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Orthopaedic Medicine is the diagnosis and non-operative treatment of
soft tissue lesions around the body. The scope of treatment includes
lesions of ligaments, tendons, bursa and muscles along with lesions of
the cervical, thoracic, and lumbar spines. The late Dr. James Cyriax, an
Internist and Orthopaedic Surgeon in England, developed his system of
Orthopaedic Medicine over an extended period starting in the early
1920's. As a young doctor he observed that his teachers could not
delineate how they arrived at a musculoskeletal diagnosis nor specify
what the problems were. He proceeded to develop a series of simple
objective clinical exams that would effectively diagnose soft tissue
musculoskeletal lesions. His collected results, after many years of
trial and error, coalesced into a set of systematic simple clinical
exams for each joint and a treatment system for the soft tissue lesions
around each joint. He coined the term ‘Orthopaedic Medicine”.
The basic principles of Orthopaedic Medicine are: 1) Every pain has a
source. 2) Treatment must reach the source. 3) Treatment must benefit
the source in order to relieve the pain. Most sources of pain in the
musculoskeletal system can be localized to a specific tissue. We look
carefully in a systematic manner to isolate the cause of pain, and then
treat it specifically. A specific diagnosis leads to successful
treatment.
The examination uses carefully chosen movements. We use active and resisted movement testing to evaluate tendons and muscles. We utilize passive
movement testing to assess ligaments for pain, laxity or limitation in
range of motion. A distinctive feature of the Cyriax method is the
capsular pattern. This capsular pattern denotes
inflammation of the capsule such as in an inflammatory or traumatic
arthritis, a fracture or a cancer which extends close to or into that
joint. It is associated with a specific pattern of limitation with the
various passive movements at the joint. Each joint has its own
distinctive capsular pattern. A non-capsular pattern
implies that the capsule is not involved and that intra- or
extra-articular tissue is inflamed or injured and the source of pain.
Either pattern will be consistent on repeated exam from one day to the
next.
The Cyriax method of Orthopaedic Medicine is an exercise of Applied or Functional Anatomy
in which assessment of body movements indicates where lesions lie.
Treatment of these lesions incorporate various distinctive techniques of
manipulation, injections or physical therapy.
Orthopaedic
Medicine is a very intellectually satisfying and challenging discipline
because the most frequently used tools of diagnosis are those of the
history and clinical exam. We establish a diagnosis by our own eyes,
ears and hands. The lesions we see are small, without visible or
palpable lumps or bumps. MRI scans or other high-technology tests
occasionally do not demonstrate the lesions that we elucidate by history
and clinical evaluation.
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