Anatomical Guide for the Electromyographer: The Limbs and Trunk, ed 4.

Anatomical Guide for the Electromyographer: The Limbs and Trunk, ed 4 Perotto AO. Springfield, IL 62704, Charles C Thomas Publisher Ltd, 2005, hardcover, 345 pp, illus, ISBN: 0-398-07577-8, $65.95.

This book is an update of a classic reference book on electromyography. Using the traditional regional approach, Perotto provides information for approximately 93 appendicular and 22 axial muscles, divided into 14 sections. This information includes the innervation and attachments of each muscle, how to position the patient for the examination, the appropriate site for insertion of the electrode, the depth of insertion of the electrode, and the action that the patient should perform to activate the muscle. Furthermore, common errors in electrode placement and clinically relevant comments are included, as well as 1 or 2 illustrations. One particularly useful inclusion is "pitfalls," which describes which muscle the electrode will record if the needle is placed too deep, not deep enough, or not at the location described. Almost all of the appendicular muscles include a cross-section illustration.

The text also contains a useful appendix, providing dermatomes of the limbs and trunk, cutaneous innervation of the head, and excellent illustrations of both the brachial plexus and the lumbosacral-coccygeal plexus. The appendix also includes a very useful table listing all muscles presented in the text with innervation from the peripheral nerve to the mixed spinal nerve root.

Changes to the fourth edition include expanded information related to the function of the muscles, more information about pitfalls, and additional bibliographic references. Although the changes do improve the text, they are not extensive.

This book continues to be a valuable reference for all electromyographers, from the beginning to the most experienced practitioner. In typical practice, clinicians often need to examine a muscle that is not part of the "routine" examination (eg, the cricothyroid, the urinary sphincter, and the diaphragm), and this book is likely to include a description of the technique for almost any muscle. The descriptions of the techniques used for these rarely examined muscles are sufficient for a clinician to have the confidence needed to perform the procedure.

The greatest strengths of this book are its comprehensive nature, the clear description of techniques, and the clinical pearls gleaned from the experience of Perotto and his colleagues. The only weakness of the book--and it is more of an annoyance than a weakness--is the presence of multiple typographic errors. For example, "prorated" is used many times instead of "pronated." These errors could be easily corrected in subsequent printings and do not compromise the value of the book. However, there are other, more substantial errors that may confuse the novice reader. For example, the description for the electrode insertion to examine the peroneus brevis muscle is "anterior to the peroneus longus (PL) tendon," but the illustration shows the electrode inserted posterior to the peroneus longus tendon. The cross-section illustrations could be improved by adding labels to muscles adjacent to the muscle being described. Although adjacent structures are included in the illustration, most are not labeled. Adding a label to all structures would clutter the illustration unnecessarily, but labeling at least the immediately adjacent structures would help to quickly orient the reader.

Overall, this text includes more muscles than similar texts on the market. It is a very useful reference for both clinical and kinesiological electromyographers. The revisions in the fourth edition are not extensive, but they do improve the text. Clinicians who currently own the third edition should review the revisions to determine whether they need to replace it. This text is definitely recommended for those who do not have the third edition.

Frank B Underwood, PT, PhD, ECS 

University of Evansville

Evansville, Ind

Underwood is a Professor of Physical Therapy and practices clinical electrophysiologic physical therapy.