Neurology Edited by Professor Emeritus Desire' Dubounet, IMUNE

ImpairmentThe Extremities, Spine, and Pelvis3.0 IntroductionThis chapter includes sections on the upper extremity, the lower extremity,the spine, and the pelvis. Each section considers techniques ofmeasurement, includes tables for impairments due to restriction of activemotion, ankylosis, amputations, and fractures. Also included are tablesrelating to specific disorders of body parts, and techniques for evaluatingthe peripheral nervous system and vasculature related to impairments ofthe upper and lower extremities.The upper extremity, the lower extremity, the spine and the pelvis areeach to be considered a unit of the whole person. The upper extremitymay be divided into four sections: the hand, wrist, elbow, and shoulderThe normal hand has five digits: the thumb, index, middle, ring, and littlefingers. The thumb has three joints: interphalangeal, metacarpophalangeal,and carpometacarpal. Each finger has three joints: the distalinterphalangeal, proximal interphalangeal, and metacarpophalangeal joints.The lower extremity may be devided into four sections: the foot;hind foot, which includes ankle and subtalar joints; knee; and hip. Thefoot has five digits: the great toe and the second, third, fourth, and fifthtoes. The great toe has three joints: the interphalangeal and themetatarsophalangeal joints. The second, third, fourth, and fifth toes allhave three joints: the distal interphalangeal, proximal interphalangeal, andmetatarsophalangeal joints.For the purpose of measuring restricted motion, the spine is dividedinto the cervical, thoracic, and lumbar regions. The cervical region hasseven vertebrae, C1-C7. The thoracic region has 12 vertebrae, T1-T12.The lumbar region has five vertebrae, L1-L5. There may be congenitalvariations in the number of vertebrae.The pelvis is composed of the pubis, ischium, and ilium that form thesides and the front and the sacrum and coccyx that form the rear.Techniques of measurement should be simple, practical, andscientifically sound. For the examination of the upper and lowerextremities, a large and a small portable goniometer are useful. For