Pain in Shoulder and Arm: An Integrated View

Abstract

Pain in Shoulder and Arm is the proceedings of a multidisciplinary symposium on diagnosis, evaluation, and treatment of pain in the shoulder and arm. It suffers from a lack of continuity because of the varied interests and backgrounds of the authors, but profits from the overview it provides readers. The book is divided into four sections. Section one covers the physical examination of the patient with arm and shoulder pain. The discussion is complemented nicely by an extensive discussion of arthrography of the shoulder, a good review of the current status of angiography of the upper extremity, and a sophisticated approach to neurophysiological evaluation of the arm. The last part of this initial section contains a discussion of the differential diagnosis of pain in the arm; it is helpful in that it considers the more common causes. The second section of this book, although called “Causes of Pain in the Shoulder and Arm,” concerns itself with additional radiological diagnosis of the shoulder joint, a discussion of rheumatoid disease of the shoulder, and a discussion of subclavian vein occlusion. This section is particularly interesting because the approach to subclavian vein thrombosis is aggressive surgically and results seem to justify the approach. The section concludes with a discussion of operative therapy of arterial occlusive disease of the upper extremities. This will be particularly interesting to those who use extraanatomical bypass procedures, as it raises the question whether carotidsubclavian bypasses or subclavian-subclavian bypasses are preferred for the so-called subclavian steal syndrome. The third section of this book is an outstanding one devoted entirely to the thoracic outlet syndrome. Physical diagnosis of this syndrome is covered in depth, as is the technique of nerve conduction studies. The value of nerve conduction studies versus physical examination is reviewed extremely well and placed in its proper perspective. The management of arterial lesions in relationship to the compression syndromes is also well outlined. The last section, ”Treatment of Pain in the Shoulder and Arm,” contains a variety of subjects. The ones most pertinent for the thoracic surgeon are two excellent discussions of sympathectomy and its current indications and surgical approaches. Additional discussion of the operative approach to subclavian vein thrombosis and management of occlusive disease of the subclavian artery complements the earlier discussions. I found this book interesting. I recommend it to thoracic surgeons dealing with shoulder and arm pain because its multidisciplinary approach provides a good reference source and it covers extensively the problems commonly seen.