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Glossary of Physiotherapy Terms A - M

[A] [B] [C] [D] [E] [F] [G] [H] [I] [J] [K] [L] [M]


A

Accessory movement

Joint movements which cannot be performed voluntarily or in isolation by the patient.

Achilles tendonitis

Inflammation of the Achilles tendon, particularly the peritendon. It may be predisposed to this type of condition because of biomechanical, muscular, training and footwear factors.

Acromio-clavicular (AC) joint

Joint between the acromion process of the scapula and the clavicle.

Acupuncture

Needle, laser, electroacupuncture or pressure (shiatsu) can be beneficial in treatment and management of a variety of conditions, primarily to alter pain threshold and/or pain perception.

Adductor tendonitis

Commonly occurring in athletes and horse riders, with localized pain over the tendinous origin of adductor longus from the pubis or at its musculotendinous junction.

Anabolic steroids

Derivatives of the male sex hormone testosterone and are used as performance enhancing, to increase muscle bulk and strength. Can be taken orally or as an injectable.

Analgesia

Pain relief which may be achieved by use of medication (e.g. aspirin, paracetamol or codeine), modalities (e.g. ultrasound, interferential and laser) or acupuncture.

Ankle sprain

Usually an over stretch of the lateral (outside) ligament of the ankle joint. Can be of varying degrees, from minor over stretch to complete rupture.

Ankylosing spondylitis

A disease process of unknown etiology, characterized by the presence of bilateral sacroilitis with inflammatory changes in the spinal joints. The onset is most common in males in their late teens to early twenties. As the name suggests, it is a process which results in a gradual stiffening of the axial skeleton, sacroiliac joints and pubic symphysis.

Annulus fibrosis

This is the peripheral portion of the intervertebral disc, consisting of collagen fibers arranged in a highly ordered pattern. The posterior fibers of the collagen lamellae are thinner and more tightly packed, hence the posterior aspect of the annulus fibrosis is thinner than the rest of the annulus.

Anterior cruciate ligament (ACL)

Intra-articular ligament of the knee, attaching on the anterior portion of the tibial plateau extending upwards and posteriorly to the medial aspect of the lateral femoral condyle. Very frequently injured during twisting type sports (e.g. Australian Rules football, soccer), or those that involve rapid deceleration (e.g. netball). Extrinsic trauma also has a large part to play in ACL injuries.

Anti-inflammatory medication

See Non Steroidal Anti-Inflammatory Drugs (NSAIDs).

Apley's test

A test of meniscal integrity comprising a compression of the knee (in 90 of flexion, with patient lying prone) and then performing both medial and lateral rotation.

Apophyseal joint

See Zygapophyseal joint.

Apprehension test

A test that places the joint in a position that would simulate subluxation or dislocation, with the degree of "positivity" being judged by the level of "apprehension" on the patient's face.

Arthroscopy

Using an intra-articular camera to assist, this less invasive procedure allows the Orthopedic Surgeon to assess, repair or reconstruct various tissues both within and around joints. Now used preferentially to "open" procedures, when permitted.

Articular cartilage

Covers the ends of bones and allows the distribution of compressive loads over the cross section of bones, as well as providing a near frictionless and wear resistant surface for joint movement.

Atrophy

Usually attributed to muscle, it is a shrinking in size, usually following a period of disuse or immobility.

Avascular necrosis

Death of tissue due to complete depletion of blood supply. Commonly seen with fractures of the femoral neck, leading to death of the head of the femur. May also be seen in scaphoid and navicular fractures.

Avulsion

Usually caused when a muscle is forcefully stretched beyond its freely available range of motion, or when it meets a sudden unexpected resistance while contracting forcefully. Can also occur in ligament injuries, where the insertion of the ligament may pull some bone off when it is damaged.

Axon

This is the main outgrowth of a neuron and is dependent on the cell body.

Axoplasmic flow

This is continually moving cytoplasm within the neuron and provides material synthesized by the cell body to meet the physiological requirements of the cell body, the axon and the target tissues. Disruption to axoplasmic flow results in diminished performance of the neuron.

B

Baker's cyst

Bursitis of the semimembranosus or the medial gastrocnemius bursa. Often presents as a large soft tumor mass in the posterior knee and may be associated with degeneration of the knee.

Bankart lesion

An anterior pouch that is formed when the humeral head dislocates anteriorly, and remains following reduction, leaving a deficit in the anterior restraining mechanisms.

Biarthrodial muscles

Muscles that span over two joints and have a function over those joints e.g. biceps brachii - shoulder flexion and elbow flexion.

Biofeedback

The use of instrumentation to bring covert physiological processes to the conscious awareness of the individual, usually by visual or auditory signals.

Blood doping

In its usual form, this involves withdrawal of blood from an athlete, followed by re-infusion after a suitable period of time, usually 4 - 8 weeks, during which time the level of red blood cells had returned to its pre-withdrawal state. The addition of the extra blood would increase the amount of cells available to carry oxygen. This practice has been used to improve endurance. This is a banned practice at elite levels of sport and may be potentially dangerous.

Bone density

A description of bone mass and is diminished in osteoporosis. Bone density has also been seen to be diminished in hormone deficiency syndromes, particularly estrogen depletion.

Bone scan

See Technetium bone scan.

Bruxism

Grinding of the teeth, which may be a predisposing factor to temporomandibular joint (TMJ) dysfunction.

Bucket handle tear

A description given to a type of tear of the meniscus of the knee joint, usually medial. The tear is one that extends along the length of the meniscus, within the body of the meniscus. This tear allows for the internal portion of the torn meniscus to slip into the joint. A common cause of a "locked" knee.

Bursa

A fluid filled sac, usually located at areas of friction e.g. between tendon and bone.

Bursitis

Inflammation of the bursa, usually caused by overuse or direct trauma.

C

Calcaneal spur

Also called calcaneal enthesiopathy, where there is repetitive microtrauma at the attachment of the Achilles tendon resulting in the formation of a spur, extending from the calcaneum into the tendon.

Carpal tunnel

A "tunnel" formed at the wrist, by the flexor retinaculum and the carpal bones.

Carpal tunnel syndrome

Where there is compression of the median nerve in the carpal tunnel, resulting in sensory and motor disturbances of the hand.

Cauda equina

Lower end of the spinal cord.

Cavitation

Production of gas from liquid.

Central nervous system

The brain, spinal cord and spinal nerves.

Cervical spine

Seven vertebrae - C1 - C7. Articulate with the occiput superiorly and the T1 vertebra inferiorly. Commonly known as the neck.

Chondromalacia patellae

Common name given to softening of the articular cartilage on the undersurface of the patella. Commonly seen in adolescents and commonly associated with functional and biomechanical deficiencies of the patello-femoral joint.

ChoPat strap

An infrapatellar strap, commonly used in the treatment of patellar tendonitis or chondromalacia patellae.

Clarke's test

Compression of the patella with resisted knee extension. Commonly used as a test of chondromalacia patellae but has not been shown to be reliable.

Cloward's spots

Areas of referred pain in the thoracic spine, close to the scapulae, secondary to cervical spine disorders.

Coccydynia

Pain around the coccyx. Often caused by local trauma, but may also be a referred pain syndrome from the lumbar spine.

Colle's fracture

A common fracture to the distal radius, usually brought about by a fall onto the outstretched hand.

Compartment syndrome

Exercise, or effort, induced pain syndrome, whereby the pain is due to the inability of the muscles within the compartment to expand. Often confirmed by using catheter pressure testing.

Conjoint tendon

The common tendinous insertion of transversus abdominis and internal oblique at the pectineal line.

Contusion

A bruise, often associated with blunt trauma.

Continuous passive motion (CPM)

A form of passive mobilisation, assisting in the recovery of cartliage. Used commonly following knee reconstructions.

Coronary ligament

Lies on the anterior aspect of the knee and attaches the anterior horn of the medial meniscus to the tibial plateau.

Corticosteroids

Anti-inflammatory medication. Can be taken orally (not common) or as an injectable, particularly in superficial tissues undergoing inflammatory pathology.

Cortisone

See Corticosteroids.

Costochondral junction

Junction between rib and costal cartilage. Commonly disrupted in contact sports.

Crepitus

A grinding noise or sensation within a joint. Commonly felt in knees, particularly on change of position after a long period of time.

D

de Quervain's disease

Inflammation of the tendons and sheath of abductor pollicis longus and extensor pollicis brevis, in the first dorsal compartment of the wrist, with subsequent thickening and stenosis.

Deep transverse frictions

Cross fibre, deep massage. Often a technique utilised on scar tissue and chronic tendon disorders.

Deep vein thrombosis (DVT)

Blockage of the deep veins, particularly common in the calf. Often mistaken for calf strain, the DVT is characterised by sharp pain in the calf, swelling, worsening with foot dependency and relief with elevation, tenderness and possibly some ecchymosis.

Dermatome

Area of skin supplied by one spinal segment.

Disc herniation

Often used interchangeably with disc prolapse, disc bulge, slipped disc etc. Disruption to the normal integrity of the intervertebral disc, causing the nucleus pulposus to breach the annular fibres internally. There are varying degrees, from minor bulging, to bursting through the outer annular fibres into the spinal canal.

Discectomy

Surgical removal of prolapsed nucleus pulposus.

Double crush syndrome

Defined as a serial impingement of a nerve tract. An initial injury to a nerve (e.g. nerve injury in the neck) may lead to a secondary lesion (e.g. median nerve in the carpal tunnel).

Dupuytren's contracture

A fibrous proliferation in the palmar fascia of the hand, that gradually produces a flexion deformity of the metacarpophalangeal and proximal interphalangeal joints.

Dura mater

Thickest, outermost covering of the spinal cord and spinal nerves. Also lines the inside of the skull.

Dynamometer

Mechanical instrumentation that allows for measurement of concentric and eccentric muscle action, muscle endurance and muscle balance ratios. Usually associated with isokinetic testing, providing variable, accomodating resistance.

E

Eccentric

Controlled, active lengthening contraction of a muscle.

Ecchymosis

Bruising.

Effusion

Swelling, with particular reference to joints and their related superficial structures.

Electrical stimulation

Provides a situation whereby there is an electrical generation of action potentials, giving rise to therapeutically significant physiological responses e.g. increased muscle strength, stmulated lymph and blood flow, analgesia, kinaesthetic awareness and autonomic nervous system responses.

Electrotherapy

Modalities used in the treatment of musculoskeletal disorders e.g. ultrasound, short wave diathermy, interferential therapy, biofeedback, transcutaneous electrical nerve stimulation and laser.

Electromyography

Quantified information regarding overall muscle performance and function.

Endfeel

Physiotherapist appreciation of the "feel" at the end of the range of motion, either of joint or other tissue. This is a sensation felt during passive movement, by the Therapist.

Endorphins

These are endogenous biomechanical substances implicated in the alleviation of pain, produced as a result of body stress.

Entrapment neuropathy

Pathological situation where a nerve is trapped in an abnormally produced anatomical or physiological site.

Erector spinae

Muscles of the spine that lie posteriorly. These are commonly known as the "anti-gravity" muscles.

Ergonomics

The account of how the workplace relates to the human and its function.

Extra-articular

That which lies external to the joint.

Extraneural

That which lies external to neural tissue.

F

Fabella

A sesamoid bone that is within the lateral head of gastrocnemius, which often articulates with the femoral condyle.

Faber test

Flexion - Abduction - External Rotation test of the hip.

Facet joint

See Zygapophyseal joint.

Fasciotomy

Division of fascia. Often associated with compartment syndromes of the lower leg.

Fat pad

A "filler" in caverns. The most common is the infrapatellar fat pad.

Fibrositis

A benign, intermittently recurring and protracted disease process, with a lack of underlying pathology. The condition is often associated with muscular pain and stiffness.

Finkelstein's test

Test for de Quervain's syndrome, whereby the patient clenches the fingers over the thumb and performs an ulnar deviation. To be positive, pain in the correct region must be elicited.

Freiberg's disease

Considered as an osteochondritis dissecans, due to an osteochondral fracture, with avascular necrosis of the bone, usually involving the head of the second metatarsal.

Frozen shoulder

Alternate name for "capsulitis" of the shoulder, which undergoes four distinct stages of pathology: Pain; Pain and stiffness; Stiffness; Resolution. These four stages usually run a protracted course, varying in length from 9 - 18 months.

G

Gait

The pattern of locomotion. Alterations to this pattern may be altered weight distribution, lack of mobility in hips, knees, ankles or presence of a Trendelenburg sign.

Ganglion

Benign tumour of synovium arising from the joint or tendon sheath.

Gastrocnemius

Calf muscle made up of medial and lateral heads.

Genu valgum

Seen at the knee. Commonly known as "knock knees".

Genu varum

Seen at the knee. Commonly known as "bowed legs".

Gerdy's tubercle

Lateral tubercle at upper end of tibia, being the site of partial insertion of iliotibial band. Common site of pathology due to friction of iliotibial band on bone.

Gluteus maximus

Large, superficial buttock muscle.

Goniometer

Apparatus for measuring range of motion at a joint. Error rate quite high as there are often problems locating the exact axis of movement, particularly for complex movements.

Gout

Metabolic disease associated with hyperuricaemia, with symptoms occurring as a result of uric acid crystals being deposited into the tissues.

Grades of movement

Standardised means of documenting techniques of mobilisation, relating it to the true feel of joint movement.

Groin injuries

Description of injury to any one of the following muscles: sartorius; long head of rectus femoris; any or all of the adductor muscles; the abdominals or the iliopsoas.

H

Hemarthrosis

Bleeding within a joint. If swelling of a joint occurs quickly (i.e. within 3 - 4 hours) it is probably an haemarthrosis and, in the knee, in 75% of all cases indicates an ACL injury.

Hematoma

Bleeding into tissues, usually as a result of blunt trauma.

Hallux rigidus

Loss of range of the movement of the metatarsophalangeal (MTP) joint of the first (great) toe, particularly extension.

Hallux valgus

Deformity of the metatarsophalangeal (MTP) joint of the first toe, whereby the toe deviates into the lateral position.

Hammer toe

Deformity of the toe whereby there is PIP flexion and DIP extension. The MTP is usually extended or neutral.

Hamstrings

Muscles located in the posterior compartment of the thigh. Made up of the semitendinosus, semimembranosus and biceps femoris muscles. Some anatomists will also include the "hamstring" head of adductor magnus.

Heberden's nodes

Bony swellings around the margins of joints, associated with degenerative changes of arthritis.

Heel lock

Technique of strapping, to ensure sub-talar joint stability.

Hill-Sachs lesion

Following anterior dislocation of the shoulder, the head of the humerus can sustain a compression fracture. This consequent depression of the humeral head is known as a Hill-Sachs lesion.

Hip pointer

Contusion of the iliac crest. Usually due to a severe knock against the iliac crest.

Horner's syndrome

Caused by interruption to the sympathetic nerves to the face and eye. A common feature is ptosis of the eyelid.

Housemaid's knee

Inflammation of the superficial infrapatellar bursa.

Hyaluronidase

Substance that assists in the resolution of a haematoma. Usually prepared in a cream form.

Hydrotherapy

Rehabilitation exercises performed in a appropriately designed pool.

Hyperextension

Active or passive force which takes the joint into extension, but beyond its normal physiological range.

Hypermobility

An increase in the normal range of joint movement. This may lead to instability.

Hypertrophy

An increase in the size of tissue.

Hypomobility

An decrease in the normal range of joint movement. Often characterised by the loss of accessory movements.

Hypoxia

Depletion of oxygen to tissues. Often caused by a cessation of blood flow and hence oxygen carrying cells.

I

Ice therapy

Cooling of deeper tissues, with vasoconstriction and reduction of localised bleeding.

Idiopathic pain

Pain without well defined physiological correlates.

Iliopsoas

Deep hip flexor, with attachments to the lumbar spine. Often tight in the presence of lower back pain.

Iliotibial band

Laterally situated structure in the thigh. Has action over the hip (muscular attachments of tensor fascia lata and gluteus medius) and over the knee (can act as a flexor at >30 of knee flexion and as an extensor at <30 of flexion). Tends to be a victim of overuse, rather than trauma.

Iliotibial band friction syndrome

Pain over the lateral compartment of the knee where the iliotibial band passes over the femoral condyle. Usually brought on by running. May have associated creaking, crepitus or clicking. Palpation often tender and with compression of the iliotibial band during flexion and extension, pain should be reproduced.

Immobilization

Prevention of movement, presumably to allow for natural healing to take place. Side effects include disuse atrophy, deconditioning of muscles and stiffness.

Infrapatellar bursa

Fluid filled sac located between the patellar ligament and the skin.

Infrapatellar fat pad

Lies deep to the patellar ligament and fills the space between the condyles of the tibia and the femur.

Intercostal muscles

Muscles lying between ribs and are often injured by rotary stress of the thorax.

Intervertebral disc

The disc forms a cartilaginous joint between the vertebral bodies, providing extremely efficient shock absorption. Made up of the annulus fibrosis, nucleus pulposus and the cartilage end plates. Research implies the disc is the most commonly damaged structure, being the most common cause of lumbar spine disorders.

Intra-articular

Being within the joint.

Intraneural

Being within neural tissue.

Irritability

Represented by the amount of activity necessary to worsen the condition, the extent of the exacerbation and the duration of the response. Based on a movement rather than a static posture, as this would give an idea of the amount of activity necessary to worsen the conditon. This has implications for the amount of assessment and treatment provided to the patient.

Isokinetic

Applies to muscle contraction in which a constant joint angular velocity is maintained by accommodating resistance.

Isometric

Muscle contraction without movement at the joint.

Isotonic

Constant loading of a muscle, with variable velocity.

J

Joint locking

An extremely painful condition, usually caused by entrapment of a loose body within the joint, between the joint surfaces.

Jordan frame

A specialized stretcher developed for transport of suspected spinal injured patients.

Jumper's knee

Associated with a small area of degeneration at the tendon attachment at the lower pole of the patella, characterized by pain and extreme local tenderness. Often associated with activities that require jumping off one leg e.g. high jumpers. Often associated with aptellar tendinitis.

K

Knee reconstruction

Surgical restoration of "normal" biomechanics of the knee, using tendon grafts to replace damaged tissues. Commonly seen with ACL injuries, when there is a concurrent rotary instability caused by damage to other structures, knee reconstructions are often the only way to restore acceptable mechanics. If the knee is unstable, reconstructive procedures are undertaken to restore function stability.

Kyphosis

Exaggerated curvature of the spine, in the flexion/extension axis. In the thoracic spine, in adolescents, the most common cause of kyphosis is Sheuermann's disease. In the elderly, the most common cause of kyphosis is disc dengeneration. Localised kyphosis may be caused by collapse of one or more thoracic vertebrae which, in the elderly, may be associated with osteoporosis.

L

Lachman's test

Drawing forward of the tibia, relative to the femur, in 10 - 20 of knee flexion. A test for ACL disruption.

Laminectomy

Surgical procedure, which includes removal of a portion of the lamina, to provide more room in the vertebral canal. Usually for disc herniation or spinal canal stenosis.

Laser therapy

Use of low powered lasers, for treatment of pain, swelling, inflammation and promotion of healing.

Lateral epicondylitis

Also described as "tennis elbow", but often with no history of sporting endeavour. Condition affecting the lateral compartment of the elbow. Pathology affecting the junctional tissue associated with the origin of the common extensor tendon at the lateral humeral epicondyle, specifically the tendinous origin of the extensor carpi radialis brevis.

Lateral release

Surgical procedure whereby there is division of the lateral patellar retinaculum, from the patellar tendon to within the muscle fibres of vastus lateralis. Usually as a treatment of patellofemoral dysfunction, following failed conservative measures.

Leg length

A measure from the anterior superior iliac spine, to the tip of the medial malleolus, although this may be inaccurate in the presence of pelvic rotation or asymmetry. Leg length discrepancies may not be significant if they are less than 6 mm, as many asymptomatic patients have a leg length difference of up to 12 mm.

Lenox Hill brace

A commonly used brace, developed in New York for the use in ACL deficient knees, with particular emphasis on its de-rotation properties.

Loose body

A title given to an object, located within a joint, that has become detached. A common cause of locking of a joint.

Lordosis

Curve of the spine, whereby there is hollowing. Normal lordosis is seen in the lumbar spine, although variances do exist.

Lumbar spine

Made up of five vertebrae, it is commonly called the "lower back".

Luschka, joints of

Known as neurocentral joints, uncovertebral joints or lateral interbody joints, these joints are located near the posterolateral margin of the cervical discs.

M

Magnetic field therapy

Employs an alternating magnetic field to generate an electric current inside the tissues, resulting in changes to blood flow.

Mallet finger

A common condition due to the rupture of the long extensor tendon of the finger, at its insertion into the base of the distal phalanx of the finger.

Manipulation

Small amplitude, high velocity thrust technique at the end of range, with sufficient speed that the patient is unable to prevent the movement.

Manual therapy

The art of passive movement techniques.

Massage

A mechanical form of therapy, whereby the soft tissues are made more pliable with different techniques, promoting increased blood flow and subsequent healing.

McMurray test

A test for assessing the knee for the presence of a medial meniscal lesion. Performed with the knee in external rotation and abduction, with the knee in 90 of flexion, the knee is extended from 90. An audible or palpable click may be felt in the joint, thus indicating a positive test.

Median nerve

A large nerve, comprising segments from the cervical spine, that is involved in neural function of the upper limb. Commonly entrapped in the carpal tunnel of the wrist, to create a carpal tunnel syndrome.

Meniscus

The mensci are fibrocartilaginous structures that function as "washers" - to deepen the joint surfaces, shock absorbers, assist in joint lubrication and provide joint stabilization. Often damaged, particularly in the knee, when there is a rotational force.

Meniscectomy

Removal of a torn section (or complete) of meniscus. Usually performed arthroscopically.

Mobilization

Passive movement technique that is performed that is always in the control of the patient. Usually performed as oscillatory movements in either the physiological or accessory range of a joint.

Morton's neuroma

Painful swelling of one of the digital branches of the plantar nerves. Occurs usually at the bifurcation of the nerve as it lies between the two adjacent metatarsal heads. The most common site is between the third and fourth metatarsal heads.

Movement diagram

Diagrammatic and graphical depiction of the palpation of a joint. Effective as a teaching tool to describe grades of movement.

Multifidus

Deep lumbar spine muscle. Its primary function is to stabilize the lumbar spine.

Myofascial trigger point

Areas of focal muscle tenderness and spasm, usually precipitated by a central cause of symptoms e.g. lumbar or cervical spines.

Myositis ossificans

Ossification of a hematoma, secondary to a blunt trauma. Should the hematoma be unresolved, calcification and subsequent ossification, can occur after approximately 3 weeks. Surgical intervention may then be necessary

Myotome

Segmental innervation of muscle. Testing of specific nerve root function can be performed by testing myotomes at different levels.

[Glossary of Physiotherapy Terms A - M]              [Back to IHC's Home Page]

Glossary of Physiotherapy Terms N - Z

 

[N] [O] [P] [Q] [R] [S] [T] [U] [V] [W] [X] [Y] [Z]


N

Nerve conduction tests

Procedure to determine nerve impulse generation. Differentiation tool for neural deficits when there is a suspicion of central (i.e. spinal) cause.

Neural mobilization

Techniques by which neural tissues are "moved", either by movement relative to their surroundings or by tension development.

Neural tension

Inappropriate terminology. This term is interchangeably used when performing assessment of neural extensibility and mobility, but should be more aptly titled neural mobility.

Neurogenic

Of nerve origin.

Non steroidal anti-inflammatory drugs (NSAIDs)

Medication which produces antipyretic, analgesic and, most importantly, anti-inflammatory effects. They act by modifying the complex chemical process that mediates inflammation in musculoskeletal conditions.

Nucleus pulposus

Semi-gelatinous substance contained within the annulus fibrosus of the intervertebral disc. Internal derangement of the disc may result in leakage of the nucleus pulposus through the breached annular fibres. It is the nucleus pulposus (or remnants thereof) which is removed during a discectomy.

O

Ober's test

A test to determine the extensibility of the iliotibial band, although the test may not be discriminating enough.

Oedema

Soft tissue swelling, which can be intra- or extra-articular.

Osgood-Schlatter's disease

Traction epiphysitis of the tibial tubercle, occurring before the secondary ossification centre has closed, in adolescents. It results in avulsion, with repetitive healing. Usually manifests itself as pain on direct pressure and contraction of the quadriceps e.g. landing on the leg, squatting or climbing stairs. There is often a noticeable lump, with x-rays showing some separation of the apophysis. The treatment is rest.

Osteitis pubis

Inflammatory reaction in the pubic symphysis, usually as a result of overuse. Often pain is felt bilaterally, in the groin region, thigh lower abdomen and around the perineal structures. X-rays will often show irregularities in the pubic symphysis, with erosions or cystic changes. "Flamingo" views (single leg standing) may display instability, with often > 2 mm vertical shift.

Osteoarthritis

Often described as degenerative disease, it covers a variety of signs and symptoms, including osteophyte formation, stiffness, deformity (e.g. Heberben's nodes) and pain.

Osteochondritis dissecans

A fragment of cartilage and subchondral bone that becomes detached, either partially or completely, from the bone underneath. Tends to occur on the convex surface of joints and in the knee.

Osteophyte

Outgrowth of bone, usually in reaction to pathological processes within, or at, a joint. Often formed as a result of traction on the bony margin.

Osteoporosis

In this condition, the total amount of bone is reduced, with the bone present being normal but less dense. Common cause of fractures, particularly crush fractures of the spine and neck of femur fractures.

P

Palpation

The art of examination by feel. Looking for abnormalities of skin, muscle, joint and bone.

Passive accessory intervertebral movements (PAIVMs)

Investigation of accessory gliding movements occurring in a joint.

Passive physiological intervertebral movements (PPIVMs)

Investigation of passive physiological movements, passively, to confirm restrictions seen on active movement testing.

Patellar dislocation/subluxation

Instability of the patello-femoral joint, whereby the patella usually dislocates laterally. Degree of instability may be examined with the Apprehension test.

Patellar tendinitis

Inflammatory condition of the patellar ligament, usually due to overuse.

Patello-femoral dysfunction

Also known as Chondromalacia Patellae. May be dysfunctional, whereby the patellar tracking mechanism is altered, giving rise to a pain syndrome.

Peak torque

Measure of isokinetic performance, whereby the maximum "torque" is achieved.

Periostitis

Inflammatory condition at the border of muscular attachment and bone. Commonly seen in the lower leg, manifesting itself as "shin splints".

Peroneal tendon subluxation/dislocation

Occurs usually after an inversion injury, whereby there may be a shallow peroneal groove that predisposes to the subluxation or dislocation. The patient will often complain of a "popping" sound or a "snapping" sensation behind the lateral malleolus. They usually spontaneously relocate.

Perthe's disease

Avascular necrosis of the femoral head, usually more common in boys than girls and occurring between 3 and 12 years of age. This avascular necrosis usually results in a "flattened" femoral head.

Pes anserinus bursitis

Inflammation of the bursa which lies between the medial collateral ligament insertion and the overlying pes anserinus insertion. The "pes" muscle group consists of sartorius, gracilis and semitendinosus. Often aggravated by downhill running, trauma or repeated knee flexion.

Pes cavus

Foot deformity characterised by an increased elevation of the medial longitudinal arch of the foot, so that the forefoot lies at a lower level than the hindfoot. The foot is foreshortened.

Pes planus

Characterised by a lowering of the medial longitudinal arch of the foot. Also known as "pronated feet".

Phalen's test

A test for carpal tunnel syndrome, whereby the wrists are flexed for one minute. If the symptoms are reproduced, the test is deemed positive.

Piriformis syndrome

Whereby the piriformis muscle is implicated in the irritation of the sciatic nerve, as it passes through or underneath the muscle. Often accompanied by deep buttock pain, usually in the area of the sciatic notch. Occurs more commonly in females.

Pivot shift

Very sensitive test for assessing ACL deficiency or injury, predominantly when one suspects anterolateral rotary instability.

Plantar fasciitis

Also known as painful heel syndrome, calcaneal periostitis or calcaneodynia. Characterised by pain at the attachment of the plantar fascia to the medial tubercle of the calcaneum. Morning pain is predominant and may be aggravated by running or jogging. Studies show that 52% of sufferers had overpronation of the feet, while 42% had pes cavus.

Plicae

Synovial folding, which may become pathological and painful if there is some form of trauma. Around the knee, the most common plicae are the mediopatellar plica and the suprapatellar plica.

Prednisolone

Corticosteroid medication, usually utilised in highly inflammatory conditions.

Prepatellar bursitis

Lying between the anterior surface of the patella and the skin, this is the most commonly injured bursa at the knee. When inflamed, it is generally known as "housemaid's knee". Often presents as a large superficial swelling over the front of the patella, and is usually caused by falls onto the knee.

Proprioception

Defined as the intrinsic feedback mechanism that participants use to monitor their own ability to maintain stability.

Proprioceptive neuromuscular facilitation (PNF)

These techniques improve motor skill through positive motor transfer, using the principles of facilitation/inhibition; irradiation/reinforcement; reciprocal innervation (i.e. maximal contraction of agonist muscle results in maximal relaxation of the antagonist); and successive induction (i.e. flexion augments extension and extension augments flexion).

Pubic symphysis

Anterior joint of the pelvis.

Q

Q-angle

The direction of the quadriceps force - as measured by a line drawn from the anterior superior iliac spine (ASIS), through the centre of the patella and intersecting a line to the tibial tubercle. The average angle is 15.8 +/- 4.5 for females and 11.2 +/- 3.0 for males. Clinically, above 15 is considered excessive in males, while greater than 17 is considered excessive in females.

Quadriceps

Large muscle located at front of thigh, made up of rectus femoris, vastus medialis, vastus lateralis and vastus intermedius.

R

Reflex sympathetic dystrophy (RSD)

Caused by an abnormal sympathetic reflex, giving rise to a response that is out of proportion to, and inconsistent with, the injury. Quite variable with regard to signs and symptoms, with treatment ranging from sympathetic blockade, to TENS to Physiotherapy.

Rehabilitation

Recovery from injury, with emphasis on return to pre-injury physical and emotional state of being.

Reiter's syndrome

Usually made of the triad of urethritis, conjunctivitis and arthritis. Any peripheral joint may be involved, usually joints of the lower limb, with a synovitis that is often intense and asymmetrical. Achilles tendinitis is very common, as are tendon sheath or tendon conditions.

Retrolisthesis

Posterior slippage of one vertebra on another.

Rheumatoid arthritis

Inflammatory disease affecting synovial joints. Commonly seen in the upper cervical spine, with loosening of the transverse ligament of the dens, leading to a subluxation of the antlantoaxial joint. Many deformities are characteristically seen in the Rheumatoid arthritic patient.

R.I.C.E.

Abbreviation for Rest, Ice, Compression and Elevation. Acute injury management, to prevent inflammatory processes to go uncontrolled and to speed up the recovery process by eliminating swelling.

Rotator cuff

Made up of 4 muscles: subscapularis, supraspinatus, infraspinatus and teres minor. Their insertional tendons converge to form a "cuff" over the shoulder joint, on their way to attaching from the scapula to the humerus. One of its major functions is to control, and produce, rotation of the shoulder.

S

Sacro-iliac joint

Synovial joint formed between the medial surface of the ilium and the lateral aspect of the upper sacral vertebrae. It is a fibrous joint, comprising and surrounded by very strong ligamentous structures. The major function is to transmit body weight, but does have a role in movement.

Scaphoid fracture

Usually occurs as a result of compression of the scaphoid, when there is a fall onto the outstretched hand in hyperextension. When there is some ulnar or radial deviation, during the trauma, there is alteration to the nature of the fracture. Commonly, if the fracture involves the proximal third of the scaphoid, there is a high risk of non-union and threat of avascular necrosis, due to the poor blood supply.

Scapula

Commonly known as the "shoulder blade"..

Scapulo-humeral rhythm

Smooth transition between the movements of clavicular rotation, scapular gilding, scapular rotation and gleno-humeral elevation, during movement of the "shoulder" complex.

Scheuermann's disease

Adolescent disorder characterised by radiological findings of vertebral wedging, Schmorl's nodes, kyphosis of the vertebral segments and irregularity of disc spaces. Pain is present in the adolescent years only and the diagnosis is often made incidentally, in the adult years.

Schmorl's node

Described as fractured end plates, often large enough to allow the nucleus pulposus to extrude into the vertebral body. Often a feature of lower thoracic and/or thoracolumbar spines.

Sciatica

Traditionally defined as pain in the distribution of the sciatic nerve, or its branches, that is caused by direct pressure or irritation. It does not include referred pain derived from spinal joints, ligaments or muscles.

Sclerotome

Historical depiction, via a body map, indicating regions of the body that are supplied by a spinal nerve, presumably corresponding to an area of pain or symptomatology.

Scoliosis

A lateral curvature of the spinal column. The cause may be structural, compensatory or protective. In structural scoliosis, there is a vertebral rotation associated with the lateral curvature, with both the curve and the rotation being accentuated in forward flexion.

Sequestrated disc

A term describing the complete detachment of a portion of prolapsed nucleus pulposus, with migration, often, into the spinal canal.

Sesamoiditis

Inflammatory condition affecting the two sesamoid bones in the flexor tendon of the great toe. It is usually precipitated by trauma. If the trauma is sever enough, fracture may result. Stress fractures of the sesamoid bone are quite common with overuse. Treatment is usually conservative, but occasionally removal of the sesamoids may be necessary.

Sever's disease

Traction apophysitis of the separate ossification centre on the calcaneum for the insertion of the Achilles tendon. Can mimic tendinitis.

Shin splints

Often used to describe a multitude of lower leg conditions. Traditionally, used to describe teno-periostitis of either the muscles inserting into the medial border of the tibia (i.e. tibiailis posterior, flexor hallucis longus, flexor digitorum longus and soleus) - "posterior shin splints", or else, the pathology of the tibialis anterior, extensor hallucis longus and extensor digitorum anteriorly - "anterior shin splints". The major predisposing factors are: biomechanical, training methods, training surfaces, muscle dysfunction and flexibility, shoe design and diet. Differentiation must be made from stress fractures, compartment syndromes and referred pain syndromes.

Sinding-Larsen-Johansson's disease

Traction osteochondrosis at the inferior pole of the patella, which may avulse to form a "teardrop" ossicle within the patellar tendon. Treatment, as for Osgood-Schlatter's disease, is rest.

Sinuvertebral nerve

From the spinal nerve, after its formation from the joining of the ventral and dorsal nerves, comes a small filament of nerve, which is joined by a branch from the sympathetic trunk - this is the sinuvertebral nerve or "recurrent nerve of Luschka". It re-enters the spinal canal through the intervertebral foramen and provides innervation to the dura mater, the posterior longitudinal ligament, blood vessels, periosteum and the outer fibres of the annulus fibrosus.

Slump test

Described by Maitland in 1985, as a test for assessing the mobility of the pain sensitive structures in the vertebral canal, it is a test combining cervical/trunk flexion, straight leg raising and ankle dorsiflexion. Finally, when all components are in place, with the nervous system at full stretch, the cervical flexion is released. Response is deemed positive or negative based on this release.

Spina bifida occulta

Non union of the laminae, most commonly L5, posteriorly behind the cauda equina. It may be simply due to a failure of ossification of an otherwise united cartilaginous neural arch, or else, it may be associated with quite severe abnormalities of the dural sac, cauda equina and spinal cord.

Spinal canal stenosis

Reduction of the anterior-posterior and lateral diameters of the spinal canal. May be due to congenital factors, developmental factors or degenerative processes. Degenerative processes may occur in the intervertebral disc, zygapophyseal joints and with concurrent thickening of the ligamentum flavum. May be associated with spondylolisthesis, spondylolysis, bone diseases, post-laminectomy and neoplasms. The most common symptom is leg pain on activity, with or without paraesthesia or anaesthesia, and quickly relieved with rest.

Spondylolisthesis

Forward displacement of one vertebra on its lower neighbour. Most commonly seen at L5/S1. The degree of spondylolisthesis is determined by the distance the slipped vertebra travels on its lower counterpart - Grades 1 - 4. Most commonly described as: congenital, spondylolytic, traumatic, degenerative or pathological. Can often be found incidentally.

Spondylolysis

Caused by a defect in the pars interarticularis, a narrow strip of bone lying between the lamina and the inferior articular process below, and the pedicle and the superior articular process above. May be congenital, of traumatic origin or of overuse, resulting in a stress fracture. In oblique x-ray views, which have the appearance of a "Scotty Dog" , a spondylolysis through the pars interarticularisshowing will show up a "collar" around the dog's neck. This may be incidentally found.

Spondylosis

Degenrative processes which affect the intervertebral disc. Most commonly, the major change is that of osteophytosis, the formation of bony spurs along the junction of the vertebral bodies and the corresponding intervertebral discs.

Stirrups

Technique of ankle strapping using rigid tape (usually zinc oxide). The tape is placed on the ankle, medial to lateral adhering to the undersurface of the heel, mimicking a "stirrup".

Straight leg raise (SLR)

Technique for measuring sciatic nerve mobility and/or hamstring length. Non-specific test, but still used as a guide during musculoskeletal examination.

Strain

Non-specific term given to excessive or abnormal loading of tissues. Muscle strain is an overload, to a degree of failure, of muscle tissue. Can be used interchangeably to describe the sensation felt during exercise or activity.

Stress fracture

Fracture caused by non-traumatic, cumulative overload on bone. Can be caused by a number of factors including overtraining, incorrect biomechanics, fatigue, hormonal imbalance, poor nutrition and osteoporosis. Best investigated by Technetium bone scan, as this will show up a stress fracture within 48 hours. Plain x-rays will show up a stress fracture, but ususally only after 10 days. Examination will almost always show up a specific point of maximal tenderness over bone, with possibly some global tenderness, in the region, due to the reactive periostitis and soft tissue irritation.

Subacromial space

A region of the shoulder that is bordered by the so-called subacromial joint - a joint made up by the humerus and a superior arch, consisting of the acromion process and the coracoid process of the scapula, joined by the coraco-acromial ligament. This arch is lined by the synovium of the subacromial bursa. In the subacromial space runs the rotator cuff.

Sudeck's atrophy

A condition characterised by severe pain, swelling an disability. Commonly seen in the foot, but may occur in other joints of the lower limb. Aetiology unknown, but it probably represents a neurovascular disorder leading to an intense hyperaemia and osteoporosis of bone. Has been considered part of the Reflex Sympathetic Dystrophy "family" of conditions.

Supraspinatus impingement

If the subacromial space is pathologically, or congenitally, narrowed, an impingement of the supraspinatus tendon may occur. Characterised by pain, into abduction, and positive "impingement" tests. Patients will often attempt to deviate away from the impingement, attempting to gain the necessary movement by using "trick" movements.

Supraspinatus tendonitis

Overuse or trauma to the supraspinatus tendon. Commonly seen when there is a degree of supraspinatus tendon degeneration or degradation. Active contraction of the supraspinatus will cause pain and there is usually an arc of pain on abduction - described as 60 - 120 in most textbooks.

T

T4 syndrome

Symptoms associated with, usually, a hypomobility lesion at T4 (+/- 1 - 2 levels). Complaints of arm pain or vague discomfort in the arm, accompanied by parasthesia, do not follow any dermatomal patterns. There may also be associated hand symptoms, which are considered to be an integral part of T4 syndrome. The mechanism of pain production in T4 syndrome is unknown, but it is postulated that autonomic nerve control may be compromised.

Technetium bone scan

A sensitive radiological investigation, utilising a radio-isotope, used in the detection of stress fractures, as well as other bony pathology.

Temporomandibular joint (TMJ)

Joint between the condyle of the mandible and the mandibular fossa and the articular eminence of the temporal bone. There are several distinctive features of this joint, namely: a separate joint is formed on each side of the face, but function together as one unit; it is lined by fibrous cartilage and not hyaline cartilage; it contains an intra-articular meniscus that divides the joint into two separate synovial cavities.

Tendonitis

Inflammatory condition of the tendon. Has been used interchangeably with inflammatory conditions of the tendon sheath or paratenon. Pain is reproduced with resisted movements and tendon stretching, with active range of motion often normal, but with pain experienced at the end of range.

Tennis elbow

See Lateral epicondylitis.

Tenosynovitis

May follow trauma, overuse or inflammatory conditions. There is complaint of pain, swelling and/or restricted movements. The swelling has a characteristically linear appearance, along the tendons.

Thomas's test

Detects a fixed hip deformity, in patients who have developed a compensatory lumbar lordosis that then masks the hip flexion.

Thoracic outlet syndrome

Compression of the neurovascular bundle, comprising the brachial plexus and the subclavian artery, will produce a mix of symptoms, ranging from pain in the shoulder and arm, to neurological and vascular symptoms. The compression usually occurs in the thoracic outlet of the neck. Pain and parasthesiae are most commonly experienced on the ulnar side of the arm. Three syndromes have been identified: the costoclavicular syndrome (most common) which is characterised by a decreased space between the clavicle and the first rib; the cervical rib syndrome which is characterised by the presence of either a rib emanating from the C7 or a fibrous band passing from C7 to the first rib. Cervical ribs occur in approximately 1% of the population; and the anterior scalene syndrome (very rare) whereby the neurovascular bundle is compressed between the scalenus anterior and the scalenus medius muscles. Some tests are available to attempt to diagnose this condition, but they often provide false positives during the procedure.

Thoracic spine

Comprising 12 vertebrae, sitting between the cervical and lumbar spines. Provide attachments for the ribs.

Traction

Therapy to provide a distraction force, whether it be to the spine or to the peripheral joints. Indicated for nerve root lesions or conditions that have, as part of their pathological process, compressive forces e.g. osteoarthritis.

Transcutaneous Electrical Nerve Stimulation (TENS)

Modality for providing pain relief, in a portable form.

Transverse frictions

Deep massage technique, predominantly used for tendon and ligament conditions. Technique is performed across the line of the tissue fibres.

Trendelenburg gait

Intrinsic disorder of the abductors of the hip, due to either a weakness or an inhibition to function. As a result, the hip abductors are unable to stabilise the hip, as body weight is transferred to the affected side, resulting in a pelvic drop or tilt towards the opposite side.

Trendelenburg test

Tests the ability of the hip abductor mechanism to stabilise the hip, while the patient stands on one leg. The Trendelenburg test is positive when the patient stands on one leg and the opposite side of the pelvis then drops.

Trigger finger

Occurs when there is nodule formation within the flexor tendon of the hand. It usually occurs secondary to tenosynovitis (usually due to overuse) or to rheumatoid arthritis. Most commonly, the nodule is trapped under the metacarpophalangeal ligament, as the tendon flexes. Corticosteroid injection usually relieves the symptoms, but sometimes surgery is indicated.

Trochanteric bursitis

Often associated with gluteus medius tendinitis, this condition is characterised by an inflammation of the bursae overlying the greater trochanter of the femur, most commonly the large multilocular bursa that lies between the gluteus medius and the tensor fascia latae. It is an overuse injury, predominantly seen in runners. Pain is often reproduced on stretch (hip flexion to 90 with full lateral rotation of hip) or contraction of the gluteus medius (resisted abduction of the hip).

U

Uncovertebral joint

see Luschka, joints of

Upper limb tension test (ULTT)

Considered an analogue to the straight leg raise test for the lower limb, it assesses pain responses consequent upon passive movements of the upper limb and neck. The traditional ULTT produces strain on the brachial plexus by a combination of movements involving shoulder girdle depression, shoulder abduction, external rotation of the shoulder, elbow extension, forearm supination and wrist/finger extension. Cervical spine ipsilateral and contralateral lateral flexion are also important to differentiate. This traditional test provides bias to the median nerve. Variations have developed , over the years, to address the other nerves of the upper limb, including the radial nerve and ulnar nerve.

V

Valgus deformity

Refers to a lateral inclination of a distal bone, of a joint, from the midline.

Varus deformity

Refers to medial inclination of a distal bone, of a joint, from the midline.

Vastus intermedius

This forms part of the quadriceps mechanism. The fibres lie in a plane parallel with the anterior aspect of the shaft of the femur.

Vastus lateralis

Forms the middle layer of the quadriceps group, providing stability rather than fast movement.

Vastus medialis

Located on the anteromedial aspect of the thigh. Recently been investigated for its role in patellar stability, with particular reference to patellofemoral dysfunction.

Vertebral artery testing

Performed to assess the relationship between cervical spine movement and symptoms which may be vertebrobasilar in origin. If the subjective examination suggests that blood flow may be affected (with complaints of dizziness, tinnitus, diplopia, dysphagia, dysarthria or "drop attacks"), then vertebral artery testing MUST be performed. The tests that are advocated are:

        sustained rotation, left and right;

        sustained extension;

        sustained rotation and extension, left and right; and

        any position that is described, by the patient, that elicits dizziness.

W

Winging scapula

Elicited when the extended arm is pushed against resistance. The scapula "wings" out when there is a weakening of the serratus anterior, usually caused by a long thoracic nerve lesion.

Wobble board

An apparatus used for the re-education of proprioception and balance.

X

X-rays

Plain radiographs, usually taken when there is a history of trauma, to exclude fractures. Also used to confirm degenerative disease processes. Non-specific investigation for soft tissue injuries.

Y

Yergason's test

A test for biceps tendon subluxation, at the shoulder. It is performed with the Therapist resisting shoulder flexion, elbow flexion and forearm supination. Palpating the biceps tendon is integral, to feel for the subluxation. May also be used to detect biceps tendinitis, but it will be pain in the bicipital groove noted and not instability of the tendon.

Z

Zygapophyseal joint

Formed between the superior articular process, of the lower vetebra, and the inferior articular process, of the upper vertebra. They are described as plain synovial joints.


 

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