Definitions /viva related

Pain grading (total 4)

 Grade I (mild) Pain that can easily be ignored.
 Grade II (moderate) Pain that cannot be ignored, interferes with function and needs
attention or treatment from time to time.
 Grade III (severe) Pain that is present most of the time, demanding constant
attention or treatment.
 Grade IV (excruciating) totally incapacitating pain.
Assessment of joint tenderness (total 4)
 Grade 1: The patient says the joint is tender
 Grade 2: The patient winces
 Grade 3: The patient winces and withdraws the affected part
 Grade 4: The patient will not allow the joint to be touched
ROM:
 ‘knee flexion 0–140°’ means that the range of flexion is from zero (the knee
absolutely straight) through an arc of 140 degrees (the leg making an acute angle
with the thigh).
 Similarly, ‘knee flexion 20–90°’ means that flexion begins at 20 degrees (i.e. the
joint cannot extend fully) and continues only to 90 degrees.
Muscle power is usually graded on the Medical Research Council scale:
Grade 0 No movement.
Grade 1 Only a flicker of movement.
Grade 2 Movement with gravity eliminated.
Grade 3 Movement against gravity.
Grade 4 Movement against resistance.
Grade 5 Normal power.
Superficial reflexes
The superficial reflexes
 abdominal (T7–T12), cremasteric (L1, 2) and anal (S4, 5) reflexes.
 These are corticospinal (upper motor neuron) reflexes.
 Absence of the reflex indicates an upper motor neuron lesion (usually in the spinal
cord) above that level.
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 Babinski sign – a type of withdrawal reflex which is present in young infants and
normally disappears after the age of 18 months.
 Varus means that the part distal to the joint is displaced towards the median plane,
 Valgus means that the part distal to the joint is displaced away from the median
plane. Seen from side.
 spinal curves which convex posteriorly in the thoracic region (kyphosis), and
convex anteriorly in the cervical and lumbar regions is called lordosis. Seen from
side.
 Scoliosis: is an apparent lateral curvature of the spine. ‘Apparent’ because,
although lateral curvature does occur, the commonest form of scoliosis is actually a
triplanar deformity with lateral, anteroposterior and rotational components. Two
broad types of deformity are defined: postural and structural.

Most cases have no obvious cause i.e. idiopathic scoliosis; other varieties are
congenital or osteopathic (due to bony anomalies), neuropathic, myopathic
(associated with some muscle dystrophies) and some connective-tissue disorders.
 ‘Fixed flexion deformity’ it means that extension cannot be completed. The joint
may be able to flex fully but not extend fully – at the limit of its extension it is still
‘fixed’ in a certain amount of flexion.
 WHAT IS SPASTICITY? Spasticity is defined as an involuntary, velocity-dependent,
increased resistance to stretch. The amount of resistance to stretching is partly
determined by the speed with which a spastic muscle is stretched, and manifests as
pain, tightness, or posturing
 WHAT IS A CONTRACTURE? Fixed resistance to passive stretching of a joint due
to shortening (due to a decrease in the number of sarcomeres in series along the
myofibrils,) /wasting (atrophy) of muscle fibers, tendons, or the development of scar
tissue (fibrosis) of the joints.
 JOINT STIFFNESS: The term ‘stiffness’ covers a variety of limitations of joint
movement. three types of stiffness in particular: (1) all movements absent; (2) all
movements limited; (3) one or two movements limited.

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