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The fourth edition of this book is an update of information and bibliography provided in the previous versions together with a reorganization of various chapters.

The United States currently spends more money on healthcare per person than any other country in the world, with current projections indicating that 20% of the gross domestic product of the United States will be spent on healthcare by the year 2019.1 As the population continues to age, the treatment of musculoskeletal conditions, and their subsequent expenses, will also increase. This will place an increasing burden on the clinician to provide value for money—the achievement of a health outcome relative to the costs incurred. Gone are the days when a clinician can rely on an expensive shotgun approach to treatment. Instead, emphasis is now placed on outcomes such as patient satisfaction and accurate measures of clinical outcomes, for it is the consistent measurement and reporting of clinical outcomes that is the most powerful tool in moving toward a value-based system.2

To that end, the aim of this book is to provide the reader with a systematic and evidence-based approach to the examination and intervention of the orthopaedic patient. Such an approach must be eclectic because no single method works all of the time. Thus, this book attempts to incorporate the most reliable concepts currently available.

I hope that this book will be seen as the best available textbook, guide, review, and reference for healthcare students and clinicians involved in the care of the orthopaedic population.

Mark Dutton, PT
Comments about this book may be sent to me at

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