[Back to IHC Home Page] [Glossary of Physiotherapy
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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.
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 90º of
flexion, with patient lying prone) and then performing both medial and lateral
rotation.
Apophyseal 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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.
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.
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-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.
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.
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.
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.
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.
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
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).
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.
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.
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-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.
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.
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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