Document 2255041

by user








Document 2255041
Chapter 5 Diagnosis of Musculoskeletal Disorders
ng of the cause list
~fyour personal experience is limited, you
would naturally wish; in the interests of your
patient, to seek consultation with a more experienced colleague.
Solving the problcm of diagnosis for your patients is just the &st of many steps toward
the goal of helping them with their problem.
Having madc a diagnosis of the present situadon, you must then consider the future outlook iprognosicj for your patients and he Prepared to communicate with them at their level
of understanding. They and their close relatives have the right to know (ifthey wish) just
what your diagnosis means in relation to them
and their future. How often one hears patients
say of their medical practitioner: "He raid
quite a bit, and used some big words hatI
could not understand, hut he really didn't tell
Wilson has \r?inen that the rncdical doctor
communicates best when he or she is honest,
compassionate, caring, calm, readily available,
sensitive and trustworthy.
The practice of medicine is becoming progressively more scientific and rhis is as it
should be because science must always be thc
basis of medical knowledge. At the same time,
however, you must develop the art of communicating with your patients, which, in effect,
requires that you acquire a keen and sqmpathetic awareness of their needs as well as their
concerns, for as Sir William Osier stated so
clearly "Thc practice of medicine is an art
based on science."
testingin petipheralvascular disease. Surg GyneObstet 1980;150 :26&?8.
Apley AG, Solomon L. Apley's system of onhopacdim and &acmes. 7th ed. Oxford:United h-
dam: Buttemotth-Heinem-,
Browcr AC. Atthritis in hlack and white. Philadelphia. n3 Saunders, 1988,
Conway lw.
In,aging. =ditorid oven,icw.
Opin ~ r t h o p1992; 3: 135-136.
Eddy DM, Clanton CH. Theart of diagnosis. Solving the cliicopathological conference. N Engl
J Med 1982;306:1263-1268.
and meraholic bone
and I am confused and 'Onme
disease. In: Frymoger JW,ed. Otthopaedic
cemed." No matter how bdianr you havc
howledgc update 4 . Rosemont, E American
Academy of Orthopaedic Surgeons, 1993.
been in the scientific aspect ofyour investigaEl-KhoT' GY, Kesai K, Moorr TE. Ima&
tion, it is oflittle comfort to your patient unthe musculoskeletal system. In: Weinstein SL,
less you have developed the art ofcommunicaohop aedics:prinBucMter Jheds,
tion. It is, ofcourse, not only unnecessary, but
ciples and heir applications,philadelphia: JB
also unwise, to explain the minutiae of your
Lippincon, 1994.
Feldman W. On ordcring tests (editorial).Ann R
patients' diagnosis and treatment to them as
&' U Phys Surg Can 1993;26:269-270.
though they were nlcdical students or medical
Goldbloom KB. Intervieuing: dlc most sophistidoctors. Nevertheless, it is essential that you
cated of diagnostic technologies. Ann Roy Con
give them an understanding oftheir condition
phys sUg can1993;26:224-228.
and also that you be aware of their particular
Hayes CW, Conway WF. Magnetic resonance of
imaging of amcular cartilage. Cum Opin Orthop
needs and fears.
Your patients may either fear death fiom a
S. Physical examination of the spine
progressive disease such as cancer, or fca~lif~-~.:an73 extremities. New Yorh: Appleton-Centurywith a painful, crippling, or disabling condi1976.
tion. They will want and need to lcnow the
Hoppenfeld S. Orthopaedic neurolog: a diagnostic guide to neurologic levels. Philadelphia: JB
answers to questions such as "What is wrong
Lippincon, 1977.
with me? How serious is it? Can it be treated?
How successfilb' What is the weaunent? Hughes SPF. Radionudidcs in orthopaedics surgery, JBone Jointsurg 1980;62B:141-150.
How long
I be away from my home or
Jackson RW, Dandy DJ. Arthroscopy of the knee.
from my work: What would happen if it is not
New York: Grune & Stratton, 1976.
Keller MS, Harhhajan SC, Weiss A. Red-cimr sotreated?"
Section I
Basic Musculoskeletal Science
nography of infant hip dislocation. RadioOzonoff .MB. Pediamc orthopedc radiology. 2nd
ed. Phladelpllia: WB Saunden, 1992.
graphics 1986;6:447-456.
Paul DJ, Giday DL. Polphosphate hone scanning
I(esse1 L. Color atlas of clinical orthopacdics. Chiof non-malignant bonc diseasein children. J Can
c a p : Year Book Medical, 1980.
Avsoc Radio1 1975;26.285-290.
E m HKW,Babyn PS, Harasiewicz KA, Gahurua
H& prizktr DPH, postcr FS. imaging of im- Post M. Physical examination ufthc musculoskeletal system. Chicago: yea^ Book Medical, 1987.
ardculdl cadage
using dwaound
backscaner mcroscopyat 50 M H z JUirEojae- - k ~ n ~ _ d i Q I & ~ o r i sIma'
_ ~&.ing of the muscdoshlctd system. I n : Onhopaedic knowledge updic Research 1995;13:963-970.
M & ~ HI: ~ ~ ~bone~ dscsc:
b ~= insmc.
l i ~ date 3. Roiemont, IL.9mericanAcademy o f o r thopaedic Surgeons, 1990.
tional come lecture. Amencan Acadcmy o f o r thopaedic Surgeons. 1 none
suig 1 9-9 4~. Romcro R. Pilu G, leanw P,Ghidini A, Hobbins
JC. Prenatal diagnosis of congenital abnormali76-A:780-788.
htarsha]l kw, hfkulis DJ, Gllthrlc Bh.1. Quantiaties.
CT: *pplcron &
Sackett DL, Rennis D. Thc sricnce of h e art of
wing magnetic reso.
of ardcular
the clinical examination. JAMA 1992:
" a c e imaging and dncc-dimensional recon267:2650-2652.
srmcrion. J Orthop Kes 1995;13:814-823
Sissons HA, f i f w a y RO, Kemp HBS. Ortl~opacdic
McGintyJ, Caspari RB, Jackson RW: Pochling GG.
diagnosis: clinical, radiological and pathological
Operative Arthroscopy. NswYor)r: h v e n Press,
coordinarcs, Berlin: ~
Smith RV, Gilday DL. Scintigraphic appearances
McGmry JB, Johnson LL, Jackon RW, McBryde
osteoid osteoma. &dioloU
AM, (;oodEellow JW.Uses and abuses of ar137:191-195.
throscopy: a symposium. Current Concepts ReSpringfieldDS. Radioluccnt lcsions of the extremiview. JBoneJointSurg 199?;74-A:1563-1577.
ties J
. surg
$ 1994;2:306-316.
M c h e R Clinical nnhopaedic examination. 3rd
stouerIIU.. ti^ resonance imaging rn o&o.
cd. Edinburgh: ChurchiU Livingstone, 1990.
paedics and spom medicine. Philadelphia: JB
Kyberg D, hIahony BS, Pretonus D. Diagnostic
Lippincott, 1993.
ultrasound of fetal anomalies. St. Louis: CV
Ivan I. Magnetic resonance i m a p g in o d ~ o p a e Mosby, 1990.
dics (invitcd amcle). J Bonc Joint Surg 1991;
0 Keefe D, Mamtora H. Ulrmsound in clinical or7311:539-550.
thopaedics. J Bone Joint Surg 199?;74-B:
Wilson D. Comnlunication and the family physidan. Can Pam Phys 1980;26:1710-1716.
Fly UP