Second Edition
Manish Kumar VarshneyMS (Ortho), DNB (Ortho Surg), MNAMS, MRCS (Glas)
Consultant Orthopaedic Surgeon Tata Motors Hospital,
Jamshedpur Jharkhand, India
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This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure the accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Practical Orthopedic Examination Made Easy®
First Edition: 2009
Second Edition: 2012
9789350257838
Printed at
To
My doting wife Neeta Verma
My loving son Siddhant
and
All my respectable teachers
and
Caring students...
- Aditya Soral MBBS, MS
- Senior Resident
- Department of Orthopaedics
- All India Institute of Medical
- Sciences
- New Delhi, India
- Manish Kumar Varshney
- MBBS, MS (Ortho), DNB (Ortho Surg) MNAMS, MRCS (Glas)
- Consultant Orthopedic
- Surgeon, Tata Motors
- Hospital, Jamshedpur,
- Jharkhand, India
- Mohit Singh MBBS, MS (Gen Surg)
- Senior Resident
- Department of General
- Surgery, Safdarjung Hospital
- New Delhi, India
- Prashanth I MBBS, MS (Ortho)
- Senior Resident
- Department of Orthopaedics
- Safdarjung Hospital
- New Delhi, India
- Ram Kinkar Jha
- MBBS, MS (Ortho), MRCS
- Specialist, Tata Main
- Hospital, Jamshedpur,
- Jharkhand, India
- Sudeep Kumar
- MBBS, MS (Ortho)
- Consultant, Jolly Grant
- Hospital, Dehradun,
- Uttarakhand, India
- Sameer Naranje
- MBBS, MS (Ortho)
- Senior Resident
- Department of Orthopaedics
- All India Institute of
- Medical Sciences (AIIMS)
- New Delhi
- India
- Tahir Ansari
- MBBS, MS (Ortho)
- Senior Resident
- Department of Orthopaedics
- All India Institute of
- Medical Sciences (AIIMS)
- New Delhi
- India
After moving out of my parent institute, I realised that there are a few cases that postgraduates encounter during exams which are not covered in the current text. Brief teaching experience at Lady Hardinge Medical College and associated hospitals reaffirmed the need for second edition incorporating some more cases. I have not changed the original text to a large extent for simple reason that the basic approach to questions and their answer remain the same. Minor changes have been done in examination section of hip, knee and spine and ankle and foot cases. Additions are in the form of new cases for malunited distal radius fracture and intertrochanteric fractures. Hand section has been upgraded to large extent and now additionally carries cases on cut tendon injuries, carpal tunnel syndrome and malunited distal radius fractures. Some more questions have been added to Chapters 11 and 12. My current practice as joint replacement and arthroscopy surgeon has segregated me from most of the usual instruments and implants, so I could not gather enough courage to add chapter on instruments and implants, though I feel there an erstwhile need for the same. I promise to include section on instruments and implants and surgical exposures that are commonly asked in exams in future reprints/edition. I am thankfully obliged to my previous mentor Prof PP Kotwal for encouraging me to remain in academics and timely guiding me for current needs, he himself is a great academician. My current head Dr VP Singh had immensely cooperated by omitting my inconsistencies at work and extracurricular activities while providing me time and support to finish the writing work. New author, Dr Ram Kinkar Jha has given good support to revise spine section and writing carpal tunnel syndrome. Dr Aditya Soral has re-contributed in the form of new inputs and editing few deficiencies in the previous text. I am thankful to all the DNB students for making 7the text a success, while myself being able to continue with my initiation of helping in academics for postgraduate students.
Most importantly in the end, I urge all DNB students who have read or are reading the current text (or even previous text) for providing me with regular inputs either at Facebook (Manish Kumar Varshney) or writing to me at manish.varshne@tatamotors.com (y unknowingly removed from this new e-mail ID). This will help me in generating the quality work useful to all.
Manish Kumar Varshney
8Preface to the First Edition
The first edition of Practical Orthopedic Examination Made Easy has emerged after giving immense thought over the imminent need for a text that could serve to guide the postgraduates in the field for preparing through the ultimate acknowledgement of degree. The book specifically serves the stratified group of people preparing for orthopedic practical exams but also it does help a beginner in the field; gain theoretical knowledge and grab some basics often not found in modern orthopedic textbooks.
It has been an endeavor to keep the text as simple and directed to maintain interest of the reader. Also preservation of continuity in the text and standardization of information has been specifically dealt with. This gives an advantage for reader rehearse the examination scenario virtually and identify weaknesses to improve upon and strengths to maintain. While providing the most frequently asked questions and the ‘expected’ answers, consideration has also been given to some uncommon or unique questions with diligent answers. I have tried to provide as non-controversial an answer as possible with direct impact on the next possible questions while simultaneously being adequate. Still some controversial answers are detailed and are expected to be accepted by prevailing popular choice.
The examination points given at the beginning of every region serve as a quick synopsis along with comments on some uncommon tests that are still uncommonly asked. Figures have deliberately been omitted to make the material less bulky which considering the same are easily found in standard textbooks for orthopedic clinical examination. This work should be perceived in the deserved perspective and is not expected to substitute the standard orthopedic textbooks that have been the masterpieces in the field. When read as contemporary to the 9standard textbooks, this work helps one understand the meaning of ‘reading between lines’ that is often the basis of some formidable questions stumbling even some avid book lovers. Organization of the book into regional affections and pertinent cases is more deliberate than accidental considering the relevance of ‘regions’ to examination cases. Some short cases however, have to be clubbed into miscellaneous section as they are either common to various sections or are full sections by themselves. Named signs, tests, procedures have been kept only to bare minimum necessary level as they are stressed only by an exceptionally uncommon unrealistic examiner unless one heads for a gold medal. No work is impeccable (that's why future editions follow) and readers' comments are delightfully welcome to improve upon the present text.
I personally wish appreciation to the various chapter contributors, colleagues and my seniors and junior residents in bringing this book to fruition in a timely manner. Particularly the constructive criticism and helpful suggestions given by Dr Mohit Singh in formatting the book needs mention. The book is a concise upshot of training and teaching from the expert and experienced teachers at Department of Orthopaedics, All India Institute of Medical Sciences to whom I am grateful.
All my sincere dedications and gratitude towards my wife Mrs Neeta Verma, will always fall short of the immense help I received from her in preparing the major part of this work.
Finally, I am highly indebted to the dedicated team of M/s Jaypee Brothers Medical Publishers(P) Ltd, New Delhi for giving constant encouragement and sage advice in the preparation of this book.
I wish the readers astounding success in examinations and accomplishments!
Manish Kumar Varshney