Rehabilitation of the Hand and Upper Extremity, 5th ed., 2 vols.

Mackin E J, Callahan AD, Skirven TM, eds. St Louis, MO 63146, Mosby Inc, 2002, hardcover, 2,311 pp, illus, ISBN: 0-323-01094-6, $225.

This comprehensive two-volume series is organized into 29 sections on topics related In the medical and therapeutic management of hand and upper extremity conditions. It is the fifth edition of a classic reference both for experienced physicians, surgeons, physical therapists, and occupational therapists and for those beginning professional practice. The growing list of impressive contributing authors includes many leaders in the field of hand surgery and rehabilitation. This latest edition has expanded to include new chapters on topics such as radial tunnel syndrome, fibrocartilage complex injuries, outcome assessment, manual edema mobilization, and "kinesio taping." Because of the length of this publication, this review focuses on those chapters that are of particular relevance to physical therapists.

The first several chaplets constituting part I cover essential anatomy and kinesiology of the upper extremity. These first chapters are both well written and contain clear illustrations, and they would support the remainder of this Work as a review or a point of reference, depending on the level of experience of the physical therapist. An entire chapter (chapter 2) is devoted to surface anatomy of the upper extremity and is an excellent "road map" for examinations by the newly licensed physical therapist.

Part 11 is devoted to diagnostic and general examination methods, with an emphasis on the distal upper extremity. Although the first 2 chapters of this section provide an overall examination and evaluation scheme, several subsequent chapters are devoted specifically to the evaluation of edema, range of motion, and sensation (also known as "sensibility"). These chapters provide in-depth information on the intricacies of how to administer various tests, on the reliability and validity of measurements, and on documentation methods. An additional chapter on outcome measurements discusses their role in patient examination and discusses the selection of the appropriate tools and the considerations for their administration. An easy-to-use chart summarizes approximately 30 outcome instruments for the shoulder, elbow, wrist, and hand, with a description of the purpose, format, and measurement reliability and validity for each.

The majority of this book, parts VI to XXIV, is devoted to the therapeutic treatment of specific upper-extremity pathologies. Topics include, but are not limited to, postoperative flexor tendon repair and reconstruction, extensor tendon injuries, lenolysis, peripheral nerve injuries, compression neuropathies, brachial plexopathies, tendon transfers, stiffness of the band, soft tissue conditions (tendinopathies and Dupuytren contraction), cumulative trauma disorders, regional diagnoses for the shoulder, elbow and wrist, rheumatoid arthritis and osteoarthritis, complex regional pain syndromes, burns, and major traumatic injuries. Within each chapter; pertinent anatomy, biomechanics, and pathophysiology are included as a basis for understanding therapeutic interventions. Where applicable, examination techniques and special tests are described and supplemented with illustrations. The rationale for treatment is clearly presented, and the recommended treatment techniques are current and appear comprehensive in scope. Both the rationale for treatment and the effectiveness of treatment techniques are supported by current references to primary, peer-reviewed literature. The accompanying figures provide useful illustration of recommended splints, exercises, and examination methods.

The topics of ultrasound and other physical agents, continuous passive motion, biofeedback, and "kenisio taping" are covered in separate chapters in part XXV. The chapter on physical agents provides a general review of the biophysical principles and indications and contraindications for modalities used in hand rehabilitation. The chaplets on continuous passive motion, biofeedback, and "kinesio taping" similarly provide a rationale for their use in hand rehabilitation, along with guidelines and case examples on their clinical application.

Part XXVI contains several chapters related to splinting of the upper extremity'. Each of the 7 chapters discusses a specific type of splint, including dynamic or mobilizing splints, serial plaster splints, cylinder casting for proximal interphalangeal joint contractures, splints for the thumb, soft splints, and functional bracing. Principles of application and indications and contraindications are covered for each type of splint. The chapters are well illustrated to demonstrate principles of splinting and the specific application of a splint for a particular condition or diagnosis. Although this part of the book provides examples of splints that can be fabricated by the physical therapist, it does not include specific methods for their fabrication. This portion of the book also does not provide the beginning therapist with most of the basic knowledge necessary to fabricate splints for the upper extremity.

The last three parts of this work address treatment concerns and methods for specific populations, including pediatric and geriatric populations, athletes, people with work-related injuries, and musicians.

This book review [housed on the material most directly relevant to physical therapists. It would not be complete, however; without acknowledging the numerous other well-written and well-illustrated chapters that address the medical and surgical management of hand pathologies. Even in those chapters on topics such as arthritis, major traumatic conditions, fractures and joint injuries, and nerve injuries, therapeutic intervention and concerns are addressed. This is an excellent reference to understand the comprehensive treatment of the patient with hand conditions.

Janet Palmatiet; PT, MHS, CHT Work Injury Care Center Milwaukee, Wis

Ms Palmatier is a staff physical therapist and specializes in managing patients with occupation-related upper-extremity injuries.