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Chad Starkey, PhD, AT, FNATA
Professor
Division of Athletic Training
School of Applied Health Sciences and
Wellness
College of Health Sciences and Professions
Ohio University
Athens, OH
Sara D. Brown, MS, LAT, ATC
Clinical Associate Professor
Director, Programs in Athletic Training
Boston University
College of Health and Rehabilitation
Sciences: Sargent College
Department of Physical Therapy and
Athletic Training
Boston, MA
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Library of Congress Cataloging-in-Publication Data
Starkey, Chad, 1959- , author.
Examination of orthopedic & athletic injuries / Chad Starkey, Sara D. Brown. — Fourth edition.
p. ; cm.
Examination of orthopedic and athletic injuries
Includes bibliographical references and index.
ISBN 978-0-8036-3918-8 — ISBN 0-8036-3918-X
I. Brown, Sara D., author. II. Title. III. Title: Examination of orthopedic and athletic injuries.
[DNLM: 1. Athletic Injuries—diagnosis. 2. Orthopedic Procedures—methods. QT 261]
RD97
617.1’027—dc23
2014041993
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Whenever I put my foot in my mouth and
you begin to doubt
That it's you that I'm dreaming about
Do I have to draw you a diagram?
Chad Starkey, PhD, AT, FNATA
To my colleagues at Boston University, for
your relentless curiosity, commitment to
improvement, and willingness to laugh
every day.
Sara D. Brown, MS, LAT, ATC
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Preface
T
Some chapters have been reorganized, with the cervical
he continued evolution of health care necessitates care- and thoracic spine now bundled together to reflect clinical
ful changes in how we think about and approach the exam- reality. The chapter on environmental conditions has been
ination and diagnostic process for patients with orthopedic removed since this content is not typically included in
conditions. In this edition, we emphasize a patient-centered courses relating to orthopedic examination. The relevant
examination process using the World Health Organization’s content on thoracic, abdominal, and cardiopulmonary
International Classification of Functioning, Disability, and pathologies, a stand-alone chapter in the third edition, has
Health disablement model. This model reminds us to look been redistributed to the specific systems.
for connections between what the patient can and cannot The content is now organized into five discrete sections.
do and the involved body structures and functions. Section I presents the foundations of the examination
We continue to highlight the practical integration of evi- process. Chapter 1 describes the clinical examination process
dence into practice. Updated information regarding the used, and Chapter 2 presents the on-field processes used
clinical usefulness of selective tissue tests and other exami- throughout the text. Chapter 3 introduces the elements of di-
nation techniques is presented in the associated boxes using agnostic evidence and describes the measures commonly
a standardized format. Most notable, perhaps, is how little used for assessing outcomes (which are then presented in the
continues to be known about the validity and reliability of relevant Section Openers). Chapter 4 gets the messy vernacu-
some of the commonly used techniques. We have added lar used to describe pathology out of the way and presents the
multiple new techniques that have promising or established examination findings of common musculoskeletal disorders
diagnostic value. The values we present are dynamic and (e.g., sprains, inflammatory conditions, fractures). Chapter 5
are not intended to supplant current systematic reviews or describes diagnostic imaging techniques that are often the
meta-analyses. gold standard used to confirm the clinical diagnosis. Chapters 6
The values used to represent the range of scores for (Assessment of Posture) and 7 (Evaluation of Gait) emphasize
inter- and intrarater reliability, sensitivity, specificity, and general alignment and function that can contribute to a
positive and negative likelihood ratios were obtained from patient’s status.
the references cited in the Appendix. Ranges for metrics Section IIcontains those chapters that describe the ex-
that had 12 or more data points were calculated using the amination of the lower extremity. Although the content is
95% confidence interval, while those having 5 to 11 data presented in separate chapters, the actual clinical examina-
points were calculated using the interquartile range. For tion will most likely require the examination of the sur-
those tests having two to four data points, the low value, rounding body parts. Section IIIpresents the examination
high value, and median value were reported. Instructors of the torso. Lumbar and sacral examination is presented in
and students are encouraged to regularly scan the literature Chapter 13, while Chapter 14 covers the cervical and tho-
for the most recent information. racic spine and the thorax. The upper extremity, shoulder
Integration of outcome measures into daily practice is be- and upper arm, elbow, wrist, hand, and fingers are covered
coming the expectation for high-quality health care. Outcome in Section IV. The text concludes with Section V, involving
measures provide a standard approach to understanding the injuries to the eye (Chapter 18), face (Chapter 19), and the
patient’s current status, the impact of a condition on the pa- brain and skull (Chapter 20).
tient’s life, and the extent to which an intervention is helping The most visually striking change is the new full-color
the patient. This text emphasizes the incorporation of out- format, designed to provide still greater clarity of the
come measures into the examination process and connects pathologies and diagnostic techniques described in this
these outcomes to a brief description of the interventions text. We encourage both instructors and students to contact
used. A new opener for each section describes commonly us with questions or comments. Chad’s e-mail address is
used patient-rated outcome measures and region-specific [email protected], and Sara’s is [email protected]. We also
functional assessments, and clinician-rated outcome meas- invite students and instructors to visit us on Facebook at
ures are incorporated into each chapter. facebook.com/EOAI4.
v
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Contributors
Monique Mokha, PhD, ATC, LAT Brady L. Tripp PhD, ATC
Associate Professor Clinical Associate Professor
Division of Math, Science, and Technology Director of Graduate Athletic Training
Farquhar College of Arts and Sciences Dept. Applied Physiology and Kinesiology
Nova Southeastern University College of Health and Human Performance
Fort Lauderdale-Davie, FL University of Florida
Gainesville, FL
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Reviewers
John W. Burns, MS, ATC, LAT Heather Schuyler, MA, AT, MT, KTP
Program Director, Athletic Training Education Assistant Professor
Kinesiology Athletic Training Education Program/ESPE
Washburn University Adrian College
Topeka, KS Adrian, MI
Erin M. Jordan, MS, ATC Bret A. Wood, MEd, LAT, ATC
Clinical Instructor Lecturer, Clinical Coordinator
Health and Kinesiology Department of Kinesiology
Georgia Southern University University of North Carolina at Charlotte
Statesboro, GA Charlotte, NC
Joanne Klossner, PhD, LAT, ATC
Clinical Assistant Professor
Kinesiology
Indiana University
Bloomington, IN
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