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Dr. Google can see you now

Educating yourself online is valuable, but let's get on the same page when it comes to terminology

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It's no surprise 50 per cent of Canadians polled have admitted to using Google to self-diagnose injuries. The Internet is full of good information, and I highly recommend providing yourself with as much knowledge as possible from multiple sources. Despite the depth of the online medical knowledge pool, we therapists still encounter many misconceptions and patient confusion when it comes to certain injury terms and beliefs. While there is most likely some difference between beliefs and terminology from one practitioner to another, the majority of these are rock-solid science; straight from my hard-covered friends, Prentice & Arnheim. After polling a few colleagues, here are a few confounding issues that stand out.

Ligament/tendon: Similar in structure -- a ligament is a fibrous band that joins one bone to another and supports a joint, while a tendon is a fibrous band that joins muscle to bone and provides extra length and leverage to that muscle.

Sprain/strain: are terms used to indicate an overload or over-pulling injury to a particular structure. Strains occur in muscles and tendons, while sprains occur only in ligaments. You cannot strain a ligament, nor can you sprain a muscle or tendon. Life is confusing -- I know.

Broken/fractured: "It's not broken, just fractured," is a ridiculous comment I have heard countless times in the clinic. Fractured means exactly that -- broken, and while fracture alone is a synonym for 'break' or 'broken', there are many different kinds of fractures. Some commonly heard terms are: hairline -- not all the way through or without separation; greenstick -- meaning incomplete with a bend; avulsion -- which means a fragment was pulled off the bone via a ligament or tendon. While these are all types of traumatic fractures, stress fractures are 'fatigue' fractures caused by repetitive, low-magnitude stress on a weakened area of bone. The bottom line is, fractured equals broken, and broken equals fractured.

Rupture/tear: These terms can be used to describe sprains and strains. 'Rupture' is an absolute term, and means 100 per cent. If you ruptured something, it is torn in two pieces that are totally separated. In my books, you cannot partially rupture a structure; that's like saying you half-killed someone -- you either did or didn't. 'Tear' is a term normally broken down into degrees, often into three categories that describe the percentage of fibres in a structure that are thought to be torn. A first-degree tear indicates up to 33 per cent of the fibres in a structure, while second- and third-degree tears indicate 33 to 66 per cent and 66 to 99 per cent, respectively. Pop quiz: What do you call it if it's 100 per cent torn?

Dislocation/subluxation/out-of-place: A dislocation indicates the (two) bones that make up a joint have been pulled apart, beyond the physical limits of the ligaments and capsule that surround and support it. Most importantly, it means the joint remains that way until it is reduced (put back), and afterwards, there is severe injury to the supporting structures around it. A subluxation is a dislocation that spontaneously reduces itself but still results in significant injury afterwards. Both of these typically refer to a traumatic injury.

My personal favourite coined phrase from patients is 'out of place' or 'out of joint.' This is normally used when referring to a chronic injury, and that they themselves or another practitioner simply 'put it back.' Joints can have poor quality of movement or be fixated, but if it is out of place, it is dislocated, and you've got bigger fish to fry than simply hearing a loud pop and going about your business.

 

How I would love to have everyone on the same page when it comes to terms and phrases -- but that page is my page -- and while Stedman's Concise Medical Dictionary should clear up any quarrels between practitioners, there still seems to be variation and dispute. Wiki-educate yourself by any means possible so if and when you do come in for an assessment, everyone in the room is speaking the same medical language. Don't be so steadfast when it comes to those antiquated or just plain incorrect terms your grandparents threw around, and be open to the appropriate terminology. We know a thing or two about a thing or two.

 

We welcome your questions. Email tim@mordenphysiotherapy.ca and you could be featured in a future article. Tim Shantz is a certified athletic therapist and trainer.

Republished from the Winnipeg Free Press print edition May 10, 2014 D15

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