Peripheral Nerve Injuries in the Athlete.

Feinberg JH, Spielholz NI, eds. Champaign, IL 61825-5076, Human Kinetics, 2003, 279 pp, hardcover, illus, ISBN: 0-7360-4490-6, $49.

Because most sports medicine-related textbooks focus primarily on injuries to the musculoskeletal system, not as much attention is placed on less common, but potentially more serious, neurological injuries. The editors--Joseph Feinberg, a physician specializing in physical medicine and rehabilitation, and Neil Spielholz, a physical therapist--state that the text should serve as a guide for the sports medicine clinician in the early recognition, diagnosis, and management of these conditions.

The text is divided into 2 parts: part I covers the anatomy, etiology, and diagnosis of peripheral nerve injuries, and part II focuses on the prevention and management of common injuries. The individual chapter authors are primarily physicians specializing in physical medicine and rehabilitation. The chapter formats are similar, with the text effectively balanced by good use of section headings, black-and-white photographs, and radiographic images associated with peripheral nerve injuries. In addition, several chapters conclude with case reports that integrate content presented in the chapter with suggestions for more advanced readings.

Part I begins with a very brief chapter on the pathophysiology of peripheral nerve injury along with a 5-page overview on electrodiagnostic testing. Although the literature review on nerve classification schemes is helpful, the authors have chosen to provide only the most basic information on the sequelae of nerve injury and subsequent healing. The electrodiagnostic testing section of this chapter is similarly brief and provides only a cursory review.

Chapters 2 through 6 take a regional approach to common peripheral nerve injuries. The editors of the text wrote chapter 2, which covers cervical radiculopathies, brachial plexopathies, and the burner syndrome. The next 2 chapters cover proximal and distal upper-extremity nerve injuries, respectively. Part I concludes with a chapter on lumbar radiculopathies and a single chapter reviewing lower-extremity nerve injuries. Each chapter follows a similar format: a brief review of pertinent anatomy and then description of common diagnoses, which typically includes content on mechanism of injury, appropriate diagnostic tests, and decision-making processes.

As a complement to the earlier chapters, part II includes 3 chapters related to the prevention and rehabilitation of injuries introduced in earlier chapters. The extensive chapter on the general principles of peripheral nerve injury rehabilitation (chapter 7) covers goal setting, appropriate use of modalities, and other general rehabilitation principles (eg, flexibility, strength training, sport-specific conditioning). The next 3 chapters on rehabilitation focus on injuries to the upper extremity, radiculopathies, and injuries to the lower extremity. Each chapter provides injury-specific rehabilitation approaches to common peripheral nerve injuries, including the use of orthoses. Extensive use of photographs illustrating the specific rehabilitation techniques augments the text. Interestingly, none of the coauthors for these chapters is a physical therapist, although the content is almost exclusively related to physical therapist practice.

In summary, Peripheral Nerve Injuries in the Athlete is a good text for those practitioners who work with athletes and want a general resource on peripheral nerve injuries in this population. The authors have used an effective approach that combines readable text, anatomical figures, radiographic imaging, and case reports to provide the reader with an excellent background of the peripheral nerve conditions. However, practitioners looking for more extensive information on pathophysiology or evidence-based interventions may need to look for other resources. For example, information on the sensitivity and specificity of suggested diagnostic tests typically is not included, and the intervention strategies are not supported by outcomes studies. These comments aside, students and clinicians will benefit from the content emphasized in this text.

J Timothy Noteboom, PT, PhD, ATC 

Regis University

Denver, Colo

Dr Noteboom is Associate-Professor in the Department of Physical Therapy. He is Chair of the Transition DPT program and is responsible for teaching orthopedics, sports medicine, and evidence-based practice.