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Orthopedic Clinical Examination: An Evidence-Based Approach for Physical Therapists

Stuberg, Wayne PT, PhD

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Pediatric Physical Therapy: April 2007 - Volume 19 - Issue 1 - p 105
doi: 10.1097/PEP.0b013e318030e7d7
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Orthopedic Clinical Examination: An Evidence-Based Approach for Physical Therapists, by Joshua Cleland, Carlstadt, New Jersey, Icon Learning Systems, 516 pp, $66.95.

Orthopedic Clinical Examination: An Evidence-Based Approach for Physical Therapists, is a first-edition text whose purpose is to “serve as a supplement in musculoskeletal evaluation courses in an academic setting and to provide a quick, user-friendly guide and reference for clinicians who wish to locate evidence related to diagnostic usefulness of commonly used tests and measures.” Principles of evidence-based practice as described by Sackett1 are central to the construction of the text as the author successfully provides the reader with a clear, quick reference to enhance knowledge for evidence-based decision-making.

The first two chapters of the text provide the reader with a concise overview of the topics; reliability and diagnostic utility of the orthopedic clinical examination and on the identification and analysis of articles investigating diagnostic utility of clinical tests and measures. Discussion of individual cases with select test and measurement procedures demonstrate the application of data to clinical practice.

The remaining 10 chapters of the book focus on specific regions of the body, starting with the temporomandibular joint followed by the cervical spine, thoracolumbar spine, sacroiliac joint, hip and pelvis, knee, foot and ankle, shoulder, elbow and forearm, and ending with the wrist and hand. Each chapter begins with an overview of osteology, arthrology, ligaments, muscles, and nerves using excellently illustrated diagrams from Netter and a talented group of medical illustrators. The remaining sections of each chapter then move to examination history, presentation of select testing procedures, reliability of the procedure, diagnostic utility of the procedure and, finally, references. Information on each test procedure includes a figure with the measurement instrument placement demonstrated, if applicable. Tabular information is also given based on a literature review of use of the test procedure in normal or select pathologic populations and the reliability of the procedure. If available, the sensitivity, specificity, likelihood ratio of a positive or negative test result is also provided to the reader.

Although a significant amount of work has gone into the writing of the text to document the clinical utility of the examination procedures, there are areas pertaining to the practice of pediatrics that are missing. For example, the text does not present any information on the examination of scoliosis. There are pediatric examples provided such as for avascular necrosis of the hip or hip dysplasia. Another limitation of the text is that no information is provided on the normal developmental changes that take place in the musculoskeletal system. For example, the frontal plane changes of the knee into valgus and varus or the torsional changes of the long bones such as the femur or tibia that can contribute to abnormal knee joint or foot orientation. Another example is the absence of discussion of the physiologic contractures seen in the newborn period that are necessary for the practitioner to understand when performing an orthopedic examination on a very young infant. Finally, data on the reliability of common orthopedic tests, such as goniometry in pediatric pathologic populations such as with cerebral palsy or spina bifida, is not provided as the emphasis of the text has been placed on testing procedures used primarily on adult orthopedics.

In summary, the text is well written and an excellent example of moving from a text providing only qualitative information on testing procedures used in physical therapy and other areas or rehabilitation medicine to providing an evidence-based approach to test selection and clinical interpretation of testing results. The author is to be applauded for this effort. The illustrations are outstanding. For the practitioner working primarily in pediatrics, the text would provide a firm foundation, but other reference materials would be necessary for a comprehensive approach to the orthopedic examination of the child.

Wayne Stuberg PT, PhD

Munroe-Meyer Institute, Omaha, NE


1. Sackett, DL, Straws SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. London: Harcourt Publishers Limited; 2000.
© 2007 Lippincott Williams & Wilkins, Inc.