Clinical Examination Methods in Orthopaedics John Ebnezar
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1Clinical Examination Methods in Orthopedics
(Supplement to Textbook of Orthopedics, Fourth edition)
Second Edition
John Ebnezar MBBS D'Ortho, DNB (Ortho), MNAMS (Ortho), DAc, DMT, PhD (Yoga) Sports Medicine (Australia), INOR Fellow (United Kingdom) Consulting Orthopedic and Spine Surgeon and Holistic Orthopedic Expert, Sports Specialist Formerly Assistant Professor of Orthopedics Devaraj Urs Medical College Kolar, Karnataka Senior Specialist in Orthopedics Department of Orthopedics Victoria Hospital Bangalore Medical College Currently Chief Consulting Orthopedic Surgeon and Medical Director Parimala Health Care Services, An ISO 9001:2000 hospital, Bengaluru Chairman Ebnezar Orthopedic Center, Bengaluru Chairman Dr Ebnezar's Medical Institute President Geriatric Orthopedic Society President All India Medical Author's Association Chairman The Physically Handicapped and Paraplegic Charitable Trust of Karnataka President The Karnataka Orthopedic Academy Director Bangalore Holistic Orthopedic Centre, Bengaluru President Vaidya Kala Ranga, Bengaluru Chairman Rakesh Cultural Academy
3Published by
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Clinical Examination Methods in Orthopedics
© 2010, John Ebnezar
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2006
Second Edition: 2010
Typeset at JPBMP typesetting unit
Printed at
My mother (Late) Sampath Kumari
who taught me that life is more than self and there
is more joy in giving and sharing than taking
My wife Dr Parimala, my lovely children
Rakesh and Priyanka
who are an epitome of love, sacrifice, encouragement and inspiration
All my teachers
who made me what I am today
All my students past and present
5Preface to the Second Edition
Clinical examination is an art which helps us to diagnose the diseases. Unfortunately, it is a dying art in the modern times, thanks to the boom in diagnostic services and dependence on investigations by clinicians cutting across all specialties. Our ancestors who were deprived of these investigations were very good clinicians and believed in diagnosing diseases clinically based on their experience and knowledge. We need to revive this art for we first need to be good clinicians, then good surgeons and I am sure this will make us better doctors. We need to make our diagnosis clinically and depend on investigations for confirming our diagnosis and not the other way around as it is today.
To instill the interest in the art of clinical examination, a supplement is being provided with the 4th edition of the Textbook of Orthopedics. I recommend using this book before examining a patient in the wards and acquaint you with the proper knowledge and technique of clinical examination methods. This book gives you a brief insight into the clinical examination methods and you need to refer bigger books for the details.
The page numbers and figures mentioned in the supplement refer to the relevant portions in the main Textbook of Orthopedics. Students are requested to refer to these frequently. Hence just reading the supplement alone without reading and referring to the Textbook of Orthopedics will not be of much help. I suggest the students to first read the Textbook of Orthopedics and then read the Clinical Supplement and not vice-versa.
John Ebnezar
6Preface to the First Edition
I have always felt a proper clinical examination is the key, which opens the treasure of knowledge and this, applies to orthopedics too. To keep the students abreast with the know-how of proper clinical examination methods a supplement is being provided with the main Textbook of Orthopedics. This makes it easier for the students to carry and refer it during the clinical postings and ward rounds and is relieved of carrying the bigger textbook to the clinical postings. I suggest the students to keep the following things in mind:
John Ebnezar