A System of Orthopaedic Medicine.

Ombregt L, Bisschop P, Jter Veer H, Van de Velde T. Philadelphia, PA 19106-3399, WB Saunders Ltd, 1995, hardcover, 974 pp, illus, $120.

It is stated in the preface of this text that the "system of orthopaedic medicine" is that of Cyriax, often referred to as "the father of orthopedic medicine." The authors, all former students and colleagues of Cyriax, have collected in one source not only the principles of evaluation and treatment that Cyriax developed, but also his professional philosophy regarding the practice of medicine and rehabilitation. This book was written to be used by family physicians, physical therapists, rheumatologists, orthopedic surgeons, and sports medicine practitioners.

The book is organized into 12 sections covering different regions of the body, as well as additional sections on general principles, psychogenic pain, nerve lesions, and entrapment neuropathies of the upper limb and lower limb. The introductory section on general principles is an excellent overview of the systematic approach on which Cyriax based his techniques. Also very well described is the importance of recognizing referred pain, useful insight into the nature of this phenomenon, and finally a means of using referred pain in making the diagnosis. The section on psychogenic pain, although not comprehensive, includes clinical examination, diagnosis, and treatment and focuses on pitfalls for the examiner and inconsistencies that point to this diagnosis.

Within each section are several chapters on applied anatomy, clinical examination, classes of disorders, and other relevant topics. Readers may find a lack of detail in the anatomy chapters but will appreciate the well-presented and concise coverage and relevant, high-quality illustrations. The chapters on examination and treatment of each area of the body comprehensively cover Cyriax's techniques for a variety of clinical disorders. Thorough evaluation procedures featuring his methods provide the reader with an orderly and systematic approach to clinical diagnosis with special emphasis on differential diagnosis and clinical interpretation of signs and symptoms. Highlighted warning sections detail findings that imply serious disorders. The treatments presented in the book are exclusively those techniques used by Cyriax, primarily consisting of deep friction massage, manipulation, and injections. Although these treatments are explained in detail, they may be of limited use to some physical therapists. The authors stated, "Although there may be equally effective treatments practiced by others, [we] have confined [ourselves] to those with which [we] have considerable personal experience."

The authors of this text have done a commendable job in providing a comprehensive reference of Cyriax's work. This book, with its logical format, clear illustrations and photographs, and inclusive index, will be a valuable tool for those who wish to explore his methods. It is not intended to be an all-inclusive source for the myriad of evaluative and treatment options available to the physical therapist. Students and entry-level clinicians would find this book useful as a supplemental text because of its excellent coverage of clinical evaluation and differential diagnosis of musculoskeletal disorders. Due to its formidable size and limited treatment approaches, however, this may not be an appropriate choice for a primary text in an orthopedic physical therapy course.

Mindy Turner, PT
Boston University
Boston, Mass

Ms Turner is an Assistant Professor in the Department of Physical Therapy, specializing in muscular dystrophy and low back pain.