Critical Pathways in Therapeutic Intervention: Extremities and Spine.

Saidoff DC, McDonough AL. St Louis, MO 63146, Mosby Inc, 2002, hardcover, 1135 pp, illus, ISBN: 0-323-00105-X, $79.95.

This is book covers an array of topics using a case report format. The authors' intent was to produce a book that practicing clinicians as well as students could use as a guide, a review, and a reference. The book's focus is on primary conditions that are responsive to conservative management.

The text contains 12 parts: "Hand and Wrist" (part I); "Elbow and Forearm" (part II); "Shoulder" (part III); "Brachial Plexus, Thoracic Outlet, and Shoulder Girdle" (part IV); "Nerve and Muscle Lesions" (part V); "Foot" (part VI); "Ankle" (part VII); "Heel" (part VIII); "Knee and Shin" (part IX); "Hip, Thigh, and Knee" (part X); "Pelvis" (part XI); and "Spine" (part XII). Each chapter is well organized and includes complementary figures and diagrams.

A total of 63 case reports, ranging from 2 to 12 reports per part, form the entirety of the text. For example, part VII, "Ankle," contains case reports on patients with ankle sprain, tarsal tunnel syndrome, peroneal tendon instability, and peroneal nerve entrapment. Each case report begins with a detailed history, physical examination findings, and applicable test results (eg, radiology, laboratory results, electromyographic and nerve conduction velocity test results). A series of clinically based questions follows the examination information and leads into the body of each case report. The body of each case report contains the answers to each of these clinical questions in sequence. The final section of each case answers the question on what the appropriate therapeutic intervention is. An extensive reference list is presented at the end of each case report; however, the majority of references were published before 1990.

Although only 63 specific cases are presented, the book's emphasis on, and incorporation of, differential diagnosis results in the discussion of a wide range of pathologies. In addressing differential diagnosis, the authors did an outstanding job of providing oversight on factors contributing to musculoskeletal pathology. Multidisciplinary content of the text includes information on biomechanics, surgical indications, post-surgical management, pharmacology, and nonmusculoskeletal conditions (ie, metabolic, rheumatologic, and genetic) for specific cases. Cases include fractures, neuropathies, tendon pathology, vascular disorders, joint pathology, and soft tissue pathology.

The authors fully achieved their intended purpose of providing a text for use as a reference or a guide. The case report format used in this text is unique, and it uses clinically based questions to promote thinking rather than memorization. Although the title suggests an emphasis on therapeutic intervention pathways, the text focuses predominantly on the evaluation and diagnosis of various disorders. The therapeutic intervention component of each case report is brief and not supported by evidence-based literature. The references cite a mix of textbooks and journal articles concerning the appropriate therapeutic intervention; however, most of these references are not current. The authors' failure to include more current references results in the omission of evidence on some current topics in sports medicine (ie, posterior lateral corner injuries, glenoid labrum injuries, and syndesmotic ankle sprains) and restricts the comprehensive coverage.

Despite these limitations, I still recommend the text for physical therapists, from students to experienced clinicians, and educators who cover orthopedics and sports medicine topics. The breadth of information also makes this book a good resource for certified athletic trainers, certified nurse practitioners, physician assistants, and general physicians providing care to a high volume of patients with orthopedic problems.

Michael Rosenthal, PT, MPT, SCS, ECS, ATC 

Keller Army Community Hospital

West Point, NY

LCDR Rosenthal is a resident in the United States Military-Baylor University Post-Professional Sports Medicine-Physical Therapy Doctorate of Science Program.