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Advanced Examination Techniques in Orthopaedics

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Cambridge University Press978-0-521-86241-7 - Advanced Examination Techniques in OrthopaedicsEdited by Nick HarrisFrontmatterMore information

www.cambridge.org© in this web service Cambridge University Press

http://www.cambridge.org/9780521862417

http://www.cambridge.org


ForBecky, Lucy, Rosie, Molly

&Desmond

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Advanced ExaminationTechniques in Orthopaedics

Edited byNick Harris FRCS(Tr and Orth)

Assistant Editor

David Stanley BSc(Hons) FRCS

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Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiviPreface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ivii

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiix

1 Examination of the Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001R E Page

2 Examination of the Wrist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 023S H Bostock

3 Clinical Examination of the Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 041D Stanley

4 Examination of the Peripheral Nerves in the Hand and Upper Limb . . . . . . . . . . . . . . . . . 061J Srinivasan & L C Bainbridge

5 Examination of the Shoulder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 079N Harris & P Calvert

6 Examination of the Brachial Plexus Following Trauma . . . . . . . . . . . . . . . . . . . . . . . . 105S Kay

7 Examination of the Adult Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123N Chiverton & C J M Getty

8 Examination of the Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135I Stockley

9 Examination of the Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147D R Bickerstaff

10 Examination of the Adult Foot and Ankle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163N J Harris & T W D Smith

11 Orthopaedic Examination Techniques in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . 189J A Fernandes & M J Bell

12 Examination of the Spine in Childhood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211N Chiverton & R A Dickson

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

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cambridge university press Cambridge, New York, Melbourne, Madrid, Cape Town,

Singapore, São Paulo, Delhi, Mexico City

Cambridge University PressThe Edinburgh Building, Cambridge cb2 8ru, UK

Published in the United States of America by Cambridge University Press, New York

www.cambridge.orgInformation on this title: www.cambridge.org/9780521862417

© Greenwich Medical Media Limited 2003

This publication is in copyright. Subject to statutory exceptionand to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written

permission of Cambridge University Press.

First published 2003Reprinted by Cambridge University Press 2005

Fourth printing 2010

A catalogue record for this publication is available from the British Library

isbn 978-0-521-86241-7 Hardback

Cambridge University Press has no responsibility for the persistence oraccuracy of URLs for external or third-party internet websites referred to in

this publication, and does not guarantee that any content on such websites is,or will remain, accurate or appropriate. Information regarding prices, travel

timetables, and other factual information given in this work is correct atthe time of first printing but Cambridge University Press does not guarantee

the accuracy of such information thereafter.

Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with accepted standards

and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of

the individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally

free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publishers therefore

disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay

careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.






Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiviPreface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ivii

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiix

1 Examination of the Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001R E Page

2 Examination of the Wrist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 023S H Bostock

3 Clinical Examination of the Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 041D Stanley

4 Examination of the Peripheral Nerves in the Hand and Upper Limb . . . . . . . . . . . . . . . . . 061J Srinivasan & L C Bainbridge

5 Examination of the Shoulder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 079N Harris & P Calvert

6 Examination of the Brachial Plexus Following Trauma . . . . . . . . . . . . . . . . . . . . . . . . 105S Kay

7 Examination of the Adult Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123N Chiverton & C J M Getty

8 Examination of the Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135I Stockley

9 Examination of the Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147D R Bickerstaff

10 Examination of the Adult Foot and Ankle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163N J Harris & T W D Smith

11 Orthopaedic Examination Techniques in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . 189J A Fernandes & M J Bell

12 Examination of the Spine in Childhood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211N Chiverton & R A Dickson

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

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Mr L C Bainbridge FRCSDerby Royal InfirmaryDerby

Mr M J Bell FRCSSheffield Children's Hospital, Western Bank,Sheffield

Mr D R Bickerstaff MD FRCSSheffield Centre for Sports MedicineSheffield

Mr S H Bostock FRCS(Tr and Orth)Northern General HospitalSheffield

Mr P Calvert MA FRCSSt George's HospitalLondon

Mr N Chiverton FRCS(Tr and Orth)Northern General HospitalSheffield

Professor R A Dickson MA ChM FRCS DScClinical Sciences Building, St James's HospitalLeeds

Mr James Fernandez FRCS(Tr and Orth)Sheffield Children's Hospital, Western Bank,Sheffield

Mr C J M Getty MA FRCSNorthern General HospitalSheffield

Mr N J Harris FRCS(Tr and Orth)Leeds General InfirmaryLeeds

Mr R E Page ChM FRCSNorthern General HospitalSheffield

Mr T W D Smith FRCS, FRCS(Ed)Northern General HospitalSheffield

Mr J SrinivasanDerby Royal InfirmaryDerby

Mr D Stanley BSc(Hons) FRCSNorthern General HospitalSheffield

Mr M M Stephens MSc(Bioeng), FRCSIFoot Clinics, Children's Hospital, Temple StreetDublin 1, Ireland

Mr I G Stockley MD FRCSNorthern General HospitalSheffield

Contributors

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The original concept for the book arose when I was preparing for my FRCS(Tr and Orth) Exam. I found itdifficult to quickly revise special tests on clinical examination. If you wanted to look at tests for postero-lateral rotatory instability of the knee you had to get a specialist text on knee surgery. Similarly if you wantedto review tests for rotator cuff tear of the the shoulder you had to get a specialist text on shoulder surgery.Those existing books that covered clinical examination seemed too basic for what I needed. They were aimedmainly at medical students. The aim therefore was to compile a book looking at advanced examination tech-niques in orthopaedics. Each chapter has been written by an expert or under the supervision of an expert inthat area. Rather than produce long lists of different clinical tests we asked the contributors to describe whichtests they found most useful in their day to day practice. The foundation for a good clinical examination willalways be inspection, palpatation and movement. If this can be followed up with directed specific tests it isoften possible to make an accurate diagnosis without the need for other expensive investigations.

As well as being of value to the Orthopaedic Registrar approaching the FRCS(Tr and Orth) Exam the bookwill also be of interest to physiotherapists, sports physicians, rheumatologists and G.P.’s.

N.H.Leeds

September 2002

Preface

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Foreword

With the meteoric increase in reliance on advanced technology for diagnosis and treatment, a return to thebasics is a careful physical examination. This work represents a very interesting approach to the physicalexamination and is true to its title of Advanced Examination Techniques. This effort would certainly supportthe mantra “When in doubt, examine the patient.” This orientation has never been more true than today, andthis textbook goes a long way in aiding the orthopedic surgeon along this path.

Yet, one might question the need for a text such as this given the existence of other such works. The valueof this contribution is the thorough and comprehensive nature of the text and the clarity of photographs andease of reference. Many of the examinations and diagnoses are not readily available in previous works. Theconsistent format is certainly user-friendly and allows a valuable and updated compendium of physical signsas well as the details of the examination. It goes without saying the attractiveness in no small measure is alsoenhanced by the subjects in which the examinations are being demonstrated.

The authors have realized the goals stated in the preface, and I anticipate that the reader will find this notonly a valuable and interesting reference source, but also an enjoyable one.

Bernard F. Morrey, M.D.The Mayo Clinic

Rochester, MinnesotaUSA

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Acknowledgements

There are many people I need to thank who helped with the production of this book. Dave Stanley gave methe initial encouragement to approach the publishers with the idea in the first place. Greenwich MedicalMedia have been very patient with my attempts to meet some of the deadlines promised. Gavin Smith in par-ticular has been very flexible in the construction of the book. Howmedica and Chris Lloyd provided fundsfor the models and photographer. Yvonne Paul Management who provided the models and GeorgeRichardson the photographer worked hard to ensure we got all the illustrations we needed in the one shoot.Jade and Leilani were truly professional models.

My greatest thanks go to the contrubutors all of whom have made family and professional sacrifices toensure we received their relevant chapters on time. I am also especially grateful for the support and encour-agement I have received throughout my training from Tom Smith, Mike Bell and Ian Stockley.

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