The Musculoskeletal System: Differential Diagnosis from Symptoms and Physical Signs.

This work addresses the problem of differential diagnosis of the causes of symptoms arising in the musculoskeletal system. The author emphasizes that the musculoskeletal system must be considered as part of an entire living complex and that pathology in one part of the body affects other areas as well. This work is meant to refine the physician's skills in the performance of a mechanical joint assessment; technologically advanced scanning and imaging techniques are advocated only to confirn a clinical diagnosis.

Using a unique organizational system, Mennell identifies seven components of the musculoskeletal system and five pathological conditions. He then cross-matches these components and conditions and creates an organizational framework to guide the reader through the diagnostic process. The heavy medical emphasis in this book is generally beyond the scope of physical therapy. Central to the diagnostic process is the advocation of manipulative examination procedures to assess joint play. The author illustrates manipulative diagnostic procedures in the low back, the foot, and the wrist/hand. Hence, not all areas of the body are represented. A rich use of labeled photos and radiographs complements this section of the text, guiding the reader more readily through specific procedures. Manipulation-oriented therapists will find this section useful, as subject matter is covered in sufficient depth to allow a working knowledge of hands-on technique.

A noteworthy section on the interrelationships within the body system includes a detailed exploration of trigger points and of common clinical entities as seen from the viewpoint of joint dysfunction. The chapter addressing the management of common musculoskeletal aches and pains not due to disease offers the practicing therapist little or no new information. Further, the chapter on physical therapy modalities offers only a superficial discussion on common procedures such as the application of heat, cold, ultrasound, and hydrotherapy. The purpose of this chapter, however, is to acquaint physicians with what these modalities are, rather than to serve as a primer on the specifics of their application. A brief section on injection therapy seems misplaced within this chapter because such procedures are outside the scope of physical therapy. A chapter on shoulder pain seeks to cross-match structures and pathologic changes in order to guide the physician through the thought processes needed to arrive at a diagnosis. Where appropriate, summary charts classify lession characteristics with signs and symptoms of various trauma and diseases.

An appendix following the text contains a reprint of an article about cervical joint dysfunction in which Mennell makes the case for manipulative procedures in the examination and treatment of joint dysfunction. All references cited in this article are of the author's own works. A bibliography is provided that contains, in large measure, the author's previous works. The emphasis of the text, however, is not on statistical reliability and validity, but on expected outcomes to intervention based on the author's clinical experience. Where appropriate, he cites the work of others in the field.

The text is well organized in that it follows a logical progression in presenting the organization of the musculoskeletal system first, then structural diagnosis and clinical examination, followed by the study of interrelationships within the body's systems. This work serves its purpose well in providing physicians with a basis for understanding manual diagnostic procedures and in helping them better appreciate the value of manipulation in the treatment of joint hypomobility. In contrast to texts that address only manipulation or mobilization techniques, Mennell presents a well-balanced discussion on the use of manual examination methods blended with traditional medical procedures within the framework of the living system.