Term
|
Definition
| impaired joint mobility, motor function, muscle performance, range of motion with localized inflammation |
|
|
Term
| 3 common mechanisms for rotator cuff dysfunction |
|
Definition
compression
tensile overload
macrotrauma |
|
|
Term
| what is primary impingement |
|
Definition
| superior aspect of RC compressed against surrounding bony and soft tissues d/t decreased subacromial space |
|
|
Term
| What is secondary impingement |
|
Definition
| associated with GH instability and/or tensile overload resulting in decreased control of humeral head and injury to subscpaularis and anterior capsular structures or supraspinatus |
|
|
Term
| What is internal impingement |
|
Definition
| d/t contact between posterior superior labrum and posterior aspect of the supraspinatus or infraspinatus tendons or both at the greater tuberosity |
|
|
Term
| Primary Subacromial Impingment Syndrome is a result of what? |
|
Definition
|
|
Term
| Primary Subacromial Impingement Syndrome is a result of mechanical compression of what structures under the acromial arch? |
|
Definition
rotator cuff tendons
subacromial bursa
biceps tendon |
|
|
Term
| causes of subacromial impingement syndrome: intrinsic factors (4) |
|
Definition
suprahumeral space
vascularity of RC
degeneration of RC tendons
anatomic/bony changes |
|
|
Term
| causes of subacromial impingement syndrome: extrinsic factors (4) |
|
Definition
muscle imbalance/motor control
functional arc of movement
postural changes
precipitation factors |
|
|
Term
| Causes of SIS Intrinsic Factors: normal suprahumeral space |
|
Definition
|
|
Term
| Causes of SIS Intrinsic Factors: pathological suprahumeral space |
|
Definition
|
|
Term
| Causes of SIS Intrinsic Factors: when is the suprahumeral space the smallest |
|
Definition
| between 60 and 120 degrees scaption |
|
|
Term
| Causes of SIS Intrinsic Factors: vascularity refers to what |
|
Definition
| decreased blood flow to critical zone 1 cm proximal to insertion of supraspinatus (greater tuberosity) with arm adducted. Association with age |
|
|
Term
| Causes of SIS Intrinsic Factors: degeneratino of RC tendons is d/t what |
|
Definition
natural age related changes that occur d/t changes in fiber arrangmenet
fiber disruption at insertion site |
|
|
Term
| Causes of SIS Intrinsic Factors: bony changes refers to what |
|
Definition
acromion shape changes
bone spurs |
|
|
Term
| Causes of SIS Intrinsic Factors: bony changes in atnerior/inferior surface of acromion. type I acromion |
|
Definition
|
|
Term
| Causes of SIS Intrinsic Factors: bony changes in atnerior/inferior surface of acromion. Type II acromion |
|
Definition
|
|
Term
| Causes of SIS Intrinsic Factors: bony changes in atnerior/inferior surface of acromion. type III acromion |
|
Definition
|
|
Term
| Causes of SIS Intrinsic Factors: bony changes in atnerior/inferior surface of acromion. which acromion types are associated with pathology |
|
Definition
|
|
Term
| Causes of SIS Intrinsic Factors: bony changes in atnerior/inferior surface of acromion. most individuals with RC tears have what type of acromion |
|
Definition
|
|
Term
| Causes of SIS Intrinsic Factors: anatomic changes refers to what |
|
Definition
| posterior capsule tightness forces the humeral head anterior (obligate translation) |
|
|
Term
| Causes of SIS Extrinsic Factors: muscle imbalance and decreased motor control refers to what (2) |
|
Definition
parascapular mm (overdominant upper trap and weak lower trap)
weak RC mm, upward shear of deltoid (greater than 6 mm displacement of humerla head pathologic) |
|
|
Term
| Causes of SIS Extrinsic Factors: functional arc of movement refers to what |
|
Definition
compression of supraspinatus and biceps under anterior acromion with repeated forward elevation
Neer suggests that impingement occurs d/t concomitat IR that occurs with forward flexino of the humerus |
|
|
Term
| Causes of SIS Extrinsic Factors: postural changes refers to what (5) |
|
Definition
forward head
protracted and downwardly rotated scapula
humerus in IR placing increased tension on RC mm
Constant EMG activity and increased tension in RC mm and tendons
Wringing out of RC tendons |
|
|
Term
| Causes of SIS Extrinsic Factors: precipitating factors refers to what (3) |
|
Definition
repetitive use of arm in overhead position
underlying jt instability (labrum, capsular ligaments, etc)
training errors or occuptational hazards causing repetitve impingement |
|
|
Term
| Neer's stages of impingement: Stage I |
|
Definition
|
|
Term
| Neer's stages of impingement: stage II |
|
Definition
|
|
Term
| Neer's stages of impingement: stage III |
|
Definition
| bone spurs and tendon ruptures |
|
|
Term
| Neer's stages of impingement: stage IV |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage I: Edema and Inflammation: typical age |
|
Definition
| <25 years but may occur at any age |
|
|
Term
| Neer's stages of impingement: Stage I: Edema and Inflammation: reversible? |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage I: Edema and Inflammation: pain |
|
Definition
| with activity, better with rest |
|
|
Term
| Neer's stages of impingement: Stage I: Edema and Inflammation: palpation |
|
Definition
| tenderness over the greater tuberosity and anterior margin of acromion |
|
|
Term
| Neer's stages of impingement: Stage I: Edema and Inflammation: ROM |
|
Definition
| painful arc of abduction between 60 and 120 |
|
|
Term
| Neer's stages of impingement: Stage I: Edema and Inflammation: (+) tests |
|
Definition
| positive impingement tests (Neer's, Hawkin's Kennedy) |
|
|
Term
| Neer's stages of impingement: Stage I: Edema and Inflammation: pattern |
|
Definition
| Reverse Capsular Pattern IR>ABD>ER |
|
|
Term
| Neer's stages of impingement: Stage II: Fibrosis and Tendonosis: typical age |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage II: Fibrosis and Tendonosis: reversible? |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage II: Fibrosis and Tendonosis: pain |
|
Definition
| recurrent pain with acitivty, does not always resolve with rest |
|
|
Term
| Neer's stages of impingement: Stage II: Fibrosis and Tendonosis: in addition to stage I signs, ROM |
|
Definition
| limited ROM, active and passive |
|
|
Term
| Neer's stages of impingement: Stage II: Fibrosis and Tendonosis: in addition to stage I signs, AROM |
|
Definition
| catching sensation with lowering the arm at approximately 100 degrees |
|
|
Term
| Neer's stages of impingement: Stage II: Fibrosis and Tendonosis: in addition to stage I signs, jt sounds |
|
Definition
| greater degree of soft tissue crepitus may be d/t scarring the subacromial space |
|
|
Term
| Neer's stages of impingement: Stage II: Fibrosis and Tendonosis: general idea of treatment |
|
Definition
| can't reverse teh damage, but can treat the symptoms |
|
|
Term
| Neer's stages of impingement: Stage III: Bone Spurs and Tendon Ruptures: age |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage III: Bone Spurs and Tendon Ruptures: reversible? |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage III: Bone Spurs and Tendon Ruptures: stage I and II signs: ROM |
|
Definition
| limitation of ROM, may see a capsular pattern |
|
|
Term
| Neer's stages of impingement: Stage III: Bone Spurs and Tendon Ruptures: stage I and II signs: mm observations (2) |
|
Definition
supraspinatus, infraspinatus, and/or deltoid atrophy
biceps tendon involvement |
|
|
Term
| Neer's stages of impingement: Stage III: Bone Spurs and Tendon Ruptures: stage I and II signs: additional jt involvement |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage III: Bone Spurs and Tendon Ruptures: stage I and II signs: surgical procedures |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage IV: Cuff Tear Arthropathy: age |
|
Definition
|
|
Term
| Neer's stages of impingement: Stage IV: Cuff Tear Arthropathy: previous history |
|
Definition
| history of progressive disability with RC tear |
|
|
Term
| Neer's stages of impingement: Stage IV: Cuff Tear Arthropathy: surgical procedures |
|
Definition
| manage surgically via RC repair, hemi-arthroplasty, or total shoulder replacement |
|
|
Term
| Secondary Impingement presents similarly to primary impingmeent except demonstrations of what positive clinical findings |
|
Definition
|
|
Term
| Seconadry impingement presents similiarly to primary except for (+) clinical findings for instability especially through what 3 tests |
|
Definition
sulcus sign
apprehension/relocation test
pain in late cocking phase of throwing |
|
|
Term
| Internal/Posterior Impingement: typically seen in which athlete/position |
|
Definition
throwing/overhead athlete
90/90 position |
|
|
Term
| Internal/Posterior Impingement: pain during what test and where |
|
Definition
positive apprehension/relocation test
pain located internal or posterior during test |
|
|
Term
| Internal/Posterior Impingement: pain in what phase of throwing |
|
Definition
| cocking phase of throwing |
|
|
Term
| Internal/Posterior Impingement: what msut be r/o prior to tx a pt for internal/posterior impingement |
|
Definition
labral tears
anterior instability
RC tears |
|
|
Term
| Internal/Posterior Impingement: involves what 3 structures |
|
Definition
greater tuberiosity of the humeral head
supraspinatus tendon
posterior superior labrum |
|
|
Term
| Internal/Posterior Impingement: stage 1 symptoms |
|
Definition
|
|
Term
| Internal/Posterior Impingement: stage II symptoms |
|
Definition
|
|
Term
| Internal/Posterior Impingement: stage III symptoms |
|
Definition
positive relocation est
same as stage II plus failure of rehab |
|
|
Term
| Internal/Posterior Impingement: stage 1 tx considerations |
|
Definition
2 wks rest from throwing
strengthen cuff and scapular rotators |
|
|
Term
| Internal/Posterior Impingement: stage II tx considerations |
|
Definition
| 4-12 weeks rest from throwing + rehab program |
|
|
Term
| Internal/Posterior Impingement: stage III tx considerations |
|
Definition
| anterior capsulolabral reconstruction |
|
|
Term
| Mgmt of Impingement Syndromes: initial stage tx |
|
Definition
| treat symptomtically in initial stages |
|
|
Term
| Mgmt of Impingement Syndromes: correction |
|
Definition
|
|
Term
| Mgmt of Impingement Syndromes: modification of what |
|
Definition
| activity modifications (don't sleep on your arm) |
|
|
Term
| Mgmt of Impingement Syndromes: muscular involvement |
|
Definition
strengthen cuff and scapualar mm
motor control training/address mm imbalances |
|
|
Term
| Mgmt of Impingement Syndromes: training |
|
Definition
|
|
Term
| Mgmt of Impingement Syndromes: posterior capsule tx (2) |
|
Definition
|
|
Term
| Mgmt of Impingement Syndromes: tx for chronic pts |
|
Definition
| friction massage/soft tissue manipulation |
|
|
Term
| Mgmt of Impingement Syndromes: spinal mobility |
|
Definition
|
|
Term
| Mgmt of Impingement Syndromes: if the pt has too much pain in their rotator cuff, what other musculature can you train |
|
Definition
|
|
Term
| Mgmt of Impingement Syndromes: medical mgmt (3) |
|
Definition
cortisone injections/pain meds
NSAIDS
surgery |
|
|
Term
| Mgmt of Impingement Syndromes: medical mgmt surgeries include (5) |
|
Definition
anterior acromioplasty
subacromial decompression
capsular tightening or shrinkage procedures if indicated
buresecomty |
|
|
Term
| Mgmt of Impingement Syndromes: medical mgmt surgeries include these 3 resections |
|
Definition
coracoacromial ligament resection
distal clavicle resection
AC jt inferior osteophyte resection |
|
|
Term
| A subacromial decompression is what 4 procedures combined |
|
Definition
Coracoacromial ligament resection
Anterior acromioplasty
Distal clavicle resection
AC jut inferior osteophyte resection |
|
|
Term
| Shockwave therapy and impingmenet syndrome effects |
|
Definition
| decreased pain, increased functions for 6 months |
|
|
Term
| 3 causes for rotator cuff tears |
|
Definition
tendon degeneration
acute injury (Fall onto an outstretched arm)
high velocity movement or force into abduction |
|
|
Term
| Full thickness RC Tear: where is type of tear often initiated |
|
Definition
| critical zone of the supraspinatus |
|
|
Term
| Full thickness RC Tear: this type of tear can extend to what mm (4) |
|
Definition
infraspinatus
teres minor
biceps tendon
subscapularis |
|
|
Term
| 3 Mechanisms for RC tears |
|
Definition
compression
tensile overload
macrotrauma |
|
|
Term
| Incomplete or Partial Thickness Tears may occur where? |
|
Definition
Superior Surface (Bursal)
Undersurface (Articular side)
Intratendinous (interstitial) portion of the cuff |
|
|
Term
| Incomplete/Partial Thickness Tears: why do undersfurace (articular tears) occur |
|
Definition
| d/t tensile loads and glenohumerla instability as often seen with the throwing athlete |
|
|
Term
| Incomplete/Partial Thickness Tears: Superior (bursal) tears are associated with what |
|
Definition
|
|
Term
| Incomplete/Partial Thickness Tears: intratendinous (interstitial) tears develop between what structures |
|
Definition
| bursal and articular side layers of the degenerated tendons |
|
|
Term
| Incomplete/Partial Thickness Tears: what force appears to the primary cause of intratendinous (interstitial) tears |
|
Definition
|
|
Term
|
Definition
significant loss of AROM, ABD especially
Altered glenohumeral rhythm
PROM not limited unless chronic condition
Atrophy of shoulder musculature |
|
|
Term
| Grading of RC tears by American Academy of Orthopedic Surgeons: Small |
|
Definition
|
|
Term
| Grading of RC tears by American Academy of Orthopedic Surgeons: medium |
|
Definition
|
|
Term
| Grading of RC tears by American Academy of Orthopedic Surgeons: large |
|
Definition
|
|
Term
| Grading of RC tears by American Academy of Orthopedic Surgeons: massive |
|
Definition
|
|
Term
| shoulder test which is positive for anyone with shoulder pathology |
|
Definition
|
|
Term
| PT and Partial Thickness tears |
|
Definition
| PT controversial as to its effectiveness, partial thickness tears dont appear to heal with conservative intervention |
|
|
Term
| PT intervention of partial thickness tears |
|
Definition
|
|
Term
| most common procedures for rotator cuff tears |
|
Definition
| open or athroscopic procedures |
|
|
Term
|
Definition
impaired jt mobility
impaired motor function
impaired muscle performance
impaired ROM with connective tissue dysfunction |
|
|
Term
| adhesive capsulitis/frozen shoulder aka |
|
Definition
periarthritis
periarticular lesions
Duplay's disease
Scapulohumeral periarthrtis
Tendinitis of the short rotators |
|
|
Term
| what is adhesive capsulitis/frozen shoulder |
|
Definition
| chronic capsular inflammation with fibrosis of the capsule (anterior/inferior axillary fold of the capsule is often implicated) |
|
|
Term
| adhesive capsulitis/frozen shoulder: the tissues may have also have fibrosis (5) |
|
Definition
subscapularis tendon
subscapularis bursa
biceps tendon
subacromial bursa
RC tendons |
|
|
Term
| 2 types of Frozen Shoulder |
|
Definition
Primary (Idiopathic)
Secondary (related to Known disorders) |
|
|
Term
| Describe Primary Frozen Shoulder |
|
Definition
spontaenous
unknown stimulus creates histologic changes in the jt capsule |
|
|
Term
| Describe secondary frozen shoulder |
|
Definition
| preceded by episode or trauma or immobilization, pain or systemic disease |
|
|
Term
| Incidence of Frozen Shoulder:gender |
|
Definition
|
|
Term
| Incidence of Frozen Shoulder: age related (2) |
|
Definition
particularly menopausal
typical age of onset between 40 and 60 years of age |
|
|
Term
| Incidence of Frozen Shoulder: arm involvement (2) |
|
Definition
bilateral in 12% of population
more common in the nondominant arm |
|
|
Term
| Incidence of Frozen Shoulder: diabetics |
|
Definition
|
|
Term
| characteristics of primary frozen shoulder: pt age |
|
Definition
|
|
Term
| characteristics of primary frozen shoulder: pain pattern |
|
Definition
| diffuse and often over the lateral deltoid and/or C5 dermatome |
|
|
Term
| characteristics of primary frozen shoulder: event resulting in onset |
|
Definition
| insidious or minimal event resulting in onset |
|
|
Term
| characteristics of primary frozen shoulder: significant... (2) |
|
Definition
night pain
limitations of active and passive shoulder motion in more than 1 plane |
|
|
Term
| characteristics of primary frozen shoulder: external rotation |
|
Definition
| 50% or greater than 30 degree loss of passive external rotation |
|
|
Term
| characteristics of primary frozen shoulder: end ranges |
|
Definition
|
|
Term
| characteristics of primary frozen shoulder: internal rotators |
|
Definition
| significant pain and/or weakness of the itnernal rotators |
|
|
Term
| Delphi Technique for Adhesive Capsulitis: pain |
|
Definition
night pain
pain with rapid or unguarded movements
pain lying on affected shoulder
pain easily aggravated by movements |
|
|
Term
| Delphi Technique for Adhesive Capsulitis: movement |
|
Definition
global loss of A/PROM
Pain at end range of all movements
Onset greater than 35 years of age |
|
|
Term
| Frozen Shoulder Exam Findings: acute (high irritability) [4] |
|
Definition
>7/10 pain
Pain before resistance
Constant night/resting pain
AROM more limited than PROM |
|
|
Term
| Frozen Shoulder Exam Findings: Subacute (Moderate irritability) [4] |
|
Definition
4-6/10 pain
Intermiitent resting/night pain
Pain with resistance at end range
AROM/PROM similar limitations |
|
|
Term
| Frozen Shoulder Exam Findings: Chronic (Low irritability) [4] |
|
Definition
<3/10 pain
No resting or night pain
Minimal pain after resistance at end range
AROM/PROM limitations same |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 1: duration of symptoms |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 1: pain with what |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 1: limitaitons of what motions |
|
Definition
| forward flexion, abduction, internal rotation, external rotation |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 1: examination with the pt under anesthesia |
|
Definition
| normal or minimal loss of ROM |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 2: is aka what stage |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 2: Freezing Stage: Duration of symptoms |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 2: Freezing Stage: what type of pain with what motion? |
|
Definition
| chronic pain with active and passive ROM |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 2: Freezing Stage: limitation of movements |
|
Definition
| significant limitation of forward flexion, abduction, internal rotation, external rotation |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 2: Freezing Stage: examination with pt under anesthesia |
|
Definition
| ROM essentially identical to ROM when pt is awake |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 3: aka what stage |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 3: Frozen Stage: duration of symptoms |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 3: Frozen Stage: what type of pain with what motions |
|
Definition
| minimal pain except at end ROM |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 3: Frozen Stage: ROM and end feel |
|
Definition
| significant limitation of ROM with rigid end feel |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 3: Frozen Stage: examination with the pt under anesthesia |
|
Definition
| ROM identical to ROm when pt is awake |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage IV: aka what stage? |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 4: Thawing Stage: Duration of symptoms |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 4: Thawing Stage: pain |
|
Definition
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 4: Thawing Stage: ROM |
|
Definition
| progressive ROM improvements |
|
|
Term
| Adhesive Capsulitis Nautral Progression: Stage 4: Thawing Stage: after 12-36 months, 60% have what |
|
Definition
|
|
Term
| what is the gold standard for diagnositc imaging |
|
Definition
|
|
Term
|
Definition
| injection of a contrast liquid into the jt followed by an MRI |
|
|
Term
| PT intervention for frozen shoulder: overall guidelines |
|
Definition
| must acknolwedge the stage of injury and the sequence of pain and limitation to guide treatment |
|
|
Term
| PT intervention for frozen shoulder: acute stage (7) |
|
Definition
anti-inflammatory measures
A/PROM
Grade 1 and 2 Mobs
Posture correction
Strengthening ex to tolerance
Home program
Cortisone injeciton from MD at early stages |
|
|
Term
| PT intervention for frozen shoulder: SUbacute/Chronic: (8) |
|
Definition
posture correction
home program
AROM
Mobilizations
Static prolonged Stretch
PROM
Strengthening
Ice |
|
|
Term
| PT intervention for frozen shoulder: Subacute/Chronic: thermal agents refers to what? and what also must be considered |
|
Definition
Heat, US
Heat will not reach the deeper structures but may relaxed the superficial structures allowing for tx to continue |
|
|
Term
| MEdical mgmt of Frozen shoulder: injections (2) |
|
Definition
cortisone injections (NSAIDS)
saline injection (capsular/arthrographic distension) |
|
|
Term
| Medical Mgmt of Frozen Shoulder: manipulaiton under anesthesia for what purpose |
|
Definition
controlled end range manipulation
translationtional manipulation under anesthetic |
|
|
Term
| Medical Mgmt of Frozen Shoulder: surgical mgmt (2) |
|
Definition
open capsular release
arthroscopic capsular release |
|
|
Term
| Better alternative to manipluaiton under anesthetic |
|
Definition
| steroid injections with distension as an out pt is therefore recommended for the tx of idiopathic "primary" frozen shoulder |
|
|
Term
| Pattern 4D is a condition resulting from impaired jt mobility, function, muscle performance, and range of motion associated with what |
|
Definition
| connective tissue dysfunction |
|
|
Term
| Pattern 4E is a condition resulting from impaired jt mobility, function, muscle performance, and range of motion associated with what |
|
Definition
|
|
Term
|
Definition
downward directed force applied to the top of the acromion process or a fall onto an outstretched hand
Insidious onset in the case of degenerative changes |
|
|
Term
| AC Jt pathology: common in what populations (2) |
|
Definition
overhead athletes
weight lifters |
|
|
Term
| AC Jt pathology: Grade I (4) |
|
Definition
AC ligament is stretched
Lcoalized pain and swelling
Minimal limitation in ROM
Pain in later phases of ROM |
|
|
Term
| AC Jt pathology: Grade II (5) |
|
Definition
AC ligament torn
Coracoclavicular ligament stretched
Increased tenderness and swelling
Minimal elevation of clavicle
Significant limitation in ROM (can't get past 90) |
|
|
Term
| AC Jt pathology: Grade III (4) |
|
Definition
AC and Coracoclavicluar ligaments are torn
Significant elevation of clavicle
Need to support arm
Unable to elevate arm |
|
|
Term
| AC Jt pathology: What observation is generally a sgin of separation |
|
Definition
|
|
Term
| AC Jt Dx: clinical test (3) |
|
Definition
crossed arm impingement test
AC distraction test
Palpation |
|
|
Term
|
Definition
| pain with overhead movement |
|
|
Term
|
Definition
| diagnosed with a weighted x ray |
|
|
Term
| AC Jt Intervention: Grade I |
|
Definition
| manage inflamamtion and begin early mobs |
|
|
Term
| AC Jt Intervention: Grade II/III |
|
Definition
May use sling from 3-6/8 weeks
Initiate rehab below 90 degrees and progress in ROM program |
|
|
Term
| AC Jt Intervention: contervsial treatment for Grade II/III |
|
Definition
|
|
