Musculoskeletal Examination Vivek Pandey, Hitesh Shah
INDEX
Page numbers followed by ‘b’ refer to box; ‘f’ refer to figure; ‘fc’ refer to flowchart; and ‘t’ refer to table, respectively.
A
Abdominal muscles 77
Abdominal organs 38
Abducted thigh 25f
Abduction 4, 17, 88b, 89, 89f, 379
and external rotation, loss of 476f
deformity 17, 218
measurement of hip 220f
shoulder pain 79
Abductor digiti minimi 160t, 443, 444, 444f, 445, 445t
test for 446f
Abductor mechanism 242
normal and abnormal responses of 243f
Abductor pollicis brevis 160, 437f, 438, 442
Pen test for 441f
Abductor pollicis longus 155, 155f, 162, 434f
Above-knee stump 515
Abrasion 32
Acetabular labrum 201, 202f
Acetabulum 201
Achondroplasia 51f, 378
Acromioclavicular arthritis 74
Acromioclavicular joint 71, 84
arthritis 80, 106, 112
tests for 106
stability 73
tenderness 106
Acromion 85
undersurface of 107
Adam's forward bend test 367, 367f
Adamkiewicz, artery of 351
Adduction deformity 218, 221f, 240
Adductor longus 202
brevis and magnus 202t
Adductor magnus tendon 254f
Adductor pollicis 445
Adductor tubercle 254f
Adhesive capsulitis 111
Adson's test 380, 381f
Advanced trauma life support 26
care 29fc
Aird's test 383
Airway 28
Akimbo sign 432
Alcoholism, chronic 410
Allen's test 182
Allis sign 228
Alpine hunter cap patella 259
American Spinal Injury Association Sensorimotor Impairment Scale 393b
Amputation
and disarticulation 518f
atraumatic 512
common level of 518
complications of 517
indications for 512
principles of 516
right upper limb 35f
stump
clinical evaluation of 511
examination of 520
level of 518
patient with 512
special Chopart's amputation 519
special external hemipelvectomy 519
special hindquarter amputation 519
special Lisfranc's amputation 519
special Pirogoff amputation 519
special Syme's amputation 519
types of 517
definitive end-bearing 517
definitive non-end-bearing amputation 517
provisional amputation 517
Analgesia 41
Anconeus triangle 129
palpation of 131
surface landmarks for 129f
Aneurysmal bone cyst 502, 508, 533
Anhidrosis 473
Ankle 325
and foot 330f
major ligaments of 310
parts of 327f
dorsiflexion 383f
equinus deformity, evaluation of 489fc
examination 340
foot, position of 334f
joint 24f, 310, 331
bony ankylosis of 19f
line 328, 328f
plantar flexion 331f
space 19f
ligament complex, medial 311f
medial ligament of 311
neutral position of 331f
plantar flexion 338f, 454f
plantar flexion range of movement 24f
posterior aspect of 329f
sprain 344
stability, tests for 335
Ankylosing spondylitis 57, 64, 362, 405
Ankylosis, true 19
Annular ligament 120f
Anomalies, congenital 197
Antebrachial cutaneous, medial 466f
Anterior cord syndrome 408, 408f
Anterior interosseous syndrome 461
Antituberculosis, treatment drugs 152
Aperta 212
Apley's test 294f
compression test 294
distraction test 294
grinding test 292, 294
Apprehension test 91, 91f, 295f
Arm and forearm, posterior cutaneous nerve of 434f
Arm
length measurement 90f
span 377
wasting of 136
Arnold-Chiari malformation 116
Arterial blood gas 29
Arterial circulation 156
Arterial Doppler 39
Arthritis
classification of 54fc
mutilans 65
stage of 61
tender in 84
Arthrodesis 63
Arthropathy
reactive 65
resection 63
Arthroscopic, appearance of
mucoid ACL 304f
normal ACL 302f
Arthroscopic capsular release 112
Arthroscopic synovectomy 63
Arthroscopic view of 309f
cartilage fibrillation in chondromalacia 306f
discoid lateral meniscus 300f
normal lateral meniscus 300f
normal patella cartilage 306f
OCD of right medial femoral condyle 307f
Articular facet, superior and inferior 354f
Asynchronous scapula movement 107
Ataxic cerebral palsy 485
Athetoid (dystonic) cerebral palsy 485
Atonic bladder 409
Auscultation 37, 538
Autoimmune diseases 415
Automatic bladder 409
Autonomic examination 419
Autonomic nervous system 348, 351
examination 421
outflow 351f
Autonomic symptoms 414
Autonomous zone 421
Autosomal recessive 198
Axilla 142
Axillary nerve 420
C5, 6 430
muscles supplied 431t
paralysis, features of 431
Axis deviation, normal hip 226f
Axon reflex test 422
B
Babinski sign 394
Baker's cyst 58, 271f, 530, 535
in right popliteal fossa 59f
Ballottement test 185, 273, 339, 339f
Bancroft's sign 339, 339f
Barber chair phenomena 387
Barlow test 234, 234f
Bear weight, difficulty to 44
Bear-Hug test 103
Bearing weight 5
Bechterew's disease 64
Beevor's sign 384
Beighton and Horan joint mobility index 86
Beighton hypermobility score 86
Beighton score 87f
components of 87t
Belly-off test 103, 103f
Belly press test 102
Below-knee amputation stump 514f, 517f
Below-knee prosthesis 514f
Below-knee stump 515
Benediction sign 443
Benett lesion 111
Benign chondrogenic tumors 199
Benign tumor 494t
Biceps bulk, loss of 128
Biceps femoris tendon 259, 305, 450
Biceps groove tenderness 105
Biceps tendon 72f
distal 127, 133
pathology, tests for 105
Bicipital groove 85
Bicipital tendinitis 105
Bigelow, ligament of 201
Birth brachial plexus palsy 479
Blackberry thumb 165
Bladder and bowel status 395, 492
Blount's disease 263, 264, 301
Body
dermatomes of 388f
myotomes of 392f
Bone 271
and joints, acute injury of 26
cement 505f
cyst
aneurysmal 313, 496, 502, 505, 507, 508f
simple 496, 507, 508f
unicameral 313, 507
disease 43b
fixity 543
forming arch 312
grafting of GCT cavity 505f
length of 535, 538
sarcomas, spread 499
shortening of 535
tumors 265, 504
clinical classification of 494fc
clinical evaluation of 494
during history assessment 495b
history taking in 495
Bony and soft tissue landmarks 271b, 132b
Bony crepitus 36, 47
Bony deformity 500
Bony irregularities 59, 173, 538
Bony mass, abnormal 133
Bony swellings 537
Bony tenderness 36
Bony thickening 47
Book test 445, 447f
Bouchard and Heberden's nodule 172f
Bouchard node 57
Boutonnière deformity 172
Bowstring test 383
Brachial cutaneous, medial 466f
Brachial plexus 75, 83, 89, 90, 414, 465f, 466f, 467t, 477b
common conditions affecting 471b
injury 30, 74, 76, 79, 80, 101, 470t, 475t
anatomical classification of 469t
clinical evaluation of 465
etiology and classifications of 468
examination 482
lower 470
post-traumatic 468, 483
suspicion of 475f
lower trunk of 380
nerves of 467t
palsy 9, 12, 74, 100, 474
roots of 468f
surgical anatomy of 465
tension 379
Brachioradialis 435
test for 436f
Bragard's test 383
Brain 6f
Brain's sensory cortex 349
Breathing 28
Brevis 202
Brittle bone disease 51
Broadened heel 324
Brodie's abscess 49, 50
Broken levers 76, 242
Brown-Sequard syndrome 406
Brucella spondylodiscitis 362
Bryant's triangle 244
measurement of 228, 228f
Bucket handle tears 9
Bulk 390
Bunionette 321
Bunnel's ‘OK sign’ 443
Bunnell-Littler test 180, 182
Burning sensation 513
C
Cadaveric knee 253f
Cadaveric view of lateral side of knee 256f
Café-au-lait spots 369, 369f
Calcaneofibular ligament 310
Calcaneovalgus 314
Calcaneum 325, 328
fracture, malunited 324f
Calcaneus deformity 324
Calcium pyrophosphate dihydrate crystal deposition 122
Calf muscle 229
wasting 213
Calf musculature 325
Callosities 326
Campylobacter 66
Capitate 174, 175
Capitellum 118
Caplan's syndrome 63
Capsule 71
posteromedial 255
Capsule-muscle-tendon, contracture of 125
Card test 445, 448
Cardiac disease 75
Cardiac origin pain 78
Carpal bones 174b
Carpal instability 195
tests for 184
Carpal tunnel syndrome 22, 63, 162, 165, 167, 180, 197
signs of 181f
tests for 180
Carpometacarpal 162
Carpometacarpal joint arthritis, tests for 181
Carpometacarpal joint of fingers 159
Carpometacarpal osteoarthrosis 57
Cartilage damage 7
Cauda equina 348f
Cauda equina syndrome 363, 408, 408t
Central cord syndrome 406, 406f
Central slip injury 166
Cerebellar artery, posterior-inferior 351
Cerebellar ataxia gait 529
Cerebral palsy 171, 208, 484, 487t
examination 493
mixed 485
spastic 485
geographic classification of 485
Cervical facetal disease 404
Cervical intervertebral disc prolapse 362
Cervical myelopathy 404
tests for 387
Cervical region 357
Cervical rib 400f
Cervical spine 108, 143, 353
anteroposterior X-ray 400f
flexion 373f
lateral rotation 373f
movement 372
assessment of 373f
pathology 106, 142
right lateral flexion 373f
Cervical spondylitis 142, 362, 371, 371b
myelopathy 362
Chair push-up test 140f, 140
Charcot's arthropathy 68f, 116, 135, 315
deformed foot in 347f
Charcot's foot 320, 326
medial arch collapse in 326f
Charcot's joint 67, 346
Charcot's shoulder 74, 117, 117f
Charcot-Marie-Tooth disease 322, 342, 412, 415, 416, 522
Cheiralgia paresthetica 190, 462
Chest
expansion 377
pain 78
Chiene's parallelogram 230, 231f
Child with cerebral palsy
clinical evaluation of 484
symptoms in 484
Chlamydia 66
Chondromalacia patella 265, 305
Chopart joint 313
Chordoma 502
Ciliospinal reflex, loss of 473
Clarke test 275, 275f
Clavicular head, test for 430f
Clavicular osteolysis, distal 80
Claw hand 171, 417, 444, 459
assisted and contracture angle in 187
Claw toe 63, 321
Cleidocranial dysostosis 52, 74
Clonus 394
Clubbing 499
Clubfoot 341
Coccydynia 363
Coccygeal root 348
Codfish vertebra 51
Cold abscess 369, 370f
Coleman block test 337, 337f
reverse 337
Collar stud infection 200
Collateral ligament 157
medial 138, 143, 200, 254f, 260, 309
Colles' fracture 170, 193
malunited 163, 193
Compartment syndrome 39, 194
Complex regional pain syndrome 166, 169f, 193
Compound palmar ganglion 191, 191f
Compressibility 537
Compression rotation test 104
Compression test 37, 294f
Compressive neuropathies 122
Condyloid joint 159
Connective tissue disorders 415
Contralateral flexion 379
Contralateral limb 37
measurement and examination of 538
Conus medullaris 348, 348f
Conus medullaris syndrome 408, 408t
Coracoacromial ligament 107
Coracoid process 85
Coronal plane deformity, assessment of 219fc
Coronoid fracture 123
Corticospinal tract 350, 407f, 408f
anterior 349f, 350
lateral 349f, 350, 406f
Coudane-Walch test 87
Coughing, impulse on 538
Coxa vara
adolescent 247
developmental 208, 245
right hip 245f
Cozen's test 137, 137f
reverse 137, 138f
Craig's test 227, 244
Cranial nerves 388
Crank test 104, 104f
Crepitus 10, 278
types of 278
fixed crepitus 278
mobile crepitus 279
Cross-chest adduction test 106, 106f
Crossed radial reflex 387
Cruciate ligament
anterior 252, 253, 253f, 256, 260, 262, 309
posterior 253, 253f, 256f, 260, 309
Crutch palsy 459
Crutch, axillary 206
Crystal arthropathy 66
Cubital fossa 130, 133
Cubital tunnel syndrome 122, 123, 167, 462
anatomy of 462f
Cubitus recurvatum 129f
Cubitus valgus 125, 147
of right elbow 128f
Cubitus varus 125, 128, 135, 147
Cytomegalovirus 415
D
Daily living, disruption in activities of 165
De Quervain's tenosynovitis 162, 164, 166, 180, 190
tests for 181
Dead arm syndrome 76
Debris and sclerosis 68f
Deep fascia 20
Deep penetrator sign 205
Deep peroneal nerve 333, 333f, 420, 448fc, 450f, 451, 453
Deep space infections 200
Deep tendon 421
Deep tendon reflex 394
grading 394b
Deep vein thrombosis 48, 339
Deformities 8, 15, 16, 32, 44, 56, 125, 163, 169, 171, 205, 267, 360, 472, 488, 497
angular 532
assessment, principle of 16, 268
congenital 197
correctable 331
in sagittal plane 216
of hip 215b
of knee joint 16f
progression of 314
rotational 223
assessment of 223
spasmodic 8
sprengel 74
stage of 61
structural 8
test for unilateral flexion 216
triple 58
Degenerative osteoarthritis, primary 60
Degloving injury 34
Delayed union 49
Deltoid 73, 431
ligament 329
wasting 82f
De Quervain's tenosynovitis 106, 181f
Detrusor-sphincter dyssynergia 409
Diabetes and thyroid dysfunction 78
Diabetes mellitus 68, 165
Diadochokinesia 393
Dial test 290
for posterolateral corner injury 291f
Diplegic cerebral palsy 485
Disability 28
Disarticulation 519, 519b
Disc disease, degenerative 366
Disc herniation, stages of 402f
Discoid meniscus 300
Disease, severity of 69
Disease-modifying antirheumatic drugs 148
Dislocation
primary or recurrent 76
tests for 183
Dislocation of knee, congenital 300, 301f
Dislocation patella, recurrent 309
Dislocation shoulder, recurrent 79
Distal femur and proximal tibia, fracture of 34f
Distal femur lateral condyle 505f
Distal interphalangeal 160, 172, 179, 200
Distraction test 294f
Diurnal variation 123, 205
Dizziness 360
Dorsal column tract homunculus 349f
Dorsal intercalated segment instability 184, 192
Dorsal intercarpal 153f
Dorsal interossei 445
Dorsal ramus 410
Dorsal root 410
Dorsal scapular nerve 424
Dorsal spine 355
curvature 82
left lateral rotation of 375f
movement 374
right lateral rotation of 375f
Dorsiflexion 177f, 489
Dorsolumbar spine, scoliosis of 366f
Dorsum skin condition 321
Double crush syndrome 22, 122, 142, 164, 188
Double hemiplegic cerebral palsy 485
Dowager's hump 365
Down syndrome 209
Drawer test
anterior 93, 93f, 281, 283f, 335f
false-negative 282
for anterior stability 335
anteroposterior 186, 187
posterior 95f, 95, 287f, 287
posterolateral 140, 292, 292f
Drop arm test for supraspinatus tendon tear 99
Drop sign 100
Drug-induced peripheral neuropathy 416
Duncan-Ely test 490f
Dupuytren's contracture 167, 171
Dupuytren's test 231
Dupuytren's contracture 20, 165, 171f, 190
of left hand 191f
Durkan's median nerve compression test 180
Durkan's test 180
Dyskinetic scapula 84
Dysplasia of hip
developmental 1, 207, 245
test for developmental 234
Dysplastic spondylolisthesis 355
Dystonia 492
E
Ecchymosis 32
Edema 499
Eichhoff test 181, 181f
Elbow
and radioulnar joint 134b
and superior radioulnar joint, bony anatomy of 118f
clinical diagnostic snippets 126t
common conditions affecting 122b
cubital tunnel syndrome 150
examination 143
flexion movement 18
instability 137, 144
tests for 138
joint
clinical evaluation of 118
line, palpation of 132
ligaments of 120f
location of anterior and posterior joint lines of 133f
movements, extension, flexion 134f
myositis ossificans of 147f
pain
anterior 123
causes of 123t
lateral 123
medial 123
posterior 123
pathology, case of 122
range of motion 135b
stabilizing structures 119
terrible triad of 146
varus buttress of 118
with goniometer, flexion range of movement 24f
Electrolyte imbalance 523
Elson test for central slip of extensor tendon rupture 187
Ely's test 234, 234f, 240, 379
Empty can test 99
Enchondroma 199
Enchondromatosis, multiple 199
Endoneurium 410, 456
Enophthalmos 473
Enteropathic arthropathy 66
Entrapment neuropathy 63
Eosinophilic granuloma 502
Epicondyle
lateral 120f, 256f
medial 120f, 137, 150, 253f, 254f, 272f, 274, 307f
Epileptics 78
Epineurium 410
Epiphyseal lesion 505f
Erb's palsy 481f
Erb's point 466
Erector spinae 77
Essex-Lopresti
fracture-dislocation 146
injury 192
lesion 142, 196
Eunuchoid habitus 377, 378
Eversion talar tilt test 335
Ewing's sarcoma 1, 507
of left humerus 507f
Exostoses, multiple 499
Extensor capri radialis longus and brevis 155f
Extensor carpi radialis brevis 155, 156, 434f
Extensor carpi radialis longus 155, 156, 435
test for 436f
Extensor carpi ulnaris 155, 155f, 156, 162, 175, 434f, 435
test for 436f
Extensor digiti minimi 155, 155f, 434f
Extensor digitorum communis 434f, 435
test for 436f
Extensor digitorum longus 313, 334f, 453
test for 453f
Extensor expansion 157
Extensor hallucis longus 313, 334f, 448, 448fc, 453
test for 453f
Extensor indices 155, 155f, 434f
Extensor lag 277, 277b
in knee 18
Extensor lateral and medial band 157f
Extensor pollicis brevis 155, 162
Extensor pollicis longus 155, 155f, 175, 434f, 435
Extensor retinaculum 155, 155f
compartments of 155t
Extensor tendon injuries 196
Extensor tendon zones 158
External rotation lag test 100
External rotation recurvatum test 290, 291f
External rotation test 336
External urethral sphincter 352, 354f
F
Faber test 237f
Facet joint 352, 353
Facet joint arthropathy 404
Facetal arthropathy 363
Fairbank's apprehension test 295
False ankylosis 20
Fascial contractures 8
Fasciculus cuneatus 349f, 350f, 407f
Fasciculus gracilis 349f, 350f, 407f
Felon 162, 168, 199
Felty's syndrome 63
Femoral acetabular impingement 208
Femoral condyle, lateral 253f, 256f
Femoral condyles 252
Femoral head 225, 227
blood supply of 202f
vascularity of 201
Femoral nerve 420, 421, 449
motor assessment 449
stretch 384
stretch test 384f
Femoral osteosarcoma 506f
Femoral steochondroma 504f
Femoral triangle 213
Femoroacetabular impingement 249
Femoroacetabular lesion, types of 250f
Femur component, measurement of 228f
Festinant gait 527
Fexor hallucis longus 334f
Fibrocartilage complex, triangular 154f
Fibrocartilage, triangular 187
Fibromyalgia 409
Fibrous ankylosis 19
Fibrous dysplasia 509
Fibula, neck of 276
Fibular neck 272
Figure-of-four test 385, 385f
Finger escape sign 387
Finger sign 112
Finger under normal MLA 322f
Finger-nose test 393
Finkelstein test 181
Finochietto-Bunnell test 182
Fixed abduction deformity 218
Fixed deformity 216
Fixed flexion deformity 276
Flail limb 472f
Flatfoot 314
Flatfoot, congenital 341
Flexion deformity 16, 125, 277, 240
of left knee 269f
Flexor and extensor zones of hand 158t
Flexor carpi radialis 156, 437f, 438
test for 440f
Flexor carpi ulnaris 156, 162, 175, 200, 445t
test for 446f
Flexor digitorum longus 313, 334f, 455
Flexor digitorum profundus 155, 438
test 440
Flexor digitorum superficialis 155, 438
Flexor digitorum superficialis and profundus 160, 437f
testing for 441f
Flexor digitorum superficialis test 440, 441f
Flexor hallucis longus 313, 455
Flexor pollicis brevis 160, 437f
Flexor pollicis longus 160, 437f, 438
test for 440f
Flexor retinaculum 154
anatomy of 154f
Flexor tendon
injuries 197
of fingers, pulleys over 157f
pulleys of 157
zones, injury area 158
Flexor tenosynovitis 200
Flip test 383, 384f
Fluid discharges, type of
purulent discharge 543
sanguineous 543
seropurulent 543
serosanguinous 543
serous 543
Fluid thrill 537
Foot
arches of 311, 311f
bones of 310b
ligaments of 311
sensory innervation of 333f
size of 333
types of arches of 312t
Foot and ankle 313b
clinical diagnostic snippets 317t
joint, clinical evaluation of 310
locations of 315t
muscles of 313t
surgical anatomy of 310
Foot arch, type of 320f
Foot concavity, loss of 326f
Foot drop 417, 459
Foot progression angle 237
measurement 238f
Foramen magnum 348
Forearm length 90
measurement 90f
Forearm mid-prone 81
Forearm muscles 136, 179
Forearm supinated, biceps assessment with 433f
Forefoot 321
dorsum, palpation of 330
plantarflexion reclassifies 238
pronation 337
Foreign body, presence of 543
Fovea 175
Fovea sign 183
Foveal tenderness 184f
Foveal test 187
Fracture
blisters 32, 32f
bones 242
malunited 476
neck femur 230, 242
pathological 50
Frank dislocation 77
Frankel sensorimotor classification 393b
Fredrich's ataxia 322
Frieberg disease 346
Froment's sign 445, 447f, 448
Frozen shoulder 78, 80, 111
Fulcrum issues 242
Full Can test 98
Fustilo-Anderson classification 36t
G
Gaenslen's test 386, 386f
Gagey's hyperabduction test 92
Gagey's test 93f
Gait 57, 210, 266, 320, 364, 486, 521
analysis 523
antalgic 524
ataxic 529
cautious 266, 266b
circumduction 529
coxalgic 524
Crouch 486f, 527
cycle 521f
disturbance
assessment of 523
etiology of 522
equinus 526
hand-to-knee 528f
in severe OA knee 528f
in spastic cerebral palsy 527f
knock knee 527, 528f
patterns of, 521, 524
abnormal 45
phases of 521
scissoring 486f, 526, 526f
short limb 525
spatial parameters of 522
stiff hip 526
stomping 529
true equinus 526
types of 210b
antalgic gait 210
bell clapper gait 210
gluteus maximus gait 210
high-stepping gait 210
in-toeing (pigeon gait) 210
out-toeing (Charlie Chaplin) gait 210
short-limb gait 210
stiff-hip gait 210
Trendelenburg gait 210
Galeazzi sign 244
Galeazzi test 228, 229f
Gamekeeper's thumb 182
Ganglion 190, 303f
dorsum of wrist 170f
over dorsum of left wrist 190f
over dorsum of wrist 533f
Ganglionic cyst 115
Ganglions 533
Gap, palpation of 36
Gas in soft tissue 37
Gastrocnemius 259, 454
lateral head of 256f
medial head of 254f
muscle, test for 455f
tubercle 254f
with knee, test for 454f
Gastrocsoleus 488
testing 334f
Gemellus superior and inferior 203
Genu recurvatum 16, 16f, 263, 269f
Genu valgum 58, 263, 268f 268, 280
Genu valgus 63
Genu varum 15, 58, 263, 267, 268, 280
in rickets, bilateral 52f
Gerber's lift-off test 102, 102f
Gerdy's tubercle 256f
Ghost sign 303
Giant cell tumor 1, 265, 504, 533
of distal femur 497f
of tendon sheath 167, 199
Glasgow Come Scale 28t
Glenohumeral arthritis 74, 80
Glenohumeral internal rotation deficit 74, 77, 89, 110, 110f
Glenohumeral joint 71, 73
anatomy of 71
arthritis 113
Glenohumeral ligament
anterior inferior 72f
posterior inferior 72f
Glenohumeral osteoarthritis, left 114f
Glenoid and head of humerus 73
Glenoid bony avulsion 76
Glenoid cavity 71
Global brachial plexus injury 470
Global brachial plexus palsy 474f
Global pain 123
Globular mass 240
Glomus tumor 168, 199, 199f
Gluteal muscle wasting 212
Gluteal region 215
Glutei 77
Gluteus maximus 202
Gluteus maximus contracture 208
Gluteus maximus gait 526, 526f
Gluteus medius 202
Gluteus minimus 202
Godfrey's sag sign 287, 287f
Golfer's elbow 122, 123, 126, 137, 150
test for 137
Goniometer 225, 280f
static limb of 226f
technique of using 24
using 24
Gonococcal arthritis 61
Gout 66
Gouty arthritis 344
Gracilis 202
Grazed abrasions 33, 33f
Greater trochanter 230f
level of 211, 213, 214
palpation of 214
Greater tuberosity 85
Grind test 181, 183
Gross motor function classification system 485, 486f
Growth disturbance 532
Guillain-Barré syndrome 415
Guyon's canal 174, 443
anatomy of 463f
boundaries of 463
compression 463
Guyon's canal syndrome 167
H
Habitual patella dislocation 302
Haglund's bump 318, 325, 325f, 329f
Haglund's deformity 343
Hallux rigidus 321
Hallux valgus 63, 314, 343
bilateral 321f
Hallux varus 63, 314
Hamate 174
Hammer toes 314, 321, 345
Hamstrings 260, 452
medial test for 452, 452f
Hand comprises metacarpals and phalanges 156
Hand
dominance 15, 77
dorsal aspect of 170
extensor zones of 158f
flexor zones of 158f
function, assessment of 178
infections 199
ligaments of 157
tumors 199
wrist-forearm alignment 169f
zones of 158
Hansen's disease 68, 272, 415, 463
Hawkins and Bokor, grading system, modified 93, 94t
Hawkin's sign 98f
Hawkins-Kennedy test 97
Head of
femur 201
humerus, vascularity of 73
talus 329
Head sternal 430f
Heberdon's node 57
Heel broadening 333
Heel valgus, bilateral 324f
Heel varus, left heel 324f
Heel-rise test 323f, 324, 324f, 337
Heggar's hand 481f
Hemangioma 502
Hematogenous osteomyelitis, case of 50
Hematoma, subungual 172
Hemiplegia 522
Hemiplegic cerebral palsy 485
Hemiplegic gait 529
Hemiresection interposition arthroplasty 193
Hemochromatosis 67
Hemophilia, genetics and type of 69
Hemophilic
arthropathy of right knee 69f
cysts 69
joint 69
Hemorrhages in
joint 69
muscle 69
nerves 69
Hepatorenal recess 38
Hereditary diseases 415
Herpes zoster 415
Hildreth test 199
Hill-Sachs lesion 76
Hindfoot alignment 323
Hindfoot and calf 323
Hindfoot valgus deformity 324
Hindfoot varus 323
flexibility 337
Hinge joints 135
recording in 19
Hip
abduction range of movement 25f
abductor, mechanism of 242f
and knee, attitude of 213
anteversion angle 227
arthritis, primary or recurrent 208
avascular necrosis of 248
clinical diagnostic 207t
condition, diagnosis of 203b
diseases, use of cane in 243
disorders, case of 209t
examination 244
extension 224
flexion 224
deformity assessment 490
strength assessment 449
test for 449f
impingement, tests for 235, 236f
joint
articulating bones 202f
clinical evaluation of 201
common conditions affecting 203b
ligaments of 202f
line, anterior 214f
muscles around 201, 202t
pathology, differential diagnosis of 204b
movement
abduction and adduction 226f
flexion 225f
pathologies affecting pediatric population 240t
rotations 224
with knee extended 225
stability, test for 231
subluxation 208
transient synovitis of 208, 246
Hoffmann's test 387
Holt-Oram syndrome 198
Homan's sign 339, 339f
Homogentisic acid oxidase enzyme, lack of 70
Hook grip 159
Hook test 133
for distal biceps tendon rupture 133f
Horn cell, anterior 6f, 349f
Horn, anteror
lateral meniscus 253f, 256f
medial meniscus 256f
Horn
lateral 349f
posterior 349f
Hornblower's sign 100, 432
Hornblower's test positive on right side 101f
Horner's sign 473f
Horner's syndrome 473b
Horse-shoe shape swelling 58
Huckstep triad 371b
Humeral
osteophytes 114f
tuberosity 72f
Humeroradial articulation 118
Humerus, chondrosarcoma of 534f
Hump-bump deformity 343
Hyaluronic acid 61
Hydroxychloroquine 63
Hyperextension 277
Hypermobility, presence of 86
Hyperparathyroidism 67
Hypertrophic scar 541t
Hypertrophied synovium 274
Hyperuricemia 318
Hypotension, causes of 352
Hypothenar eminence 160
Hypothenar hammer syndrome 172, 192
Hypotonic cerebral palsy 485
I
Idiopathic and degenerative 111
Idiopathic scoliosis, adolescent 362
Igawa sign 445, 448
Iliac spine
posterior superior 396
superior, anterior 211
Iliopsoas 202
Impingement in shoulder 107
Impingement test 97, 108
anterior 235, 236, 236f
anterolateral 236
posterior 236
Index finger 439f
Infections 116, 152, 199, 246, 400
Infections
acute 261
around nailbed 172
of nerve 415
Infective synovitis 265
Inflammation
acute 3
chronic 3
Inflammatory arthritis 167
Inflammatory conditions 148
Inflammatory diseases 62, 361, 410
Inflammatory seronegative spondyloarthropathy 167, 405
Inflammatory tenosynovitis 162
Infraganglionic spinal nerve 469
Infraspinatus 73
Infraspinatus tear 99
Infraspinatus tendon, tests for 101f
Injury
mechanism of 124
scene of 41
severity score 27b
type of 28
Instability 57, 125, 262
and weakness in grip 164
catch sign (active flexion test) 385
feeling of 45
lateral side 125
medial side 125
of joint 8
posterolateral rotatory 123, 139, 144146
recurrent 301, 315
Intact abductor mechanism 242
Intercarpal joints 153
Intermeniscal ligament 253f, 256f
Internal rotation lag sign 102
Internal rotation lag test 102f
Internal urethral sphincter 352, 354f
Interosseous
lateral and medial band 157f
nerve injury, posterior 459
nerve, anterior 437f, 461f
nerve, posterior 149, 156, 462f
tendon and hood 157f
Interosseous, card test for 446f
Interphalangeal 179
Interphalangeal joint 159, 176, 313
distal 163
Intersection syndrome 190
Interstitial cystitis 409
Interstyloid distance, measurement of 179f
Intertrochanteric femur fracture 242
Intertrochanteric fracture, malunion of 208, 248
Intervertebral disc 352
calcification of 70
prolapse 75, 355, 396
prolapse of cervical region 401
prolapse of lumbar region 402
Intra-articular
hip pathology 237
spread of tumor 502
swelling 5
Intramuscular swelling 537
Intrinsic and extrinsic muscles of hand 160t
Intrinsic minus 171
Intrinsic plus hand 171, 179b
Inversion talar tilt test 335
Inverted radial reflex 387
Inververtebral disc calcification in ochronosis 70f
Ipsilateral anterior horn cells 350
Iridocyclitis, signs of 364
Irritable bowel syndrome 409
Ischial tuberosity 230f
Isthmic spondylolisthesis 363
J
Jack's test 336, 336f
Javelin thrower 111, 151
Jaw pain 409
Jendrassik maneuver 394
Jerk test 94, 95f
Jersey's finger 166, 195
Jobe's supraspinatus test 99
Joint above 15, 22, 38, 48
examination of 106, 188
Joint below 15, 22, 38, 48
examination of 106
Joint capsule 7
anterior 121
Joint, crepitus 59
Joint, hyperlaxity of 86
Joint in ankle and foot, type of 312
Joint involvement, symptoms of 497
Joint line tenderness 272
Joint, misplaced 76
Joint, movement 18
normal component for 7
Joint of upper and lower limb, examination of 395
Joint of wrist, type of 156
Joint, stability of 262b
Joint, stiffness of 45
Joint, tuberculosis 57
Joint, type of 73, 121, 159, 201, 258
Juvenile kyphosis 398
K
Kapandji score for thumb opposition 178f
Keinbock's disease 165
Keloid 541t
multiple 541f
Keratoconjunctivitis sicca 63
Kienbock's disease 200
Kirk-Watson test 184, 184f, 187
Kleinman shear test 185, 185f, 187
Klippel-Feil deformity 355, 367, 399
Klippel-Feil syndrome 74, 368f
Klumpke's palsy 472
Knee
dislocation 259
effusion in standing 273
examination 299
extensors (quadriceps), test for 449f
flexion deformity of 278f
flexion movement 18
hyperextension 268
ligaments of 258t
pathology of 261b
snippets of 264t
Knee joint 9, 251, 260b
clinical evaluation of 251
function of 251
in coronal, anatomy of 251f
minimal fluid in 273b, 274f
muscles around 260t
normal hyaline cartilage of 304f
Kneeling method 233
Kothari's method 219, 222f
Kothari's parallelogram method 222
Kyphosis 397
angular 365f
deformities 365
round-back 365f
L
Labral tear
posterior 109
posterosuperior 79
Labrum 71
Lacerated wound over
cubital fossa 33f
forefoot 33f
Laceration 33
Lachman test 283
modified 284, 284f
Lasegue test 383, 383f
reverse 384
Lateral collateral ligament 143, 255, 256f, 260, 309
complex 119
stability 139
Lateral cord syndrome 406, 407f
Lateral hamstrings, test for 452, 452f
Lateral meniscus, posterior horn of 256f
Latissimus dorsi 73
test for 429f
Leflunomide 63
Left knee, horseshoe-shaped swelling of 270f
Leg and foot, long axis of 24f
Leg hanging down testing tibialis 334f
anterior 334f
posterior 334f
Leg, lateral compartment of 453
Legg-Calve-Perthes disease 247
Lelli's test 258, 281, 285, 285f
Leprosy 68
Lesser tuberosity 85
Levator scapulae 425, 424f
Lever sign 285
Lhermitte's sign 387
Lichtman test 186f, 187
for midcarpal instability 185
Ligament, anatomy 259
Ligament, anterolateral 256f
Ligament laxity 276, 331
grade of 281b
Ligamentous injury 264
Ligamentum flavum 354f
Ligamentum teres 202f
artery of 201
Limb and deformity, alignment of 46
Limb, circumference of 538
Limb, distal part of 48
Limb injuries 42
Limb length 20, 37, 58, 90
apparent discrepancy 20
discrepancy 6, 15, 16, 21, 21b, 32, 45, 46, 128, 136, 206, 263, 270, 213, 367, 370, 377
measurement 20, 108, 143, 189, 227
true discrepancy 20, 227
upper measurement 90f, 136f
Limb, major vascular injury of 40
Limb salvage surgery 506f
Limb, traumatic amputation of 40
Limb, vascular examination of 395
Limp 6, 206
Ling test 237
Lipoma 537
Lisfranc joint 313
Lisfranc's amputation stump 519f
Lister's tubercle 173, 174
Little league elbow 152
Liu's test 104
Load and shift test 94, 94f
Lobstien syndrome 51
Locking 262
Locking specific, cause for 56
Locking, true 9
Long bone
affections 49
and joints diseases, clinical evaluation of 43
common tumor in 500f
disease 43
Long extensor tendon 157, 157f
Long thoracic nerve palsy 427, 428f
Long thoracic nerve, muscles supplied 428t
Longitudinal arch, medial 330
Longitudinal ligament, anterior and posterior 354f
Love's pin test 199
Low radial nerve palsy 459
Low ulnar nerve palsy 446
Lower limb 213, 225, 227
attitude 210f
measure true length of
measurement technique of 279f
muscles, major nerves supplying 448fc
myotomes of 392f
nerves, examination of 448
normal alignment of 268
normal rational right alignment of 213f
rational deformity of 213
segmental length of measurement technique of 279f
true length of 228f
Lower motor neuron lesions 391, 391t
Lower subscapular nerve 466f
Lower trunks, typical mechanism of injury 469f
Lumbar canal stenosis 359, 403
Lumbar facetal disease 404
Lumbar intervertebral disc prolapse, type of 368f
Lumbar lordosis 213, 213f, 215, 240
Lumbar region 357
Lumbar sciatic scoliosis, acute 367
Lumbar spinal canal stenosis 363
Lumbar spine 355, 376f
extension 375
flexion and extension of 377
flexion, assessment of 375
instability, special test for 385
lateral flexion of 376
movement 375
assessment 376f
painful/limited 377b
Lumbar spondylolisthesis 369f
Lumbosacral coccygeal nerve roots 348
Lumbosacral junction 369f
Lumbosacral nerve root compression 382
Lumbosacral spine, section of 348f
Lumbrical plus finger 200
Lunate 174, 175
Lunotriquetral 184
Lunotriquetral shuck test 185, 187
Lyme's disease 415
Lymph node 60, 48, 539
enlargement 499
examination 22, 106, 108, 143, 188, 239, 244, 298, 299, 395, 423
M
Madelung deformity 163, 198, 198f
Maffucci syndrome 199
Magnus 202
Malignancies 507
Malignant bone tumor 494t
Malleolus
lateral 544f
medial 544
Mallet finger 166, 195
Mallet little finger 195f
Mallet toe 63, 321
Maneuvers, internal rotation 97
Mangled extremity 34
severity score 34, 35t
Mangled lower limb 35f
Manus valgus deformity 163, 193
right wrist 170f
Marfan's syndrome 53, 378
Marie-Strumpell disease 64
Marjolin's ulcer 545f, 545
Martel sign 67, 67f
Maudsley's test 149
McMurray for
lateral meniscus 293
medial meniscus 293, 294
McMurray's test 293, 293f
Median nerve 122, 180, 420, 437
muscles supplied 438t
Median nerve palsy, features of 439
Medical Research Council grading for muscle power 391b
Medulla oblongata 348
Megaprosthesis 506f
Meningomyelocele 68
Meniscal cyst 303f
lateral 270f
Meniscal root tear, posterior 303
Meniscal tear 9, 303
location of 293b
Meniscal tests 281, 292
Menisci 257
function of 257
Meniscofemoral ligaments 254
Meniscus
lateral 256f
medial 256f, 282b
medial posterior root tear 264
Meniscus test 299
Menstrual irregularities 207
Meralgia paraesthetica 409, 463
Metabolic arthropathy 69
Metacarpophalangeal joint 55, 87, 159, 176, 177, 178b, 179b, 435, 474f, 476, 482, 516
Metastatic tumor, secondary 532
Metatarsal heads 326f
Metatarsophalangeal 313
Metatarsus adductus 238
assessment 239f
Methotrexate 63
Midfoot 322
Midfoot Charcot's arthropathy 319
Midfoot dorsum, palpation of 330
Midfoot instability, chronic 339f
Mid-tarsal joint movement 332
Milking maneuver 138, 139f, 143, 146
Milwaukee shoulder 74, 116, 117f
Milwaukee shoulder syndrome 77, 117
Miosis 473
Mobile arm 24 24f, 25
Mobility, abnormal 36
Monoarticular exacerbation 63
Mononeuritis multiplex 63
Mononeuropathy 410
Monoplegic cerebral palsy 485
Morant-Baker cyst 265
Morel-Lavallée lesion 34, 34f
Morning stiffness 205
Morrant Baker's cyst 305
Morris bitrochanteric line 227, 230, 231f, 244
Morton's neuroma 314, 318, 346
Moses’ sign 339, 339f
Motion, restriction of 360
Motor assessment 333
Motor examination 390, 419, 421, 477, 491
Motor march phenomena 423
Motor power examination, method of 421b
Motor symptoms 413
Movements 17, 37, 48, 59, 87, 223, 331, 419, 538, 501
and stability of neighboring joints 515
difficulty in 75, 262
elbow and radioulnar joint 134
glenohumeral joint 73
hip joint 201
involuntary 393
loss of 56
painful 89
range of 24, 87, 90, 176, 177, 179, 200, 309
spasm in 18
wrist 176
Moving valgus test 138, 139f
Mulder's click 330
Muscle 121
around elbow joint 121t, 259
contractures 489
tests for 234
girth, measurement of 48
hypertrophy 128
power of 421, 492
strength around elbow 143
tendon complex 20
test of
biceps (forearm supinated) 142f
brachialis (forearm pronated) 142f
brachioradialis 142f
tone of 391, 421
wasting 15, 16, 46, 58, 82, 128, 171, 269, 475, 535
Muscular torticollis, congenital 397
Musculocutaneous nerve 421, 433
Musculocutaneous nerve, major muscles supplied 433t
Musculoskeletal integrity, lower limbs 523
Myeloma, multiple 502
Myelomeres 349f
Myelopathy hand 387
Myositis ossificans 49, 127, 130, 147
N
Nail and pulp changes 172
Nail changes 418
National Pressure Ulcer Advisory Panel grading 395b
Neck 82
Neck and scapula 367
Neck and shoulder 82f
Neck pain 78
radiation, pattern of 358f
Neck webbing 209
Neer's impingement sign 97
Neer's sign 97f, 108
Nelaton's line 230, 230f
Neoplasia 3
Nerve compression 532
Nerve conduction velocity 151, 200
Nerve entrapment 115, 150, 197
Nerve injury 326, 459
axillary 76
classification of 412
specific 413t
type of 412t
Nerve palsy, typical deformities 417b
Nerve paralysis 76
Nerve recovery, clinical signs of 422
Nerve roots 6f, 348
Nerve, structure of 411f
Nervous system, components of 352t
Neurilemma 456
Neurilemmal sheath 410
Neurofibroma 483
Neurofibromatosis 531f
Neurogenic claudication 359f, 359
Neurological condition, distal 22
Neurological diseases 522
Neurological examination 387, 419, 477, 491
Neurological status of limb 547
Neuromuscular junction 411f
Neuromusculoskeletal pathway 6f
Neuropathic arthropathy 54, 67
Neuropathic joint 346
Neuropathic ulcer 546
Neurovascular bundle 39
Neurovascular compression 539
Neurovascular examination 15, 22, 38, 48, 60, 143, 231, 244, 299, 333, 502
lower limbs 281
upper limb 90, 137, 180
Neutropenia 63
Nonunion 49
Nonunion neck femur 208, 248
Nucleus pulposus 353
Numbness 125, 315
Nutritional deficiency 415
rickets, typical 52
O
O'Brien test 104, 104f
Ober's test 234, 235f, 244
Oblique ligament, posterior 254f, 255
Oblique retinacular ligament 157f
Obturator externus and internus 203
Obturator nerve 420, 450
motor assessment 450
test for 450f
Occulta 212
Ochronosis 70
Ochsner's clasping sign 442, 442f
O'Donhogue triad 285
OK sign 137, 180, 437, 439, 440, 443, 443f, 461
Olecranon bursitis 122, 123, 127, 150, 150f
Olecranon, position of 129
Olecranon process, tip of 131
Olecranon stress fracture 123, 152
Olecranon, tip of 129, 130f
Ollier's, achondroplasia 198
Ollier's disease 199
Omovertebral bar 398f
Open degloving with skin loss 34f
Open fracture 36, 36t, 39
case of 31b
Opponens pollicis 437f, 438
Orthopedic case presentation 1
Orthopedics
basics of history taking and examination in 1
etiopathology 12b
Ortolani test 234, 234f
Os naviculare 343
Os trigonum 316, 342
Osborne-Cotterill’ lesion 144
Osgood-Schlatter disease 265, 307, 307f
Osteitis deformans 53
Osteoarthritis 309
of knee 58
Osteoarthrosis
degenerative 54
of hip, primary 249
primary 60
Osteoblastoma 502
Osteochondral loose bodies 9
Osteochondritis dessicans 9, 70, 70f, 264, 306
of capitellum 122, 123
of elbow 152
Osteochondroma 496, 502, 504
Osteochondroma femur
exposure for excision 504f
X-ray of 504f
Osteoclastoma 502, 504
Osteogenesis imperfecta 51, 51f
Osteoid osteoma 509, 510f
of spine 362
Osteomalacia 49, 53, 405
Osteomyelitis 74
chronic 7, 50
sinus 543
Osteophytes, lack of 63f
Osteoporosis 53, 355, 405
Osteoporosis, severe 70
Osteoporotic vertebral body fractures 362
Osteosarcoma 1, 505
of distal femur 506f
Overload syndrome conditions 151
Overuse syndromes 122, 123
P
Pacinian corpuscles 483
Paget's disease 53, 263, 365
Pain 3, 44, 55, 75, 123, 161, 163, 261, 356, 472, 497, 542
activities causing 44
character of 44, 205
dull aching 531
during bending backward 358
from neighboring areas mimicking shoulder 77
nature of 162, 357
of neurological origin 4
onset of 3, 44, 162, 205, 356
progression of 3
quality of 3
radiation of 3, 205, 357
referred 205
severity of 4, 205
site of 3, 123, 356
timing of 4, 75, 356
Painful arc syndrome 114
Painful catch sign 385
Painful extension 377
Painful forward flexion 377
Palmar 170
aponeurosis 156
fascia, contractures of 171
flexion 177f
interossei 445
Palpate for thuds and clicks 279
Palpate popliteal fossa 276
Palpate serratus anterior insertion, method to 478f
Palpate spine 215
Palpate tibial nerve 329
Palpating medial and lateral hamstrings 452f
Palpation technique of
anterior joint line 85f
posterior joint line 86f
Pancoast tumor 483
Paralysed muscles 9
Paralysis 480
delayed onset 414
of femoral nerve 449
of obturator nerve 450
pattern of 470t, 479t
Paraolecranon fossa 130f
for swelling 129
Paraspinal abscess 370f
Paraspinal spasm 369, 371
Parasympathetic nervous system 354f
Paronychia 168, 200
Pars interarticularis 403f
Parsonage-Turner syndrome 483
Partial rotator cuff tear 74, 80
Patella 252, 254f
facet of 272
maltracking assessment of 297, 297f
palpation of medial and lateral facets of 276f
position of 269
Patella dislocation 9
congenital 302
Patella facet tenderness 275
Patella grind 275f
Patella horizontal tilt test 296f, 296
Patella infera 269
Patella instability 264
Patella magna (large patella) 259
Patella parva (small patella) 259
Patella stability, assessment of 295
Patella stability test 281
Patella tendinosis 265
Patellar glide test 275, 296
Patellar height and geometry 259
Patellar tap 273f, 273
Patellar tracking 297
Patellofemoral joint 251
Patellofemoral ligament, medial 257
Pathological joints, clinical evaluation of 54
Pathological scarring, evidence of 540
Patte's sign 100
Patte's test 295, 295f, 100, 432
Pebble-shaped patella 259
Pectoral nerve 429
medial and lateral 430f
muscles supplied 429t
Pectoralis major 73
heads of 430f
paralysis, features of 429
test for 430f
Pediatric bone tumors 502
Pellegrini-Stieda disease 308, 308f
Pelvic floor 77
Pelvic inflammatory disease 11, 207, 361
Pelvis compression test 386
Pelvis distraction test 386
Pelvis fracture 34f
Pelvis, level of 525f
Pelvis, right hip 221f
Pelvis squared 218
Pelvis unsquared 218
Pen test 442
Periarthritis shoulder 111
Pericardial effusion 38
Perineurium 410
Peripheral nerve 6f
clinical evaluation of 410
examination 458
Peripheral nerve, surgical anatomy of 410
Peripheral nervous system 411f
Peripheral neuropathy 544
Peripheral pulses 476
Perisplenic space 38
Periungual telangiectasia 172
Perkin's method 219, 221, 222fc
Peroneal nerve injury, common 276, 459
Peroneal nerve, superficial 333f, 420, 448fc, 450f, 451, 453
Peroneal tendinitis 325, 328
Peroneus brevis 313
Peroneus longus 313
Peroneus longus and brevis 448, 448fc, 453
test for 454f
Peroneus tendon, testing 334f
Peroneus tertius 448, 448fc
Perthes’ disease 1, 207, 247
left hip 247f
Pes anserine 259, 272
Pes anserinus bursitis 271f
Pes cavus 342
common causes of 322
of left foot 322f
Pes planus 238, 341
Pes planus and pes cavus, causes of 322b
Pes planus, flat arch of left foot 322f
Petit triangle 369, 369b, 370f
Phalen's sign 180
reverse 180
Phantom limb sensation 513
Phelps test 490
Piano key sign 183f
Piano key test 183
Pigmented villonodular synovitis 309f
Piriformis syndrome 235
Piriformis tightness, test for 235
Pisiform 174
Piston test 231
Pitcher's elbow 151
Pivot shift test 284, 285f
lateral 139, 140f
reverse 292, 292f
Plano valgus 266, 314
Plano valgus foot 327
Plantar fascia contracture 322
Plantar fasciitis 318, 343
Pleural effusion 63
Pointing finger 417
Pointing index sign 442, 442f
rationale of 442b
Policeman's tip hand 417
Poliomyelitis 415
Polyneuropathy 410
Polytrauma 26, 27f, 29fc
clinical evaluation of
concepts of 26
Popeye elbow 130
Popeye sign 82, 105, 128
over right arm 82f
reverse 128
Popliteal angle
bilateral 490, 490f
unilateral 490
Popliteal artery 259
aneurysm 270
Popliteal fossa 259
examination of 270
touching couch 269f
Popliteofibular ligament 253, 255, 256f
Popliteus 256f
Popliteus tendon 255, 256f
Posterior cord syndrome 407, 407f
Posterior interosseous nerve entrapment syndrome 461
Posterolateral plica syndrome 150
Postganglionic injuries 469f
Pott's spine 355
Power, loss of 76, 163
Preacher's hand 443
Preiser's disease 200
Prepatellar bursa 270f
Primitive neuroectodermal tumor group 507
Pronator quadratus 437f
Pronator syndrome 122, 123, 151, 461, 461f
Pronators 438
test for 439f
Proprioception, position sense 349
Prosthesis
examination 516
fitting of 513
Provocative test 380
Proximal femur aneurysmal bone cyst 508f
Proximal forearm 33f
Proximal interphalangeal 160, 172, 179, 200
joints 163
Proximal tibia fracture 259
Proximal tibiofibular joint 252
Proximal ulna, coronoid process of 118
Pseudoarthrosis of tibia, congenital 51, 51f
Pseudo-coxalgia 247
Pseudogout 67
meniscal calcification in 67f
Pseudolocking 9, 262
Pseudoparalysis 20, 89
Psoriasis 172
Psoriatic arthritis 167
Psoriatic arthropathy 65
Psychological, causes 523
Ptosis 473
Pulp 172
space infection 199
Putti sign 481f
Pyogenic arthritis 60, 260
Pyogenic tenosynovitis 162
Pyramidal tract 350
Pyrazinamide 12, 66
Pyriformis syndrome 249, 409
Q
Q angle 279
Quadrant test 296f, 296
Quadratus femori 203
Quadratus lumborum 77
Quadriceps 260
active test 288, 288f
angle 259
tendinosis 265
weakness 527
Quadriplegia 406
Quadriplegic cerebral palsy 485
Quantitative pilomotor axon reflex test 422
Quervain's disease 165
R
Racial predisposition 541
Radial and ulnar artery
patency of 180
tests for patency of 182
Radial and ulnar styloid process relationship 175, 189
Radial artery 155f
Radial club hand 163, 198
Radial collateral ligament 120f
injury 182
Radial deviation 177f
of wrist 169
Radial glide test 186, 187
Radial head fracture 126
Radial head palpation 132f
Radial nerve 122, 180, 420, 421
autonomous zone of 434f
C5-8, T1 434
major muscles supply 435t
paralysis, features of 435
superficial 155f, 434f, 455f
Radial styloid process, tip of 174, 175
Radial tuberosity insertion 148
Radial tunnel syndrome 123, 126, 461
rule of nine test for 149f
Radial ulnar styloid process relationship 173
Radiation 75
area of 357
Radiocapitellar articulation 119
Radiocapitellar joint 129f, 132
Radiocarpal instability 184, 186
Radiocarpal joint 153
Radiolunate 153f
Radiolunotriquetral 153f
Radioscaphoid 153f
Radioulnar joint 135, 135f
distal 153, 162, 172, 175
superior 119
Radioulnar synostosis, congenital 144
Radius, distal end of 173
Raynaud's syndrome 382
Raynaud's phenomena 172
Reagan ballottement test 185f
Rectus femoris contracture 234
Recurvatum knee 268
Red flag sign 37
Reducibility 537
Reflex sympathetic dystrophy 193
Reflexes 393, 479, 492
deep tendon reflex 394
superficial reflex 393
Regeneration, process of 456
Regimental badge sign 432
Regional lymph node 547
cubital fossa 142
examination of 539
Reiter's arthritis 260
Reiter's syndrome 65
Relocation-release test 92, 92f
Renal phosphate wasting 52
Renal rickets 52
Resisted external rotation test 99
Retinaculum 312t
around wrist 154
Retrocalcaneal bursitis 318, 325, 325f, 329f, 343
Retrograde degeneration, primary 456
Retropatellar tenderness 275
Rheumatoid arthriti 57, 58, 60, 62, 63f, 74, 122, 123, 167, 172, 260, 265, 410
and psoriasis 172b
deformities of wrist and hand 172f
of elbow 148
severe 134
Rheumatoid nodule 533f, 533
Rhizomelic dwarfism 51, 51f
Rhomboid 424f
clinical test for 424f
palsy 425
site for palpation of 478f
Rib hump 367f, 369
Rickets 1, 52, 263
broadened wrist in 52f
Rocker bottom foot 326f
Rocking horse gait 526
Roos test 380, 381f, 381
Rotator cuff 71
arthropathy 74, 80, 113
bilateral 113f
insertion
integrity signs 108
tear 74, 76, 77, 80, 112
tendinopathy 74, 80, 112
tests for 98
Ruptured baker's cyst 48
Ryder's method 229
S
Sacroiliac joint
patohology, test for 386f
special test for 385
Sag sign 286f
modified 286, 286f
posterior 286
Salmonella 66
Saphenous nerve 420, 451
Sauve-Kapandji procedure 193
Scalene triangle 131
Scaphoid 174
Scaphoid fracture 165
Scaphoid nonunion advanced collapse arthrosis 192
Scaphoid tubercle 173f
Scapholunate 154, 184
advanced collapse arthrosis 192
instability 184, 187, 189
ligament injury 166
ligament tear 162
Scapula 83
inferior angle of 85
lateral border of 86
level of 212, 372f
medial border of 85
shape of 83
spine of 85
superomedial border of 481f
winging of 83, 417
Scapular dyskinesia 107, 109
Scapular dyskinesis 83
method to elicit 84
Scapular ligament, transverse 115
Scapular retraction test 110
Scapular winging 459
Scapulohumeral reflex 387
Scapulothoracic joint 71, 89
Scar 419, 475
and ulcer 48
clinical evaluation of 530
examination of 540
healed with
primary intention 541f
secondary intention 541f
inspection of 540
mobility of 541
palpation of 541
Scar tissue 469f, 540
Scarf test 106
Scarpa's triangle 205, 211, 213
anatomy and content of 211b
fullness in 211
Scarred limb, chronic 534f
Scheuermann's disease 360, 362, 365
Scheuermann's kyphosis 398
Schober's method, modified 375
Schober's test 376f
Schwann cells 456, 457f
Schwannoma 483
Sciatic nerve 452
injury 459
L4, L5, S1-3 450
muscles supplied 451t
Scleroderma 172
Scoliosis 51, 366, 397, 510f
functional 368f
inclination 377
Scoliosis kyphosis 16
Scoliotic spine 367f
Sectoral sign’ 224
Seddon's classification 412
Semimembranosus 254f, 259, 260, 270, 452
bursa 259, 276, 305
tendon 255
Semitendinosus 259, 452
Senile kyphosis 362
Sensitive sign, underlying shoulder pathology 75
Sensorimotor innervation 349f
Sensorimotor tracts 349f
Sensory 443
and motor disturbance in upper limb 381
supply of median nerve 437f
supply of radial nerve 434f
assessment of foot 333
ataxia gait 529
examination 388, 419, 420b, 492
innervation of
around knee 259
foot 450f
lower limb 456f
upper limb 455f
loss 439, 446
symptoms 413
Septic arthritis 74, 122, 265
acute 61, 246
of hip 208
Seronegative spondyloarthropathy 64, 358, 361, 362
Serratus anterior 73
wall push-up test for 428f
Shephard-Crook deformity 509f
Shigella 66
Shoe maker's line 230f, 230
Shoe wear pattern in various type of feet 319f
Shoulder
abduction of 114f
measurement of 25f
anterior aspect of 92
bony landmarks of 85f
clinical diagnostic snippets 79t
common conditions affecting 74b
contour 81
denotes coracoid process 85f
dislocation 1
examination proforma 108
girdle muscles, major nerves supplying 423fc
hand syndrome 74
in internal rotation 85f
instability
anterior 75
special test for 91
tests for 91
internal impingement of 111
joint 72f, 73t, 87, 142
active ROM 88f
anatomy of 72f
clinical evaluation of 71
range of movement 88b
left, calcific tendinitis of 115f
level of 82, 212
pathologies 74b
subluxation of 76
to test supraspinatus 478f
Shworth scale 491, 491b
Sickle cell anemia 207
Sign of surgical correction 540
Silfverskiöld test 489f, 489fc
for calf muscle tightness 338, 338f
Simian hand 439f
Sinus 44, 47, 543f
associated 531
clinical evaluation of 530
discharging 7
over distal tibia 47f
presence of 46
with purulent discharge 531f
Sinus tarsi syndrome 314, 316, 317, 328, 345
Sit-to-stand test 385
Skier's thumb 182
Skin
and subcutaneous tissue 20
breakdown, presence of 540
changes 10, 169f, 476
creases 325
loss 34, 34f
overlying limb 46
Slipped capital femoral epiphysis 1, 208, 247, 247f
Soft tissue 271
crepitus 37
injury 35t
palpation 476
Sole 326
palpation of 330f
Soleus muscle, test for 454f
Spasticity 491
Speed's test 105, 105f
Spina bifida 398, 341
evidence of 212
Spina bifida aperta 370
Spina ventosa 168
Spinal accessory nerve 425f
C1-C5, 6 425
injury 76
muscles supplied 426t
Spinal artery
anterior 349f, 350f, 350, 407f, 408f
posterior 349f, 350f, 407f, 408f
segmental 351
Spinal cord 6f, 348, 351
affection 389b
arterial supply of 350f
hemisection of 406
infarction 351
injury 352, 393b, 406
major ascending tracts in 349
major descending tract in 350
sensory tracts, assessment 389t
Spinal deformity 371
Spinal injury with traumatic paraplegia 363
Spinal instability 403
Spinal ligaments 352
Spinal metastasis 355
Spinal nerve 348, 410, 467t
Spinal nerve roots 352, 425
specific and single 392
Spinal osteochondrosis 362
Spinal segments 349f
Spinal tumors 322
Spinal unit, functional 354f
Spine 82f, 516
alignment of 364
and pelvis 37
clinical conditions affecting 355b
clinical diagnostic snippets of 362t
clinical evaluation of 348
common infections of 400t
curvature of 82, 353
examination proforma 396
function 353
lesions of 364
mobility 353
movement of 353, 372
normal coronal alignment of 366f
osteology of 348
pathology 356b
red flags of 360
tenderness 370
tumors 502
benign 502
malignant 502
Spinoglenoid notch cyst 116f
Spinothalamic tract
anterior 349f
lateral 349f, 406f, 407f, 408f
Spinous process 215
direct palpation of 372f
of cervical spine 372f
Spondylitis 401
Spondylolisthesis 215, 363, 402
L5 over S1 403f
types 403
Spondylolysis 355, 363, 402, 403f
degenerative 401
Sports injuries 1
Sports-related conditions 109
Sprengel deformity 398
Sprengel shoulder 74, 84, 368f, 398f
Spurling test 378, 378f
basis of 378b
Squeeze test 336
Stability test 108
elbow 137, 143
for anterior cruciate ligament 281
for posterior cruciate ligament 281, 286
for posterolateral corner 281, 289
for posteromedial corner 281, 288
lumbar spine 396
thumb 186
Staheli prone extension method 217
detecting FFD of left hip 218f
Starch-iodine test 422
Static method 84
Static valgus stress test 138f, 138
Static varus stress test 139, 139f
Sternoclavicular joint 71, 84
Sternocleidomastoid 426
test for right side 425f
Sternocleidomastoids 365
Stiff joint 7, 19
Stinchfield test 237
positive 249
Straight leg raising test 382, 382f
Stroke test 273, 274f
Stump, palpation of 515
Styloid processes 176f, 179
Subacromial bursa 107
Subacromial space 97, 107
Sublime tubercle 119
Subluxation, tests for 183
Subscapularis tear 101
Subscapularis tendon, tests for 102f, 103f
Subtalar joint 310, 332
inversion-eversion, assessment of 332f
palpation 330
Sudeck's osteodystrophy 193
Sudomotor function 422
Sulcus sign 96, 474f
grading of 97
Sulphasalazine 63
Superior labral anterior-posterior lesion 77
Superior labral anterior-posterior tear 109
Supinator crest 119
Supinator reflex 421
Supinator tunnel syndrome 122, 123
Supine method 217
Suppurative tenosynovitis, acute 168
Supraclavicular fossae 365
Supracondylar bony process 461
Supracondylar ridges 130
Supraganglionic root 469
Supramuscular swelling 537
Suprapatellar 259
Suprascapular nerve
compressive neuropathy 76
entrapment or compression 115
Supraspinatus 72f, 73
tear 98
tendon, tests for 99f
Supratrochlear 142
Sural nerve 420, 451
Sustentaculum tali 329
Swain test 289
Swallow-tail sign 432
Swan-neck deformity 172
Swelling 5, 32, 44, 46, 77, 125, 128, 163, 170, 171, 261, 270, 271, 315, 360, 369, 496, 537b, 537f
arising from nerve 537
arising from tendon 537
causes of 211
characteristics of 419
clinical evaluation of 530
diagnosis of 533t
local examination of 532
multiple 531, 531f
of distal limb 48
of right knee joint 58f
palpation of 134
plane of 536
pulsatile 536f
right ankle 328f
specific characteristics 535
submuscular 537
Syme's amputation stump 517f
Sympathetic nervous system 352, 354f
Syndactyly 198f
Syndesmosis injury, distal 336
Syndesmotic ligaments 311
Synovial chondromatosis 308, 308f
Synovial fluid 10
Synovial hypertrophy 173, 175, 261, 274
palpation of 275f
Synovial membrane 10
Synovitis, stage of 61
Syringomyelia 68
Systemic lupus erythematosus 172, 410
related arthropathy 63
T
Table-top relocation test 141
Table-top test 183
Talar dome 328
Talar osteochondral lesions 345
Talar tilt test
eversion 336f
inversion 335f
Talipes equinovarus, congenital 314, 317, 325f
Talofibular ligament, anterior 310
Tanner grading in 13
boys 14t
girls 14t
Tardieu scale 491b
Tardy ulnar nerve palsy 126, 448, 448b
Tarsal coalition 317
Tarsal collapse 326f
Tarsal tunnel syndrome 318, 329, 347, 463
Tarsometatarsal joints 68f
Tarsometatarsal junction 238
Telescopy test 231, 231f
Tenderness 47, 84, 176, 214, 271, 272, 327, 543, 547
anterior to ankle 328
around wrist 173
Tendinitis, calcific 74, 75, 80, 115
Tendo-Achilles 313, 322, 323
insertion 329
tear 318
tendinitis 318
tendon proximal 329
Tennis elbow 106, 122, 123, 126, 149
tests for 137
Tenosynovitis 165
Tensor facia lata contracture 234
Teres minor 72f, 73, 431
test for 100
Thessaly test 294, 295f
Thigh-calf circumference 244
Thigh foot angle, measurement of 239f
Thomas hip flexion test 216, 217f
rationale of 217
Thompson test 338f
Thompson-Simmond test 338
Thoracic outlet syndrome 167, 362, 399
special test for 380, 384
Thoracodorsal nerve 429f
C6-C8 428
muscles supplied 428t
Thrombocytopenia 198
Thumb 272f
abduction 442
and extension angle 177
metacarpophalangeal joint 178
movements 178f
Thyroid dysfunction 165
Tibia, pagetic bowing of 54f
Tibial bowing, anteromedial 51
Tibial component, measurement of 228f
Tibial condyles 252
Tibial nerve 420, 421
test of muscles of 454
Tibial plateau 253f
lateral 253f, 256f
medial 253, 253f, 256f
Tibial torsion 238, 239f
internal 239f
Tibial tuberosity 272
bilateral 307f
Tibialis, anterior 313, 448, 448fc, 453
test for 453f
Tibialis, posterior 313, 329, 448, 448fc, 454
insufficiency 318
tendinitis 343
test for 455f
Tibiofemoral angle 280
Tibiofemoral articulation shallow 252
Tibiofemoral joint 251
Tie beam 312
Tietze's disease 78
Tinel's sign 329, 422, 479
Tingling 125, 315, 513
Tissues, dead 546f
Toe deformities 321b
Toeing-in and toeing-out deformities 321
Toes’ sign 323f
Tom Smith arthritis 246
of hip 207
of left hip 246f
Tone 391
Torticollis 16
of right side 364f
Tourniquet inflation test 199
Trabaculae crossing joint 19f
Translucency 538
Transmitted movement, loss of 37, 47
Trans-olecranon fracture-dislocation 146
Trapezium 174
Trapezius 73, 77, 424f, 426
lower, test for 427f
middle, test for 427f
upper, test for 427f
Trapezius palsy 460
triangle sign of 460
Trapezoid 174
Trauma 3, 414
acute 261
mechanism and force of 30
related orthopedic emergencies 39
sonography in 29
triaging of 27, 28t
velocity of 30
Traumatic amputations 512
Traumatic brachial plexus injury 76
Traumatic dislocations 76
Traumatic injury
closed 414
open 414
Traumatic paraplegia 406
Trendelenburg gait 524, 525f
Trendelenburg test 232, 241
assisted 233f, 233
false-negative 232
negative 232f
positive 232f
Triangle sign 205, 460f
Triangular fibrocartilage complex 154, 162, 175, 200
functions of 154
injury 195
Triceps 435
tendinitis 122
tendinopathy 150
test for 436f
Trigger finger 166, 179, 191
Triquetrum 175
Trochanteric ‘C sign’ 204
Trochanteric region 211
Trochlear, anatomy 258
Trumpet sign 481f
Truncation sign 303
Tscherne classification 35t
Tubercular arthritis 55, 152, 305
Tubercular osteomyelitis 50
Tuberculosis 10, 45, 355
chronic infection 162
history of 57
in lung 57
of hip 21, 58, 208, 246
of infective arthritis 56
of joint 4, 44, 57, 61, 359
of knee 23, 56, 58
of musculoskeletal 55
of phalanx 161, 168
of shoulder 74, 77, 116
of spine 362, 400
of ulna 121
sicca 61
stages of 58
Tumors 199, 415
benign 49, 74
examination 503
malignant 49, 74
Turf toe 345
Turner's syndrome 209, 367, 378
Tyrosine 70
U
Ulcer 46, 544f
clinical evaluation of 530
edge, types of 546f
examination of 544
in great toe 326f
non-healing 546f
over great toe 544
over heel, non-healing 325f
over malleolus 544
over plantar aspect of foot 544
toe with gangrene 547f
types of
everted edge 546
punched out edge 546
rolled-out edge 546
sloping edge 546
undermined edge 546
Ulcus sign 96
Ulnar clawing 448
Ulnar collateral ligament
complex 120
lateral 9, 119, 120f
test 182f
Ulnar deviation 177f
forearm pronation test 183, 187
test 184f
Ulnar impaction syndrome 166, 196
Ulnar nerve 134, 180, 418f, 420
autonomous zone of 444f
C8, T1 443
muscles supplied 445t
near elbow 447
near wrist 447
neuritis 123
Ulnar nerve palsy, features of 446
Ulnar nerve signs, summary of 448
Ulnar paradox 447b
Ulnar styloid process 174
Ulnar tunnel syndrome 197
Ulnohumeral articulation 120
Ulnohumeral bony articulation 120
Ulnolunate 153f
Ulnotriquetral 153f
ULT1 test 379f
ULT1A test 379f
ULT3 test 380f
Upper brachial plexus birth palsy 481f
Upper brachial plexus injury 470, 474f
Upper limb 516
dermatomal pattern of 479f
length measurement 90f, 136f
muscles, major nerves supplying 424fc
myotomes of 392f
Upper limb tensions test 379t
Upper motor neuron 391t
bladder 409
lesions 391
Upper subscapular nerve 466f
Upper trunk brachial plexus injury 472f
Urinary bladder 352, 352t
innervation 354f
Uveitis 209
V
Vaginal discharge 207
Valgus 16, 16f
and external rotation 144f
deformity 63f, 323
extension overload syndrome 123
instability 145, 146
Valgus overload syndrome 122, 151
Valgus stress test 186, 288, 289f, 290f
Valgus thrust 266
Valgus thrust gait 527
Valsalva maneuver 387
Varicose veins 270
Varus deformity of right tibia 47f
Varus posteromedial rotatory instability 146
Varus stress test 186, 289
Varus thrust gait 266f, 527, 528f
Vascular compression 532
Vascular insufficiency changes 169
Vascular sign of Narath 233, 240
Vascular swellings 532
Vasomotor function 422
Vastus medialis obliquus 269
Veins proximal 535
Venous ulcer 547f
Ventral division 448fc
Ventral ramus 410
Vertebral compression fractures 366
Vertebral motion segment 352, 353
Vertical ground reaction force 243
Vitamin deficiency 415, 523
Volar and dorsal ligaments 153f
Volar plate injury 166
Volkmann's ischemic contracture 20, 194f
Volkmann's sign 179, 194f
Volkmann's ischemic contracture 194
Vrolik disease 51
W
Wagner-Meissner corpuscles 483
Walking stick 206
Wallerian degeneration 412, 456, 479
in proximal 457f
indirect 456
secondary 456
Wallerian regeneration 412, 456, 457f
Wartenberg's syndrome 190
Wartenburg's sign 444, 448
basis of 444
Weakness, progression of 471
Well-leg raising test 383
Wilson test for osteochondritis dissecans 299
of knee 297
Wound
boundaries 540
puncture 33, 33f
Wright's test, 380, 381f
Wrist 169
and finger drop 417, 459
and hand 161b
clinical evaluation of 153
and thumb drop 459
dorsal and volar surface of 174f
drop (left) 417
extrinsic and intrinsic ligaments of 154t
Wrist ganglion 167
Wrist hand
clinical diagnostic snippets 165t
examination proforma 189
Wrist joint 177b
clinical significance 153
line tenderness 175
surgical anatomy of 153
Wrist ligament injuries 164
Wrist osteoarthritis 192
Wrist pain, causes of 162t
Wrist ROM 177f
Wrist ulnar deviation 24f
Wrist, volar aspect of 175
X
Xiphisternum 227
Y
Yergason test 105, 105f
Yersinia 66
Z
Zancolli's sign 481f
Z-deformity of thumb 63, 172
×
Chapter Notes

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Musculoskeletal Examination
Musculoskeletal Examination
SECOND EDITION
Chief Author and Editor Vivek Pandey MBBS MS (Orthopedics) Professor Unit Head, Sports Medicine and Arthroscopy Division Department of Orthopedic Surgery Kasturba Medical College Manipal Academy of Higher Education Manipal, Karnataka, India Co-author Hitesh Shah MBBS MS Professor and Head Department of Pediatric Orthopedics Kasturba Medical College Manipal Academy of Higher Education Manipal, Karnataka, India Foreword S Rajasekaran
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© 2022, Jaypee Brothers Medical Publishers
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Musculoskeletal Examination
First Edition: 2018
Second Edition: 2022
9789354651984
Printed at:
Dedicated to
My parents, Kuldip Narain Pandey and Manju Pandey
My wife Deeksha and son Krish
My brother Abhishek and his family—Susanne, Demira and Maya
My teachers, students, and patients
Contributors and Reviewers
  • Amrithraj BK MS Ortho Fellowship (Orthopedic Oncology)
  • Associate Professor
  • Department of Orthopedic
  • Surgery
  • Kasturba Medical College
  • Manipal, Karnataka, India
  • Gabriel Rodrigues MS (Gen Surgery) DNB DipLS
  • FRCS (Glasg) FEBS
  • Professor and Head
  • Department of Surgery
  • Kasturba Medical College
  • Manipal, Karnataka, India
  • Anshu Shekhar MS Ortho
  • Consultant Arthroscopy and
  • Joint Replacement Surgeon
  • Sushrut Ortho Plastic Clinic
  • Raipur, Chhattisgarh, India
  • M Subbiah MS Ortho MNAMS FNB (Spine Surgery)
  • Professor and Consultant Spine
  • Surgeon
  • Velammal Medical College
  • Hospital and Research Institute
  • Madurai, Tamil Nadu, India
  • Ashish Babulkar DNB Ortho FRCS (Trauma and Ortho)
  • Consultant Upper Limb
  • Surgeon
  • Department of Shoulder and
  • Sports Injuries
  • Deenanath Mangeshkar
  • Hospital
  • Pune, Maharashtra, India
  • Rajeev Reddy
  • MS Ortho Fellowship in Orthopedic
  • Oncology
  • Consultant Musculoskeletal
  • Oncologist
  • Apollo Hospital, Jubilee Hills
  • Hyderabad, Telangana, India
  • Ashwath Acharya
  • MS Ortho FNB (Hand Surgery)
  • Associate Professor
  • Hand Surgery Division
  • Department of Orthopedic
  • Surgery
  • Kasturba Medical College
  • Manipal, Karnataka, India
  • Ram Chidambaram
  • MS Ortho FRCS (Trauma and Ortho)
  • Consultant Upper Limb Surgeon
  • Director, Institute of Shoulder,
  • Elbow, Hand and Sports Injuries
  • MGM Healthcare
  • Chennai, Tamil Nadu, India
  • Darshan Jain
  • MS Ortho FNB (Hand Surgery)
  • Associate Professor
  • Department of Orthopedics
  • MS Ramaiah Medical College
  • Bengaluru, Karnataka, India
  • Ramakanth Rajagopalan
  • D Ortho, DNB Ortho
  • Consultant Sports Medicine and
  • Arthroscopy
  • Department of Orthopedics
  • Ganga Medical Center and
  • Hospital
  • Coimbatore, Tamil Nadu, India
  • Sachin Tapaswi
  • MS Ortho DNB FRCS
  • Consultant Joint Replacement and
  • Arthroscopy Surgeon
  • The Orthopedic Speciality Clinic
  • Pune, Maharashtra, India
  • SR Sundararajan MS Ortho
  • Head of Sports Medicine and
  • Arthroscopy Division
  • Ganga Medical Center and
  • Hospital
  • Coimbatore, Tamil Nadu, India
  • Saktthi S Shanmuganathan
  • MS Ortho
  • Senior Resident
  • Department of Orthopedic
  • Surgery
  • Kasturba Medical College
  • Manipal, Karnataka, India
  • Sujayendra Murli MS Ortho
  • Assistant Professor
  • Department of Orthopedic
  • Surgery
  • Kasturba Medical College
  • Manipal, Karnataka, India
  • Sandeep Vijayan MS Ortho
  • Additional Professor
  • Department of Orthopedic
  • Surgery
  • Kasturba Medical College
  • Manipal, Karnataka, India
  • Vidyadhara Srinivas
  • MS Ortho FNB (Spine Surgery)
  • Head and Consultant Spine
  • Surgeon
  • Manipal Spine Care Centre
  • Manipal Hospital
  • Bengaluru, Karnataka, India
  • Sandesh Madi MS Ortho
  • Associate Professor
  • Department of Orthopedic Surgery
  • Kasturba Medical College
  • Manipal, Karnataka, India
Foreword
Diseases of the musculoskeletal system occupy a central position in non-communicable diseases and exert a considerable amount of socioeconomic impact on society. Orthopedic diseases have a wide prevalence in both developing and developed countries and are unique because musculoskeletal diseases affect all age groups, from the newborn to the aged. With the aging population increasing globally, degenerative disorders are also increasing, and musculoskeletal problems will be the cause of the maximum disability in the world. It would be essential for these diseases to be treated well for the health of the entire country.
The success of any treatment depends upon the perfect diagnosis, and clinical examination forms an important part of the same. It includes the foundation for the correct diagnosis, choice of appropriate investigations, and correct treatment decision-making. Therefore, a book that forms a stepwise guide for clinical examination, starting from history to the most specific clinical test, is always invaluable.
I congratulate Professor Vivek Pandey, an astute clinician by himself and a well-known teacher, for coming out with the second edition of the book on Musculoskeletal Examination. The book has enumerated the steps of clinical examination very well and thoroughly discussed the basis of each step of the examination in detail. Not only has the theoretical background been well covered, but the entire examination process has also been demonstrated with excellent illustrations. Each chapter is loaded with relevant knowledge and facts, and hence will be very useful not only to the students but also to surgeons at all levels and the teachers. I do not doubt that this book will be an instrumental collection in the library of one and all, and the need for a third edition is not far away.
S Rajasekaran
MS DNB FRCS (Ed) MCh (Liv) FACS FRCS (Eng) PhD
Chairman
Trauma and Spine Surgery
Department of Orthopedics
Ganga Medical Center and Hospital
Coimbatore, Tamil Nadu, India
Preface to the Second Edition
At the outset, let me thank every student and faculty members who strongly believed in the first edition of our book and made it one of the most widely read orthopedic examination books across the country. Everyone has appreciated the clarity and brevity of the text, and pictorial representation of almost all the tests. The most appreciated part was the proforma of clinical examination at the end of the examination, which ensured that the clinical findings were not missed during the examination. Based upon several inputs regarding the first edition and advances in orthopedics, we decided to proceed with the next edition.
When we started revising the first edition, the major roadblock was to balance adequate knowledge and jargon of information available in the medical literature. Although I love simple teaching and believe in discussing the common clinical conditions and relevant tests, it may not necessarily keep pace with advancements in evaluating various conditions and orthopedic clinical examination. Further, newer diseases are being diagnosed, and more tests are advocated for existing and new conditions. All this information needs to find its way into standard books to keep pace with the vast expansion in knowledge, albeit in a balanced fashion. Further, we also realized that we need to upgrade the relevant clinical anatomy for better clarity in the clinical examination and various conditions affecting the musculoskeletal system. Apart from the existing 15 chapters, we have added two new chapters discussing the examination of brachial plexus and a child with cerebral palsy. We involved one of the best clinicians, masters in their arena, writing new and editing existing chapters.
Interestingly, in the pursuit of upgrading the book, we realized that many tests are described differently in different sources, and we had to be quite careful while penning down the same in our book that now has a large following and is considered a standard. We went miles to get the best of all, read the original tests, added the modifications and kept explanations lucid and acceptable to most. Some of you may still find a different description of the same test in another source or be told differently by your professor. Follow what you find easiest to demonstrate, yet logical. Further, I have always believed that there has to be a picture to explain a test or a condition. So, we have got plenty of images in the book. We have also upgraded the surgical anatomy aspect in each section, which will help the readers a lot. The readers will also find an upgraded common condition section, which briefly discusses several common diseases and their management. Although we thought that not many were interested in the common clinical condition section of the book due to its brevity, multiple readers said they wanted that section to be there and upgraded as it helps them understand various common clinical conditions in a nutshell.
Further, in today's era, where every single test description is available on various educational platforms in the form of videos and animation, it has to be Bhagiratha's effort to keep pace with technology. So, readers of this book will find videos of standard clinical tests of different regions uploaded on the digital platform provided by the publishers.
As I finished the second edition with a nine-month-long research process and several revisions, my love for orthopedic clinical examination has grown many more folds compared to the past, and I realized that I knew less then! I feel that I must continue to remain ‘foolish and hungry’ in pursuing knowledge.
Despite multiple revisions and reviews by experts and myself, you would find some errors or controversial points. Please make a note and let me know about them. To err is human! We will rectify the mistakes in the next reprint. Mail me your suggestions and interesting clinical pictures on vivekortho@yahoo.co.in, and we will try to incorporate them in the next edition with your name. Till then, enjoy the second edition of the musculoskeletal examination and keep learning!
Vivek Pandey
Preface to the First Edition
While I was pursuing my MBBS in the 90s, I had difficulties in understanding the musculoskeletal examination due to several reasons. One, fewer books were available and were not structured in the way orthopedic examination was taught and/or be understood. Two, there was barely any description of the basic anatomy, physiology and other facts which are required for the understanding of the joint and its assessment. Three, there were barely few pictures of the tests described. Over the years, the gap between ‘requirement versus availability’ of the structured, readable and pictorial format of orthopedic examination in print format continued to exist.
After I started clinical teaching for students as a resident and later as a staff, I always wondered how to simplify the clinical teaching, make it interesting, logical and deliver it in a structured fashion, especially for undergraduates whose interaction in orthopedics remains limited as compared to surgery, medicine, etc. Even for postgraduates, the available material remains less organized and sometimes, too much for basic understanding. Further, available material is quite a bit imaginary and devoid of pictures, which is difficult for a student to understand and apply. Many sections were poorly described such as peripheral nerve injury and spine examination. These two areas need understanding of basics of anatomy and function before the reader embarks the journey of understanding the examination. Certain sections were completely missing such as amputation stump examination.
In my pursuit to make the clinical teaching simple and structured for students, I decided to pen down the entire basic orthopedic examination in a simple, structured and pictorial format, so that it becomes a ‘one-stop basic referral’ for musculoskeletal examination. I always believed that pictures and images say a lot than words! At one end, I wanted the book to have a basic understanding for undergraduates and on the other end to have advanced concepts for postgraduates too making it a complete guide for musculoskeletal examination.
After all the chapters were written, each chapter was reviewed by the specialist surgeons in the field to make it perfect for reading and understanding. However, despite multiple revisions of each chapter, paragraphs, word and reviews by another specialist, there is a possibility of some inadvertent error and unwanted omissions. We would welcome all suggestions and constructive criticism in our future reprints and revised editions.
If this simplified, structured, filled in with tips and pearls and pictorial academic material could help a student in understanding the nuances of musculoskeletal examination, I would feel blessed and consider my humble endeavor successful.
Mail your feedback and suggestions at: vivekortho@yahoo.co.in
Vivek Pandey
Acknowledgments
It gives me immense pleasure to acknowledge the efforts of every individual and organization who motivated and helped me in accomplishing my academic work on the second edition of the musculoskeletal examination. I am deeply indebted to my alma mater, Kasturba Medical College (KMC), Manipal, Karnataka, India, and its organizational support, creating an excellent teaching, clinical, and research environment.
At the outset, I express my gratitude towards Professor S Rajasekaran, one of the most revered academicians and clinicians across the globe, who agreed to write the foreword for the second edition. I was humbled when sir accepted our request to write the foreword. I am sure that this edition will live up to his expectation and standards. Another person without whose help this edition would not have seen the daylight is my colleague, Dr Saktthi S Shanmuganathan, who has painstakingly reviewed almost every chapter to weed out controversies and mistakes, which I made aplenty! Dr Saktthi, a young colleague from Sri Ramachandra Medical College (SRMC), Chennai, who recently joined us at Manipal, is a no-nonsense girl who would not accept any imperfection in the book and let me proceed until I change it. She does not like colloquial language in medical writing, which we all use a lot in routine conversations. So, I had to change a lot of text to make it perfect. Another dependable colleague of mine is Sandesh Madi, an extremely hard-working, intelligent, and methodical man, who is my man of the eleventh hour! He reviewed many critical chapters like knee, shoulder, elbow, and ankle to iron out controversies and made it more palatable to everyone.
Although many stalwarts have guided me during my academic journey, the pursuit of excellence is because of two gentlemen; One, Dr KN Pandey, my father, a Georgian (KGMC, Lucknow), an astute surgeon who knows almost every aspect of medicine just like all old-time surgeons. He has never let my guards down, whether life or profession! He continues to inspire me about simplified and structured teaching. Two, Professor Sripathi Rao, who is my first mentor in the field of arthroscopy. His impeccable teaching and patient care style have left an indelible mark on my personality. My all-weather friend, colleague, and senior Kiran Acharya continued to give me invaluable inputs at each stage of the book regarding cover, layouts, color, font, and presentation with his unmatchable taste!
I have been lucky to have great teachers like Professors Benjamin Joseph, SP Mohanti, and Sharath Rao, whose teaching style is known to everyone. Over the years, I have learned so much from them. Special thanks to Professor Vineet Sharma from King George's Medical University (KGMC), Lucknow, who always encouraged me to teach younger colleagues and spread knowledge. I also thank my senior colleagues' Professors Anil Bhat, Shyamasunder Bhat, and Monappa Naik, highly experienced in their fields and very methodical. On multiple occasions, they clarified many controversial issues regarding the examination of various sections.
I am indebted to several stalwarts from India who pitched to review chapters to ensure that each section is up to the mark. I thank Dr Ashish Babulkar, a mentor, for his valuable opinion in the shoulder section. Shoulder and Ashish are synonymous! I acknowledge the crispy contribution by Dr Ram Chidambaram, who edited the elbow chapter. When I look at the elbow chapter, I realize that Dr Ram is a powerhouse in clarity, concepts, and brevity! I thank my colleague, Dr Darshan Jain, a brilliant young wrist and hand surgeon, for reviewing the wrist and hand chapter. Dr Ashwath Acharya, one of the most experienced surgeons in microvascular and brachial plexus-peripheral nerve-hand injuries, wrote the chapter on brachial plexus and provided valuable inputs in peripheral nerve injuries and wrist-hand chapters. When I look at these two chapters, I feel indebted to Dr Ashwath for giving it a fantastic shape. I do not remember how often I called Ashwath sir on odd hours to clarify various debatable terms and definitions. Dr Sitaram, who is our Senior Resident, gave several brilliant suggestions, especially in the peripheral nerve. I also thank Dr Mithun Pai (KMC, Manipal) for various valuable suggestions in brachial plexus section.
The chapter on cerebral palsy and hip has been written and edited by my co-author Dr Hitesh Shah, one of the most accomplished Pediatric Orthopedic Surgeons and an ardent Researcher. Apart from the subject, he is our department's man regarding statistical concepts just like any Gujarati person would be good at numbers and concepts! I also thank Dr Sandeep Vijayan, one of my most dependable colleagues and an amazing trauma and replacement surgeon, for further critical inputs on the hip chapter. I thank Dr Sachin Tapaswi and his colleague Anshu Shekhar for providing invaluable inputs in the knee chapter. Dr Tapaswi's knowledge and contribution in the field of knee injuries and management are priceless, and I am privileged to get him on board. If I have trouble decision-making in a patient with a knee problem, Dr Tapaswi is my choice to discuss the issue. If one person handles ankles easily, it must be Dr Sundararajan from Ganga Hospital, Coimbatore! He is the man who stabilized our ankle chapter along with his colleague Ramakanth Rajagopal. When it came to the spine section, I wondered who would be the best for the job. Two names came to my mind, and both are trained with Professsor Rajasekaran, one of the best in the field of the spine!; A senior of mine, Dr Vidyadhara Srinivas, a dynamic, humble, and highly competent Spine Surgeon working at Manipal Hospital, Bengaluru, and Dr Subbaiah M, an ex-KMC Manipal ortho alumnus, who currently works in Madurai as a Consultant Spine Surgeon. If I count the few most sincere and dependable residents, Subbaiah was one of them! So, Spine was their baby for several weeks to ensure that the best learning material was created for the postgraduates to examine a spine! I also thank Drs Raghuraj K and Nishanth Shetty (KMC, Manipal), who cleared many doubts in spine examinations.
An orthopedic examination cannot be over until we all know about the approach to bone tumors! And so, I was lucky to get two highly trained colleagues on board, Dr Rajeev Reddy and Dr Amruth to refine the chapters on the bone tumor. I thank both for taking out time to write and review the chapter extensively. I also thank Dr Sujayendra Murli, who revised the chapter on gait and amputation and made it more comprehensive. This time, I am humbled to get my surgery Professor Gabriel Rodrigues, always smiling man, to review the chapter on swelling, scar, sinus, and ulcer. From my undergraduate days at Manipal, he has always guided me. I am sure that Ortho Residents will find edited chapter more lucid than before.
Apart from the text part of the book, the most critical contributors are two residents of mine, Drs Sanjoth and Arvind Umrani, who agreed to model for various clinical photographs. I called them on multiple occasions amidst their grueling schedule of orthopedics. I also acknowledge the contribution of Drs Aashay Modi and Devpriya Jaiswal for helping me shoot clinical pictures in the shoulder section. I also thank Dr Amanpreet, our Resident, for providing valuable inputs regarding text and layouts. I also thank Dr Aarthi Venkatramanan (KMC, Manipal) for drawing several figures for the book. I spoke to many other senior colleagues, such as Professors Jayant Sharma, Jagadish Menon, Shirish Pathak, and Nilesh Kamat, regarding multiple clarifications in clinical examination, and I am thankful to them.
Although it is the hard work of the author and multiple reviewers, this edition would not have seen the light of the day without the help of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, and their team. What I like most about Jaypee Brothers is their professionalism in medical publishing and their editorial teams’ untiring ability to go through multiple revisions without raising eyebrows as every modification consumes time! This one took five revisions! I thank Shri Jitendar P Vij (Group Chairman), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy), Ms Rajul Jain, Mr Ashwini Kumar Singh, Mr Gurnam Singh and Mr Chandra Dutt for delivering the revised edition in the most accomplished fashion.
I thank my family for an incredible support in my academic journey. A big hug to my son who helped me deciding various technical aspects of the book and act as model for two pictures in the book. I thank all those countless students and colleagues who have deposed faith in this book since its inception, making it one of the most important dependable books in the orthopedic examination! And who gave invaluable feedback regarding mistakes in the last one and the possibility of improvement in this edition. Most importantly, I am indebted to my patients, who gave me immense clinical experience in the last two decades, reflecting on each page of this book.
How to Use this Book?
  1. Start the book by reading the first chapter, which is the foundation of all the chapters. The art of history taking and examination are discussed in this chapter, which will help understand the nuances of clinical evaluation of the patient.
  2. At the end of history assessment in chapters 410, one must go through the clinical diagnostic snippets, which provides a load of clinical diagnostic wisdom. It will help readers diagnosing many clinical conditions based upon age, key symptoms and/signs.
  3. Each chapter has plenty of clinical pictures in examination section, which will help readers understand and perform the tests more easily.
  4. A simple summarized proforma of the clinical examination of each region is provided at the end of the examination. It helps ensure recollection and retention of all the points for examination.
  5. Most of the common conditions (diseases) mentioned in a chapter are briefly discussed at the end to outline the condition for easier understanding.
  6. Examination of brachial plexus injury and cerebral palsy are the new additions in this book to extend its scope.
  7. One of the most attractive feature of this edition is relevant clinical examination videos, which will be uploaded on the digital platform provided by M/s Jaypee Brothers Medical Publishers (P) Ltd. It will enhance accuracy in eliciting the tests during the clinical examination. After registering on the Jaypee website, one can access these videos with the help code concealed by the sticker behind the first page. The digital platform will be dynamic with the regular upload of clinical videos.
We hope that the revised edition will help you master clinical evaluation in orthopedics. I request you send your suggestions to vivekortho@yahoo.co.in, which will help me improve future editions as per the requirement.