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[Glossary of Physiotherapy Terms A - M] [Back to Charlie Kornberg's Home Page]



Glossary of Physiotherapy Terms N - Z

[N] [O] [P] [Q] [R] [S] [T] [U] [V] [W] [X] [Y] [Z]

N

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.

O

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.

P

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

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.

R

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.

S

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.
Scheuermann's disease
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.
Slump test
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.

T

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
See Lateral epicondylitis.
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).

U

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.

V

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.

W

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

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.

Y

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.

Z

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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