Clinical Orthopaedic Examination, Fifth Edition Ronald McRae FRCS(Eng Glas) FChS(Hon) AIMBI Fellow of the British Orthopaedic Association Computed tomography (CT) is the most rapidly evolving medical imaging technology.

• International Orthopaedics (SICOT) (2004) 28:60DOI 10.1007/s00264-003-0531-0 B OOK REV I EW M. Pecina Ronald McRae: Clinical orthopaedic examination, 5th ednChurchill Livingstone, Edinburgh, 2004, paperback, 318 pages, richly illustrated(ISBN ) 26.99 Accepted: 23 November 2003 / Published online: 12 December 2003 Springer-Verlag 2003 McRaes book, first published in 1976 and now in its fifthedition, aims again primarily at medical students, but it canalso be of great value to family practitioners, postgraduateorthopaedics students, sports medicine specialists, rheuma-tologists, physical medicine trainees, and physiotherapists. The book is divided into 13 chapters. The first twointroduce the reader to the general principles of examinationof a patient with an orthopaedic problem and involvement ofsegmental and peripheral nerves of the limbs. The following11 chapters describe clinical examinations of differentanatomical areas, because, as the author says: Patientsparade their complaints on an anatomical basis, and the texthas been arranged accordingly.

Also, the chapters arearranged so as to follow cranio-caudal or proximal-distalorder of anatomical regions as follows: the cervical spine,the shoulder, the elbow, the wrist, the hand, the thoracic andlumbar spine, the hip, the knee, the tibia, the ankle, and thefoot. The length of each chapter, of course, depends on thesignificance of orthopaedic problems that can be encoun-tered, in particular, anatomical localisation. Thus, thechapter describing clinical examination of the cervical spineis 16 pages long, whereas the chapter describing examina-tion of the knee extends over 44 pages; a similar ratio can beobserved with respect to the number of illustrations. The most valuable part of the book are the illustrations,because it is actually an atlas of clinical orthopaedicexamination. On 306 pages (index not included) there are1,054 illustrations, including 182 typical radiographs. Eachillustration is accompanied by adequate descriptions, whichtogether with clear explanatory drawings or high-qualityradiographs, allow easy understanding of a certain clinicalexamination or specific test for a particular clinical entity.Why are the drawings so sophisticated and easy to under-stand? The answer can be found in the subtitle of the book,which reads with original drawings by the author.

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No artistcould draw some clinical test so clearly and faithfully byfollowing somebody elses instructions unless that artist was a clinician with a talent for drawing, as is the case with theauthor of this book. On the opening pages of each chapter, the author presentsthe most frequent clinical entities characteristic of eachparticular anatomic region. As the author says: Theemphasis in each section is on the common rather than rarecondition to be found in the region. I have purposely avoideddetail, and where this is required a fuller orthopaedictextbook must be consulted. With this approach, somechapters could be criticised for oversimplification andintegrating different entities into one, such as abolishingdistinctions between osteoarthritis and osteochondritis dis-secans. Nevertheless, this comment is unnecessary, becausesuch an approach focuses students on the essence oforthopaedic problems and ways of reaching the diagnosisin a particular anatomical region. The textual part of each chapter is followed by drawingscoupled with detailed descriptions, which makes this book,as I already said, the atlas of clinical orthopaedic exam-ination.

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This aspect of the book deserves every commen-dation. However, there is one surprising and rather seriousomission for this type of the book: a textual part of a chapteris not clearly and systematically related to the relevantdrawings and radiographs. For example, in Chapter 3 (TheCervical Spine), the subtitle Thoracic Outlet Syndromecould have been followed by a reference to pertinent figures(Fig. 3.173.22), or the sentence The radial pulse may beabsent, and other signs of vascular impairment may bepresent by a reference to Figs.

I believe that thiswould make the book even easier to read, although it isalready as easy to follow as it is pleasurable to read. Why was I delighted when I saw this book? I wasdelighted because students and physicians simply need tohave a book that reminds them of the importance of clinicalexamination as they rely more and more via facti on theadvancement of medical technique and diagnostic proce-dures, especially in orthopaedics. They tend to forget thattaking a good medical history and performing a clinicalexamination make the basis of correct diagnosis.

All othermethods are secondary and can be used, although notnecessarily, after a good clinical orthopaedic examination,which is where this book can be of invaluable help. Pecina ())Department of Orthopaedic Surgery,School of Medicine,Salata 7, 10000 Zagreb, Croatiae-mail: marko.pecina@zg.hinet.hr.