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

Abstract

Busy orthopaedic physiotherapy clinicians who are striving to attain “evidence-based practice” can rejoice—Joshua Cleland has provided them with an indispensable tool! This text uniquely and effectively summarizes the seemingly insurmountable literature examining the reliability of the orthopaedic assessment—such as subjective questions, measurements (e.g., ROM), and special tests—into convenient, easy-to-read tables. For example, a clinician deciding which questions to ask and which tests to undertake for a patient with suspected knee ligament instability can search the tables presenting the reliability of a history of “giving way” and the procedure for/reliability of undertaking the Lachman Test. These tables also give the clinician an impression of the relative “strength” of the test or measure to detect an abnormality (e.g., its sensitivity, specificity, and likelihood ratio). As a consequence, the clinician has the information necessary to critically evaluate the outcome of the subjective and objective examinations in order to determine the likelihood of the suspected diagnosis. Clinicians will also appreciate the heavy emphasis on meticulous illustrations by Frank Netter et al. that graphically present the osteology, arthrology, ligaments, muscles, and nerves for each region of the body. The extensive use of photographs complements the review of the physical examination. Although the graphics and tables make for easy reading, the first two chapters are more challenging. They summarize concepts such as probability, reliability, sensitivity, specificity, likelihood ratios, confidence intervals, clinical prediction rules, and the fundamentals of critical analysis. These chapters provide the necessary background to understand the information provided in the tables throughout the subsequent chapters. In summary, this text skilfully amalgamates the clinical and academic worlds of orthopaedic assessment. Clearly, accuracy in clinical diagnosis is critical, and all practitioners (orthopaedic surgeons, general practitioners, and physical therapists) must ensure that they are using best practices.1 Accordingly, this text will be a valuable resource for academics in medicine and physiotherapy who are teaching the theory and skills of orthopaedic assessment, as well as for the medical or physical therapy student or clinician, as it adeptly synthesizes the academic literature to facilitate evidence-based practice.