Brachial Plexus Palsy.

Brachial plexus palsy. Edited by H. Kawai and H. Kawabata. Pp 333. Singapore: World Scientific, 2000. ISBN: 981-02-3139-3. $55.00.

This work, from four orthopaedic surgeons in Osaka, analyses the considerable clinical experience which they have acquired in the treatment of lesions of the brachial plexus. Japanese orthopaedic surgeons have made very great contributions to this field, especially in diagnosis by myelography and by neurophysiological investigation, and in treatment by nerve transfer. This depth of contribution is reflected in the strengths of this work.

Throughout, the style has admirable clarity. The opening chapter on anatomy includes a particularly good analysis of the variations of formation of the musculocutaneous nerve. The chapter describing the lesions of the spinal nerves contains important experimental observations about avulsion injury. That on clinical assessment is particularly good, although there might have been reference to the work of Jones and his colleagues who introduced intraoperative somatosensory recording in 1980. The account of the techniques of repair contains, as one might expect, an excellent analysis of intercostal transfer, discussing functional conversion and afferent reinnervation of the biceps muscle, and includes much valuable information on the remodelling of the patterns of muscle fibres. There are chapters on pain, which dispel the idea that Oriental people are immune to this complication of injury to the brachial plexus, and on reconstruction, which contains a critical analysis of the relative merits of muscle transfer and glenohumeral fusion.

Professor Shimada relates his experience of tumours of the brachial plexus with no less than 45 examples. His suggestion that nerves be repaired by graft after wide excision for malignant tumour may be open to debate. Professor Masatomi provides clear guidance on the approach to patients presenting with postirradiation plexopathy, which clarifies the indications for exploration when the diagnosis is in question. The difficulties of detecting endoneurial metastases are described. Professor Kawabata's chapter on repair in obstetric plexus palsy is particularly useful. His careful analysis points to the advantages of repair but also emphasises that rather poor results are obtained with repair of the lower root.