The paralysed hand.

The title of this beautifully produced volume suggests a much more limited subject matter than that which it contains and in this as in other respects it somewhat resembles Rehabilitation of the Hand by Wynn Parry although written from a more surgical viewpoint as is appropriate. The first section on aetiology and investigation includes a lucid account of the peripheral nerves of the upper limb, an excellent short account of clinical examination in which the author commends two-point discrimination with a bent paper-clip as being so very much better than leaving it out of the assessment and, to end the section, an account of the pathology and neurophysiological assessment of nerve compression which is an improvement on many longer accounts of electrodiagnosis in hand disorders. There is good coverage of the congenital anomalies of innervation and of the elucidation problems related to the level of compression of the nerve along its course in the arm. Some of the many predisposing medical conditions are listed. The second section has a wide scope dealing with peripheral nerve repair, function after replantation and toe transplantation, traumatic and obstetrical brachial plexus injury and for good measure the hand in leprosy, tetraplegia and cerebral palsy. The section on entrapment neuropathy whilst excellent would have been better placed with the section on electrodiagnosis. The separate section devoted to biomechanics of tendon transfer is fascinating and shows what can be achieved with really well-thought-out line drawings which are numerous throughout the book but particularly good in this chapter. The fourth section on management of pain spreads its net well beyond the book's title and some rheumatologists would take issue with the advice on the painful rheumatoid hand. In the treatment of reflex sympathetic dystrophy whilst many less commonly used therapies are described the early use of calcitonin is not considered, reflecting perhaps UK practice which contrasts with that in France where its use began. The final section on the role for the hand therapist provides a well balanced and critical account of physical therapy and splintage and reminds us of the value of patient and skilled rehabilitation. This is a first-rate book which should be in easy reach of every orthopaedic and rheumatology library and in the personal possession of its wealthier staff. Those involved in teaching medical and physiotherapy students and those studying for postgraduate rehabilitation diplomas or degrees should read it right through.