Orthopaedic Testing: A Rational Approach to Diagnosis.

Gerard JA, Kleinfield SL. New York, NY 10011, Churchill Livingstone Inc, 1993, hardback, 668 pp, illus, $129.95.

The authors intend this text to be used as a reference by health care practitioners and students. The text consists of 14 chapters, each is dedicated to testing a specific part of the body. The chapters include testing of the cervical spine, orientation and vestibular system, thoracic outlet syndrome, shoulder, elbow, wrist and hand, thoracic spine, lumbar spine, sacroiliac joint, hip, knee, ankle and foot, lower-extremity vascular system, and malingering.

The analysis of each test describes the procedure, rationale, classical significance, and follow-up tests to confirm the diagnosis. Illustrations that accompany the analysis take the reader from beginning to the end of each test. Placement of care flow charts at the beginning of all but two chapters shows the outline of the examination process for each area being tested. Range-of-motion procedures follow each flow chart. The authors demonstrate an arthrodial protractor or an inclinometer used to assess a patient's range of motion. These procedures are clearly explained, including the expected normal ranges, and are accompanied by illustrations.

Although the authors have gone to great lengths to describe each test thoroughly, they do not give the available reliability and validity information for the tests. The authors also do not address the different names each test has in the literature and the different ways of doing each test. It would have been helpful to the reader if these problems were addressed. Also, the authors refer to anatomical areas, such as "Dejerine's triangle," but they do not describe nor reference these, so the reader is not able to seek additional information.

One of the shortcomings of this text is the chapter on the malingering test. The chapter consists of 14 tests; however, 3 of the tests are repeated in the chapters on cervical, thoracic, and lumbar spine. Also, some of the common tests found in the literature, for example, Waddell's test, are not even mentioned. The bibliography is another shortcoming. It contains 16 sources the authors have used to prepare this text, but they are not cited in the text. The reader has no way of finding additional information on any of the tests.

The authors have done a nice job of writing this text. It is well organized, and the illustrations add to understanding the procedure of each test. This text provides a good review of the orthopedic tests for the musculoskeletal system and would be a useful reference for the health care student or practicing clinician.