Physical Examination Of The Spine & Extremities

289 Pages·2016·38.17 MB·English

by  Stanley Hoppenfeld

Physical Examination Of The
Spine & Extremities
Stanley Hoppenfeld
PHYSICAL EXAMINATION
OF THE
SPINE AND
EXTREMITIES
P H Y S IC A L
E X A M IN A T IO N
O F T H E S P IN E
A N D
E X T R E M IT IE S
STANLEY HOPPENFELD, M.D.
Associate Clinical Professor of Orthopedic Surgery,
Director of Scoliosis Service, Albert Einstein College
of Medicine, Bronx, New York; Deputy Director of
Orthopedic Surgery, Attending Physician, Bronx
Municipal Hospital Center, Bronx, New York; Asso­
ciate Attending Physician, Hospital for Joint Dis­
eases, New York, New York
In collaboration with
RICHARD HUTTON
Medical illustrations by
HUGH THOMAS
*cC
APPLETON-CENTURY-CROFTS/Norwalk, Connecticut
Library of Congress Cataloging in Publication Data
Hoppenfeld, Stanley
Physical examination of the spine and extremities.
Bibliography
Includes index.
1. Spine—Examination. 2. Extremities
(Anatomy)—Examination. I. Title. [DNLM:
1. Extremities. 2. Spine. 3. Physical exami­
nation—Methods. WE800 H798p]
RD734.H66 617'.375'075 76-1486
ISBN 0-8385-7853-5
Copyright © 1976 by APPLETON-CENTURY-CROFTS
A Publishing Division of Prentice-Hall, Inc.
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PRINTED IN THE UNITED STATES OF AMERICA
cover illustration: Hugh Thomas
page layout: Jean Taylor
DEDICATION
To my wife Norma, who has added a very
special dimension to my life.
To my parents, my most devoted teachers.
To all the men who preserved this body of
knowledge, added to it, and passed it
on for another generation.

Acknowledgm ents
No book is written without help. I would like to say thank you to a host of
wonderful people.
Leading all acknowledgments must be mine to Richard Hutton and Hugh
Thomas, my associates for six years. They and I worked together on this book
from start to finish. Whatever success it earns, I share with them.
To my orthopedic colleagues at the Albert Einstein College of Medicine for
all their personal help: Elias Sedlin, Robert Schultz, Uriel Adar, David Hirsh,
and Rashmi Sheth.
To the attending physicians at the Hospital for Joint Diseases who during
my residency passed on most of this knowledge to me. I express my apprecia­
tion by preserving it for yet another generation.
To the orthopedic residents at the Albert Einstein College of Medicine whom
it has been a pleasure teaching the material contained in this volume.
To Joseph Milgram who has been a friend and teacher during these many
years of education.
To Arthur J. Helfet for making the opportunity available for writing this
book and for his teachings on the knee.
To the British Fellows who have participated in the teaching of physical ex­
amination of the spine and extremities during their stay in the United States
and for their suggestions in the writing of this book: Clive Whalley, Robert
Jackson, David Gruebel-Lee, David Reynolds, Roger Weeks, Fred Heatley,
Peter Johnson, Richard Foster, Kenneth Walker, Maldwyn Griffiths, and
John Patrick.
To Nathan Allan Shore, D.D.S. for his teachings of the temporomandibular
joint and for the continued spark of inspiration he has always provided me.
To Arthur Merker, D.D.S. for his friendship and for providing his house by
the sea as a place to hide away and work.
To Paul Bresnick for his help in initiating the writings of the Lower Ex­
tremity.
To Mr. Allan Apley for his friendship and valuable suggestions in the re­
writing of the book.
To Frank Ferrieri for watching “the store” when I was working on the book.
To Laurel Courtney in appreciation for her time in reviewing the manuscript
and for her positive approach.
vii
To Sis and David for their unwaivering friendship during the midst of pre­
paring the book.
To Ed Delagi for listening to my many thoughts and for reviewing the Gait
Chapter.
To Morton Spinner for reviewing the Wrist and Hand Chapter and making
appropriate suggestions.
To Mel Jahss for reviewing the Foot and Ankle Chapter and giving it a sure
“footing.”
My deep gratitude to Muriel Chaleff our Executive Secretary and long term
friend who so generously participated in the production of this book.
To Joan Nicosia in appreciation for her help in the preparation of the Wrist
and Hand Chapter.
To Lauretta White who extended friendship, typed and kept files, thereby
holding back chaos for six long years.
To Anthea Blamire for her secretarial support.
To Carol Halpern for going out of her way to help with the typing produc­
tion of this book.
To Sabina DeFraia who worked long and productive hours in typing the many
drafts of these pages.
To Doreen Berne for her professionalism in handling the manuscript at
Appleton-Century-Crofts.
To Steven Abramson for his valuable assistance in the production of the book
and its slide package.
1 o Laura Jane Bird for her help in the design of the book.
To our Publisher who has brought our team effort to a happy conclusion.
viii
Contents
Acknowledgments vii
Preface xi
1. Physical Examination of the Shoulder l
2 . Physical Examination of the E lbow 35
3. Physical Exam ination o f th e
W rist and Hand 59
4 . Physical Examination of the C ervical
Spine and T emporomandibular Joint 105
5. Exam ination o f G ait 133
6 . Physical Examination of the Hip and Pelvis 143
7. Physical Exam ination of th e Knee 171
8 . Physical Examination of the
Foot and Ankle 197
9. Physical Exam ination o f th e Lum bar Spine 237
Bibliography 265
Index 267
ix