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Diagnosis and Treatment of the Upper Extremities - Nonoperative Orthopaedic Medicine and Manual Therapy by Dos Winkel with Omer Matthijs and Valerie Phelps. Aspen Publishers Inc, 200 Orchard Ridge Drive, Suite 200, Gaithers- berg, Maryland 20878, USA, 1997 (ISBN 0 8342 0901 2). Illus. 573 pages. $83.

This book is a companion volume to two other works by the same author - Diagnosis and Treatment of the Lower Extremities and Diagnosis and Treatment of the Spine - the series being an updated and trans- lated version of texts previously appearing in Dutch and German. There is a small amount of cross- referencing between the works, making access to all three desirable for the fullest reading but not essen- tial.

Dos Winkel himself is a Dutch physical therapist of international standing, the value of whose work was openly acknowledged by Dr James Cyriax.

This book is divided into three major parts - ‘The shoulder’, ‘The elbow’ and ‘The wrist and hand‘. Each part has a common format of chapters dealing in turn with the functional anatomy, surface anatomy, examination, pathology, treatment techniques and peri- pheral compression neuropathies pertinent to the region. The chapter list for ‘The shoulder’ is augmented

with a final inclusion dealing specif- ically with thoracic outlet syndrome.

Each part includes a useful series of questions and answers to test comprehension and concludes with the citation of references and sugg- ested further reading material. Finally, there are a number of appendices covering the distribution of the blood vessels and nerves of the upper limb and diagnostic and treatment algorithms which are occasionally difficult t o interpret because of their graphical format.

A strong, but not slavish, adher- ence to the principles of examin- ation and treatment advocated by Cyriax is unmistakably evidenced throughout. Methods of differential diagnosis by selective tension and treatment either by deep frictions, muscle stretching or injection are described in precise detail, as are some taping techniques, all being well supported by photographs and line drawings of high quality of both imaging and relevance.

Manipulations for the reduction of anterior dislocations of the shoulder in adults and radial head disloca- tion in children are described, together with manipulation of the elbow joint t o improve extension when limited by the presence of loose bodies. The importance of identifying and correcting causal factors in the patient’s presentation

is heavily stressed. Despite the wealth of material

offered in the text, it is difficult to avoid a conclusion that much of the content will already be known t o the anticipated readership which the American publishers foresee including physicians, physical ther- apists and chiropractors. Some subject matter, however, requires no apology for its reiteration, partic- ularly the value of disciplined and painstaking examination and how vital a detailed knowledge of the local anatomy has always been to those who would effectively practise the skills of administering deep fric- tions. This knowledge is equally pertinent to those who now or in the future would aspire to the skills of infiltration. The major strength of the book is that it brings so much information readily together between one set of covers. The basics of anatomy, biomechanics and pathology are so juxtaposed and integrated with examination findings and treatment techniques as to make both initial learning and subsequent remembering more easily accomplished tasks.

I would recommend perusal of this book to all colleagues engaged in manual therapy as well as under- graduates in the later stages of their formation.

John Brew MCSP MMACP

Community Care of Older People edited by David Beales, Michael Denham and Alistair Tulloch. Radcliffe Medical Press Ltd, 18 Marcham Road, Abingdon, Oxon OX14 lAA, 1998 (ISBN 185775 032 2). 206 pages. f17.50 plus fl. 75 postage and packing.

This well-written book considers all aspects of caring for elderly people in the community. Each chapter, written by an expert in their field, is well presented with good cross refer- ences and easy to follow ‘key points’ in highlighted boxes. The reference is a t the end of each chapter which makes the book easy to manage and facilitates reading a t random if readers so wish.

There is a lot of information in the book and three appendices give specific screening tools, assessment questionnaires and an anticipatory care model, including how a volun- teer visiting scheme was set up.

The principal theme of the book is that working with older people requires a generic approach, so that function and independence are maintained. A chapter on ‘Health promotion and keeping fit in old age’ also gives information on preventive measures. However, perhaps more depth would have been appropriate, as this is such an important subject.

This book would be a very useful addition to a hospital library where medical students, professionals allied to medicine, nurses and social workers could use it in conjunction with a general medical textbook for cross-referencing. I t would also be appropriate reading for student or junior physiotherapists before embarking on the ‘medicine for the elderly’ service.

Any person involved in primary care teams or in setting up a

preventive service would find the appendices a t the end of the book useful and encouraging.

There are two chapters which deserve particular mention: ‘The presentation and management of physical disease in older people’, written by consultant physician, gives well presented information that looks at assessments of syst- ems and clear ‘aides memoir’ in box form. ‘Nutrition of older people’ written by a senior dietitian in- cludes an interesting assessment grid and a case presentation which illustrates much of the information discussed in the chapter.

This really is an up-to-date book which contains practical informa- tion and advice for any one who is involved in delivery of care to older people.

Deborah Russell MCSP

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Physiotherapy, July 1998, vol84, no 7