Upper Extremity Injury Evaluation: An Interactive Approach.

Upper Extremity Injury Evaluation: An Interactive Approach Wiksten D, Barry B. Thorofare, NJ 08086, Slack Inc, 2000, CD-ROM, ISBN: 1-55642-402-7, $189. [System requirements: For PC: Pentium 100 processor, Microsoft Windows 95, 98, or NT 4.0, 2X CD-ROM drive, 16 MB RAM, 1 MB SVGA video card, 8-bit Sound Blaster-compatible sound card. For Macintosh: Power PC processor, Mac OS 7.5, 2X CD-ROM drive, 16 MB RAM.]

This CD-ROM presents a comprehensive view of commonly used tests for upper-extremity injury examination. According to the learning objectives, the viewer should be able to identify anatomical structures being tested, correlate the functional role of the anatomical structure as it relates to specific tests, position the subject and examiner appropriately, apply procedures and techniques for performing the test appropriately, discriminate between positive and negative test results, and understand the pathomechanics of positive test results as they relate to the performance of specific tests.

This CD-ROM was reviewed on a Compaq Presario Model 5635, with a 400 MHz Pentium II processor with 512 KB Pipeline Burst Cache; 128 MB 100MHz Sync-DRAM Memory; a 2X AGP Graphics Card with 8MB SGRAM; and a 12 GB ULTRA DMA hard drive.

Five anatomical areas are listed on the main menu: (1) cervical spine, (2) brachial plexus, (3) shoulder, (4) elbow, and (5) wrist and hand. Once the anatomical region is chosen, a submenu lists the tests for that area. The information for each test includes the correct positioning of subject and examiner, the procedure, and a demonstration of both positive and negative test results. At any time, the user may adjust sound levels, view a specific test, take a virtual anatomy tour, play the video forward or backward, return to the main menu, or quit the program. Navigation through the menu-driven program is quite user-friendly, with prompts placed in logical order. The program was installed, and it ran without difficulty. All parameters were easily accessible, even for the novice computer user.

The disc is meant to supplement traditional demonstration and provide an updated look at how to perform upper-extremity examination procedures. In contrast to other works, which utilize animated subjects or cadaver models, this CD-ROM uses real-life models and virtual reality to illustrate the performance of special tests and the pathomechanics of a positive test result. Its interactive format encourages active participation in learning by providing the means to work through the material independently. The full-motion video format lends itself very well to the demonstration of test techniques and is more realistic than still photographs. Positive test results are displayed not only in the test subject but, in some cases, on the anatomical model as well, which leads to a better understanding of pathomechanics. The anatomic review feature, in which structures are labeled and listed along the side of each anatomical model, is particularly noteworthy. Anatomy pertinent to the specific test is highlighted on the accompanying list. The user may zoom in or out and view the model from any angle by rotating it in 3 dimensions.

The material is written with a minimum of verbiage. The clear, concise style of audio, video, and written content is far more conducive to learning than an exhaustive narrative. The written text on each screen matches the audio and video in all but 2 instances. First, in the finger collateral ligament stability test, the audio correctly stated the positive test results for varus and valgus stress; the written graphic, however, had varus results listed twice, whereas the valgus results were omitted. Second, within the empty can test for the shoulder, the audio refers to the cora-coacromial arch, whereas the graphic labels the same structure the cora-coacromial head--this latter terminology is somewhat confusing.

The work presents a variety of test procedures for each of the 5 anatomical areas, ranging from 5 to 8 tests per area. In fact, the section on the brachial plexus contains several tests for each nerve root level, including dermatomes, myotomes, and reflexes when indicated. Test procedures were displayed correctly and concisely. Where appropriate, the authors presented more than one possible implication of a positive test result. The variety of tests are not meant to be exhaustive or all-inclusive; the experienced examiner would find the scope of the material somewhat basic, whereas a physical therapist practicing outside the orthopedics domain or a student would find it valuable as a learning tool.

The work did not include a summary table, which would have been a handy reference for students, or a self-test tool to measure comprehension. There were no printable features, accompanying manual, or online links to other resources.

Nevertheless, the authors succeeded in creating an organized, user-friendly interactive learning tool for the performance and interpretation of clinical tests for the upper extremity. Users should be able to achieve the stated learning objectives. Although the target audience was not specified, physical therapist students will find this work a helpful adjunct to hands-on and classroom instruction; physical therapists practicing outside the orthopedics arena will find it useful for review.

Eugene Pavone, PT Sports Physical Therapy of New York, PC Spring Valley, NY

Mr Pavone practices in an outpatient setting and specializes in orthopedic physical therapy.