This new book has a pleasing breadth and depth of information that seems
best targeted toward medical students and residents. About a fourth of the
book is devoted to a discussion of musculoskeletal biology and anatomy, and
these presentations are quite clear. The remainder of the book is devoted to
the pathophysiology, diagnosis, and treatment of common musculoskeletal
disorders.
There are many things to like about the book: the writing is clear and many
of the illustrations are excellent, especially some particularly clear
anatomical drawings. A very useful section on physical examination extends for
some sixty pages and contains excellent photographs that illustrate common
maneuvers.
The book is reasonably complete, and its length seems appropriate for
trainees. However, it is certainly not comprehensive, and some omissions may
be frustrating to primarycare physicians or to specialists. For example, while
reviewing the book, I had a clinic patient with a biceps tendon rupture. I
found no discussion of this syndrome in the book and therefore no information
on the treatment options or the prognosis associated with this relatively
common condition in older adults. Similarly, there is no mention of some
inflammatory conditions, such as psoriatic arthritis or Reiter's syndrome.
As a primary-care physician, I was particularly interested in the sections
on very common problems, such as osteoporosis, osteoarthritis, back pain,
shoulder pain, and knee pain. I was somewhat disappointed that the clinical
management and treatment strategies were not arranged in a fashion that made
decisions and sequential management clearer. When is a trial of therapy
warranted from the clinical examination alone? Which treatments should be
tried first? When should a diagnostic test or a referral take place?
While the treatment recommendations generally seem to reflect the thinking
found in the current literature, the clinical evidence on the efficacy of some
treatments was only superficially presented. It would be fairly easy to
provide more data on the success rates and complication rates for total joint
implantation in various joints, for example. There is little mention of the
inconclusive evidence for the efficacy of transcutaneous electrical nerve
stimulation in many applications or for viscosupplementation in the treatment
of osteoarthritis. Some readers may need to supplement this discussion of
therapy with recent evidence-based clinical guidelines or critical literature
syntheses such as those found in the online Cochrane Collaboration
Database.
Similarly, I was surprised to find little discussion of the dramatic
changes that are underway with regard to hormone replacement therapy for
osteoporosis as a result of the Women's Health Initiative or of the dramatic
impact of tumor necrosis factor-alpha inhibitors on a range of inflammatory
arthritides, such as rheumatoid arthritis and psoriatic arthritis.
In summary, this book can be recommended to medical students and residents
as an excellent introduction to musculoskeletal medicine. However, it may not
be the best reference text for primary-care practitioners who are searching
for quick treatment advice or for specialists who are seeking a comprehensive
text.