Table Of ContentOxford American Handbook of
Physical Medicine
and Rehabilitation
Published and Forthcoming Oxford American Handbooks
Oxford American Handbook of Clinical Medicine
Oxford American Handbook of Anesthesiology
Oxford American Handbook of Clinical Dentistry
Oxford American Handbook of Clinical Diagnosis
Oxford American Handbook of Clinical Pharmacy
Oxford American Handbook of Critical Care
Oxford American Handbook of Emergency Medicine
Oxford American Handbook of Geriatric Medicine
Oxford American Handbook of Nephrology and Hypertension
Oxford American Handbook of Obstetrics and Gynecology
Oxford American Handbook of Oncology
Oxford American Handbook of Otolaryngology
Oxford American Handbook of Pediatrics
Oxford American Handbook of Physical Medicine and Rehabilitation
Oxford American Handbook of Psychiatry
Oxford American Handbook of Pulmonary Medicine
Oxford American Handbook of Rheumatology
Oxford American Handbook of Surgery
Oxford American
Handbook of
Physical
Medicine and
Rehabilitation
Edited by
Lyn D. Weiss
Jay M. Weiss
Thomas Pobre
1
3
Oxford University Press, Inc. publishes works that further
Oxford University’s objective of excellence
in research, scholarship and education.
Oxford New York
Auckland Cape Town Dar es Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto
With offi ces in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal
Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam
Copyright © 2010 by Oxford University Press, Inc.
Published by Oxford University Press Inc.
198 Madison Avenue, New York, New York 10016
www.oup.com
Oxford is a registered trade mark of Oxford University Press
First published 2010
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press,
Library of Congress Cataloging-in-Publication Data
Oxford American handbook of physical medicine and rehabilitation / edited by
Lyn D. Weiss, Jay M. Weiss, Thomas Pobre.
p. ; cm.—(Oxford American handbooks)
Includes bibliographical references and index.
ISBN 978–0–19–536777–5 (fl exicover : alk. paper)
1. Medicine, Physical—Handbooks, manuals, etc. 2. Medical rehabilitation—
Handbooks, manuals, etc. I. Weiss, Lyn D. II. Weiss, Jay, MD. III. Pobre, Thomas.
IV. Series: Oxford American handbooks.
[DNLM: 1. Physical Medicine—methods—Handbooks. 2. Rehabilitation—methods—
Handbooks. WB 39 O9785 2010]
RM701.6.O94 2010
617’.03—dc22 2009021103
9 8 7 6 5 4 3 2 1
Printed in China
on acid-free paper
This material is not intended to be, and should not be considered,
a substitute for medical or other professional advice. Treatment for
the conditions described in this material is highly dependent on the indi-
vidual circumstances. And, while this material is designed to offer accurate
information with respect to the subject matter covered and to be current
as of the time it was written, research and knowledge about medical and
health issues is constantly evolving and dose schedules for medications are
being revised continua lly, with new side effects recognized and accounted
for regularly. Readers must therefore always check the product informa-
tion and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most
recent codes of conduct and safety regulation. Oxford University Press and
the authors make no representations or warranties to readers, express
or implied, as to the accuracy or completeness of this material, including
without limitation that they make no representation or warranties as to
the accuracy or effi cacy of the drug dosages mentioned in the material.
The authors and the publishers do not accept, and expressly disclaim, any
responsibility for any liability, loss or risk that may be claimed or incurred
as a consequence of the use and/or application of any of the contents of
this material.
vi
Preface
Physical medicine and rehabilitation (PM&R, or physiatry) is a growing, but
still misunderstood medical specialty in the United States. Perhaps no fi eld
is as broad in the areas it covers as PM&R, as this book attempts to show.
By necessity, areas that could fi ll volumes are limited to a few pages or
paragraphs. We have tried to distill the information into as useful a format
as possible while attempting to include most of the important points.
This book is aimed primarily at medical students rotating through PM&R,
and PM&R residents. It is meant to be available for quick reference on a
topic when in the hospital or clinic. There is ample space for note taking
while on rounds, and its size and layout are meant to encourage this. It
is also intended for physiatrists who may encounter conditions or top-
ics that they rarely see or haven’t seen in years. Our residents enter our
programs with varied experiences and knowledge of this fi eld. In contrast
to fi elds such as internal medicine or Ob/Gyn, there is no standard expo-
sure to PM&R in medical school. Thus we have to assume that residents
and students have no familiarity with PM&R and start with the most basic
knowledge of the fi eld. This Handbook should be considered only a fi rst
step, and we hope it will help provide a foundation for understanding that
can be advanced by further reading and research.
Many aspects of the specialty (such as spinal procedures, electromyog-
raphy, and others) are impossible to learn without a guided preceptorship
or fellowship. This book tries to stress an understanding of when, where,
and why these procedures fi t into the care of patients, but cannot teach
how to perform them. In those cases we hope this book serves as an
introduction.
There are many excellent texts in the fi eld of PM&R that are written by
well-respected authors. The reader is encouraged to consult these books
for a more detailed discussion of PM&R in general. There are also many
excellent books that focus on specifi c topics. Obviously, the Internet has
increased the amount of material available exponentially. The resources
chapter at the end of this book lists organizations, journals, and Web sites
that serve as resources for the most up-to-date information.
vii
Acknowledgments
The authors have been privileged to work for and with many talented indi-
viduals. Students, colleagues, and mentors have all infl uenced our practice
of medicine.
We would like to thank all of the contributors to this book. Their enthu-
siasm for learning and teaching is evident in their work.
The editors at Oxford University Press have been wonderful to work
with. Special thanks go to Elizabeth Kates and Andrea Seils for their assist-
ance and patience. Of course, we couldn’t do half of the things we do
without our coordinator, secretary, and offi ce manager Sheila Slezak. We
would like to thank Dr. Yasha Magyar for his outstanding illustrations.
We are extremely grateful to have the support and encouragement of
our Medical Director and CEO at Nassau University Medical Center. Steve
Walerstein, MD, and Arthur Gianelli, CEO, are role models in the prac-
tice of medicine and administration. They always put patient care fi rst and
strive to provide the best care possible. We have given better care to our
patients because of them, and for that we are appreciative.
Finally, and most importantly, we would like to thank our spouses, chil-
dren, and family for their love and support. Jay, Lyn, Ari, Helene, Stefan,
Richard, Rhona, and Nicole have been our foundation and the most impor-
tant part of our lives. This book is dedicated to them, in the hopes that
they may always fi nd happiness and fulfi llment.
Lyn Weiss
Jay M. Weiss
Thomas Pobre
This page intentionally left blank
ix
Contents
Detailed contents xi
Contributors xvii
Symbols and abbreviations xxi
1 General principles 1
2 Head and neck 15
3 Spine 33
4 Upper extremity 71
5 Lower extremity 121
6 Pain syndromes 165
7 Procedures and medications 183
8 Neurological disorders 227
9 Rheumatological disorders 253
10 Prosthetics and orthotics 277
11 Spinal cord injury 305
12 Traumatic brain injury 321
13 Stroke 327
14 Pulmonary and cardiac rehabilitation 343
15 Pediatrics 351
16 Common complications 363
17 Rehabilitation issues 401
Index 441
