Orthopedic Differential Diagnosis in Physical Therapy: A Case Study Approach.

Orthopedic Differential Diagnosis in Physical Therapy: A Case Study Approach

Meadows JTS. New York, NY 10011, McGraw-Hill Inc, 1999, paperback, 453 pp, ISBN: 0-07-041235-9, $42.

This text instructs students and experienced therapists alike in the analysis and integration of "subjective" and "objective" information in the differential diagnosis of patients requiring orthopedic physical therapy. The text is divided into 3 parts. The first part begins with an in-depth discussion of the components of a comprehensive subjective examination. It covers the causes for subjective findings and provides clinical hints about areas that should be paid particular attention. The first part then covers the observation component of the examination and provides detailed lists of pathological conditions and their clinical features.

The text then addresses the objective examination. The differential examination that the author uses is based on principles developed by Cyriax. The book presents an excellent discussion of the musculoskeletal examination, along with clinical hints that the author has developed through years of clinical practice. The text includes a chapter devoted to cancer and its presentation in the physical therapy examination. Red flags associated with a wide variety of cancers are listed. The first part concludes with detailed region-specific examinations of the cervical spine, thoracic region, lumbar spine, and the pelvis.

The second part of the text presents 24 different case studies encompassing a wide variety of patients. The text provides subjective and objective information to the reader followed by thought-provoking questions designed to lead the reader to a differential diagnosis. After each case, the reader is referred to the third part of the text where each case study is discussed. This section shows how the author arrived at his diagnosis and discusses the treatment that was provided, its results, and patient outcomes.

Although the text was designed with the orthopedic manual physical therapist in mind, it is an excellent resource for all therapists. The author's insights into clinical practice are invaluable to all those who practice physical therapy. Physical therapist students would benefit from early use of this text in the formation of their orthopedic evaluation skills. This text is especially useful to those therapists who find that they need additional evaluation and treatment suggestions for their patients with orthopedic conditions.

Byron Russell, PT Hardin-Simmons University Abilene, Tex

Mr Russell is Assistant Professor in the Department of Physical Therapy.