The Hand: Fundamentals of Therapy, 2d ed.

Boscheinen-Morrin J, Davey V, Conolly WB. Stoneham, MA 02180, Butterworth-Heinemann, 1992, paperback, 276 pp, illus, $24.95.

The major focus of this British publication is the therapeutic management of common hand-related diagnoses. The authors have written this book to assist "those whose experience with hand patients is limited."

An introduction to the text provides the reader with a review of the stages of wound healing and healing times for specific tissues, which serves to establish the theoretical basis for the hand therapy protocols. Also, common methods utilized in hand therapy, referred to later in the book, are reviewed briefly.

The first chapter provides an overview of the basic components of hand therapy assessment techniques. Although the clinical assessment techniques described for range of motion, edema, and sensation are adequate, strength measurement, particularly for grip and pinch, could be described in greater detail. Furthermore, a table of normative data for grip and pinch strengths, or at minimum, a reference for the reader to obtain this information as a clinical resource, would complement the text.

From chapters 2 through 14, the book is organized by categories of hand injuries or conditions. These categories include amputations, arthritis, arthroplasties, bums, crush injuries, Dupuytren's contracture, fractures, peripheral nerve injuries, reflex sympathetic dystrophy, and tendon injuries. Each of these chapters begins with a brief, yet generally sufficient, discussion of the theoretical background for that category of injuries. The authors provide a simple overview of the surgical management for each diagnosis where applicable. In nearly all of the chapters, the authors have listed therapy goats along with common complications to guide the less-experienced clinician. Finally, commonly accepted therapy protocols, including splinting and exercise progression, are presented for each diagnosis or postoperative category.

The final chapter covers basic hand splinting. The indications for common splints, including static and dynamic, are presented, along with the required materials and methods of fabrication. The authors have conveniently included a list of suppliers for splint materials and equipment referred to throughout the text.

Although the authors intended to limit the scope of their text to the more common types of injuries involving the hand, their omission of information on conservative treatment techniques for compression neuropathies and tendinitis is unfortunate. Indeed, of the more common diagnoses involving the hand, most therapists at some time have been or will be referred a patient for conservative management of carpal tunnel syndrome or de Quervain's disease. A brief inclusion of splinting and modalities for these categories would have completed the scope of the book.

Also of concern regarding the scope of this book is the detail in which flexor tendon management is presented. First, the authors should have included the other equally common rehabilitation protocol, early passive mobilization, as advocated by Duran, a pioneer in the area of tendon injuries. Second, a word of caution to the reader about protection of pulley reconstruction with flexor tendon repairs would be appropriate.

The authors effectively include numerous pictures and figures to complement and clarify the text. Their use in the chapter on peripheral nerve injuries is particularly effective in conveying to the reader the deformities observed with the three peripheral nerve injuries discussed and the various tendon transfers used.

Although at the end of each chapter the authors provide a list of references and recommended readings, none of the information presented within the text is referenced for the reader. This omission makes additional inquiry into concepts presented in the book difficult for the less experienced clinician.

This revised book offers nothing new in the area of hand rehabilitation. It does, however, provide the reader with greater detail into the management of hand-related diagnoses than chapters in the most popular orthopedic texts. Relative to the level of complexity, the book is fast reading and may be a welcome, inexpensive addition to the library of the therapist with infrequent referrals of patients with hand injuries and conditions.