This textbook and CD-ROM cover the musculoskeletal evaluation process for the spine and extremities. The editors are well-known for their expertise in the application of evidence-based practice to musculoskeletal medicine. In this text, they have linked the evidence to the physical examination. This text is designed for any clinician who treats patients with musculoskeletal complaints. The book is spiralbound and would easily fit in a lab coat for quick reference.
The first section of this text is dedicated to explaining reliability, diagnostic accuracy, sensitivity, specificity, and likelihood ratios. The explanations are very concise and accurate. Clinical examples are given to assist the reader in understanding these terms and how they are applied. Nine self-report measures are discussed. Examples of forms for these self-report measures are found on the accompanying CD-ROM. These forms include a medical screening form; Patient Specific Functional Status form; Numeric Pain Rating Scale; Neck Disability Index; Quick Disability of the Shoulder, Arm and Hand; Oswestry Disability Index; Lower Extremity Functional Scale; Global Rating of Change; and Fear-Avoidance Beliefs Questionnaire. There is a superb chart that illustrates the reliability and the minimal clinically important difference for each of these self-report forms when they have been reported in the literature.
In the “Medical Screening Examination” section, signs and symptoms are mentioned for conditions that may warrant referral to another health care provider. These are referred to as red flags. Pain diagrams illustrate different patterns of pain that might be present with specific diseases. Clinical predication rules for deep vein thrombosis are presented. The level of specificity and sensitivity and the positive and negative likelihood ratios of specific questions and their answers are provided according to system: cardiovascular, gastrointestinal, genitourinary, endocrine, pulmonary, and integumentary. There also are screenings for depression, peripheral arterial disease, neurologic disorders, and a mini-mental examination.
The CD is most useful in conjunction with the remainder of the book. The CD contains the full text of the book along with accompanying videos that demonstrate the specific evaluative maneuvers. This allows the reader not only to read the directions for the proper manner in which to perform the test, but to see it as well. The pictures and videos are clear and demonstrate both the therapist's and patient's positioning. These are the strengths and real value of this text.
Region-specific historical questions are presented in each section to assist the reader in making a more accurate diagnosis. For example, in the cervicothoracic spine examination section, likelihood ratios are presented for 2 questions that will assist the reader in identifying a patient with cervical radiculopathy. Although treatment techniques are not the focus of this book, the editors present evidence regarding specific treatment regimens. In the lumbar spine section, test item clusters are listed for patients who are likely to benefit from either lumbar manipulation or stabilization exercise treatment.
The book includes examination schemes and procedures for the cervicothoracic spine, shoulder, elbow, wrist and hand, temporomandibular joint, lumbar spine, hip, knee, and the foot and ankle. The examination scheme is specific and includes historical examination and visceral referral patterns; observation, functional tests, and palpation; active range of motion, passive range of motion, and overpressure; and resisted muscle tests, assessment of accessory movements, and special tests. Rather than demonstrating every examination test available, the editors have selected those tests that are evidence based and assist the clinician in making a more accurate diagnosis.
This book is unique in combining evidence and physical examination, helping the clinician to make a diagnosis more accurately. It is well referenced and up to date. Updates to the book are available on the Internet. The CD is extremely user friendly, and the video clips, along with the written description, make the examination techniques very clear and easy to follow.
I would enthusiastically recommend this text for any clinician or student that will be examining patients with musculoskeletal dysfunctions. This text would be a significant asset for any medical student, nurse practitioner, physician assistant, or physical therapy student. This is an excellent reference for clinical instructors as well.
- American Physical Therapy Association
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