Clinical Orthopaedic Diagnosis
Clinical Orthopaedic Diagnosis
Fourth Edition
Sureshwar Pandey MBBS (Hons) MS (Gen) FICS FIAMS MS (Ortho) FACFAS FACS FNAMS
Professor Emeritus, University of Ranchi Founder and Founder Director, Charitable GNH Handicapped Children Hospital and RJS Artificial Limb Centre, Ranchi
Founder and Consultant, Ram Janam Sulakshana Institute of Orthopaedics and Research
Ranchi, Jharkhand, India
Founder and Emeritus President and Ex-Secretary General, Indian Foot and Ankle Society [Affiliated to International Federation of Foot and Ankle Societies (IFFAS)] Founder and Emeritus Editor, The Journal of Foot and Ankle Surgery Visiting Professor, Universities of Tokyo, Osaka, Teikyo, Adelaide, Flinders, Ujung Pandang, Singapore Ex-Chairman, ASIA-CIP (IFFAS) Founder and Chairman, Ram Janam Sulakshana Pandey Charitable Cancer Hospital & Research and Rehabilitation Centre, Ranchi Hon President, Asia-Pacific Society for Foot and Ankle Surgery • Best Book Award of BOS (2000–2001) for his Book Clinical Orthopaedic Diagnosis, 2nd Edition • Best Book Award of BOA 2002 for his Unique Books • Best Book Award (2009–2010) for his book The Clubfoot Revisited
Anil Kumar Pandey MBBS CORM PhD (Ortho) MAMS
Director and Consultant Ram Janam Sulakshana Institute of Orthopaedics and Research (RJSIOR) Associate Director and Consultant GNH Handicapped Children Hospital and RJS Artificial Limb Centre Executive Director and Consultant Ram Janam Sulakshana Pandey Charitable Cancer Hospital and Research and Rehabilitation Centre Ranchi, Jharkhand, India Consultant—Kiran Centre for Education and Rehabilitation Varanasi, Uttar Pradesh, India Consultant—RAHA, Chhattisgarh, India Reconstructive Surgeon, Rotary International Project, Government of Nigeria
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
Email: info@jpmedpub.com
Jaypee-Highlights Medical Publishers Inc
City of Knowledge, Bld. 235, 2nd Floor
Clayton, Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
Email: cservice@jphmedical.com
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
Email: kathmandu@jaypeebrothers.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2019, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM(if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Clinical Orthopaedic Diagnosis
First Edition: 1995
Second Edition: 2000
Updated Second Edition: 2002
Third Edition: 2009
Fourth Edition: 2019
9789352705504
Printed at
I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the Gods and Goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.
If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.
“DHANVANTARI”*
The Hindu God of Medicine
Commonly worshipped as the Hindu God of Medicine, DHANVANTARI is regarded as the original exponent of Indian medicine. DHANVANTARI has many myths and legends woven around him. He emerged with the pot of ambrosia (symbolic of medicine) in his hand from the ocean when it was churned by the contesting Gods and demons. He is viewed as the very incarnation of God VISHNU. He is said to have recovered ambrosia which had been lost, and thus obtained a share in sacrifices.
Legends make him reappear as “DIVODASA”, the prince of Benaras (Kasiraja), in the family of Ayus. Dhanvantari, Divodasa and Kasiraja are names of the same person who is “the first God and who freed the other Gods from old age, disease and death”, and who in his Himalayan retreat taught surgery to Susruta and other sages. DHANVANTARI appeared on earth in Benaras in the princely family of Bahuja and became known as Divodasa; he wandered about as a mendicant even during his early years.
DHANVANTARI also appears to have been an actual historical person, although his precise identity is hard to be ascertained. He taught surgery and other divisions of Ayurveda (Indian system of medicine) at the instance of Susruta, to a group of sages among whom Susruta was the foremost.
DHANVANTARI is regarded as the patron-God of all branches of medicine. While DHANVANTARI is not credited with any medical treatise of his own, in the early accounts, there is a voluminous glossary and materia medica in the nine sections known as Dhanvantari-Nighantu; it is a compilation which is probably contemporaneous with the famous Amara-kosha (A.D. 100). There are a few other works which are also ascribed to Dhanvantari.
There are numerous preparations which are ascribed to him, and many of them quite ancient.
Dhanvantari-Nighantu is considered the most ancient of the medical glossaries that are available. The original work is said to have been in three recensions; the present version which may have been based on one of them, is in six sections and deals with 373 medicinal substances; their names, synonyms, and brief description of properties being given. The work which claims to be ‘like the third eye’ for the practising physician, is extensively relied upon, despite several more comprehensive glossaries that have been compiled subsequently. Since there is no authentic source of information, this text can be considered more as indicative.
(By courtesy Pfizer Limited)
Foreword to the Fourth Edition
Clinical Othopaedic Diagnosis is based upon the author's (Prof. Sureshwar Pandey) personal observations made during nearly 50 years of interaction with orthopaedic disease and patients.
With the availabilities of modern imaging modalities and investigations, there has been some reduction of the importance of clinical examinations and human-touch; however, all observations made by the modern investigative facilities are mandated to be correlated by clinical features. Clinical examination as suggested by our ancestral orthopaedic educators must include: listen, look, feel, move, measure, and compare (clinically and radiologically), all this has been documented by Prof Pandey, through the written script, tables, photographs, and drawings. The clinical approach for diagnosis is of great importance in areas of the world having constrained resources and for cost-containment in general. A sound clinical judgement helps the clinicians to ask for pertinent investigations rather than order for “MRI screening of whole spine”, “scanogram of both lower limbs” in every case. Despite the development of sophisticated investigations and evolution of superspecialities during a situation of clinical and therapeutic dilemma, the clinical judgement still remains supreme.
In addition to the clinical examination methodology, relevant clinical anatomy of the region being dealt with in a chapter has been described at the beginning of each chapter. The clinical pictures and X-rays collated by Prof Pandey over the life-time covers almost all orthopaedic diseases, deformities and traumatology. The book presents a comprehensive clinical orthopaedics, the illustrations almost present a “book-museum” of complete orthopaedics.
With continuous progress in biological science, no compendium is complete and perfect; however, Prof Pandey deserves congratulations from all students of orthopaedics and myself for his tremendous effort. Prof Pandey should continue to have a sense of accomplishment that he is leaving behind a monumental educative document for the posterity. This book is recommended to be kept in all clinics taking care of orthopaedic diseases, disorders and trauma.
SM Tuli MS PhD FAMS
Senior Consultant in Spinal Diseases and Orthopedics
Vimhans-Primamed Hospital
Nehru Nagar, New Delhi, India
Formerly, Director, Institute of Medical Sciences, Banaras Hindu University
Professor and Head, Department of Orthopaedics
Banaras Hindu University
Varanasi, Uttar Pradesh, India
University College of Medical Sciences
Delhi, India
Foreword to the First Edition
Professor Sureshwar Pandey has undertaken a very worthwhile project in writing a book on Clinical Orthopaedic Diagnosis. The importance of proper clinical examination needs no emphasis. All investigations are based on clues provided by proper and systematic clinical examination and a logical interpretation of the findings.
Unfortunately, there has been a lack of standard textbook giving a detailed and systematic approach to a methodical clinical examination of orthopaedic patients, including correct interpretation of physical signs provided by such examination. Professor Pandey has produced a textbook which embodies all the methods utilised in a systematic clinical examination of the motor skeletal system.
By providing relevant line-drawings, which are very helpful in understanding clinical features and also providing charts that include a step-by-step interpretation of the clinical findings, he has made a proper clinical approach—logical and simple.
I feel confident that the approach he has adopted in eliciting and interpreting clinical features will be most useful not only to undergraduate and postgraduate students but even to practitioners so that they can look upon this book as a guide to reduce incidents of errors in examination.
I heartily congratulate Professor Pandey on this effort.
Padmabhushan Dr B Mukhopadhyay
MBBS (Hons) MCh Ortho (L'Pool) FRCS (Lond) FNAMS
Emeritus Professor
University of Patna
Saidpur Road, Patna, India
Preface to the Fourth Edition
The overwhelming acceptance of the book Clinical Orthopaedic Diagnosis right from the launch of its first edition in 1995, till up till now—the era of its third edition in mid-2018, encouraged us to go for this fourth edition. Acceptance of this book was not only in Indian subcontinent, but also in several countries in the world, which led to the publication of its Spanish edition. This was predicted by the Journal of Bone and Joint Surgery (British Volume) in the review of the first edition itself. Similar has been the opinion in the reviews of other journals and elsewhere.
This edition has been upgraded by the tiresome efforts of the young doctors of my family, besides my co-authorDr Anil Kumar Pandey—and they are Dr Pushpa Pandey, Dr Pallavi Pandey, Dr Kumar Sangam, Dr Shivam, Dr Vaishnavi, and Dr Soumya Anil. My other family members—Mrs Asha Pandey, Mrs Sandhya Pandey, Advocate Shruti and Satyam helped us in proofreading. The sweet young ones of the family Master Atharva Pranjal and Adhrit Pranjal always helped me in easing the tension. Mrs Shabana, Mr Madhukar, Ms Sarita, Ms Laxmi and Ms Mileta have helped in searching the recent works, and arranging the photographs and the manuscript.
Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President) and the devoted team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, have always been at out help. We are thankful to them.
We have tried to mention the source, from wherever any text or photograph has been used in this book; however, ifWe have inadvertently missed anywhere, we beg excuse for that.
Sureshwar Pandey
Anil Kumar Pandey
Preface to the First Edition
Orthopaedic practice demands repetitive and complex decision making. All decisions are necessarily influenced by non-scientific considerations, such as limited facilities, patients’ non-compliance, and financial constraints, as well as the current limitations of orthopaedic science. Despite these impediments, we all strive towards accuracy in our decision making. Accurate clinical diagnosis forms the basis of successful management of any ailment. No doubt, the development of a sound judgement is largely a matter of experience; yet one must remember the words of Sir Astley Cooper, “Nothing is known in our profession by guess, and I do not believe that from the first dawn of medical science to the present moment a single correct idea has ever emanated from conjecture…, there is no short road to knowledge”. The great Indian surgeon Sushruta has also warned against diagnosing a disease merely on speculation. He gave explicit instructions regarding exploration of the history of the disease, thorough examination (inspection, palpation, auscultation, etc.) and analysis of the symptoms and signs, before coming to a conclusion.
The immense importance of systematic clinical examination cannot be overemphasised. No one can be familiar with the clinical signs and their interpretation in a short period or just by going through the text. A rigorous apprenticeship is mandatory to learn the clinical methodology step by step, lest a snap diagnosis based on a cursory examination may prove to be disastrous. Whatsoever may be the advances in the field of investigation procedures, these must remain the supplement to and not the substitute of thorough clinical examination.
With this backdrop, an attempt has been made to further enhance the importance of ‘clinical methodology’ in orthopaedics. The effort has been made to create an atmosphere of positive and practical approach towards diagnosing the clinical conditions on a sound basis, so that therapy becomes easy and less complex. No patient can be examined just for one system, rather it should be the total examination of the patient. However, for the osteoarticular and neuromuscular affections, a more detailed examination than usual is necessary, such as assessment of movements, length disparities, neuromuscular status, etc.
A knowledge of clinical anatomy is quite essential for any orthopaedic student, trainee or even surgeon. To cover this, a brief description of the relevant clinical anatomy of the region dealt with was thought to be essential, and it has been given at the beginning of each chapter. Wherever it was necessary, a note on the basic physiology concerning that zone has been added. Quick and fairly clear conception of the subject can be had by going through a tabular form of description, which has been given whatever deemed to be essential. Reminder of the ‘key diagnostic points’ at the end of the chapters would help the clinicians come to a quick diagnosis, the trainees/residents to learn methods of elimination, and the students/examinees to quickly revise the subject.
With due apology to the stalwarts, whose names could not be included due to my ignorance, an attempt has been made at the end of the book to recall the noted works of the pioneers of orthopaedics.
The manuscript has been revised through the scrutiny of more than seven batches of postgraduate and undergraduate students in orthopaedics and the project is the result of their inspiration, encouragement and criticism. However, a lot of improvements and modifications have to be done in future editions after reviewing the frank criticisms and remarks of the readers—the real watchdogs.
I am deeply obliged to my revered teacher, Padmabhushan Prof Emeritus B Mukhopadhyay, who lit the lamp of knowledge in my mind and soul. And also to my senior and contemporary colleagues all over the country and abroad, like Emeritus Prof N Tsuyama (Tokyo), Prof SM Tuli, Prof PT Rao, Prof DP Baksi, Prof NS Laud, Dr BB Joshi, Prof RR Ganguli, Prof RC Ram, Prof SV Sharma, Prof RP Singh, Prof KM Pathi, Prof NK Agarwal, Prof K Ono (Osaka), Prof T Koshino (Yokohama), Prof B Helal (London), Prof K Bose (Singapore), Prof JM Martorell (Barcelona), Dr R Bauze (Adelaide), and others who helped me to clear my confusion at several stages. I did derive benefit, pleasure, and profit from their stimulating exchange of ideas, which I very humbly and deeply acknowledge.
My colleagues, Prof RL Rajak, Prof B Alam, Prof HN Sinha, Prof AK Mishra, Prof KP Pandey, Dr PD Singh, Dr KN Jha, Dr SS Jha, Dr RC Mishra, Dr SN Sinha, and others with whom I have been privileged to work through the years and have helped by providing healthy criticism, I am indebted to all of them.
The tiresome work of proofreading has been ably assisted by my son Dr Anil, daughter-in-law Dr Pushpa and the fleet of my very dear postgraduate students, especially Drs SP Bhagat, Awadhesh Singh and Sanjeeva Kumar, whose helpI cannot forget.
My family—my loving wife, sons (Dr Anil, Arun and Akhil) and their wives (Dr Pushpa, Asha and Sandhya) tolerated many of my eccentricities all through the period of preparation of this book. I cannot repay the debt. My grandchildren (Pallavi, Shivam, Vaishnavi, Shruti and Saumya) proved to be the real source of pleasure in tense moments. God bless them.
And finally, I sincerely acknowledge the help of Dr Ravi, for preparing the line drawings and Mr Ajit Kumar Shukla, for typing the manuscript.
Sureshwar Pandey
Introductory Comments (Based on the First Edition itself)
This textbook authored by Prof Sureshwar Pandey contains a large number of orthopaedic diseases from children to adult ones. He spent really many years to collect all these materials to complete this marvellous book. From general common diseases to even quite special rare diseases and deformities, this book is dealing with orthopaedic disorders of many kinds. One can have very clear and concise picture of orthopaedic conditions described in this book.
The readers can easily understand and refer to the contents of this book presented in simple and lucid manner, especially the detailed instructional explanations on various diseases, tests, diagnosis strategies, etc. This book is sure to be suitable to be kept on the desk of the Outpatient Clinics to refer at every moment of questions.
I really strongly recommend this book to undergraduate and postgraduate students and trainees who are interested in orthopaedics.
Tomohisa Koshino MD PhD
Professor and Director
Department of Orthopaedic Surgery
Yokohama City University School of Medicine and
President, University Hospital
Yokohama 236-0004, Japan
Professor Pandey's ‘Clinical Orthopaedic Diagnosis’ arouses scepticism against fragmentation, so-called ‘subspecialities of orthopaedics’. His suggestion for a “total orthopaedist” and comprehensive knowledge of the whole musculoskeletal system as the key point to make accurate decision in any situation deserves appreciation.
“The whole art of medicine is in observation, as the old motto goes, but to educate the eye to see, the ear to hear and the finger to feel takes time” (William Osler, 1906). We really hope this book would provide guidelines in favour of the saying, “teach him how to observe, give him plenty of facts to observe and make him proficient in his art through constant contact with diseases”, and prove precious for those who want to know.
Congratulations for your great success in publishing such an excellent textbook—“Clinical Orthopaedic Diagnosis”.I am very much impressed by the fact that it covers comprehensively such a wide area of orthopaedic expertise yet implies concisely the wisdom of orthopaedics. You have presented so precious cases of wide variation…
I am very proud to have been working with such a wonderful orthopaedist and scholar.
Keiro Ono MD PhD
Ex-Professor and Chairman, Department of Orthopaedic Surgery
Osaka University Medical School, Osaka
Professor Emeritus, Osaka University Medical School
Director, Osaka Kosei-Nenkin Hospital, Osaka 553, Japan
I am indeed impressed with this book—“Clinical Orthopaedic Diagnosis” authored by Professor Sureshwar Pandey. It is a unique book on clinical methodology available today. It contains the wisdom of orthopaedics and traumatology as a whole, with an emphasis on the problems in tropical countries and developing world. Clinical methodology is quite clear supported by superb line-drawings and numerous clinical photographs.
The descriptions are simple and straightforward, but at the same time quite informative.
I am sure, those who are interested in orthopaedic surgery—students, practitioners or teachers—will find this book quite useful at all steps. It has great potential to be accepted all over the world.
Chairuddin Rasjad MD PhD
Professor, Department of Orthopaedic Surgery
Chairman, Department of Surgery
International Cooperation
Faculty of Medicine
Hasanuddin University
Ujung Pandang, Indonesia
Professor Sureshwar Pandey has accomplished a unique feat of collecting, analysing, and categorising the voluminous clinical material he managed to observe and treat during four decades of his active professional career. He has been a great enthusiast of proper clinical methods which are so essential for clinicians and society in general in the less privileged half of the world. A rational clinical assessment would help to employ the most appropriate and cost-effective newer modalities of investigations which are very expensive by any standards.
Most of the active orthopaedists in the Indian subcontinent deal with similar rich clinical material; however, it is to the credit of Prof Pandey to put it in a fashion to be understood by any student and practitioner of orthopaedics.
Though extensive strides have been made in the diagnostic tools in the last two decades (almost threatening to replace the humane touch by robotics); however, these serve best on the shoulders of the observations made by the clinical methods, Prof Pandey has re-emphasised for the newer generations. There is no substitute for clinical observations made by ‘listening’, ‘looking’, ‘feeling’, ‘moving’, ‘measuring’, ‘percussing’ and ‘auscultating’. Clinical methods should be a way of orthopaedics as is Yoga the way of life.
Though no compendium is complete and perfect; however, Prof Pandey deserves congratulations and gratitudes from all students of orthopaedics for his tremendous effort. I can assure Prof Pandey that he will cherish and continue to have a sense of accomplishment that he is leaving behind a monumental document for the posterity.
SM Tuli MS PhD FAMS
Former Director, Institute of Medical Sciences
Benaras Hindu University
Former Professor and Head, Department of Orthopaedics
Benaras Hindu University and
University of Delhi
Past President, Indian Orthopaedic Association
The Sureshwar Pandey's book “Clinical Orthopaedic Diagnosis” is a boon to the postgraduate students and practicing orthopaedic surgeons. It has also helped me in teaching the postgraduate students. His collection of clinical photographs is amazing. The language is so simple that Indian students can easily understand the clinical problems in orthopaedics. Postgraduate students in my institution are using it day in and day out and have expressed great satisfaction. Some have stated that they have passed MS (Ortho) and DNB (Ortho) because of this book. I am sure this new edition will be an exciting one.
GS Kulkarni MS MS (Ortho) FICS
Professor, Department of Orthopaedics
Director, Postgraduate Institute of Swasthiyog Pratishthan
Miraz, Maharashtra, India
Past President, Indian Orthopaedic Association
I am glad to know “Clinical Orthopaedic Diagnosis” written by Prof Sureshwar Pandey will be published soon. The style of writing this book has got special characteristic features. Brief anatomical consideration at the beginning of the chapter, essential classification of diseases and trauma, detailed clinical tests of different diseases including those prevalent in the developing countries are the special aspects of this book. The excellent illustrations, tabular presentations of diagnostic features with keynotes at the end of each chapter will make the subject lucid to the undergraduate and postgraduate students and the practicing orthopaedic surgeons for their quick revision. The art of masterly presentation of clinical acumen of different diseases for their interpretation are important clues for its wide acceptance to the reader. The author deserves warm congratulation in his endeavour.
DP Baksi MS FRCS MS (Orth) PhD (Orth) FAMS
Ex-Professor and Head
Department of Orthopaedic Surgery
NRS Medical College
Kolkata, West Bengal, India
Past President, Indian Orthopaedic Association
It has been unique privilege for me to write my comments on the masterpiece work “Clinical Orthopaedic Diagnosis” by Prof Sureshwar Pandey. Prof Pandey, an eminent teacher in the field of orthopaedics has utilised his wide knowledge of the subject to simplify the problems of orthopaedic teaching, for which till now no other substitute was available. It is being, and will be always appreciated by the postgraduate and undergraduate students, orthopaedic surgeons, and nonetheless the teachers.
The text and the self-explanatory illustrations are superb and exemplary.
P Tejeswar Rao MBBS (Hons) FRCS (Edin)
FRCS (London) MCh Orth (L'Pool)
Ex-Professor and Head
Department of Orthopaedics, SCB Medical College, Cuttack
Ex-Director, Medical Education
Past President, Indian Orthopaedic Association
Cuttack, Odisha, India
I am indeed pleased to read your new book “Clinical Orthopaedic Diagnosis”. I must confess that this is one of the concise, informative and complete principles on Clinical Orthopaedic Diagnosis. The illustrations used in your book have clarity, the attempt to elicit clinical aids with precise analysis is noteworthy. I am certain, your book will be one of the best clinical aids for postgraduate students or young orthopaedic surgeons who can utilise it for clinical orthopaedic practice. I am certain, the book has potential of finding worldwide acceptance.
NS Laud
Chief, Orthopaedic Surgery and Traumatology
LTM Medical College and Hospital
Mumbai, Maharashtra, India
Past President, Indian Orthopaedic Association