Occupational Disorders of the Upper Extremity.

Millender LH, Louis DS, Simmons BP, eds. New York, NY 10011, Churchill Livingstone Inc, 1992, hardback, 308 pp, illus, $59.95.

Since the time of the Industrial Revolution, industry has focused on increasing productivity. Unfortunately, a deleterious outcome of this increase has been workrelated injuries, which have increased dramatically in the past decade. The health care professional must recognize that work-related injuries are a part of a complex array of physical, emotional, and institutional factors. We also must deal more efficiently with the prevention of work-related injuries and return-to-work following these injuries. The goal of this text is to present a guide for physicians and other health care professionals who manage these problems.

This text is divided into four main sections. Section 1 presents an overview of the historical perspective of work-related injuries, as well as an epidemiological review. Identification of work-related factors and biomechanical analysis of these factors are also reviewed in this section.

Section 2 is extremely valuable and covers a wide variety of topics related to legal and industrial perspectives of these injuries. These chapters focus on the legal basis of workers' compensation, practical approach to workers' compensation, employers' response to work-related disorders, and managed care programs, along with other topics. These chapters give a good perspective of how the legal system functions in work-related injuries, and they also address the perspectives of the worker, employer, and insurance company.

Section 3 deals with the clinical approach to the injured worker and covers a myriad of disorders including the following: carpal tunnel syndrome, occupational disorders of the elbow, occupational disorders of the wrist, disorders of the neck and shoulder, rheumatologic factors, and upper-extremity disorders of musicians. Each of these chapters is fairly complete, and they are especially valuable in explaining how repetitive motion or cumulative trauma may contribute to each disorder. The overall medical management of these conditions is reviewed, as are nonmedical factors such as legal, socioeconomic, and psychological issues. Pathophysiology is covered only minimally and would have been a valuable expansion of these chapters.

Section 4 covers rehabilitation of the injured worker. Therapy and work hardening are covered, and the text addresses work capacity evaluations and other testing to determine work readiness. Rehabilitation services are reviewed, and helpful explanations of impairment and disability evaluation are provided. Work site assessments are covered minimally, but ergonomic analysis of these assessments is not addressed in this chapter. (It is covered elsewhere.) An integrated approach would have been beneficial. This section would have benefited greatly from chapters on injury prevention and on education for injured and noninjured workers.

After initially reviewing this text, I questioned its value to physical therapy practitioners. It has no physical therapists as contributing authors, and the target audience is physicians. Upon extensive review, however, I concluded that this text is extremely informative and comprehensive for a variety of health care professionals, including physical therapists and physical therapist assistants. It is truly a multidisciplinary guide. Physical therapy practitioners are uniquely qualified to deal with the challenges that these patients present, and the practitioner working in industrial rehabilitation would find this text to be an excellent reference. Another benefit is that it allows the reader to understand the role of the physician in dealing with work-related injuries, as well as the roles of other health care professionals such as rehabilitation counselors. It is not a text that explains physical therapy evaluation and treatment of work-related disorders, nor is this the intended goal of the book.

It would be hard to write a better overall text on this topic, despite the detailed criticisms and its lack of specificity to physical therapy. It is a well-organized text with sound information adding significantly to the professional literature in this field.

David Levine, PT The Unw of Tennessee at Chattanooga Chattanooga, Tenn