Book Review

Surgery of the Hand and Upper Extremity

N Engl J Med 1996; 335:1248-1249October 17, 1996

Article

Surgery of the Hand and Upper Extremity
Edited by Clayton A. Peimer. 2468 pp. in two volumes, illustrated. New York, McGraw-Hill, 1996. $295. ISBN: 0-07-04938-8

The field of hand surgery is rich with multivolume textbooks of encyclopedic proportions, and Clayton Peimer presents us with yet another, purported to be “the single largest source for information about the hand and entire upper extremity.” Records aside, for a multiauthored book with more than 190 contributors from 14 countries there is a remarkable consistency of style and organization, a tribute to the editing or the disciplinary skills of the editor. The contributors come from all of the multiple disciplines involved in the comprehensive care of the upper extremity, including such nonsurgical specialties as physiotherapy, rheumatology, psychiatry, dermatology, genetics, prosthetics, and the law. Each chapter begins with an outline, which proved to be a helpful guide through the tightly packed text. The uniform and comprehensive order of each chapter covers history, functional anatomy, diagnosis, the contributor's favored treatment and alternatives (with justification for the preference), rehabilitation, and complications. Each chapter ends with a short annotated list of references and a more comprehensive bibliography.

The term “motivation” has permeated the assessment of all hand-surgery patients and has been used both as an alibi for failure and as the recipe for success, thus explaining the wide variation in outcomes of hand treatment. The noted Joseph Boyes called the term a “kick in the pants” characteristic of the image of the hand surgeon of the past as a simple mechanic. As one browses through this book, it is refreshing to see the breadth of understanding — and the amount of text devoted to — the important interrelation between the physical and psychological aspects of diagnosis and treatment. This epitomizes the modern concept of a multidisciplinary treatment team and belies the caricature of the hand surgeon as just a mechanic.

If completeness is the signature of an encyclopedic work, a search for obscurities should not come up empty-handed. A rarity such as hard dorsal edema of Secretan is discussed twice, and arthritis of the pisotriquetral joint is in three separate sections. Almost everything you want to know is found in one or more places, which, paradoxically, represents the book's one flaw.

When looking for a discussion of some of the common problems seen in day-to-day hand care one frequently has to search in several places, often without a cross-referencing map. For example, for information on secondary shoulder stiffness after an unrelated upper-extremity injury, one must explore several different places. Most chapters make casual reference to prevention, but I was hard pressed to find a comprehensive discussion of the pathophysiology, prevention, and treatment of secondary shoulder stiffness in one place. The chapter on burns makes no mention of the not-infrequent occurrence of heterotopic ossification at the elbow or the therapeutic dilemma when it is accompanied by antecubital scar contracture. A third example is the chapter on neuromas, which ignores the tried and true desensitization techniques popularized by Barber that are useful for both prevention and treatment. One has to look to the chapter on rehabilitation for a description of these useful techniques.

The chapter on myofascial pain syndrome is most comprehensive, but then leaves the reader high and dry with just a tantalizing reference to the chief differential — fibromyalgia. Unfortunately, the chapter offers no help with the question of whether these disorders can be considered work-related injuries.

Since the hand is the most frequently injured part of the body, one can hardly practice hand surgery without involvement in workers' compensation. Comprehensive chapters on workers' compensation and a complementary chapter on medicolegal issues are excellent.

My only major disappointment was the boxed disclaimer notice on the flyleaf. It is a sad commentary on contemporary jurisprudence that a readership of sufficient intelligence to graduate from medical school and complete extensive medical training must be warned that opinions may change, treatments become obsolete, and humans make mistakes. Soon we will probably see warning labels on kitchen knives and disclaimers on matches. We seem to be witnessing the death of common sense. This book lives up to its promise to deliver the newest testament in hand surgery.

Garry S. Brody, M.D.
University of Southern California, Los Angeles, CA 90033