Dr. LoGiudice D.C.- Linn City Chiropractic, West Linn Pain Relief & Massage

Car accident? Were you hurt? Leave it up to the experts to see if the pain you feel is a result your accident?  Call us, we can help manage your case! 

“If you have been hurt in an automobile accident through no fault of your own, you are entitled to treatment for your injuries, compensation for pain and suffering, and reimbursement of all losses which you have suffered.”

If you are seriously injured, we suggest that you hire a reputable personal injury (PI) attorney. It will be worth your time time and money.  Many chiropractors recommend the law firms: Gatti, Gatti, Maier, Sayer, Thayer, Smith & Associates as well as Paul Krueger because of their reputation and dedication to helping auto accident victims obtain the medical treatment necessary for recovery and just and fair compensation for your pain, suffering and economic losses. You should consult with your attorney shortly after starting care.

*OREGON PERSONAL INJURY PROTECTION (PIP) INSURANCE LAW*

“All Oregon non-commercial auto insurance policies have no-fault Personal Injury Protection (PIP) healthcare and wage loss coverage. This means that if you are injured in an automobile, bicycle, or pedestrian accident, your auto insurance provides a minimum of one year and $10,000 in no-fault medical coverage. In addition to medical coverage, your personal injury protection insurance provides wage loss coverage.  This coverage is mandatory for all auto insurance, but not motorcycle insurance.”

Who does PIP cover?

Oregon personal injury protection insurance covers all of the occupants of the car. Each occupant is considered a separate claim, although all of claimants will have the same claim number. It also covers pedestrians and cyclists hit by a car. If you are on a bicycle or a pedestrian, your personal injury protection should pay your medical expenses if you are struck by a motor vehicle. If you do not have auto insurance and do not have health insurance, than the other driver’s insurance should pay all your medical bills related to the motor vehicle accident.

What does Oregon PIP cover?

PIP coverage covers all your medical bills related to the accident, up to one year or up to $15,000. It covers your wage loss up to $3,000 for 52 weeks. It covers loss of essential services for up to $30 a day.

How much wage loss will my personal injury protection insurance pay?

You PIP insurance will pay up to 52 weeks of wage loss up to the maximum monthly amount of $3,000.

Will my insurance company pay all of my medical bills?

Your insurance company is required to pay all of your medical expenses within the first year that are reasonable and related to the accident, up to your policy limit ($15,000 on most policies). This does not mean that they will pay these bills. Insurance companies do not pay bills if they don’t have to. They can deny payment and send you to an Independent Medical Exam (IME), which is an exam performed by a doctor hired by the  insurance company.  The vast majority of the time these doctors say that your treatment is not necessary, which is the reason why the insurance companies use these doctors rather than talking to your primary treating doctor.

What can I do if they refuse to pay my medical bills?

If the accident was not your fault, the best course of action is to pursue the at fault driver’s insurance company for your medical expenses as well as your pain and suffering. If you were at fault, your only choice is to sue your insurance company or request arbitration. If the accident was your fault, you can sue your personal injury protection carrier and force them to pay your medical expenses.

Is there anything I can do to make it less likely that my personal injury protection will deny payment of my medical bills?

Yes, your medical bills are much less likely to be denied if they are from a doctor (DC-Chiropractor, DO-Osteopath, MD-Medical Doctor, ND-Naturopath)  that can write a well-documented narrative about your injuries no matter their specialty.  Chiropractors, Naturopaths, Physical Therapists, Licensed Massage Therapists, as well as Licensed Acupuncturist practice natural, hands-on treatment, thus may need to be seen more frequently than medical doctors that prescribe drugs and medication. Medical doctors are not the only good doctors out there, however, beware of providers who just want to run up a bill. If you are seeing a doctor who says you need to treat 5x/week for months, there is a very good chance that your personal injury protection will be exhausted quickly.

Do I have to pay back for my PIP benefits?

You may have to pay for services if your PIP coverage is exhausted or your insurance company denies claims. If this happens before one year, you may need to hire an attorney to represent you, or you can appeal the insurance companies decision.  You are required to report the injury to your insurance company and and ask them for a claim number. You will need your claim number for any medical supplies and or medical treatment.  Apply for PIP benefits as soon as you recognize the accident caused an injury, this may take hours, days, even weeks. If months go by without you reporting injury, your insurance may refuse the claim…however it is possible to get them to pay if you have been self-treating the entire time.   Whether or not you have to pay the benefits back out of any settlement or award depends largely on what your attorney does early on in your case. Most of the time they can force the insurance companies to elect to pay the attorney a fee to recover the medical expenses or waive recovery out of the client’s settlement or award. Insurance companies do not want to pay the attorney a fee, and in some cases you can be your own advocate, so the vast majority of the time the insurance companies do not require any repayment by their clients.

What happens if my PIP coverage does not cover my medical expenses?

If you have healthcare insurance, your healthcare insurance will usually pay any additional amounts, however, you will have to provide documentation that your PIP benefits were exhausted.   If you do not have healthcare insurance, you will be billed personally for any amounts in excess of your PIP coverage. Often times attorneys will work with providers to get them to wait for payment until the case is resolved. An attorney lien will be submitted to your attorney, and most attorneys do not like to sign them.  If you have hired an attorney, you must insist that he signs the attorney lien. Attorneys are advocates for their client and will ask the physician to discount their final bill, putting more cash into their client’s pocket as well as theirs.

Am I limited to what doctors I can see?

NO!  You can see any licensed physician, this includes: chiropractors, medical doctors, osteopaths, naturopaths,  acupuncturist, psysiatrist, licensed massage therapist (with a prescription), orthopedist, neurologist,  and  surgeon.  For Kaiser insured, you can go outside the Kaiser system. Your Oregon PIP insurance is required to pay for any reasonable and necessary treatment that you have related to the motor vehicle accident. You get to choose which doctor you would like to see.

How much Personal Injury Protection (PIP) insurance should I buy?

This is not only a matter of opinion, but a matter of business.  In my professional opinion, you should have a sit down with your insurance agent and discuss your needs.  If you are self-employed and are the sole bread-winner, I think it is in the best interest of your family to increase the PIP coverage to what you can afford.  As a business owner an increased PIP coverage equates to a few additional dollars per month and a whole lot of peace of mind.  Some think that if you have a great healthcare insurance, you won’t need additional coverage, just remember deductibles, co-pays, and prescription medication all require out of pocket expenses. If your health insurance has low co-pays, than buying more than the minimum PIP coverage is up to the personal preference of the insured and is a serious decision that should be discussed thoroughly with your insurance broker/agent and significant other. If you do not have health insurance, than you should increase your PIP coverage immediately.

What information will my personal injury attorney need?

If you have been injured in an accident (car or other type of accident), or have suffered an injury due to the non-action, negligence or actions of another, it is important to see an attorney to discuss your possible claim. Before you see your attorney, gather documents and other information you may have regarding the incident that caused your injury. Bring this information with you to give your attorney. You may have different types of information depending on your situation, or your attorney may ask you to bring additional information not listed in this checklist. Keep meticulous records in any accident, a pain diary, and separate jacket for each provider visited is highly recommended.  This will make it easy when it comes time to deliver the package to the attorney.

Information and documentation related to your injury may include:

• Name and address of the ambulance company
• Name and address of the hospital you were taken to
• The dates of the accident that caused your injury
• The dates that you were taken to the hospital/emergency room
• Names and addresses of all the doctors that examined and treated you
• Names and addresses of any witnesses to the incident that caused your injury
• Dates you were unable to work due to your injuries
• Name and contact information for your Ins. Co, Ins Agent and your claim rep.
• A copy of your accident report
• Copies of written statements
• Applicable Ins. policies: homeowners, renters or automobile
• Health Ins. documents, including your policy or coverage information
• Disability Ins. documentation
• Veterans Ins. policy
• Any other documentation, including hospitalization(s).
• Keep all correspondence you have had with your Ins Co, including letters, emails, etc.
• Medical bills
• Receipts for anything you’ve had to buy or fix because of your injuries
• Documentation of lost wages
• If your injuries are due to a car accident, there may be other types of documents and information you should bring to your attorney, including:
• Proof of premium payments, including statements, bills, canceled checks, receipts or anything you have to show that your insurance premium has been paid
• Information exchanged at the time of the accident, including names, contact information from the other party or witnesses or any correspondence with any of the parties after the accident
• Information you gave the police at the time of the accident, including the police report
• Traffic tickets related to the accident
• Photographs of any property damage caused by the accident
• Any statements you may have given to your insurance company or the other party’s insurance company
• Medical records
• Records of any Psychological/Psychiatric care or treatment needed due to the accident
• Any information you may have about the other driver in the accident, pedestrians or witnesses, including name, address, phone number, make/model/color of car, license plate number, ins co, location at the time of the accident and/or description of what they saw
• Date, Time, Location of the accident

What Should I Expect in a Personal Injury Lawsuit?

Establishing a Personal Injury Case: In order to prevail on your personal injury claim, you must be able to prove to the court that the defendant (responsible party) is responsible for your injuries. In most cases, this is done by showing the defendant’s negligence. To do this, the elements of negligence must be established based on the facts of your case. The elements of negligence are as follows:

• Duty of care– A reasonable person is held to a legally recognized duty of care. This means, a person must prevent reasonable harms to another by their actions or in-actions.
• Breach of duty – A defendant breaches this duty by failing to meet the standard of care. Based on the circumstances, this could mean a failure to warn, failure to keep the plaintiff safe or by behaving in a way (conduct) that caused the plaintiff’s injury.
• Causation – Causation is often the most difficult element to prove. The defendant must have been the direct or proximate cause of the plaintiff’s injuries. Generally, a “but for” test is used to show causation. The plaintiff’s injuries would not have occurred if it hadn’t been for the defendant’s behavior (action or inaction).
• Damages – The plaintiff must show that due to the defendant’s breach, he or she suffered harm and incurred loss.

Damages in a Personal Injury Case:

If each element is established in the plaintiff’s case, the court may award damages for losses. Most damages awarded are compensatory in nature. They are to compensate the plaintiff for actual losses incurred or suffered. The court will consider several factors when determining the amount of compensatory damages. The factors vary depending on the specific facts of your case. I.e. pain and suffering (physical and/or emotional), lost wages, medical expenses, future medical treatment, loss of consortium, loss of household duties, loss of quality of life, disfigurement, disability and loss of parental guidance.

Furthermore, some jurisdictions may award punitive damages, in addition to compensatory damages. The judge or jury may award the plaintiff punitive damages to punish the defendant for his or her conduct. Usually, the conduct must have been especially atrocious or shocking. These type of damages are also intended to discourage others from the same behavior. The type and availability of damages may depend on the facts of your case and the applicable law in your state. A personal injury attorney, worth his salt, will be able to tell you more about damages.

Car Accident Terminology used in Personal Injury Law:

Action: Proceeding taken in a court of law. Synonymous with case, suit, lawsuit.

Additional Insured: A person other than the named insured or covered person who is protected under the named insured’s auto policy.

Adjudication: A judgment or decree.

Adversary system: Basic U.S. trial system in which each of the opposing parties has opportunity to state his viewpoints before the court. Plaintiff argues for defendant’s guilt (criminal) or liability (civil). Defense argues for defendant’s innocence (criminal) or against liability (civil).

Affidavit: A written declaration under oath

Affirm: The assertion of an appellate court that the judgment of the lower court is correct and should stand.

Allegation: A declaration of a party to an action made in a pleading, stating what he expects to prove.

Alleged: Stated; recited; claimed; asserted; charged.

Answer: A formal response to a claim, admitting or denying the allegations in the claim.

Anti-Theft Device: Devices designed to reduce the chance an auto will be vandalized or stolen, or assist in its recovery. Includes car alarms, keyless entry, starter disablers, motion detectors, parts of the vehicle etched with the Vehicle Identification Number, and recovery systems.

Appeal: Review of a case by a higher court.

Appearance: The formal proceeding by which a defendant submits to the jurisdiction of the court.

Arbitration: The hearing and settlement of a dispute between opposing parties by a third party whose decision the parties have agreed to accept.

Assigned Risk: A risk not ordinarily acceptable to insurers which is, according to state law, assigned to insurers participating in a plan in which the insurers agree to accept their share of these risks.

At issue: The time in a lawsuit when the complaining party has stated his claim and the other side has responded with denial and the matter is ready to be tried.

Automobile Insurance: A form of insurance that protects against losses involving autos. Examples of coverage types include: bodily injury liability, property damage liability, medical payments, and collision and comprehensive coverage for physical damage to the insured’s vehicle

Catastrophic Injuries – Catastrophic injuries are severe physical injuries that require extensive medical treatment and are often long lasting or permanent in nature. These injuries may result from any kind of accident and may affect all body systems.

Basic Limits of Liability: The least amount of liability coverage that can be purchased. In determining rates, a carrier will use the basic limits to develop the base rates. If an insured person wants higher limits, the carrier applies an increased limits factor to the base rate in calculating the new premium for the increased coverage.

Best evidence: Primary evidence; the best evidence which is available; any evidence falling short of this standard is secondary.

Bodily Injury Liability: Legal liability for causing physical injury or death to another.

Brief: A legal document, prepared by an attorney which presents the law and facts supporting his client’s case

Burden of proof: Measure of proof required to prove a fact. Obligation of a party to probe facts at issue in the trial of a case.

Calendar: List of cases arranged for hearing in court.

Caption: The caption of a pleading, or other papers connected with a case in court, is the heading or introductory clause which shows the names of the parties, name of the court, number of the case, etc.

Case: Any proceeding, action, cause, lawsuit or controversy initiated through the court system by filing a complaint, petition, indictment or information.

Caseload: The number of cases a judge handles in a specific time period.

Cause of action: A legal claim.

Certiorari: Procedure for removing a case from a lower court or administrative agency to a higher court for review.

Challenge for cause: A request by a party that the court excuse a specific juror on the basis that the juror is biased.

Citation: Summons to appear in court. Reference to authorities in support of a legal argument.

Civil law: All law that is not criminal law. Usually pertains to the settlement of disputes between individuals, organizations or groups and having to do with the establishment, recovery or redress of private and civil rights.

Claim: The assertion of a right to money or property.

Clerk of the court: An officer of a court whose principal duty is to maintain court records and preserve evidence presented during a trial.

Closing argument: The closing statement, by counsel, to the trier of facts after all parties have concluded their presentation of evidence.

Collision Insurance: This covers loss to the insured person’s own auto caused by its collision with another vehicle or object.

Code: A collection, compendium or revision of laws systematically arranged into chapters, table of contents and index and promulgated by legislative authority.

Commit: To lawfully send a person to prison, a reformatory or an asylum

Common law: Law which derives its authority solely from usage and customs of immemorial antiquity or from the judgments and decrees of courts. also called “case law.”

Comparative negligence: Negligence of a plaintiff in a civil suit which decreases his recovery by his percentage of negligence compared to a defendant’s negligence.

Competency: In the law of evidence, the presence of those characteristics which render a witness legally fit and qualified to give testimony.

Complaint: In a civil case, it is the initial document entered by the plaintiff which states the claims against the defendant.

Contempt of court: Any act that is meant to embarrass, hinder or obstruct a court in the administration of justice. Direct contempt is committed in the presence of the court; indirect contempt is when a lawful order is not carried out or refused.

Continuance: Adjournment of the proceedings in a case from one day to another.

Corroborating evidence: Evidence supplementary to that already given and tending to strengthen or confirm it.

Costs: An allowance for expenses in prosecuting or defending a suit. Ordinarily does not include attorney’s fees.

Counter claim: Claim presented by a defendant in opposition to, or deduction from, the claim of the plaintiff.

Court: Place where justice is administered.

Court administrator: Manager of administrative, non judicial affairs of the court.

Court commissioner: A judicial officer at both trial and appellate court levels who performs many of the same duties as judges and justices.

Court of appeals: Intermediate appellate court to which most appeals are taken from superior court.

Court superior: State trial court of general jurisdiction.

Court supreme: “Court of last resort.” Highest court in the state and final appellate court.

Courts of limited jurisdiction: Includes district, municipal and police courts.

Comprehensive Coverage: Covers damage to a vehicle caused by an event other than a collision or overturn. Examples include fire, theft, vandalism, and falling objects.

Criminal law: Body of law pertaining to crimes against the state or conduct detrimental to society as a whole. Violation of criminal statues are punishable by law.

Cross examination: The questioning of a witness by the party opposed to the one who produced the witness.

Damages: Compensation recovered in the courts by a person who has suffered loss, detriment or injury to his/her person, property or rights, through the unlawful act or negligence of another.

De novo: “Anew.” A trial de novo is a completely new trial held in a higher or appellate court as if the original trial had never taken place.

Declamatory judgment: A judgment that declares the rights of the parties on a question of law.

Decree: Decision or order of the court. A final decree completes the suit; an interlocutory decree is a provisional or preliminary decree which is not final.

Deductible: The amount an insured person must pay before the insurance company pays the remainder of each covered loss, up to the policy limits.

Default: A failure of a party to respond in a timely manner to a pleading; a failure to appear for trial.

Defendant: In a civil case, such as an car accident lawsuit, the defendant is the person against whom a civil action is brought.

Defense attorney: The attorney who represents the defendant.

Deposition: Sworn testimony taken and recorded in an authorized place outside of the courtroom, according to the rules of the court.

Direct examination: The questioning of a witness by the party who produced the witness.

Discovery: A pretrial proceeding where a party to an action may be informed about (or “discover”) the facts known by other parties or witnesses.

Dismissal with prejudice: Dismissal of a case by a judge which bars the losing party from raising the issue again in another lawsuit.

Dismissal without prejudice: The losing party is permitted to sue again with the same cause of action.

Disposition: Determination of a charge; termination of any legal action.

Dissent: The disagreement of one or more judges of a court with the decision of the majority.

Docket: Book containing entries of all proceedings in a court.

Due process: Constitutional guarantee that an accused person receive a fair and impartial trial.

En banc “On the bench.” All judges of a court sitting together to hear a case.

Enjoin: To require a person to perform, or abstain or desist from some act.

Evidence: Any form of proof legally presented at a trial through witnesses, records, documents, etc.

Exception: A formal objection of an action of the court, during the trial of a case, in refusing a request or overruling an objection; implying that the party excepting does not acquiesce in the decision of the court and will seek to obtain its reversal.

Exhibit: Paper, document or other object received by the court as evidence during a trial or hearing.

Expert evidence: Testimony given by those qualified to speak with authority regarding scientific, technical or professional matters.

Fact-finding hearing: A proceeding where facts relevant to deciding a controversy are determined.

Fair Preponderance: Evidence sufficient to create in the minds of the triers of fact the belief that the party which bears the burden of proof has established its case.

Felony: Crime of grave nature than a misdemeanor.

Fine: A sum of money imposed upon a convicted person as punishment for a criminal offense.

File: “To file” a paper is to give it to the court clerk for inclusion in the case record.

Hearing: An in-court proceeding before a judge, generally open to the public.

Hearsay: Evidence based on what the witness has heard someone else say, rather than what the witness has personally experienced or observed.

Hit and Run: An accident caused by someone who does not stop to assist or provide the required and necessary information.

Inadmissible: That which, under the established rules of evidence, cannot be admitted or received.

Induction: Writ or order by a court prohibiting a specific action from being carried out by a person or group.

Injure: Hurt or harm; violate the legal rights of another person.

Instruction: Direction given by a judge regarding the applicable law in a given case.

Interrogatories: Written questions developed by one party’s attorney for the opposing party. Interrogatories must be answered under oath within a specific period of time.

Judgment: Final determination by a court of the rights and claims of the parties in an action.

Lapse in Coverage / Policy Lapse: A point in time when a policy has been canceled or terminated for failure to pay the premium, or when the policy contract is void for other reasons.

Lawsuit: A civil action; a court proceeding to enforce a right (rather than to convict a criminal).

Lawyer: A person licensed to practice law; other words for “lawyer” include: attorney, counsel, solicitor and barrister.

Litigant: One who is engaged in a lawsuit.

Litigation: A law suit.

Misdemeanor: Criminal offenses less than felonies; generally those punishable by fine or imprisonment of less than 90 days in a local facility. A gross misdemeanor is a criminal offense for which an adult could be sent to jail for up to one year, pay a fine up to $5,000 or both.

Mistrial: Erroneous or invalid trial. Usually declared because of prejudicial error in the proceedings or when there was a hung jury.

Mitigating circumstances: Those which do not constitute a justification or excuse for an offense but which may be considered as reasons for reducing the degree of blame.

Motion: Oral or written request made by a party to an action before, during or after a trial upon which a court issues a ruling or order.

Moot: Unsettled; undecided. A moot point is one not settled by judicial decisions

Negligence: The absence of ordinary care.

Parties: Persons, corporations, or associations, who have commenced a law suit or who are defendants.

Personal Auto Policy: The most common auto insurance policy sold today. Often referred to as “PAP,” this policy provides coverage for liability, medical payments, uninsured/under insured motorist coverage, and physical damage protection.

Personal Injury Protection: Personal Injury Protection (PIP) usually includes benefits for medical expenses, loss of income from work, essential services, accidental death, funeral expenses, and survivor benefits.

Petition: Written application to a court requesting a remedy available under law.

Petition for review: A document filed in the state Supreme Court asking for a review of a decision made by the Court of Appeals.

Perjury: Making intentionally false statements under oath. Perjury is a criminal offense.

Physical Damage: Damage to your covered vehicle from perils including (but not limited to) collision or upset with another vehicle object, fire, vandalism and theft.

Plaintiff: The party who begins an action; the party who complains or sues in an action and is named as such in the court’s records. Also called a petitioner.

Plea: A defendant’s official statement of “guilty” or “not guilty” to the charge(s) made against him.

Pleadings: Formal, written allegations by the parties of their respective claims.

Policy: The written documents of a contract for insurance between the insurance company and the insured. Such documents include forms, endorsements, riders and attachments.

Polling the jury: A practice whereby the jurors are asked individually whether they agreed, and still agree, with the verdict.

Precedent: Previously decided case which is recognized as an authority for determining future cases.

Preponderance of evidence: The general standard of proof in civil cases. The weight of evidence presented by one side is more convincing to the trier of facts than the evidence presented by the opposing side.

Presiding judge: Chief or administrative judge of a court.

Proceeding: Any hearing or court appearance related to the adjudication of a case.

Record: 1. To preserve in writing, print or by film, tape, etc. 2. History or a case. 3. The word-for-word written or tape recorded account of all proceedings of a trial.

Rebuttal: The introduction of contradicting or opposing evidence showing that what witnesses said occurred is not true, the stage of a trial at which such evidence may be introduced.

Redirect examination: Follows cross examination and is carried out by the party who, first examined the witness.

Remand: To send back. A disposition by an appellate court that results in sending the case back to the original court from which it came for further proceedings.

Reply: Pleading by the plaintiff in response to the defendant’s written answer.

Respondent: Party against whom an appeal is brought in an appellate court. the prevailing party in the trial court case.

Restitution: Act of giving the equivalent for any loss, damage of injury.

Rests the case: When a party concludes his presentation or evidence.

Reversal: Setting aside, annulling, vacating or changing to the contrary the decision of a lower court or other body.

Service: Delivery of a legal document to the opposite party.

Set aside: Annul or void as in “setting aside” a judgment.

Settlement: Conclusion of a legal matter.

Settlement conference: A meeting between parties of a lawsuit, their counsel and a judge to attempt a resolution of the dispute without trial.

Soft Tissue Injuries – Soft tissue injuries may be caused from a single event or over a period of time (repetitive activity). Generally, soft tissue injuries are bruises, sprains or strains to the muscles, ligaments or tendons. Injuries to the internal organs or bones are not considered soft tissue injuries.

Statute: A law created by the Legislature.

Statute of limitations: Law which specifies the time within which parties must take judicial action to enforce their rights.

Stay: Halting of a judicial proceeding by order of the court.

Stipulation: Agreement by the attorneys or parties on opposite sides of a case regarding any matter in the trial proceedings.

Subpoena: Document issued by the authority of the court to compel a witness to appear and give testimony or produce documentary evidence in a proceeding. Failure to appear or produce is punishable by contempt of court.

Subpoena duces tecum: “Under penalty you shall take it with you.” A process by which the court commands a witness to produce specific documents or records in a trial.

Suit: Any court proceeding in which an individual seeks a decision.

Summons: Document or writ directing the sheriff or other officer to notify a person that an action has been commenced against him in court and that he is required to appear, on a certain day, and answer the complaint in such action.

Testimony: Any statement made by a witness under oath in a legal proceeding.

Transcript: The official record or proceedings in a trial or hearing, which is kept by the clerk.

Trial: The presentation of evidence in court to a trier of facts who applies the applicable law to those facts and then decides the case.

Tort: A private wrong or harm committed against another, resulting in legal liability. A tort is either intentional or accidental. Automobile liability insurance is purchased to protect one from suits arising from unintentional torts.

Tortfeasor: One who commits a tort.

Venue: The specific county, city or geographical area in which a court has jurisdiction.

Verdict: Formal decision made by a judge or jury (trier of facts).

Voir dire: “To speak the truth.” The process of preliminary examination of prospective jurors, by the court or attorneys, regarding their qualifications.

Willful act: An intentional act carried out without justifiable cause.

Witness: Person who testifies under oath before a court, regarding what he/she has seen, heard or otherwise observed.

Workers’ Compensation – Workers compensation refers to benefits given to workers who have been injured during the course of their employment. Employees may receive compensation for costs, such as, lost salary, medical treatment, job rehabilitation and other types of compensation depending on the situation. In return, the employer cannot be sued by the employee for the same injuries/incident. Such benefits are required for all United States workers by state and federal law.

Writ: A special, written court order directing a person to perform, or refrain from performing, a specific act.

Wrongful Death – A wrongful death claim is a legal action by survivor’s of a deceased individual. In order to have such a claim, the loved one’s death must have been caused by the wrongful actions of another party. The decedent’s loved ones, bringing the claim, may receive monetary compensation for their losses, as determined by the court. Every state has a wrongful death statute; however, the laws may differ greatly.

Medical-legal Terminology used in Reports for Attorneys and Insurers:

Abduction: Lateral movement of the limbs away from the midline of the body. Opposite of Adduction.

Aberrant Intersegmental Motion: Abnormal movement between two adjacent vertebral segments.

ABSTRACT CONCEPT: A concept or idea not related to any specific instance or object and which potentially can be applied to many different situations or objects. People with cognitive deficits often have difficulty understanding abstract concepts.

ABSTRACT THINKING: Being able to apply abstract concepts to new situations and surroundings.

ACALCULIA: The inability to perform simple or complex problems of arithmetic.

Acceleration-Deceleration Injury: Injury syndromes commonly associated with hyperextension-hyperflexion of the neck. Most often caused by a rear-end auto accident.

ACQUIRED BRAIN INJURY (ABI): Harm to the brain that occurs after birth. Usually it means harm caused by pressure on the brain from inside the body. Examples are harm to the brain as a result of heart attacks, strokes, illness, and near drowning.

Acquired Spinal Stenosis: Spinal stenosis usually due to degenerative changes.

Acromion: The triangular projection of the scapula that forms the point of the shoulder and articulates with the clavicle.

Active Range of Motion: Range of motion in the cervical, thoracic, lumber spine, or any other joint of the body which patient does under his or her own power.

Activities of Daily Living: The normal daily activities and functions a person must perform or fulfill to maintain cleanliness, self-grooming, home maintenance, eating, working and recreation.

ACUITY: Sharpness or quality of a sensation.

Acupressure: The application of manual pressure to specific points along acupuncture meridian pathways for the purpose of decreasing pain. Pain relief is believed to be accomplished by stimulating or sedating the selected acupuncture points.

Acupuncture: An oriental medicine treatment modality where needles are inserted in particular points on the  “meridians” of Qi (channels of energy in the body). This is believed to have neurophysiologic effects which decrease pain and promote healing by balancing Qi.

Acute: A recent onset of an injury or problem. The precise time line of an acute condition can range from hours after onset to 16 weeks depending upon thestandard of the particular physician or treatment provider.

Acute Exacerbation: A sudden aggravation of symptoms or increase in severity of an already existing condition without re-injury or trauma.

ADAPTIVE/ASSISTIVE EQUIPMENT: A special device which assists in the performance of self care, work or play/leisure activities or physical exercise.

Adaptive Changes: Changes in a spinal segment which occur secondarily to another biomechanical problem in the spine. This usually involves loss of range  of motion in a specific direction to compensate for the trauma at another area.

Adaptive Scoliosis: A lateral curvature of the spine, which is secondary to soft tissue biomechanical imbalance and not to bony changes (structural).

Adduction: Movement of a limb toward the middle of the body. Opposite of Abduction.

Adhesions: Fibrosis tissue and scar tissue that bind together tissues which are usually not attached.

Adjustment: A chiropractic term which describes the skilled application of force to a joint or motion segment to improve intersegmental motion, decrease localized muscle tension, and restore normal motion and position.

ADJUSTMENT DISORDER: This diagnosis involves the development of emotional or behavioral symptoms in response to an identifiable stress. It is not as severe a reaction as is found in post-traumatic stress disorder or acute stress disorder.

ADL: Activities of daily living. Routine activities carried out for personal hygiene and health (including bathing, dressing, eating) and for operating a household.

ADMINISTRATIVE LAW JUDGE (ALJ): A judge who makes decisions about federal programs, such as Social Security, Medicaid, Medicare, housing, education, and tax laws. When you appear before an ALJ, it is called a hearing.

ADVANCE DIRECTIVE: A document people create to explain what type of health care they would accept and would not accept if they were to get sick. The Directive is only used if the person gets so sick that they cannot think clearly or tell people what health care they want. Advance Directives often include things like: 1) medications the person is allergic to and don’t want to be given; 2) treatments that the person doesn’t want; and 3) treatments that have worked in the past.

AFFECT: The observable emotional condition of an individual at any given time.

Afferent Nerve Fibers: Nerve fibers which carry sensory impulses to the central nervoussystem.

AFFIDAVIT: A written statement made under oath.

AGNOSIA: Failure to recognize familiar objects although the sensory mechanism is intact. May occur for any sensory modality.

ALERT: State of being watchful or ready.

Allograft: A graft taken from another person (living or dead).

ALTERNATIVE DISPUTE RESOLUTION (ADR): Refers to the broad array of alternatives to trial for resolution of legal disputes. Includes mediation, arbitration, and settlement conferences.

AMBULATE: To walk.

AMNESIA: Lack of memory about events occurring during a particular period of time.

ANEURYSM: A balloon-like deformity in the wall of a blood vessel. The wall weakens as the balloon grows larger, and may eventually burst, causing a hemorrhage.

Ankylosing Spondylitis: A chronic inflammatory disease wherein the spinal motion segments and the sacroiliac joints progressively fuse, resulting in painful restriction of spinal movement.

Ankylosis: A joint condition of decreased or full loss of range of motion, often due to advanced degenerative changes. A spinal segment which is fused can be said to be “ankylosed”. Also, the fusion of a joint either by advanced degeneration or by artificial means (surgery).

Annular Bulge: A bulging out of the annulus fibrosis, the tough fibrosis outer ring that provides support to the disc, which is diffuse and, usually due to degenerative changes or trauma, leading to degenerative changes. This condition may include partial rents or tears in the annulus fibrosis.

Annular Rent: Another way to describe a tear in the annulus, usually seen during discography, less commonly on MRI, or during surgery. These tears can be traumatic in origin. Also known as an annular fissure.

Annulus: See Annulus Fibrosis.

Annulus Fibrosis: The outer covering of the softer, gel-like nucleus pulposus of the intervertebral disc. The intervertebral discs are located between each of the vertebrae of the spine.

ANOMIA: Inability to recall names of objects. Persons with this problem can often speak fluently but have to use other words to describe familiar objects.

ANOSMIA: Loss of the sense of smell.

ANOXIA: A lack of oxygen. Cells of the brain need oxygen to stay alive. When blood flow to the brain is reduced or when oxygen in the blood is too low, brain cells are damaged.

ANSWER: A formal pleading which states the defendant’s response to plaintiff’s complaint.

Anterior: Front side, the opposite of posterior. Synonymous with ventral.

Anterior Disc Herniation: An extrusion of the nucleus pulposus through the front side of the annulus of the disc.

Anterior Discectomy and Fusion: The surgical removal of an abnormal intervertebral disc and replacement with bone graft and/or surgical hardware for fusion, using an anterior approach to the spine.

Anterior Scalene Syndrome: Compression of the bundle of nerves, veins and arteries as it passes between the anterior and middle scalene muscles. This is a cause of thoracic outlet syndrome or cervicobrachial syndrome, as this is one of the more common areas of entrapment.

ANTEROGRADE AMNESIA: Inability to consolidate information about ongoing events. Difficulty with new learning.

Anterolisthesis: A vertebral segment which is moved forward relative to the segment below.

ANTICONVULSANT: Medication used to decrease the possibility of a seizure (e.g., Dilantin, Phenobarbital, Mysoline, Tegretol).

AO Joint: Atlanto-occipital joint is the vertebral joint formed by the occiput (a portion of the skull) at the base of the skull resting upon the atlas or first cervicalvertebra (C1).

AP: Anterior to Posterior or front to back. This refers to the orientation of the patient to the x-ray beam. With AP films the patient faces away from the x-ray film and faces the x-ray machine. The x-ray photons pass from anterior to posterior through the patient. The image produced is a “front to back” view of the patient.

APATHY: A lack of interest or concern. Opposite of empathy.

APHASIA: Loss of the ability to express oneself and/or to understand language. Caused by damage to brain cells.

APPEAL: A request by a party for a higher court to review a lower court’s decisions regarding questions of law.

Applied Kinesiology: A chiropractic diagnostic technique based on the theory the neuromuscular system can be accessed through specific neuromuscular pressure points. This is usually combined with manual muscle testing to determine which muscles are weak and need to be balanced. Some chiropractors use this technique as a way to plan their adjustments and to recheck the patient following the chiropractic adjustment.

APRAXIA: Inability to carry out a complex or skilled movement, not due to paralysis, sensory changes or deficiencies in understanding.

ARBITRATION: Alternative to trial where parties agree to appoint an individual or panel to make a binding award or decision based on the evidence and testimony presented.

AROM Exercise: An exercise designed to increase Active Range of Motion.

AROUSAL: Being awake. Primitive state of alertness managed by the reticular activating system (extending from medulla to the thalamus in the core of the brainstem) activating the cortex. Cognition is not possible without some degree of arousal.

ARTERIAL LINE: A very thin tube (catheter) inserted into an artery to allow direct measurement of the blood pressure, the oxygen and carbon dioxide concentrations in arterial blood.

Arthralgia: Joint pain.

Arthrochondritis:Inflammation of the cartilage portion of a joint.

Arthrogram: The injection of radiographic dye into a joint that is then x-rayed. The contrast dye allows for better visualization of the joint and possible irregularities. Arthrograms are being progressively replaced by MRI.

Arthrosis: A disorder of a joint.

Articulation: 1. The joint between bones. The movement of bones as a result of the joint. 2. Movement of the lips, tongue, teeth and palate into specific patterns for purposes of speech. Also, a movable joint.

Articular Dysfunction: A chiropractic term, which refers to an abnormality of spinal biomechanics involving a loss of normal movement of vertebral motion segment.

Articular Fixation: A loss of one or more joint motions. One of the components of the chiropractic diagnosis of subluxation. See Subluxation. See Hypomobility.

Articular Spondylolisthesis: A forward or anterior “slipping” of one vertebra in relation to another, due to trauma and/or degenerativechanges within the facet joints and/or the discs.

Articular Surface: The surface of a joint, lined with cartilage and synovial fluid to lubricate joint movement.

ASSISTIVE TECHNOLOGY DEVICE (AT): Equipment used by people with disabilities to help them function better. Examples include crutches, wheelchairs, hearing aids, flashing doorbells, computers, and memory aids, such as, post-it notes, alarm clocks, or tape recorders.

Atlanto-Occipital: Referring to the articulation of the joint between the occiput of the skull and the C1 vertebra (atlas). See AO Joint.

Atlas: The first cervicalvertebra which moves with the occipital bone of the skull, and the second cervical vertebra in the neck. Also known as C1.

ATAXIA: A problem of muscle coordination not due to apraxia, weakness, rigidity, spasticity, or sensory loss. Caused by lesion of the cerebellum or basal ganglia. Can interfere with a person’s ability to walk, talk, eat and perform other self-care tasks.

Atrophy: A wasting or decrease in size, often in reference to muscle tissue.

ATTENTION/CONCENTRATION: The ability to focus on a given task or set of stimuli for an appropriate period of time.

AUDIOLOGIST: One who evaluates hearing defects and who aids in the rehabilitation of those who have such defects.

AUGMENTATIVE AND ALTERNATIVE COMMUNICATION: Use of forms of communication other than speaking, such as: sign language, “yes, no” signals, gestures, picture board and computerized speech systems to compensate (either temporarily or permanently) for severe expressive communication disorders.

Autonomic Nervous System: The part of the nervous system controlling involuntary bodily functions, including regulation of glands, organs, and smooth muscle tissue. The autonomic nervous system acts upon these tissues to slow or initiate their function.

Autograft: A graft taken from the patient.

Avulsion: The pulling away of one tissue from another, either by trauma or surgery.

AWARENESS: Conscious of stimulation, arising from within or from outside the person.

Axilla: The armpit.

Bad Faith : Actions by an insurer designed to mislead an insured; refusal or negligence of insurer in fulfilling some duty or contractual obligation.

Balance: The ability to use appropriate righting and equilibrium reactions to maintain an upright position. It is usually tested in sitting and standing positions.

Bench Trial : A case heard and decided by a judge without a jury.

Bone: The hard, osseous material consisting of bone cells (osteocytes) embedded in a matrix of calcified intercellular material.

Bone Spur: See Osteophyte.

Brachial: Pertaining to the arm.

Brachial Plexus: A complex network of nerve tissues in the neck and armpit, which stem from the C5-T1 nerve roots. The brachial plexus contains the nerves going to the arms.

Brainstem: The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brainstem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert).

Brief: A written document prepared by an attorney to serve as the basis for a legal argument. It includes a summary of legal points and precedent, together with arguments to be presented to the court deciding the case or a particular issue of the case.

Bulging Disc: Same as Disc Bulge.

Bursitis: Inflammation of pad-like fluid-filled sacs (bursa) found within the connecting tissue of the joints, as in the shoulder and knee.

Business Records : Common type of documentary evidence. Business includes any association, profession, occupation, and calling of any kind, whether or not conducted for profit. Records include memoranda, reports, chart notes, billing ledgers, etc., created and kept in the ordinary course of doing business, that document acts, events, and conditions. The information contained in the record must be supplied by a person with first-hand knowledge of the underlying events, conditions, etc.

Capsulitis: Inflammation of tissues enclosing a joint.

Carpal Tunnel Syndrome: Soreness, tenderness, and weakness of the muscles of the thumb, index and middle fingers caused by pressure on the median nerve at the point at which it goes through the carpal tunnel of the wrist.

Cartilage: The dense connective tissue between the bodies of the vertebrae (the intervertebral discs) and between the articular surfaces of the joints.

Cauda Equina: The end portion of the spinal cord and the roots of the spinal nerves below the first vertebra in the low back.

Central Nervous System: The combination of the brain, spinal cord, and nerves that control voluntary and involuntary acts.

Cerebellum: The portion of the brain (located at the back) which helps coordinate movement. Damage may result in ataxia.

Cerebrospinal Fluid (CSF): Liquid which fills the ventricles of the brain and surrounds the brain and spinal cord.

Cervical: Referring to the neck. The cervical spine has seven vertebrae (C1 through C-7) which allow for head and neck movement.

Cervicogenic Headache: A headache that originates in the neck.

Chiropractic: A branch of the healing arts focused on human health, disease processes, and physiological and biochemical aspects of the body including structural, spinal, musculoskeletal, neurological, vascular, nutritional, emotional and environmental relationships. Chiropractic procedures include the adjustment and manipulation of the articulations and adjacent tissues of the human body, particularly of the spinal column. Included is the treatment of intersegmental dysfunction for alleviation of related functional disorders. Chiropractors do not use medications or surgery. However, nutritional supplementation may be prescribed.

Chronic: A condition of long standing. Health care providers consider injuries or conditions still existing 12 weeks after the occurrence to be chronic.

Circumlocution: Use of other words to describe a specific word or idea which cannot be remembered.

Civil Law: Law developed by governmental groups such as statutes, regulations and ordinances enacted by legislative bodies such as Congress, state legislatures, county and city officials. This is different from laws based on custom.

Claim: A demand for compensation.

Claimant: A person who makes a claim or asserts a right. The plaintiff in a personal injury case may also be known as the claimant.

Clavicle: The “collar bone” which articulates with the scapula, acromion and the sternum.

Clonus: A sustained series of rhythmic jerks following quick stretch of a muscle.

Closing Argument : The chronological and psychological conclusion of a trial. The last opportunity for the attorneys representing each party to communicate directly with the jury and/or judge about their theory of the case, explain contested facts, and argue why their side should prevail.

C.O.B.R.A.: A federal program that allows people who lose or leave their jobs to pay for and keep their employee health insurance for up to 18 months. People who become disabled soon after they lose their job can pay for and keep their employee health insurance for up to 29 months after leaving their job.

Cognition: The conscious process of knowing or being aware of thoughts or perceptions, including understanding and reasoning.

Cognitive Rehabilitation: Therapy programs which aid persons in the management of specific problems in thinking and perception. Skills are practiced and strategies are taught to help improve function and/or compensate for remaining deficits.

Coma: A state of unconsciousness from which the person cannot be aroused, even by powerful stimulation; lack of any response to one’s environment.

Community Resources: Public or private agencies, schools or programs offering services, usually of a social nature, to the public. They are usually funded by governmental bodies, community drives, donations and fees.

Comparative Fault: An affirmative defense available to the defendant. Reduction of the plaintiff’s recovery in proportion to the percentage of negligence or fault attributed to the plaintiff.

Competency OR Capacity: A decision only a judge can make about whether a person is able to make informed choices about their living situation, finances, or health care. A judge must hold a hearing and be given convincing evidence that the person cannot make informed choices. People who lack the ability to make these choices are called “incompetent” or “incapacitated”.

Complaint: A formal statement filed by the plaintiff with the court that sets forth his/her injuries and damages and why he/she believes the defendant is liable.

Common Law: Body of law developed over a long period of time which derives its authority solely from usage and custom.

Concrete Thinking: A style of thinking in which the individual sees each situation as unique and is unable to generalize from the similarities between situations. Thinking in which language is interpreted literally.

Concussion: Any alteration in cerebral function caused by direct or indirect (rotation) force transmitted to the head resulting in one or more of the following: a brief loss of consciousness, lightheadedness, vertigo, cognitive and memory dysfunction, tinnitus, difficulty concentrating, amnesia, headache, balance disorder, nausea or vomiting.

Confabulation: Verbalizations about people, places and events with no basis in reality. The person appears to “fill in” gaps in memory with plausible facts.

Confusion: A state in which a person is bewildered, perplexed or unable to self-orient.

Connective Tissue: Tissue connecting and supporting muscles, tendons, and ligaments.

Consciousness: The state of awareness of the self and the environment.

Continent: The ability to control urination and bowel movements.

Contracture: Loss of range of motion in a joint due to abnormal shortening of soft tissues.

Contusion, Brain: A bruise. The result of a blow to the head which bruises the brain.

Cortical Blindness: Loss of vision resulting from a lesion of the primary visual areas of the occipital lobe. Light reflex is preserved.

Corticosteroid: A potent anti-inflammatory drug.

Contrecoup: Bruising of brain tissue on the side opposite where the blow was struck.

Coup Damage: Damage to the brain at the point of impact.

Counter Claim: The defendant sues the plaintiff for damages for which the defendant claims the plaintiff is legally liable or at fault.

Court Rules: The rules governing legal proceedings in all courts in Washington state. Many counties also have Local Rules (LR) specifying rules of practice unique to that county.

Court of Appeals: This court is established to review appeals from the trial court. It can affirm or overturn, in whole or in part, a trial court’s decision. A party has a legal right to appeal any final decision of a superior court to the Court of Appeals.

Craniosacral Therapy: A manipulation-based therapy first developed by William Sutherland, D.O. It is based upon the belief that cranial plates are mobile and connected to the spinal cord and sacrum through the meninges. Some techniques concentrate on detecting cranial plates that are “out of place” and correcting these dysfunctions. While controversial, many patients report relief of headaches and tempormandibular joint pain with the technique.

Crepitus: Crunching, rubbing or snapping sounds heard or felt when moving a joint.

Cross Claim: The defendant brings a claim against another defendant in the same lawsuit or identifies a new party not previously named by the plaintiff in the lawsuit, asserting that party is responsible for the plaintiff’s damages.

Cross Examination: The questioning of a witness by the adverse party.

Cryotherapy: The application of ice to injury sites to reduce inflammation and pain by decreasing blood flow in the area of the injury or discomfort.

CT Discogram: A discogram followed by a CT Scan. The CT scan allows visualization of the disc structure following the injection of radiographic dye during the discography procedure.

CT Myelogram: A myelogram followed by a CT scan. This technique visualizes the spinal nerves as they relate to the surrounding bony structures. This study is commonly used for surgical planning.

CT Scan: Also called CAT scan, Computer Tomography, Computer Assisted Tomography, or Computer Axial Tomography. The use of x-ray energy passing through the body at different angles and processed through a computer to produce a cross-sectional (axial) image of an area of the body. The current term, CT Scan, is the most accurate since reformatting has allowed other planes to be imaged besides just the axial plane.

Cubital Tunnel Syndrome: “Cubital tunnel” refers to a passageway along the inner part of the elbow bounded by bones, muscles and ligaments. Cubital Tunnel Syndrome involves symptoms of numbness, tingling, or weakness of the pinky and ring fingers due to compression of the ulnar nerve passing through the cubital tunnel.

Cue: A signal or direction used to assist a person in performing an activity (telling a person the initial of your first name serves as a cue when he cannot remember your name).

Custodial Care: Services and supports that can be provided by most people and do not require special training. The opposite of custodial care is often called skilled nursing care.

DABCO: Diplomate of the American Board of Chiropractic Orthopedists.

DACBR: Diplomate of the American Chiropractic Board of Radiology.

DACS: Diplomate of Applied Chiropractic Science.

Damages: Money or property a court or jury gives to an injured person.

DC: Abbreviation for Doctor of Chiropractic, aka Chiropractic Physician or Chiropractor

DDD: See Degenerative Disc Disease.

Decerebrate Posture (Decerebrate Rigidity): Exaggerated posture of extension as a result of a lesion to the prepontine area of the brainstem, and is rarely seen fully developed in humans. In reporting, it is preferable to describe the posture seen.

Decompression: In spine surgery, the term refers to the lessening of pressure on a nerve root, spinal nerve or the spinal chord. This is also a manual therapy term referring to the lessening of pressure on a nerve or joint through manual traction.

De-conditioned: The loss of strength, flexibility and endurance due to long-term illness, injury, or lack of proper motion or exercise.

Decorticate Posture (Decorticate Rigidity): Exaggerated posture of upper extremity flexion and lower extremity extension as a result of a lesion to the mesencephalon or above. In reporting, it is preferable to describe the posture seen.

Decree: A judgment or order issued by a court.

Decubitus: Pressure area, bed sore, skin opening, skin breakdown. A discolored or open area of skin damage caused by pressure. Common areas most prone to breakdown are buttocks or backside, hips, shoulder blades, heels, ankles and elbows.

Deductible: An amount of money a person must pay for their health care costs before their health insurance company will begin to pay for any other health care costs. Generally, a person must pay a deductible every year.

Defamation: Injury to a person’s character, fame, or reputation by false and malicious statements.

Default Judgment: When a defendant fails to formally answer a plaintiff’s complaint in a timely manner, the plaintiff may ask the court to enter a judgment against the defendant. Most often in personal injury cases, these judgments are set aside once the defendant begins to comply with the rules and initiates a formal defense by filing an answer.

Defendant: The party the plaintiff claims is responsible for his/her damages and from whom the plaintiff seeks some form of relief.

Deficit: A deficiency in amount or quality of functioning.

Degenerative Changes: Degeneration of any joint due to wear and tear, trauma, or unusual postures. The degenerative changes include discspace narrowing, osteophytes or bony spurring. These type of changes can be seen both on x-ray and MRI imaging.

Degenerative Disc Disease: An intervertebral disc, which has suffered the effects of the aging process or the effects of trauma. A disc becomes degenerated over time, often spanning years. Often there are small circumferential tears in the annulus fibrosis, the tough outer covering of the disc. A degenerated disc is also characterized by a loss of its height due to a drying-out of the nucleus pulposus, the gelatinous material inside the disc. It is often caused by a loss of motion between the vertebrae above and below, thus decreasing the mechanical flow of nutrients to the disc.

Degenerative Facet Joints: Facet joints, which, as a result of age and time or trauma, have signs of arthritic changes. The degenerative arthritic changes may include thinning of joint spaces, changes in the joint and cartilage surfaces, and inflammation of the joint and connecting tissues of the joint. Degenerative facet joints may or may not be symptomatic.

Degenerative Joint Disease: (DJD) In the spine, DJD refers to the inflammatory changes in the facet joint, also known as the zygapophyseal joints of the vertebral bodies. These changes often lead to bone changes and reduced range of motion at the joint. Degenerative joint disease is not limited to the spine.

Degenerative Symptoms: Pain and physical restrictions are a result of degenerative changes usually in the weight-bearing joints of the body.

Demand Letter: A letter expressly stating a legal right and an amount due as reasonable compensation for injuries to person and/or property.

Denervation: The blocking of a nerve supply by trauma, degeneration or surgery.

Deposition: A form of discovery whereby the attorney calling for the deposition has the right to ask questions and obtain answers from a party, witness, or expert while that individual is under oath. Notice of the deposition must be served on the party or witness five (5) days in advance of the date of the deposition unless the parties agree otherwise. A court reporter makes a word-for-word record of all that is said at the deposition.

Dermatomal Somatosensory Evoked Potential: An electrical conductivity test specific to nerve (dermatome) patterns. See Somatosensory Evoked Potential, SSEP.

Dermatome: A specific sensory nerve distribution pattern, which can be outlined or traced on the skin.

Dessication: Dehydration of an intervertebral disc.

Diffuse Axonal Injury (DAI): A shearing injury of large nerve fibers (axons covered with myelin) in many areas of the brain. It appears to be one of the two primary lesions of brain injury, the other being stretching or shearing of blood vessels from the same forces, producing hemorrhage.

Diffuse Brain Injury: Injury to cells in many areas of the brain rather than in one specific location.

Diplopia: Seeing two images of a single object; double vision.

Direct Examination: The questioning of a witness by the attorney for the party on whose behalf the witness is called.

Directed Verdict: At the close of a plaintiff’s case, a defendant asks the court to rule that the plaintiff has failed to put forth sufficient evidence, even when viewed in a light most favorable to the plaintiff, to support his/her claim. If the court so rules, the defendant is entitled to a dismissal without the defendant ever having to put on his/her case. Also, at the close of defendant’s case, plaintiff can ask the court to rule in its favor with a directed verdict on liability or special damages.

Disc: See Intervertebral Disc.

Disc Bulge: A broad-based enlargement of the annulus fibrosis extending past the edges of the adjoining vertebral end plates with herniation of the nucleus pulposus into or through the annulus fibrosis. See Bulging Disc.

Disc Herniation: See Herniated Disc.

Discectomy: The surgical removal of the bulging or extruding disc material (nucleus pulposus). Access to the bulging or extruding disc material may be had by removal of the lamina of the vertebral body (laminectomy) or the cutting of an opening in the lamina (laminotomy). Discectomy may be done in conjunction with a foraminotomy and/or a fusion.

Discogenic Pain: Pain coming from the nerves embedded in the annular wall of the disc. Pain can arise from chemical or mechanical irritation of these nerves as a result of damage to the intervertebral disc. The outer portion of the annulushas sensory nerves and trauma or degenerative changes to the annulus can cause pain.

Discography: An imaging procedure which reveals the inner structure and condition of an intervertebral disc by injecting dye through a needle placed into the disc. A CT Scan is then performed to image the disc more precisely. Discography can also be used to determine if the disc is a source of pain, in addition to revealing the disc’s inner structure. Discography is often employed to determine a patient’s suitability for fusion surgery in the neck, mid back, or low back.

Discovery Process: Procedure for examination of documentary and physical evidence, and questioning of witnesses and parties to uncover evidence which is reasonably calculated to lead to the discovery of admissible evidence. Discovery may be obtained by the parties through interrogatories, requests for production of documents, depositions, and defense medical examinations. Information that can be obtained in discovery is broader in scope than what is deemed to be admissible at trial.

Discrimination, Sensory: A process requiring differentiation of two or more stimuli.

Disc Space Narrowing: A narrowing of the space between the vertebrae, produced by disc dehydration (dessication) and is often imaged by x-rays. See Degenerative Disc Disease.

Disinhibition: Inability to suppress (inhibit) impulsive behavior and emotions.

Disorientation: Not knowing where you are, who you are, or the current date. Health professionals often speak of a normal person as being oriented “times three” which refers to person, place and time.

Distraction: (1) Application of a force to mildly and temporarily release pressure from a joint. This tractioning of a joint space is for the purpose of releasing entrapped soft tissues, such as the joint capsule or spinal nerve roots. This may be performed manually, by application of weight, or mechanically; (2) An orthopedic test wherein the examiner places his/her hands under the chin/jaw and gently pulls up. This maneuver may relieve pressure from the nerve roots and discs. If the patient feels relief of symptoms, the test is “positive”; or (3) The diversion of a patient’s attention from the primary activity being performed during physical examination.

District Court: These are courts of limited jurisdiction in Washington State which have jurisdiction over cases not involving real estate, false imprisonment, defamation, malicious prosecution, or actions against executors of wills, and which otherwise do not exceed $50,000.00 in claimed damages.

Diversified Technique: A chiropractic technique in which the primary manipulative force is applied by the practitioner’s hands. See Manipulation, Chiropractic.

DJD: See Degenerative Joint Disease.

DO: A physician graduating from a medical school of osteopathic medicine. Osteopathic doctors can use manipulation of the spine and administration of medications as part of their treatment of spinal complaints. See Osteopathic Physician.

Docket: A calendar or agenda of court proceedings prepared by the clerk of the court. For example, a trial docket is a list of cases set to be tried at a specified term.

Dominant Hand: The hand one uses most often because it is usually more coordinated and stronger than the non-dominant hand.

Dorsal: Reference to the back or upper aspect of the body. On occasion it refers to the thoracic spine.

Double Crush Syndrome: A nerve entrapment at two or more places along a nerve. Most typically the diagnosis refers to a carpal tunnel syndrome, cubital tunnel syndrome, and/or ulnar neuropathy nerve compression at the elbow, co-existing with pressure on the spinal nerve in the neck, causing numbness or tingling, muscle weakness or loss of reflex in the arm or hand.

Dura: The outermost, toughest, fibrosis layer covering of the brain, spinal cord and nerve roots. It also holds the brain in place and contains the cerebral spinal fluid.

Durable Power of Attorney: A legal document that appoints a person or agency to use your money to pay your bills and make medical decisions. Nursing homes or service providers are often appointed durable power of attorney to handle money and other decisions for the people with disabilities whom they serve.

Dural Impingement: Pressure or deformation of the dura caused by bulging disc, bone spurs, or thickened ligaments.

Dynamometer: A device which measures grip strength.

Dysarthria: Difficulty in forming words or speaking them because of weakness of muscles used in speaking. Speech is characterized by labored, imprecise articulation. Tongue movements are usually slurred and the rate of speaking may be very slow. Voice quality may be abnormal, usually excessively nasal; volume may be weak; drooling may occur. Dysarthria may accompany aphasia or occur alone.

Dysesthesia: An abnormal sensation that a patient reports as uncomfortable that may include burning, tingling, numbness, or “pins and needles”.

Dysphagia: A swallowing disorder characterized by difficulty in oral preparation for the swallow, or in moving material from the mouth to the stomach. This definition also includes problems in positioning food in the mouth.

Dysthymia: A chronic depressed mood lasting more than two years.

Edema: Collection of fluid in the tissue causing swelling.

EMG: Electromyogram or Electromyelogram. A test to evaluate the motor function of the peripheral nerves and the related spinal nerves. The test involves use of a needle to test nerve conduction speed. The method of the EMG is to insert small needles in muscle groups and observe for electrical indications of denervation or loss of nerve function.

Emotional Lability: Exhibiting rapid and drastic changes in emotional state (laughing, crying, anger) inappropriately without apparent reason.

Encephalography: Non-invasive use of ultrasound waves to record echoes from brain tissue. Used to detect hematoma, tumor or ventricle problems.

End Feel: The quality of the resistance to movement that the health care provider feels when testing the range of motion end point of a particular joint.

Epidural: Outside the brain and its fibrous covering, but under the skull.

Epidural Block: The injection of anesthetic into the epidural space in order to block or desensitize a specific nerve at particular points of a nerve pathway.

Epidural Space: The space outside the dura of the brain and spinal cord. The dura is the outer membrane covering the spinal cord and the brain.

Epidural Steroid Injection: The injection of a potent anti-inflammation drug into the epidural space around the nerve or joint for therapeutic purposes. It is used to decrease inflammation in the spinal space and spinal nerves and reduce pain.

Estate Plan: A plan for how a person’s property should be handled after the person dies or becomes unable to make informed decisions about their property because of a disability. A will is part of an estate plan.

Estate Recovery: A federal law requiring the state to take money or property from certain people after they die in order to pay for the Medicaid services the state spent on the person while they were living.

Evidence: Testimony, writings, material objects, etc. that are admissible and offered by a party to the trier of fact to prove the existence or non-existence of a fact.

Evoked Potential: Registration of the electrical response of brain cells as detected by electrodes placed on the surface of the head at various places. The evoked potential, unlike the waves on an EEG, is elicited by a specific stimulus applied to the visual, auditory or other sensory receptors of the body. Evoked potentials are used to diagnose a wide variety of central nervous system disorders.

Executive Functions: Planning, prioritizing, sequencing, self-monitoring, self-correcting, inhibiting, initiating, controlling or altering behavior.

Expert Witness: An individual who possesses specialized knowledge through skill, education, training, or experience beyond that of the ordinary person or juror, and whose knowledge will aid the triers of fact (jury, judge, arbitrator) in reaching a proper decision. Often, a health care provider who examines and evaluates a patient in anticipation of litigation.

Extension: A movement that brings two parts of a joint toward a straight position. In the lumbar spine, this is starting in a forward bent position and returning to a straight position (the neutral or standing position) or bending backwards from the neutral position. In the cervical spine the term is used to refer to the movement involved in looking-up or starting in a forward bent position and returning to a straight position.

Extradural Defect: Indentation of the thecal sac or dura by disc bulge, osteophyte, defect in the bone,ligament, cyst or tumor. This terminology is often used by radiologists noting abnormalities on imaging studies.

Extremity: Arm or leg.

Extruded Disc: See Herniated Disc.

Facet Arthrosis: Degenerative changes of the facetjoints.

Facet Block: The injection of anesthetic and/or steroid into a facet joint using video x-ray or CT scan to assist the practitioner in guiding a needle through the skin. This can be done for both diagnostic and therapeutic purposes.

Facet Hypertrophy: Enlargement of the facet joints as a result of degenerative changes.

Facet Injection: See Facet Block.

Facet Joint Dysfunction: A vertebral motion segment whose joint does not move freely in all directions or moves excessively. Commonly used by treatment providers to refer to a syndrome producing facet joint pain.

Facet Joints: A set of paired joints representing the articulation (joining) of the back portions of two adjoining vertebrae at the back of each vertebra articulating with the vertebra above and vertebra below. An injured or degenerative facet joint may be the source of spinal pain and stiffness. Also referred to as zygapophyseal joint.

Facet Neurotomy: A therapeutic technique whereby the medial branch nerve supply to the facet is cut. This is done surgically, most often with radio frequency current. See Medial Branch Neurotomy. Sometimes called Facet Rhizotomy.

Facet Rhizotomy: See Facet Neurotomy.

Facet Syndrome: Pain coming from facet joints. Degenerated facet joints may also put pressure upon exiting spinal nerves and cause radiculopathy and/or stenosis.

FACO: Fellow of the Academy of Chiropractic Orthopedists.

FACS: Fellow of the American College of Surgeons.

Family and Medical Leave Act: A 1993 federal law requiring employers with more than 50 employees to provide eligible workers up to 12 weeks of unpaid leave for births, adoptions, foster care placement, and illnesses of employees and their families.

Fascia: The connective tissue sheath which is continuous through-out the body. The fascial system covers the muscles, the skeleton, and the organ systems of the body. It also creates tunnels through which the nerves and blood vessels travel.

Fascial: Of or pertaining to the fascia.

FASBE: Fellow of Applied Spinal Biochemical Engineering.

Federal Courts: Courts of the United States created by Article III of the Constitution or by Congress. Lawsuits filed in federal court include cases in which an agency of the federal government is named as a defendant or where the plaintiff and defendant reside in different states.

Federal Law: Laws that apply equally to all Americans no matter where they live in the United States. Federal laws are different from state laws, as the latter apply only to individuals who live in a particular state.

Fibromyalgia: A syndrome involving diffuse systemic muscle pain. The diagnostic criteria has been defined by the American College of Rheumatology as pain at 11of 18 tender point sites, presence of subcutaneous nodules, and a history of widespread pain for more than three months. Trauma can be a cause of this syndrome.

Fibromyositis: An inflammatory muscle condition leading to fibrosis and muscle pain, commonly secondary to trauma.

Fibrosis: Abnormal formation of scar tissue.

Fibrositis: A term with multiple meanings that have been applied to myofascial pain, tendinitis, bursitis, capsulitis, and tenosynovitis. Generally it is understood to be an inflammation of connective tissue.

Fixation: (1) A chiropractic term for a vertebral segment which does not move well in all directions. Fixations are corrected by chiropractic adjustments. See Subluxation. (2) A manual therapy term indicating a blocking technique of one bone to allow for specific movement of an adjacent bone.

Flaccid: Lacking normal muscle tone; limp.

Flexion: Bending a joint forward.

Flexion-Extension Injury: A sprain/strain injury of the cervical spine and adjacent structures caused by a hyperextension-hyperflexion injury. See Acceleration-Deceleration Injury, Whiplash Injury.

Flexion-Extension X-rays: Side view x-rays taken at the extremes of flexion and extension of the spine to detect abnormal movement between adjacent vertebrae suggestive of ligament damage or ligamentous laxity. These views are compared to a neutral view.

Fluoroscopy: An x-ray machine capable of producing both still images and “real-time” motion of the joints or vertebrae. Often used to visualize intervertebral joint motion through flexion and extension of the neck or back or to place a syringe needle at a targeted site.

Foley Catheter: This is a tube inserted into the urinary bladder for drainage of urine. The urine drains through the tube and collects into a plastic bag.

Foramen: The opening between the vertebrae through which the spinal nerve root and spinal nerve sheath pass to exit the spinal canal. The size of the foramen may be reduced by degenerative joint disease, a herniated disc, bulging disc, bone spurs,facet joint hypertrophy, or by soft tissue (cyst, tumor, ligament, etc.).

Foraminal Stenosis: A decrease in the overall size of the intervertebral foramen (the bony window through which the spinal nerves pass) caused by enlargement of the facet or a degenerative disc. The spinal nerve passing through the foramen can become irritated or compressed. Severe foraminal stenosis can cause radiculopathy. Surgical management can include enlarging the foremen by removing bone (foraminotomy), and/or fusion to reduce continued facet joint degeneration.

Foraminotomy: A surgical opening of the intervertebral foramen to provide more space for the spinal nerve.

Forward Head: Forward translation of the head/skull in relation to the mid back. A postural dysfunction where the upper back is in flexion and the head protrudes forward over the chest. This position places the head and neck in a structural disadvantage. It is often seen after flexion-extension injuries to the cervical spine.

Frontal Lobe: Front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of “higher cognitive functions.”

Frontal-Occipital Headaches: Pain emanating from the base of the skull or in the back of the head and radiating to the forehead. This headache pain is often secondary to acceleration-deceleration injuries (also know as hyperextension-hyperflexion injuries or whiplash) involving the upper joints of the neck (O-C1, C1-2, C2-3 joints).

Full Spine Radiography: A method of x-ray most commonly found in chiropractic practice in which a patient’s entire spine and pelvis are produced on a single x-ray film in both the anterior to posterior (AP) and lateral projections. The x-ray film size is typically 14”x 36”.

Functional Ability: Capacity for performing an act that results in a practical end result.

Functional Capacity Evaluation: A series of tests measuring physical strength, range of motion, stamina, and tolerance to functional activities, including lifting and carrying. These tests can be used to evaluate work tolerance, and the necessity for work restrictions. More commonly referred to as a Physical Capacities Evaluation (PCE).

Functional Impairment Index (FRI): A questionnaire used to quantify the patient’s degree of dysfunction and how it affects activities of daily living.

Functional Leg Length Discrepancy: A short leg which is the result of a biomechanical subluxation complex (inclusive of a muscle imbalance, myospasm, segmental dysfunction or combination of these factors). It is not due to bone length. Chiropracticadjustment seeks to correct leg length difference.

Fusion: A surgical procedure performed to eliminate spinal pain or immobilize unstable joint segments. Can be used to treat degenerative disc disease and to immobilize injured vertebral segments. A bone graft is placed across a spinal segment which then grows together with the patient’s bone and the area is immobilized. There is a loss of motion between two vertebrae that are fused together. The graft can be an autograft (bone taken from the patient) or an allograft (cadaver bone).

Gait: The manner in which a patient walks.

Gait Evaluation: Observation and analysis of a patient walking. The type of gait is noted.

General Damages: Money damages for pain and suffering, disability, or reduction in quality of life.

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.

GI Tube: A tube inserted through a surgical opening into the stomach. It is used to introduce liquids, food or medication into the stomach when the person is unable to take these substances by mouth

Giveway Weakness: An abnormal muscle weakness noted upon examination. It is weakness that is inconsistent; usually involving full motor strength against initial resistance, followed by the strength “giving way”.

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.

Goniometer: A protector device used for measuring joint angle and range of motion.

Gonstead Technique: A chiropractic technique that uses the practitioner’s hands to make corrections of the spine. This is a high-velocity (high-acceleration), low-amplitude adjusting technique. It is taught at most chiropractic colleges. It was developed over several decades by Clarence Gonstead, D.C. It also utilizes specific x-ray analysis and spinal heat readings.

GP: Abbreviation for a medical doctor who is a General Practitioner.

Grip Strength Testing: Determination of the amount of strength in the hand and forearms while gripping a dynamometer. It can be used to assess changes over time of the motor function of nerves exiting the lower cervical spine.

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).

Guardian: A person with the lawful power and duty to take care of a person and manage his/her property and/or rights.

Guardian Ad Litem: A guardian appointed by the court to represent the interests of a minor.

H/A: Abbreviation for Headache.

Health Insurance Portability and Accountability Act (HIPAA): A federal law passed in 1996 to help people buy and keep health insurance, even when they have serious health conditions. The law sets basic requirements that health insurance plans must meet, including keeping a person’s medical information private.

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.

Hellerwork: A method of deep tissue body work for 11 one-hour sessions. This technique is used to realign the body’s myofascial planes. Some degree of movement training is included. Each session covers a specific area of the body and discussion with a specific emotional focus.

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.

Herniated Nucleus Pulposus: See Herniated Disc.

Hung Jury: A jury which is unable to agree on a verdict after a suitable period of deliberation; sometimes referred to as a dead-locked jury. The result is a mistrial.

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.

ICP: See Intracranial Pressure.

Idiopathic: A condition or disease of unknown cause or etiology.

ILA: An osteopathic or manual physical therapy term referring to the Inferior Lateral Angle of the sacrum. Often designated as a reference point in the diagnosis of sacroiliac joint dysfunction.

Iliac: Referring to the Ilium.

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.

Iliosacral Dysfunction: An osteopathic or manual physical therapy term referring to a dysfunction of the ilium on the sacrum. See Sacroiliac Joint Dysfunction.

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.

Impeachment: A technique used during cross-examination to discredit a witness’s testimony. Impeachment can be accomplished in a number of ways: by demonstrating and emphasizing the difference between the witness’s testimony at trial and a prior statement, showing bias, showing erroneous assumptions made by the witness in drawing conclusions, etc. The intent of impeachment is to show the jury that the witness cannot be believed.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.

Impulse Control: Refers to the person’s ability to withhold inappropriate verbal or motor responses while completing a task. Persons who act or speak without first considering the consequences are viewed as having poor impulse control.

Incapacity OR Incompetency: A legal decision made by a judge that a person lacks the ability to take action or make informed choices about their property, health, or living situation.

Incontinent: Inability to control bowel and bladder functions. Many people who are incontinent can become continent with training.

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

Individualized Education Plan (IEP): A plan a student must have in order to get free special education services from a school. The IEP must include annual goals for the individual and a description of any special services a student needs to participate in school. The plan must be agreed upon by the child’s teacher, parents and professionals who have tested or worked with the child.

Inferior: Relative anatomical position a body part or region as being below that of another.

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.

Inflexible: Inability to adjust to changes.

Initiative: Refers to the individual’s ability to begin a series of behaviors directed toward a goal.

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: Between two adjacent vertebrae.

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.

Intracerebral: In the brain tissue.

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.

JUDGMENT: 1. Process of forming an opinion, based upon an evaluation of the situation at hand in comparison with personal values, preferences and insights. The ability to make appropriate decisions. 2. (legal) A final order which puts an end to a lawsuit. The judgment states the final amount of any monetary award made to a party by a judge, jury or arbitrators, as well as which party must pay for it.

JUDGMENT of Safety: The extent to which an individual can correctly judge the dangers and risks in a variety of situations. A person with poor judgement may smoke in bed late at night, touch a red hot stove burner or show extreme friendliness to complete strangers. People with brain injury with poor insight regarding their impairments are also likely to show poor judgement of safety.

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.

Juror: A member of the jury.

Jury: A group of persons selected from the citizens of a particular district who are temporarily invested with the power to indict a person for a criminal offense or to decide a question of fact in a civil case and award damages. In personal injury cases, either party may ask for a jury trial. Depending on the court, a jury will consist of 6 or 12 people. With a six-person jury, five out of six jurors’ votes are needed for a verdict. With a twelve-person jury, ten jurors are needed for a verdict; twelve out of twelve are needed for a criminal conviction.

Kinesiology: The study of movement.

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

Lamina: The posterior part of a vertebra which forms the roof of the spinal canal.

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.

Lateral Bending: Side to side bending.

Lateral Flexion: Bending to one 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.

LBP: Abbreviation for Low Back Pain.

Leading Question: A question which suggests an answer with which the witness is asked to agree. Form of questioning used during cross-examination and generally not permitted during direct examination.

Lability: State of having notable shifts in emotional state (e.g., uncontrolled laughing or crying).

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.

Life Care Plan: A plan that looks at how a person will pay for medical and non-medical needs and goals in the future. The plan includes personal choices about where the person wants to live in the future, what healthcare he or she is willing to accept, and who the person wants to provide needed healthcare and other supports.

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.

Ligamentum Flavum: Literally, yellow ligament. A ligament, which attaches on the laminae (the backside surface of the spinal canal) of the vertebrae.

LMP: Abbreviation for Licensed Massage Practitioner. See Massage Therapy.

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

Liquidated Damages: The amount of money agreed upon by the parties to a contract that must be paid by one or the other in the event that contract is breached.

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.

Long Term Care: A range of health and personal assistance services provided either at home, in the community, or in skilled nursing facilities for individuals with long term disabilities.

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)

Low-Velocity Thrust: A type of chiropractic adjustment in which a slow manipulation or mobilization is applied to a joint.

LPN: Abbreviation for Licensed Practical Nurse.

Lumbar: Relating to the low back. The lumbar spine has five vertebrae stacked on top of the sacrum (L1 - L5).

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 facet joint 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.

Malingerer: A medical-legal term for one who consciously and willfully misrepresents or overstates illness or symptoms in order to escape work duties or school and/or for financial gain. True malingering is thought to be rare. See Secondary Gain.

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.

Mandatory Arbitration: When a party files a lawsuit in Superior Court (trial court in the State of Washington) and claims damages of $50,000.00 or less, he/ she may first submit their case to arbitration before a full trial. Either party can appeal a mandatory arbitration award by going to trial. The risk to the appealing party is that if it does not obtain a better result at trial, it must pay the costs and attorney fees of the other party. Not all counties have mandatory arbitration.

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.

Massage Therapy: Deep or light pressure applied to the musculoskeletal system for the purpose of muscle relaxation, myofascial release, increasing joint function, increasing lymphatic drainage, realigning scar tissue, or increasing local blood flow.

Mastoid Process: The rear portion of the temporal bone on each side of the head behind the ear.

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.

Maximum Voluntary Effort: A determination made during physical capacity evaluation testing whether a patient is giving his/her true maximum effort.

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.

Medicaid OR Medical Assistance: A joint federal and state program that provides health care for people with very limited income and resources. Every state has different rules about who qualifies for Medicaid and what they can receive. In many states people who qualify for Supplemental Security Income (SSI) automatically qualify for Medicaid.

Medicaid Waiver OR Home and Community-Based Services Waiver, (Also called a 1915C(B) Waiver): An optional Medicaid program that allows the state to fund services in the community for a limited group of people who would normally have to go to an institution to get these services covered. Generally, when Medicaid covers a service, it must cover the service on an equal basis for everyone in the state with similar needs. A waiver allows the state to make an exception. For example, states can cover a service only for people with certain disabilities, limit coverage to certain cities or regions of the state, limit coverage to only 10 people even if 50 people need the service, limit the amount of money it will spend on any one person receiving waiver services, and waive income rules to allow more people to be eligible. For information on your state’s Medicaid waivers go to: www.cms.hhs.gov/medicaid/waivers or www.hcbs.org

Medicaid Buy-In: A program that allows working people with disabilities who make too much money to qualify for Medicaid, but have high medical expenses, to buy Medicaid coverage. Not all states allow a Medicaid buy-in and each state sets its own rules for eligibility. For information on whether your state offers this go to: http://www.cms.hhs.gov/TWWIA/07_BuyIn.asp

Medicare: The national health insurance program to which all Social Security recipients who are either over 65 years of age or permanently disabled are entitled. Medicare benefits should be the same no matter what state you live in. Coverage under Medicare is similar to that provided by private insurance companies. It pays a portion of the cost of medical care and usually charges a copayment or deductible. Part of the program is paid for with payroll taxes paid into Social Security by employers and employees. Another part of the Medicare program is paid for by monthly payments from people receiving its benefits.

Memory: The process of perceiving events, organizing and storing representations of the events and recalling these representations to consciousness at a later time.

Memory/Learning: Acquisition of new information determined by the extent to which an individual benefits from repetition, rehearsal, or practice. For example, a person who learns quickly will likely remember an entire set of instructions after hearing them a single time. A person with severely-impaired learning ability will show little gain in recall after numerous repetitions. Learning and memory are interdependent. If immediate memory is poor, learning will be poor because only a portion of the information will be available for rehearsal/ repetition. It is important to note that persons may have intact learning ability, but poor delayed memory. For example, a person with brain injury may learn a set of instructions after several repetitions, but forget them the next day.

Migraine Headache: A headache caused by excessive dilation of the arteries in the brain. Symptoms include severe head pain, sensitivity to light (photophobia), occasionally sensitivity to smells, nausea, dizziness, vomiting and/or visual disturbances. See Vascular Headache.

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

Minor: A person who is under the age of legal competence. In Washington, a person less than eighteen (18) years old.

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.

Mitigate: To diminish or reduce. An injured party has the duty to mitigate his/her damages, including pain and suffering, by taking reasonable steps to get better.

Mobility: Ability of an individual to move within, and interact with, the environment, usually involving utilization of public and/or private transportation, wheelchairs or ambulation.

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.

Money Management: Ability to distinguish the different denominations of money, count money, make change, budget.

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: Pertaining to movement.

Motor Control: Regulation of the timing and amount of contraction of muscles of the body to produce smooth and coordinated movement. The regulation is carried out by operation of the nervous system.

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

Motor Planning: Action formulated in the mind before attempting to perform.

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.

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.

Myotherapy: The application of progressively stronger pressure on a trigger point. This pressure causes reduced blood flow within that portion of the muscle followed by increased blood flow response on the release of pressure.

Nasogastric Tube (NG Tube): A tube that passes through the person’s nose and throat and ends in the person’s stomach. This tube allows for direct “tube feeding” to maintain the nutritional status of the person or removal of stomach acids.NCS: Abbreviation for Nerve Conduction Study.

NCV:Nerve Conduction Velocity. An electrodiagnostic test to evaluate the nerve roots.

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.

Neologism: Nonsense or made-up words used when speaking. The person often does not realize that the word makes no sense.

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.

Nerve Root Sheath: The covering of the nerve root continuous with the dura.

Network Chiropractic:An integration of chiropractic techniques which utilizes light touch or taps to relieve spinal tension to clear the body of central nervous system interference. Changes in the sequence or timing of adjustments are determined by objective changes such as leg length. This technique is reported to “release” spinal imprints caused by physical, emotional, or chemical stress.

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.

Neural Foramina: More correctly termed the intervertebral foramen. The space through which a spinal nerve and spinal nerve sheath must pass to exit the spinal canal.

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.

Neurologically Intact: A normal neurologic exam.

Neurologist: A physician who specializes in treating disorders of the nervous system and has completed an ACGME approved specialty training program in neurology to be “board certified”.

Neuropsychologist: A psychologist who specializes in evaluating (by tests) brain/behavior relationships, planning training programs to help the person’s brain compensate for cognitive impairment and recommending alternative cognitive strategies to assist with daily functioning.

Neurology: The study of the nervous system.

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.

Neurosurgeon: A physician who specializes in surgery of the brain and nervous system and who has completed an ACGME approved specialty training program in neurosurgery.

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.

Nociceptors: Free nerve endings within the peripheral nervous system. They are normally stimulated by noxious stimuli and are responsible for the perception of pain.

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.

Nondominant Hand: The hand opposite the most used one. The non-dominated hand generally possesses less strength and less coordination.

Nonforce Technique: A chiropractic term which refers to a light adjusting force technique being administered to correct spinal subluxation.

Nonorganic Pain Behaviors: Patient behaviors to express pain that do not relate to anatomic or organic cause. This phrase is often used by doctors hired by an insurer to conduct a medical examination of an injured person to discredit the patient.

Nonorganic Signs: This term applies to any magnified pain behavior or malingering. See Nonorganic Pain Behaviors.

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.

NSAID: Abbreviation for Non-Steriodal Anti-Inflammatory Drug. More commonly known as ibuprofen, aspirin, and naprosyn.

Nucleus Pulposus: The soft, squishy and spongy inner portion of the intervertebral disc.

O, Obj: An abbreviation for Objective.

OA: An abbreviation for Osteoarthritis or Occipito-Atlantal joint.

Objection: Used to call the court’s attention to improper evidence or procedure. Objections also serve to identify evidence or legal issues that may be taken up on appeal to a higher court.

Occipital Lobe: Region in the back of the brain which processes visual information. Damage to this lobe can cause visual deficits.

Occipito-Atlantal Joint. The spinal joint between the base of skull and the top vertebra of the spine (atlas). This designation is often used in the osteopathic or manual treatment community rather that Atlanto-Occipital Joint.

Objective: A finding that is measurable by the examiner and not dependent on the patient’s statement.

Occipital: Referring to the back of the head or the base of the skull.

Occipital-Frontal Headaches: Pain which is usually described as starting at the base of the skull or in the back of the head and radiating to the forehead.

Occupational Medicine: A speciality of medical practice concentrating on work-related diseases and injuries.

Occupational Therapist: A licensed health care provider who assists in restoring activities of daily living to the disabled or injured person.

Occupational Therapy: Occupational Therapy (OT) is the therapeutic use of self-care, work and play activities to increase independent function, enhance development and prevent disability; OT may include the adaptation of a task or the environment to achieve maximum independence and to enhance the quality of life. The term “occupation,” as used in occupational therapy, refers to any activity engaged in for evaluating problems that interfere with functional performance.

Odontoid Process: The tooth-like projection from the upper surface of the body of the second vertebra in the neck. Also referred to as the Dens.

OMT: An abbreviation for Osteopathic Manipulative Treatment. The type of manipulation performed by most osteopaths and manual therapists. This usually refers to a low-velocity, low-to-medium-amplitude technique where a joint is carried through its full range of motion with the goal being to increase joint movement and function.

Opening Argument: The attorney’s first opportunity to tell the jury or other trier of fact what the case is about, including what evidence will be revealed through the witnesses’ testimony and exhibits.

Orger: A directive of a judge.

Organization, Cognitive: Using selective attention skills, the person correctly perceives stimulus attributes or task elements, selects a strategy, monitors use of the strategy and reaches a correct solution.

Orientation (see Disorientation): An awareness of one’s environment and/or situation, and the ability to use this information appropriately in a functional setting.

Orthopedic Surgery: Surgery of the bony skeleton, tendons, ligaments, and muscles.

Orthopedics: The branch of medicine devoted to the study and treatment of the skeletal system, its joints, muscles and associated structures.

Orthotic: A shoe insert used to control the position of the foot and ankle to create better mechanical stability.

Orthosis: Splint or brace designed to improve function or provide stability.

Orthotist: A skilled craftsman who develops and fits mechanical devices, such as a brace, splint or body jacket, designed to support or supplement a weakened body part or function.

Osteoarthritis: The most common form of arthritis involving the effects of wear and tear on the body’s structures. In the spine this is a degenerative process that includes spondylosis, spurring of the vertebral bodies, and deterioration of the facet joints. Cartilage degeneration is the hallmark of this type of arthritis.

Osteopath: Referring to an osteopathic physician or Doctor of Osteopathy (DO).

Osteopathic Manipulative Treatment: The type of manipulation performed by most osteopaths. See OMT.

Osteopathic Physician (DO): A physician who has completed a graduate course of medical education at an American Osteopathic Association – approved college of osteopathic medicine. See DO, Osteopath.

Osteophyte: A bony outgrowth, often in response to trauma to a joint or as a result of normal degenerativejoint disease. Also known as bone spurs.

Osteoporosis: Decreased bone density which may lead to mechanical failure or fractures due to even minimal physical stress on the bone.

Osteotomy: Literally, it means the cutting of bone.

OT: An abbreviation for Occupational Therapist.

Pain Clinic: A multidisciplinary team approach for treating patients with chronic pain. Education is emphasized, as well as physical conditioning, self-management techniques, decreasing narcotic dependence, and addressing psychological barriers to recovery.

Pain Generator: The anatomic structure that is causing pain.

Pain Scale: One method for quantifying pain. There are many different types of pain scales. The most common is a 0-10 scale termed the Visual Analog Scale with 10 as the “most severe” pain.

Palmer Diversified: A chiropractic technique where the primary adjustive force is the practitioner’s hands, also Diversified Technique.

Paraplegia: Paralysis of the legs (from the waist down).

Paraspinal Musculature: The muscles that can be readily palpated on either side of the spinous processes during an examination.

Paraspinal Tenderness: Tenderness in the muscles on one or both sides of the spinous processes.

Paravertebral: Adjacent to the vertebral column.

Paresthesia: An abnormal sensation of numbness usually involving tingling or pins and needles, which is typically not painful. It may also include a burning feeling.

Parietal Lobe: One of the two parietal lobes of the brain located behind the frontal lobe at the top of the brain.

Parietal Lobe, Right: Damage of this area can cause visuo-spatial deficits (e.g., the person may have difficulty finding their way around new or familiar places).

Parietal Lobe, Left: Damage to this area may disrupt a person’s ability to understand spoken and/or written language.

Pars Interarticularis: It literally means “the part between the articulations.” This is the portion of the vertebra which lies between the upper facet process and the lower facet process. If this section of bone is fractured or not fully fused, it may result in a spondylolysis or spondylolisthesis.

Pars Interarticularis Defect: A fracture or congenital defect in the bony portion connecting facet joints and the pars interarticularis. This is also called a spondylolysis and may lead to spondylolisthesis.

Party: A person or entity that takes part in a legal proceeding or transaction.

Passive Range of Motion: In the spine or extremities, passive range of motion (ROM) is measured in flexion, extension, lateral flexion, and rotation, abduction, adduction, inversion, and aversion. This differs from active range of motion in that the patient uses no voluntary muscle contraction and must be taken through the ROM by the examiner.

Patella: A bone located in front of the knee, commonly referred to as the kneecap.

PCE: Abbreviation for physical capacities evaluation.

PDR: Physicians Desk Reference.

Pedicle: That portion of a vertebra which separates the larger, vertebral body in the front from the smaller bony structures toward the back.

Perception: The ability to make sense of what one sees, hears, feels, tastes or smells. Perceptual losses are often very subtle, and the person and/or family may be unaware of them.

Peripheral Nervous System: The portion of the nervous system outside the central nervous system.

Peripheral Neuropathy: A generalized “slowing” of the peripheral nervous system which is often characterized by decreased sensation in a stocking and glove distribution in the feet and hands. This condition can sometimes be diagnosed with a nerve conduction study.

Perjury: False or misleading testimony while under oath to tell the truth. A criminal offense.

Perseveration: Refers to the inappropriate persistence of a response in a current task which may have been appropriate for a former task. Perseverations may be verbal or motoric.

Pettibon Technique: A chiropractic technique which uses complex formulas to ascertain various misalignment angles. Specific manual and instrument adjustments are used to correct these misalignments.

Physiatrist: A medical doctor who has completed residency training in Physical Medicine and Rehabilitation. A specialist in rehabilitation and outpatient non-operative orthopedic musculoskeletal care, as well as neurologic rehabilitation, who is trained to diagnose and treat disabling conditions. Board certification is given by the American Academy of Physical Medicine and Rehabilitation.

Physical Capacity Evaluation: A test of physical strength and stamina used to determine work restrictions and work tolerance. See Functional Capacity Evaluation.

Physical Therapist: The physical therapist (P.T.) evaluates components of movement, including muscle strength, muscle tone, posture, coordination, endurance and general mobility. The physical therapist also evaluates the potential for functional movement, such as ability to move in the bed, transfers, and walking; and then proceeds to establish an individualized treatment program to help the person achieve functional independence.

Physical Therapy: Treatment for musculoskeletal and neurological disorders provided by a licensed physical therapist. Usually involving exercise, electrical modalities, and myofascial techniques.

P.T. : Physical Therapist.

Physical Therapist: Graduate from a university program with a Master of Science or a Ph.D. in physical therapy. Licensed in each state, a physical therapist focuses on biomechanical components of the neuro-musculoskeletal systems with emphasis on functional limitations. Procedures used include manual physical therapy neuro-muscle exercises, posture correction, and home and work place analysis.

Piriformis Syndrome: Various symptoms involving posterior hip pain localized in the piriformis muscle that may include radiating numbness or tingling down one leg. A small portion of the population has a sciatic nerve which goes through the piriformis muscle, which may be irritated when inflammation occurs within the muscle.

Plaintiff: The party who requests damages and initiates a civil lawsuit.

Pleadings: The formal, written documents filed by the parties with the court which set forth, or elaborate on, their respective claims and defenses.

Plexopathy: Dysfunction of the brachial plexus or lumbar plexus.

Plexus: A network of nerves.

Positional Dysfunction: A manual therapy term for dysfunction or pathology when a spinal motion segment is in a particular position.

Post-Concussive Syndrome: Any alteration in cerebral function caused by direct or indirect forces transmitted to the head resulting in brief loss of consciousness, light-headedness, vertigo, cognitive and memory dysfunction, tinnitus, difficulty concentrating, amnesia, headaches, balance disorder, nausea and/or vomiting.

Posterior: The backside of a bodily part. Opposite of anterior.

Posterior Longitudinal Ligament: The ligament along the length of the spine attached to the backside of a vertebral body.

Post Traumatic Amnesia (PTA): A period of hours, weeks, days or months after the injury, when the person exhibits a loss of day-to-day memory. The person is unable to store new information and therefore has a decreased ability to learn. Memory of the PTA period is never stored, therefore things that happened during that period cannot be recalled. May also be called Anterograde Amnesia.

Post-Traumatic Stress Disorder: This is a psychologicalcondition involving emotional and behavioral distress after exposure to a traumatic event or events. Physiologic change such as increased sympathetic nervous system activity, alterations in stress hormones secretion, memory processing and limbic system abnormalities in brain imaging studies of traumatized patients have been shown in significant, longer term cases. The formal diagnosis is contained in the DSM-IV (Diagnostic and Statistical Manual) published by the American Psychological Association. Symptoms may include insomnia, irritability, difficulty concentrating, extreme psychological or physical distress when exposed to cues that remind the person of the incident, nightmares, anxiety, exaggerated startle response, numbing of the senses, avoidance of activities or places that bring back memories of the event, among others.

Posture: The attitude of the body. Posture is maintained by low-grade, continuous contraction of muscles which counteract the pull of gravity on body parts. Injury to the nervous system can impair the ability to maintain normal posture, for example holding up the head.

PPD: An abbreviation for Permanent Partial Disability.

Power of Attorney: A letter or document authorizing one person to act as an agent or attorney for another.

Prejudice Outweighs Probative Value: Rule of evidence which provides that relevant evidence may be excluded if its probative value is substantially outweighed by the danger that it may confuse or mislead the jury, or unfairly prejudice the opposing party.

Pre-Morbid Condition: Characteristics of an individual present before the disease or injury occurred.

Preponderance of the Evidence: Degree of evidence necessary for a plaintiff to win in a civil case. Evidence which is of greater weight or more convincing than the evidence which is offered in opposition. On a scale of 1 to 100, fifty-one percent (51%) or better.

Privilege: Protection against disclosure of information based on communications made in confidence between parties having legally protected relationships. Based on the policy that it is better to have frank, open communications between parties in certain relationships by protecting these communications from disclosure in litigation. Pertains to communications between attorney/client, doctor/patient, priest/penitent, and husband/wife.

Problem-Solving: Ability of the individual to bring cognitive processes to the consideration of how to accomplish a task.

Prognosis: The prospect as to recovery from a disease or injury as indicated by the nature and symptoms of the case.

Prone: Lying on one’s stomach.

Proprioception: The sensory awareness of the position of body parts with or without movement. Combination of kinesthesia and position sense.

Pro Se: When a party does not retain an attorney and appears for and represents himself/herself in court.

Prosody: The inflections or intonations of speech.

Proximal: Next to, or nearest, the point of attachment.

PRN: An abbreviation for Per Required Need.

Progressive Resistance Exercise:A rehabilitation technique with progressively increasing strength training.

Prolapsed Disc: A term often used synonymously with herniated disc the annulus fibrosis becomes disrupted and the inside of the disc material, the nucleus pulposus, extends outward.

Prolotherapy: The injections intended to cause scarring of tissue around joints to reduce ligament hypermobility at a joint area.

Pronated Foot: A foot that is extra lax, resulting in excessive roll of the foot and flattening of the arch.

Prone: Lying in a face-down position.

Protection & Advocacy TBI Program (PATBI): Free legal programs available in every state that provide individuals with TBI information, legal representation, and self-advocacy assistance.

Protective Order: If an objection is made to a discovery request because it seeks information of a sensitive nature, is not relevant, or is harassing in nature, a motion is made for a protective order. A common example is medical information that is clearly irrelevant to the injuries claimed, will not lead to admissible evidence, and which is of a sensitive nature. The court may grant a protective order allowing a party or witness to not comply with a discovery request for that information. In some instances, protective orders may allow the defense attorney to review the information, but will dictate how the information is to be stored, who has access to it, and what happens to the information once the case concludes.

Protruded Disc: A contained disc herniation, sometimes called a bulging disc.

Provocative Maneuver: A physical exam test which attempts to reproduce pain through movement, mobilization, pressure over a structure, or other means.

Proximate Cause: Refers to a cause which leads directly, or in an unbroken sequence, to a particular result. An element of negligence.

Psychometric Instrument: Standardized tests (utilizing paper and pencil) which measure mental functioning.

Ptosis: Drooping of a body part, such as the upper eyelid, from paralysis, or drooping of the visceral organs from weakness of the abdominal muscles.

PTSD: An abbreviation for Post Traumatic Stress Disorder.

Quadriparesis: Weakness of all four limbs.

Radicular: Of or pertaining to a nerve root exiting the spinal cord.

Radicular Pain: Pain caused by a radiculopathy or radiculitis.

Radicular Symptoms: Sensations such as pain radiating down arms or legs. Symptoms may involve motor or sensory dysfunction.

Radiculitis: Inflammation of a nerve root causing symptoms of pain in the distribution of that root.

Radiculopathy: Dysfunction of a nerve root that can cause (1) numbness or tingling in a specific pattern corresponding to that nerve root or (2) muscle weakness in the muscles supplied by that nerve, or (3) loss of reflex associated with that nerve.

Range of Motion: (ROM) The range of movement of a joint or a spinal area that is measured and compared to normal. Restrictions in the range of motion of a joint or spinal area indicates some type of dysfunction.

Range of Motion Active: The muscles around the joint do the work to move it.

Range of Motion Passive: Movement of a joint by means other than contraction of muscles around that joint (e.g., someone else moves the joint).

Reasonable Accommodation: In general, a reasonable accommodation is a change that enables a person with a disability to have equal opportunities with people who do not have a disability. Examples of reasonable accommodations include adding a ramp so people using wheelchairs can get into a building, changing work schedules, and providing interpreters.

Reasonable Medical Certainty: Standard for admission into evidence of opinions of a health care provider concerning his/her patient’s condition, diagnosis, or prognosis. A doctor’s opinion cannot be based on possibilities, but rather must be founded on probabilities. Reasonable medical certainty means “more probably than not.”

Reasoning, Abstract: Requires that the individual recognize a phrase that has multiple meanings and select the meaning most appropriate to a given situation. The term “abstract” typically refers to concepts not readily apparent from the physical attributes of a given object or situation.

Reconditioning: A supervised exercise program designed to promote physical conditioning through strength, flexibility, and increasing aerobic capacity.

Referred Pain: Pain that originates in one part of the body, but is felt in another part of the body.

Reflex Dystrophy: See Reflex Sympathetic Dystrophy.

Reflexology: A therapy which connects various regions in the sole of the foot with different body parts. The theory is that life energy, or chi, is channeled through these zones.

Reflex Sympathetic Dystrophy: A clinically determined syndrome characterized by burning, atrophy, hypersensitivity, temperature changes in the affected area, and decreased range of motion. The cause is usually trauma. This has recently been renamed Complex Regional Pain Syndrome.

Rehabilitation: Comprehensive program to reduce/overcome deficits following injury or illness and to assist the individual to attain the optimal level of mental and physical ability.

Release: Waiver, relinquishment, or giving up a right, claim, or demand.

Relevant Evidnece: Evidence having a tendency to make the existence of any fact that is of consequence to the determination of the action more or less probable than it would be without the evidence. Generally, only relevant evidence is admissible.

Respirator/Ventilator: A machine that does the breathing work for an unresponsive person. It serves to deliver air in the appropriate percentage of oxygen and at the appropriate rate. The air is also humidified by the respirator.

Respite Care : A means for taking over the care of a person temporarily (for a few hours to a few days) to provide a period of relief for the primary caregiver.

Restriction: A term to describe limitation of movement of vertebral sections.

Retrograde Amnesia: Inability to recall events prior to the accident; it may be a specific span of time or type of information.

Retrolisthesis: A term which refers to a vertebral body which has moved backwards relative to the vertebral body below.

Reversal: A radiographic term which describes a spinal curve which has been reversed to the opposite direction, e.g., the reversal of the normal lordotic curve of the cervical or lumbar spine.

Revised Code of Washington (RCW): Compilation of statutory laws enacted by the Washington State legislature. Organized topically into volumes, containing chapters and sections.

Rheumatoid Arthritis: A common type of inflammatory arthritis believed to be a result of an autoimmune process which primarily affects the joints of the hands and feet as well as the cervical spine. It can also affect all other joints in the body. It is characterized by pain, stiffness and swelling in the joints.

Rhizotomy: The cutting or burning of a nerve root. See also Neurotomy.

Roentgenometrics: A chiropractic technique which involves the study of x-rays by biomechanical analysis and measurement, using markers on static spinal views or acetate overlays on bending views.

Rolfing: A manual therapy technique creates by Ida Rolf used to correct posture and integrate structure. The technique involves manual soft tissue manipulation to balance the body in the gravitational field. The 10 sessions are often completed in sequence followed by an integrating session.

ROM: Abbreviation for Range of Motion.

Roos Test: A test for thoracic outlet syndrome in which the shoulder is abducted to 90 and the shoulder joint is externally rotated. The fingers are then rapidly flexed and extended. If this test elicits arm pain, vascular thoracic outlet syndrome may be implicated. The pulse is also monitored.

Rotated: An osteopathic, chiropractic, or manual treatment term which refers to a spinal vertebral segment which is rotationally out of position with respect to the vertebra below. The term rotated may apply to misposition of other skeletal parts.

Rotator Cuff Impingement: Compression of any of the rotator cuff or tendonous fibers at the shoulder joint underneath the supraspinatus tendon.

Rules of Evidence: Rules of law which determine which testimony, documents, etc. should be submitted for consideration by a judge or a jury, and the weight such evidence is to be given in determining a question of fact.

Sacroiliac Joint: Referring to the area where the sacrum and ilium bones form a joint.

Sacroiliac Joint Dysfunction: Dysfunction of the sacroiliac joint due to trauma or degenerative changes.

Sacral: See Sacrum.

Sacrum: The base of the bone support for the spine. It is made up of the S1 through S5 vertebrae, which fuse to form a triangular shaped bone.

Scalene: Three anterior neck muscles which attach between the back of the first six cervical vertebrae and the first and second ribs. This muscle group allows for bending and rotating the neck.

Scapula: The large, flat, triangular bone which forms the backside part of the shoulder. Also referred to the shoulder blade.

Schmorl’s Node: A bone defect in the upper or lower margin of the body of the vertebra. It may be traumatic, developmental, or degenerative in nature.

Sciatica: A description of pain and/or numbness associated with inflammation of the sciatic nerve, usually due to compression of the spinal nerve between fifth lumbar (L5) and first sacral vertebrae(S1). It is often the result of a herniatednucleus pulposus at the L4-5 or L5-S1 levels.

Sciatic Nerve: The major nerve supplying motor and sensory functions to the legs. This is the largest peripheral nerve in the body. This nerve later divides to form the tibial and peroneal nerve. It arises from the L4, L5, and S1-S3 spinal nerves. It emerges from the lumbar spine and sacrum into the gluteal region through the sciatic notch. It is the largest diameter nerve in the body.

Sciatic Notch: A notch between the sacrum and the ilium. The sciatic nerve travels through this region.

Scoliosis: An abnormal lateral curvature and/or rotation of the spine. May be idiopathic, anatomic (as with a short leg) or functional (as with muscle spasm) in etiology.

SCM: An abbreviation for Sternocleidomastoid Muscle.

Secondary Gain: An external benefit which arises from an illness such as monetary gain or attention. See Malingerer.

Section 504 of the Reahbilitation Act: Requires the state and federal government to make their programs and buildings accessible to people with disabilities. Governments must also make sure that people with disabilities have equal access to government jobs. For example, governments must provide devices or extra assistance to help people with disabilities do their jobs or apply for a job.

Section 508 of the Rehabilitation Act: Requires all federal agencies and agencies getting federal funds to make websites, telephone services, videos, and other electronic information accessible to people with disabilities.

Section 8 Housing Program (HCVP): A federal housing program that helps poor families, elderly people, and people with disabilities rent decent, low-cost housing. The program gives people and families a voucher that can be used to help pay rent for housing that the state has approved as safe and low-cost. For more information go to: Section 8 Made Simple at: www.tacinc. org or www.hud.gov.

Segmental Dysfunction: Refers to vertebral segments which are not moving normally in relation to one another.

Segmental Instability: Motion of a spinal motion segment which significantly exceeds normal range of motion for that segment so that further over-stretching of the supporting soft tissue may occur.

Seizure: An uncontrolled discharge of nerve cells which may spread to other cells nearby or throughout the entire brain. It usually lasts only a few minutes. It may be associated with loss of consciousness, loss of bowel and bladder control and tremors. May also cause aggressive or other behavioral change.

Selective Nerve Root Block: Injection of an anti-inflammatory and local anesthetic onto the sleeve surrounding a spinal nerve. This can be done for both therapeutic and diagnostic purposes to determine if a spinal nerve is causing pain. Also known as a Spinal NerveBlock.

Self-mobilization: Exercises by a patient to help move restricted joints.

Sensation: Feeling stimuli which activate sensory organs of the body, such as touch, temperature, pressure or pain. Also seeing, hearing, smelling and tasting.

Sensory Deficit: A decrease in one or more types of sensation noted on physical exam.

Sensory Stimulation: Arousing the brain through any of the senses.

SEP: A diagnostic technique called Somatosensory Evoked Potentials used to detect a sensory radiculopathy or significant myelopathy.

Sequencing: Reading, listening, expressing thoughts, describing events or contracting muscles in an orderly and meaningful manner.

Service of Process: Refers to the rules of law prescribing the manner, and upon whom, a summons and complaint giving a defendant notice of a lawsuit must be served. The person giving notice must be someone other than a party to the lawsuit, who is eighteen (18) years or older, and competent to be a witness.

Settlement: A final resolution of a claim by agreement between the parties.

Shiatsu: A style of acupressure/massage therapy that stimulates points along meridians and focuses on balancing “chi”. See acupressure and acupuncture.

Shoe Lift: An orthotic to correct a short leg or an abnormal or less than ideal postural position of a lower extremity part. See Orthotic.

Short Leg Syndrome: Pain symptoms arising from a difference in length between the lower extremities. Short leg syndrome may cause musculoskeletal-type symptoms which can be corrected with a shoe lift.

Shunt: A procedure to draw off excessive fluid in the brain. A surgically placed tube running from the ventricles which deposits fluid into the abdominal cavity, heart or large veins of the neck.

SI Dysfunction: A mechanical abnormality of the sacroiliac joint which alters normal movement.

SI Joint: See Sacroiliac Joint.

Skilled Nursing Care: Daily nursing and rehabilitative care that can be performed only by or under the supervision of skilled health care providers.

Skin Rolling: A physical examination technique in which the thumb and fingers are used to grasp the paravertebral skin and roll this tissue from inferior to superior. The ease of displacement of both skin and subcutaneous tissue is evaluated, as are the thickness of the skin and pain symptoms. Also a manual treatment technique used to break up scar tissue.

Skull Fracture: The breaking of bones surrounding the brain. A depressed skull fracture is one in which the broken bone exerts pressure on the brain.

Small Claims Court: Court of limited jurisdiction, available for resolution of disputes by the parties without attorneys. Original purpose was to “bring justice home to every man’s door.” Limited to claims not in excess of $2,500.00. Parties represent themselves at the hearing. Attorneys are restricted from participating.

SOAP: An acronym for a standard record keeping method of patient visit: Subjective, Objective, Assessment, and Plan.

Social Security Disability Income (SSDI): A federal program for people who have worked for several years and who become severely disabled and unable to return to work for at least a year. In order to qualify, a person must have almost no resources or money saved. The program gives the person money every month to pay for food, clothing, and shelter. For more information go to: www.ssa.gov/disability

Soft Cervical Collar: A soft neck collar made of foam rubber covered with fabric which provides support and limits movement of the neck.

Soft Tissue: Muscles, tendons, ligaments, cartilage, connective tissues and other non-bony structures of the musculoskeletal system.

Somatosensory Evoked Potentials: An electrical test used to determine the integrity of the sensory pathways in the spinal cord. Also termed SSEP.

Somatic Dysfunction: An osteopathic term meaning an alteration in the normal function of a joint.

Spasm: A painful involuntary, sustained contraction of a muscle, due to irritation.

Spasticity: An involuntary increase in muscle tone (tension) that occurs following injury to the brain or spinal cord, causing the muscles to resist being moved. Characteristics may include increase in deep tendon reflexes, resistance to passive stretch, clasp knife phenomenon and clonus.

Special Damages: Fixed costs or expenses attributable to any injury or loss, including past, present, and future income loss, treatment costs, and other out-of-pocket expenses.

SPECT: An acronym for Single Photon Emission Computed Tomography, a nuclear-radiographic technique. Often used to detect presence of fractures or other bone abnormalities.

Spinal Cord: The extension of the central nervous system which extends from the brain stem to the cauda equina and is surrounded by the spinal canal. This acts as a conduit for information to and from the brain as it relates to the rest of the body.

Spinal Fusion: A surgical procedure to form a bony bridge between two or more spinal vertebrae to eliminate movement over painful or unstable spinal segments. Spinal fusion can also occur at birth or as a result of the aging process.

Spinal Instability: Abnormal or excessive motion in a vertebral segment with respect to the vertebrae above and/or below it.

Spinal Motion Segment: A unit of the spine, including the two adjacent vertebrae, the intervertebral disc, the facet joints, all the interconnecting ligaments, two intervertebral foramen, and the nerves and vessels emerging there from the spinal canal.

Spinal Nerve: One of 31 right and left paired peripheral nerves which connect with the spinal cord.

Spinal Nerve Block: Injection of an anti-inflammatory and local anesthetic on to the sleeve surrounding a spinal nerve. This can be done for both therapeutic and diagnostic purposes to determine if a spinal nerve is causing pain. Also known as Selective Nerve Root Block.

Spinal Nerve Root: See Nerve Root.

Spinal Stenosis: Narrowing of the central spinal canal that contains the spinal cord and/or cauda equina. This can be caused by congenital conditions, abnormal development or degenerative changes of the disc and/or facet joints or ligaments.

Spinal Subluxation: A term used in chiropractic to describe the alteration of the normal dynamics between adjacent vertebrae, which may result in motion, muscular or neurological dysfunction.

Spinous Process: A projection of bone which extends from the junction of the two laminae projecting off the back of the vertebra.

Spondylitis: An inflammatory condition of the spine.

Spondyloarthritis: An arthritic condition of the spine. It is related to spondylosis.

Spondyloarthropathy: A form of inflammatory arthritis which typically involves the spine, especially the sacroiliac joints.

Spondyloarthrosis: Arthrosis of the synovial joints of the spine. This usually refers to degenerative joint disease.

Spondylolisthesis: Forward or backward displacement of one vertebra in the relation to the adjacent vertebra below. Depending on the amount of the displacement, spondylolisthesis may require surgical intervention to fuse the spine.

Spondylolysis: A defect or fracture of the pars interarticularis, on one or both sides. This condition is often associated with spondylolisthesis.

Spondylopathy: Any disease process or disorder of the vertebrae.

Spontaneous Recovery: The recovery that occurs as damage to body tissue heals. This type of recovery occurs with or without rehabilitation and it is very difficult to know how much improvement is spontaneous and how much is due to rehabilitative interventions. However, when the recovery is guided by an experienced rehabilitation team, complications can be anticipated and minimized, the return of function can be channeled in useful directions and in progressive steps so that the eventual outcome is the best possible.

Sprain: Trauma to the joint capsule or ligaments, causing pain and impairment of joint movement, depending upon the degree of severity of injury to the ligaments.

Spray and Stretch: A manual technique for the treatment of trigger points and tender points within muscle.

SSEP: Somatosensory Evoked Potentials. This is a neurodiagnostic test to evaluate sensory nerves.

Static Intersegmental Subluxation: A chiropractic describing term a malposition of vertebrae detected on static palpation testing.

Statute: Written law enacted by the legislature.

Statute of Limitations: Laws enacted by every state which govern the time frame when a lawsuit must be filed, and beyond which the claim can no longer be made. Statutes of limitation differ from state to state and according to the nature of the claim. The limitation period applicable to most claims for personal injuries and damages caused by negligence, including motor vehicle accidents, is usually three years.

Stenosis: In the spine, this can refer to a narrowing of the vertebral canal (central spinal stenosis), the bony foramen through which a spinal nerve passes (foraminal stenosis), or the lateral passage where a nerve descends to prepare to exit the spine (lateral recess or sub-articular stenosis).

Step Defect: A spinal fracture noted at the front side of the vertebral body.

Sternoclavicular Joint: The joint between the upper portion of the sternum and the clavicle.

Sternocleidomastoid Muscle: An anterior neck muscle which attaches at the sternum and collarbone and then at the mastoid process of the skull. It is often injured in whiplash injuries.

Sternum: The breast bone. It articulates with the clavicle and the cartilage of the first through the seventh ribs.

Steroid: A potent anti-inflammatory drug which can be given orally in tablet form, intravenously, intramuscularly, or into a joint, a tendon sheath or other tissues.

Stimulus: That which causes sensation (i.e., light for vision, salt for taste, sound for hearing, etc.). When a person begins to emerge from coma, an organized program of controlled stimulation is sometimes used to begin “exercising” the brain. However, when a person becomes agitated, the amount and intensity of stimulation should be limited (e.g., only one task for one sense at a time).

Strain: Trauma to the muscle or tendons as a result of violent contraction or excessive stretching.

Subacute: Between acute and chronic. Further defined by some to mean the time period six to twelve weeks into the healing process. Defined by others by the level of inflammation and symptoms.

Subarachnoid Space: The space below the arachnoid membrane which is filled with spinal fluid. The arachnoid membrane is a layer enclosing the brain and spinal cord, just below the dura.

Subdural: Beneath the dura (tough membrane) covering the brain and spinal cord.

Subjective: A finding on any exam that is reported by the patient and is dependent on patient report for its reliability.

Subluxation: In chiropractic terms, subluxation refers to an abnormal joint movement beyond normal range of motion, producing neurological effects. In medical terms, an incomplete or partial dislocation of a joint.

Subluxation Complex: A chiropractic term relating to the various components of a spinal subluxation. These components include spinal kinesiopathology (abnormal spinal position or movement), myopathology (abnormal muscle function), neuropathology (abnormal nerve function), histopathology (abnormal soft tissue function), and pathophysiology (resultant degenerative processes.

Subpoena: A written command requiring a person to appear at a certain time and place to give testimony at a deposition or other proceeding. A subpoena need only give the person five (5) court days notice to be valid.

Subpoena Duces Tecum: A written command requiring a witness to produce documentary or other tangible evidence he/she possesses or controls and which is relevant to matters at issue in the case.

Subrogation: When an insurance company pays the claim of a policy holder, the policy holder then gives the insurance company the right to seek money back from the person or manufacturer who caused the accident or damage. This is called subrogating the claim.

Summary Judgment: A procedure by which one party seeks to persuade the court that there is no genuine issue or controversy regarding material facts, and accordingly, that the party filing the motion is entitled to prevail as a matter of law.

Summons: Notice to all defendants that a lawsuit has been commenced, that they have been named as a defendant, and that they must answer the complaint within twenty (20) days or a default judgment may be taken against them.

Superior: Position of an anatomical part which is above or higher than another anatomical part.

Superior Court: This is the court of general jurisdiction over all personal injury type claims and cases involving probate, family law, real estate and criminal felonies. Also, it has jurisdiction over appeal from District Court.

Superior Ilium: One of the bones of each half of the pelvis. It is the top and widest part of the pelvis. See Ilium.

Supplemental Security Income (SSI): A federal program that provides money to people with low incomes who are age 65 and older and to people with low incomes and who have severe disabilities. The money helps pay for food, clothing, and shelter. For more information go to: http://www.ssa.gov/notices/supplemental-security-income/

Supreme Court of Oregon: Highest appellate court. Has discretion to accept or reject any appeal from the Court of Appeals.

Supported Employment: Competitive work in integrated work settings for individuals for whom competitive employment has not traditionally occurred, or for whom competitive employment has been interrupted as a result of a severe disability, and whom, because of the disability, need ongoing support services to perform that work.

Supraspinous Ligament: A ligament which attaches to and continues over the spinous processes.

Supraspinatus Tendinitis: Inflammation of the supraspinatus tendon, found at the top of shoulder blade/lower neck region.

Supraspinatus Tendon: The tendon attaching the supraspinatus muscle to the anatomy of the shoulder joint.

Surface EMG: A graphic record of micro-voltage present in muscles in static or active contraction as measured by sensors placed upon the skin.

Swayback: Excessive forward curve of the spine, including excessive lumbarlordosis and traumatic kyphosis. See lumbar lordosis.

Sx: Abbreviation for “symptoms” or “subjective” pain complaints.

Sympathetic Dystrophy: See Reflex Sympathetic Dystrophy.

Sympathetic Nervous System: One of the two divisions of the autonomic nervous system which effects heart rate, blood pressure, and blood flow to the skeletal muscles, perspiration, dilation of the pupils, and depression of gastrointestinal activity.

Symptom Magnification: The reporting of symptoms by a patient which are greater than would be expected. See Malingerer, Secondary Gain.

Synovial Fluid: The lubricating fluid within the joints.

Synovial Membrane: The normal lining of a joint, which becomes inflamed when traumatized or arthritic.

Synovitis: Inflammation of the synovial membrane.

T1 Weighted Image: An MRI technology for imaging of fat tissue as a bright signal and water as a dark signal. This is particularly helpful in the lumbar spine, as many of the structures are outlined by fatty tissue and show up dark against the bright fat signal.

T2 Weighted Image:MRI technology for the imaging of fluid, water, or fat as a bright signal.

Temporal: Toward the temples; the side of the skull.

Temporal Bone: A bone on both sides of the skull at its base, which contains the ear canal.

Temporal Lobes: There are two temporal lobes, one on each side of the brain, at about the level of the ears. These lobes allow a person to tell one smell from another and one sound from another. They also help in sorting out new information and are believed to be responsible for short-term memory.

Temporomandibular Dysfunction (TMD): Dysfunction of the temporomandibular joint. May result in headaches, jaw pain and contribute to neck pain.

Temporomandibular Joint (TMJ): The jaw joint between the mandible and the articular surface of the temporal bone. This joint allows opening and closing of the jaw, as well as numerous other movements. The joint contains a disc.

Tender Point: A specific area of tenderness within a muscle which does not refer pain to other body parts. It is commonly seen in fibromyalgia. Sometimes considered a latent trigger point.

Tendinitis: Inflammation of a tendon.

Tendon: Primarily the fibrosis non-contractile connective tissue attaching muscles to bones.

Tendon Reflex: A physical exam technique which evaluates the integrity of the neurologic function of the muscle being tested.

TENS: Transcutaneous Electrical Nerve Stimulation. A form of electrical treatment used to block pain perception.

Tension Headache:A headache caused by excessive contraction of cervical muscles.

Testimony: A formal statement, by a party or witness in a case under oath. Statement may be verbal or written.

Thecal Sac: Another name for the area within the dura.

Therapeutic Exercise: Instructing a patient in body mechanics, exercise to increase strength or range of motion, and general conditioning and flexibility.

Therapeutic Massage: Deep or light pressure applied to the musculoskeletal system for the purpose of muscle relaxation, myofascial release, or increasing local blood flow and lymph flow.

Thompson Technique: A chiropractic technique using a mechanical drop mechanism with an adjusting table, requiring less adjustive force.

Thoracic: Pertaining to the chest or thorax.

Thoracic Outlet Syndrome: TOS. Compression of the neurovascular bundle in the shoulder, collarbone and neck (usually irritation of nerves within the bundle). The compression may cause decreased or abnormal blood flow into the arms, often associated with certain overhead positions of the arms. Symptoms include paresthesia, numbness, pain in the arm and hand, and weakness in the hand.

Thoracolumbar Junction: The region of the twelfth thoracic vertebra and the first lumbarvertebra. This is the region where the relatively less flexible mid-back spine (due to the rib cage) joins with the more mobile low back.

Thoracic Vertebrae: The twelve vertebrae which connect the ribs and form the back wall of the thorax.

Ticket to Work AND Work Force Investment Act: A federal law passed in 1999 to help people who receive Social Security disability benefits get the supports they need to be able to return to work. For example, the law gives states the option to allow people with disabilities who return to work and make too much money to qualify for Medicaid to be able to buy Medicaid coverage. The law also helps people receiving SSDI to get free job training and help finding a job.

Tinnitus: Ringing in the ears or in the head due to nerve damage, over dosage of certain drugs, or excessive contraction of the small intricate muscle of the inner ear. Tinnitus can result from trauma.

Tissue Texture Abnormality: An osteopathic term describing a palpable change in the tissues that is associated with somatic dysfunction.

TMD Dysfunction: See Temporomandibular Dysfunction.

TMJ Syndrome: See Temporomandibular Dysfunction.

Tort: French word meaning “wrong”. Body of law which determines rights and liabilities when property is damaged or a person is injured, through negligent or intentional conduct.

Tort Reform Act: In 1986, the Washington State Legislature made numerous and substantial changes to Washington tort liability law. Changes include automatic waiver of patient/physician privilege after ninety (90) days after filing a lawsuit, and a cap on non-economic damages (which has since been found unconstitutional and invalidated by the Washington Supreme Court).

Tortfeasor: One who has committed a tort.

TOS: An abbreviation for Thoracic Outlet Syndrome.

Tracking, Visual: Visually following an object as it moves through space.

Transfer: Moving one’s body between the wheelchair and the bed, toilet, mat or car with or without the assistance of another person.

Transverse Ligament of the Atlas: A strong ligament passing over the odontoid process of the atlas.

Transverse Process: The lateral bony process (vertebral process) projecting from the side of the vertebrae.

Trapezius: A large, flat, triangular muscle on each side of the upper back that serves chiefly to rotate the scapula and assist in turning one’s head.

Traumatic Brain Injury (TBI): An injury caused by a blow or jolt to the head, penetrating head injury, or by being violently shaken, that disrupts the function of the brain. A TBI can change how a person acts, moves, communicates, and thinks. The term TBI is not used for brain injuries that happen during birth; those are called developmental disabilities.

Traumatic Brain Injury Act: A federal law passed in 1996 that creates programs to assist people with TBI and to help prevent TBI. For example, the TBI Act helps to provide 1) grants to states to provide services for people with TBI; 2) money to the National Institutes of Health to do TBI research and prevention; 3) money to the Centers for Disease Control and Prevention to collect data on TBI; and 4) grants to state protection and advocacy programs to provide free legal services and information to people with TBI. For more information on the programs funded under the TBI Act go to: www.biausa.org and click on Government Relations or www.tbitac.nashia.org

Traumatic Brain Injury Trust Fund: Laws in many states require money to be set aside in a fund to pay for services and supports for people with TBI. Many states get money for the fund from fines people pay if they break laws and could have caused accidents resulting in a TBI, for example, driving when drunk or speeding. Currently, the State of Washington does not have this type of fund.

Trial: Judicial examination and determination of legal and factual issues between the parties to an action. May be civil or criminal. In a trial by jury the jury decides questions of fact with the judge determining the law to be applied. In a trial by judge, he/she decides both the facts and the law to be applied.

Trial De Novo: Means “new trial.” In mandatory arbitration, after the parties receive the award or decision, a party not satisfied with the award may appeal by filing a request for a trial with the Superior Court. The request must be made within twenty (20) days of the award being filed with the court. No information related to the previous arbitration hearing or award from it can be made at the trial.

Trier of Fact: The decision maker who will hear the evidence and decide the outcome of a claim. Can be an arbitrator at a hearing, or a judge or jury at trial. VENUE: Relates to determination of which county a lawsuit should be filed in. In personal injury cases the plaintiff may sue the defendant in the county where the defendant resides, has his/her principal place of business, or where the collision took place.

Trigger Point (TP): A taut, palpable spot in muscle that is painful to touch and refers pain to another body area.

Trochanteric Bursitis:Inflammation of the trochanteric bursa surrounding the hip joint.

Tx: An abbreviation for “treatment”

Ulnar Nerve: The ulnar nerve provides sensory function to the pinky and ring finger. It takes its name from the ulna, one of the bones of the forearm, in close proximity and along which the nerve is located.

Ulnar Neuropathy: A lesion of the ulnar nerve which can cause numbness in the fourth and fifth fingers. This can be confused with a radiculopathy from the eighth cervical (C8) nerve root.

Ultrasound: High-frequency sound that is applied as a therapeutic heat treatment in physical therapy rehabilitation.

Uncovertebral Joint: The joints in the lower cervical spine from the second to the seventh cervical vertebrae (C2-C7). These are formed by the side projections on the rim of the vertebral bodies. They are independent of the disc and facet joints. Also known as the Joints of Luschka.

Unilateral: Pertaining to only one side.

Upper Cervical Dysfunction: A restriction or abnormal movement of the top two vertebral joints in the neck following a neck injury. A common cause of headaches.

VAS:Visual Analog Scale. A pain scale in which the patient records pain from 1 to 10, with 10 as the most extreme pain.

Vascular Headache: A headache caused by excessive dilation of the arteries in the brain and its dural coverings. See Migraine Headaches.

Vegetative State: A condition in which the person utters no words and does not follow commands or make any response that is psychologically meaningful. The transition of a person who remains unconscious from a state of “coma” to one of “vegetative behaviors” reflects subtle changes over a period of several months from a condition of no response to the internal or external environment (except reflexively) to a state of wakefulness but with no indication of awareness (cortical function). A person in this state may have a range of biological responses at the subcortical level such as eye opening (with sleep and wake rhythms) and sometimes the ability to follow with their eyes. Normal levels of blood pressure and respiration (vegetative functions) are maintained automatically. Also called Coma Vigil.

Ventral: Pertaining to the front part of the human anatomy.

Ventricles, Brain: Four natural cavities in the brain which are filled with cerebrospinal fluid (CSF). The outline of one or more of these cavities may change when a space-occupying lesion (hemorrhage, tumor) has developed in a lobe of the brain.

Verdict: The definitive answer given by the jury concerning the issues the judge asked them to resolve.

Vertebra: One of the twenty-four (24) bones that make up the spine. There are three types: cervical (seven in number), thoracic (twelve), and lumbar (five), with each section possessing unique characteristics. The sacralvertebrae are fused in one bone.

Vertebrae: The plural of vertebra.

Vertebral: Of or pertaining to the vertebrae.

Vertebral Body: The front portion of the vertebra which forms the vertebral column when stacked on another vertebra. The disc of the vertebral joint is found between adjacent vertebral bodies.

Vertebral Subluxation Complex: See Subluxation Complex.

Vertigo: Dizziness with a sensation of spinning.

Vocational Rehabilitation (VR): Services and supports that help a person with disabilities get a job, go to school, or get a volunteer position. For example, job counseling, computer training, and help finding a job. All states receive federal funding to run vocational rehabilitation programs. These are places people with disabilities can go to and request free VR services and speak to job counselors.

Voir Dire: Part of the jury selection process. A number of prospective jurors are selected and seated in the jury box. The judge and/or lawyers ask a series of questions to disclose any predisposition or biases that may impact their judgment. Generally, each party is entitled to three preemptory challenges by which prospective jurors can be removed without cause. If the judge so finds, jurors may also be removed for cause due to obvious bias or other reasons demonstrating an inability to serve.

V Sign: A radiographic sign seen on a lateral x-ray view which may represent a torn or stretched transverse ligament.

Waiver: A knowing, intelligent, and voluntary surrender of a known right or claim.

Whiplash Injury: A sprain or strain syndrome of the cervical spine caused by a hyperextension-hyperflexion or acceleration - deceleration injury. This most commonly occurs in car collisions.

Witness: Someone with knowledge pertaining to the facts of the case. Each party identifies his/her witnesses prior to trial or arbitration.

WNL: An acronym for “within normal limits”.

Work Hardening Program: A rehabilitation program involving gradually progressive work-related activities performed with good body mechanics in an attempt to prepare that person to return to work.

Workers’ Compensation: A state program that requires employees and employers to pay the cost of medical treatment and some lost pay for employees who are injured on the job. The employer pays regardless of who was at fault. In return, employees give up the right to sue employers even if the injury was the employer’s fault.

Z-joint: An acronym for zygapophyseal joint.

Zygapophyseal: Of or pertaining to the facet joints.

Zygapophyseal Joint: Same as facet joint.

COMMON CHIROPRACTIC EXAMINATION TERMINOLOGY

NEUROLOGIC EVALUATION:

Pathologic Reflexes Tests:

Platysma Sign: This is a pathologic reflex of the head indicating ipsilateral corticorspinal tract disease as seen in hemiplegia. The sign is present when the examiner applies counter-pressure to the patient’s flexing of the chin toward the chest. The Platysma muscle contracts on the sound side only, drawing the outer part of the lower lip downward and backward.

Snout Reflex: This is a pathologic reflex of the head most frequently seen in bilateral corticopontine lesions and indicates an upper motor neuron lesion. This reflex is considered positive when sharp tapping of the nose or of the middle of the upper lip causes an excessive face grimace or an exaggerated reflexion contraction of the lips.

Zygomatic Reflex: On this test the examiner taps the Zygoma lightly with a reflex hammer. If this results in lateral motion of the lower jaw on the percussed side, then the reflex is positive, indicating damage to the cortical innervation of the motor portion of the Trigeminal Nerve.

Finger Thumb Reflex: This test is done by the examiner firmly flexing the third to fifth finger of each of the patient’s hands at the proximal joints. This action produces opposition and adduction of the thumb and flexion at the metacarpophalangeal joint. This reflex is absent in patients with corticospinal lesions. If the reflex is absent only on one side it indicates a possible Pyramidal Tract lesion.

Kleist’s Hooking Sign: This is an upper extremity pathologic reflex performed by the examiner gently elevating the patient’s fingers with his or her own fingers. If the patient’s involved hand reactively flexes and hooks into the examiner’s fingers instead of passively going into extension, then this sign is considered present, indicating Frontal and Thalamic lesions.

Klippel-Weil Sign: This is an upper extremity pathologic reflex sign which is considered present when the flexed fingers of the patient’s affected limb are quickly pried open or extended by the examiner and it results in flexion and adduction of the patient’s thumb. The sign’s presence indicates Pyramidal Tract disease.

Babinski Reflex: In this test, which is considered the most constant of the pathologic reflexes, the plantar surface of the foot is directly and firmly stroked from the heel to the metatarsophalangeal joints, testing both inner & outer borders of the sole. If this results in a slow, tonic digital extension of the great toe with fanning of other toes (which usually disappears after the stimulus is removed), as opposed to a voluntary response (which is faster and usually accompanied by a rapid withdrawal of the leg), it indicates Corticospinal (Pyramidal) Tract disease.

Gordon’s Reflex: This is a lower extremity pathologic reflex where dorsiflexion of the great toe or all the toes results when the calf muscles are firmly compressed by the examiner. A positive reflex indicates a Pyramidal Tract lesion.

Oppenheim Sign: This is a lower extremity pathologic reflex where the examiner applies heavy pressure with the index fingers and thumb or with the knuckles of the index and middle fingers along the anterior tibial surface on either side of the tibial crest, stroking from the tibial tubercle down to the ankle. If at the end of this stimulation there is a slow, tonic digital extension of the great toe with fanning of the other toes, the sign is considered present, indicating Corticospinal (Pyramidal) Tract disease.

Strumpell’s Tibialis Anterior Sign: This test is performed with the patient supine. The examiner places one hand under the patient’s knee and the other hand over the middle anterior tibial third. First, the examiner strongly flexes the hip on the pelvis. Then, using the other hand, the examiner firmly flexes the knee. The sign is considered present when either of these actions causes dorsiflexion and adduction of the foot, indicating an upper motor neuron lesion (Spastic paralysis) of the lower limb.

Auditory Nerve Disorder Tests:

Bing’s Test: In this test, a 256 Hz tuning fork is placed on the top or crown of the patient’s head, while having the patient cover one ear. Normally, the blocked ear hears the sound the best by way of bone conduction. If no sound is heard in the covered ear, then the test is considered positive, indicating nerve deafness.

Gruber Test: The examiner holds a vibrating tuning fork close to the patient’s ear until the patient indicates he can no longer hear it. At that point, using his or her index finger, the examiner blocks off the patient’s external auditory canal and places the still vibrating tuning fork against the finger. If the sound does not become audible again, then this test is considered positive, indicating a lack of sensitivity of the ear to sounds.

Rinne Test: In this test, the stem of a vibrating 256 or 512 cycle tuning fork is placed on the mastoid process of the Temporal Bone. When the patient reports no longer hearing the sound, the opposite end of the tuning fork is immediately held in front of the patient’s ear about half inch from the external auditory meatus until the patient again reports no longer hearing the sound. If the sound is heard longer externally through air conduction, the test is considered Rinne Positive, which is normal. If the sound is heard for equal lengths of time at both positions, the test is considered Rinne Equal. If the sound is heard longer on the mastoid process (bone conduction), it is considered Rinne Negative. Rinne Equal or Rinne Negative indicates a physical obstruction of some sort in the airway or possibly middle ear disease. In the case of severe nerve deafness, no sound is heard at all.

Weber (Lateralization) Test: With the patient seated, the examiner places the stem of a vibrating 256 cycle tuning fork on the patient’s vertex or on the midline of the forehead just above the glabella. If the sound is heard equally on both sides, the test is considered Weber Negative, which is a normal response. If the sound is heard better on one side (lateralization), it is considered “Weber Left” or “Weber Right”, relative to the side on which it is best heard.

Clonus Tests:

Suprapatellar Reflex: This reflex is tested with the patient supine with both limbs straight and parallel. Using his or her index finger, the examiner exerts downward pressure on the patellar toward the feet. Using the index finger as a pleximeter, the superior portion of the patella is stroked posteriorward and toward the feet with a reflex hammer. Normally there is a single rebound response of the patella for each percussion. More than one kickback per stroke indicates suprapatellar clonus, which is one of the criteria for an upper motor neuron lesion.

Trepidation Sign: This reflex is tested with the patient supine with both limbs straight and parallel. Using his or her index finger, the examiner exerts downward pressure on the patellar toward the feet. Using the index finger as a pleximeter, the superior portion of the patella is stroked posteriorward and toward the feet with a reflex hammer. Normally there is a single rebound response of the patella for each percussion. When the patella goes into a rapid up and down movement, it is called The Trepidation Sign, which is one of the indicators of an upper motor neuron lesion.

Posterior Column Disorders:

Finger to Finger Test: In this test the patient with outstretched arms attempts to bring the tips of the index fingers together. The test is done with the eyes open and closed. If the patient can hit the mark with the eyes open but not closed, the test is considered positive, indicating Posterior Column Disease. If the patient cannot hit the mark in a coordinated way with eyes open or closed, then Cerebellar Disease is indicated.

Finger to Nose Test: In this test the patient with outstretched arms attempts to alternately bring the tip of each index finger to the tip of the nose. The test is done with the eyes open and closed. If the patient can hit the mark with the eyes open but not closed, the test is considered positive, indicating Posterior Column Disease. If the patient cannot hit the mark in a coordinated way with eyes open or closed, then Cerebellar Disease is indicated.

Heel-Knee Test: This test is done with the patient supine. The patient places the heel of one foot on top of the opposite knee and slowly slides the heel down the shin to the ankle. The test is done bilaterally first with the eyes open, then with the eyes closed. If the patient is unable to smoothly perform the above, then the test is considered positive, revealing evidence of proprioceptive system imbalance. More specifically, if the patient can perform the above better with the eyes open than closed, then Posterior Column Disease is indicated. If the patient cannot perform the test well with eyes open or closed, then a Cerebellar lesion is indicated.

Heel-Toe Test: In this test the patient walks a straight line heel to toe about ten steps forward, turns around, then returns ten steps back. Providing there is normal lower limb strength, this action should be done without faltering or loss of balance. If the patient is unable to perform the test normally, it is considered positive, indicating evidence of proprioceptive system imbalance.

Lhermitte’s Sign: This sign is present when bending the neck into flexion causes an electric shock like sensation to radiate down the neck and spine, which is indicative of Posterior Column disease of the spinal cord.

Romberg’s Sign: In this test, the patient stands upright with feet together and hands at the side. A slight amount of swaying is normal, but if the patient is unable to maintain balance without moving the feet, with the eyes open or closed, this sign is considered present, indicating spinal cord Posterior Column disease, notably Multiple Sclerosis and Tabes.

Brachial Plexus Disorders:

Adson’s Test: A physical exam test used in evaluation of thoracic outlet syndrome at the junction of the brachial plexus and the scalene muscles of the neck. The patient is placed in the sitting position with one arm straight out to the side and extended slightly backwards. The patient then takes a deep breath and turns the head toward the side being tested. A positive test is loss or diminishment of the wrist pulse on the side being tested.

Bikele’s Sign: With the patient outstretching the arm upward and backward with the elbow fully flexed, extending the elbow causes resistance and increased radicular pain from the cervicothoracic region. Because of the stretch this action puts on the brachial plexus nerve roots or their covering, it results in brachial plexus neuritis or meningitis symptomatology when this sign is present.

Brachial Plexus Tension Test: The patient elevates the shoulders through abduction and then extends the elbows to the onset of pain and hods for several seconds. This is followed by the external rotation of the shoulders which is held for several seconds. The examiner supports the shoulders and forearm in this position while the patient flexes the elbows. Reproduction of symptoms is a positive finding and may suggest brachial plexus or cervical root involvement

Cranial Nerve Testing:
There are 12 cranial nerves which are routinely examined on patients who have complaints which may suggest pathology. Below is a list of the 12 nerve and their function:

• CN I — Olfactory Nerve: Smell
• CN II — Optic Nerve: Vision
• CN III — Oculomotor Nerve: Light accommodation, eye movement
• CN IV — Trochlear Nerve:  Eye Movement
• CN V — Trigeminal Nerve: Facial sensation
• CN VI — Abducens Nerve: Eye Movement
• CN VII — Facial Nerve: Facial Muscle, Taste
• CN VIII — Auditory Nerve: Auditory function and balance
• CN IX — Glossopharangeal Nerve: Taste, gag reflex
• CN X — Vagus Nerve:  Voice and swallow
• CN XI — Spinal Accessory Nerve: Shoulder shrug
• CN XII — Hypoglossal Nerve:  Tongue Movement

 

Peripheral Nerve Tests:

Deep Tendon Reflex Test: A physical exam technique used to determine the existence and functioning of the nerves connected to the tested muscle. With proper technique, in normal patients, striking the tendon of the muscle will elicit a standard contraction of the muscle, thus assuring the reflex “arc” is intact. Disruption of either the sensory or motor pathways will affect the reflex.

Biceps Reflex: The patient is seated with the forearms resting on the thighs. The examiner places the biceps tendon under slight tension by placing his or her thumb over the center of the tendon. Using a percussion hammer, the examiner strikes his thumbnail, observing and feeling the flexion of the elbow and contraction of the Biceps Muscle, which normally results, otherwise the test is positive. A positive test may indicate an upper and lower motor neuron lesion as well as ascertaining the integrity of afferent and efferent fibers of the Musculocutaneous Nerve.

Brachioradialis Reflex: This reflex is tested with the patient seated with the forearms resting on the thighs with the thumbs facing up. While palpating the belly of the Brachioradialis, the examiner strokes its tendon with a reflex hammer at its point of maximum response. In a true brachioradialis stretch reflex, only the forearm will flex. This reflex is used to determine the afferent and efferent integrity of the Radial Nerve in relation to an upper or lower motor neuron lesion.

Infraspinatus Reflex: This reflex is tested with the patient seated. The examiner strokes the area over the scapula with a reflex hammer at a point that’s on a line that bisects the angle formed by the spine of the bone and its inner border. A normal reflex would be external rotation of the arm along with extension of the elbow. A positive test indicates a lack of integrity of the C5/C6 nerve roots and the Suprascapular Nerve.

Patella Tendon Reflex: The reflex contraction of the quadriceps muscle with tapping of the tendon of the patella. Used to discern indirectly the functioning of the L4 and, to a lesser extent, the L3 spinal nerve functions. Also known as the Knee Jerk Reflex.

Pectoral Reflex: The examiner puts his or her index finger over the anterior fold of the axilla, hooking the tendon of the Pectoralis Muscle. The patient’s arm is positioned halfway between adduction and abduction. The examiner then strokes the tendon with a reflex hammer. A normal response is little, if any, contraction of the Pectoralis Muscle. If there is hyperreflexia when compared to the opposite side, it is indicative of a Corticospinal Tract lesion above the level of the fifth cervical segment.

Radial Reflex: In this test, the seated patient rests the forearms on the thighs with the thumbs facing upward. The examiner taps the forearm over the radius proximal to its styloid process, working upward until the point of maximum response is located. A normal response would be slight supination, flexion and radial deviation of the hand. Hypo or Hyperreflexia reveals lack of C5/C6 segmental integrity, indicating an upper or lower motor neuron lesion.

Inverted Radial Reflex This reflex is tested with the patient seated with the forearms resting on the thighs with the thumbs facing up. While palpating the belly of the Brachioradialis, the examiner strokes its tendon with a reflex hammer at its point of maximum response. When this action causes flexion of the hand and fingers without forearm flexion or response, then the test is positive, which is considered an important arm reflex indicative of a lesion of the 5th Cervical segment of the spinal cord.

Ulnar Reflex: This reflex is tested with the patient seated with the forearms resting on the thighs with the elbows at right angles and palms facing downward. While palpating the ulnar musculature with one hand, the examiner strokes the styloid process of the ulna right next to the apex with a glancing blow from medial to lateral. The normal response to this reflex would be minimal pronation and ulnar deviation of the hand. A positive reflex indicates a lack of integrity of the afferent and efferent fibers of the Ulnar Nerve through their center C8 and T1.

Tinel Sign: This test is performed by gentle tapping with the finger or reflex hammer over the site or along the course of the involved nerve. If pain and/or a tingling sensation results in the distal distribution of the injured nerve, which persists for several seconds, the sign is considered present, indicating Carpal Tunnel Syndrome.

Phalen’s Sign: In this test, the wrist is held in complete flexion for 30 to 60 seconds. This sign is present when discomfort, numbness & paresthesia is reproduced or exaggerated in the hand & digits, indicating median nerve compression such as in Carpal Tunnel Syndrome.

Wartenberg’s (Oriental Prayer): In this test the patient adducts and extends the fingers while extending the thumbs. The examiner then has the patient raise both hands so they are side by side facing the floor, with the thumbs and index fingers touching tip to tip. The thumbs will not coincide when the index fingers touch, if there is paralysis of the Abductor Pollicis Brevis, indicative of Median Nerve palsy.

Lumbosacral Nerve Tests:

Heel-Walk Test: The patient walks on the heels several steps forward, then back the same way. If the patient has low back complaints and is unable to perform this action because of either pain or weakness, then a lesion of the fibers of the L5 Nerve Root should be suspected.

O’Connell’s Test: Specifically, a positive test would be evidence of neuritis proximal to the distal extent of the radiculopathy.

Quadriceps Reflex: In this test, the patient should be completely relaxed, with both lower limbs parallel and fully extended. The examiner elevates the limbs slightly by placing his or her forearm under the patient’s knees. The examiner then palpates the patellar tendons and then briskly strokes each side equally with a reflex hammer observing and comparing the response of the Quadriceps’ contractions and knee extensions. Hyporeflexia or hyperreflexia may indicate a lower or upper motor neuron lesion of the L2, L3 or L4 nerve roots or of the Femoral Nerve.

Toe Walk Test: In this test the patient walks on the toes about seven steps forward, turns still on the toes, then walks back the seven steps. The patient’s inability to do this easily could indicate a loss of integrity of fibers from the S1-2 nerve roots.

ORTHOPEDIC EVALUATION:

Cervical Lesion Tests:

Bakody Sign: This test is normally done with patients who have cervical radicular pain. The patient actively places the palm of the affected extremity flat on the top of the head while raising the elbow level with the head. When this action reduces or eliminates the radiating pain, the sign is considered present. A positive sign is indicative of nerve root irritation because of cervical foraminal compression.

Cervical Distraction Test: While seated, the patient actively rotates the head and neck until radicular pain is produced. The examiner then rotates the head to the same extent but with strong upward traction added to the motion. If this action performed by the examiner gives relief or significantly reduces the patient’s cervical and/or radicular pain, this test is considered positive, indicating nerve root compression. If the patient can’t actively rotate the head or neck because of pain, the examiner can still do this test by adding traction with or without rotation.

Jackson Compression Test: In this test, the patient, sitting upright, attempts to laterally flex the neck and head toward the affected shoulder. Then the examiner exerts downward pressure with clasped hands on top of the patient’s head. The test is positive if this action exacerbates the patient’s cervical and/or radicular pain indicating nerve root compression.

Foraminal Compression Test: A physical examination technique which reduces the opening of the foramen which may demonstrate if there is pressure upon the exiting spinal nerve. The test is done to detect spinal nerve root involvement, a herniated disc, bulging disc, or foraminal stenosis. The patient is seated with the head and neck in a neutral position. Pressure is increasingly applied on the head and neck in mild lateral flexion to either side. A positive result replicates numbness or tingling into a dermatome of the upper extremity. Also called Sparely’s Manuever.

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.

Maximum Cervical Compression Test: In this test, the patient, sitting upright, attempts to laterally flex the neck and head toward the affected shoulder. Then the examiner directs the patient to bring the chin as close as possible to the shoulder. The test may be repeated passively if there is no response when the patient does the action actively. The test is positive when the action causes radicular pain on the side of the flexion and rotation. A positive test reveals cervical nerve root compression in that the action narrows the diameters of the intervertebral foramina as much as anatomically possible.

Shoulder Depression Test: This test is done with the patient supine. The examiner standing at the head of the patient, flexes the neck to the side opposite to the shoulder being tested while pushing the shoulder caudad. Then, while maintaining the depression of the shoulder, the head is rotated, again to the side opposite to the shoulder being tested. If radicular pain is either produced or aggravated the first action and then confirmed by the second, the test is considered positive. A positive test indicates adhesions of the dural sleeves, the spinal roots, or the adjacent structures of the joint capsule on the side of the shoulder being depressed.

Soto-Hall Test: With the patient supine and the examiner exerting pressure on the sternum to prevent either lumbar or thoracic flexion, the examiner places the other hand under the patient’s occiput and flexes the head and neck slowly and forcibly upon the sternum. This causes more and more of a pull on the posterior spinous ligaments, starting at the Ligamentum Nuchae, moving downward until it reaches the spinous process of the involved vertebra. There the pull acts as a lever compressing the vertebral body, thus causing localized pain. This test is mainly used to diagnose and localize vertebral bony disease and injuries, particularly of the compression type. This patient’s pain was localized at C3/4.

Spurling’s Sign: A physical examination procedure test in which the patient’s head is rotated sideways and extended backwards, while gentle compression is applied to the top of the head. The test is used to determine if neural foraminal narrowing is compressing the exiting spinal nerve. A positive test involves pain, numbness, or paresthesia extending into the arm below the elbow. Also called Foraminal Compression Test.

Spurling’s Test The examiner stands behind the seated patient and has the patient turn his or her head toward the involved side in maximal axial rotation and then maximal lateral flexion is added. The examiner then delivers a vertical blow to the uppermost portion of the cranium. Any significant increase of neck, shoulder or arm pain from the blow would be a positive test, indicating a stimulation of existing nerve root irritation or other problems related to disc disease and cervical spondylosis.

Valsalva Maneuver: This test is done on patients with cervical problems and is done with the patient seated. The examiner directs the patient to hold the breath and bear down, as if moving the bowels. This action increases intrathoracic pressure and if it results in an increase in cervical pain and radicular neuralgia the test is considered positive, indicating intervertebral nerve root compression from a disc occlusion.

Thoracic Lesion Tests:

Chest Expansion Test: With the patient standing or sitting erect, the examiner takes a chest measurement with the tape measure over the lowest part of the fourth intercostal space with the patient maximally exhaling. The patient then maximally inhales and another measurement is taken. Normal expansion for an adult male is at least two inches, and one and one-half inches for an adult female. Less than these amounts would be a positive test, indicating thoracic fixation. This is considered an important sign in any ankylosing condition such as Marie-Strumpell Disease.

Forestiers Bowstring Sign: In this test, the patient performs lateral bending while in a standing position. If there is ipsilateral tightening and contracture of the paraspinal muscles instead of the contralateral side tightening, the sign is present, indicating Ankylosing Spondylitis (Marie-Strumpell’s Disease).

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.

Lewin Supine Test The supine patient with the arms held straight out above the thighs and the legs together and held down by the examiner is asked to sit up. If the patient cannot perform this action, the test is considered positive, indicating an ankylosing dorsolumbar spinal lesion.

Schepplemann’s Sign: The patient is asked to side bend with their arms over their head. Pain elicited on the concave side suggests intercostal neuritis. Pin on the convex side suggests generalized musculoligamentous strain/sprain

Spinal Percussion Test: The patient is seated while the doctor percusses the spinous process’ and paraspinal tissues. Pain during percussion of the spinous process suggests fracture or severe sprain. Pain during percussion of the paravertebral soft tissues suggests muscular strain or sensitive myofascial trigger points.

Soto Hall Test: A physical exam test in which the chin is brought to the chest, with the patient flat on their back. Pain will be felt at the site of the lesion in spine abnormalities. Classically used to screen for spinal meningitis and to clarify spinal related pain.

Sternal Compression Test: The patient is supine and the examiner exerts downward pressure on the sternum. A positive finding of lateral rib pain suggest possible rib fracture.

Lumbar Lesion Tests:

Adam’s Sign: This sign is present when acute bilateral low back pain results when flexion is performed from the standing Adam’s position, with flexion being the most painful position when compared to extension, lateral bending and rotation. Rotation is the freest and least painful of the spinal motions performed by the patient. This sign indicates an intervertebral disc posterior or posterolateral rupture, as forward flexion is the motion that most antagonizes this type of lesion, whereas rotation causes the least amount of stress in this type of pathology.

Demianoffs Sign: This sign is useful in differentiating sacrolumbalis muscle pain from lumbar pain of any other origin. In this test, the examiner performs straight leg raising on the supine patient. The sign is present when pain prevents the examiner from raising the leg more than fifteen degrees, indicating the pain is due to the stretching of the sacrolumbalis (Iliocostalis Lumborum Muscle).

Double Leg Raise Test: This test is performed with the patient supine. The examiner straight leg raises each leg separately, noting the angle where pain in produced. Then both legs are raised together, again noting the angle where pain is produced. If the angle where pain occurs when both legs are lifted together is less than either leg when lifted separately, then this test is considered positive indicating lumbosacral joint involvement.

Duchenne’s Sign: In this test, the supine patient is asked to plantar flex the foot while the examiner pushes up (dorsally) the head of the first metatarsal with his or her thumb. The sign is present when the medial border of the foot dorsiflexes and the lateral border plantar flexes. Also, the head of the first metatarsal gives no resistance to the examiner’s thumb. A positive sign indicates paralysis of the Peroneus Longus from a lesion of the Superficial Peroneal Nerve or a lesion at or above the L4, L5 and S1 Nerve Roots.

Goldthwait’s Sign: This test is designed to differentiate between sacroiliac and lumbosacral involvement. With the patient supine, the examiner palpates the lumbosacral joint while slowly straight leg raising the limb on the affected side. The test is then repeated on the unaffected side. When pain is brought on before the lumbosacral joint is opened and it’s possible to raise the leg on the unaffected side to a greater level than the limb on the affected side without pain, then a lesion of the sacroiliac joint or ligaments is presumed. When no pain is experienced until the lumbosacral movement occurs and pain is felt when either leg is raised to approximately the same height then a lumbosacral lesion is more likely.

Heel-Toe Gait: A physical examination maneuver wherein the patient is asked to walk on heels and then walk on toes across the room. Inability or difficulty walking on the heels suggests an L4-L5 motor radiculopathy. Difficulty walking on the toes suggests an S1 radiculopathy. Also, commonly used to test cerebellar function.

Lumbosacral Stress Test: This test is used to localize posterior joint involvement in the lower lumbar motor units. The patient is in the prone position. Both legs are flexed at the knee and approximated to the buttock. A positive finding is pain at the lumbosacral junction without radiation to the lower extremities. This test demonstrates generalized musculoligamentous involvement of the lumbar spine and suggests strain/sprain

Low Back Hyperextension Test: This test helps to localize low back lesions. The patient lies prone with the arms at the sides and legs straight and together. The examiner holds the legs down and has the patient lift the head, neck, and shoulders as far back as possible. Then the examiner has the patient point to the center of the pain resulting from this action. This patient pointed to L4/5.

Lasegue Differential Sign . This test is normally done on patients with Sciatica. If pain results from straight leg raising, but flexing the thigh on the pelvis with the knee flexed produces no sciatic pain, the sign is considered present, tending to rule out hip joint disease.

Lewin Punch Test: In this test, if punching the left or right buttock of the standing patient produces a referred pain in the back, it is a positive test, indicating a spinal lesion, usually a protruded disc. The punched buttock that produces the pain is the side of the lesion. Punching the buttock on the side opposite the lesion, does not elicit pain.

Lindner’s Sign: This test is done with the patient supine. Standing behind the patient, the examiner enforces head, neck and dorsolumbar flexion, placing the patient’s trunk into a large “C-shaped” curve. The sign is present when this action aggravates or reduplicates the radicular pain of the patient’s main complaint, which is indicative of low back nerve root compression.

Nachlas’ Test This test is performed with the patient in a prone position. Each foot is passively raised from the table, maximally flexing the knee. The examiner also exerts downward pressure over the pelvis to prevent buckling at the hips. The test is considered positive when the patient experiences pain in the sacroiliac region or the lumbosacral region, and at times, along the nerves that run in front of these joints, indicating a lesion of those joints.

Smith-Peterson Test: The examiner palpates the low back of the supine patient, while straight leg raising each leg. When there is acute inflammation, motion is more restricted toward the affected side. The opposite is true when the sacroiliac is involved. However, when straight leg raising, if pain begins after lumbosacral movement occurs, then a sacroiliac or lumbosacral lesion may be present. If the lesion is sacroiliac, the leg on the opposite side can be brought higher without pain If the lesion is lumbosacral, the pain comes on when both legs are at the same height.

Straight-Leg Raise(SLR): A physical examination maneuver typically used to determine if a low back spinal nerve is under tension. The patient is lying on his/her back or in a sitting position, and the leg is raised.

Sacroiliac Lesion Tests:

Anterior Innominate Test: This test is done on patients with lower trunk pain. The standing patient places the leg opposite the painful side two to three feet in front of the other foot. The patient then bends over the forward extremity putting all the weight on the front leg until the back foot raises off the floor. If this action causes or further aggravates the patient’s lower trunk pain, the test is considered positive, indicating a forward derangement of the ilia (anterior innominate) in relation to the sacrum.

Erichsen’s Sign: This test is done with the patient prone. The examiner, with the hands over the dorsum of the ilia, bilaterally thrusts toward the midline. If this produces pain over the sacroiliac area, the test is positive indicating sacroiliac joint disease as opposed to hip joint disease.

Gaenslen’s Test: On this test, the examiner has the patient lie supine with the affected side lying close to the edge of the table. The hip and knee on the unaffected side are flexed, while the patient clasps the flexed knee to his chest. The examiner then applies pressure against the clasped knee and the knee of the extended hip. If this action results in an exacerbation of pain from the pelvis, then the test is positive, indicating a sacroiliac joint lesion.

Gillis’ Test: On this test the examiner places the base of the palm of one hand over the prone patient’s sacroiliac joint on the unaffected side, thus fixing the sacrum with the fingertips fanning over the affected sacroiliac joint. With the other hand, the examiner lifts the thigh of the affected side putting the hip joint into extension. If this action exacerbates the pain of the main complaint over the sacroiliac joint, the test is considered positive, indicating Sacroiliac joint disease.

Goldthwait’s Sign: This test is designed to differentiate between sacroiliac and lumbosacral involvement. With the patient supine, the examiner palpates the lumbosacral joint while slowly straight leg raising the limb on the affected side. The test is then repeated on the unaffected side. When pain is brought on before the lumbosacral joint is opened and it’s possible to raise the leg on the unaffected side to a greater level than the limb on the affected side without pain then a lesion of the sacroiliac joint or ligaments is presumed. When no pain is experienced until the lumbosacral movement occurs and pain is felt when either leg is raised to approximately the same height, then a lumbosacral lesion is more likely.

Hibb’s Test:This test is performed with the patient in a prone position. The examiner, while stabilizing the pelvis on the side nearest to him, flexes the opposite knee to a right angle. From this position, the examiner slowly laterally pushes the leg causing strong internal rotation of the femoral head. The test is done bilaterally. Pelvic pain reveals a positive test, indicative of a sacroiliac lesion.

Iliac Compression Test: Patient is Prone, examiner places open palm on one PSIS, the the other feeling for joint play and reproduction of pain. Used to rule out a sacroiliac lesion.

Laguerre’s Sign: This test is done with the patient supine while the thigh and knee are flexed to right angles. Then the thigh is abducted and rotated outward. This forces the head of the femur against the anterior portion of the hip joint capsule. The sign is present when this action produces pain, tending to rule out a lumbosacral lesion, but indicating a hip joint lesion, iliopsoas muscle spasm or a sacroiliac lesion.

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.

Lewin-Gaenslen’s Test: In this test, the patient lies on one side and pulls the knee of that same side up to the chest, while extending the other thigh. The examiner applies additional pressure from behind, forcing extension of the other thigh. Exacerbation of pain from the pelvis is considered a positive test, indicating a Sacroiliac joint lesion.

Nachlas’ Test: This test is performed with the patient in a prone position. Each foot is passively raised from the table, maximally flexing the knee. The examiner also exerts downward pressure over the pelvis to prevent buckling at the hips. The test is considered positive when the patient experiences pain in the sacroiliac region or the lumbosacral region, and at times, along the nerves that run in front of these joints, indicating a lesion of those joints.

Sacroiliac Resisted Abduction Test: This test is done with the patient lying on the side with the upper leg straight out and slightly abducted while the lower leg is flexed at the hip and knee for stability. With the patient resisting, the examiner applies downward pressure on the upper limb. The test is then repeated on the opposite side. If this action causes pelvic pain around the posterior superior iliac spine, the test is considered positive, indicating a Sacroiliac lesion, and more specifically, a sacroiliac sprain or subluxation.

Sacroiliac Stretch Test: This test is done with the patient supine. The examiner, with crossed arms, places his or her hands on the anterior superior spine of each ilium and applies pressure downward and laterally. The test is considered positive only if the patient can identify deep seated unilateral gluteal or posterior crural pain, as opposed to pain from table pressure on the skin over the sacrum, or from the examiner’s hands or from the lumbosacral area from the pelvis being rocked. A positive test would indicate an anterior sacroiliac ligament strain.

Smith-Peterson Test: The examiner palpates the low back of the supine patient, while straight leg raising each leg. When there is acute inflammation, motion is more restricted toward the affected side. The opposite is true when the sacroiliac is involved. However, when straight leg raising, if pain begins after lumbosacral movement occurs, then a sacroiliac or lumbosacral lesion may be present. If the lesion is sacroiliac, the leg on the opposite side can be brought higher without pain. If the lesion is lumbosacral, the pain comes on when both legs are at the same height.

Yeoman’s Test: This test is done with the patient in a prone position. The examiner exerts downward pressure over the suspected sacroiliac joint, while maximally flexing the ipsilateral knee. Then the thigh is hyperextended while holding down the pelvis. The test is positive when deep pain in both sacroiliac joints is causes from the above action, indicating a strain of the anterior sacroiliac ligaments.

Sciatic Nerve Lesion Tests:

Bonnet’s Sign: is used to rule out radiculopathy of the sciatic nerve. The test is similar to a Straight Leg Raise with the leg and though rotated internally

Bragard’s Sign: This test is done with the patient supine with both legs straight. The examiner straight leg raises the leg on the affected side until the point the patient feels pain. At this position, the examiner firmly dorsiflexes the foot. If there is an increase in radicular pain from the above, the test is considered positive, indicating peripheral or nerve root irritation of the sciatic nerve.

Deyerle’s Sciatic Tension Test: This test is performed with the patient seated. The examiner extends the affected leg at the knee to the point of the pain being reproduced. Then the knee is slightly flexed with firm pressure being applied in the popliteal fossa. If radiculitis symptoms are increased, the test is considered positive, indicating a sciatic nerve lesion, in that the test shows irritation of the sciatic nerve above the knee from stretching the nerve over an obstruction.

Lasegue (Straight Leg Raise) Test: This test is done with the patient supine and with the knee in extension. The examiner, actively flexes each thigh slowly while holding the other hand on the knee to prevent its flexion. The leg is lifted 90 degrees or until pain prevents further motion. The final angle of flexion at which pain occurs, as well as the location and intensity of the pain are noted by the examiner. This test is considered positive when the straight leg cannot be raised to 90 degrees without pain.

Sicard’s Sign: With the patient supine and legs fully extended, the examiner lifts the leg to a point that is just short of producing pain. Then the great toe is dorsiflexed. The sign is present when this action results in sciatic pain, indicating sciatic radiculopathy.

Turyn’s Sign: This test is performed with the patient supine with both legs straight out. If dorsiflexion of the great toe brings on pain in the gluteal region, then the sign is present, indicating sciatic radiculopathy.

Intervertebral Disc Syndromes:

Amoss’ Sign: This test is usually performed on patients with dorsolumbar or lumbosacral complaints. The patient is made to lie on his or her side and then is told to rise from the table. When this action of arising from a recumbent position causes significant localized thoracic or lumbosacral pain, the test is considered positive. A positive test indicates either Ankylosing Spondylitis, Severe Sprain or Intervertebral disc Syndrome.

Bechterew’s Test (seated straight-leg raising): is used to rule out a lumbosacral intervertebral disc protrusion.

Bowstring Sign: This test is done with the patient supine. The examiner performs straight leg raising until the patient experiences some discomfort. At this level the examiner flexes the knee slightly and rests the foot on his or her shoulder until any pain subsides. The examiner then applies pressure to the hamstrings. If this doesn’t produce pain, the examiner moves the thumbs over the popliteal fossa and applies pressure over the popliteal. If pain is reproduced in the leg or in the back, this sign is considered present, indicating nerve root compression or a ruptured intervertebral disc.

Cox Sign: This test is performed with the patient supine. The examiner performs straight leg raising, and if the patient’s pelvis rises from the table instead of the hip being passively flexed, then the sign is present. The sign indicates a disc Prolapse into the Intervertebral Foramen.

Dejerine’s Sign: is used to rule out a mechanical obstruction from a herniated disc, tumor or bony closure.

Fajersztajn’s “Well Leg Raising” Test: This test is used when unilateral sciatica is present. The examiner passively straight leg raises the unaffected limb to the point of causing or increasing radiculitis in the opposite side. When none is produced, then strong dorsiflexion of the foot is added. The test is positive when either of these two actions produce radicular pain on the opposite side to the leg being lifted. A positive test tends to confirm the existence of a ruptured disc lesion as it produced sciatica at the nerve root level.

Kemp’s Test: This test can be done with the patient standing or sitting. While stabilizing the pelvis, the patient’s shoulder if firmly forced obliquely backward, downward and medial. The idea is to put the lower spine on the opposite side to the one being tested, into a combined position of rotation, lateral bending, and extension. The test is considered positive when low back pain radiates into the lower extremity, indicating facet syndrome, fracture or disc involvement.

Lasegue Rebound Test: This test is done with the patient supine with the arms at the side. The examiner performs straight leg raising on the side of the main complaint until reaching muscle resistance or pain as indicated by the patient. The leg is then dropped into a pillow or the examiner’s hand, without warning. If this action aggravates backache and sciatic pain and low back spasm, the test is considered positive, which is particularly diagnostic of Psoas spasm or irritation, and generally indicative of an intervertebral disc lesion above the lumbosacral level.

Lewin Snuff Test . In this test, the patient is given a pinch of mild pepper, snuff, etc. to sniff up the nostril in order to cause sneezing. If the resultant sneezing causes a localized spinal and radicular pain, the test is considered positive. A positive test indicates an intervertebral disc Rupture.

Sitting Root Test: In this test, the patient is seated in a chair with the neck flexed. The examiner extends the knee on the affected side up to ninety degrees. Low back pain and radiation of the pain indicate the test is positive. This test places abnormal tension on the Sciatic Nerve and patients with true Sciatica will tend to arch backwards and complain of radicular pain. A malingerer will not complain of any symptoms.

Milgram’s Test: This test is performed with the patient supine while both limbs are held straight out with the heels two to three inches from the table for at least 30 seconds. The test increases subarachnoid pressure and is positive when the patient is unable to hold the position for 30 seconds without pain, indicating pathology within or outside the spinal cord sheath, such as a herniated disc.

Naffziger’s Test: On this test, the examiner stands behind the seated patient and compresses both internal jugular veins with the index and middle fingers for a period of up to forty-five seconds. If this results in radiating sciatic pain, the test is considered positive, indicating nerve root compression by an extruded disc or other mass.

Nervous System Lesion Tests:

Ciliopupillary Reflex: This test has the patient seated erect, looking straight ahead. The examiner carefully observes the size and shape of the patient’s pupils while passively and maximally rotating the patient’s head and neck to one side and then the other. This reflex is observed when either pupil becomes larger or smaller after the head and neck have been rotated, indicating a positive test. A positive test is indicative of an Autonomic Nervous System lesion. This reflex is considered to be especially important on a post-traumatic basis, such as when the patient suffers a “whiplash” type injury to the cervical spine.

Huntington’s Sign: This test is performed with the patient supine with the legs hanging over the edge of the table at the knees. The examiner has the patient cough hard at least three times. If this action causes flexion of the thigh and extension of the knee on the weak side, the sign is considered present, indicating the weakness may be due to an Upper Motor Neuron Lesion.

Morquio’s Sign: The supine patient’s legs are straight out with the examiner at the head of the patient attempting to raise the patient to a sitting position, with the patient vigorously resisting. If when the patient’s knees and hips are placed into passive flexion the trunk can be lifted to a sitting position with little opposition, then this sign is considered present. The sign is indicative of Epidemic Poliomyelitis.

O’Connell’s Test: In this test, the patient’s unaffected leg is raised straight, with the angle of flexion noted along with the location of pain, if any. Then the affected leg is tested in the same way. Then, both legs are simultaneously flexed just short of the point of pain. The good leg is then lowered and if this last action causes an exacerbation of pain on the affected side, the test is considered positive, indicating lumbar peripheral neuropathy. Specifically, a positive test is evidence of neuritis proximal to the distal extent of the radiculopathy.

Thomas’ Test: On this test, the examiner maximally flexes the supine patient’s hip and knee of the side opposite to the side being tested, bringing the knee to the patient’s chest. The examiner then has the patient clasp the knee in order to maintain this posture. If this action causes the hip and knee of the opposite limb to elevate off the table, the test is considered positive. Normally, the opposite limb should have enough hip flexor stretch to allow the thigh to continue to lie flat on the table during this action. Thus a positive test indicates flexor tightness or flexion deformity of the hip.

Soft Tissue Lesion Tests:

Sign of the Buttock: On this test, the examiner performs a straight leg raise test on the supine patient. If this action along with passive hip flexion with the knee extended are both limited and painful, with the pain originating from the buttock as opposed to the hip, lumbosacral spine, etc., then this sign is considered present. When fever is also present it indicates inflammation of the upper femur (osteomyelitis), the sacroiliac joint (septic arthritis), ischio-rectal abscess or septic bursitis. If there is no accompanying fever, then neoplasm of the upper femur or iliac bone would be suspected.

Dejerine’s Signs aka Dejerine’s Triad: involves coughing sneezing and straining during defication which reproduces and aggravates radicular symptoms . This sign is present in space occupying lesions which can be caused from herniated discs, spinal cord tumor, fracture, etc. The course of the referred pain helps to localize the suspected lesion.

Hueter’s Fracture Sign: This test can be used to differentiate types of lesions, such as semisolid lesions as distinguished from a more dense lesion such as a hard tumor, etc. In this test, the examiner marks the main point of irritation and two more points on either side of the central point. These marks are duplicated on the non-affected side in order to establish what normal sounds like. Using either a 512 cycle tuning fork or a percussion hammer on the bone on the opposite side of the lesion, the examiner listens to see how vibration is transmitted across the lesion site. The sign is present if the sound is not transmitted normally over the lesion site. If the lesion is semisolid, the sounds will be less distinct, duller and less intense than the normal side. If the lesion is more dense, the sounds will be sharper, more distinct and intense than the normal side.

Manual Percussion Test: On this test, the patient is prone with the arms hanging over the sides of the table with a firm pillow propping up the area to be examined. The examiner manually percusses each spinous process in the area of the main complaint with up to 15 pounds of downward pressure. The test is positive when this action duplicates and aggravates the pain of the main complaint. A positive test indicates a vertebral sprain/strain.

Mennell’s Test: This is a two stage test, with the second stage dependent upon the first. The first stage has the examiner’s thumbs over the prone patient’s posterior superior iliac spines. The thumbs are slid outward and inward as far as the superficial tissue laxity will allow. If the inward or outward pressure elicits tenderness and/or a reduplication of the pain of the main complaint, then the test is considered positive. Outward tenderness indicates sensitive deposits (myofascitis) of the gluteal aspect of the posterosuperior spine. If the pain and/or tenderness is elicited at the inward pressure, then the second stage is performed on the side or sides of the tenderness. In this second stage, the examiner first pulls the pelvis backwards and then pressures the pelvis forward. When the tenderness increases with the backward pressure but decreases with the forward pressure, then the significance of the inward tenderness is substantiated, indicating superior sacroiliac ligament strain due mostly to sprain or subluxation.

Murphy’s Punch Test: In this test, the patient can either be sitting upright or standing. The examiner, using the edge of the hand or the thumb, gives short jabbing blows under the twelfth rib posteriorly on either side. If this results in lancinating pain which either shoots straight through anteriorly or goes around the chest wall, the test is considered positive, indicating deep seated tenderness and muscular rigidity, as in kidney inflammation.

Percussion Test: This test has the patient seated and bent over facing the floor. The examiner, standing behind the patient, strokes the spinous processes with a reflex hammer within and outside the main area of complaint, first moving superiorly, then moving inferiorly. This is then repeated on the paraspinal musculature in the same manner. The test is considered positive when the percussion reproduces or aggravates the pain of the main complaint. If the pain occurs on percussing the spinous process, it is indicative of joint lesion, such as sprain, subluxation, dislocation, etc. If the pain occurs on percussing the spinal musculature then it indicates a soft tissue lesion, such as a strain, rupture, etc.

Thompson’s Test:: This test is performed on patients with shoulder complaints. The examiner passively abducts the arm on the side of the complaint. The sign is considered present when the abduction can be done without pain and a sudden release of the patient’s arm (with it above the horizontal, which causes the deltoid to suddenly contract) causes shoulder pain and a hunching of the shoulder due to the absence of rotator cuff function. The sign is indicative of a rotator cuff tear (Rupture of the Supraspinatus Tendon)

Cozen’s Test: The examiner has the patient clench the fist tightly while dorsiflexing it. The patient maintains that position while the examiner then grasps the lower forearm and applies pressure counter to the dorsiflexion posture of the patient. If this action causes acute lancinating pain in the lateral epicondyle region, the test is considered positive, indicating Tennis Elbow (Epicondylitis; Radiohumeral Bursitis)

Dawbarn’s Sign: This test has the patient standing with the arms hanging loosely at the side. The examiner deeply palpates the patient’s shoulder eliciting a localized tender area. The examiner, while leaving the finger on the painful spot, passively abducts the patient’s arm. This sign is present when the painful spot disappears on abduction, indicating Subacromial Bursitis.

Dugas’ Test: is used to rule out a shoulder dislocation.

Hamilton’s Ruler Test: This test is considered positive if a straight edge, such as a ruler or a yardstick, can rest on the acromial tip and the lateral epicodyle of the elbow at the same time. A positive test is indicative of a shoulder dislocation.

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

Impingement Sign: The patient’s arm is moved through flexion while in a slightly abducted position. This results in a jamming of the greater tuberosity against the acromial surface. Pain at the shoulder is a positive sign suggestive of overuse injury of the supraspinatus and/or biceps muscle tendon.

Maisonneuve’s Sign: This sign is present when there is marked hyperextensibility (Dorsiflexion) of the hand, which is one of the symptoms of Colles’ Fracture.

Mill’s Maneuver The patient fully extends the elbow while fully flexing the wrist and fingers. Then the patient maximally pronates the forearm. If this action causes sharp tenderness and pain at the lateral elbow joint, then the test is considered positive, indicating Radiohumeral Epicondylitis (Tennis Elbow). This test is considered to be the classic maneuver for Tennis Elbow, because the action will only aggravate a true “Tennis Elbow”, and no other lesion.

Shoulder Compression Test: The patient sits upright and the examiner palpates the distal apex of the coracoid process and marks it. The examiner then applies downward pressure over the marked area. When this action produces symptoms similar to neurovascular compression of the Subclavian Artery and Brachial Plexus, the test is considered positive indicating Coracoid Pressure Syndrome identical to a hyperabduction type of Thoracic Outlet Syndrome.

Supraspinatus Press Test: On this test, the seated patient hangs the upper extremities limply at the sides. The examiner, using the thumb, presses toward the midline at a midclavicular point above the scapular spine. If this causes or exacerbates shoulder pain, then the test is considered positive, which is indicative of a Rotator cuff tear of the Supraspinatus Tendon.

Yergason’s Test: This test has the examiner facing the seated patient and slightly lateral to the upper extremity being tested. The patient, with the palm facing upward, makes a fist and bends the elbow to about 90 degrees. The examiner palpates over the bicipital groove while clasping the patient’s fist. The examiner then internally and externally rotates the patient’s arm while also keeping the patient from further flexing the elbow. If this action causes a painful palpable and/or audible click or snap, which is the bicipital tendon slipping in and out of the bicipital groove, then this test is considered positive, which indicates a loss of stability of the Biceps’ Tendon.

Hip Lesion Tests:

Ely’s Heel to Buttock Test: This test is a two stage test done with the patient in a prone position. First the knee is flexed to the opposite buttock. Then the thigh is hyperextended. If this action cannot be performed normally, then the test is positive, indicating one of the following: a hip lesion, irritation of the Iliopsoas muscle or its sheath, inflammation of the lumbar nerve roots, or the presence of lumbar nerve root adhesions.

Hip Abduction Stress Test: On this test, the patient lies on the non-affected side and actively abducts the affected limb at the hip. The patient holds the limb in abduction while the examiner exerts downward pressure on it. If this action brings on pelvic pain, then the test is considered positive, indicating a sacroiliac lesion.

Laguerre’s Sign: This test is done with the patient supine while the thigh and knee are flexed to right angles. Then the thigh is abducted and rotated outward. This forces the head of the femur against the anterior portion of the hip joint capsule. The sign is present when this action produces pain, tending to rule out a lumbosacral lesion, but indicating a hip joint lesion, iliopsoas muscle spasm or a sacroiliac lesion.

Fabere Test: An orthopedic physical examination test with the patient on his or her back, the thigh and knee are flexed and one ankle is placed over the opposite knee; the knee is depressed, and if pain is produced thereby, arthritis of the hip, psoas muscle or SI joint is indicated. The name comes from the initial letters of movements that are necessary to perform it, namely, flexion, abduction, external rotation, extension. Also called Patrick’s Sign.

Patrick’s Test: Performed with the patient supine, the examiner places the external malleolus over the patella of the opposite limb. Then downward pressure is applied to the thigh. When pain results from this action, particularly in the hip flexor area, the test is positive. A positive test suggests hip joint disease, because this action antagonizes hip flexor spasm brought on by an inflammatory lesion. This test is also known as the FABER or FABERE Sign from the acronym of the maneuver: Flexion, Abduction, External Rotation and Extension.

Thomas’ Test: On this test, the examiner maximally flexes the supine patient’s hip and knee of the side opposite to the side being tested, bringing the knee to the patient’s chest. The examiner then has the patient clasp the knee in order to maintain this posture. If this action causes the hip and knee of the opposite limb to elevate off the table, the test is considered positive. Normally, the opposite limb should have enough hip flexor stretch to allow the thigh to continue to lie flat on the table during this action. Thus a positive test indicates flexor tightness or flexion deformity of the hip.

Trendelenburg’s Test: In this test, the patient stands on one foot, using a wall or chair for support. The patient then lifts the opposite knee above waist level. The test is done bilaterally. This action will normally elevate the gluteal fold and pelvis of the side being lifted above that of the standing leg side. When the gluteal fold and pelvis on the side being lifted are lowered, the test is considered positive, indicating a gluteal (abductor) insufficiency on the standing leg side.

Hamstring Tests:

Lewin Standing Test: This test has the patient standing on a short stool or platform with the examiner stabilizing the patient’s pelvis from behind with one hand. The other hand sharply pulls the patient’s knee (on the same side) into extension. This action is repeated on the opposite side. Then the examiner braces his or her shoulder against the patient’s sacrum and pulls both knees into extension. If any of these actions results in pain followed by either or both knees snapping back into flexion, then this test is considered positive indicating unilateral or bilateral Hamstring spasm.

Neri’s Bowing Sign: Is used to rule out unilateral tight and spastic hamstrings, which would be indicative of sacroiliac, lumbosacral or lumbar lesions. This sign is fairly constant in lumbar radiculopathy and may also be present in sciatic peripheral neuropathy.

Tripod Sign: This test is used to rule out tightness of the hamstring muscles, which exists in almost any spinal irritation from the midthoracic area to the sciatic notch.

Lower Extremity Tests:

Abduction Stress Test: On this test, the supine patient’s knees are in complete extension. The examiner places one palm against the lateral aspect of the knee at the joint line of the side being tested and with the other hand the examiner grips the ankle pulling it laterally, thus opening the medial side of the joint. If this action causes no pain, then the examiner repeats it with the knee in approximately thirty degrees of flexion, which puts the knee joint maximally vulnerable to a torsion stress. If either of these actions produces or exacerbates pain, below, above or at the joint line, then the test is considered positive, indicating a medial collateral ligament injury.

Adduction Stress Test: This test is done with the patient supine and the knees in complete extension. The examiner places on palm against the medial aspect of the patient’s knee (opposite to the one being tested) at the joint line. With the other hand the examiner grips the ankle, pulling it medialward, thus opening the lateral side of the joint. If this action causes no pain, then the examiner repeats it with the knee in approximately thirty degrees of flexion, which puts the knee joint maximally vulnerable to a torsion stress. If either of these actions produces or exacerbates pain, below, above or at the joint line, then the test is considered positive, indicating a lateral collateral ligament injury.

Apley Test: This test involves four steps. If any or all of them elicit knee pain or clicking, the test is considered positive. In Step 1, the patient is in a prone position with the ankles hanging over the end of the table. The examiner grasps the foot, strongly rotating the leg internally flexing the knee past ninety degrees. Step 2 is the same as Step 1, except the leg is rotated externally. On Step 3, the examiner anchors the patient’s thigh to the table by placing his own knee in the patient’s popliteal space cushioned by a pillow or towel while strongly lifting up on the foot, followed by rapidly rotating the leg internally and externally. Step 4 is the same as Step 3 except the examiner pushes downward instead of lifting. A positive test is indicative of a meniscus tear

Childress Duck Waddle Test: On this test, the standing patient first attempts to fully squat with the legs somewhat apart and in maximal internal rotation. The action is then repeated with the legs in maximal external rotation. If either of these actions results in pain or if the patient is unable to fully flex the knee and/or if there is a clicking sound on either posterior side of the joint, then the test is considered positive, indicating a medial or lateral meniscus tear.

Dreyer’s Sign: On this test, the supine patient attempts to actively raise the affected leg with the knee fully extended. If the patient is able to perform this action only when the examiner applies forceful extension to the thigh using the flat of the hands which gives anchorage to the patient’s quadriceps, then the sign is considered present. The sign indicates a fracture of the patella.

Ely’s Sign: On this test, the prone patient’s knee is flexed toward the buttock on the same side. If the pelvis rises off the table and the thigh goes into abduction at the hip joint, both somewhat in unison with the knee flexion, then this test is considered positive, indicating a Rectus Femoris and/or lateral thigh fascia contracture.

Hennequin’s Sign: This sign is present when digital compression by the examiner below Poupart’s (inguinal) ligament, lateral to the major vessels, causes pain, tenderness and crepitation. If the sign is present, it indicates a fracture of the neck of the femur.

Anterior Foot Draw Sign: This test is done with the patient seated on an examining table with the legs hanging over the table’s edge. The examiner places one hand around the anterior aspect of the lower tibia just above the ankle. The other hand grips the calcaneus. While pushing the tibia posteriorly, the calcaneus (and talus) is drawn anteriorly. This sign is present when the above action causes the talus to slide anteriorly from under cover of the ankle mortise, indicating anterior talofibular ligament instability, usually secondary to rupture.

Hoffa’s Sign: This test has the prone patient’s ankles hanging over the edge of the examiner’s table. By movement and palpation, the examiner checks the Achilles Tendon on the involved side to see if it’s less taut than the other side as well as checking for increased dorsiflexion in the relaxed position. If either of these is the case, then the sign is present, indicating an avulsion fracture of the calcaneus. A loose fragment may also be seen and/or felt behind either malleolus.

Metatarsal Test: This test has the seated patient’s lower limbs straight out with the feet extending over the table. First, the examiner forcibly extends the outer four toes so that the ball of the foot is made prominent. Then the examiner percusses the protruding metatarsophalangeal joints of the outer four toes with a reflex hammer. When this action causes neuritic pain, the test is considered positive, indicating Anterior Metatarsalgia due to inflammation of the metatarsophalangeal joints.

Strunsky’s Sign: This test has the patient supine with one foot resting in the examiner’s hand. With the other hand the examiner grasps the patient’s toes and flexes them suddenly. Normally, this action produces no pain. When it causes lancinating pain, the sign is present, indicating inflammation of the anterior arch of the foot, mainly the Metatarsophalangeal Joints.

Circulatory Disorder Tests:

Adson’s Maneuver: On this test, the patient is seated while the examiner palpates the radial pulse to determine its rate, force and amplitude. The examiner then has the patient rotate the head to the side being tested, followed by elevating the chin as high as painlessly possible, and finally taking a deep breath and holding it for about 10 seconds. The test is positive when this action stops or diminishes the radial pulse rate. If the above maneuver is negative the test should be repeated with the patient rotating the head opposite to the side being tested. A positive test indicates a subclavian artery compression commonly caused by a cervical rib thoracic outlet syndrome and/or scalenus anticus syndrome.

Allen’s Test: This test has the patient seated with the forearms resting on the thighs and the palms facing up. First the patient makes a fist on the side being examined, then the examiner digitally occludes either the radial or ulnar arteries right next to the wrist while the patient maintains the clenched fist. Next, with the examiner maintaining the occlusion, the patient opens the hand. Normally, the color returns to that hand in ten seconds or less. The test is considered positive if there is a delayed color return during digital compression, indicating a partial blockage, or if there is no color return until the examiner releases the wrist which indicates a complete blockage of the artery which is not being compressed.

Buerger’s Test: This test measures arterial blood supply to the lower limbs. The examiner straight leg raises the supine patient’s leg to about 45 degrees for no less than three minutes. The examiner then lowers the limb and has the patient sit up with both legs hanging over the examining table. The test is considered positive if the dorsum of the foot blanches and any prominent veins collapse when the leg is initially straight leg raised, or if after lowering the leg it takes one or two minutes for a ruddy cyanosis to spread over the affected part and for the veins to once again become prominent, either of which indicates a deficient blood supply.

George’s Test: Many doctors use this test before attempting any high velocity cervical manipulation. The supine patient extends the head and neck over the edge of the table. With eyes open the patient actively rotates the head and neck while maintaining the extended position. One or more of the following indicates a positive test: either blanching or cyanosis of the face, nystagmus, sweating, dizziness, nausea, headache or an increase of temperature. Until vascular disorders are ruled out by further examination, a positive test would indicate that cervical manipulation involving rotation and/or extension is contra-indicated.

Homan’s Sign: This test is done with the patient supine with the knee extended. When dorsiflexion of the ankle by the examiner causes a localized deep pain either in back of the calf or behind the knee, the sign is considered present, indicating Thrombophlebitis (thrombosis of the deep veins of the leg).

Moskowicz Test: In this test, the patient’s extremity being tested is wrapped firmly with an elastic bandage, elevated and held there for 5 minutes. The extremity is then released and quickly unbandaged. Normally, the blood rapidly flows back into the area as the bandage is removed, seen by a hyperemic blush. The test is considered positive when the blush is either absent or slight and lags behind the unbandaged area, indicating an inadequacy of collateral circulation, as in an arteriovenous fistula.

Wright’s Test: This test is usually performed after the Allen’s Test in order to rule out other underlying pathology which would be indicated by the Allen’s Test. The seated patient has both arms hanging at the sides, with the examiner behind the patient. The examiner palpates the radial pulse during 180 degrees of active and then passive abduction of both arms, while noting at how many degrees of abduction the radial pulse on the affected side diminishes or disappears when compared to the opposite side. If this action diminishes or eliminates the radial pulse, the test is considered positive, indicating a neurovascular compression of the Axillary Artery as seen in the Hyperabduction Thoracic Outlet Syndrome.

Malingering Tests:

Burn’s Bench Test: On this test, the patient kneels upright on the examining table or a padded bench that is about eighteen to twenty inches high. The examiner firmly grasps the patient’s ankle from behind and instructs the patient to bend over and touch the floor with the fingertips. Patient’s who normally cannot be expected to carry out this action are those extremely weak from injury or disease or those significantly diseased at the hip or knee. Those patients who may be able to perform the action are those with sciatic neuralgia, congenital anomalies, arthritis, a specific disease of the spine (such as tuberculosis), or a compression fracture of the spine. Any patient (other than those mentioned above who cannot be expected to carry out this action) either refuses to perform the action or claims they can only go part way, is presenting evidence of malingering or hysteria.

Hoover’s Sign: When the patient is alleging unilateral lower limb paralysis, the examiner places the hands under the heels of the supine patient. The patient is then asked to lift the paretic leg. If the leg is truly weak or paralyzed, the patient will involuntarily push downward with the non-affected leg, which would be felt as pressure on the examiner’s hand. The sign is present if no counterpressure can be felt by the examiner on the healthy side, which is evidence of malingering or hysteria.

Lasegue’s Sitting Test: is used for indicating low back radiculopathy, spasmophilia or lumbar disc herniation. This test has the patient sitting upright on the edge of an examining table or bench without a backrest. The examiner extends the patient’s legs below the knee one at a time, so each limb is parallel with the floor. If there is no radiculoneuropathy, the patient should experience no discomfort from this action. This is a modification of the Lasegue Straight Leg Raise. It has advantages when checking for malingering, because the test can be performed without the patient knowing what is being tested. This version can be used on those patients where simulation, falsifying or magnification of symptoms is suspected.

Magnuson’s Test: This test is performed when malingering or hysteria is suspected in the patient with low back complaints. The patient points to the site of the pain which in turn is marked by the examiner. The examiner then performs other actions away from the marked site of pain. The test is positive if there is any significant change of the pain site once the examiner resumes the examination of the low back. A positive test would indicate evidence of simulated pain, hysteria or malingering.

Waddell’s Test: A series of five tests to assess whether a patient is faking or exaggerating their pain responses. Three of five must be positive for the test to be significant.