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Examination Techniques in Orthopedics

Nick Harris and Fazal Ali. pp. 214 Cambridge University Press, 2013. ISBN-13: 978-1107623736

This is a good book, from which almost all surgeons will learn something.

It is short, at just under 200 pages, but comprehensive, with thirteen chapters covering general principles and specific regional examinations for both adults and children.  The examination techniques are well shown, with purpose drawn illustrations and both clinical photographs and photographs of models. For this new edition, all of the chapters have been rewritten in a uniform style and a chapter on general principles has been added.

Each chapter starts with history taking, including specific symptoms analysis, followed by step by step eliciting of clinical signs, and ends with a useful summary of techniques.

The contents

  1. General principles of orthopedics clinical examination
  2. Examination of the shoulder
  3. Examination of the elbow
  4. Examination of the wrist
  5. Examination of the hand
  6. Examination of the peripheral nerves in the hand and upper limb
  7. Examination of the adult spine
  8. Examination of the hip
  9. Examination of the knee
  10. Examination of the foot and ankle
  11. Examination of the brachial plexus
  12. Orthopedics examination techniques in children
  13. Examination of the spine in childhood

Many of us have picked up examination skills without formally studying their original descriptions, and it is a great pleasure to review techniques with which one is familiar, as well as to learn new tests.  I particularly enjoyed the sections on apprehension signs in testing elbow instability, contractures affecting the hip (Ely’s test of rectus femoris, Ober’s test of abductor tightness, Phelps’ test of the gracilis) and Clarke’s test for patella-femoral problems.

Clinical examination skills are especially important for those of us in developing countries with limited access to advanced imaging. It is also very helpful for students who will sit for clinical examinations, and the editors are teachers and examiners.

The only weakness of this book is its limited explanations and correlation between clinical tests and their underlying anatomy and pathology, which is probably a function of its brevity. This may be a challenge for junior trainees, but more experienced surgeons should not find this a problem.

In conclusion, this book is useful to trainees preparing for examinations and experienced surgeons wishing to hone their skills, and is applicable to surgeons worldwide.

Reviewed by: Dr Thurein Win Naing, Senior Orthopaedic Trainee, Myanmar