Waldman’s Comprehensive Atlas of Diagnostic Ultrasound of Painful Conditions

Abstract

There has been an explosion of interest in the use of ultrasound (US) as an imaging modality to aid in the diagnosis of, and guide interventional treatments for, painful conditions. Both traditional (eg, palpation or anatomic landmarks and fluoroscopy) and advanced imaging (eg, computed tomography [CT] and magnetic resonance imaging [MRI]) modalities are being replaced by US, a modality that provides accuracy and safety while reducing expenditure and avoiding exposure to radiation. US is also portable, so allows clinicians to use it as an extension of their examination in the clinic or the bedside (point of care), resulting in a shorter interval between diagnosis and treatment. Finally, the ability to perform dynamic imaging with US, especially of the musculoskeletal and peripheral nervous systems, is a significant advantage over static imaging modalities such as CT and MRI. The increasing awareness of the potential of US for assessing and treating pain syndromes is reflected in the recent publication of several excellent textbooks and atlases. Although only a few of these tomes have focused on the role of US as a diagnostic tool, Ultrasound of the Musculoskeletal System by Stefano Bianchi and Carlo Martinoli1 (Springer) and Atlas of Ultrasound-Guided Procedures in Interventional Pain Management by Samer N. Narouze2 are both worth mentioning here. Over the years, Dr Waldman has contributed several books on the diagnosis and interventional treatment of pain syndromes. Waldman’s Comprehensive Atlas of Diagnostic Ultrasound of Painful Conditions reflects his experience in this field. There are several excellent features of this book that are being reviewed. These include extensive line drawings, anatomic sections, and CT and MRI scans correlated with US images that will help both the novice and experienced clinician to understand the anatomy and pathology of structures of interest. The positioning of US transducers is often shown next to the US images. This is helpful because US is a dynamic, user-dependent modality and it is important to recognize the importance of appropriate scanning technique. This atlas is an ambitious attempt to cover the vast spectrum of diagnoses associated with pain conditions. The book covers pain syndromes expansively over 137 chapters, 1100 pages, and more than 1900 US images. It is divided into sections based on anatomical regions of the body with the subsections devoted to common structures involved in pain syndromes. Images from several other books and publications are also featured within the chapters. This helps expand the base of “contributors” to this book, but it also results in inconsistent style and quality of images. Other useful features include a hierarchical approach with details about the presentation and physical examination of various pain syndromes preceding images from US and other modalities. Each chapter is divided into sections on anatomy, clinical presentations, and US scanning technique. The last section (“Clinical Pearls”) at the end of each chapter includes pertinent information that may explain patients’ symptoms, and it should help readers avoid the pitfalls of tunnel vision in clinical encounters. We have a few minor criticisms of this otherwise excellent contribution to the field of diagnostic US for evaluating pain. Some of the anatomic photographs featured in this atlas are difficult to understand because of lack of orientation (cephalad, caudal, medial, and lateral) for the reader. A related criticism is that the US images have superimposed labeling or coloring that makes it hard to appreciate the sonoanatomy (examples include the chapters on nerves innervating the foot and Baker’s cyst), especially for small structures such as peripheral nerves. Providing an unlabeled image with a line diagram next to it explaining the visualized structures may be a feature to consider for future editions of this book. We also wondered whether the radiographs and histologic sections provided in various chapters were necessary, such as the slides in the chapter on adhesive capsulitis of the shoulder. Finally, this atlas comprehensively covers pain syndromes related to musculoskeletal and nervous systems, but pain originating from pathology in the spine is not addressed in detail. A suggestion for future editions would be to include detailed chapters on the sonographic appearance of arthritis of the spinal facet joints. Another area that should be addressed is the use of US for evaluating trigger points in muscles. There has been increased interest in the use of sonomorphology and elastography for this common pain condition. Readers also need to be aware that with a weight of over 14 pounds, this is a book for the library or the study room that may not be easy to carry around, but readers have the option of purchasing, for example, a Nook or Kindle version of the book. Overall, Waldman’s Comprehensive Atlas of Diagnostic Ultrasound of Painful Conditions is an excellent contribution to the ongoing discussion of the role of US in enhancing diagnostic ability for practitioners who are involved in caring for patients with pain. Anuj Bhatia, MBBS, MD, FRCA, FRCPC, FIPP, FFPMRCA, EDRA, CIPSDepartment of Anesthesia and Pain ManagementInstitute of Health Policy Management and EvaluationUniversity Health Network-Toronto Western HospitalUniversity of TorontoToronto, Ontario, Canada[email protected] Rajendra Sahoo, MBBS, MD, CIPSDepartment of Anesthesia and Pain ManagementUniversity Health Network-Toronto Western HospitalUniversity of TorontoToronto, Ontario, Canada