.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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Iliotibial band
The iliotibial band lesion usually lies just cranial from the greater trochanter ; it gives rise to the same symptoms as a gluteal bursitis, and therefore the clinical image is sometimes doubtful. When in doubt, a diagnostic deep friction massage or infiltration can offer the solution.
The signs are : pain on trunk side flexion away from the painful side and pain on passive hip adduction. A complementary test, contralateral trunk side flexion with the legs crossed, hurts more. Deep friction massage is the treatment.
Occasionally, as mentioned above, the clinical pattern resembles that of a gluteal bursitis ; if passive abduction also hurts, bursitis is more likely.
(Part I, p109 ; Part II, p25-26)
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Impingement syndrome
During the last 20 years the term painful arc has been substituted by the modern and more fashionable term
" impingement syndrome".
Is it a diagnosis?
What does it mean?
No , it isn't, it just means that, during the elevation of the arm, there is pain, usually between 80° and 110°, due to the compression of a sensitive or inflammed structure between the tuberosities and the acromion.
A painful arc must be regarded as an accessory sign. Once the tissue at fault is singled out, the arc shows which part of the structure is affected.
Impingement in the shoulder may be due to stenosis, inflammation and/or fibrosis of the content in the subacromial space.
Young athletes using the arm in an overhead position are at risk of impingement because of the repetitive microtrauma of the structures under the acromion.
Impingement may also be secondary to minor instability, possibly involving labral tears.
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Inert structure
Inert structures are : capsule, fascia, dura mater, nerves, nerve roots, discs, meniscs, bursae, ligaments.
A lesion of an inert structure has a typical clinical pattern. It could be a capsular pattern as well as a non capsular pattern.
(Part I, p10-11)
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Infiltration
Infiltrations can be a useful treatment method, but are only applied based upon solid data obtained from the functional examination.
The specific indications and contraindications of triamcinolone-acetonide infiltrations need to be respected.
Infiltrations with a procaine solution can be used for diagnostic purposes too, in order to confirm a preliminary diagnosis.
DVD on infiltrations and injections in orthopaedic and sports medicine.
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Infraspinatus
A tendinous lesion of the infraspinatus is less frequent ; make sure you excluded the subdeltoid bursa and the supraspinatus as the culprit. The lesion mostly lies at the tenoperiostal extent.
Deep friction massage should be carried out from a comfortable position for both patient and therapist and you need a layer of cotton wool between your finger and the skin of the patient in order not to damage the skin.
If a localizing sign is found in the clinical examination(painful arc or pain at full range on passive elevation), the lesion lies at the tenoperiosteal junction and palpation for tenderness becomes superfluous. Without a localizing sign, we expect the lesion to lie at the body of the tendon and palpation is used to find it.
Treatment : infiltration with triamcinolone and/or deep friction massage.
(Part I, p44-45 ; Part II, p7)
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Inherent likelihood
Inherent likelihood ? Soft tissue lesions are typical lesions, so we expect to hear typical similar stories in the history and see typical similar patterns in the functional examination.
If a pattern does not agree with what we normally might expect for that lesion, then this is an inherent unlikelihood, pointing in the direction of another pathology.
(Part I, p4-5)
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Injection
Injections can be a useful treatment method, but are only applied based upon solid data obtained from the functional examination.
The specific indications and contraindications of triamcinolone-acetonide injections need to be respected. Sometimes injections are the treatment of choice, sometimes it's only second option.
Read on...
Intermittent pain
This describes pain that comes and goes during the course of the day. Commonly this relates to intermittent mechanical deformation that results in pain. Pain may be momentary or appear and linger for varying amounts of time, but does at some point during the day completely stop.
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Ischial bursitis
An ischial bursitis has a typical history, that hardly can be missed : gluteal pain appearing as soon as the patient sits down (particularly on a hard surface) and disappearing immediately as he stands up.
Much more frequent is a nuclear self-reducing disc protrusion in the lumbar spine. Here the pain comes on after sitting for some time (especially in kyphosis) and ceases after walking around for, say, ten minutes.
On examination, there is only tenderness on palpation. All the other functional tests are negative.
Treatment : local anaesthetic injection to confirm the diagnosis, then an infiltration of triamcinolone at the next attendance.
(See Part I, p108)
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