Additional Information
Book Details
Abstract
Merriman's Assessment of the Lower Limb has established itself through two editions as the benchmark text book of lower limb examination and assessment. The third edition preserves the lucidity, logical approach and comprehensive coverage of its predecessors but adds many exciting features, including online resources (videos and images), many new contributors, thorough updating of all chapters – many of which have been completely rewritten – and an entirely new chapter on functional assessment. The online resources (access via http://booksite.elsevier.com/9780080451077) provide extensive videos of assessment techniques and illustrations: practitioners with patients and models show how to assess all parts of the lower limb, and evaluate various conditions.
Together with its companion volume Clinical Skills in Treating the Foot, the new third edition of Merriman’s Assessment of the Lower Limb is a truly indispensable guide for podiatry students and practitioners, as well as trainee general practitioners, medical students working in rheumatology, diabetology and orthopaedics, sports therapists and sports medicine trainees.
- Online resources incorporating videos and illustrations:Â
- invaluable footage of assessment techniques
- downloadable full colour figures and extra
- radiological photographs
Log on to http://booksite.elsevier.com/9780080451077 and follow the on-screen instructions.
- Many new contributors bringing fresh expertise and insights for today’s student
- All chapters thoroughly rewritten and updated
- New chapter on functional assessment
- Case histories help put learning in context
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover\r | cover | ||
| Merriman’s Assessment of the Lower Limb | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Contributors | vii | ||
| Preface | ix | ||
| Acknowledgements | xi | ||
| Part 1 Approaching the patient | 1 | ||
| CHAPTER 1: Assessment | 2 | ||
| Introduction | 2 | ||
| Why undertake a primary patient assessment? | 2 | ||
| The assessment process | 3 | ||
| Risk assessment | 4 | ||
| Making a diagnosis | 4 | ||
| Aetiology | 6 | ||
| Time management | 6 | ||
| Re-assessment | 6 | ||
| Recording assessment information | 7 | ||
| Confi dentiality | 8 | ||
| Summary | 8 | ||
| CHAPTER 2: The assessment interview | 10 | ||
| Introduction | 10 | ||
| Is an interview different from a normal conversation? | 10 | ||
| Aims of the assessment interview | 11 | ||
| Communicating effectively | 11 | ||
| Questioning skills | 12 | ||
| Listening skills | 14 | ||
| Non-verbal communication skills | 14 | ||
| Stereotyping | 18 | ||
| Documenting the assessment interview | 19 | ||
| Structuring the assessment interview | 20 | ||
| Preparation | 20 | ||
| The interview | 21 | ||
| Confi dentiality | 22 | ||
| What makes a good assessment interview? | 22 | ||
| Feedback | 23 | ||
| Summary | 23 | ||
| CHAPTER 3: The presenting problem | 25 | ||
| The problem | 25 | ||
| Introduction | 25 | ||
| Encouraging the patient to tell you about concerns and problems | 26 | ||
| Patients with special needs | 27 | ||
| Why did the patient seek your help? | 27 | ||
| Assessment of the problem | 27 | ||
| History of the problem | 27 | ||
| Dimensions of pain | 29 | ||
| Techniques for assessing pain | 29 | ||
| Summary | 31 | ||
| CHAPTER 4: Health outcome assessment | 33 | ||
| Outcome measurement | 33 | ||
| Surrogate outcome measurement | 33 | ||
| Introduction | 33 | ||
| Health status and quality-of-life measurement | 34 | ||
| Choosing an outcome measure: issues of validity and reliability | 36 | ||
| Specifi c outcome measures | 37 | ||
| Visual analogue scale | 37 | ||
| Clinician-based outcome measures | 38 | ||
| Patient-reported outcome measures: foot specifi c | 39 | ||
| Patient-reported outcome measures relating to the feet: condition-specifi c | 44 | ||
| Patient-reported outcome measures: generic | 46 | ||
| Summary | 47 | ||
| Part 2 Systems examination | 53 | ||
| CHAPTER 5: The medical and social history | 54 | ||
| Introduction | 54 | ||
| Purpose of the medical and social history | 54 | ||
| Format of the medical and social history enquiry | 55 | ||
| Medical history | 55 | ||
| Case history 5.1 | 58 | ||
| Family history | 59 | ||
| Personal social history | 59 | ||
| The systems enquiry | 60 | ||
| Cardiovascular system | 60 | ||
| Case history 5.2 | 60 | ||
| Case history 5.3 | 60 | ||
| Case history 5.4 | 61 | ||
| Respiratory system | 63 | ||
| Alimentary system | 64 | ||
| Case history 5.5 | 64 | ||
| Case history 5.6 | 64 | ||
| Genitourinary system | 65 | ||
| Case history 5.7 | 66 | ||
| Central nervous system | 67 | ||
| Case history 5.8 | 67 | ||
| Endocrine system | 68 | ||
| Case history 5.9 | 68 | ||
| Locomotor system | 70 | ||
| Summary | 71 | ||
| Appendix 5.1: Medical Health Questionnaire | 71 | ||
| Case history 5.10 | 71 | ||
| Your foot/leg problem | 72 | ||
| Your general health | 72 | ||
| Past medical history | 72 | ||
| Family history | 72 | ||
| Social history | 73 | ||
| Heart and circulatory problems | 73 | ||
| Respiratory problems | 73 | ||
| Diet and digestive problems | 73 | ||
| Genitourinary problems | 74 | ||
| Head and nerve problems | 74 | ||
| Glandular problems | 74 | ||
| Bone and joint problems | 74 | ||
| CHAPTER 6: Vascular assessment | 75 | ||
| Purpose of a vascular assessment | 75 | ||
| Introduction | 75 | ||
| Overview of the cardiovascular system | 76 | ||
| Anatomy of the cardiovascular system | 76 | ||
| Normal physiology of the cardiovascular system | 78 | ||
| The vascular assessment | 79 | ||
| General overview of the cardiovascular system | 79 | ||
| Case history 6.1 | 81 | ||
| Peripheral vascular system | 84 | ||
| Arterial insuffi ciency | 85 | ||
| Case history 6.2 | 88 | ||
| Venous disease | 105 | ||
| Case history 6.3 | 106 | ||
| Lymphatic drainage | 111 | ||
| Case history 6.4 | 111 | ||
| Summary | 112 | ||
| CHAPTER 7: Neurological assessment | 119 | ||
| Introduction | 119 | ||
| Why and when to undertake a neurological assessment | 119 | ||
| Clinical overview of the function and organisation of the nervous system | 121 | ||
| Function | 121 | ||
| Organisation of the nervous system | 121 | ||
| Refl exes | 133 | ||
| Coordination and posture | 136 | ||
| The neurological assessment | 136 | ||
| Clinical signs | 137 | ||
| In-depth medical history | 137 | ||
| General physiology | 138 | ||
| Assessment | 138 | ||
| Risk and referral | 139 | ||
| Assessment of the level of consciousness | 140 | ||
| Clinical signs | 140 | ||
| In-depth medical history | 140 | ||
| General physiology | 140 | ||
| Assessment | 141 | ||
| Risk and referral | 141 | ||
| Laboratory tests | 141 | ||
| Assessment of lower limb sensory function | 142 | ||
| Clinical signs | 142 | ||
| In-depth medical history | 142 | ||
| General physiology | 143 | ||
| Assessment | 143 | ||
| Risk and referral | 148 | ||
| Assessment of lower limb motor function | 149 | ||
| Upper motor neurone lesions | 149 | ||
| Lower motor neurone lesions | 151 | ||
| Case history 7.1 | 151 | ||
| Case history 7.2 | 151 | ||
| Case history 7.3 | 153 | ||
| Assessment of coordination and proprioception function | 154 | ||
| Clinical signs | 154 | ||
| In-depth medical history | 155 | ||
| General physiology | 156 | ||
| Case history 7.4 | 156 | ||
| Assessment | 157 | ||
| Risk and referral | 157 | ||
| Case history 7.5 | 157 | ||
| Assessment of autonomic function | 158 | ||
| Clinical signs | 158 | ||
| In-depth medical history | 158 | ||
| General physiology | 159 | ||
| Assessment | 159 | ||
| Risk and referral | 159 | ||
| Summary | 160 | ||
| Case history 7.6 | 160 | ||
| CHAPTER 8: Dermatological assessment | 164 | ||
| Approach to the patient | 164 | ||
| Introduction | 164 | ||
| Psychological aspects of skin disease | 165 | ||
| The purpose of assessment | 165 | ||
| How common is skin disease? | 165 | ||
| Skin structure and function | 165 | ||
| Epidermis | 165 | ||
| Dermo-epidermal junction | 167 | ||
| Dermis | 168 | ||
| Skin appendages | 168 | ||
| History and examination of the skin | 169 | ||
| History taking | 169 | ||
| Clinical examination | 170 | ||
| Assessment of the sweat glands | 178 | ||
| Common tests and investigations | 180 | ||
| Recording of the assessment | 181 | ||
| Hyperkeratotic disorders | 181 | ||
| Assessment of corns and callus | 181 | ||
| Blistering disorders | 184 | ||
| Infl ammatory conditions of the skin | 185 | ||
| Eczema | 185 | ||
| Psoriasis | 186 | ||
| Case history 8.1 | 186 | ||
| Case history 8.2 | 187 | ||
| Vasculitis | 188 | ||
| Lichen planus | 188 | ||
| Granuloma annulare | 188 | ||
| Necrobiosis lipoidica | 188 | ||
| Other infl ammatory conditions | 188 | ||
| Allergies and drug reactions | 189 | ||
| Allergic contact dermatitis | 189 | ||
| Juvenile plantar dermatosis | 190 | ||
| Drug reactions | 190 | ||
| Case history 8.3 | 190 | ||
| Infections of the skin | 191 | ||
| Viral | 191 | ||
| Case history 8.4 | 191 | ||
| Bacterial | 192 | ||
| Fungal | 192 | ||
| Case history 8.5 | 193 | ||
| Infestations and insect bites | 194 | ||
| Scabies | 194 | ||
| Insect bites | 194 | ||
| Larvae migrans | 194 | ||
| Disorders of the subcutaneous tissue | 194 | ||
| Atrophy | 194 | ||
| Painful piezogenic papules | 194 | ||
| Case history 8.6 | 194 | ||
| Erythema nodosum | 195 | ||
| Systemic disorders and the skin | 195 | ||
| Pigmented lesions | 196 | ||
| Freckles or ephelis | 196 | ||
| Lentigo | 196 | ||
| Seborrhoeic warts | 196 | ||
| Pigmented naevi | 196 | ||
| Junctional naevi | 196 | ||
| Blue naevi | 196 | ||
| Malignant melanoma | 196 | ||
| Skin tumours | 197 | ||
| Case history 8.7 | 197 | ||
| Benign tumours | 198 | ||
| Malignant lesions | 198 | ||
| Summary | 199 | ||
| CHAPTER 9: Footwear assessment | 201 | ||
| Introduction | 201 | ||
| What do patients want from their footwear? | 202 | ||
| Parts of the shoe | 202 | ||
| Vamp | 202 | ||
| Toe puff (stiffener) | 202 | ||
| Tongue | 203 | ||
| Quarters | 203 | ||
| Heel counters | 203 | ||
| Lining | 204 | ||
| Facings | 204 | ||
| Fastenings | 204 | ||
| Topline | 204 | ||
| Throat | 204 | ||
| Innersole | 204 | ||
| Outersole | 204 | ||
| Shank | 204 | ||
| Heel | 204 | ||
| Toe spring | 204 | ||
| The last | 204 | ||
| Last measurements and sizing | 204 | ||
| The recede | 205 | ||
| Treadline | 205 | ||
| Toe spring | 205 | ||
| The fl are | 205 | ||
| The ideal shoe – the clinician’s perspective | 206 | ||
| What to advise patients about footwear | 206 | ||
| Shoe style | 207 | ||
| Shoe sizing and fi tting | 209 | ||
| Shoe construction techniques | 210 | ||
| Cemented construction | 210 | ||
| Moulded construction | 212 | ||
| Stitch down, sandal veldt or veldtschön construction | 212 | ||
| Machine welted | 212 | ||
| Turn shoe | 212 | ||
| Pegged, riveted or screwed shoe | 212 | ||
| Strobel construction | 212 | ||
| Moccasin construction | 212 | ||
| Materials used in footwear manufacture | 212 | ||
| Sole and heel units | 212 | ||
| Shoe uppers | 213 | ||
| Sports footwear | 214 | ||
| Socks for sporting activity | 215 | ||
| Therapeutic footwear | 216 | ||
| Indications for specialist footwear | 216 | ||
| Heels | 219 | ||
| Heel height | 219 | ||
| Using orthoses in shoes | 219 | ||
| Forensic podiatry | 219 | ||
| Wear marks | 220 | ||
| Patient concordance | 223 | ||
| Conclusion | 223 | ||
| CHAPTER 10: Musculoskeletal assessment | 225 | ||
| Section 10A: Orthopaedic assessment of the lower limb | 225 | ||
| Introduction | 225 | ||
| Terms of reference | 226 | ||
| The position of a part of the body | 226 | ||
| Joint motion | 226 | ||
| Position of a joint | 228 | ||
| Deformity of a part of the body | 228 | ||
| Why is an orthopaedic assessment indicated? | 230 | ||
| The assessment process | 230 | ||
| General assessment guidelines | 232 | ||
| Non-weightbearing examination | 236 | ||
| Examination of the hip | 236 | ||
| Imaging of the hip joint | 239 | ||
| Knee examination | 240 | ||
| Imaging of the knee | 250 | ||
| Foot and ankle examination | 251 | ||
| Ankle and hindfoot examination | 251 | ||
| Examination of the forefoot | 267 | ||
| Imaging of the foot and ankle | 267 | ||
| Limb-length inequality | 267 | ||
| Assessment of limb-length inequality | 268 | ||
| Observation during patient standing and walking for limb-length inequality | 268 | ||
| Observation with the patient supine | 268 | ||
| Summary | 272 | ||
| Acknowledgements | 272 | ||
| Section B: Functional assessment | 273 | ||
| Introduction | 273 | ||
| Defi nitions | 274 | ||
| Biomechanics | 274 | ||
| Function | 274 | ||
| Functional assessment | 274 | ||
| Theoretical concepts | 274 | ||
| Weightbearing versus non-weightbearing movement | 274 | ||
| Pathology – position versus symptom | 275 | ||
| Primary ‘deformity’ and compensation | 276 | ||
| Principles of assessment | 277 | ||
| History, observation, examination | 277 | ||
| Weightbearing static evaluation: the border between observation and examination | 284 | ||
| Relationship between static and dynamic measures | 284 | ||
| Q angle | 285 | ||
| Tibial varum | 285 | ||
| Relaxed calcaneal stance position | 286 | ||
| Navicular height | 286 | ||
| Complex approaches to static assessment – the foot posture index | 287 | ||
| Foot print and other indirect static measures | 287 | ||
| Radiographic measures | 288 | ||
| Examination: moving on from observation only | 289 | ||
| Quasi-functional tests | 289 | ||
| Non-weightbearing static examination | 292 | ||
| The non-weightbearing static examination process | 292 | ||
| Measuring the range of motion of joints | 292 | ||
| Hip | 293 | ||
| Knee | 296 | ||
| Tibial varum angle | 296 | ||
| Ankle dorsifl exion | 296 | ||
| Midtarsal joint motion | 297 | ||
| Subtalar joint motion | 297 | ||
| First and fi fth rays | 299 | ||
| Metatarsophalangeal joints | 300 | ||
| Interphalangeal joints | 301 | ||
| Secondary features | 301 | ||
| Bony change (osteophytes, retrocalcaneal exostosis) | 302 | ||
| Hallux valgus/limitus/rigidus | 303 | ||
| Soft tissue | 303 | ||
| Skin | 303 | ||
| Summary | 303 | ||
| Part 3 Laboratory and hospital investigations | 307 | ||
| CHAPTER 11: Methods of analysing gait | 308 | ||
| How can gait by analysed? | 308 | ||
| Introduction | 308 | ||
| Observation of gait | 309 | ||
| Treadmill | 310 | ||
| Video | 311 | ||
| Methods of quantitative gait analysis | 312 | ||
| Temporal and spatial parameters | 312 | ||
| Kinematics | 314 | ||
| Kinetics | 315 | ||
| Accelerometers | 318 | ||
| Electromyography | 318 | ||
| Energy expenditure | 318 | ||
| Summary | 319 | ||
| CHAPTER 12: Diagnostic imaging | 321 | ||
| Plain radiographs | 321 | ||
| Generation of radiographs | 321 | ||
| Introduction | 321 | ||
| Ordering radiographs | 323 | ||
| Radiographic views | 323 | ||
| Basic radiographic assessment | 326 | ||
| Other imaging modalities | 336 | ||
| Magnetic resonance imaging | 336 | ||
| Computed tomography | 339 | ||
| Ultrasound | 340 | ||
| Nuclear isotope scanning | 341 | ||
| Fluoroscopy | 342 | ||
| Radiological assessment of specifi c bone pathology | 342 | ||
| Infection (diabetic foot) | 342 | ||
| Osteochondrosis | 343 | ||
| Trauma | 343 | ||
| Bone tumours | 349 | ||
| Radiological assessment of specifi c joint pathology | 353 | ||
| Arthritis | 353 | ||
| Gout | 354 | ||
| Sero-negative spondyloarthropathy | 355 | ||
| Neuropathic or Charcot’s joint | 355 | ||
| Synovial osteochondromatosis | 357 | ||
| Pigmented villonodular synovitis | 357 | ||
| Radiological assessment of specifi c soft-tissue pathology | 357 | ||
| Soft-tissue masses | 357 | ||
| Tendons | 359 | ||
| Plantar fascia | 362 | ||
| Ligaments | 362 | ||
| Foreign bodies | 363 | ||
| Conclusion | 363 | ||
| CHAPTER 13 Laboratory tests | 365 | ||
| Introduction | 365 | ||
| Microbiology | 366 | ||
| Indications for microbiology | 366 | ||
| Sampling techniques | 366 | ||
| Identifi cation of microorganisms | 371 | ||
| Urinalysis | 374 | ||
| Indications for urinalysis | 375 | ||
| Collection of the urine specimen | 375 | ||
| Clinical assessment | 375 | ||
| Laboratory assessment | 377 | ||
| Blood analysis | 377 | ||
| Indications for blood analysis | 377 | ||
| Collection of the blood sample | 378 | ||
| Haematology | 379 | ||
| Biochemistry | 381 | ||
| Case history 13.1 | 382 | ||
| Serology | 382 | ||
| Histology | 382 | ||
| Indications for histological examination | 383 | ||
| Sampling techniques | 383 | ||
| Transportation and storage | 385 | ||
| Tests and interpretation of results | 385 | ||
| Summary | 385 | ||
| Part 4 Specific client groups | 387 | ||
| CHAPTER 14: Assessment of the paediatric patient | 388 | ||
| Introduction | 388 | ||
| Normal development | 388 | ||
| Early posture | 389 | ||
| Determinants of gait | 389 | ||
| Growth and development | 390 | ||
| The assessment process | 392 | ||
| Initiating the process | 392 | ||
| General considerations | 392 | ||
| Interviewing | 392 | ||
| History taking | 393 | ||
| Examination | 395 | ||
| Case history 14.1 | 395 | ||
| Footwear | 403 | ||
| Conditions affecting the lower limb of children | 403 | ||
| Developmental dysplasia of the hip | 403 | ||
| Knee pain in the child | 404 | ||
| Abnormal frontal plane confi guration of the knee | 405 | ||
| Intoe | 406 | ||
| Case history 14.2 | 408 | ||
| Congenital talipes equinovarus (clubfoot) | 410 | ||
| Flatfoot | 410 | ||
| Case history 14.3 | 414 | ||
| Toe deformities | 414 | ||
| Causes of limping in children | 415 | ||
| Vasospastic disorders | 418 | ||
| Juvenile idiopathic arthritis | 418 | ||
| Summary | 418 | ||
| CHAPTER 15: Assessment of the sports patient | 422 | ||
| Guiding principles | 422 | ||
| Introduction | 422 | ||
| Role of the sports podiatrist | 423 | ||
| Assessment environment | 424 | ||
| Injury risk factors | 424 | ||
| Case history 15.1 | 424 | ||
| Intrinsic risk factors | 425 | ||
| Case history 15.2 | 427 | ||
| Case history 15.3 | 430 | ||
| Extrinsic factors | 431 | ||
| History taking | 435 | ||
| Medical history | 435 | ||
| Social history | 435 | ||
| Drug history | 436 | ||
| Sport history | 436 | ||
| Injury history | 437 | ||
| Case history 15.4 | 437 | ||
| Examining the injured structure | 438 | ||
| Specialist investigations | 439 | ||
| Injury grading systems | 440 | ||
| Summary | 440 | ||
| CHAPTER 16: Assessment of the older person | 443 | ||
| History taking | 443 | ||
| Introduction | 443 | ||
| Use of medications | 444 | ||
| Pain assessment | 445 | ||
| Assessment of cognitive status | 445 | ||
| Systems examination | 446 | ||
| Dermatological assessment | 446 | ||
| Vascular assessment | 447 | ||
| Neurological assessment | 449 | ||
| Musculoskeletal assessment | 450 | ||
| Functional assessment | 454 | ||
| Activities of daily living | 454 | ||
| Objective measures of mobility | 457 | ||
| Evaluation of gait disorders | 457 | ||
| Falls risk assessment | 459 | ||
| Assessment of the ability to perform basic footcare | 461 | ||
| Footwear assessment | 461 | ||
| Footwear and falls | 461 | ||
| Compliance issues | 462 | ||
| Outcome measurement | 462 | ||
| Conclusion | 464 | ||
| CHAPTER 17: The painful foot | 469 | ||
| How common is foot pain? | 469 | ||
| Introduction | 469 | ||
| Examination of the patient with foot pain | 470 | ||
| Causes of pain in the foot | 474 | ||
| Articular conditions | 474 | ||
| Tarsal coalition | 477 | ||
| Rheumatoid arthritis | 477 | ||
| Case history 17.1 | 478 | ||
| Psoriatic arthritis | 479 | ||
| Reiter’s syndrome | 479 | ||
| Case history 17.2 | 479 | ||
| Ankylosing spondylitis | 480 | ||
| Gout | 480 | ||
| Bone conditions | 480 | ||
| Ligaments injuries | 483 | ||
| Tendon pathology | 485 | ||
| Fascia | 487 | ||
| Nerves | 488 | ||
| Case history 17.3 | 490 | ||
| Referred pain (radiculopathy) | 491 | ||
| Skin and subcutaneous tissues | 491 | ||
| Case history 17.4 | 492 | ||
| Vascular | 493 | ||
| Global foot pain | 494 | ||
| Complex regional pain syndrome | 495 | ||
| Summary | 496 | ||
| Case history 17.5 | 496 | ||
| CHAPTER 18: Assessment of the at-risk foot | 499 | ||
| Introduction | 499 | ||
| The at-risk foot | 500 | ||
| Tissue viability | 500 | ||
| Trauma | 500 | ||
| Risk factors in diabetic foot ulceration | 501 | ||
| Screening | 501 | ||
| Renal failure | 502 | ||
| Biopsychosocial approach | 504 | ||
| Motivational interviewing | 504 | ||
| Wound assessment | 507 | ||
| Wound size | 508 | ||
| Infection | 509 | ||
| Assessment of the patient with an infected ulcer | 509 | ||
| Clinical investigations and laboratory tests | 511 | ||
| Osteomyelitis | 512 | ||
| Pain | 513 | ||
| Ulcer classifi cation | 513 | ||
| Aim and purpose | 513 | ||
| Systems approach to risk assessment | 514 | ||
| Cardiovascular system | 514 | ||
| Assessment of the critically ischaemic limb | 516 | ||
| Skin | 516 | ||
| Case history 18.1 | 516 | ||
| Malignancy | 517 | ||
| Case history 18.2 | 517 | ||
| Periulcer area and dry skin | 518 | ||
| Endocrine system | 518 | ||
| Neurological system | 518 | ||
| Charcot’s neuroarthropathy | 518 | ||
| Musculoskeletal system | 521 | ||
| Haematological system | 523 | ||
| Clinical decision making | 523 | ||
| Clinical reasoning | 523 | ||
| Refl ective practice | 525 | ||
| Critical incident analysis | 525 | ||
| Summary | 526 | ||
| CHAPTER 19: Assessment of the surgical patient | 529 | ||
| Introduction | 529 | ||
| Pre-operative assessment | 530 | ||
| Purpose of the pre-operative assessment | 530 | ||
| Determining surgical need | 531 | ||
| Current health status | 532 | ||
| Case history 19.2 | 533 | ||
| Case history 19.1 | 533 | ||
| Case history 19.3 | 533 | ||
| The systems enquiry | 534 | ||
| Case history 19.4 | 534 | ||
| Physical examination | 538 | ||
| Factors affecting operative risk | 539 | ||
| Laboratory investigations and imaging modalities | 541 | ||
| Case history 19.5 | 541 | ||
| Post-operative assessment | 542 | ||
| Evaluation of the wound dressing | 542 | ||
| Evaluation of the wound | 542 | ||
| Evaluation of pain | 543 | ||
| Summary | 543 | ||
| Index | 545 |