.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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Tarsal tunnel syndrome
Tarsal tunnel syndrome
* A direct contusion where the nerve crosses the front of the ankle joint.
* Deep peroneal nerve : paraesthesia in the distal part of the dorsum of the foot, especially in the area between the first and the second toe.
* Long saphenous nerve : paraesthesia in the medial part of the dorsum of the foot and the big toe, with twinges when performing flexion of the big toe.
* A plantarflexion-inversion movement in both cases brings on the paraesthesia.
* Treatment : local anaesthetic.
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Temporomandibular joint, intra articular injection
Temporomandibular joint
PATIENT'S POSTURE The patient lies on his side with the affected joint uppermost.
PRODUCT 0.5 ml triamcinolone acetonide (40 mg/ml)
SYRINGE 1 ml tuberculin syringe
NEEDLE 0.6x25 mm (23 G 1)
TECHNIQUE One palpates the lower edge of the zygoma and the posterior edge of the condyle of the mandible, which lies just anterior to the tragus and under the zygomatic process. The injection is given under the articular disc and behind the condyle of the mandible in the lower part of the joint, while the patient has his mouth wide open. Therefore, a felt pad is used between the patient's teeth. The needle is inserted almost vertically (directed slightly forwards) at the base of the tragus. The tip of the needle lies intra-articularly at about 1.5 cm. Here the injection is given, normally without any resistance. If resistance is felt, the tip of the needle lies either subperiosteally, or in the articular cartilage or the disc. The needle must then be slightly withdrawn and the tip of the needle re-orientated.
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Tennis elbow
A tennis elbow is one of the most frequent and invalidating tendinous lesions in the elbow region.
Mostly there is a lesion of the m. extensor carpi radialis brevis at the tenoperiostal site (Type II)
In total 4 types of tennis elbow are described, each with a specific treatment strategy. A combination lesion of the extensor carpi radialis brevis and longus tendon is also a possiblity.
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Tennis leg - gastrocnemius lesion
A tennis leg is a lesion in the gastrocnemius muscle belly. An acute lesion can be very invalidating, but reacts very fast on a combined treatment of infiltration of local anaesthetic, friction massage and active mobilization.
(Part I, p154-155 ; Part II, p35)
Read on...
Tenosynovitis
Inflammation between a tendon and its sheath
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Tensile strength
The maximum stress or load sustained by a material.
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Thoracic spine, sclerosis dorsal part of the facet joints
Sclerosis of the posterior part of the facet joints
PATIENT'S POSTURE The patient lies prone.
PRODUCT Per level 2 ml
- 1.5 ml P2G
Phenol 2 %
Dextrose 25 %
Glycerol 30 %
Water 43 %
- 0.5 ml lidocaine 2 %
SYRINGE 5 ml syringe
NEEDLE 0.7x40 mm (22 G 1 ½)
TECHNIQUE The spinous processes are identified and marked, and so are the midline and the interspinous ligaments. The facet joints between T1-T5 and T10-T12 lie level with the interspinous ligament of the level above, at 1.5 cm from the midline. The facet joints between T6-T9 lie level with the spinous process of the vertebra of the level above, at 1.5 cm from the midline. The needle is thrust in vertically ; it hits bone after about 3 cm. It should now to be re-orientated in such a way as to feel a capsular resistance first and then bone. Here 1 ml is infiltrated in contact with the bone. This is repeated at the other side of the same level and then at the adjacent level.
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Thoracic spine, sclerosis of the interspinal ligaments
Sclerosis of the thoracic interspinous ligaments
PATIENT'S POSTURE The patient lies prone.
PRODUCT Per level 2 ml
- 1.5 ml P2G
Phenol 2 %
Dextrose 25 %
Glycerol 30 %
Water 43 %
- 0.5 ml lidocaine 2 %
SYRINGE 5 ml syringe
NEEDLE 0.7x40 mm (22 G 1 ½)
TECHNIQUE The spinous processes are identified and marked, and so are the midline and the interspinous ligaments. The needle is thrust in vertically, halfway between the spinous processes. After about 1 cm the needle is moved upwards in an angle of 30° to the horizontal and aimed at the lower edge of the upper spinous process. In contact with the bone 0.5 ml is infiltrated by drops deeply and 0.5 ml superficially at the ligamentoperiosteal insertion. Considerable pressure is required. The needle is then half withdrawn and, in a more vertical position, aimed at the upper edge of the lower spinous process. Again 1 ml is infiltrated at the ligamentoperiosteal insertion. This is repeated at the adjacent level.
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Tibial nerve pressure around the knee
Pressure on the tibial nerve (at the knee)
* Sitting with the legs crossed : underlying patella squeezes the tibial nerve against the back of the tibia, followed by a release phenomenon (pins and needles appear when the pressure is released).
* Probably no appreciable muscle weakness ; but numbness for several months at the heel and the sole if the pressure on the nervous structure is contstant.
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Tight fascial compartment
Tight fascial compartment
This is an occlusion of the tibial artery, due to increased muscular activity in a restricted space. The anterior compartment, the space between tibia, fibula, interosseous membrane and the fascia around the muscles, is too small.
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Torticollis
A torticollis can occur at different ages and can be the result of diffferent patholgies ; mostly it is seen in adults as the result of a big internal derangement.
There are specific reduction patterns.
(Part I, p268-270 ; Part II, p66)
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Transverse frictions
A specific type of massage applied to connective tissue structures to produce therapeutic movement, traumatic hyperaemia, pain relief and improved function.
See friction massage
Read on...
Traumatic arthritis shoulder
Traumatic arthritis shoulder
a) History
On empirical grounds, the patient is usually over 45 years old (never under 40, except if there has been a fracture).
The history is typical :
a trivial onset (injury or overuse). A trauma/overuse occurs, the patient experiences some pain, disappearing at first and then, after 3-4 days, returning and increasing every day. This is the starting point of the traumatic arthritis.
Read on... |
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