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detail, in the text. The exercise protocols are all

presented in an interesting way, especially in relation to returning to the various sports. There could be more detail, for instance exercises to build up the strength in the medial aspect of the hand, which can be such an important factor in both recovery from and prevention of medial and lateral epicondylitis.

I t is also striking that , while much is made of the importance of objective measurements as indica- tors of improvements and goals in treatment, nothing is said about the patients’ state of mind, and part- icularly the need for therapists to take into account patients’ natural fear and frustration, which are major factors in the process and progress of rehabilitation after injury and surgery.

Children’s elbow injuries are mainly contained within the sectors on growth plate injuries. Treatment suggestions are scanty, described as ‘non-operative’, ‘protection’ and ‘modality application’, which I hope would not include ultrasound, in view of its suspect effect on growth plates (CSP, 1990; Dyson, 1989).

I feel i t is a pity that the authors do not go into the differences in soft- tissue injury mechanisms due to youth and age. For instance, a pre- teen tennis player with ‘tennis elbow’ symptoms, in the absence of a growth plate problem, is more likely t o be suffering from referred pain and inhibition due to imbalance or covert injury in the shoulder girdle, rather than the localised problem familiar in mature patients.

The Elbow in Sport is certainly worth reading, because i t is a rare text covering problems which are often very difficult to treat; much of the background material is excellent; and i t affords a good opportunity t o re-evaluate and question one’s one practice.

Vivian Grisogono MA(0xon) MCSP

References Chartered Society of Physiotherapy (1990). ‘Guidelines for the safe use of ultrasound therapy equipment‘, Physio- therapy, 76, 1 1 , 683-684.

Dyson, M (1989). ‘The use of ultrasound in sports physiotherapy’, in: Grisogono, V A L (ed) International Perspectives in Physical Therapy Sports Injuries, Churchill Livingstone, Edinburgh.

Shoulder Injuries in Sport Evaluation, treatment and rehabilitation by Jerome V Ciullo MD. Human Kinetics, Leeds, 1996 (ISBN 0 87322 651 8). lllus. 291 pages. €45.

shoulder problems. Two chapters cover the simpler but very common problems of sprains and strains - followed by chapters on problems which are less common but which would seriously impede ultimate

The author intended this book to promote better treatment for shoulder injuries and t o provide a common frame of reference for the needs of all team members including the sports physician, surgeon, physiotherapists and athletic trainers.

Par t 1 covers basic anatomy, analysis of movements and diag- nosis of problems. Motion analysis breaks down not only the usual base ball pitch seen in most examples but also freestyle, butterfly and back- stroke, golf swing and javelin throw.

The chapter on medical history gives practical advice on the signif- icance of various symptoms such as night pain lying on the shoulder (suggesting a-c joint) and not lying on the shoulder (possible rotator cuff). The problems of triad degen- eration, ie the relationship between instability, muscle imbalance and arthritis, are also discussed.

The chapter on physical examina- tion follows a similar format - describing range of movement, specific strength testing and the additional special tests. The different methods of analysis such as plain X-rays, bone scan, MRI arthrogram and EMG are all explained and indications for their use are discussed.

The chapter on arthroscopy includes a lot of technical detail for surgeons but is interesting and well worth reading as it is interspersed

with explanations of condi- tions and examples from

the author’s practice. Part 2 gives a substan-

t ia l breakdown of the assessment and

shoulder function. The chapter on what the author

terms ‘sprains’ includes everything from mild subluxation to full dislo- cation with SLAP and Bankhart lesions and is excellent. Clear descriptions of mechanisms of injury, differential diagnosis and both conservative and surgical managements are given. Prognosis is also discussed for each type of injury and the importance of patient education and prevention is emphasised.

The chapter on strains is equally as informative and follows exactly the same format. Again, under the heading ‘strains’ i t covers every- thing from minor impingement problems to avulsion fractures.

Part 3 covers rehabilitation and is tiny compared to the rest of the text (12 pages out of 290). What is there is quite good, albeit brief and a little disappointing at the end of an other- wise comprehensive text.

Overall I found this book an excel- lent comprehensive reference on shoulder injury, diagnosis and management. As the author is a surgeon it would be unfair to expect a more detailed breakdown of reha- bilitation techniques and practical ideas. For this the reader would need to look elsewhere.

There is a good combination of black and white photographs and diagrams illustrating the text.

The price might limit individual purchase unless a very large propor- tion of your work is with shoulders, however the amount of information available makes this book well worth having as a reference in phys- iotherapy departments or hospital libraries.

treatment of specific Nicola t

Pulley, pendulum and wall climbing exercises for various stages in muscle healing

Physiotherapy, February 1998, vol84, no 2