Soft Tissue Rheumatology. Brian Hazleman, Cathy Speed, Graham Riley

Soft Tissue Rheumatology



Download Soft Tissue Rheumatology



Soft Tissue Rheumatology Brian Hazleman, Cathy Speed, Graham Riley. chm ebook
Publisher: Oxford University Press, USA
Language: English
Page: 584
ISBN: 0192630938, 9780192630933

From The New England Journal of Medicine

Cambridge, England, where the authors of Soft Tissue Rheumatology are from, is known for its scientifically rigorous approach to medicine, and this book is very effective at capturing the current knowledge in the field of soft-tissue rheumatology. The authors first provide an excellent review of the basic science of the soft tissues and of how we approach them in terms of history, physical examination, and investigation. They then emphasize the multidisciplinary aspect of soft-tissue rheumatology by describing the roles of various health care practitioners, followed by good reviews of pharmacologic and other types of treatment for soft-tissue rheumatism, including discussions of the evidence of the effectiveness for each. In the second half of the book, the authors take the reader through the history, physical examination, and investigation of disorders in each region of the body, from the neck and back to the limbs. What is lacking, however, is a problem-based approach. Patients present with pain, stiffness, and numbness, and for busy physicians dealing with so many of these cases, what is needed most is a clearly delineated approach to the problem -- a series of steps one should take with each general presentation that will lead to a rapid and accurate diagnosis. Experienced rheumatologists, for example, can usually make a diagnosis on the patient's first visit because they know which questions to ask that will bring out a pattern of responses that suggests a given diagnosis over others. Thus, the first important step is to point, with one finger, at the site of the patient's pain and get a sense of whether the pain is diffuse (e.g., fibromyalgia) or local (e.g., elbow tendinitis). The next most vital question is whether there has been joint swelling (to distinguish an arthritic process from a soft-tissue process). Then there should be a set of quick and easy diagnostic maneuvers to separate joint disorders from those not involving the joints (e.g., a comparison of active vs. passive range of motion and maneuvers to elicit pain). The rest of the history and physical examination, if needed, should be directed toward the confirmation of the suspected diagnosis by means of leading questions. When these standard, rapid approaches fail to elicit a diagnosis, the condition is probably unusual, and one has to venture more widely with questions and investigations to arrive at a diagnosis. Experienced clinicians realize that most shoulder pain is caused by tendinitis, most foot pain by collapse of the arch, and most knee pain by bursitis and that the patient who points to his or her upper lateral thigh as a site of pain has trochanteric bursitis. Clinical practice does not take the academic approach found so often in textbooks but, rather, a more pragmatic approach based on the recognition of the frequency and consistency of the patterns of soft-tissue rheumatism in presentation. When a patient presents with shoulder pain, for example, the clinician asks him or her to point to the site; if the patient points to the trapezius of the neck region, this is a sign that the shoulder joint and rotator cuff are not the cause of what the patient calls "shoulder pain." If the patient places a finger over the shoulder joint proper and the clinician directs him or her to abduct the shoulders, noting at which point the motion becomes painful, and then put his or her hand behind the back and attempt a passive range of motion, this will usually allow the clinician to sort out whether the disorder is of the glenohumeral joint, the rotator cuff, or another structure. Because this type of problem-based approach is used in practice, it should have been included in the clinical sections of Soft Tissue Rheumatology, but otherwise the book is a good effort at elucidating a much-ignored topic. Robert Ferrari, M.D.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.


"...this book is very effective at capturing the current knowledge in the field of soft-tissue rheumatology. ...I recommend this book as a timely update for all endocrinologists and urologists who care for patients with hypogonadism." --New England Journal of Medicine




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