Shoulder Pathophysiology: Rehabilitation and Treatment.

Haig SV, Gaithersburg, Md, 20878 Aspen Publishers Inc, 1996, hardback, $54.

This book's objective is to provide an up-to-date guide to the major elements of modern diagnosis, physical therapy, and surgical treatment of the shoulder for the practitioner in physical and sports medicine. Although there is considerable coverage of diagnosis and surgical treatment, there is minimal emphasis on physical therapy and a limited acknowledgment of the important contributions of physical therapy in treatment of the shoulder.

This book is divided into two sections. The first is entitled "Modern Shoulder Practice" and includes a general description of the physical examination, diagnosis, and treatment of shoulder conditions. The second section covers in detail the common pathological conditions seen in the shoulder and their presentation, evaluation, and treatment.

The first two chapters, "Symptomatology" and "Physical Examination of the Shoulder," are concise and set the tone for this book, which is presented from a pathophysiology viewpoint. The information in these chapters is reinforced and embellished throughout the book, through the examination of specific pathologies.

Chapter 3, "Radiographic Examination of the Shoulder," covers radiographs, arthrograms, computed tomography scans, magnetic resources imaging, and bone scans. A brief review of each of these diagnostic procedures and their value in diagnosing shoulder injuries is given. Chapter 4 is a review of nonmusculoskeletal causes of shoulder pain: cardiac, abdominal, neurologic, and vascular. This chapter could have been fuller, not only in the areas that are covered, but in other areas, such as the pulmonary and gastrointestinal systems.

Chapter 5, "Pharmacologic Treatment of Shoulder Pain," reviews nonsteroidal anti-inflammatory drugs, steroids, and other commonly prescribed drugs. Local steroid injection is also addressed in a practical manner. Chapter 6 covers the roles of physical medicine and orthopedics in treatment of the shoulder. The author discusses his opinions on the indications and justifications for conservative treatment, surgical treatment, physical therapy, and the overall rehabilitation process. The opinions offered on physical therapy display a lack of understanding of the profession and the professional responsibilities of physical therapy practitioners.

Section 2 covers specific shoulder disorders and begins with a chapter on frozen shoulder. Chapter 8, " Rotator Cuff Disease and Impingement," is one of the most useful chapters in this book and is an excellent overall reference. It covers impingement and tears and their surgical and nonsurgical management. Chapter 9 does an excellent job of discussing the various instabilities of the glenohumeral joint and their treatments.

Chapters 10 and 11 contain in-depth reviews of disorders of the acromioclavicular joint and arthritis of the glenohumeral joint, in addition to other diseases causing destruction of this joint. Chapter 12, "The Shoulder in Sports Medicine," is a brief overview of common injuries occurring during sports. Medical management and surgical procedures are the primary areas of treatment that are addressed. Chapter 13 reviews fractures of the humerus, scapula, and clavicle and includes general principles of fracture management and rehabilitation. Displacement of fractures due to the muscular forces acting on them during healing is discussed and has major implications in physical therapy. Chapter 14 addresses the less commonly seen disorders of the shoulder and includes the hemiplegic shoulder, calcific tendinitis of the rotator cuff, Charcot's shoulder, and other conditions.

This book was written primarily for physicians, although other health care professionals who treat the shoulder also may find it useful. The author provides a well-written and comprehensive text that should be useful as a reference in both academic and clinical settings. This book is effective in bridging the gap between theory and practice, providing functional information that is essential for evaluation and treatment of shoulder dysfunction.

Because the book was written by only one author; a writing style, is maintained. It is remarkably clear, given the complex subject matter, and it is easy to find the needed information without trouble. Another strength is the excellent photographs throughout, although many of them would be more interesting to orthopedic surgeons. The limited amount of information directly related to physical therapy treatment of shoulder injuries could be regarded as a major weakness. This book would certainly be useful as a resource for physical therapy practitioners, but it is not comprehensive enough to be used as a textbook in physical therapy curricula.

David Levine, PhD, PT The University of Tennessee at Chattanooga Chattanooga, Tenn

Dr Levine is a UC Foundation Assistant Professor in the department of physical therapy. His teaching, research, and clinical practice are in the areas of orthopedics and sports medicine.