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Gait: The manner in which a patient walks.

George’s Line: An x-ray study technique to detect abnormal vertebral alignment as seen on  a side view x-ray of the neck. The back-side edges of the vertebral bodies are connected with a continuous line. In a normal study, there is a smooth curving line. In an abnormal study there is an abrupt jog or offset in the line to an anterolisthesis or retrolisthesis position. If there is a sharp break in the line, or a stepping effect, this could be a sign of fracture, dislocation or gross ligamentous instability.

Glascow Coma Scale: A standardized system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome. The system involves three determinants: eye opening, verbal responses and motor response - all of which are evaluated independently according to a numerical value that indicates the level of consciousness and degree of dysfunction. Scores run from a high of 15 to a low of 3. Persons are considered to have experienced a “mild” brain injury when their score is 13 to 15. A score of 9 to 12 is considered to reflect a “moderate” brain injury and a score of 8 or less reflects a “severe” brain injury.

Gross Instability: An orthopedic spine term which refers to excessive motion between two joints or two vertebral segments. In spinal evaluation, gross instability usually indicates ligamentous injury.

Gross Range of Motion: A term that usually refers to the overall range of motion of a spinal region. See Range of Motion (ROM).

Hearing: Proceedings at which a judge, arbitrator, or administrative officer makes determinations of fact or law after argument by both parties. Administrative hearings may be investigative or result in a final order or determination of the matter. Ex Parte hearing is when only one party is present, although notice of the hearing may be given to the other party.

Hearsay: Refers to statements made by persons other than the person testifying. The statement is a mere repetition of what the witness has heard others say out of court, and is offered as proof in the matter on which the witness is testifying. Generally, hearsay evidence is not admissible and is excluded from consideration by the trier of fact; however, there are numerous exceptions. One exception to the rule is statements made for the purpose of medical diagnosis or treatment, including description of medical history, past or present pain, sensations, etc.

Hematoma: The collection of blood in tissues or a space following rupture of a blood vessel.

Hemianopsia: Visual field cut. Blindness for one half of the field of vision. This is not the right or left eye, but the right or left half of vision in each eye.

Hemiplegia: Paralysis of one side of the body as a result of injury to neurons carrying signals to muscles from the motor areas of the brain.

Hemiparesis: Weakness of one side of the body.

Herniated Disc: A rupture of the annulus fibrosis, through which the inner disc material (nucleus pulposus) extrudes. This may put pressure on the exiting spinal nerve and/or cause an inflammatory reaction leading to radiculopathy or weakness, numbness, and/or tingling in the arms or legs.

Hyperabduction Test: A physical exam test for thoracic outletsyndrome. The arms are raised up to an overhead position to evaluate muscle compression on the neurological and vascular flow. Also called Wright’s Test.

Hyperextension/Hyperflexion: Extreme bending backward and forward of the cervical spine from an acceleration/deceleration trauma.

Hyperkyphosis: Abnormally increased spinal curve in the mid back.

Hyperlordosis: An abnormally increased spinal curve in the neck or low back.

Hypermobile Subluxation: An abnormal intervertebral joint condition in which the supporting tissues have been stretched or degenerated such that there is excess movement at that level.

Hypertonicity: An increase in muscle tone or muscle tension.

Hypoesthesia: Decreased sensitivity of the skin to touch.

Hypolordosis: Loss of a normal spinal curve and straightening of the neck or low back. Often seen in the cervical spine after a rear-end auto impact.

Hypotonicity: Decreased muscle tone or muscle tension.

Hypoxia: Insufficient oxygen reaching the tissues of the body.

Iliac Crest: The uppermost part of the iliac “wings.” This is the superior border of the ilium easily palpated above the lateral hip. This point is commonly used as a reference point for many physical exam techniques. This is often the site from which bone grafts are harvested.

Iliotibial Band Syndrome: An inflammatory condition of the thick band of tissue (iliotibial band) extending from the hip to the knee down the side of the leg. Patients report a snapping or pain at the lateral hip or knee or both.

Ilium: One of the bones of each half of the pelvis, forms a joint with the sacrum.

IME: Insurer’s refer to this as an “independent medical examination.” Attorneys representing injured people refer to this as an “insurance medical examination.” An insurer may require the injured person to attend an IME under the provision of the Personal Injury Protection (PIP) Policy or by a defendant after a lawsuit is filed in court. See Civil Rule 35 Examination. In either instance, the insurance company selects the doctor of their choice and pays for the examination.

Impairment: An anatomical, physiological, mental or psychological loss or abnormality. Reduced capacity for functioning. This term may be used in describing the reduction in functions of a single muscle or organ that results in reduced capacity for social and family relations, independent living, or enjoyment of life as the result of some event or illness, including pain.

Impairment Rating: The degree of permanent impairment assigned to a patient with residual pain and/or loss of function when the patient has reached maximum medical improvement.

Impingement: Abnormal compression or encroachment of one anatomical structure on another.

Impingement Syndrome: A syndrome in which soft tissue is entrapped or impinged between two hard (bone) tissue structures with resultant inflammation, pain, and dysfunction.

Indemnify: One party gives another party security for the reimbursement of payments required in case of an anticipated loss.

Inflammation: The reaction of tissue to injury, characterized by increased blood flow and exuding of fluid from the blood vessel into the tissues. Inflammation may be characterized by swelling, redness, and increased warmth of the tissue.

Injunction: An order issued by the court prohibiting a person from or requiring him/her to perform some act.

Instability: Excessive motion which is beyond normal physiologic motion. Spinal instability can be a result of traumatic disruption of the ligamentous supporting structures, degenerative disc disease, or fracture.

Insured: The person who purchases an insurance policy or is otherwise covered by it.

Insurer: The underwriter or insurance company with whom a contract of insurance is made.

Interdisciplinary Approach: A method of diagnosis, evaluation, and individual program planning in which two or more specialists, such as medical doctors, psychologists, recreational therapists, social workers, etc., participate as a team, contributing their skills, competencies, insights and perspectives to focus on identifying the developmental needs of the person with a disability and on devising ways to meet those needs.

Interrogatories: A discovery device consisting of written questions submitted by one party to another party. Written answers to interrogatories are given under oath.

Intersegmental Dysfunction: Disease or mechanical dysfunction of the vertebrae as they function with each other, resulting in symptoms of pain, discomfort or loss of motion.

Intersegmental Range of Motion Palpation: A manual spine evaluation method of assessing vertebral position by touch with the spine in a static position or in motion. The relative motion of two vertebrae is measured in several directions.

Intervertebral Disc: A soft tissue structure in between each vertebrae of the spine. It contains a fibrosis outer ring call the annulus fibrosis and a gelatinous center called the nucleus pulposus.

Intracranial Pressure (ICP): Cerebro-spinal fluid (CSF) pressure measured from a needle or bolt introduced into the CSF space surrounding the brain. It reflects the pressure inside of the skull.Inversion: Reversal of the normal relationship of positions between anatomical parts.

Intracranial Pressure Monitor: An ICP monitor. A monitoring device to determine the pressure within the brain. It consists of a small tube (catheter) attached to the person at the skull by either a ventriculostomy, subarachnoid bolt, or screw, and is then connected to a transducer, which registers the pressure.

Joint Mobilization: Low-amplitude, low-velocity forces applied to restore joint range of motion. In the fields of manual spine treatment, five different grades of mobilization exist and vary in amplitude and velocity.

Jump Sign: A sudden contraction of muscle seen as a twitch in response to stimulation of a trigger point or other area of muscular hypertonicity or spasm.

Kemp’s Test: An orthopedic test in which a patient is in a seated position and is placed into simultaneous extension and rotation of the lumbar spine. A true positive test produces numbness or tingling radiating to the legs. This indicates disc involvement. Many examiners use it to assess the facet joints as well.

Kyphosis: An extreme reversal of the normal curve in the neck or low back. The normal posteriorly arching curve of the mid back.

Laminectomy: A surgical technique in which the lamina and spinous process are removed to lessen the pressue on the spinal canal or the spinal nerves exiting an intervertebral foramen.

Lasegue Test: A test of the low back used by spinal care health providers in which the hips are passively flexed with the knee in full extension. A positive test produces low back or sciatic pain prior to reaching 90 degrees of hip flexion and no pain when the hip is flexed with the knee bent. Synonymous with straight leg raise test. This test helps to distinguish low back disorders from disease of the hip joint.

Lateral: X-rays views taken from the side. Also, the body or anatomical part from the side.

Lawsuit: A claim or cause of action instituted or pending between private persons or entities in a court of law. In order to properly commence a lawsuit, a complaint must be filed with the court and the defendant must be served or given a copy of the summons and complaint.

Lay Witness: A person, with knowledge based on his/her first-hand observations, whose testimony is helpful to determine the facts at issue. Liability lay witnesses testify regarding the facts of the accident. Lay damage witnesses testify regarding the plaintiff’s injuries and the effects of those injuries on the plaintiff’s lifestyle.

Leg Length Discrepancy: A difference in length between the lower extremities that, if anatomical, will usually result in lateral deviations of the sacral base, and can be a cause of low back pain. Many chiropractors and manual practitioners use leg length compared side to side to assess subluxation dysfunction and determine the effectiveness of their treatments.

Lhermitte’s Sign: A physical finding in cervical myelopathy. The patient is usually seated with the head and neck in neutral position. The head and cervical spine are then flexed forward toward the patient’s chest. A positive test is reproduction of sharp, electric, radiating pain or paresthesia along the spine and into one or both arms/hands; seen mainly in multiple sclerosis but also in other disorders of the cervical cord.

Liability: Responsibility or fault for an incident resulting in injuries and damages to person and/or property.

Lien: An encumbrance on property to secure payment of a debt. A health care provider has a right to place a lien on a claim to guarantee that his/her bills will be paid when the case concludes.

Ligament: The strong tissue connecting the articular ends of bones which serves to bind the joint together and permits or limits motion.

Ligamentous Laxity: An over-stretching or a lessening of tension of ligaments from chronic over-pressure or traumatic injury. In the spine, this may be a result of degenerative joint disease or acute trauma. It can be the cause of excess motion at vertebral segments, i.e., segmental instability.

Lipping: An overgrowth of bone in response to injury or chronic degenerative processes. See Osteophyte.

Litigation: The process of filing a lawsuit and then prosecuting it or defending against it. Discovery will begin after a lawsuit is filed.

Locked-In Syndrome: A condition resulting from interruption of motor pathways in the ventral pons, usually by infarction. This disconnection of the motor cells in the spinal cord from controlling signals issued by the brain leaves the person completely paralyzed and mute, but able to receive and understand sensory stimuli; communication may be possible by code using blinking, or movements of the jaw or eyes, all of which are spared.

Lordosis: The spinal curve of the low back and neck. The term is used to refer abnormally increased curvature (hyperlordosis) or to the normal curvature (normal lordosis)

Lumbar Lordosis: The normal curvature of the spine in the low back area.

Lumbar Plexus: A grouping of nerves formed by the ventral branches of the second to fifth lumbar nerves.

Lumbar Radiculopathy:Lumbarspinal nerve or sacralspinal nerve impingement caused by a herniated disc, resulting in pain and possibly numbness and tingling and/or weakness sensation into one or both legs.

Lumbar Sprain: An acute injury to the ligaments of the low back.

Lumbar Strain: An acute injury to the musculature and tendons of the low back.

Lumbosacral Joint: The area of attachment where the last lumbarvertebra (L5) meets the sacrum (S1).

Lumbosacral Sprain: An acute injury to the ligaments of the lumbar and sacral spine. It may be associated with an injury to muscles and tendons.

Lumbosacral Strain: An acute or chronic injury to the muscles and tendons of the lumbar and sacral spine.

MacNab’s Line: A x-ray indicator line used to evaluate facet joints. No longer considered to be a reliable indicator of facetjoint dysfunction.

Maitland Technique: A manipulative physical therapy technique developed by Geoffrey Maitland which concentrates on establishing normal segmental spinal motion through the use of mobilization.

Malposition: A chiropractic term for a vertebra, which is out of normal position with respect to the vertebral segments above and below it.

Malpractice: Misconduct in a professional capacity through negligence, carelessness, lack of skill, or malicious intent.

Manipulation: The general application of a force to a joint that takes it beyond its normal or restricted range of motion. This term applies generally to joint manipulations by manual therapy practitioners.

Manual Muscle Testing: Physical exam testing used to grade muscle strength. The most common scale is graded 0-5. A 5/5 rating means the muscle that can hold a strong manual resistance, 4/5 against moderate resistance, 3/5 against gravity, 2/5 cannot overcome the force of gravity, 0/5 is a muscle absent the ability to resist.

Maximum Medical Improvement (MMI): A medical-legal term used in insurance claims to describe a point in time when the patient’s condition will no longer improve with or without further healthcare treatment.

Medial Branch: A network of nerves serving the facet joints of the spine.

Medial Branch Neurotomy: A surgical technique whereby the medial branch nerve supply to the facet joints is cut by use of a radio frequency current to produce small, well-localized, heat lesions. Also called Medial Branch Rhizotomy. See Facet Neurotomy.

Median Nerve: One of the nerves of the medial branch. It innervates the lateral aspect of the forearm and hand including thumb, 1st and 2nd fingers. It is the nerve compressed by Carpal Tunnel Syndrome.

Mediation: A procedure by which an impartial third person meets with all the parties and attempts, in an informal setting, to find common ground so that a compromise can be reached to settle the claim or complaint.

Military Neck: A cervical spine that has a straightened rather than the normal lordotic curve.

Mistrial: Trial which is terminated before its normal conclusion. The judge may declare a mistrial because of some extraordinary event, prejudicial error that cannot be corrected, or because of a hung jury.

Mobilization: Low-amplitude, low-velocity forces, which are used to restore joint function. It is of common practice among manual therapists, osteopaths, and chiropractors. There are different grades and techniques of mobilization.

More Probable Than Not: A medical-legal term used to imply a likelihood of greater than 50 percent.

Motion: A formal written request, submitted by a party to a court on a specific issue, for consideration and resolution.

Motion In Limine: A motion requesting the court to exclude or limit certain types of documentary evidence and/or testimony which are not relevant to the issues or are unfairly prejudicial. Most commonly done prior to commencement of the trial.

Motion Palpation: A manual treatment term, which refers to assessing by touch the spinal motion segments while moving the patient through specific maneuvers. It is used to check relative motion between two adjacent vertebral segments.

Motion Restriction: An osteopathic, chiropractic, or manual treatment term referring to the direction a spinal segment or a joint cannot move.

Motion Segment: A unit made up of two adjacent vertebrae ,which move against one another and the soft tissue which connects them.

Motor Deficit: A term that describes loss of muscle strength in a particular area due to impairment of nerve conduction.

Movement Dysfunction or Restriction: An osteopathic, chiropractic, or manual treatment term in which the dysfunction or restriction refers to the direction in which a spinal motion segment or joint will not move.

MRI: Abbreviation for Magnetic Resonance Imaging. An imaging technique, which uses magnetic fields to obtain detailed pictures of both soft tissue and bony anatomy.

Multiple Sclerosis (MS): A central nervous system disorder which commonly affects the brain stem, brain, spinal cord, and peripheral nerves, characterized by white matter lesions (or sclerotic changes), resulting in wasting away of these nervous system parts.

Muscle Contraction Headache: A headache caused by myofascial pain and spasming of the cervical muscles.

Muscle Spasm: Involuntary contraction of muscle or muscle guarding to prevent its use in an attempt to protect an injured area. Also known as Muscular Splinting.

Muscular Splinting: Increased local muscle tone or spasm due to involuntary muscle contraction. Often a protective response to injury or pain.

Muscle Stimulation: An electrical application to decrease pain and spasm of the muscles. Often used by physical therapists.

Myalgia: Pain of the muscles.

Myelogram: The injection of a radiographic contrast liquid into the subarachnoid space through a space through a lumbar puncture. This effectively outlines the spinal cord and spinal nerves on an x-ray.

Myelopathy: Dysfunction of the spinal cord.

Myofascial: Referring to the muscles and fascia.

Myofascial Pain: Pain coming from muscles and fascia.

Myofascial Pain Syndrome: Pain coming from the muscles and fascia which in turn, is spread out to other areas of the body.

Myofascial Release: Deep tissue massage for the purpose of relaxing and lengthening tight and restricted muscle and connective tissues.

Myofascial Trigger Point: Classically, a taut palpable band in muscle that is painful to touch and refers pain to an adjacent body area.See Trigger Point.

Myofascitis: An inflammation of the muscles and fascia covering the muscles. See Myofascial Pain.

Myofibrosis: Infiltration of muscle tissue by scar tissue often leading to inflammation.

Myositis: Inflammation within the muscles.

Negligence: Failure to exercise ordinary care or caution.

Negligence Per Se: Negligent as a matter of law. Currently, this is limited to violations of statutes and administrative codes relating to electrical fire safety, use of smoke alarms, or driving while under the influence of intoxicating liquors and/or drugs. In these instances a plaintiff does not have to prove that the defendant’s actions or inaction fell below a reasonable standard of care - the mere violation of the statute is sufficient proof of negligence.

Nerve Block: The injection of local anesthetic into tissue surrounding a nerve for diagnostic or treatment purposes.

Nerve Conduction Study: Evaluates the function of peripheral nerves and the related spinal nerves. A nerve conduction study records the speed (velocity) of small electrical impulses upon the pathways of a nerve or nerves in order to determine if they are functioning properly.

Nerve Conduction Velocity: A diagnostic test to evaluate the function of peripheral nerves and nerve roots.

Nerve Root: A bundle of the motor and sensory branches which join to form a spinal nerve which exits the spinal cord through a bony opening called the intervertebral foramen. Two nerves leave at each spinal motion segment, one on the right and one on the left.

Nerve Root Compression: Pressure on a spinal nerve most commonly as a result of a hermiated disc, foraminal stenosis, lateral stenosis or a combination thereof.

Nerve Root Decompression: The surgical release of pressure on a spinal nerve.

Neural Arch: The arch of bone which attaches to the back portion of the vertebral body and surrounds the neural elements that pass through the vertebral canal. Of the vertebral bodies, it consists of the pedicles and lamina.

Neuralgia: Pain, generally sharp or severe, along the distribution of a nerve or spinal nerve.

Neuritis: Inflammation or irritation of a nerve.

Neurogenic TOS: A thoracic outlet syndrome involving compression of the brachial plexus passing out of the neck, under the clavicle, and through the axilla. The compression can cause denervation of the corresponding muscle groups, or pain involving the neck and arm. See Thoracic Outlet Syndrome.

Neuromuscular Therapy: A combination of soft tissue mobilization techniques based on the belief adhesions and hardening of the muscle fibers can block nerve impulses through impingement and irritation of the nervous structures as they pass through the musculature. The therapy techniques include deep tissue manipulation, myofascial release, cross fiber friction, and trigger point therapy.

Neuropathy: Dysfunction or disease of a nerve, often manifested by change of sensation and/or muscle strength. Neuropathy can apply to any nerve, including the sympathetic nervous system.

Neurotomy: The cutting or division of a medial branch nerve by surgical means to temporarily or permanently prevent the transmission of pain. Often misnamed rhizotomy.

Non-anatomic Sensory Loss: Reported loss of sensation by the patient on neurological exam that clearly does not correspond to any known nerve in the peripheral nervous system or spinal nerve pattern.

Nonspondylitic Spondylolisthesis: A slippage of one vertebra on another without a fracture in the pars interarticularis. This usually refers to a degenerative spondylolisthesis which is caused by degenerative facetjoints and not a fracture in the neural arch.