Book Review

Nerve Injuries: Operative results for major nerve injuries, entrapments, and tumors

N Engl J Med 1996; 334:927-928April 4, 1996

Article

Nerve Injuries: Operative results for major nerve injuries, entrapments, and tumors
By David G. Kline and Alan R. Hudson. 611 pp., illustrated. Philadelphia, W.B. Saunders, 1995. $130. ISBN: 0-7216-3264-5

Most comprehensive textbooks that attempt to deal with a complex clinical problem require contributions from multiple authors. Often, this results in duplication of material, disjointed information, poor organization, and an unreadable product. In Nerve Injuries, however, two world-renowned neurosurgeons use their own vast experience and expertise to create a well-organized and comprehensive textbook on the subject of peripheral-nerve injury. The result is a logical and consistent approach to the diagnosis and management of peripheral-nerve injuries. The authors describe areas of debate and controversy, discuss the merit of opposing views, and give practical guidance.

The first few chapters concentrate on general anatomical and physiologic considerations of peripheral nerves. The description of basic mechanisms of injury lays the important groundwork for consideration of appropriate treatment. The clinical evaluation and a grading system of surgical results are clearly and succinctly described, and there are clear definitions of the appropriate use of electrophysiologic tests and radiographic studies. The extremely well presented and detailed chapters on the upper-extremity nerves integrate clinical presentations with neurologic examination and give excellent descriptions of surgical procedures. The authors use a logical grading system to analyze the results of these procedures, so that the future results of other practitioners may be compared with theirs. Problems of lower-extremity nerves are dealt with in a single chapter, since these injuries are much less common than injuries to the upper-extremity nerves. Several chapters deal with the brachial plexus and its more complex injuries. The indications for operative repair as opposed to nonoperative treatment are discussed clearly. Several other chapters focus on specific peripheral-nerve entities, including thoracic outlet syndrome and reconstructive procedures. The final chapter takes up peripheral-nerve tumors.

This textbook will be of primary interest to neurosurgeons, neurologists, physiatrists, and orthopedic and plastic surgeons. Its emphasis on surgical technique is not overwhelming, even for nonsurgeons, and its advice will be extremely useful to any physician caring for peripheral-nerve injuries. One of the most important contributions of this work is the grading system for measuring surgical results. This book is an up-to-date, clear, and organized account of the entire spectrum of peripheral-nerve injuries.

G. Rees Cosgrove, M.D.
Massachusetts General Hospital, Boston, MA 02114