AAOS Orthopaedic Knowledge Update Shoulder and Elbow: 3

Abstract

The Journal of Bone and Joint Surgery. British volumeVol. 91-B, No. 7 Book ReviewsFree AccessAAOS Orthopaedic Knowledge Update Shoulder and Elbow: 3 Edited by L. Galatz. Pp. 789. Illinois: American Academy of Orthopaedic Surgeons, 2007. ISBN: 978-0-89203-409-3. £87.50.S. LambertS. LambertSearch for more papers by this authorPublished Online:1 Jul 2009https://doi.org/10.1302/0301-620X.91B7.0910983aAboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail In a rapidly evolving specialty such as that of shoulder and elbow surgery, a summary statement of the current state of knowledge is welcome. The demands and ever-increasing expectations of an active ageing population on the specialty have, over the last three decades, stimulated research into the basic sciences of complex tissue synthesis, injury and repair, and into the bio- and pathomechanics of these two very different joints, leading to the development of innovative solutions for trauma and degenerative conditions in both. Latterly, the emergence of sophisticated cross-sectional imaging and arthroscopic techniques have driven a technology-led expansion of the indications for surgical intervention in both joints.In their tradition of excellent educational material, the AAOS have produced a single volume which provides the specialist with an update on the current basic surgical management of a spectrum of shoulder and elbow disorders. The content is beyond the needs of a generalist and the pre-Fellowship trainee. The editor, Dr Galatz, was set a huge task marshalling this material into an accessible format. Inevitably, with 93 contributors, there are variations of style and detail, and the section editors have had variable success in producing a coherent whole. It is curious to note that much of the trauma material has been written by European authors. As usual in the format of the Orthopaedic Knowledge Update series the annotated bibliographies are a strength, and will guide the interested reader to relevant material.Inevitably there is a bias towards English language literature, with virtually no reference to the wealth of information in other languages. This is a shame and a weakness. For example, the Japanese have a fascinating literature concerning shoulder instability, and the French have been discussing the biceps and other cuff problems for a long time. A clear exception to this general observation is the chapter from Gerber on rotator cuff arthropathy.There is much repetition of content and some notable exclusions. There was a clear mandate to retain the section on arthroscopic techniques for the shoulder, but this has led to repetition of sections concerning the treatment of multidirectional glenohumeral instability, complications of arthroscopic repair for instability, some aspects of the treatment of disorders of the rotator cuff and the conservative treatment of the arthritic shoulder. The ‘throwers’ shoulder and instability is dealt with in detail in chapters 2, 4 and 11, but there is no reference to non-structural causes of shoulder instability. There is a short discussion of the neurological control mechanisms of shoulder posture, proprioception and movement, but little concerning the important role of physiotherapy in rehabilitation of the shoulder. The definitions of laxity and instability, given in chapter 4, are misleading and incomplete. The separation of arthroscopic from non-arthroscopic techniques is artificial. Each complements the other in a spectrum of management options, and the separation only serves to emphasise prejudices without helping the reader to a useful conclusion. In future it would be useful to combine these sections. Similarly it might be better if the basic science of each topic was dealt with in the relevant section. For instance the basic science of proximal humeral fractures might be more appropriately placed with trauma, and the chapter on calcific cuff disease in the section on the rotator cuff, in order to include the basic science with cuff tear arthropathy. Such organisation might assist the readers in their appreciation of this sterling work.A wealth of knowledge, opinion, and experience has evolved over the last three decades, and a summation will eventually emerge, perhaps leading to the development of a conceptual framework for further research. This book does not provide this. The three overlapping but increasingly discrete specialties of shoulder surgery, sports medicine, and arthroscopic surgery (allied to so-called minimally-invasive surgery), brought about by societal and economic pressures, have forced an artificial trichotomy, to the detriment of the book as a whole. Only elbow surgery emerges as a single conceptual continuum. Perhaps the next edition might have as its object a restructuring of the superb educational content so as to bring together the disciplines rather than to permit their separation, while providing sectional editorial commentary to give appropriate weighting to the otherwise overwhelming and diverse evidence.FiguresReferencesRelatedDetails Vol. 91-B, No. 7 Metrics Downloaded 279 times History Published online 1 July 2009 Published in print 1 July 2009 InformationCopyright © 2009, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download