Brachial Plexus Injuries.

Gilbert A, ed. London, England, NW1 OAE, Martin Dunitz Ltd, 2001, hardcover, 343 pp, illus, ISBN: 1-84184015-7, $125.

A French physician edited this book, and all chapters contain a bibliography of current and historical research reports. This book is divided into sections that deal with general aspects of the brachial plexus (anatomy, physical examination, and so forth), adult traumatic brachial plexus injuries, obstetrical paralysis, and special lesions (traumatic brachial plexus injuries in children, war injuries). The anatomy chapter is a very good review and includes photographs of cadaver dissections. These are excellent dissections, but photographs are, in my experience, unsatisfying to anatomy students, because photographs lack the necessary contrast. The photographs also contain few labels for structures, and some have no labels.

As an anatomist who teaches the brachial plexus to physical therapist students, I personally found the anatomy chapter very interesting, mainly because it used eponyms, which are usually left out of anatomy texts. Eponyms add a historical view of the anatomy of the brachial plexus. For example, the musculocutaneous nerve as it passes into the coracobrachialis muscle was once referred to as Casserius' perforating nerve. The historical view of anatomy may not appeal to the physical therapist clinician because contemporary terminology tends to focus on specific anatomical relationships rather than eponyms.

The chapter on physical examination is very good and includes a review of manual muscle and sensory testing for brachial plexus injuries. Descriptions of manual muscle testing are complete and include drawings and text in table form for each muscle innervated by the brachial plexus. This chapter is appropriate for the physical therapist clinician and may be a valuable reference. The short chapters on radiology and clinical neurophysiology investigations are not particularly informative. The clinical neurophysiology chapter may have value to physical therapists who perform these tests or to clinicians who need an explanation of electromyographic findings.

The next section addresses adult traumatic brachial plexus injuries and surgical treatment. This section contains very detailed information about adult traumatic injuries and pictures of patients with lesions of the brachial plexus. Surgical interventions include muscle transfer and reinnervation surgeries and a very short part (2 pages) on rehabilitation. An obstetrical paralysis section includes chapters on etiology, examination, and prognosis. The pediatric clinician may find this section informative and valuable. This section includes a chapter on conservative treatment and rehabilitation for obstetrical brachial plexus palsy, which is the major contribution of the book to rehabilitation. The majority of this section, however, is written for physicians, particularly surgeons.

The final section of the book is about special lesions and includes a chapter on war injuries and traumatic brachial plexus injuries in children. The chapter on traumatic injuries concentrates on surgical repair and outcomes. This chapter is short and does not discuss rehabilitation. The final chapter of the book is both interesting and distressing, because it involves diagnosis and treatment of projectiles that pass through the body and damage the brachial plexus. The author of this chapter emphasizes the importance of early diagnosis and surgical repair, which, in his opinion, is necessary for the best outcome possible. The author also summarizes the physics of a bullet passing through living tissue.

This book is written by physicians for physicians and has limited usefulness to the general physical therapist clinician. The book has more appeal to those physical therapists in academics and those specializing in brachial plexus injuries in children. To some clinicians, the reference information at the end of each chapter may be the most valuable aspect of the book. The book is very limited in the area of rehabilitation and, therefore, is of minimal value to the practicing physical therapist.

Richard J Kasser, PT, PhD
University of Tennessee Health
  Science Center
Memphis, Tenn

Dr Kasser is an Associate Professor in the Departments of Anatomy and Physical Therapy. He teaches "Gross Anatomy," "Principles of Research," "Exercise Physiology," and other courses.