Anatomical Guide for the Electromyographer: The Limbs and Trunk, 3d ed.

Perotto AO, ed, illus; Hammond PB, illus; Thomas H, illus. Springfield, IL 62794-9265, Charles C Thomas, Publisher, 1994, hardback, 309 pp, illus, $45.75.

This is a remarkable revision of a classic reference book for clinical electrophysiology. The purpose of the book is to detail the correct placement of an electrode during needle electromyography. The target audience for this book is anyone performing this procedure.

The book presents individual muscles in a regional approach. The muscles are presented in alphabetical order within each region. The alphabetical approach is presumably used to aid the reader in finding a particular muscle more rapidly. Approaching the muscles from an innervation perspective would be more appropriate from a pathological viewpoint, but this would make it more tedious to find a particular muscle. The book starts with the muscles of the hand, then moves on to the forearm, arm, shoulder joint, shoulder girdle, foot, leg, thigh, and finally, the pelvis and hip joint. This is where the second edition of the book (published in 1980) ended. This new edition goes on to include sections on muscles innervated by the cranial nerves, the perineal and paraspinal regions, abdominal wall muscles, and finally, the diaphragm and intercostal muscles. The addition of these sections has enhanced the utility of this book significantly. Also included is an appendix, including illustrations of dermatomes, the brachial plexus, and the lumbo-sacral-coccygeal plexus, and a table of all muscles covered in the book and their nerve roots and peripheral nerves.

For each muscle, the book lists the complete innervation, the muscle attachments, the patient position for examination of the muscle, a description of the needle electrode insertion site, what the patient should do to recruit the muscle, and pitfalls or hazards to be aware of when examining the muscle. Comments about anomalous innervations of that muscle, any unique elements of the muscle (eg, most distal muscle innervated by a peripheral nerve), and syndromes the muscle is commonly involved in are also included.

The illustrations are line drawings of the individual muscles and are the same ones that were used in the second edition. The electrode insertion site and surface landmarks used to guide needle placement are marked clearly on illustrations. Probably the most important change in this edition is the addition of cross-section illustrations for almost every muscle listed. These line drawings indicate the principal surrounding tissues, with the target muscle highlighted clearly; a needle electrode is shown as it is positioned correctly within the muscle. The addition of directional markers (medial, lateral, anterior, and posterior) would improve the cross-section diagrams considerably by making it easier for the reader to become oriented more rapidly.

Overall, this third edition is markedly better than the previous edition. The added muscles addressed and the added illustrations increase the utility of the book enough to warrant its purchase to replace the earlier edition. There are a few annoying typographical errors (eg "medial" when referring to the median nerve, "ASIC" when referring to the ASIS). If an electromyographer has been using the second edition of this book and likes it, he or she will like this edition even more. I believe this is the best book of its type on the market. Even though the principal audience for this book is electromyographers, anatomists and possibly even kinesiologists may find the book useful. Though the complete action of the muscle is not given, at least one method of activating the muscle is listed along with the illustration and anatomical location.

Frank B Underwood, Phd, PT, ECS US Army-Baylor University Fort Sam Houston, Tex

Dr Underwood is assistant professor and research director for the physical therapy program. He also manages an electrophysiological testing practice with the Neurology Service at Brooke Army Medical Center.