In the early 1990s, Andrews and Wilk undertook the formidable task of putting together this comprehensive textbook on the shoulder. Despite the title, the information applies to all patients who have an activity-related problem involving the shoulder.
The fact that Andrews is an orthopaedic surgeon and Wilk is a physical therapist lends a multidisciplinary perspective to the text. Of the seventy-six contributing authors, forty-one are physicians; thirty-one are physical therapists or athletic trainers, or both; and the remaining four are researchers or other allied-health professionals. The editors state that the text is intended for "clinicians, physicians, therapists, athletic trainers, and others," but any attempt to appeal to such a broad audience can be dangerous as the material may be too general for some readers and too specific for others. Nevertheless, the balance that the editors have managed to achieve makes this volume unique among texts on the shoulder.
The text is divided into four main sections: basic science, physical examination, treatment of specific problems, and rehabilitation. The first two sections are appropriate for all members of the intended audience. The writing style is concise and easy to follow. The section of the text dealing with treatment is divided into three subsections: arthroscopy, pathology and surgery, and sports-specific injuries. Although these subsections initially seem to be intended solely for orthopaedic surgeons, closer inspection reveals a broader purpose. Regardless of how well a clinician or therapist understands anatomy or pathology, nothing is more instructive than visualizing a lesion firsthand in the operating room. Arthroscopic photography can impart this understanding to non-orthopaedists, physical therapists, trainers, and other individuals who cannot be present at the actual procedure. Photographs are used extensively in the section on arthroscopy and in most of the other sections of the text as well. Unfortunately, the photographs have been reproduced in black and white. Although the use of color is very expensive and the added cost of color plates could have resulted in fewer practitioners having access to this resource, every effort should be made to reproduce the arthroscopic photographs in color in future editions.
Just as those who are not orthopaedists benefit from seeing actual lesions, those who are not physical therapists benefit from an understanding of rehabilitation. An entire section is devoted to rehabilitation, and specific protocols are presented throughout the text either within the chapters or as appendices. The step-by-step format permits easy modification by practitioners who want to use the protocols for their own patients. All of the protocols are concise and complete. The approaches to rehabilitation range from moderate to somewhat accelerated. In an ideal situation, when the patient has unlimited access to therapy, the protocols can be followed precisely; however, such access usually is available only to collegiate and professional athletes. Most patients have only limited access to supervised rehabilitation. Regardless of whether these limitations are due to the patient's schedule or to the restrictions imposed by third-party payers, patients usually need a home program at some point. Breaking down the rehabilitation protocols into activities requiring supervision and those that can safely be done at home would be extremely useful.
As the text is four years old, some of the information needs to be updated. However, the book's continued popularity speaks well for the physician-therapist approach taken by the editors. The chapters have an evenness that is difficult to achieve in a multiauthored text. Particularly noteworthy are the chapters on soft-tissue injury, by Ott, Clancy, and Wilk, and on scapulothoracic disorders, by McCluskey and Bigliani; both of these areas have been neglected in other texts on the shoulder.
In summary, this text contains a wealth of information. The relationships among a complex group of articulations are clearly explained. The book is comprehensive enough that the reader can identify risk factors for certain injuries and can begin to focus on preventing rather than simply treating them. This text and any subsequent edition should be a standard reference for anyone who treats injuries involving the shoulder.
Peter Gerbino, M.D.
Department of Orthopaedics
Children's Hospital Medical Center
Boston, Massachusetts