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TT
DUTTON’S ORTHOPAEDIC
EXAMINATION, EVALUATION,
AND INTERVENTION
NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden
our knowledge, changes in treatment and drug therapy are required. T e authors and the
publisher o this work have checked with sources believed to be reliable in their e orts
to provide in ormation that is complete and generally in accord with the standards
accepted at the time o publication. However, in view o the possibility o human error
or changes in medical sciences, neither the authors nor the publisher nor any other party
who has been involved in the preparation or publication o this work warrants that the
in ormation contained herein is in every respect accurate or complete, and they disclaim
all responsibility or any errors or omissions or or the results obtained rom use o the
in ormation contained in this work. Readers are encouraged to con rm the in ormation
contained herein with other sources. For example and in particular, readers are advised
to check the product in ormation sheet included in the package o each drug they plan to
administer to be certain that the in ormation contained in this work is accurate and that
changes have not been made in the recommended dose or in the contraindications or
administration. T is recommendation is o particular importance in connection with new
or in requently used drugs.
DUTTON’S ORTHOPAEDIC
EXAMINATION, EVALUATION,
AND INTERVENTION
FOURTH EDITION
Mark Dutton, PT
Allegheny General Hospital
West Penn Allegheny Health System (WPAHS)
Adjunct Clinical Instructor, Duquesne University
School of Health Sciences
Pittsburgh, Pennsylvania
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney oronto
Dutton’s Orthopaedic Examination, Evaluation, and Intervention, Fourth Edition
Copyright © 2017 by McGraw-Hill Education. All rights reserved. Printed in China. Except as
permitted under the United States Copyright Act o 1976, no part o this publication may be
reproduced or distributed in any orm or by any means, or stored in a data base or retrieval
system, without the prior written permission o the publisher.
1 2 3 4 5 6 7 8 9 DSS 21 20 19 18 17 16
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the Contact Us pages at www.mhpro essional.com.
For my parents,
Ron and Brenda, who have always helped, guided, and inspired me
and to my two daughters, Leah and Lauren, who provide me with such joy.
Your Legacy
Will you have earned the respect o your peers and the admiration o your critics?
Will you have acted humbly during success and grace ully in the ace o adversity?
Will you be remembered or how o ten you brought smiles to the hearts o others?
Will you have looked or the very best, and done your utmost to build worth, in others?
Will you have le t this world a better place by the li e you have lived?
Pre ace ix
SECTION IV
Acknowledgments xi
Introduction xiii THE EXTREMITIES
16 The Shoulder 577
17 Elbow 711
SECTION I 18 The Forearm, Wrist, and Hand 779
ANATOMY 19 Hip 869
1 The Musculoskeletal System 3 20 The Knee 966
2 Tissue Behavior, Injury, Healing, and Treatment 29 21 Lower Leg, Ankle, and Foot 1081
3 The Nervous System 64
SECTION V
SECTION II THE SPINE AND TMJ
EXAMINATION AND EVALUATION 22 Vertebral Column 1191
4 Patient/Client Management 163 23 The Craniovertebral Region 1209
5 Dif erential Diagnosis 218 24 Vertebral Artery 1246
6 Gait and Posture Analysis 287 25 The Cervical Spine 1256
7 Imaging Studies in Orthopaedics 344 26 The Temporomandibular Joint 1340
27 The Thoracic Spine 1382
28 Lumbar Spine 1425
SECTION III 29 The Sacroiliac Joint 1529
INTERVENTION
8 The Intervention 369 SECTION VI
9 Pharmacology or the Orthopaedic
Physical Therapist 398 SPECIAL CONSIDERATIONS
10 Manual Techniques 417 30 Special Populations 1569
11 Neurodynamic Mobility and Mobilizations 445
12 Improving Muscle Per ormance 463 Index 1613
13 Improving Mobility 521
14 Improving Neuromuscular Control 557
15 Improving Cardiovascular Endurance 566
vii
Pre ace
T e ourth edition o this book is an update o in ormation it is the consistent measurement and reporting o clinical
and bibliography provided in the previous versions together outcomes that is the most power ul tool in moving toward a
with a reorganization o various chapters. value-based system.2
T e United States currently spends more money on o that end, the aim o this book is to provide the reader
healthcare per person than any other country in the world, with a systematic and evidence-based approach to the
with current projections indicating that 20% o the gross examination and intervention o the orthopaedic patient.
domestic product o the United States will be spent on Such an approach must be eclectic because no single method
healthcare by the year 2019.1 As the population continues works all o the time. T us, this book attempts to incorporate
to age, the treatment o musculoskeletal conditions, and the most reliable concepts currently available.
their subsequent expenses, will also increase. T is will I hope that this book will be seen as the best available
place an increasing burden on the clinician to provide value textbook, guide, review, and re erence or healthcare students
or money—the achievement o a health outcome relative and clinicians involved in the care o the orthopaedic
to the costs incurred. Gone are the days when a clinician population.
can rely on an expensive shotgun approach to treatment.
Instead, emphasis is now placed on outcomes such as patient Mark Dutton, P
satis action and accurate measures o clinical outcomes, or
ix
Acknowledgments
From inception to completion, the various editions span almost o the production crew o Aptara, especially the project
12 years. Such an endeavor cannot be completed without the manager Amit Kashyap.
help o many. I would like to take this opportunity to thank the Bob Davis or his creative eye and the excellent photography.
ollowing:
Leah or agreeing to be the photographic model.
T e aculty o the North American Institute o Manual
T e sta o Human Motion Rehabilitation, Allegheny
and Manipulative T erapy (NAIOM )—especially, Jim
General Hospital including roy Baxendell, Susan Berger,
Meadows, Erl Pettman, Cli Fowler, Diane Lee, and the
Diane Ferianc, Leslie Fisher, Keith Galloway, Dave Hahn,
late Dave Lamb.
Dean Hnaras, John Karp, Ronald Klingensmith, Randi
T e exceptional team at McGraw-Hill, or their superb Marshak, Dan McCool, Renee Nacy, Dan Norkiewicz,
guidance throughout this object. T ank you especially Darcy Skrip, Jodi Weiher, Melissa Willis, and Joe Witt.
to Michael Weitz or his advice and support and to other
o the countless clinicians throughout the world who
members o the initial lineup. Special thanks also to Brian
continually strive to improve their knowledge and clinical
Kearns.
skills.
xi
Introduction
“T e very f rst step towards success in any occupation is evidence will have a greater likelihood o success with the
to become interested in it.” least associated risk.3,4
T e goal o every clinician should be to enhance patient/
—Sir William Osler (1849–1919) client satis action, increase ef ciency, and decrease unproven
treatment approaches.4 T e management o the patient/client
Until the beginning o the last century, knowledge about the is a complex process involving an intricate blend o experience,
mechanism o healing and the methods to decrease pain and knowledge, and interpersonal skills. Obtaining an accurate
su ering were extremely limited. Although we may sco at diagnosis requires a systematic and logical approach. Such
many o the interventions used in the distant past, many o an approach should be eclectic because no single method
the interventions we use today, albeit less radical, have still to works all o the time. For any intervention to be success ul,
demonstrate much more in the way o e ectiveness. T at may an accurate diagnosis must be ollowed by a care ully planned
soon change with the recent emphasis within many healthcare and speci c rehabilitation program to both the a ected area
pro essions on evidence-based clinical practice. T e process and its related structures. In this book, great emphasis is placed
o evidence-based practice is outlined in Table I-1. When on the appropriate use o manual techniques and therapeutic
combining clinical expertise with the best available external exercise based on these considerations. Electrotherapeutic
clinical evidence, clinicians can make in ormed decisions and thermal/cryotherapeutic modalities should be viewed
regarding patient management, including the selection and as adjuncts to the rehabilitative process. T e accompanying
interpretation o the most appropriate evaluation procedures. DVD to this book contains numerous video clips o manual
Also, intervention strategies based on the best available techniques and therapeutic exercises, which the reader is
encouraged to view. T e ollowing icon is used throughout
TABLE I-1 The Process of Evidence -Based Practice the text to indicate when such clips are available. [VIDEO]
1. Identi y the patient problem. Derive a specif c question.
2. Search the literature.
3. Appraise the literature. REFERENCES
4. Integrate the appraisal o literature with your clinical expertise, 1. Sisko AM, ru er CJ, Keehan SP, et al. National health spending
experience, patient values, and unique circumstances. projections: the estimated impact o re orm through 2019. Health Af .
5. Implement the f ndings. 2010; 29:1933–1941.
6. Assess outcome and reappraise. 2. Porter ME. What is value in health care? New Engl J Med. 2010; 363:2477–
2481.
Data rom Sackett DL, Strauss SE, Richardson WS, et al. Evidence Based 3. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine:
Medicine: How to Practice and Teach EBM. 2nd ed. Edinburgh, Scotland: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007; 455:3–5.
Churchill Livingstone; 2000. 4. Schroder JA. Manual therapy and neural mobilization: our approach and
personal observations. Orthop Pract. 2004; 16:23–27.
xiii
S EC TIO N I ANATOMY
T
C H AP TER 1 M s os ta
Syst m
Loose irregular connective Found in capsules, muscles, Random ber orientation Provides structural support
tissue nerves, ascia, and skin
4
two layers: an inner (visceral) layer and an outer (parietal) than it does in tendons, but its structural ramework still pro-
layer with occasional connecting bridges (mesotenon). I vides sti ness (resistance to de ormation—see Chapter 2).28
there is synovial uid between these two layers, the paratenon Small amounts o elastin (1% o the dry weight) are present in
is called tenosynovium; i not, it is termed tenovagium.9 ligaments, with the exception o the ligamentum avum and
endons are metabolically active and are provided with a the nuchal ligament o the spine, which contain more. T e cel-
rich and vascular supply during development.20 endons receive lular organization o ligaments makes them ideal or sustain-
their vascular supply through the musculotendinous junction ing tensile loads, with many containing unctional subunits
(M J), the osteotendinous junction, and the vessels rom the that are capable o tightening or loosening in di erent joint
various surrounding tissues including the paratenon and meso- positions.29 At the microscopic level, closely spaced collagen
tenon.18 endons in di erent areas o the body receive di erent bers ( ascicles) are aligned along the long axis o the liga-
amounts o blood supply, and tendon vascularity can be com- ment and are arranged into a series o bundles that are delin-
promised by the junctional zones and sites o riction, torsion, or eated by a cellular layer, the endoligament, and the entire liga-
T
h
compression—a number o tendons are known to have reduced ment is encased in a neurovascular biocellular layer re erred
e
tendon vascularity, including the supraspinatus, the biceps, the to as the epiligament.26 Ligaments contribute to the stability
M
u
Achilles, the patellar, and the posterior tibial tendon.18 o joint unction by preventing excessive motion,30 acting as
S
T e mechanical properties o tendon come rom its highly guides or checkreins to direct motion, and providing proprio-
c
u
oriented structure. endons display viscoelastic mechanical ceptive in ormation or joint unction through sensory nerve
l
O
properties that con er time- and rate-dependent e ects on the endings (see Chapter 3) and the attachments o the ligament
S
tissue. Speci cally, tendons are more elastic at lower strain rates to the joint capsule.31–33 Many ligaments share unctions. For
k
e
and sti er at higher rates o tensile loading (see Chapter 2). example, while the anterior cruciate ligament o the knee is
l
e
endons de orm less than ligaments under an applied load and considered the primary restraint to anterior translation o the
T
A
are able to transmit the load rom muscle to bone.9 Material tibia relative to the emur, the collateral ligaments and the pos-
l
and structural properties o the tendon increase rom birth terior capsule o the knee also help in this unction (see Chap-
S
Y
through maturity and then decrease rom maturity through ter 20).26 T e vascular and nerve distribution to ligaments is
S
T
old age.18 Although tendons withstand strong tensile orces not homogeneous. For example, the middle o the ligament is
e
M
well, they resist shear orces less well and provide little resis- typically avascular, while the proximal and distal ends enjoy
tance to a compression orce (see Chapter 2). a rich blood supply. Similarly, the insertional ends o the liga-
A tendon can be divided into three main sections:21 ments are more highly innervated than the midsubstance.
T e bone–tendon junction. At most tendon–bone
inter aces, the collagen bers insert directly into the Cartilage
bone in a gradual transition o material composition. T e
physical junction o tendon and bone is re erred to as an Cartilage tissue exists in three orms: hyaline, elastic, and
enthesis,22 and is an inter ace that is vulnerable to acute brocartilage.
and chronic injury.23 One role o the enthesis is to absorb Hyaline cartilage, also re erred to as articular cartilage,
and distribute the stress concentration that occurs at the covers the ends o long bones and permits almost
junction over a broader area. rictionless motion to occur between the articular sur aces
T e tendon midsubstance. Overuse tendon injuries can o a diarthrodial (synovial) joint.34 Articular cartilage
occur in the midsubstance o the tendon, but not as is a highly organized viscoelastic material composed o
requently as at the enthesis. cartilage cells called chondrocytes, water, and an ECM.
M J. T e M J is the site where the muscle and tendon
meet. T e M J comprises numerous interdigitations CLINICAL PEARL
between muscle cells and tendon tissue, resembling
interlocked ngers. Despite its viscoelastic mechanical Chondrocytes are specialized cells that are responsible or the
characteristics, the M J is very vulnerable to tensile development o cartilage and the maintenance o the ECM.35
ailure (see Chapter 2).24,25 Chondrocytes produce aggrecan, link protein, and hyal-
uronan, all o which are extruded into the ECM, where they
aggregate spontaneously.4 The aggrecan orms a strong,
Ligaments porous-permeable, ber-rein orced composite material with
collagen. The chondrocytes sense mechanical changes in
Skeletal ligaments are brous bands o dense C that connect their surrounding matrix through intracytoplasmic laments
bones across joints. Ligaments can be named or the bones and short cilia on the sur ace o the cells.27
into which they insert (coracohumeral), their shape (deltoid
o the ankle), or their relationships to each other (cruciate).26
T e gross structure o a ligament varies according to location Articular cartilage, the most abundant cartilage within
(intra-articular or extra-articular, capsular), and unction.27 the body, is devoid o any blood vessels, lymphatics, and
Ligaments, which appear as dense white bands or cords o nerves.5,6 Most o the bones o the body orm rst as hya-
C , are composed primarily o water (approximately 66%), line cartilage, and later become bone in a process called
and o collagen (largely type I collagen [85%], but with small endochondral ossi cation. T e normal thickness o articu-
amounts o type III) making up most o the dry weight. T e lar cartilage is determined by the contact pressures across
collagen in ligaments has a less unidirectional organization the joint—the higher the peak pressures, the thicker the 5
cartilage.27 Articular cartilage unctions to distribute the Elastic (yellow) cartilage is a very specialized C ,
joint orces over a large contact area, thereby dissipating primarily ound in locations such as the outer ear, and
the orces associated with the load. T is distribution o portions o the larynx.
orces allows the articular cartilage to remain healthy and Fibrocartilage, also re erred to as white cartilage,
ully unctional throughout decades o li e. T e patellar has unctions as a shock absorber in both weight-bearing
the thickest articular cartilage in the body. and nonweight-bearing joints. Its large iber content,
Articular cartilage may be grossly subdivided into our dis- rein orced with numerous collagen ibers, makes
tinct zones with di ering cellular morphology, biomechani- it ideal or bearing large stresses in all directions.
cal composition, collagen orientation, and structural proper- Fibrocartilage is an avascular, alymphatic, and
ties, as ollows: aneural tissue and derives its nutrition by a double-
T e super cial zone. T e super cial zone, which lies di usion system.36 Examples o ibrocartilage include
A
adjacent to the joint cavity, comprises approximately the symphysis pubis, the intervertebral disk, and the
N
10–20% o the articular cartilage thickness and menisci o the knee.
A
T
unctions to protect deeper layers rom shear stresses.
O
T e collagen bers within this zone are packed tightly
M
Y
and aligned parallel to the articular sur ace. T is zone Bone
is in contact with the synovial uid and handles most o
Bone is a highly vascular orm o C , composed o collagen,
the tensile properties o cartilage.
calcium phosphate, water, amorphous proteins, and cells. It
T e middle (transitional) zone. In the middle zone, is the most rigid o the C s (Table 1-2). Despite its rigidity,
which provides an anatomic and unctional bridge bone is a dynamic tissue that undergoes constant metabolism
between the super cial and deep zones, the collagen and remodeling. T e collagen o bone is produced in the same
bril orientation is obliquely organized. T is zone manner as that o ligament and tendon but by a di erent cell,
comprises 40–60% o the total cartilage volume. the osteoblast.10 At the gross anatomical level, each bone has a
Functionally, the middle zone is the rst line o distinct morphology comprising both cortical bone and can-
resistance to compressive orces. cellous bone. Cortical bone is ound in the outer shell. Can-
T e deep or radial layer. T e deep layer comprises 30% cellous bone is ound within the epiphyseal and metaphyseal
o the matrix volume. It is characterized by radially regions o long bones, as well as throughout the interior o
aligned collagen bers that are perpendicular to the short bones.24 Skeletal development occurs in one o the two
sur ace o the joint, and which have a high proteoglycan ways:
content. Functionally the deep zone is responsible or
providing the greatest resistance to compressive orces. Intramembranous ossi cation. Mesenchymal stem cells
T e tidemark. T e tidemark distinguishes the deep within mesenchyme or the medullary cavity o a bone
zone rom the calci ed cartilage, the area that prevents initiate the process o intramembranous ossi cation. T is
the di usion o nutrients rom the bone tissue into the type o ossi cation occurs in the cranium and acial bones
cartilage. and, in part, the ribs, clavicle, and mandible.
T
the ascia to unite all o the bers o a single motor unit and,
h
which surrounds the cartilage, becomes the periosteum.
e
Chondrocytes in the primary center o ossi cation begin there ore, adapt to variations in orm and volume o each
M
to grow (hypertrophy) and begin secreting alkaline phos- muscle according to muscular contraction and intramuscular
u
S
phatase, an enzyme essential or mineral deposition. Cal- modi cations induced by joint movement.15 Groups o ascic-
c
ci cation o the matrix ollows, and apoptosis (a type o uli are surrounded by a connective sheath called the epimy-
u
l
cell death involving a programmed sequence o events sium (Fig. 1-1). Under an electron microscope, it can be seen
O
S
that eliminates certain cells) o the hypertrophic chon- that each o the myo bers consists o thousands o myo brils
k
e
drocytes occurs. T is creates cavities within the bone. T e (Fig. 1-1), which extend throughout its length. Myo brils are
l
composed o sarcomeres arranged in series.39
e
exact mechanism o chondrocyte hypertrophy and apopto-
T
A
sis is currently unknown. T e hypertrophic chondrocytes
l
(be ore apoptosis) also secrete a substance called vascular
S
CLINICAL PEARL
Y
endothelial cell growth actor that induces the sprouting o
S
T
blood vessels rom the perichondrium. Blood vessels orm- The sarcomere (Fig. 1 2) is the contractile machinery o
e
M
ing the periosteal bud invade the cavity le by the chondro- the muscle. The graded contractions o a whole muscle
cytes, and branch in opposite directions along the length occur because the number o bers participating in the
o the sha . T e blood vessels carry osteoprogenitor cells contraction varies. Increasing the orce o movement is
and hemopoietic cells inside the cavity, the latter o which achieved by recruiting more cells into cooperative action.
later orm the bone marrow. Osteoblasts, di erentiated
rom the osteoprogenitor cells that enter the cavity via the
periosteal bud, use the calci ed matrix as a sca old and All skeletal muscles exhibit our characteristics:40
begin to secrete osteoid, which orms the bone trabecula. 1. Excitability, the ability to respond to stimulation rom the
Osteoclasts, ormed rom macrophages, break down the nervous system.
spongy bone to orm the medullary cavity (bone marrow). 2. Elasticity, the ability to change in length or stretch.
T e unction o bone is to provide support, enhance lever-
3. Extensibility, the ability to shorten and return to normal
age, protect vital structures, provide attachments or both
length.
tendons and ligaments, and store minerals, particularly
calcium. From a clinical perspective, bones may serve as 4. Contractility, the ability to shorten and contract in
use ul landmarks during the palpation phase o the exami- response to some neural command. T e tension developed
nation. T e strength o bone is related directly to its density. in skeletal muscle can occur passively (stretch) or actively
O importance to the clinician, is the di erence between (contraction). When an activated muscle develops tension,
maturing bone and mature bone. T e epiphyseal plate or the amount o tension present is constant throughout the
growth plate o a maturing bone can be divided into our length o the muscle, in the tendons, and at the sites o the
distinct zones:37 musculotendinous attachments to the bone. T e tensile
orce produced by the muscle pulls on the attached bones
Reserve zone: produces and stores matrix. and creates torque at the joints crossed by the muscle. T e
Proli erative zone: produces matrix and is the site or magnitude o the tensile orce is dependent on a number
longitudinal bone cell growth. o actors.
Hypertrophic zone: subdivided into the maturation One o the most important roles o C is to transmit
zone, degenerative zone, and the zone o provisional mechanically the orces generated by the skeletal muscle cells
calci ication. It is within the hypertrophic zone that to provide movement. Each o the myo brils contains many
the matrix is prepared or calci ication and is here bers called myo laments, which run parallel to the myo bril
that the matrix is ultimately calci ied. he hypertrophic axis. T e myo laments are made up o two di erent proteins:
zone is the most susceptible o the zones to injury actin (thin myo laments) and myosin (thick myo laments)
because o the low volume o bone matrix and the that give skeletal muscle bers their striated (striped) appear-
high amounts o developing immature cells in this ance (Fig. 1-2).39
region.38 T e striations are produced by alternating dark (A) and
Bone metaphysis: the part o the bone that grows during light (I) bands that appear to span the width o the muscle
childhood. ber. T e A bands are composed o myosin laments, whereas 7
Epimys ium
Pe rimys ium
Fa s ciculus
Ca pilla ry
A
N
A
T
O
M
Y
Nucle us
Mitochondrion
Endomys ium
Myofibril
S a rcole mma
Myofibril
the I bands are composed o actin laments. T e actin la-
ments o the I band overlap into the A band, giving the edges
o the A band a darker appearance than the central region
(H band), which contains only myosin. At the center o each
e I band is a thin, dark Z line. A sarcomere (Fig. 1-2) repre-
er
ar
c om sents the distance between each Z line. Each muscle ber is
S
limited by a cell membrane called a sarcolemma (Fig. 1-1).
T e protein dystrophin plays an essential role in the mechani-
cal strength and stability o the sarcolemma.41 Dystrophin is
Myos in lacking in patients with Duchenne muscular dystrophy.
(thick fila me nt)
Actin
CLINICAL PEARL
(thin fila me nt) The sarcoplasm is the specialized cytoplasm o a muscle
cell that contains the usual subcellular elements along
with the Golgi apparatus, abundant myo brils, a modi ed
Tropomyos in endoplasmic reticulum known as the sarcoplasmic reticu-
Troponin complex lum (SR), myoglobin, and mitochondria. Transverse tubules
(T-tubules) invaginate the sarcolemma, allowing impulses
FIGURE 1-2 Troponin and tropomyosin action during a muscle
to penetrate the cell and activate the SR.
8 contraction.
T e basic unction o muscle is to contract. T e word con- contractions require the use o special equipment that
traction, used to describe the generation o tension within produces an accommodating resistance. Both high-
muscle bers, conjures up an image o shortening o muscle speed/low-resistance and low-speed/high-resistance
bers during a resistance exercise. However, a contraction regimens result in excellent strength gains.48–51 T e major
can produce shortening or lengthening o the muscle, or no disadvantage o this type o exercise is its expense. Also,
change in the muscle length. T us, three types o contraction there is the potential or impact loading and incorrect
are commonly recognized: isometric, concentric, and eccen- joint axis alignment.52 Isokinetic exercises may also have
tric (see Chapter 12). questionable unctional carryover.53
Isometric contraction. Isometric exercises provide a Econcentric contraction. T is type o contraction
static contraction with a variable and accommodating combines both a controlled concentric and a simultaneous
resistance without producing any appreciable change in eccentric contraction o the same muscle over two
T
muscle length.42 separate joints.54 Examples o an econcentric contraction
h
include the standing hamstring curl, in which the
e
Concentric contraction. A concentric contraction
M
produces a shortening o the muscle. T is occurs when hamstrings work concentrically to ex the knee while the
u
the tension generated by the agonist muscle is suf cient hip tends to ex eccentrically, lengthening the hamstrings.
S
c
to overcome an external resistance and to move the body When rising rom a squat, the hamstrings work
u
concentrically as the hip extends and work eccentrically
l
segment o one attachment toward the segment o its
O
other attachment.42 as the knee extends. Conversely, the rectus emoris work
S
k
eccentrically as the hip extends and work concentrically as
e
Eccentric contraction. An eccentric contraction occurs
l
the knee extends.
e
when a muscle slowly lengthens as it gives in to an
T
Isolytic contraction. An isolytic contraction is an
A
external orce that is greater than the contractile orce it
l
is exerting.42 In reality, the muscle does not lengthen, it osteopathic term used to describe a type o eccentric
S
contraction that makes use o a greater orce than the
Y
merely returns rom its shortened position to its normal
S
patient can overcome. T e di erence between an eccentric
T
resting length. Eccentric muscle contractions, which are
e
contraction and an isolytic contraction is that, in the ormer,
M
capable o generating greater orces than either isometric
or concentric contractions,43–45 are involved in activities the contraction is voluntary whereas, in the latter, it is
that require a deceleration to occur. Such activities include involuntary. T e isolytic contraction can be used in certain
slowing to a stop when running, lowering an object, or manual techniques to stretch brotic tissue (see Chapter 10).
sitting down. Because the load exceeds the bond between Structures called cross-bridges serve to connect the actin
the actin and myosin laments during an eccentric and myosin laments. Increased synthesis o actin and myo-
contraction, some o the myosin laments probably are sin stimulates new myo brils that are added to the external
torn rom the binding sites on the actin lament while layers o the pre-existing myo brils.55 T e myosin laments
the remainder are completing the contraction cycle.46 contain two exible, hinge-like regions, which allow the cross-
T e resulting orce is substantially larger or a torn cross- bridges to attach and detach rom the actin lament. Dur-
bridge than or one being created during a normal cycle o ing contraction, the cross-bridges attach and undergo power
muscle contraction. Consequently, the combined increase strokes, which provide the contractile orce. During relax-
in orce per cross-bridge and the number o active cross- ation, the cross-bridges detach. T is attaching and detaching
bridges results in a maximum lengthening muscle tension is asynchronous, so that some are attaching while others are
that is greater than the tension that could be created detaching. T us, at each moment, some o the cross-bridges
during a shortening muscle action.46,47 are pulling, while others are releasing.
T e regulation o cross-bridge attachment and detachment
CLINICAL PEARL is a unction o two proteins ound in the actin laments:
tropomyosin and troponin (Fig. 1-2). ropomyosin attaches
Both concentric and eccentric muscle action comprise the directly to the actin lament, whereas troponin is attached
type o exercise called isotonic. An isotonic contraction is a to the tropomyosin rather than directly to the actin lament.
contraction in which the tension within the muscle remains
constant as the muscle shortens or lengthens.42 This state is CLINICAL PEARL
very di cult to produce and measure. Although the term
isotonic is used in many texts to describe concentric and Tropomyosin and troponin unction as the switch or mus-
eccentric contractions alike, its use in this context is errone- cle contraction and relaxation. In a relaxed state, the tropo-
ous because in most exercise orms the muscle tension dur- myosin physically blocks the cross-bridges rom binding to
ing exercise varies based upon the weight used, joint veloc- the actin. For contraction to take place, the tropomyosin
ity, muscle length, and type o muscle contraction.42 must be moved.
Der Eimer wird vom Netze gelöst, die Schraube, die sich in der
Röhre am Boden des Eimers befindet, herausgedreht, so dass der
Inhalt in eine darunter gestellte Flasche gelangt. Aus der Flasche
kann man dann nach und nach die Masse in den Filtrator giessen.
Diese Methode ist sicherer, als wenn man den Fang direkt aus dem
Eimer in den Filtrator bringt, da bei schwankendem Schiffe leicht
etwas vorbeilaufen kann.
Das Wasser sickert nun allmählich durch die Gazewände des
Filtrators durch, und zwar verschieden schnell, je nach der
Beschaffenheit des Fanges. Sind viel Diatomeen oder Nostocaceen
(Limnochlide) vorhanden, so hat der Fang ein schleimiges Aussehen
und filtriert sehr langsam. Sind dagegen Copepoden oder Peridineen
am zahlreichsten, so läuft das Wasser sehr schnell ab, da sich die
Poren des Netzzeuges nicht verstopfen. Nachdem auf diese Weise
die Organismen ziemlich vollständig vom Wasser befreit sind, wird
die Glasplatte, denn auf dieser hat sich jetzt der Fang niedergesetzt,
unter dem Filtrator hervorgenommen und mit Spatel und
Spritzflasche werden die Tiere und Algen in die
Konservierungsflüssigkeit gebracht, in der sie bis zur Verarbeitung
bleiben oder, wie oben auseinandergesetzt ist, in Alkohol übertragen
werden. In jedes Glas wird ein Zettelchen gelegt, auf dem der
Fundort, das Datum, die Tiefe des Planktonzuges, die
Konservierung, die Temperatur des Wassers und allenfalls noch die
Windrichtung angegeben sind.
Die nun folgenden Arbeiten, die die q u a n t i t a t i v e B e s t i m m u n g
des Fanges bezwecken, werden ausgeführt, nachdem wir zu Hause
angelangt sind. Zuerst wird das Vo l u m e n des Fanges festgestellt.
Zu dem Zwecke wird der Inhalt eines einen Fang enthaltenden
Glases in einen Messcylinder entleert. Nach und nach sinken die
Organismen zu Boden, die grösseren schneller, die kleinen
langsamer. Unter letzteren sind namentlich die Diatomeen zu
erwähnen, diese setzen sich, wenn sie in grösseren Mengen
vorkommen, so langsam ab, dass nach tagelangem Stehen noch
immer eine Volumenverringerung zu beobachten ist. Befinden sich
grosse Tiere im Fange, so muss bei diesen das Volumen besonders
bestimmt werden und dieses geschieht am besten und genauesten
durch „Ve r d r ä n g u n g “, d. h. das Tier wird in einen Messcylinder
hineingebracht, in dem sich eine bekannte Menge Flüssigkeit
(Wasser — oder Alkohol, wenn der Fang in Alkohol war —) befindet,
dann kann man durch das Steigen der Wasseroberfläche das
Volumen des Körpers bestimmen. Meist hat sich die Masse in 24
Stunden so weit abgesetzt, dass das Volumen derselben abgelesen
werden kann. Da die Volumenbestimmung zum Vergleiche der
einzelnen Fänge unter sich dienen soll, so ist es zweckmässig, allen
Fängen die gleiche Zeit zum Absetzen zu lassen und zwar genügen
dazu 24 Stunden.
Nachdem so das Volumen des Fanges festgestellt ist, wird zur
Z ä h l u n g der Organismen geschritten. Es ist selbstverständlich, dass
nicht alle Individuen des Fanges gezählt werden können, das
beweisen schon folgende Zahlen, die ich Zählungen H e n s e n s [XCV]
entnehme: Hensen fand im Oktober 1884 in 1 cbm Ostseewasser
(Kieler Bucht) 13 Millionen Ceratium tripos, und im März 1885
ebenda 102 Millionen Rhizosolenia semispina, und wenn wir gar
lesen, dass im September sich im Stettiner Haff in ½ cbm Wasser
9983 Mill. Fäden von Limnochlide[XCVI] fanden, dann ist es klar, dass
diese Zahlen auf anderem Wege gewonnen sind, als durch Zählung
jedes einzelnen Individuums. Die sinnreich von H e n s e n erdachte
und angewendete Methode ist folgende:
[XCV] H e n s e n , Planktonwerk.
[XCVI] Die letzte Zahl entnehme ich einem Zählungsprotokolle
von Herrn Geheimrat H e n s e n , das er mir freundlich für diese
Arbeit überliess und das am Ende des Kapitels sich abgedruckt
findet. Die folgenden Zahlen sowie Betrachtungen beziehen sich
auf dieses Protokoll. Siehe auch H e n s e n [105].
Bringen wir nun auf eine liniierte Glasplatte ein bestimmtes Mass
einer Verdünnung, so können wir die Zahl der einzelnen
Organismen, die sich in diesem Volumen befinden, bestimmen. Die
Verdünnung wählt man am besten so, dass man von der häufigsten
Spezies nie mehr als 3000 und nie weniger als 1000 auf der Platte
hat. Würde es sich nur um e i n e Spezies handeln, so wäre die
Zählung leicht auszuführen. Man brauchte nur die Platte allmählich
zu durchsuchen und jedes Individuum, das in das Gesichtsfeld
kommt, zu zählen, dann wüsste man, wie viel Organismen auf der
Platte sind und könnte, da man die Verdünnung kennt, die Summe
der Organismen im ganzen Fange berechnen. Hätten wir z. B. eine
Verdünnung von 1 : 10 angewendet und 1 ccm Verdünnung
durchgezählt und fanden 146 Coscinodiscen, dann wären im ganzen
Fange (von 500 ccm) 146 × 10 × 500 = 730000 Coscinodiscen
vorhanden.
Handelt es sich jedoch um mehrere Spezies, so kann man diese
nicht im Kopfe getrennt zählen. Doch auch hier hat H e n s e n Rat
geschafft. Da in einem Fange 30–50 verschiedene Spezies von
Tieren und Pflanzen vorhanden sind, so werden an einem
Setzerkasten, der ebenso viel Fächer enthält, die Namen der
vorhandenen Organismen angebracht, für jede Spezies ein Fach.
Untersucht man jetzt eine Platte, so werden die mannigfaltigen
Organismen nicht mehr gezählt, sondern sobald irgend einer im
Gesichtsfelde sich blicken lässt, wird für ihn ein Pfennig (Spielmarke
etc.) in sein betreffendes Fach gelegt. So kann man leicht eine
Platte, auf der sich 50 verschiedene Arten durcheinandergemengt
befinden, zählen. Auf den ersten Platten werden die Diatomeen, die
meist am zahlreichsten in einem Fange vorhanden sind, gezählt,
andere Organismen natürlich auch berücksichtigt. Zuerst wird ein
stark verdünnter Teil des Fanges genommen, da trotzdem genug
Individuen auf die Platte kommen. Die Vergrösserung muss anfangs
sehr stark sein, etwa 200, zum Zählen der Diatomeen und anderer
Algen. Auf die Platte kommt nur 0.1 ccm Flüssigkeit, die mit der
betreffenden Stempelpipette abgemessen wird. Für die starke
Vergrösserung bildet diese geringe Wasserschicht aber immerhin
noch ein Hindernis alle Organismen zu sehen; hat man das
Mikroskop auf die Oberfläche der Platte eingestellt, so entgehen
einem die Organismen, die an der Oberfläche der Flüssigkeit sich
befinden. Daher ist es vorteilhaft, die Diatomeen trocken zu zählen.
Es wird zu diesem Zwecke ein bestimmtes Volumen Flüssigkeit auf
eine Platte gebracht und diese dann der Wärme eines heizbaren
Objekttisches oder eines Ofens ausgesetzt, damit die Flüssigkeit
verdunstet; dann sind die Diatomeen auf der Platte in einer Ebene
ausgebreitet und können nicht so leicht übersehen werden. Da die
Mischungen und Verdünnungen nie ganz genau sein können, so
wird natürlich die Zählung jeder neuen Platte etwas abweichende
Resultate ergeben, es fragt sich daher, wie lange eine Spezies
gezählt werden muss; wann solch ein Grad von Genauigkeit erreicht
ist, um von den wenigen Zählungen auf die quantitative
Zusammensetzung des ganzen Fanges schliessen zu können. Im
allgemeinen lässt sich sagen, dass es bei den häufigsten Formen
genügt, wenn man einen Bruchteil (z. B. ⅒ ) der Quadratwurzel
sämtlicher Individuen zählt. Haben wir (siehe Protokoll) auf der
ersten Platte für Melosira 27 Fäden gefunden und wissen wir, dass
die durchzählte Wassermasse der 5000000. Teil von dem ganzen
Fange ist, so würden wir nach dieser ersten Zählung schliessen,
dass 135000000 Melosira im Fange sein werden, daraus nehmen
wir ⅒ der Quadratwurzel = 1162. Haben wir also mindestens 1162
Melosira gezählt, so können wir diese aus den Zählungen
ausscheiden, d. h. wir brauchen sie nicht mehr mitzuzählen.
Um die Genauigkeit zu finden, bis zu welcher die Zählung
erfolgen muss, führt H e n s e n [XCIX] noch folgende Erwägung an.
Nachdem einige Zählungen gemacht sind, zieht man aus diesen das
Mittel. Denken wir nun, dass noch eine Zählung hinzugekommen
wäre und diese mit der am meisten abweichenden übereinstimmen
würde, und nähmen wir dann aus diesen das Mittel, so genügen die
Zählungen, wenn das Resultat sich nicht mehr als um 5% ändert. Im
Protokoll finden wir für Melosira die Zahlen 382, 396, 396, Summe
1174, Mittel daraus 391. Käme noch eine Zählung hinzu und zwar
382, so wäre die Summe 1556, Mittel daraus 389.
Durch die letzteren Betrachtungen sind wir nun schon bei den
H o r i z o n t a l r e i h e n angelangt.
In einer Spalte derselben stehen die Namen der Organismen, die
sich in dem gezählten Fange befanden. Rechts davon sind dann die
Ergebnisse der Zählung jeder einzelnen Platte angegeben und zwar
in der Rubrik, deren Kopfzahl der betreffenden Platte entspricht. Hört
man auf, einen Organismus mitzuzählen, so steht in der Rubrik der
betreffenden Platte ein Fragezeichen. Wird auf einer Platte von einer
Spezies kein Individuum gefunden, so steht natürlich eine Null. Ist
dagegen eine Spezies beobachtet, aber auf einigen Platten nicht
mitgezählt, wie z. B. bei Spirogyra 1–11, so wird auch hier ein
Fragezeichen gesetzt.
In den beiden letzten Spalten sind zuerst die S u m m e n d e r
g e z ä h l t e n I n d i v i d u e n jeder Spezies angegeben, dann die Platten,
auf denen diese Organismen gezählt wurden.
Um nun die Gesamtsumme der in dem Fang vorhandenen Tier-
und Pflanzenindividuen zu finden, brauchen wir nur die Summe der
g e z ä h l t e n Organismen mit dem Koeffizienten, welcher der
angewendeten Plattenzahl entspricht, zu multiplizieren. So haben wir
bei Limnochlide 9653 Fäden gezählt, und zwar auf Platte 1–5, der
Koeffizient der Platten 1–5 ist 1000000, also sind im ganzen Fange
9653000000 Limnochlide-Fäden vorhanden.
Diese Gesamtsumme „G e z ä h l t e M a s s e “ steht in einer Rubrik
vor den Namen, damit man mit diesen das Endresultat sogleich
übersieht.
Vor der letzteren Rubrik finden wir eine solche mit der Überschrift
„G a n z e M a s s e “. Wie wir oben gesehen haben, wird nicht die ganze
Wassersäule filtriert, die dem Querschnitte des Netzes und der Tiefe
des Wassers, bis zu der das Netz herabgelassen wurde, entspricht,
sondern ein kleiner Teil fliesst über den Netzrand ab. H e n s e n hat
deshalb für jedes Netz den Filtrationskoeffizienten[CII] berechnet, der
besagt, mit welcher Zahl man Volumen oder Anzahl der Organismen
eines Fanges multiplizieren muss, um die wirklichen Werte zu
finden, wenn die ganze Flüssigkeitssäule filtriert worden wäre. In
unserem Falle war der Koeffizient 1.034. Von Leptodora waren z. B.
371 Individuen im Fange. In der Wassersäule von 0.1 qm
Querschnitt und 5 m Höhe waren aber 371 × 1.034 = 384 Individuen
vorhanden. In Folgendem habe ich aber die Zahlen der gezählten
Masse benutzt.
[CXIII] Synchaeta?
Die beiden anderen unbestimmten Rotatorien waren sehr
zahlreich zu finden, das eine in der Zahl von 776240, das andere
von 3203200 unter derselben Oberfläche. Von Anuraea fanden sich
A. aculeata Ehbg. mit 203840, quadridentata mit 722180 und
foliacea Ehbg. mit 58240 Individuen. Ausserdem 2567380
Rädertiereier.
Von Daphniden wurden sechs Arten gefunden. Drei von diesen
sind allgemein als pelagisch bekannt, nämlich Leptodora hyalina
Lilj., Hyalodaphnia Kahlbergensis Schödler und Chydorus
sphaericus O. Fr. M., während die drei übrigen bei den bisherigen
Untersuchungen von Süsswasserbecken meist als littorale Formen
nachgewiesen wurden. Daphnia longispina Leyd. ist jedoch auch
von Z a c h a r i a s [109] in den 6–8 m tiefen Mansfelder Seen pelagisch
gefunden, ebenso Sida crystallina von F o r e l [99] in Schweizer Seen.
Da die Daphniden vielen Süsswasserfischen zur Nahrung dienen, so
ist ihre Bestimmung von hohem praktischen Interesse, namentlich
da sie sich in Bezug auf ihren Gehalt an organischer Substanz
ähnlich wie die Copepoden verhalten dürften, für die wir oben 99.4%
gefunden haben. Wenn wir in unserem Fange unter einem
Quadratmeter Oberfläche 1826100 Daphniden finden, so können wir
uns leicht ein Bild von ihrer Bedeutung für die Fischzucht machen.
Mit Hilfe der Planktonmethode würde sich ein sehr klares Bild über
den Entwickelungsgang dieser Tiere finden lassen. Bei fortgesetzten
Untersuchungen könnte man das Auftreten der Daphniden im
Frühjahr feststellen, sowie dessen Abhängigkeit von der
Wassertemperatur, ferner würde sich die rapide Zunahme gegen den
Sommer hin zeigen, wobei es von Wichtigkeit wäre, die Zahl der Eier
und Embryonen im Brutraume zu berücksichtigen, so dass sich für
jede Art eine Durchschnittszahl ergeben würde. Zugleich liesse sich
das Erscheinen der verschiedenen Arten in den einzelnen Monaten
finden. Im Spätsommer würden dann die Männchen hinzukommen
und schliesslich würde man die Cladoceren verschwinden sehen,
nachdem man die Bildung der Dauereier beobachtet hätte.
Es würden sich alle diese Verhältnisse zahlenmässig klarlegen
lassen und einen präzisen Ausdruck liefern für die bisherigen