.JPG&w=300) In this glossary you will find an illustrative explanation of some keywords which are frequently used in research papers and, more general, in updated Orthopaedic Medicine Cyriax, as well as some summarized descriptions of certain clinical images and diagnostic procedures
General remark : sometimes I refer the reader to "Part I" and "Part II" for further information on that specific subject i.e. the two books "Orthopaedic Medicine Cyriax : updated value in daily practice, Part I and Part II "
I also refer to the interesting glossary of some other publications such as :
"Orthopaedic Medicine, a practical approach ; Kesson-Atkins, 2nd edition, Elsevier BH 2005" and
"The lumbar spine, mechanical diagnosis and therapy, volume one, McKenzie-May, Spinal publications New Zealand 2003"
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Dancer's heel
In a dancer's heel the patient (dancer, soccer player) has hypermobility in plantarflexion, resulting in a periostitis.
A periostitis of the os trigonum is also possible. This is a complementary bone on the posterior aspect of the talus (in about 10% of the population), also causing a small limitation of flexion with a harder end-feel.
The dancer's heel reacts well on a treatment with infiltration.
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Deep transverse friction
The deep transverse friction massage techniques can be applied for muscular, tendinous and ligamentous lesions, in acute, subacute and chronic stages.
The main purpose is to have a beneficial effect on the scar formation in every stage of the healing process and to avoid/or rupture cross links.
The structure has to regain its normal strength and flexibility.
Deep transverse friction massage can also be used for differential diagnostic purposes !
(Part II, p1-4)
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Derangement
An internal derangement in the spine is due to a disc protrusion or a deformation of disc material resulting in painful pressure on disc tissue, dura mater or nerve root.
There are reducible and irreducible internal derangements. Treatment options are : manipulation, traction, mobilisation, self treatment exercises.
In case of non reducible internal derangements a local epidural injection can be an interesting treatment option too.
(Part I, p175-280 ; Part II, p41-73)
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Diagnostic imaging
Can be helpful for differential diagnostic purposes, but don't consider the result of medical imaging as THE thruth ; it only offers part of the truth, a momentary impression of a continuum.
A diagnosis always should be based upon positive clinical functional tests.
(Part I, p1)
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Diagnostic tests
We use following tests : active, passive and resisted movements ; repeated movements.
It is our purpose to gather as much information as possible by using as less tests as possible. We need reliable and useful information.
Many "palpation tests" in the spine are highly unreliable, that's why we don't perform any "diagnostic" palpations in the spine.
Diagnoses can be confirmed by using diagnostic infiltrations.
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Directional preference
Directional preference describes the situation when postures or movements in one direction decrease, abolish or centralise symptoms and often decrease a limitation of movement.
Postures or movements in the opposite direction often cause these symptoms and signs to worsen.
This phenomenon is characteristic of the derangement syndrome in the spine.
Of course, directional preference is used in the treatment strategy.
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Distraction - traction
A force applied in opposite directions across a joint causing the joint surfaces to separate.
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Dura mater
Pressure on dura mater causes extrasegmental reference of pain and tenderness, which can be very misleading.
This is one of the reasons why "diagnostic" palpation for tenderness in the spine is utmost unreliable.
There is no dural reference of pain in the lower arm and in the feet.
The dura mater forms the general exception to the rule of segmental reference.
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Dural signs
A patient with a lumbar internal derangement frequently shows dural signs in the functional examination. Those dural signs are pathognomic for a disco-dural conflict.
Dural signs in the lumbar spine are :
The patient performs a flexion in standing and produces some back or gluteal pain ; an accessory neck flexion makes this pain worse or better
or, flexion in standing is negative and on accessory neck flexion lumbar or gluteal pain is produced
or, a straight leg raise is e.g. end range painful and an accessory neck flexion increases or decreases the pain
a crossed straight leg raise is also a nice example : the e.g. left SLR produces pain on the right side of the back
(More information ?)
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Dural symptoms
Dural symptoms are back pain, suprascapular, or gluteal pain on coughing or sneezing.
In the thoracic spine pain (anterior and/or posterior) on taking a deep breath could be a dural symptom.
Pain in the gluteal area on coughing could be a dural symptom too, but could also be the result of a sacro iliac arthritis.
Pain in the leg on coughing could be the result of a primary posterolateral protrusion or a neuroma.
(More information ?)
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Dysaesthesia
Damage to any of the senses, especially touch, but not to the point of anaesthesia.
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Dysfunction syndrome
Sometimes patients patients present with double clinical images : an internal derangement (disc) can be combined with an underlying dysfunction syndrome.
Mostly the image of the internal derangement is prominent ; once this derangement is reduced, then the image of the dysfunction becomes more obvious.
Typical for a dysfunction syndrome is the fact that normal loading or tension on abnormal tissue (inflamed, shortened,..) will cause symptoms.
Patients will describe end range pain on certain movements.
The patient's reaction on repeated movements will be diagnostically helpful : repeated movements will produce the same end range pain all over again, but after some repetitions the patient is not better, nor worse.
Patients with a dysfunction syndrome react well on a stretching program.
(Part I, p182)
Read on... |
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