Authors: Jeffrey Gross, Joseph Fetto and Elaine Rosen
The most memorable and effective teachers of clinical medicine are those who can discuss the broadest contexts of a particular problem and are, when necessary, able to focus on the specific discriminating elements that allow an accurate differential diagnosis to be generated.
Reading this thorough and engaging text brings to mind those eminent and learned educators who have the power to demystify complex and challenging scenarios with genuine pearls of wisdom. There is a wealth of detail here that maintains a clarity of exposition while remaining thoroughly comprehensive. It becomes clear that the conceptualisation of the musculoskeletal "system" as a discrete entity akin to, say, the cardiovascular system is a basic error in clinical reasoning. To fully understand the presentation of a musculoskeletal problem, one must also appreciate the neurological and vascular elements, a concept that this book attempts to instil from the outset.
Having authoritative co-authors from the fields of rehabilitation medicine, orthopaedics and physiotherapy provides a feeling of breadth to each chapter so that the proper examination technique is placed firmly within its functional relevance to the evaluation of the patient as a whole.
The opening chapters provide a good brief overview of the physiological and anatomical principles underlying musculoskeletal assessment. Each chapter is subsequently tailored in the same pattern towards the assessment of a specific joint or region.
There is an excellent conglomeration of information. For example, in the assessment of spinal root lesions, each root is described consistently in terms of the sensory, motor and reflex components, with clear accompanying diagrams. Although the text could have benefited, in places, from bullet-pointing or summarisation, the information is generally readily accessible.
There are one or two unusual features to the book. The emphasis on the importance of using the examiner's "dominant eye" in a physical examination is not a concept that most readers will be familiar with or necessarily agree with, and the use of "paradigms" to describe clinical vignettes is sometimes confusing. These are minor criticisms, however, and while the influence of Oliver Cyriax's system of physical examination (Textbook of Orthopaedic Medicine, 1979) is obvious throughout, this text brings a more rounded, functional approach that should be of value to relatively novice as well as more seasoned medical practitioners from a range of disciplines.
Who is it for? A valuable reference for specialists in rehabilitation medicine, sports medicine, orthopaedics and rheumatology as well as physiotherapists. Medical students may initially find the exhaustive amount of information intimidating.
Presentation: Having the same co-authors for each chapter generates a consistent, clear approach from which information is readily accessible.
Would you recommend it? Certainly.