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Mononeuropathies: Examination, Diagnosis and Treatment

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    Mononeuropathies: Examination, Diagnosis and Treatment by a staal, j van gijn, and f spaans (pp 243, £35.00). Published by W B Saunders, London, 1999.

    The authors say that they wrote this book from a frustration at having to look at several different sources to solve a single clinical problem.

    The introductory chapters contain sound clinical advice on a general approach to patients with mononeuropathy. Then each nerve is dealt with in turn using the same format: anatomy; history; examination—including the method of examination of the relevant muscles and the area of sensory loss—electrophysiological findings; differential diagnosis; causes, often tabulated; and finally treatment. The line drawings of the anatomy are clear, highlighting sites of compression. The line drawings of power testing are less satisfactory. The movement to be tested is well illustrated but the site of the muscle being tested (and hopefully observed) is not shown and for some muscles lies outside the illustration. This is followed by some chapters discussing causes of peripheral nerve injury other than focal lesions, including metabolic and physical factors and tumours. The description of the clinical syndromes is clear and succinct and well referenced throughout. The advice on treatment is sensible with a strong emphasis towards conservative management with clear statements as to when more rapid intervention is needed.

    The text is interspersed with illustrative cases which appear in boxes. I thought this worked well, although was surprised to find eight doctors (including a Professor of Neurology with a partial musculocutaneous nerve lesion, and a Dean of the Faculty of Medicine with neuralgic amyotrophy), among the 40 or so cases.

    While for mononeuropathies the book manages to act as a single point of reference it does not do this for some similar clinical problems whose presentations may be similar. It only briefly touches on radiculopathies as they appear in the differential diagnosis of mononeuropathies and skirts round some contentious issues such as the thoracic outlet syndrome. The anatomy of the brachial plexus (something I always have to look up) is not reproduced.

    Overall I think the authors have succeeded in their objectives and there is indeed justification for this book. The book is moderately priced at less than half the price of the combined costs two of the books they aim to replace.

    I would suggest that most neurology units should get a copy. I would urge you to persuade your orthopaedic colleagues to get one too.

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