Neck Ache and Shoulder Pain.

Macnab I, McCulloch J. Baltimore, MD 21202, Williams & Wilkins, 1994, hardback, 507 pp, illus, $69.

The increasing autonomy of physical therapists in the health care system is evident by the number of states that allow evaluation and treatment without physician referral. The responsibility of the physical therapist during the initial patient contact is to make an accurate differential diagnosis. This text helps the clinician provide effective care and recognize and refer patients with problems that are beyond the scope of physical therapy practice.

Management of individuals with shoulder and neck pain often challenges even the most experienced clinician. The purpose of this book is to increase the reader's understanding of these patients. As stated in the preface, the book was written for primary care physicians, orthopedic residents, and therapists. The authors have drawn on their extensive experience in orthopedic medicine and surgery to develop a practical resource covering degenerative and traumatic lesions of the shoulder and neck.

The book is organized in, to three sections: "Neck Ache," "Shoulder Pain," and "The Bridge." Sections on the neck and shoulder begin with a review of anatomy and are followed by chapters addressing pathologic process, pathogenesis of characteristic symptoms, and treatment of both degenerative and traumatic lesions. Anatomy sections give a timely review and provide a framework for discussion of pathology and assessment. The experience of the authors provides the reader with a practical, comprehensive view of the pathologic process and evaluation of the patient. A broad spectrum of conservative and surgical interventions is offered. Discussion of physical therapy intervention, however, is limited in scope and serves as an overview of patient management only.

The authors focus on common orthopedic problems in addition to those pathologies less frequently encountered. The section addressing neck ache includes chapters that focus on the pathogenesis, assessment, and treatment of degenerative disk disease. Additional chapters in this section discuss psychogenic neck pain, whiplash, fractures and dislocations, arthritic conditions, tumors, infections, and torticollis. The shoulder pain section examines classification of shoulder disorders and assessment of function, pathogenesis of rotator cuff tendinitis and tears, and assessment and treatment of rotator cuff tendinitis and related syndromes. Additional chapters examine osteoarthritis, miscellaneous inflammatory and infectious conditions, instability, sports injuries, and tumors. Evaluation guidelines and a general presentation of conservative and surgical management are outlined.

The final chapter examines the differential diagnosis of neck ache and shoulder pain, beginning with a discussion of basic principles of differential diagnosis. The primary intent of the chapter is to provide a list of various conditions that produce symptoms at the neck and shoulder. Discussion focuses on intracerebral, intraspinal, and extraspinal conditions.

Each of the 21 chapters is well written, and the authors' sense of humor makes the book easy to read. Information in each chapter is presented clearly and concisely, with appropriate references. The authors' liberal use of tables, illustrations, and photographs augments the presentation of material. An appendix presents general exercises designed primarily to increase mobility and strength of the neck and shoulder musculature. One limitation of this book is the exclusion of case studies, which would have served to enhance the presentation of information by illustrating the clinical decision-making process.

This book contributes to physical therapy practice by expanding the reader's understanding of pathology and evaluation of individuals with neck and shoulder pain. An increased ability to accurately identify sources of pain may enhance the quality and efficiency of patient care. An additional benefit offered by this book is the opportunity for the therapist to view the perspective of orthopedic surgeons on the assessment and management of these patients. Physical therapists and occupational therapists who treat this patient population will find this book a worthwhile reference.

Douglas R Keskula, PhD, PT, ATC Medical College of Georgia Augusta, GA

Dr Keskula is Assistant Professor in the Physical Therapy Program, with a research interest in the reliability and validity of clinical measures and a specific focus on functional outcome assessment.