Clinical Examination in Orthopedics=The link is as follows: http://www.springer.com/medicine/orthopedics/book/978-0-85729-970-3 This book also contains the Chapter on `Clinical Examination of Gait’,by my respected teacher,Dr.L.N.Vora of Mumbai

1. Clinical Examination in Orthopedics
Iyer, K. Mohan
This book has been written step wise by enumerating various aspects of the importance of clinical
examination derived by laying one’s hands on the affected part. By a thorough clinical examination, it
can help an individual to arrive at a tentative differential diagnosis of the condition and hence help in
investigating the same by numerous tests which are relevant to the given condition. The manner in
which a given case is handled in this way is far more important than the diagnosis of the condition and
this feature comes with practicing the same many times. It is a must for anyone embarking in life on
Orthopedics as a career.

2. Preface
This book has been written after many years of working in orthopedics at four wellrecognized universities in different parts of the world: namely, Bombay University,
Liverpool University, London University, and Bangalore University. I have had the
pleasure of working in various capacities in these universities and would expect any
candidate (whether undergraduate or postgraduate) to know these fundamental basic
examination criteria when arriving at the various features of discussion, which are
extremely important in getting good marks in their final examinations. This book
outlines the basic points which must be kept in mind when examining any bone or
joint in orthopedics.
I would like to thank my dear friend and colleague Dilip Malhotra, M.S. Orth.,
M.Ch. Orth., F.I.C.S., senior consultant orthopedic surgeon, International Hospital
of Bahrain, Bahrain, for his timely and valuable help with the X-rays and photographs for this book, without which it would have been very difficult for me to
complete this book. I would also like to thank my other colleagues, in particular
Dushyant H. Thakkar, M.S. Orth., M.Ch. Orth., F.R.C.S. Orth., senior consultant
orthopedic surgeon, London, UK, who has also given me X-rays and photographs
for this book. Above all, it gives me great pleasure to thank immensely my respected
teacher, L.N. Vora, M.S. (Bom.), F.C.P.S. (Bom.), F.R.C.S. (Eng.), M.Ch. Orth.
(L’Pool), Hon. Orthopedic Surgeon, Sir. H. N. Hospital, Mumbai; Hon. Prof. of
Orthopedics (Retd.), Seth G. S. Medical College, Mumbai; Hon. Orthopedic
Surgeon (Retd.) K.E.M. Hospital, Mumbai; for his kind permission to insert the
ix

3. x
Preface
entire chapter “Examination of Gait” in my book. Finally I would like to express my
sincere thanks to Mr. Steffan D. Clements, editor, Clinical Medicine, Springer
(London), for his guidance in the preparation of this book.
Karnataka, India
K Mohan Iyer, M.Ch. Orth. (Liverpool, UK),
M.S. Orth. (Bom), F.C.P.S. Orth. (Bom),
D’Orth. (Bom), M.B.B.S. (Bom).

4. http://www.springer.com/978-0-85729-970-3

5. Contents
1 Examination of Diseases of Bone ...........................................................
1
General Survey ..........................................................................................
General Examination.................................................................................
Special Investigations ................................................................................
Classification of Bony Swellings ..............................................................
2
4
4
5
2. Examination of the Shoulder..................................................................
9
Inspection ..................................................................................................
Palpation ....................................................................................................
Range of Movements ................................................................................
Neurologic Examination ...........................................................................
Reflex Testing .........................................................................................
Sensation Testing ....................................................................................
Special Tests ..............................................................................................
Examination of Related Areas ..................................................................
9
10
12
13
15
15
15
16
3. Examination of the Elbow ......................................................................
19
Inspection ..................................................................................................
Palpation ....................................................................................................
Range of Motion .......................................................................................
Neurologic Examination ...........................................................................
Special Tests ..............................................................................................
Examination of Related Areas ..................................................................
19
20
21
22
23
24
4. Examination of the Wrist and Fingers ..................................................
27
Inspection ..................................................................................................
Palpation ....................................................................................................
Bony Palpation........................................................................................
Soft Tissue Palpation ..............................................................................
27
28
28
31
xi

6. xii
Contents
Range of Motion .......................................................................................
Active Range of Motion .........................................................................
Passive Range of Motion ........................................................................
Neurologic Examination ...........................................................................
Muscle Testing ........................................................................................
Sensation Testing ....................................................................................
Special Tests ..............................................................................................
Examination of Related Areas ..................................................................
34
35
35
36
36
39
40
41
5. Examination of the Hip and the Pelvis ..................................................
47
Inspection ..................................................................................................
Palpation ....................................................................................................
Anterior Aspect.......................................................................................
Posterior Aspect ......................................................................................
Zone I: Femoral Triangle ........................................................................
Zone II ...................................................................................................
Zone III: Sciatic Nerve ...........................................................................
Zone IV: Iliac Crest ................................................................................
Zone V: Hip and Pelvic Muscles ............................................................
Range of Motion .......................................................................................
Active Range of Movements ..................................................................
Passive Range of Movements .................................................................
Neurologic Examination ...........................................................................
Muscle Testing ........................................................................................
Sensation Testing ....................................................................................
Special Tests ..............................................................................................
Examination of Related Areas ..................................................................
47
47
48
48
48
49
49
49
49
50
50
51
51
51
52
53
54
6. Examination of the Knee ........................................................................
63
Inspection ..................................................................................................
Palpation ....................................................................................................
Medial Aspect .........................................................................................
Lateral Aspect .........................................................................................
Soft Tissue Palpation ..............................................................................
Tests for Joint Stability..............................................................................
Range of Motion .......................................................................................
Active Range of Movement ....................................................................
Passive Range of Movement ...................................................................
Neurologic Examination ...........................................................................
Muscle Testing ........................................................................................
Sensation Testing ....................................................................................
Reflex Testing .........................................................................................
Special Tests ..............................................................................................
Examination of Related Areas ..................................................................
63
64
64
64
65
67
68
69
69
69
69
70
70
70
71

7. Contents
xiii
7. Examination of the Foot and Ankle .......................................................
81
Inspection ..................................................................................................
Palpation: Bony Points ..............................................................................
Sinus Tarsi Area ......................................................................................
Area of the Hindfoot ...............................................................................
Plantar Surface ........................................................................................
Zone I: Head of First Metatarsal Bone ...................................................
Zone II: Navicular Tubercle and Talar Head ..........................................
Zone III: Medial Malleolus.....................................................................
Zone IV: Dorsum of the Foot Between the Malleoli ..............................
Zone V: Lateral Malleolus ......................................................................
Zone VI: Sinus Tarsi ...............................................................................
Zone VII: Head of the Fifth Metatarsal ..................................................
Zone VIII: Calcaneus..............................................................................
Zone IX: Plantar Surface of the Foot ......................................................
Zone X: Toes...........................................................................................
Tests for Ankle Stability............................................................................
Range of Motion .......................................................................................
Active Range of Movements ..................................................................
Passive Range of Movements....................................................................
Neurologic Examination ...........................................................................
Muscle Testing ........................................................................................
Sensation Testing: ...................................................................................
Special Tests ..............................................................................................
Examination of Related Areas ..................................................................
81
82
82
83
83
83
84
84
85
85
86
86
86
86
87
87
89
89
89
90
90
91
92
92
8. Examination of the Cervical Spine ........................................................
97
Inspection and Palpation ...........................................................................
Range of Movements ................................................................................
Neurologic Examination ...........................................................................
Muscle Testing of the Intrinsic Muscles .................................................
Examination by Neurologic Levels ........................................................
Sensory Distribution..................................................................................
Neurologic Level – C5 ..............................................................................
Neurologic Level – C6 ..............................................................................
Neurologic Level – C7 ..............................................................................
Neurologic Level – C8 ..............................................................................
Neurologic Level – T1 ..............................................................................
Special Tests ..............................................................................................
97
99
100
100
101
101
102
102
103
103
103
104
9. Examination of the Lumbar Spine ........................................................
109
Inspection ..................................................................................................
Palpation ....................................................................................................
Range of Movements ................................................................................
109
110
111

8. xiv
Contents
Neurologic Examination ...........................................................................
Neurologic Levels T12, L1, L2, and L3 .................................................
Neurologic Levels L2, L3, and L4 ..........................................................
Neurologic Level L4 ...............................................................................
Neurologic Level L5 ...............................................................................
Neurologic Level S1 ...............................................................................
Neurologic Level S2, S3, and S4 ............................................................
Superficial Reflexes ...................................................................................
Pathologic Reflexes ...................................................................................
Special Tests ..............................................................................................
Tests to Stretch the Spinal Cord or Sciatic Nerve...................................
Tests to Increase Intrathecal Pressure .....................................................
Tests to Rock the Sacroiliac Joint ...........................................................
Neurologic Segmental Innervation Test..................................................
Examination of Related Areas ..................................................................
111
111
111
112
112
112
113
113
114
114
114
115
115
115
116
10. Examination of the Temporomandibular Joint ....................................
123
Inspection ..................................................................................................
Palpation ....................................................................................................
Range of Motion .......................................................................................
Neurologic Examination ...........................................................................
Muscle Testing ........................................................................................
Reflex Testing: Jaw Reflex......................................................................
Special Test for the Temporomandibular Joint..........................................
123
124
124
124
124
125
125
11. Examination of Gait ................................................................................
127
Index ................................................................................................................
137

9. http://www.springer.com/978-0-85729-970-3