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11 of 12 people found the following review helpful:
Unique and indispensable for physicians in many specialties, July 4, 2000
"Oh, not another back!" is a frequent lament by physicians, whether a generalist or specialist. In medical school, physicians learn very little about conditions that might be classified as "mechanical diseases," except for fractures, dislocations, and other conditions treatable by immobilization or surgery. Most diagnosis is perfunctory and imprecise (such as "low back strain" or "sprained wrist"), and the treatment armamentarium is limited to non-steroidal anti-inflammatories, exercises that are unhelpful if not actually harmful, "muscle relaxants," or other anodyne intended to get the patient out of the office, preferably with a referral slip.This book is indispensable to physicians who would actually like to help the 15% of their patients with an ailment in the neglected province of orthopedic medicine. It is based on meticulous work in the dissecting room, prolonged study with pioneers in the field, and extensive clinical experience and research. The book begins with diagnostic and treatment principles and a discussion of morbid anatomy. I found it to be a remedial education, filling in great gaps in my basic knowledge and challenging widely held beliefs on the basis of compelling logic. Specific soft-tissue injuries are discussed by region: the neck, the back, the thoracic spine, the shoulder, the elbow, the wrist, the hand, the hip, the knee, the ankle, and the foot. There are lucid descriptions of basic physical examination techniques, most of which are omitted or poorly described in standard textbooks. (I relied upon it extensively for the second edition of Sapira's Art and Science of Bedside Diagnosis.) Excellent radiographs and line drawings complement the clear and well-organized explanations. There is a wealth of reference material. Most physicians will need to read this book with an anatomy text close at hand, at least if they were trained after the great curricular upheavals. A good neurology book is also helpful. Dorman calls orthopedic medicine the "Cinderella of medical specialties." Though the foundation for the specialty was laid in 1929 by James Cyriax at the St. Thomas Hospital in London, scores of clinical entities that respond to orthopedic medical procedures remain unrecognized and untreated. Neglect of these vexing ailments by "mainstream" physicians probably accounts for the great popularity of chiropractic as well as many lay practitioners who provide some form of manual medicine. This book opened a whole new world of medicine to me. The discussions of referred pain and tenderness, the elucidation of the role of the sacrum and the sacro-iliac joint, the technique of examination by resisted movements (especially in the shoulder), and the explanation of the mechanism for the varied presentations of whiplash are more than worth the price of the book. Even those physicians who do not aspire to master the more difficult treatments for the neck or the back can learn how to benefit patients with common problems involving the shoulder and other peripheral joints and ligaments. At the very least, the book can help to save patients from the harm of misguided treatment or the misdiagnosis of malingering in those with genuine injury. General practitioners, general internists, physiatrists, and orthopedists -- or anyone who treats "musculoskeletal" conditions -- should own this book. Patients who aren't being helped by today's standard treatment might want to take a look at it also. They might help to lead physicians to what I believe will (or should) become standard treatment in the future.
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