Table Of ContentTT
DUTTON’S ORTHOPAEDIC
EXAMINATION, EVALUATION,
AND INTERVENTION
NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden
our knowledge, changes in treatment and drug therapy are required. T e authors and the
publisher o this work have checked with sources believed to be reliable in their e orts
to provide in ormation that is complete and generally in accord with the standards
accepted at the time o publication. However, in view o the possibility o human error
or changes in medical sciences, neither the authors nor the publisher nor any other party
who has been involved in the preparation or publication o this work warrants that the
in ormation contained herein is in every respect accurate or complete, and they disclaim
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in ormation contained in this work. Readers are encouraged to con rm the in ormation
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or in requently used drugs.
DUTTON’S ORTHOPAEDIC
EXAMINATION, EVALUATION,
AND INTERVENTION
FOURTH EDITION
Mark Dutton, PT
Allegheny General Hospital
West Penn Allegheny Health System (WPAHS)
Adjunct Clinical Instructor, Duquesne University
School of Health Sciences
Pittsburgh, Pennsylvania
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney oronto
Dutton’s Orthopaedic Examination, Evaluation, and Intervention, Fourth Edition
Copyright © 2017 by McGraw-Hill Education. All rights reserved. Printed in China. Except as
permitted under the United States Copyright Act o 1976, no part o this publication may be
reproduced or distributed in any orm or by any means, or stored in a data base or retrieval
system, without the prior written permission o the publisher.
Previous editions copyright © 2012, 2008, 2004 by he McGraw-Hill Companies, Inc.
1 2 3 4 5 6 7 8 9 DSS 21 20 19 18 17 16
ISBN 978-1-259-58310-0
MHID 1-259-58310-4
his book was set in Minion Pro by Aptara, Inc.
he editors were Michael Weitz and Brian Kearns.
he production supervisor was Catherine Saggese.
Project management was provided by Amit Kashyap, Aptara, Inc.
RR Donnelley was the printer and binder.
Library of Congress Cataloging-in-Publication Data
Names: Dutton, Mark, author.
itle: Dutton’s orthopaedic examination, evaluation, and intervention / Mark
Dutton.
Other titles: Orthopaedic examination, evaluation, and intervention
Description: Fourth edition. | New York : McGraw-Hill Education, [2016] |
Preceded by Dutton’s orthopaedic examination, evaluation, and intervention
/ Mark Dutton. 3rd ed. c2012. | Includes bibliographical re erences and
index.
Identi iers: LCCN 2016011470 | ISBN 9781259583100 (hardcover) | ISBN
1259583104 (hardcover)
Subjects: | MESH: Orthopedics–methods | Physical Examination–methods |
Musculoskeletal Diseases–diagnosis | Orthopedic Procedures–methods
Classi ication: LCC RD734 | NLM WE 168 | DDC 616.7/075–dc23 LC record available at
http://lccn.loc.gov/2016011470
McGraw-Hill Education books are available at special quantity discounts to use as premiums and
sales promotions or or use in corporate training programs. o contact a representative, please visit
the Contact Us pages at www.mhpro essional.com.
For my parents,
Ron and Brenda, who have always helped, guided, and inspired me
and to my two daughters, Leah and Lauren, who provide me with such joy.
Your Legacy
Will you have earned the respect o your peers and the admiration o your critics?
Will you have acted humbly during success and grace ully in the ace o adversity?
Will you be remembered or how o ten you brought smiles to the hearts o others?
Will you have looked or the very best, and done your utmost to build worth, in others?
Will you have le t this world a better place by the li e you have lived?
Modif ed rom The Legacy You Leave ©2000 by Rick Beneteau
Conte nt s
Pre ace ix
SECTION IV
Acknowledgments xi
Introduction xiii THE EXTREMITIES
16 The Shoulder 577
17 Elbow 711
SECTION I
18 The Forearm, Wrist, and Hand 779
ANATOMY 19 Hip 869
20 The Knee 966
1 The Musculoskeletal System 3
21 Lower Leg, Ankle, and Foot 1081
2 Tissue Behavior, Injury, Healing, and Treatment 29
3 The Nervous System 64
SECTION V
SECTION II
THE SPINE AND TMJ
EXAMINATION AND EVALUATION 22 Vertebral Column 1191
23 The Craniovertebral Region 1209
4 Patient/Client Management 163
24 Vertebral Artery 1246
5 Dif erential Diagnosis 218
25 The Cervical Spine 1256
6 Gait and Posture Analysis 287
26 The Temporomandibular Joint 1340
7 Imaging Studies in Orthopaedics 344
27 The Thoracic Spine 1382
28 Lumbar Spine 1425
SECTION III
29 The Sacroiliac Joint 1529
INTERVENTION
8 The Intervention 369 SECTION VI
9 Pharmacology or the Orthopaedic
SPECIAL CONSIDERATIONS
Physical Therapist 398
10 Manual Techniques 417 30 Special Populations 1569
11 Neurodynamic Mobility and Mobilizations 445
12 Improving Muscle Per ormance 463 Index 1613
13 Improving Mobility 521
14 Improving Neuromuscular Control 557
15 Improving Cardiovascular Endurance 566
vii
Pre ace
T e ourth edition o this book is an update o in ormation it is the consistent measurement and reporting o clinical
and bibliography provided in the previous versions together outcomes that is the most power ul tool in moving toward a
with a reorganization o various chapters. value-based system.2
T e United States currently spends more money on o that end, the aim o this book is to provide the reader
healthcare per person than any other country in the world, with a systematic and evidence-based approach to the
with current projections indicating that 20% o the gross examination and intervention o the orthopaedic patient.
domestic product o the United States will be spent on Such an approach must be eclectic because no single method
healthcare by the year 2019.1 As the population continues works all o the time. T us, this book attempts to incorporate
to age, the treatment o musculoskeletal conditions, and the most reliable concepts currently available.
their subsequent expenses, will also increase. T is will I hope that this book will be seen as the best available
place an increasing burden on the clinician to provide value textbook, guide, review, and re erence or healthcare students
or money—the achievement o a health outcome relative and clinicians involved in the care o the orthopaedic
to the costs incurred. Gone are the days when a clinician population.
can rely on an expensive shotgun approach to treatment.
Instead, emphasis is now placed on outcomes such as patient Mark Dutton, P
satis action and accurate measures o clinical outcomes, or
Comments about this book may be sent to me at [email protected].
ix
Ackn owle d gm e nt s
From inception to completion, the various editions span almost o the production crew o Aptara, especially the project
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12 years. Such an endeavor cannot be completed without the manager Amit Kashyap.
help o many. I would like to take this opportunity to thank the
Bob Davis or his creative eye and the excellent photography.
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ollowing:
Leah or agreeing to be the photographic model.
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T e aculty o the North American Institute o Manual
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T e sta o Human Motion Rehabilitation, Allegheny
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and Manipulative T erapy (NAIOM )—especially, Jim
General Hospital including roy Baxendell, Susan Berger,
Meadows, Erl Pettman, Cli Fowler, Diane Lee, and the
Diane Ferianc, Leslie Fisher, Keith Galloway, Dave Hahn,
late Dave Lamb.
Dean Hnaras, John Karp, Ronald Klingensmith, Randi
T e exceptional team at McGraw-Hill, or their superb
(cid:0) Marshak, Dan McCool, Renee Nacy, Dan Norkiewicz,
guidance throughout this object. T ank you especially
Darcy Skrip, Jodi Weiher, Melissa Willis, and Joe Witt.
to Michael Weitz or his advice and support and to other
o the countless clinicians throughout the world who
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members o the initial lineup. Special thanks also to Brian
continually strive to improve their knowledge and clinical
Kearns.
skills.
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