Orthopedic Physical Assessment, ed 4.

Magee DJ. Philadelphia, PA 19106, Saunders, 2002, hardcover, 1,034 pp, illus, ISBN: 0-7216-9352-0, $69.95.

The purpose of this textbook is to present a systematic approach to the clinical examination of the neurological and musculoskeletal components of the major joint systems of the spinal column and the extremities. The text emphasizes a sequential method of fundamental and special test procedures for the differential diagnosis of both common and uncommon orthopedic conditions. Although it focuses on physical therapy and contains essential knowledge for physical therapist students and practicing physical therapists and physical therapist assistants, the book is also important for a variety of other health care providers: athletic trainers, chiropractors, family practitioners, and orthopedic physicians.

The first chapter, "Principles and Concepts," builds an effective foundation for the rest of the book through its presentation of the general principles of orthopedic examination. Topics include the basic importance of the patient history and chief complaint; the assessment of pain, with patterns of referred pain; a review of peripheral neuro-anatomy, with emphasis on the brachial plexus; the general differentiation among muscle, tendon, and ligament injuries; a review of manual muscle testing and manual therapy evaluation procedures, including end-feels, capsular patterns, and accessory motion testing; and the fundamental techniques of diagnostic imaging procedures. The material is based on the traditional works of Cyriax, Kaltenborn, Maitland, McKenzie, and Mennell, and is complemented effectively by descriptions of common laboratory test values relevant to orthopedic problems and by the inclusion of functional assessment scoring scales and disability indexes for activities of daily living.

The chapter then outlines the assessment format and the subsections that appear in most of the chapters in the book: "Applied Anatomy," which includes biomechanics; "Patient History," which includes pathomechanics, signs, and symptoms; "Observation"; "Examination," which uses the traditional orthopedic scheme of active, passive, and resisted motion testing, functional assessment, special tests, neurological tests, accessory movements, and palpation; "Precis"; and "Case Studies."

The assessment format is systematically applied to the major joint systems of the body through the following chapters: "Head and Face"; "Cervical Spine"; "Temporomandibular Joint"; "Shoulder"; "Elbow"; "Forearm, Wrist, and Hand"; "Thoracic (Dorsal) Spine," which includes the ribs; "Lumbar Spine"; "Pelvis"; "Hip"; "Knee"; and "Lower Leg, Ankle, and Foot." Overall, the text is clear, succinct, and effectively complemented by numerous tables, diagrams, and photos. In each chapter, the author incorporates age-specific information from the fields of pediatrics and geriatrics and application-specific information from industrial and sports settings. Although little information on the reliability and validity of the measurements appears directly in the text, each chapter is well referenced with citations to studies where this supporting information can be found.

Several chapters are noteworthy because they include special content not found in other physical assessment texts. Chapter 2, "Head and Face," addresses the aspects of concussion, headache, vision problems, and eye and ear examination procedures in surprising detail. Chapter 9, "Lumbar Spine," includes ergometric tests for intermittent claudication. Chapter 10, "Pelvis," details the biomechanical causes and effects of innominate obliquity and leg length differences. Chapter 13, "Lower Leg, Ankle, and Foot," describes common abnormal ossicles in the foot and ankle region.

The book also includes several specialized chapters on the testing of gait and posture and the examination of people with amputations; emergency sports assessment; and pre-participation evaluation. Chapter 14, "Assessment of Gait," contains not only a description of the normal gait cycle, but a practical analysis of the parameters of base width, step and stride lengths, pelvic movements, and cadence. The chapter also details an extensive variety of abnormal gait patterns, including arthrogenic gait, Trendelenberg gait, psoatic limp, and steppage or drop-foot gait. Chapter 15, "Assessment of Posture," addresses the aspects of the developmental sequence and the age continuum and includes an excellent summary chart that compares "good" versus "faulty" postures.

Chapter 16, "Assessment of the Amputee," is unique to the general assessment literature and is another strength of this book. It contains detailed descriptions of levels of amputation, phantom limb pain, postsurgical pathomechanics and pathophysiology, and prosthetic fitting issues that rival specialized textbooks on these subjects. In sharp contrast, chapter 17, "Emergency Sports Assessment," deviates from the book's primary mission as a textbook on clinical examination by describing "on the field" responses to a sports injury. Although accurate, the material merely duplicates the information found in basic books on first aid and emergency care, and the chapter is biased toward football, with little mention of other sports, and toward head and neck injuries, with no mention of other sports-related emergencies, such as heat stroke or tibiofemoral joint dislocation. The author could have folded the information in this chapter into chapter 2, "Head and Face," or chapter 3, "Cervical Spine."

The final chapter, "Preparticipation Evaluation," is noteworthy because it presents the concept of a physical fitness profile that is applicable to occupational and industrial activities, not just to sports. The text describes a screening approach (examination of vision; vital signs; the musculuskeletal, neurological, cardiopulmonary, urogenital, and gastrointestinal systems; skin; teeth; and general medical problems) that provides baseline data usable for reference and comparison; however, this chapter lacks the specific and extensive detail found in the rest of the book and includes minimal information on instrumented testing methods, such as inclinometry and performance dynamometers.

These matters and the previously mentioned limitations, however, do nut significantly detract from an overall fine and economical textbook that is important reading for any evidence-based practitioner.

Kent E Timm, PT, PhD, OCS, SCS, ATC 

Aleda E Lutz Veteran's Affairs

Medical Center

Saginaw, Mich

Dr Timm is Clinical Specialist in the Physical Medecine and Rehabilitation Service and specializes in the treatment of musculoskeletal conditions, especially sacroiliac joint dysfunction, low back pain, and rotator cuff disorders.