Reviews and Notes: Neurology: Neck Ache and Shoulder Pain

Neurology: Neck Ache and Shoulder Pain

Ian Macnab and John McCulloch. 507 pages. Baltimore, Maryland: Williams & Wilkins; 1994. $69.00.

Classic treatises on our current knowledge of both cervical spine and shoulder problems are well known. If these books are overwhelming and serve as references rather than readable texts, Neck Ache and Shoulder Pain is more user-friendly, albeit with a quirky approach to the same subject. Macnab and McCulloch approach this material as a summary of their personal experiences rather than as a compendium of our understanding of neck and shoulder problems. The first section seems more oriented to neurosurgeons, whereas orthopedic students will enjoy the latter. Nonsurgeons can pick their way through this book as well. Chapters on subjects such as whiplash injuries and psychogenic neck pain will yield an interesting perspective not often presented. (The authors take a more compassionate view of whiplash than we usually do.)

Normal anatomy is adequately presented, followed by the pathophysiology of the various diseases (for example, rotator cuff tendinitis). The authors have a relaxed, avuncular style that is usually easy to follow. After a few references to the Wallenberg syndrome, I did have to scurry to a neurology textbook to refresh my memory. The text is not long on references. One may be surprised, however, to find a quote and reference to Gilbert and Sullivan's Mikado. Radiographs and magnetic resonance images are of varying quality. I am sure the authors were not pleased to find the first one upside-down. However, the reader's interest is maintained by the Socratic demands of finding abnormalities in some of the figures.

Treatment of neck and shoulder disorders is presented in a reasonable and conservative fashion. I take exception to the statement that histamine-2-receptor antagonists offer gastric protection (they do not), but physical therapy modalities are well presented. A good appendix of exercises is included. An interesting commentary on collars shows the woeful limitations of the oft-ordered soft cervical collar. Orthopedic surgeons will probably feel short-changed by the discussion of shoulder arthroscopy. Limited mention is made of the indications and benefits for refractory rotator tendinitis, labrum tears, and evaluation of glenohumeral instability.

This book has practical merit and can be easily read in a few sittings.