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Ronald McRae: Clinical orthopaedic examination, 5th edn

Article  in  International Orthopaedics · February 2004

DOI: 10.1007/s00264-003-0531-0

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International Orthopaedics (SICOT) (2004) 28:60
DOI 10.1007/s00264-003-0531-0
BOOK REVIEW
M. Pecina
Ronald McRae: Clinical orthopaedic examination, 5th edn
Churchill Livingstone, Edinburgh, 2004, paperback, 318 pages, richly illustrated
(ISBN 0443–074070) £26.99
Accepted: 23 November 2003 / Published online: 12 December 2003

Springer-Verlag 2003
McRae’s book, first published in 1976 and now in its fifth
edition, aims again primarily at medical students, but it can
also be of great value to family practitioners, postgraduate
orthopaedics students, sports medicine specialists, rheuma-
tologists, physical medicine trainees, and physiotherapists.
The book is divided into 13 chapters. The first two
introduce the reader to the general principles of examination
of a patient with an orthopaedic problem and involvement of
segmental and peripheral nerves of the limbs. The following
11 chapters describe clinical examinations of different
anatomical areas, because, as the author says: “Patients
parade their complaints on an anatomical basis, and the text
has been arranged accordingly.” Also, the chapters are
arranged so as to follow cranio-caudal or proximal-distal
order of anatomical regions as follows: the cervical spine,
the shoulder, the elbow, the wrist, the hand, the thoracic and
lumbar spine, the hip, the knee, the tibia, the ankle, and the
foot. The length of each chapter, of course, depends on the
significance of orthopaedic problems that can be encoun-
tered, in particular, anatomical localisation. Thus, the
chapter describing clinical examination of the cervical spine
is 16 pages long, whereas the chapter describing examina-
tion of the knee extends over 44 pages; a similar ratio can be
observed 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 orthopaedic
examination. On 306 pages (index not included) there are
1,054 illustrations, including 182 typical radiographs. Each
illustration is accompanied by adequate descriptions, which
together with clear explanatory drawings or high-quality
radiographs, allow easy understanding of a certain clinical
examination 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.” No artist
could draw some clinical test so clearly and faithfully by
following somebody else’s instructions unless that artist was
M. Pecina ())
Department of Orthopaedic Surgery,
School of Medicine,
Salata 7, 10000 Zagreb, Croatia
e-mail: marko.pecina@zg.hinet.hr
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a clinician with a talent for drawing, as is the case with the
author of this book.
On the opening pages of each chapter, the author presents
the most frequent clinical entities characteristic of each
particular anatomic region. As the author says: “The
emphasis in each section is on the common rather than rare
condition to be found in the region. I have purposely avoided
detail, and where this is required a fuller orthopaedic
textbook must be consulted.” With this approach, some
chapters could be criticised for oversimplification and
integrating different entities into one, such as abolishing
distinctions between osteoarthritis and osteochondritis dis-
secans. Nevertheless, this comment is unnecessary, because
such an approach focuses students on the essence of
orthopaedic problems and ways of reaching the diagnosis
in a particular anatomical region.
The textual part of each chapter is followed by drawings
coupled with detailed descriptions, which makes this book,
as I already said, “the atlas of clinical orthopaedic exam-
ination.” This aspect of the book deserves every commen-
dation. However, there is one surprising and rather serious
omission for this type of the book: a textual part of a chapter
is not clearly and systematically related to the relevant
drawings and radiographs. For example, in Chapter 3 (The
Cervical Spine), the subtitle “Thoracic Outlet Syndrome”
could have been followed by a reference to pertinent figures
(Fig. 3.17–3.22), or the sentence “The radial pulse may be
absent, and other signs of vascular impairment may be
present” by a reference to Figs. 3.19–3.21. I believe that this
would make the book even “easier” to read, although it is
already as easy to follow as it is pleasurable to read.
Why was I delighted when I saw this book? I was
delighted because students and physicians simply need to
have a book that reminds them of the importance of clinical
examination as they rely more and more via facti on the
advancement of medical technique and diagnostic proce-
dures, especially in orthopaedics. They tend to forget that
taking a good medical history and performing a clinical
examination make the basis of correct diagnosis. All other
methods are secondary and can be used, although not
necessarily, after a good clinical orthopaedic examination,
which is where this book can be of invaluable help.