Fam's Musculoskeletal Examination and Joint Injection Techniques: Expert Consult - Online + Print, 2nd Edition

145 Pages·2010·13.17 MB·English

by  George V. Lawry MD

FAM’S MUSCULOSKELETAL
EXAMINATION AND
JOINT INJECTION
TECHNIQUES
SECOND EDITION
GEORGE V. LAWRY, MD, FACP, FACR
Clinical Professor of Medicine
Chief, Division of Rheumatology
University of California, Irvine
Orange, California
HANS J. KREDER, MD, MPH, FRCS(C)
Professor
Departments of Orthopaedic Surgery and Health Policy Management and Evaluation
University of Toronto;
Chief
Holland Musculoskeletal Program;
Marvin Tile Chair and Chief
Division of Orthopaedic Surgery
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
GILLIAN A. HAWKER, MD, MSc
Professor
Department of Medicine and Health Policy Management and Evaluation
University of Toronto;
Physician-in-Chief of Medicine
Division of Rheumatology
Women’s College Hospital
Toronto, Ontario, Canda
DANA JEROME, MD, MEd, FRCP(C)
Assistant Professor of Medicine
Division of Rheumatology
University of Toronto
Toronto, Ontario, Canada
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
FAM’S MUSCULOSKELETAL EXAMINATION AND  
JOINT INJECTION TECHNIQUES  ISBN: 978-0-323-06504-7
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden 
our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. 
Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the 
manufacturer of each product to be administered, to verify the recommended dose or formula, the method 
and  duration of administration, and contraindications. It is the responsibility of the practitioner, relying  
on his or her own experience and knowledge of the patient, to make diagnoses, to determine dosages and the 
best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent  
of the law, n either the Publisher nor the Authors assume any liability for any injury and/or damage  
to persons or property  arising out of or related to any use of the material contained in this book.
  The Publisher
Library of Congress Cataloging-in-Publication Data
Fam, Adel G. Musculoskeletal examination and joint injections techniques.
 Fam’s musculoskeletal examination and joint injection techniques / [edited by] George V. Lawry ... [et al.]. — 
2nd ed.
   p. ; cm.
 Other title: Musculoskeletal examination and joint injections techniques
 Rev. ed. of: Musculoskeletal examination and joint injections techniques / Adel G. Fam, George V. Lawry,  
Hans J. Kreder. c2006.
 Includes bibliographical references and index.
 ISBN 978-0-323-06504-7
 1.  Joints—Diseases—Diagnosis.  2.  Joints—Examination.  3.  Arthrocentesis.  I. Lawry, George V. II. Fam, 
Adel G. III. Title. IV. Title: Musculoskeletal examination and joint injections techniques. 
 [DNLM: 1.  Musculoskeletal Diseases—diagnosis.  2.  Injections, Intra-Articular—methods.   
3.  Musculoskeletal Diseases—drug therapy.  4.  Physical Examination—methods.  WE 141 F1985 2010]
 RC932.F36 2010
 616.7’2075—dc22  2010010435
Acquisitions Editor: Pamela Hetherington
Editorial Assistant: Jessica Pritchard 
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Sukanthi Sukumar
Marketing Manager: Helena Mutak
Designer: Ellen Zanolle
Printed in Canada
Last digit is the print number:  9  8  7  6  5  4  3  2  1
DR. ADEL FAM
October 14th, 1936–April 16th, 2007
Students can often point to a mentor who was a particular 
source of inspiration and motivation in their professional 
and personal lives.  
For those fortunate enough to have been taught by him, 
Dr. Adel Fam was that special mentor. 
He shared his internationally recognized talents  
with skill and passion in an academic career that spanned 
over 37 years.  
Dr. Fam taught us that a careful history and  
 physical examination is the most important diagnostic 
tool  available to clinicians, which can be augmented,  
but not supplanted, by blood tests, radiographs, CT scans 
and MRI.  
This second edition of the project originally begun by 
Dr. Fam is dedicated to his memory, and to all those who 
share Dr. Fam’s enthusiasm for perfecting their clinical 
skills to benefit those patients in their care.

PREFACE
The aim of Fam’s Musculoskeletal Examination and Joint musculoskeletal disorders are a common presentation in 
Injection Techniques is to provide medical students, trainees,  rheumatologic, orthopedic, and general practices, teaching 
rheumatologists, orthopedic surgeons, and other medical  of joint examination is not sufficiently emphasized in many 
practitioners with an accurate, systematic, up-to-date, eas- medical schools and postgraduate residency training pro-
ily accessible approach to detailed, comprehensive physical  grams. Furthermore, in most textbooks of rheumatology, 
examination of the joints and the spine. The text emphasizes  orthopedic surgery, and physiatry, there is limited informa-
pertinent basic anatomy of the joints as it relates to diagnos- tion about the essential details of basic anatomy, history tak-
tic accuracy and interpretation of physical signs. Evidence- ing, and principles of joint examination.
based critical appraisal of the available literature on physical  A great many people have contributed, directly or indi-
examination is correlated with the experiences and concepts  rectly, to the production of this textbook. We are particularly 
of the authors, other rheumatologists, orthopedic surgeons,  indebted to our colleagues, both junior and senior, teachers, 
and physiatrists. and mentors for their guidance.
The chapters are expertly written, richly illustrated, and  Our hope is that this book, written by clinicians for clini-
both clinically relevant and practical. Each chapter contains a  cians, will become a useful resource both as a teaching text 
brief description of rheumatic disorders specific to a particular  and a general reference on the basic concepts and techniques 
joint. This includes a unique section in the hip and knee chap- of physical examination of the joints and spine. It should 
ters on problems following joint replacement arthroplasties.  benefit not only medical students, trainees, rheumatologists, 
At the end of each section, the techniques of joint and bursal  orthopedic surgeons, and physiatrists but also physiothera-
aspiration and injection are discussed with the more common  pists, occupational therapists, and other health professionals 
ones demonstrated in accompanying videos. dealing with musculoskeletal disorders.
The diagnosis of rheumatic disorders largely depends on 
clinical skills and knowledge of applied anatomy. Although 
vii

CONTRIBUTORS
CARLO AMMENDOLIA, DC, PhD BRUCE V. FREEMAN, DDS, DOrtho, MSc
Assistant Professor Associate in Dentistry 
Department of Health Policy Management and Evaluation Department of Orthodontics
Faculty of Medicine, University of Toronto; Faculty of Dentistry
Chiropractor/ Clinical Researcher University of Toronto;
Department of Medicine Clinician, Headache and Facial Pain Clinic
Division of Rheumatology, Mount Sinai Hospital Department of Dentistry 
Toronto, Ontario, Canada Mount Sinai Hospital
Toronto, Ontario, Canada
DENNIS BEWYER, PT
Senior Physical Therapist MICHAEL B. GOLDBERG, MSc, DDS, Dip Periodontology
University of Iowa Assistant Professor
Iowa City, Iowa Faculty of Dentistry
University of Toronto;
MURRAY J. S. BEUERLEIN, MD, MSc, FRCS(C) Head
Orthopaedic Surgeon Division of Periodontology
Department of Surgery Mount Sinai Hospital
Red Deer Regional Hospital Toronto, Ontario, Canada
Red Deer, Alberta, Canada
ELIZABETH GRIGORIADIS, MD, FRCP(C)
ARTHUR A. M. BOOKMAN, MD, FRCP(C) Lecturer
Associate Professor of Medicine Department of Medicine
Department of Medicine University of Toronto;
Division of Rheumatology Division of Rheumatology
University of Toronto; Women’s College Hospital
Coordinator Toronto, Ontario, Canada
Multidisciplinary Sjogren’s Clinic
Department of Medicine HAMILTON HALL, MD
Division of Rheumatology Professor
Toronto Western Hospital/ University Health Network Department of Surgery
Toronto, Ontario, Canada University of Toronto;
Orthopaedic Spine Service
GREGORY W. CHOY, MD, FRCP(C) Sunnybrook Health Sciences Centre
Assistant Professor Toronto, Ontario, Canada
Sunnybrook Health Sciences Centre
University of Toronto GILLIAN A. HAWKER, MD, MSc
Toronto, Ontario, Canada Professor
Departments of Medicine and Health Policy Management 
ADEL G. FAM† and Evaluation
Professor Emeritus of Medicine University of Toronto;
Sunnybrook and Women’s College Health Sciences Centre Physician-in-Chief of Medicine 
Department of Medicine Division of Rheumatology
Division of Rheumatology Women’s College Hospital 
University of Toronto Toronto, Ontario, Canada
Toronto, Ontario, Canada
DANA JEROME, MD, MEd, FRCP(C)
Assistant Professor of Medicine
Division of Rheumatology
University of Toronto
†Deceased Toronto, Ontario, Canada
ix