Preface

The fifth edition of Examination of Orthopedic & Athletic Injuries introduces several new features and upgrades. First, we have expanded the Intervention Strategies sections for each condition discussed. This narrative is not intended to provide a detailed explanation of the interventions needed for an individual to return to maximum function. Rather, it provides an overview of the approaches that can be used and serves as the foundation for integrating the diagnostic process with the subsequent interventions.

Each chapter in Sections 2 through 4 includes a new feature, Clinical Correlation tables. When read horizontally, these tables provide a visual representation of key clinical findings (e.g., muscle testing, ROM, clinical tests) and their relationships to pathologies. When read vertically, they present the key clinical findings associated with the pathology. The new Clinical Correlation tables will allow students to identify which clinical tests may be used to develop the differential diagnosis.

Where applicable, we have updated the Muscle Test procedures to include instructions on the use of handheld dynamometry, a technique that allows for a more precise assessment of muscular strength than traditional manual muscle testing. This addition will allow students to understand the process of obtaining precise, objective strength measurements during the evaluation process and, when possible, compare those measurements with those assessed during manual muscle testing. This edition updates the information regarding the diagnostic accuracy of clinical testing and includes additional representation of clinical prediction rules.

The values used to represent the range of scores for interrater and intrarater reliability, sensitivity, specificity, and positive and negative likelihood ratios were obtained from the references cited in Appendix A. When more than five data points were available, the scales were calculated using the interquartile range. For those tests having two to four data points, the low value, high value, and median value were reported. Instructors and students are encouraged to regularly review the literature for the most recent information.

Integration of outcome measures into daily practice is becoming the expectation for high-quality health care. Outcome measures provide a standard approach to understanding the patient’s current status, the impact of a condition on the patient’s life, and the extent to which an intervention is helping the patient. This text emphasizes the incorporation of outcome measures into the examination process and connects these outcomes to a brief description of the interventions used. New opening content for each text section describes commonly used patient-rated outcome measures and region-specific functional assessments. Clinician-rated outcome measures are incorporated into each chapter as well. References for each section have likewise been updated to reflect contemporary evidence that has become available since the publication of previous editions.

The content is organized into five discrete sections. Section 1 presents the foundations of the examination process. Chapter 1 describes the clinical examination process used, and Chapter 2 presents an overview of the immediate and on-field examination processes. Chapter 3 introduces the elements of diagnostic evidence and describes the measures commonly used for assessing outcomes, which are then presented in the relevant section openers. Chapter 4 presents the examination findings of common musculoskeletal disorders (e.g., fractures, sprains, strains, and other inflammatory conditions). Chapter 5 describes diagnostic imaging techniques that often serve as the gold standard in confirming a clinical diagnosis. Chapters 6 (Posture Assessment) and 7 (Gait Evaluation) emphasize general alignment and function that can contribute to a patient’s status.

Section 2 contains those chapters that describe the examination of the lower extremity. Although the content is presented in separate chapters, the actual clinical examination will most likely require an examination of the surrounding body parts. Section 3 presents the examination of the torso. Lumbar and sacral examination is presented in Chapter 13, and Chapter 14 covers the cervical and thoracic spine and the thorax. The examinations of the upper extremity, shoulder, upper arm, elbow, wrist, hand, and fingers are covered in Section 4. The text concludes with Section 5, which addresses injuries to the eye (Chapter 18); face (Chapter 19); and brain, acute cervical spine, and skull trauma (Chapter 20).

We encourage both instructors and students to contact us with questions or comments. Chad’s e-mail address is scalenes@gmail.com, Blaine’s is long4b@cmich.edu, and Julie’s is jcavalla@odu.edu.