.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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Paraesthesia
Numbness, tingling, "pins and needles".
Can be the result of a compression or a release phenomenon.
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Patellofemoral arthrosis
The clinical findings in case of patellofemoral arthrosis seem to be very limited. The basic functional examination is negative, crepitation on squatting movement can be present
I refer with pleasure to the publications of Jenny McConnell for what is concerned diagnosis and treatment of patellofemoral pain.
(See Part I, p135).
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Pelvic tilt
Pelvic tilt ?
A difference of length of legs often is thaught to be responsible for back problems ; in reality however this link is mostly not valid.
If we find an oblique position of the pelvis, we could neutralize it by putting boards under the shorter leg. If this would abolish the pain on standing, then a raised heel is recommended. A difference in leg length of less than 1 cm is considered irrelevant.
There a five factors to decide whether there is a real difference in leg length or not :
compare, bilaterally, the position of the posterior superior iliac spine
Compare, bilaterally, the caudal aspect of the gluteal muscles
Compare, bilaterally, the hight of the iliac crests
Compare, bilaterally, the position of the anterior superior iliac spine
Measure and compare bilaterally the distance between the SAIS and the medial malleolus.
Only when all five elements agree are we convinced that a true leg length discrepancy or pelvic tilt presents. This does not necessarily indicate the cause of the patient's symptoms, however.
(See Part I, p186)
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Peripheralisation
Peripheralisation describes the phenomenon when pain emanating from the spine, although not necessarily felt in it, spreads distally into, or further down, the limb. This is the reverse of centralisation. It only occurs in the derangement syndrome.
The temporary production of distal pain with end-range movement, which does not worsen, is not peripheralisation, as this response may occur with an adherent nerve root.
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Peronei lesion
An inversion trauma in the ankle can present itself as a double lesion : a ligamentous and a tendinous component.
A ligamentous sprain in combination with a tendinitis.
If there is a tendinous component then mostly the peroneus longus or brevis (in that case we would also find a positive resisted test) is involved.
Treatment consists of the combination of deep transverse friction massage, mobilisation and proprioceptive exercises.
(See Part I, p156, 158 ; Part II, p36)
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Peroneus superficialis compression
Superficial peroneal nerve ; n. peroneus superficialis
* Pressure at the junction between middle and lower third of the leg (where the nerve issues from the deep fascia).
* The cause is a swelling of the tibialis anterior muscle in a tight fascial compartment syndrome ; the alternative is an idiopathic disorder.
* The nerve divides into two branches (three outer and three inner toes). That is why the paraesthesia are felt in all toes and in the entire dorsum of the foot.
* Treatment : first the exact pressure point needs to be found by a diagnostic infiltration. If the local anaesthetic does not give sufficient therapeutic result, triamcinolone is used.
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Pes plantaris
Pes plantaris
* False flat foot : the angle between the forefoot and the hindfoot is too small (over-arched as in a pes cavus but otherwise the foot is normal).
* Three possible consequences : mid-tarsal strain, chronic metatarsalgia and plantar fasciitis.
* Treatment : raised heel with horizontal upper surface, strengthtening exercises of the short flexor muscles of the sole.
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Plantar fasciitis - heel spur
This lesion often is mistaken for a heel spur. A heel spur mostly is the consequence of a chronic plantar fasciitis. Thus there is no sense in treating the heel spur itself.
The functional examination is completely negative ; the only positive finding is pain on palpation on the anteromedial aspect of calcaneus.
Typical history : plantar heel pain on weight-bearing, particularly severe on the first steps after sitting or sleeping, quickly relieved by avoiding weight-bearing.
Negative functional examination ; local tenderness at the anteromedial border of the calcaneus (origin of the plantar fascia).
Plantar fasciitis is due to a pes plantaris or to short calf muscles ; a spur, visible on the X-ray, is the consequence, not the cause, of the strain.
Treatment :
taking the strain off the plantar fascia (raised heel with upper surface horizontal, possibly Root's shoe)
strengthening the short flexor muscles
triamcinolone , (tenotomy).
(part I, p163-164)
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Plasticity
The property of a structure which permits it to undergo permanent deformation when the distorting force is large enough to load the structure beyond its elastic range.
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Plica synovialis lesion
Plica synovialis
Plicae are seen in more than 20% of the knees examined. The patient describes a sudden twinge during movement (the inflamed plica gets squeezed between the patella and the medial femoral condyle). Perhaps we see a painful arc during a flexion-extension movement ; the PA becomes more obvious when the movement is carried out with the knee in lateral rotation. Local end range pain on extension is also possible.
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Prepatellar bursitis
This is the most frequent bursitis in the knee and mostly the result of overuse (working position with constant pressure on the knees). The patient has anterior knee pain and swelling, possibly resulting in a limitation of flexion. Surgery seems to be an effective treatment for prepatellar bursitis.
(See Part I, p131)
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Pressure on n. peroneus communis
Common peroneal nerve (peroneus communis)
* A blow or sustained pressure at the neck of the fibula (the patient sits with legs crossed or with the knee against the side of a desk).
* Weakness of the tibialis anterior, extensor hallucis longus and peroneal muscles (drop-foot), with numbness at the outer leg and the dorsum of the foot.
* Spontaneous recovery within one to two months ; the particular sitting position should be avoided.
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Pressure phenomenon
Pain and paraesthesia occuring as the pressure is applied.
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Psoas bursitis
Psoas bursitis :
Spontaneous onset of anterior thigh pain. On examination, there is usually pain on passive flexion, lateral rotation and extension, with a soft end-feel. Passive adduction in 90° hip flexion, as a complementary test, is generally the most painful movement.
In most cases, treatment consists of infiltration of a local anaesthetic, which also confirms the diagnosis. In a minority of cases, triamcinolone is added.
Differential diagnosis :
psoas muscle belly (= resisted hip flexion should be positive)
rectus femoris tendinitis (= resisted knee extension should be positive)
osteoarthrosis (= we expect a capsular pattern with a harder end-feel)
loose body without osteoarthrosis (= we expect twinges and giving way)
gluteal bursitis (= pain lateral instead of anterior).
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Pulled elbow
"Pulled elbow"
This mainly occurs in young children by pulling on the child's arm. There is a caudal, longitudinal displacement of the radius.
The patient has sudden pain and limitation of movement (he supports his elbow in 90° flexion and pronation).
On examining we see that the P extension is about 20° limited, with a softer end-feel. The wrist X-ray clearly shows the displacement.
This can be reduced manually.
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