The Wrist and Its Disorders, 2d ed.

The Wrist and Its Disorders, ed 2

Lichtman DM, Alexander AH, eds. Philadelphia, PA 19106, WB Sounders Co, 1997, hardcover, 754 pp, illus, $195.

The primary editor of this textbook (DML) is a highly respected hand surgeon and expert on the wrist. The Wrist and Its Disorders, 2nd ed, was written to incorporate the 10 years of information about the wrist discovered since the first edition. This comprehensive work on the wrist is written primarily for physicians in orthopedics and plastic and hand surgeons. Physical therapists involved in the management of wrist injuries will also find this text to be a valuable reference. The text is well organized and contains many excellent illustrations.

The textbook is arranged into 9 sections. Part I covers the basic science related to the wrist: anatomy, vascularity, kinematics, pathogenesis and pathokinematics of the wrist joint. Although quite technical in some aspects, this portion of the text provides material essential for the reader's appreciation of many of the concepts presented in subsequent chapters.

Part II addresses clinical and diagnostic procedures used in the examination of the wrist. The chapter on the physical examination of the wrist is well written and of definite use for the clinician. A practical feature of this chapter is the arrangement of the material according to "zones" of the wrist (ie, ulnar, dorsal). Descriptions of provocative maneuvers for wrist instabilities and pathologies of the triangular fibrocartilage complex (TFCC) and the distal or radial ulnar joint (DRUJ) are also included in this chapter. The chapter on advanced imaging of the wrist joint includes the technical aspects of wrist imaging. The physical therapist may find this chapter of value in learning how to interpret diagnostic studies. There are many excellent pictures of imaging studies, demonstrating a variety of wrist pathologies, that are well captioned and marked.

Part III consists of numerous, in-depth chapters on the diagnosis of wrist pathologies and the management of these conditions. These topics include carpal instabilities, fractures and dislocations, scaphoid nonunion, and Kienbock disease. Part IV is devoted to the examination, evaluation, and treatment of DRUJ and TFCC injuries; part V, to the carpometacarpal (CMC) joints. Parts VI through VIII include occupational and sports injuries, developmental and degenerative disorders of the wrist, and surgical options for common wrist disorders.

The remaining section, part IX, is devoted to rehabilitation of the wrist. The chapters on assessment and conservative management are quite basic in content and would likely be of limited value to even the novice therapist. Some basic splinting designs are presented and may be of use. The chapter on postoperative wrist rehabilitation is helpful in providing the therapist with general protocols, treatment goals, and expected outcomes for a variety of wrist procedures. These procedures include proximal row carpectomy, limited and total wrist fusions, wrist arthroplasty, CIVIC arthroplasty, the Darrach procedure, external fixation for distal radius fractures, and open reduction internal fixation for scaphoid fractures.

This comprehensive work on the wrist would be an excellent reference for any therapist involved in the management of wrist pathologies. The reader is provided with the necessary information to perform a thorough and meaningful examination and evaluation of the otherwise "mysterious" wrist. Furthermore, the importance of early diagnosis and appropriate management is apparent in the discussion concerning the prevention of the progression of many wrist pathologies. Through the well-written text and numerous excellent illustrations, the complex nature of the wrist is made easier to understand.

Janet Palmatier, PT, CHT Work Injury Care Center Glendale, Wis

Ms Palmatier is a certified hand therapist and clinician at an industrial medicine clinic. She also is an instructor of orthopedics in the physical therapist assistant program at Milwaukee Area Technical College.