Book Review

Occupational Disorders of the Upper Extremity

N Engl J Med 1993; 328:588-589February 25, 1993

Article

Occupational Disorders of the Upper Extremity
Edited by Lewis H. Millender, Dean S. Louis, and Barry P. Simmons. 308 pp., illustrated. New York, Churchill Livingstone, 1992. $59.95. ISBN: 0-443-08797-0

Very little formal training in the disposition of workers' compensation cases is provided in today's residency-training programs, no matter what the specialty. Most physicians who examine and treat patients covered by workers' compensation have learned about this area of medicine from older colleagues, from experience, and from their own mistakes. Instructional courses are offered by reputable subspecialty organizations, but the average orthopedic surgeon, neurosurgeon, or physical medicine specialist would much rather spend his or her limited continuing-medical-education time on a subject that is more exciting or related to a special interest. This book attempts to fill part of that gap in our medical-education process. The editors have brought together a group of physicians, a rehabilitation specialist, an occupational therapist, an industrial health specialist, and an attorney, all with an interest in work-related upper-extremity injuries, and have produced an overview of this complex subject.

This book is divided into four sections; if sections on low-back injuries and lower-extremity injuries were added, it could be considered a complete general guide through the maze of occupational injuries. Section I gives a historical perspective on work-related injuries and guidelines for categorizing these injuries. It also covers biomechanical studies that analyze cumulative-trauma disorders. Section II presents an overview of the workers' compensation system, including the roles of the insurance company, the employee, the employer, the state, and the attorney in workers' compensation disputes. It becomes clear to the reader why injured workers sometimes end up in the hands of attorneys. This section also discusses managed-care programs and shows how they can be of great benefit to the patient, the physician, and the employer without involving expensive legal advice. Section III provides a general approach to the diagnosis and management of occupational injuries. This material, which is laid out in “cookbook” fashion, is quite easy to follow and provides a ready reference source for conservative treatment of numerous occupational disorders of the upper extremity. This is not a surgical textbook, and it does not need to be. It outlines good, rational, conservative treatment, something that is lacking in many subspecialty textbooks. Section IV discusses rehabilitation and work-hardening programs. It also discusses the detrimental effect of attorneys both in prolonging the rehabilitation of an injured worker and in the settlement of the disability claim. This section ends with an overview of impairment rating and disability evaluation.

Although the targeted reader is the senior resident or young practitioner who will be caring for injured workers, certain sections of this book should be read by all parties involved in the evaluation, treatment, and reimbursement process. Employers, supervisors, and union officials would do well to read and follow the material presented in chapter 6 on the role of the employer and chapter 8 on managed-care programs. Legislators should spend some time with chapter 4, trying to understand basic workers' compensation law as it would apply to the average unskilled worker. Maybe the law would be as confusing to them as it is to me, and some steps would be taken to simplify it for all states. Attorneys handling workers' compensation claims should read the chapters that deal with compensation law, managed-care programs, therapy and work hardening, vocational-rehabilitation services, and disability evaluation. They would then understand how obstructive some of them can be when it comes to the care of an injured worker. This book discusses all sides of this issue and approaches it from the standpoints of the employer, worker-patient, and physician or health care provider.

Andrew H. Crenshaw, Jr., M.D.
Campbell Clinic, Memphis, TN 38103