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Atlas of uncommon pain syndromes
  1. A P Garnham
  1. Deakin University, School of Health Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia; agarnm{at}

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    S D Waldman. Saunders, 2002, £74.99, hardcover, pp 224. ISBN 0721693725

    This title arouses interest, and immediately brings to mind the aphorism “when you hear hoof beats, think of horses, not zebras.” Indeed, the preface begins with just that advice. However, a dip into the book soon reveals that this is a mixed collection of conditions under the broad heading of “uncommon.” Of course, uncommon depends on one’s field—within any sports medicine practice, such conditions as supraspinatus tendinitis (sic), iliotibial band friction, and talofibular pain are very much everyday horses. However, omohyoid syndrome, Parsonage-Turner syndrome, quadriceps expansion syndrome, and many others are more intriguing.

    The text is arranged regionally, with 71 conditions dealt with in individual chapters, with accompanying illustrations. The term syndrome is loosely applied to a variety of causes of pain of predominantly musculoskeletal and neural origin. A particular condition or area of pain is very easily located, and each chapter describes the condition in detail, and offers sections on symptoms, signs, tests, differential diagnoses, treatment, complications, and clinical pearls. The illustrations are large, colourful, and well executed, and immediately help the reader to localise the potential diagnosis. Thus far this appears to be an accessible and useful text for all who treat musculoskeletal conditions. Unfortunately, closer examination soon reveals deficiencies that detract from its value.

    When looking at the conditions covered in a particular region, it rapidly becomes apparent that it is also necessary to consult the author’s companion volume Atlas of common pain syndromes if all likely diagnoses are to be considered. A cross reference to conditions covered in that book would be invaluable, but is absent. The text has been word processed in such a way that paragraphs are often identical from one condition to another. The text has been inadequately proofread, with paragraphs sometimes copied repetitively, and other paragraphs apparently left out. For a number of conditions the text refers to the success of “this injection technique”, yet fails to describe the technique. Investigation advice is too often non-specific. MRI is usually offered as the investigation of first choice, when in many cases other modalities are undoubtedly superior and cheaper. Characteristic investigation findings are rarely mentioned, and the few diagnostic images reproduced are of little value. There is a defensive approach throughout, which encourages more tests to exclude other diagnoses, but rarely helps to pinpoint the condition in question.

    The author is an anaesthesiologist, and the focus of treatment is on injection techniques to block pain. Some injection techniques are described and illustrated clearly, but, for many, either direct instruction or more companion volumes, Atlas of pain management techniques and Atlas of interventional pain management, are essential to safe conduct. Again, there are no cross references to the companion texts. For most conditions the treatment proposed is non-steroidal anti-inflammatories, heat and cold application, and if those measures fail, injection. Rest is invariably offered for activity related conditions. For conditions such as ankle sprain, these measures can hardly be called best practice. Physiotherapy is rarely mentioned, and rehabilitation and biomechanical correction are virtually ignored. Guided injection techniques, using ultrasound, fluoroscopy, and computed tomography, which are ideal for some of the conditions covered, are not mentioned.

    There are several major omissions. Evidence based practice is not considered, and the treatments offered for several conditions are clearly counter to well established guidelines. There are no references, and no recommendations for further reading. For many of the conditions less familiar to me, I would welcome the chance to do some additional reading before making a diagnosis.

    Overall, this text has a role as an easy guide to unusual conditions that may not otherwise be considered. The illustrations are evocative, but in many cases are more like cartoons than diagnostic tools. Diagnostic information is inadequate, and treatment options one dimensional. The author’s companion volumes would enhance the value of this text, but at a price perhaps too high to recommend them. Handy for the library, worth looking through, but not a must buy for most practitioners.


    Presentation 18/20

    Comprehensiveness 14/20

    Readability 14/20

    Relevance 12/20

    Evidence basis 0/20

    Total 58/100