Cyriax's Illustrated Manual of Orthopaedic Medicine

267 Pages·1996·68.19 MB·English

by  James H. Cyriax MD MRCP, P. J. Cyriax MCSP

CYRIAX’S

ilustrated Manual of

Cyriax
Launched in 1983, this remarkable presentation of the Cyriax metho! was an immediate
success. Valuable information previously hidden in large and unwieldy textbooks suddenly
became easy to understand, Using sreaalined text with superb sequences of fll colour
ilustration, it allowed the reader rapid access to the essence of Cyriax's unique approach
to sll tissue lesions

But onhopuedie medicine continues to develop, and the Cyriax school is playing an
active part in this process. Asa result, many changes to theory and practice have then
place since the “Ilusrated Manual” was fist conceived. To reflect these, the new edition
hus required substantial revision and although the basic style and stucture remain the
same, both rext and illstaions have been completely overhauled

For the tex of this new edition, numerous improvements ard supplementary details
have been included 10 give a greater recognition of sltemative diagnoses and treatments
Different treatment approaches and new conditions are considered, doubiful areas
claritied, refined, new technology and equipment assessed, and terminology
updated. Sports injuries now aecount for a high proponton of problems inthe orthopaedic
‘medicine clinic and are given greater prominence. The result is a broader, more balanced
account, less dogmatic than its pedecesor, in keeping with the discriminating appreach of
the 1990s,

The illustrations are an integral part of the presentation and they too have been given
their share of atenton. Photographs ofthe examination sequences have been replaced by
drawings, nd now often include clear directional indicators showing at a glance ech
successive movement. Many of the illustrations have been re-sized for clarity, and
‘uitonal drawings and photographs added, The eect is to srengthen the visual impact
‘while cussing attention onthe essential features,

This fly updated and re-designed edition remains the indispensable guide t0 the
CCyriax method. No funher recommendation willbe needed for those who are familiar with

the ftst edition, Anyone new 10 the book will find no betler way of keaming about the
approach and technique of one of the acknowledged modern masters of orthopaedic
medicine

JuTTeERWORTH Il
EINEMANN oan

ll
Cyriax’s Illustrated Manual of

ORTHOPAEDIC MEDICINE
Also by James Cyriag

‘ebook of Orthopaedic Meee. Name
Diggnous of Sof swe Lesion (8h con 1983, Bailie Tindal)

Textbook of Othepcedic Medicine, Volare H
‘Treaoment hy Manipulation, Massage and nection (100 eon 1980, Bailie Tidal)

(Osteopathy and Manipulation (1949, Crosby Lock od)
‘The Sippe Dise (1995, Gower Pres}
Cervical Spondyosis (1971, Buteeworts)
Manipudation, Past and Present (1975, Heinemann)
Cyriax’s Illustrated Manual of

ORTHOPAEDIC
MEDICINE

Second Edition

JH Cyriax Mp, MRcP

PJ Cyriax Mcsp
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‘Sepa any pa oh pblenton soe ares
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For Jane Foreman and Holly Nuttall
CONTENTS

Preface tothe First Edition
Preface to the Second Ealtion

Part One General Principles
| Principles of Diagnosis
2 Principles of Treatment

Part Two The Peripheral Joints
3 The Shoulder

4 The Eltow

5 The Wrist and Hand

6 The Sacroiliac, Buttock and Hip
7 The Knee

8 The Leg

9 The Ankle and Foot

Part Three The Spine
10 Principles of Examination
11 The Cervical Spine
12 The Thoracie Spine
13 The Lumbar Spine

Part Four Appendices -
1 The Dermatomes

1 Pins and Needles

ILL The Capsular Patterns

TV Fact Sheets

un
119

143
1ST
181
197

23
246
7
248

265
PREFACE
TO THE FIRST EDITION

many ailments espod 3 real to reatmet. Yet al too
‘en ther ar i egrded an a ter indifrence
Tile bene, the prvineof«marow and eomplex
specials beyond arinary ech,

Bott view are misconceivet nopoetic medicine i
ssunighforea and pacts dcp forthe profession
{tags With he puesto of this on, the work bas
ect silent terms suitable for ead adoption by che
nary practioner, whether family dost
physitheapist oe specialist in spo maine.

‘This epescts an important sap fran: onopasdic
medicine may have ben borin 1929 tan ow si
oming of a. Sines the ely Yous tomes sides
have ben lized in dianostie theory Bt pothaps for
wane a working textbook, the subject has ot made
sersed headway towards widespeca implemestatia. To
take esto cxampls, nce te id-14G thasBoen
posible to abort atti ofthe shoulder, saving he pint
fnyting up ta year's pin and ke wise by a simple
injection e del wit many cases of ahersseinactabie
hackache. Buti ony ty propeton a eases do paints
ceding sich weaument atl esive i and this kindof
neglect means ha over he years onopac medicine has
‘esinodt anomalous status as asp tht has Deen
‘overlooked hut pt superseded. Only its esol insstnce
‘onthe vines of lnical examination accurate diagnos
fd accuate eaten might be teed old-fashioned, but
no substituss can place these skills

Tris uc tha al ses f sophisticated new echnaogies
have develope over he last $0 yeas —arthogras,
nigelogus lrseunl blond Ks, computerizad.
Aisgnostic ids nd soon, Naturally these are
indispensable inthe appropriate cxcunsances, Dutt
happens thal thy have raring cn the onary
Hse lesion. Thus a pariene with sy. sprained Higarnen

tes ning wrong wit is lod or hs bones and
air ay sh up a atest hain ality
pastes. Procedures Rasting the latest equipment, ete
{isgnonicur erp, ae advance when mee ow
indie, The ost mone exercise machines oe
hea delivery systems canto be reganded as upto dei
the pict does ot sed these treatments what mas is
te cstaish whats wong withthe patent and then oat
him for that eonon

"This was the challange facing me in 1929. then found
staring ts an orthopaedic house surgeon, thal paints were
visible int two categories those whos fet showed
‘po Xray and those whoxe X-ays were norm. A that
Hine it asthe eusom tops the late on or
Dhysotherap,consing of wariows kinds of ht herp.
evel difuse mesage and exercises. Ir was a question of
‘vided responsiblity. No diagnosis was made ratempted.
inter the Onhopacse er Phsisterapy Deparment
tnd the eatments werent given because they were
indicate or ven specified bu snl boseuse they wore
tell, Fy yours ater one il ears of pions
Agnosed as painful shoulder’ and batched ap forbes
therapy or excise clases.

“To be iective, easnt must Be an propriate
countemeusre forte comin diagnose, and tis is
‘uch the concem ofthe doctor asthe physiotherapist. The
hose canot sas is ars oe pien merely By
refer elsewhere with ome vague label fore ca fest
‘sure that one else will ake good any shortcomings
inhi nial diagnosis, Whenever a pation set for
Dysioterap, mst be with he diagnostic cemtany nt
nly tha physiotherapy the appropiate recourse ut also
that he physiotherapist knows the work that show t0
teat the ight issue nse ph way. sucha itoiped
context he elatonshipbetcen physician and
physiotherapist becomes complementary; he can nj
PREFACE 10 THE FIRST EDITION

where she cannot se ca ake mc time-sonsaimine Work
‘of his ands by ranavere fiction or manipulation,
Berween there of them, nest ll patients can e dealt
with an the sp: eenerall the ashing needed so callin
specialist, east all a specialst ouside the Hel ef sot
teu lesion,

‘To summarize the tai principles of onhopaedic
‘medicine now the mater of fee minutes, bt fom 1929
Jntook nearly evo decaes to establish he theoretic
rounder the ndings rst sw publication in 1947 in
ook form as Rheumatism ad Sf Tissue Lesions. Over
‘he yea tht work grew unt it mow stands the Febook

| of Orthopaedic Medicine Volumes a I together
Spanning some 900 pages These tes are the repsioy of
‘he tm al of my investiga in sss lesions
nar, [believe the sand erence work.

‘ut as imerest in onhopoeic medicine grew. 0 ee

rove fru renewed pishingprgerne, One
Fd agireent wn a ductor textbook
‘sth oder appeal forthe workin practioner iting
the ee dcp in& single volume, This was the

| gxmess ofthe Musirated Manual of Orthopedic Medicine
Neary al the proceses- whether examination, injection.

sg or mipulition ler themselves rei sep
by step phoworapy: hence the major olin this new book
accor olstations, whi come wal
‘complete pictorial presentation of mtopaetic metic,
Indeed, eset med only logical o preston to make fl
‘of he book a ecordngly a companion series of 10 al
Tour videotapes snow ben compe

The lactated Mana sets of equip the rear
Face the ret blk of pints with cence
Alp is te that exci eco this werk
aloe sil mesa the rar nd ficult eases rein ube,
fsarule the ater has heen no so ach spied
ified, Everyone ses thee ccs with ile lore
realy everyone cr dagnose and ea them with

>

a,
al

os

James Cyt |
London 1982