Illustrated Orthopedic Physical Assessment

Ronald C. Evans

• Publisher: Mosby
• Year: 2009
• eBook ISBN: 9780323062985
• Edition: 3
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Logically organized with comprehensive coverage, this newly revised third edition prepares you to choose the right orthopedic tests, accurately assess any patient, and arrive at a clear diagnosis. Trusted for both its depth of coverage and its accessible, accurate information, it features gamuts, clinical pearls, and cross-reference tables for quick and easy reference. Now in brilliant full color, with all new photos of every test, it's even more visually appealing, and illustrates common conditions and procedural tests more effectively than ever before. This edition offers a fresh look at testing for orthopedic conditions, with detailed text that explains the key moves of each test, its alternate names, and the appropriate reporting statement. Extensive cross-referencing ensures that you can easily find the right test for efficient and effective practice, and protocol charts guide you through the examination process step by step.- Chapters are logically organized by region, and tests within each chapter are arranged alphabetically, so you can find the information you need in seconds!- Each test begins with a brief discussion of basic anatomy, then moves into a description of the actual procedure and ends with next-step directives.- Critical Thinking questions at the end of each chapter help you apply what you've learned to clinical practice.- Orthopedic Gamuts provide summaries of key points in a concise list – numerous gamuts within each chapter help you master material quickly and easily.- Clinical Pearls share the author's knowledge gained through years of clinical experience, helping you avoid common misdiagnoses.- Cross-reference tables offer at-a-glance guidance on which tests should be used to diagnose particular diseases, for maximum accuracy and efficiency in practice.- Each chapter begins with an index of tests for easy reference, and axioms that remind you of elemental information, such as how painful certain maneuvers may be or the extent of some body parts' range.- Contains a chapter on malingering (non-organically-based complaints), helping you investigate and determine the root cause of complaint, whether due to injury, for psychological reasons, or an attempt to feign injury for various purposes, such as for improper receipt of worker's compensation.- Companion DVD contains video footage of Dr. Evans performing and explaining each assessment test in the book.- Full-color photographs demonstrate how to perform 237 orthopedic tests!- At the Viewbox feature contains high-quality radiographs that depict various pathologies, as well as musculature and other anatomy that can't be shown photographically.

CHAPTER ONE PRINCIPLES IN ASSESSING MUSCULOSKELETAL DISORDERS

AXIOMS IN ASSESSING MUSCULOSKELETAL DISORDERS

• Eliciting the patient’s history is the quintessential skill in orthopedics.

• An examiner needs to learn about the patient’s major presenting symptoms, the chronology of the disorder, and its impact on the patient’s activities of daily living, as well as ancillary information that includes history and involvement of other systems.

• The orthopedic examination is the focal activity in assessing the patient’s musculoskeletal complaint.

• The orthopedic examination process is adapted to the specific needs of the patient’s musculoskeletal system, such as inspection, palpation, and observation.

INTRODUCTION

Health care providers assess patients every day in clinical practice. Commonly, clinical practice is impossible without structured assessments and tests. Examination procedures appear to be straightforward; results are either positive or negative. However, all assessment and testing in clinical practice is based on the assumption of uncertainty: Does the patient have a disease? The probability of a particular disease can be established only by performing a test or a chain of tests.

The accuracy of a test for detecting a disease or a condition is determined by sensitivity and specificity. A high sensitivity (or a high specificity) does not suffice to make a test useful in clinical practice; a test should be as sensitive as possible. The sensitivity and specificity of examination procedures and tests can often be found in the literature. Sensitivity and specificity are important characteristics of evidence-based physical assessment procedures but only in the context of a specific disease or condition.

The probability of a disease or condition after having performed a test (Bayes theorem) is dependent on two things: (1) the specificity and sensitivity of the procedure (test characteristics) and (2) the probability of the disease or condition before conducting the procedure. Interpretation of Bayes’ theorem is that the probability of having a disease is not only dependent on the test or examination procedure result and the characteristics of the procedure, but is also dependent on how likely the existence of the disease is before the procedure is actually conducted. This likelihood is dependent on the prevalence of the disease.

ORTHOPEDIC GAMUT 1-1 ORTHOPEDIC EVALUATION PROCESS

The orthopedic evaluation process has three phases:

1. History taking

2. Examination

3. Diagnosis

ORTHOPEDIC GAMUT 1-2 CLINICAL ASSESSMENTS

In clinical practice, assessments occur all day, every day, including:

1. Elucidating complaints

2. Establishing impact of the complaints

3. Checking the complaint consistency with specific diagnoses

4. Performing a general physical examination

5. Performing special physical examinations

6. Performing laboratory and imaging tests

7. Interpreting test results

8. Formulating a diagnosis

9. Commencing treatment

10. Evaluating treatment efficacy

11. Referring to a specialist, as needed

The decision on whether to perform a new test depends on the result of the previous test. Procedures with the lowest burden, risk, and costs for the patient are performed first, and those with the highest burden, risk, or costs are reserved for specific patients in which the prior probability is highest. Examination procedures in the context of a low prior probability of disease is rarely, if ever, informative. The yield of diagnostic testing will increase the prior probability in the range of approximately 50%. Very experienced clinicians intuitively apply these rules and arrange their diagnostic process in such a way that the highest possible yield (a highly probable diagnosis) will be obtained at the lowest possible burden, risk, and costs for the patient. Less experienced clinicians may learn from experienced colleagues by recalling Bayes theorem and implementing its principles in everyday clinical practice.

ORTHOPEDIC GAMUT 1-3 BAYES THEOREM

Rules of Thumb rationale for use in clinical situations:

1. Highly sensitive and specific tests will not perform very well i...

Table of contents

• Cover
• Title Page
• DEDICATION
• COPYRIGHT
• ABOUT THE AUTHOR
• PREFACE
• ACKNOWLEDGMENTS
• INTRODUCTION
• Table of Contents
• Chapter 1: PRINCIPLES IN ASSESSING MUSCULOSKELETAL DISORDERS
• Chapter 2: ASSESSING CARDINAL MUSCULOSKELETAL SYMPTOMS AND SIGNS
• Chapter 3: CERVICAL SPINE
• Chapter 4: SHOULDER
• Chapter 5: ELBOW
• Chapter 6: FOREARM, WRIST, AND HAND
• Chapter 7: THORACIC SPINE
• Chapter 8: LUMBAR SPINE
• Chapter 9: PELVIS AND SACROILIAC JOINT
• Chapter 10: HIP
• Chapter 11: KNEE
• Chapter 12: LOWER LEG, ANKLE, AND FOOT
• Chapter 13: MALINGERING
• GLOSSARY OF ABBREVIATIONS
• LISTING OF TESTS, ALPHABETICALLY AND ANATOMICALLY
• LISTING OF TESTS ACCORDING TO THE POSITION OF THE PATIENT
• ANSWERS TO CRITICAL THINKING QUESTIONS
• INDEX