The Hand: Diagnosis and Indications, 3d ed.

Lister G. New York, NY 10011, Churchill Livingstone Inc, 1993, hardback, 593 pp, illus, $105.

As the diagnostic knowledge base available to clinicians who treat hand injuries has grown dramatically, so has the most recent edition of this text. Although Dr Lister has enhanced the content of the text with major revisions and the addition of new sections, he preserves the book's main tenet of "detailing the techniques of diagnosis."

This text is an extensive review of the subjective and objective patient findings that influence how clinicians treat hand problems. Most comprehensive hand texts, while not ignoring the science and art of evaluation and decision making, focus on the surgical techniques used to treat specific pathologies. By focusing on diagnostics and indications for treatment, this book fills the void left by preceding hand texts. it is a natural choice for all clinicians who have to make day-to-day decisions concerning the hand. The importance of surface anatomy, careful observation, and systematic testing is emphasized throughout the book. Although the limited number of chapters does not portray this book as an exhaustive resource, it does reflect the author's ability to take a massive topic and present it in a manageable format. The first chapter has major sections devoted to the decision-making process related to soft-tissues, osseous fractures/ dislocations, tumors, and surgical indications. This is followed by a review of the traditional assessment of skin, nerves, joints, tendons, and vessels, and how the results relate to specific hand diagnosis. Acute and chronic inflammatory/swelling disorders are reviewed, as well as the unique congenital and rheumatoid deformities of the hand. The common elements of pain, sensory disturbances, motor loss, and electrophysiological changes seen in compression of the hand and the proximal regions of the upper quadrant are discussed in detail. With some chapters having close to 700 up-to-date references, this should be considered the definitive text on diagnosing hand problems.

Besides being well written, the figures in this book add tremendously to the educational experience. The photographs of patient examples (clinical and intraoperative), schematics of hand principles, and diagnostic imaging reprints make for a superb teaching text. Being true to the book's purpose, the author only takes the reader up to the point where treatment should begin. This is not the reference for those looking for a therapeutic or surgical treatise on the hand; however, citations for the "how to treat" approaches are numerous.

This is an important resource for clinicians who are hand specialists. As well, it would be an appropriate reference source for physical therapists and physical therapist assistants who would like to improve their hand diagnostic skills. I am sure that whoever has the privilege to read this text will find answers to their diagnostic questions.

Paul Lastayo, PT, CHT Univ of Florida Gainesville, Fla

Mr LaStayo is an instructor in the department of physical therapy at the Univ of Florida. He bas written several research articles and chapters on evaluating and treating upper-extremity dysfunction.