The Orthopaedic Physical Examination, ed 2.

The Orthopaedic Physical Examination, ed 2 Reider B. Philadelphia, PA 19106, Elsevier Saunders, 2005, hardcover, 383 pp, illus, ISBN: 0-7216-0264-9, $64.95.

The second edition of this text was developed to introduce new examination techniques that have been found to be reliable since the publication of the first edition in 1999. In order to better delineate relevant clinical anatomy, anatomic drawings have been added to complement the photographs of subjects. Tables now reference specific situations, such as "when the patient complains of medial elbow pain," and then provide a summary of the most common findings and differential diagnosis.

The 383-page book is divided into 9 chapters, each dedicated to major joints or body regions. Each chapter describes surface anatomy, range of motion, palpation, and manipulation, which includes muscle and sensation testing, as well as special tests. Seven contributors have cowritten chapters with the author; all, including the author, are orthopedic surgeons. A bibliography is included at the end of each chapter but is not referenced in the text, making it difficult to use this book to confirm or find more information.

It should be emphasized that this text illustrates the clinical examination from the physician's perspective. Physical therapists should not expect detailed analysis of musculoskeletal movement disorders. For example, to assess knee extension, the text instructs the reader to lift a supine patient's feet and compare the level of the knees. Also, there is just one picture of the examiner using a goniometer in the book. Other instances can be found in chapter 1, which states that estimation of range of motion is often satisfactory. Strength testing is equally brief: "Hamstring strength is usually measured with the patient in the prone position." The author makes no mention of the degree of knee flexion (although the picture of the technique places the knee in 65 degrees of flexion), placement of resistance, or grading the response when weakness is present. I bring out these points not to criticize but rather to illustrate the author's apparent goal of providing a guide for an efficient orthopedic assessment leading to a diagnosis rather than careful documentation of impairments.

Unfortunately, by being brief, little information regarding the validity, reliability, or clinical relevance of the special tests is included. Therefore, it is very difficult to incorporate this text in evidence-based practice. For instance, in the description of tests for labral pathology of the shoulder in chapter 2, the O'Brien test is said to be reliable; however, the Fact that some researchers (Stetson WB, Templin K. The crank test, the O'Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. Am J Sports Med. 2002;30:806-809) found that the test had a specificity of 31%, a sensitivity of 54%, and a positive predictive value of just 41% is not mentioned.

The stated goal of the book is to serve as the definitive text on orthopedic examination techniques. Although it does an admirable job of providing information in a useable format, it will likely be of most interest to the non-orthopedic specialist. Most orthopedic physical therapists who are concerned with evidence-based practice will find the depth of material insufficient. On the other hand, the non-orthopedic physical therapist or physician who wants to have an overview of the main points of the orthopedic examination may appreciate the drawings, text boxes that help guide the examination, and test descriptions.

Terry Randall, PT, DPT, OCS, ATC 

Total Rehab Center

Somerset, Ky

Dr Randall is co-owner of Total Rehab Center, an outpatient orthopedic clinic. He is a clinical instructor for several physical therapy education programs, and his clinical and teaching interest is in primary care and patient management.