
53415_CH01_FINAL.indd 6 4/23/12 12:28:50 PM
D
i
f
f
e
r
e
n
t
i
a
l

W
B
C

C
o
u
n
t
N
e
u
t
r
o
p
h
i
l
s
:
1
,
8
0
0
7
,
0
0
0

c
e
l
l
s
/
m
m
3
L
y
m
p
h
o
c
y
t
e
s
:
1
,
5
0
0
4
,
0
0
0

c
e
l
l
s
/
m
m
3
M
o
n
o
c
y
t
e
s
:
0
8
0
0

c
e
l
l
s
/
m
m
3
E
o
s
i
n
o
p
h
i
l
s
:
0
4
5
0

c
e
l
l
s
/
m
m
3
B
a
s
o
p
h
i
l
s
:
0
2
0
0

c
e
l
l
s
/
m
m
3
T
h
e

v
a
r
i
o
u
s

w
h
i
t
e

b
l
o
o
d

c
e
l
l
s

p
l
a
y

d
i
f
f
e
r
e
n
t

r
o
l
e
s

i
n

t
h
e

i
m
m
u
n
e

p
r
o
c
e
s
s
.

T
h
e
y

e
x
i
s
t

i
n

s
t
e
r
e
o
t
y
p
i
c
a
l

p
r
o
p
o
r
t
i
o
n
s
.

Table 1.1 BloodComplete Blood Count (CBC) 7
53415_CH01_FINAL.indd 7 4/23/12 12:28:50 PM
T
a
b
l
e

1
.
2

B
l
o
o
d
E
l
e
c
t
r
o
l
y
t
e
s
N
o
t
e
:

N
o
r
m
a
l

v
a
l
u
e
s

m
a
y

v
a
r
y

f
r
o
m

o
n
e

l
a
b
o
r
a
t
o
r
y

t
o

a
n
o
t
h
e
r
.

T
h
e

v
a
l
u
e
s

p
r
e
s
e
n
t
e
d

i
n

t
h
e
s
e

c
h
a
r
t
s

s
h
o
u
l
d

n
o
t

b
e

c
o
n
s
i
d
e
r
e
d

a
b
s
o
l
u
t
e
.
A
s
s
e
s
s
m
e
n
t

C
o
m
p
o
n
e
n
t
V
a
l
u
e
s
D
e
s
c
r
i
p
t
i
o
n
/
I
m
p
l
i
c
a
t
i
o
n
s
/
r
e
d

F
l
a
g

V
a
l
u
e
s
P
o
t
a
s
s
i
u
m
c
h
i
l
d
r
e
n
:

3
.
5
5
.
5

m
E
q
/
L
A
d
u
l
t
s
:

3
.
5
5
.
3

m
E
q
/
L

h
y
p
o
k
a
l
e
m
i
a
:

d
i
z
z
i
n
e
s
s
,

m
u
s
c
l
e

w
e
a
k
n
e
s
s
,

f
a
t
i
g
u
e
,

l
e
g

c
r
a
m
p
s
h
y
p
e
r
k
a
l
e
m
i
a
:

m
u
s
c
l
e

w
e
a
k
n
e
s
s
,

f
l
a
c
c
i
d

p
a
r
a
l
y
s
i
s
,

p
a
r
e
s
t
h
e
s
i
a
s
S
o
d
i
u
m
1
3
5
1
4
5

m
E
q
/
L
h
y
p
o
n
a
t
r
e
m
i
a
:

m
u
s
c
l
e

t
w
i
t
c
h
i
n
g
,

w
e
a
k
n
e
s
s
h
y
p
e
r
n
a
t
r
e
m
i
a
:

f
e
v
e
r
,

c
o
n
v
u
l
s
i
o
n
s
C
h
l
o
r
i
d
e
c
h
i
l
d
r
e
n
:

9
8
1
0
5

m
E
q
/
L
A
d
u
l
t
s
:

9
5
1
0
5

m
E
q
/
L

C
h
l
o
r
i
d
e

s
h
i
f
t
s

a
r
e

m
o
s
t

o
f
t
e
n

a
s
s
o
c
i
a
t
e
d

w
i
t
h

s
h
i
f
t
s

i
n

s
o
d
i
u
m
.
C
a
l
c
i
u
m
c
h
i
l
d
r
e
n
:

9
1
1
.
5

m
g
/
d
L
A
d
u
l
t
s
:

9
1
1

m
g
/
d
L

h
y
p
o
c
a
l
c
e
m
i
a
:

p
a
r
e
s
t
h
e
s
i
a
s
,

m
u
s
c
l
e

s
p
a
s
m
s
h
y
p
e
r
c
a
l
c
e
m
i
a
:

l
e
t
h
a
r
g
y
,

m
u
s
c
l
e

w
e
a
k
n
e
s
s
,

f
l
a
c
c
i
d
i
t
y
,

b
o
n
e

p
a
i
n
M
a
g
n
e
s
i
u
m
c
h
i
l
d
r
e
n
:

1
.
6
2
.
6

m
E
q
/
L
A
d
u
l
t
s
:

1
.
5
2
.
5

m
E
q
/
L

h
y
p
o
m
a
g
n
e
s
e
m
i
a
:

m
u
s
c
l
e

c
r
a
m
p
i
n
g
,

t
e
t
a
n
y
,

c
o
n
f
u
s
i
o
n
h
y
p
e
r
m
a
g
n
e
s
e
m
i
a
:

d
e
c
r
e
a
s
e
d

r
e
f
l
e
x
e
s
,

m
u
s
c
l
e

w
e
a
k
n
e
s
s
,

l
e
t
h
a
r
g
y
53415_CH01_FINAL.indd 8 4/23/12 12:28:50 PM
T
a
b
l
e

1
.
3

B
l
o
o
d
P
r
o
t
h
r
o
m
b
i
n

T
i
m
e
N
o
t
e
:

N
o
r
m
a
l

v
a
l
u
e
s

m
a
y

v
a
r
y

f
r
o
m

o
n
e

l
a
b
o
r
a
t
o
r
y

t
o

a
n
o
t
h
e
r
.

T
h
e

v
a
l
u
e
s

p
r
e
s
e
n
t
e
d

i
n

t
h
e
s
e

c
h
a
r
t
s

s
h
o
u
l
d

n
o
t

b
e

c
o
n
s
i
d
e
r
e
d

a
b
s
o
l
u
t
e
.
A
s
s
e
s
s
m
e
n
t

C
o
m
p
o
n
e
n
t
V
a
l
u
e
s
D
e
s
c
r
i
p
t
i
o
n
/
I
m
p
l
i
c
a
t
i
o
n
s
/
r
e
d

F
l
a
g

V
a
l
u
e
s
P
r
o
t
h
r
o
m
b
i
n

T
i
m
e

(
P
T
)
1
2
1
5

s
e
c
T
h
i
s

a
s
s
e
s
s
m
e
n
t

m
e
a
s
u
r
e
s

t
h
e

c
l
o
t
t
i
n
g

a
b
i
l
i
t
y

o
f

b
l
o
o
d
.
P
a
r
t
i
a
l

P
r
o
t
h
r
o
m
b
i
n

T
i
m
e

(
P
T
T
)
3
0
4
0

s
e
c
M
e
a
s
u
r
e
s

o
f

1
.
5

t
o

2
.
5

t
i
m
e
s

t
h
e

r
e
f
e
r
e
n
c
e

r
a
n
g
e

a
r
e

c
o
n
s
i
d
e
r
e
d

t
h
e
r
a
p
e
u
t
i
c
.
P
h
y
s
i
c
a
l

t
h
e
r
a
p
y

m
a
y

b
e

c
o
n
t
r
a
i
n
d
i
c
a
t
e
d

a
t

v
a
l
u
e
s

o
f

2
.
5

t
i
m
e
s

t
h
e

r
e
f
e
r
e
n
c
e

r
a
n
g
e

i
n

i
n
d
i
v
i
d
u
a
l
s

n
o
t

t
a
k
i
n
g

a
n
t
i
c
o
a
g
u
l
a
n
t
s

a
n
d

v
a
l
u
e
s

o
f

2
.
5
3
.
0

t
i
m
e
s

t
h
e

r
e
f
e
r
e
n
c
e

r
a
n
g
e

f
o
r

t
h
o
s
e

t
a
k
i
n
g

a
n
t
i
c
o
a
g
u
l
a
n
t

m
e
d
i
c
a
t
i
o
n
s
.
Table 1.3 BloodProthrombin Time 9
53415_CH01_FINAL.indd 9 4/23/12 12:28:50 PM
C2
C3
C4
C2
C3
C4
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
C5
C6
C6
C7 C7
C8
C8
C6
C6
C5
T2 T2
T1 T1
L1
L2 L2
L3
L4
L5 L5
L4
L3
L1
S1 S1
S1
S3
S2
L5 L5
S1 S1
S2
L2 L2
L3 L3
S3
S4-5
L4
SENSORY
Key sensory points
= Key
sensory
point
Palm
Palm
Dorsum
Dorsum
Figure 1.3 Key Sensory Points
(2005).
53415_CH01_FINAL.indd 10 4/23/12 12:28:51 PM
Range of MotionLower Extremity Percentages
In some instances, it may be preferable to report measured range of
motion as a percentage of normal values. This may be especially true
when setting or interpreting long- and short-term goals and for report-
ing to third-party payers or nonphysical therapy personnel. The chart
on page 16 provides percentage approximations in 5% intervals. An
approximate percentage can be determined by choosing the number
from the chart that is closest to the measured joint range (e.g., 95 of
knee flexion represents an approximate 30% deficit).
Table 1.4 Range of MotionLower Extremity and Spine
Note: Values are according to the American Academy of Orthopedic Surgeons.
Joint Hip
Range of Motion
(in degrees)
Hip Flexion
Extension
Adduction
Abduction
Lateral rotation
Medial rotation
0120
030
030
045
045
045
Knee Flexion 0150
Ankle Dorsiflexion
Plantar flexion
Inversion
Eversion
020
050
035
015
Cervical Flexion
Extension
Rotation
Lateral flexion
045
045
060
045
Thoracolumbar Flexion
Extension
Rotation
Lateral flexion
080
025
035
045
range of MotionLower Extremity percentages 11
53415_CH01_FINAL.indd 11 4/23/12 12:28:51 PM
T
a
b
l
e

1
.
5

R
a
n
g
e

o
f

M
o
t
i
o
n
L
o
w
e
r

E
x
t
r
e
m
i
t
y

P
e
r
c
e
n
t
a
g
e
s
%

o
f

N
o
r
m
a
l
1
0
0
9
5
9
0
8
5
8
0
7
5
7
0
6
5
6
0
5
5
5
0
4
5
4
0
3
5
3
0
2
5
2
0
1
5
1
0
5
%

o
f

D
e
f
i
c
i
t
0
5
1
0
1
5
2
0
2
5
3
0
3
5
4
0
4
5
5
0
5
5
6
0
6
5
7
0
7
5
8
0
8
5
9
0
9
5
H
i
p

f
l
e
x
.
1
2
0
1
1
4
1
0
8
1
0
2
9
6
9
0
8
4
7
8
7
2
6
6
6
0
5
4
4
8
4
2
3
6
3
0
2
4
1
8
1
2
6

A
b
d
.
4
5
3
2
4
1
3
8
3
6
3
4
3
2
2
9
2
7
2
5
2
3
2
0
1
8
1
6
1
4
1
1
9
7
5
2

A
d
d
.
3
0
2
9
2
7
2
6
2
4
2
3
2
1
2
0
1
8
1
7
1
5
1
4
1
2
1
1
9
8
6
5
3
2

E
x
t
.

r
o
t
.
4
5
4
2
4
1
3
8
3
6
3
4
3
2
2
9
2
7
2
5
2
3
2
0
1
8
1
6
1
4
1
1
9
7
5
2

I
n
t
.

r
o
t
.
4
5
4
2
4
1
3
8
3
6
3
4
3
2
2
9
2
7
2
5
2
3
2
0
1
8
1
6
1
4
1
1
9
7
5
2

E
x
t
.
3
0
2
9
2
7
2
6
2
4
2
3
2
1
2
0
1
8
1
7
1
5
1
4
1
2
1
1
9
8
6
5
3
2
K
n
e
e

f
l
e
x
.
1
5
0
1
4
3
1
3
5
1
2
8
1
2
0
1
1
3
1
0
5
9
8
9
0
8
3
7
5
6
8
6
0
5
3
4
5
3
8
3
0
2
3
1
5
8
A
n
k
l
e

d
o
r
s
i
.
2
0
1
9
1
8
1
7
1
6
1
5
1
4
1
3
1
2
1
1
1
0
9
8
7
6
5
4
3
2
1

P
l
a
n
t
a
r
5
0
4
8
4
5
4
3
4
0
3
8
3
5
3
3
3
0
2
8
2
5
2
3
2
0
1
8
1
5
1
3
1
0
8
5
3

I
n
v
e
r
s
.
3
5
3
3
3
2
3
0
2
8
2
6
2
5
2
3
2
1
1
9
1
8
1
6
1
4
1
2
1
1
9
7
5
4
2

E
v
e
r
s
.
1
5
1
4
1
4
1
3
1
2
1
1
1
1
1
0
9
8
8
7
6
5
5
4
3
2
2
1
53415_CH01_FINAL.indd 12 4/23/12 12:28:51 PM
Table 1.6 Range of MotionUpper Extremity
Note: Values are according to the American Academy of Orthopedic Surgeons.
Joint Motion
Range of Motion
(in degrees)
Shoulder Flexion
Extension
Abduction
Lateral rotation
Medial rotation
0180
060
0180
090
070
Elbow Complex Flexion
Pronation
Supination
0150
080
080
Wrist Flexion
Extension
Radial deviation
Ulnar deviation
080
070
020
030
Thumb CMC flexion
CMC extension
CMC abduction
MCP flexion
IP flexion
015
020
070
050
080
2nd through
5th digits
MCP flexion
MCP hyperextension
MCP abduction
PIP flexion
DIp flexion
DIp hyperextension
090
045
045
0100
090
010
cMc=carpometacarpal; DIp=interphalangeal distal; Ip=interphalangeal;
MCP=metacarpophalangeal; PIP=posterior interphalangeal.
Table 1.6 range of MotionUpper Extremity 13
53415_CH01_FINAL.indd 13 4/23/12 12:28:51 PM
T
a
b
l
e

1
.
7

R
a
n
g
e

o
f

M
o
t
i
o
n
U
p
p
e
r

E
x
t
r
e
m
i
t
y

P
e
r
c
e
n
t
a
g
e
s

(
S
e
e

r
a
t
i
o
n
a
l
e

a
n
d

u
s
e

i
n
s
t
r
u
c
t
i
o
n
s

o
n

p
a
g
e

1
5
.
)
%

o
f

N
o
r
m
a
l
1
0
0
9
5
9
0
8
5
8
0
7
5
7
0
6
5
6
0
5
5
5
0
4
5
4
0
3
5
3
0
2
5
2
0
1
5
1
0
5
%

o
f

D
e
f
i
c
i
t
0
5
1
0
1
5
2
0
2
5
3
0
3
5
4
0
4
5
5
0
5
5
6
0
6
5
7
0
7
5
8
0
8
5
9
0
9
5
S
h
o
u
l
d
e
r

a
b
d
.
1
8
0
1
7
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1
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I
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W
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2
53415_CH01_FINAL.indd 14 4/23/12 12:28:51 PM
T
h
u
m
b

C
M
C

f
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.
1
5
1
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1
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C
M
C

e
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2
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1

C
M
C

a
b
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2
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4

M
C
P

f
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I
P

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D
i
g
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s

2
-
5

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P

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9
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5
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M
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h
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4
5
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M
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P

a
b
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P
I
P

f
l
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x
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1
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9
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5
8
0
7
5
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6
5
6
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5
5
5
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4
5
4
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5
1
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D
I
P

f
l
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x
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9
0
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D
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h
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p
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x
t
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1
1
Table 1.7 range of MotionUpper Extremity percentages 15
53415_CH01_FINAL.indd 15 4/23/12 12:28:52 PM
Table 1.8 Manual Muscle TestingHip and Knee
Joint Motion Muscle(s)
Gravity+
Fair
Gravity
Poor
Hip Flexion Iliopsoas
Rectus femoris
Pectineus
Tensor fas. latae
Sartorius
Sitting Side lying
Extension Gluteus maximus
Hamstrings
Prone
Prone
Side lying
Abduction Gluteus medius
Gluteus minimus
Side lying Supine
Adduction Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Pectineus
Side lying Supine
Lateral rot. Piriformis
Gemellus sup./inf.
Obturator ext./int.
Quadratus fem.
Gluteus maximus
Sitting Supine
Medial rot. Gluteus minimus
Gluteus medius
Tensor fas. lat.
Sitting Supine
Knee Extension Quadriceps Sitting Side lying
Flexion Hamstrings
Gastrocnemius
Prone Side lying
53415_CH01_FINAL.indd 16 4/23/12 12:28:52 PM
T
a
b
l
e

1
.
9

M
a
n
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a
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(
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a
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Table 1.9 Manual Muscle TestingAnkle 17
53415_CH01_FINAL.indd 17 4/23/12 12:28:52 PM
Table 1.10 Manual Muscle TestingShoulder
Joint Motion Muscle(s)
Gravity+
Fair
Gravity
Poor
Shoulder Abduction Deltoid
Supraspinatus
Sitting Supine
Extension Deltoid
Latissimus dorsi
Teres major
Prone Side lying
Flexion Deltoid
Coracobrachialis
Pectoralis major
Sitting Side lying
horizon.
abd.
Deltoid
Teres minor
Infraspinatus
Prone Sitting
horizon.
add.
Deltoid
Pectoralis major
Supine Sitting
Lateral
rot.
Teres minor
Infraspinatus
Deltoid
Prone Prone
(with
elbow ext.)
Medial
rot.
Deltoid
Latissimus dorsi
Teres major
Pectoralis major
Subscapularis
Prone Prone
(with
elbow ext.)
53415_CH01_FINAL.indd 18 4/23/12 12:28:52 PM
T
a
b
l
e

1
.
1
1

M
a
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r
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Table 1.11 Manual Muscle TestingElbow and Wrist 19
53415_CH01_FINAL.indd 19 4/23/12 12:28:52 PM
T
a
b
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e

1
.
1
2

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o
r

l
o
n
g

h
e
a
d

o
f

b
i
c
e
p
s
S
u
p
r
a
s
p
i
n
a
t
u
s

t
e
n
d
o
n

i
m
p
i
n
g
e
m
e
n
t
S
u
b
a
c
r
o
m
i
a
l

i
m
p
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n
g
e
m
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n
t
S
u
p
e
r
i
o
r

l
a
b
r
a
l

t
e
a
r
B
i
c
e
p
s

t
e
n
d
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n

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n
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t
a
b
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r

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d
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B
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t
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n
d
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b
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T
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F
l
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t
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E
l
b
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T
e
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M
i
l
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t
T
i
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l
s

S
i
g
n

a
t

e
l
b
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a
t
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e
p
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C
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b
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y
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M
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p
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v
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t

53415_CH01_FINAL.indd 20 4/23/12 12:28:52 PM
c
o
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t
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W
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H
a
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B
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l
-
L
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r

T
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t
C
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p
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l

S
h
a
k
e

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t
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k
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T
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t

F
r
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m
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a
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y
n
d
r
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m
e

Table 1.12 Special Tests Listing 21
53415_CH01_FINAL.indd 21 4/23/12 12:28:52 PM
H
i
p
9
0
9
0

S
t
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D
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T
a
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1
.
1
2

S
p
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l

T
e
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L
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c
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m
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t
53415_CH01_FINAL.indd 22 4/23/12 12:28:52 PM
c
o
n
t
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s
K
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D
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p
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D
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T
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r
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(
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o
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p
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p
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M
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P
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r
y

A
n
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B
u
e
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T
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t
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l
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i
n
e
G
u
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r

T
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t
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o
m
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S
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g
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g
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r

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t
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a
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T
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T
h
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m
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H
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a
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h
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d
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l
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m
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h
r
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A
c
h
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t
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d
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n

r
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a

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f
r
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A
c
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t
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A
c
h
i
l
l
e
s

t
e
n
d
o
n

r
u
p
t
u
r
e

Table 1.12 Special Tests Listing 23
53415_CH01_FINAL.indd 23 4/23/12 12:28:52 PM
C
r
a
n
i
o
v
e
r
t
e
b
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B
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r
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T
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S
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V
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C
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M
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r
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t
B
r
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p
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T
h
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c

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N
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r
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i
r
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p
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r
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a
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o
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t
53415_CH01_FINAL.indd 24 4/23/12 12:28:52 PM
c
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a
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1
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3

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u
l
d
e
r

a
g
a
i
n
s
t

g
r
a
v
i
t
y
.

I
n
s
t
r
u
c
t

p
a
t
i
e
n
t

t
o

s
l
o
w
l
y

l
o
w
e
r

a
r
m

t
o

s
i
d
e
.
T
h
e

p
a
t
i
e
n
t

w
i
l
l

n
o
t

b
e

a
b
l
e

t
o

l
o
w
e
r

a
r
m

s
m
o
o
t
h
l
y

a
n
d

s
l
o
w
l
y
;

t
h
e

a
r
m

w
i
l
l

d
r
o
p
.

H
a
w
k
i
n
s
-
K
e
n
n
e
d
y

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

i
m
p
i
n
g
e
m
e
n
t

s
y
n
d
r
o
m
e

i
n
v
o
l
v
i
n
g

t
h
e

s
u
p
r
a
s
p
i
n
a
t
u
s
.
F
l
e
x

t
h
e

s
h
o
u
l
d
e
r

a
n
d

e
l
b
o
w

t
o

9
0

t
h
e
n

i
n
t
e
r
n
a
l
l
y

r
o
t
a
t
e

t
h
e

s
h
o
u
l
d
e
r
.
T
h
e

p
a
t
i
e
n
t

w
i
l
l

c
o
m
p
l
a
i
n

o
f

p
a
i
n
.

I
m
p
i
n
g
e
m
e
n
t

S
i
g
n
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

i
m
p
i
n
g
e
m
e
n
t

o
f

t
h
e

s
u
p
r
a
s
p
i
n
a
t
u
s

a
n
d
/
o
r

l
o
n
g

h
e
a
d

o
f

t
h
e

b
i
c
e
p
s
.
W
h
e
n

s
i
t
t
i
n
g
,

p
a
s
s
i
v
e
l
y

h
o
r
i
z
o
n
t
a
l
l
y

a
d
d
u
c
t

t
h
e

s
h
o
u
l
d
e
r

w
i
t
h

a
r
m

i
n

9
0

o
f

s
h
o
u
l
d
e
r

f
l
e
x
i
o
n
.
P
a
t
i
e
n
t

w
i
l
l

h
a
v
e

p
a
i
n

a
t

t
h
e

e
n
d

r
a
n
g
e
.

N
e
e
r

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

s
h
o
u
l
d
e
r

i
m
p
i
n
g
e
m
e
n
t

i
n
v
o
l
v
i
n
g

t
h
e

b
i
c
e
p
s

t
e
n
d
o
n
.
P
a
s
s
i
v
e
l
y

a
n
d

f
o
r
c
i
b
l
y

f
l
e
x

t
h
e

s
h
o
u
l
d
e
r
.
P
a
t
i
e
n
t

w
i
l
l

c
o
m
p
l
a
i
n

o
f

p
a
i
n
.

Table 1.13 Selected Special Test Descriptions 25
53415_CH01_FINAL.indd 25 4/23/12 12:28:52 PM

S
p
e
e
d
s

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

b
i
c
i
p
i
t
a
l

t
e
n
d
o
n
i
t
i
s
.
F
l
e
x

t
h
e

s
h
o
u
l
d
e
r

a
g
a
i
n
s
t

g
r
a
v
i
t
y

a
b
o
u
t

6
0

w
i
t
h

t
h
e

e
l
b
o
w

e
x
t
e
n
d
e
d

a
n
d

f
o
r
e
a
r
m

s
u
p
i
n
a
t
e
d
.

I
s
o
m
e
t
r
i
c
a
l
l
y

r
e
s
i
s
t

s
h
o
u
l
d
e
r

f
l
e
x
i
o
n

a
t

t
h
e

f
o
r
e
a
r
m
.
P
a
t
i
e
n
t

w
i
l
l

c
o
m
p
l
a
i
n

o
f

p
a
i
n

a
t

t
h
e

b
i
c
i
p
i
t
a
l

g
r
o
o
v
e
.

Y
e
r
g
a
s
o
n
s

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

b
i
c
i
p
i
t
a
l

t
e
n
d
o
n
i
t
i
s
.
p
o
s
i
t
i
o
n

t
h
e

s
h
o
u
l
d
e
r

a
t

t
h
e

s
i
d
e

a
n
d

f
l
e
x

t
h
e

e
l
b
o
w

t
o

9
0

a
n
d

p
r
o
n
a
t
e

t
h
e

f
o
r
e
a
r
m
.
R
e
s
i
s
t

s
u
p
i
n
a
t
i
o
n

a
n
d

e
x
t
e
r
n
a
l

r
o
t
a
t
i
o
n
.
P
a
t
i
e
n
t

w
i
l
l

c
o
m
p
l
a
i
n

o
f

p
a
i
n

a
t

t
h
e

b
i
c
i
p
i
t
a
l

g
r
o
o
v
e
.
E
L
B
O
W

G
o
l
f
e
r
s

E
l
b
o
w

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

m
e
d
i
a
l

e
p
i
c
o
n
d
y
l
i
t
i
s
.
S
t
a
b
i
l
i
z
e

t
h
e

e
l
b
o
w
.

S
u
p
i
n
a
t
e

t
h
e

p
a
t
i
e
n
t
s

f
o
r
e
a
r
m

w
h
i
l
e

e
x
t
e
n
d
i
n
g

t
h
e

e
l
b
o
w

a
n
d

w
r
i
s
t
.
P
a
t
i
e
n
t

w
i
l
l

c
o
m
p
l
a
i
n

o
f

p
a
i
n

a
t

t
h
e

m
e
d
i
a
l

e
p
i
c
o
n
d
y
l
e
.

M
i
l
l
s

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

l
a
t
e
r
a
l

e
p
i
c
o
n
d
y
l
i
t
i
s
.
S
t
a
b
i
l
i
z
e

t
h
e

e
l
b
o
w
.

A
s
k

t
h
e

p
a
t
i
e
n
t

t
o

p
r
o
n
a
t
e

t
h
e

f
o
r
e
a
r
m

a
n
d

e
x
t
e
n
d

a
n
d

r
a
d
i
a
l
l
y

d
e
v
i
a
t
e

t
h
e

w
r
i
s
t

a
g
a
i
n
s
t

m
a
n
u
a
l

r
e
s
i
s
t
a
n
c
e
.
P
a
t
i
e
n
t

w
i
l
l

c
o
m
p
l
a
i
n

o
f

p
a
i
n

a
t

t
h
e

l
a
t
e
r
a
l

e
p
i
c
o
n
d
y
l
e
.

T
a
b
l
e

1
.
1
3

S
e
l
e
c
t
e
d

S
p
e
c
i
a
l

T
e
s
t

D
e
s
c
r
i
p
t
i
o
n
s
,

c
o
n
t
i
n
u
e
d
N
a
m
e
A
s
s
e
s
s
m
e
n
t
P
o
s
i
t
i
v
e

T
e
s
t
53415_CH01_FINAL.indd 26 4/23/12 12:28:53 PM
c
o
n
t
i
n
u
e
s

T
i
n
e
l
s

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

a

p
r
o
b
l
e
m

w
i
t
h

t
h
e

u
l
n
a
r

n
e
r
v
e
.

F
l
e
x

t
h
e

e
l
b
o
w

t
o

9
0
.

T
a
p

o
v
e
r

t
h
e

u
l
n
a
r

n
e
r
v
e
.
P
a
t
i
e
n
t

w
i
l
l

c
o
m
p
l
a
i
n

o
f

p
a
r
e
s
t
h
e
s
i
a
s

a
l
o
n
g

t
h
e

u
l
n
a
r

n
e
r
v
e

s
e
n
s
o
r
y

d
i
s
t
r
i
b
u
t
i
o
n
.
W
R
I
S
T

B
u
n
n
e
l
-
L
i
t
t
l
e
r

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

t
i
g
h
t
n
e
s
s

o
f

t
h
e

i
n
t
r
i
n
s
i
c

m
u
s
c
l
e
s

o
f

t
h
e

h
a
n
d

o
r

a

c
a
p
s
u
l
a
r

p
r
o
b
l
e
m

o
f

t
h
e

j
o
i
n
t
s
.

H
o
l
d

t
h
e

M
C
P

i
n

e
x
t
e
n
s
i
o
n

a
n
d

m
o
v
e

t
h
e

P
I
P

i
n
t
o

f
l
e
x
i
o
n
.
T
h
e

P
I
P

w
i
l
l

n
o
t

b
e

a
b
l
e

t
o

b
e

f
l
e
x
e
d
.

P
h
a
l
e
n
s

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

c
a
r
p
a
l

t
u
n
n
e
l

s
y
n
d
r
o
m
e
.
T
h
e

p
a
t
i
e
n
t

f
l
e
x
e
s

b
o
t
h

w
r
i
s
t
s

a
n
d

p
r
e
s
s
e
s

t
h
e

d
o
r
s
a
l

s
u
r
f
a
c
e
s

a
g
a
i
n
s
t

e
a
c
h

o
t
h
e
r

t
o

m
a
i
n
t
a
i
n

f
l
e
x
i
o
n

f
o
r

1

m
i
n
u
t
e
.
T
h
e

p
a
t
i
e
n
t

w
i
l
l

e
x
p
e
r
i
e
n
c
e

p
a
r
e
s
t
h
e
s
i
a
s

a
l
o
n
g

t
h
e

m
e
d
i
a
n

n
e
r
v
e

s
e
n
s
o
r
y

d
i
s
t
r
i
b
u
t
i
o
n
.

T
i
n
e
l
s

S
i
g
n
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

l
a
t
e
r
a
l

e
p
i
c
o
n
d
y
l
i
t
i
s
.
S
u
p
i
n
a
t
e

t
h
e

f
o
r
e
a
r
m
.

T
a
p

o
v
e
r

t
h
e

m
e
d
i
a
n

n
e
r
v
e
.
T
h
e

p
a
t
i
e
n
t

w
i
l
l

e
x
p
e
r
i
e
n
c
e

p
a
r
e
s
t
h
e
s
i
a
s

a
l
o
n
g

t
h
e

m
e
d
i
a
n

n
e
r
v
e

s
e
n
s
o
r
y

d
i
s
t
r
i
b
u
t
i
o
n
.

53415_CH01_FINAL.indd 27 4/23/12 12:28:53 PM
H
I
P

O
b
e
r

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

t
i
g
h
t
n
e
s
s

o
f

t
h
e

i
l
i
o
t
i
b
i
a
l

b
a
n
d

o
r

t
e
n
s
o
r

f
a
s
c
i
a

l
a
t
a
e
.
P
o
s
i
t
i
o
n

t
h
e

p
a
t
i
e
n
t

i
n

s
i
d
e

l
y
i
n
g

o
n

t
h
e

u
n
i
n
v
o
l
v
e
d

l
i
m
b
.

A
b
d
u
c
t

a
n
d

e
x
t
e
n
d

t
h
e

u
p
h
i
l
l

h
i
p
,

a
n
d

t
h
e
n

r
e
l
e
a
s
e

t
h
e

l
i
m
b
.
T
h
e

l
i
m
b

w
i
l
l

n
o
t

l
o
w
e
r

t
o

t
h
e

u
n
i
n
v
o
l
v
e
d

l
i
m
b
.

P
i
r
i
f
o
r
m
i
s

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
t
e

t
i
g
h
t
n
e
s
s

o
f

t
h
e

p
i
r
i
f
o
r
m
i
s

m
u
s
c
l
e
.
p
o
s
i
t
i
o
n

t
h
e

p
a
t
i
e
n
t

i
n

s
i
d
e

l
y
i
n
g

o
n

t
h
e

u
n
i
n
v
o
l
v
e
d

l
i
m
b
.

F
l
e
x

t
h
e

h
i
p

t
o

6
0
9
0

a
n
d

t
h
e

k
n
e
e

t
o

9
0
.

S
t
a
b
i
l
i
z
e

t
h
e

p
e
l
v
i
s

a
n
d

a
d
d
u
c
t

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p

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o

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h
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e
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T
h
e

p
a
t
i
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t

w
i
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l

c
o
m
p
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a
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f

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n

i
n

t
h
e

b
u
t
t
o
c
k
s
.

T
h
o
m
a
s

T
e
s
t
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o
s
i
t
i
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e

t
e
s
t

m
a
y

i
n
d
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c
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h
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r
e
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l
a
c
e

p
a
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i
n

s
u
p
i
n
e
.

H
a
v
e

p
a
t
i
e
n
t

f
l
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b
o
t
h

h
i
p
s

a
n
d

k
n
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e
s

t
o

t
h
e

c
h
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s
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n
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r
u
c
t

p
a
t
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e
x
t
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d

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l
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o

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h
e

t
a
b
l
e
.
T
h
e

p
a
t
i
e
n
t

w
i
l
l

b
e

u
n
a
b
l
e

t
o

f
u
l
l
y

e
x
t
e
n
d

t
h
e

l
i
m
b
.

T
r
e
n
d
e
l
e
n
b
u
r
g

S
i
g
n
P
o
s
i
t
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m
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y

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n
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c
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u
s

m
e
d
i
u
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.
H
a
v
e

p
a
t
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n
t

s
t
a
n
d

o
n

o
n
e

l
e
g
.
T
h
e

p
e
l
v
i
s

w
i
l
l

d
r
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p

t
o

t
h
e

n
o
n
i
n
v
o
l
v
e
d

s
i
d
e
.
T
a
b
l
e

1
.
1
3

S
e
l
e
c
t
e
d

S
p
e
c
i
a
l

T
e
s
t

D
e
s
c
r
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p
t
i
o
n
s
,

c
o
n
t
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u
e
d
N
a
m
e
A
s
s
e
s
s
m
e
n
t
P
o
s
i
t
i
v
e

T
e
s
t
53415_CH01_FINAL.indd 28 4/23/12 12:28:53 PM
K
N
E
E

9
0
9
0

S
t
r
a
i
g
h
t

L
e
g

R
a
i
s
e

T
e
s
t
P
o
s
i
t
i
v
e

t
e
s
t

m
a
y

i
n
d
i
c
a
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t
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g
h
t
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e
s
s

o
f

t
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e

h
a
m
s
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.
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n

s
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p
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,

h
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e

t
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e

p
a
t
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t

f
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x

t
h
e

h
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p

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d

k
n
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e

t
o

9
0
.

U
s
i
n
g

t
h
e

p
a
t
i
e
n
t
s

o
r

c
l
i
n
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c
i
a
n
s

h
a
n
d
s

t
o

m
a
i
n
t
a
i
n

h
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f
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x
i
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,

e
x
t
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k
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a
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m
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.
p
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b
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t
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x
t
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k
n
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e

b
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y
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d

2
0

e
x
t
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s
i
o
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.

A
p
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s

(
C
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m
p
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s
i
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)

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t
P
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t

m
a
y

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s

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k
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0
.
W
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t
h

t
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e

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l
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n
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c
i
a
n
s

h
a
n
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p
l
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e

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n
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a
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g

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o
w
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t
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e
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t

w
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l
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f

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n

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t

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e
.

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p
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y
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t
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o
n

T
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t
P
o
s
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t
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e

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t

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y

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n
d
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c
a
t
e

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o
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g
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a
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.
h
a
v
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t
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t
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t

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s
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m
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p
r
o
n
e

p
o
s
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t
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n

a
n
d

f
l
e
x

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h
e

k
n
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e

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o

9
0
.
U
s
e

o
n
e

h
a
n
d

t
o

g
r
a
s
p

t
h
e

l
e
g

j
u
s
t

p
r
o
x
i
m
a
l

t
o

t
h
e

m
a
l
l
e
o
l
i

a
n
d

d
i
s
t
r
a
c
t

t
h
e

l
e
g

w
h
i
l
e

t
h
e

o
t
h
e
r

h
a
n
d

s
t
a
b
i
l
i
z
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s

a
t

t
h
e

p
o
s
t
e
r
i
o
r

t
h
i
g
h
.
P
a
t
i
e
n
t

w
i
l
l

c
o
m
p
l
a
i
n

o
f

p
a
i
n

a
t

t
h
e

k
n
e
e
.
53415_CH01_FINAL.indd 29 4/23/12 12:28:53 PM
T
a
b
l
e

1
.
1
4

V
i
t
a
l

S
i
g
n
s
N
o
t
e
:

N
o
r
m
a
l

v
a
l
u
e
s

m
a
y

v
a
r
y

f
r
o
m

o
n
e

l
a
b
o
r
a
t
o
r
y

t
o

a
n
o
t
h
e
r
.

T
h
e

v
a
l
u
e
s

p
r
e
s
e
n
t
e
d

i
n

t
h
e
s
e

c
h
a
r
t
s

s
h
o
u
l
d

n
o
t

b
e

c
o
n
s
i
d
e
r
e
d

a
b
s
o
l
u
t
e
.
V
i
t
a
l

S
i
g
n
A
g
e

G
r
o
u
p
N
o
r
m
a
l

R
a
n
g
e
H
e
a
r
t

R
a
t
e

(
P
u
l
s
e
)
N
e
w
b
o
r
n
s
1

y
2
6

y
8
1
2

y
1
3
1
6

y
A
d
u
l
t
s
7
0
1
9
0

b
e
a
t
s
/
m
i
n
8
0
1
6
0

b
e
a
t
s
/
m
i
n
7
0
1
2
5

b
e
a
t
s
/
m
i
n
7
0
1
1
0

b
e
a
t
s
/
m
i
n
6
0
1
0
0

b
e
a
t
s
/
m
i
n
5
5
1
0
0

b
e
a
t
s
/
m
i
n

B
l
o
o
d

P
r
e
s
s
u
r
e
B
i
r
t
h
1

m
o
2
3
6

m
o
3
6

m
o
a
d
u
l
t
S
y
s
t
o
l
i
c
:

6
0
9
0

m
m

H
g
D
i
a
s
t
o
l
i
c
:

3
0
6
0

m
m

h
g
S
y
s
t
o
l
i
c
:

7
5
1
3
0

m
m

H
g
D
i
a
s
t
o
l
i
c
:

4
5
9
0

m
m

h
g
S
y
s
t
o
l
i
c
:

9
0
1
4
0

m
m

H
g
D
i
a
s
t
o
l
i
c
:

5
0
8
0

m
m

h
g

53415_CH01_FINAL.indd 30 4/23/12 12:28:53 PM
R
e
s
p
i
r
a
t
o
r
y

R
a
t
e
B
i
r
t
h
1

m
o
3

m
o
6

y
6
1
0

y
1
0
1
6

y
A
d
u
l
t
s
3
5
5
5

b
r
e
a
t
h
s
/
m
i
n
2
0
3
0

b
r
e
a
t
h
s
/
m
i
n
1
5
2
5

b
r
e
a
t
h
s
/
m
i
n
1
2
3
0

b
r
e
a
t
h
s
/
m
i
n
1
2
2
0

b
r
e
a
t
h
s
/
m
i
n

O
x
y
g
e
n

S
a
t
u
r
a
t
i
o
n

(
a
s

m
e
a
s
u
r
e
d

w
i
t
h

a

p
u
l
s
e

o
x
i
m
e
t
e
r
)
N
o
r
m
a
l

o
x
y
g
e
n

s
a
t
u
r
a
t
i
o
n

a
t

r
e
s
t

o
r

d
u
r
i
n
g

e
x
e
r
c
i
s
e

i
s

9
8
%
.
E
x
e
r
c
i
s
e

m
a
y

b
e

c
o
n
t
r
a
i
n
d
i
c
a
t
e
d

i
n

v
a
l
u
e
s

o
f

9
0
%
.
Table 1.14 Vital Signs 31
53415_CH01_FINAL.indd 31 4/23/12 12:28:53 PM
References
American Spinal Injury Association. (2005). International
standard for neurological classification of spinal cord injury.
Chicago: ASIA.
Dutton, M. (2008). Orthopedic examination, evaluation and
intervention. Second Edition. philadelphia: McGraw hill.
Goodman, c., Boissonault,W., & Fuller, K. (2009). Pathology:
Implications for the physical therapist. Third edition.
Philadelphia: Saunders.
hislop, h., & Montgomery, J. (2007). Daniels and Worthinghams
muscle testing: Techniques of manual examination. Eighth
edition. Philadelphia: W.B. Saunders Company.
hoppenfeld, S. (1976). Physical examination of the spine and
extremities. Norwalk, cT: prentice hall.
Norkin, c., & White, J. (2009). Measurement of joint motion: A guide
to goniometry. Fourth edition. philadelphia: F.A. Davis.
palmer, L., & Epler, M. (1998). Fundamentals of musculoskeletal
assessment techniques. philadelphia: Lippincott.
53415_CH01_FINAL.indd 32 4/23/12 12:28:53 PM

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