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Yоur pаtient is а 55-yeаr-оld female high schоol teacher who tripped and fell on her L side eight weeks ago. She sustained a humeral fracture and underwent surgery (Open Reduction Internal Fixation - ORIF) three days after her fall. Recent x-rays demonstrate callus formation at the fracture site, as well as decreased bone density in other parts of the humerus, consistent with osteoporosis. The patient had been cleared to participate in PT with no restrictions. She has been attending PT for the last three weeks at another clinic, but you are now examining her as a new patient. She reports stiffness and weakness in her L upper extremity, with pain up to 4/10 with activities. She finds it difficult to perform daily activities such as dressing,grooming, and cooking. When asked about the fall during which she sustained her fracture, she reports no other recent falls, but says she doesn’t feel as strong or steady as she used to feel. She also states that she has always been active but has never followed a specific training or workout regimen. Previous medical history includes:Moderate osteoporosisAtrial fibrillationMetabolic syndromeUrgency urinary incontinence (Was prescribed meds but stopped after three months due to side effects. Was referred to PT but hasn’t gotten around to going.) Current medications: Warfarin (blood thinner), Acetaminophen (pain), Alendronate (osteoporosis) On physical examination, you noted the following:Increased thoracic kyphosis with forward head postureDecreased flexibility of bilateral pectoralis minor musclesAROM: (L/R)Shoulder F 100 deg/165 degShoulder AB 90 deg/150 degShoulder ER 10 deg/60 degMMT: L/R Shoulder F 4/5/5/5AB 4/5/5/5Shoulder ER 3/5/5/5Scapular musculature grossly 4-/5 5/5 Due to her mechanism of injury (fall) and her subjective report of feeling less strong and more unsteady, you decide to assess her balance and gait. Findings include: Able to maintain double leg stance eyes open and eyes closed, 30 seconds.Single leg stance eyes open limited to 7 seconds both L and R sidesUses hip or stepping strategy to manage very small balance perturbationsDecreased L hip extension during terminal stance
Oxyhemоglоbin fоrms by а chemicаl reаction between which of the following?