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Glossary of WPI terms and definitions of clinical findings

Abduction: Movement of a limb away from the midline of the body.
Active Motion: How far a joint can be independently moved by the examiner (compare to Passive Motion).
Activities of Daily Living (ADLs): ADLs refer to the activities of life, for example self- care. A Table listing ADLs with examples can be found on page 317 of the AMA4 Guides.
Adduction: Movement of a limb towards the midline of the body.
AMA4 Guides: American Medical Association Publication: Guides to the Evaluation of Permanent Impairment, 4th Edition, 3rd Printing (1995).
Amputation: Traumatic or surgical removal of part or all of a limb.
Ankylosis: Fusion of a joint, in a position such that it cannot be moved or bent in another way.
Anosmia: Absence or the loss of the sense of smell.
Anterior: Towards the front.
Arthritis: Arthritis: An inflammatory condition involving joints.
Arrhythmia: Irregular Heartbeat.
Atrophy: Wasting of an organ e.g. muscle.
Bilateral: On both sides.
Bone scan: This is a test that is performed to detect areas of increased or decreased bone metabolism, which is an indication of abnormal bone process such as fracture, infection and tumours. The test normally involves an intravenous injection of radioactive material and a series of photographs are taken using a specialised camera.
Causation: A physical, chemical or biological factor contributed to the occurrence of a medical condition. To determine this it is necessary to verify that the factor could have caused or contributed to the impairment and that factor did cause or contribute to the impairment (page 316, AMA4).
Clinical Dementia Rating: A tool used to assess impairment due to disturbances of the nervous system, specifically mental status and integrative functioning (Table 5.1, page 33, MAA Guides).
Combining: Separate impairment percentages for different injuries are generally NOT added but combined using the Combined Values Chart (pages 322 – 354 AMA4).
Complex Regional Pain Syndrome:

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition in which high levels of nerve impulses are sent to an affected site. For a diagnosis to be made, at least 8 of 11 criteria must be met (see clause 2.14, page 11, MAA Guides), being:

1. Skin colour that is mottled or cyanotic;
2. Cool skin temperature;
3. Oedema;
4. Skin dry or overly moist;
5. Skin texture that is smooth and non elastic; 6. Soft tissue atrophy (especially at fingertips);
7. Joint stiffness and decreased passive motion;
8. Nail changes with blemished , curved or talon like nails;
9. Hair growth changes with hair falling out, longer or finer; 10. X-rays showing trophic bone changes or osteoporosis; and 11. Bone scan showing findings consistent with CRPS.

Contralateral: The opposite side.
Crepitus: A crackling sensation when bony surfaces rub against each other.
C.T scan: Computerised Tomography Scan is a radiographic technique that uses a computer to assimilate multiple x-ray images into a two dimensional cross sectional image.
Deglutition: Swallowing.
Dermatome: An area of skin supplied by a single spinal nerve for sensation. If a particular nerve is injured, altered sensation is experienced by all people in approximately the same area of skin.
Disability: Consequence of impairment.
Distal: Away or distant from the centre of the body.
D.R.E: Diagnosis Related Estimate (DRE) is the method used for evaluation of impairment of the spine.
D.B.E: Diagnosis Based Estimate (DBE). Certain impairment estimates of the lower extremity are assigned more appropriately on the basis of their diagnosis: these can be found on pages 85-86 of AMA4.
DSM (IV): Diagnostic Statistics Manual of Mental Disorders (4th edition.) DSM (IV) describes various diagnostic criteria for mental disorders.
Dysaesthesia: Disturbed sensation (often painful or uncomfortable).
Dysmetria: Non-uniform loss of motion in any one of the three planes of movement in the spine.
E.C.G: Electrocardiography - procedure by which a doctor obtains a tracing of the electrical activity of the heart.
Epistaxis: Excessive nose bleeds.
Extension: A movement that increases the angle, or the distance, between two bones or parts of the body.
External Rotation Rotation occurring away from midline.
Flexion: A movement that decreases the angle of a joint and brings two bones closer together.
Fracture: Break in a bone.
Glasgow Coma Scale:

A scale used to evaluate a patient's level of awareness that indirectly indicates the extent of neurological injury. The lowest possible GCS is 3 (coma) whilst the highest is 15 (fully awake). The scale is comprised of three tests with the points for each test added:

Eye Opening - Spontaneous (4 points), to Command (3 points), to Pain (2 points) and None (1 point).

Verbal Oriented - (5 points), Confused (4 points), Inappropriate, (3 points) Incomprehensible (2 points) and None (1 point).

Motor Responses - Obeys commands (6 points), Localises pain (5 points), Withdraws to pain (4 points), Flexion to pain (3 points), Extension to pain (2 points) and None (1 point).

Goniometer: Goniometer: Apparatus for measuring range of motion of a joint.
Internal Rotation: Rotation of a body part towards the midline.
Impairment: An alteration to a person’s health status, a deviation from normal in a body or organ system and its functioning.
Impingement: Intrusion by one part of anatomy on another, e.g. nerve root impinged upon by protruding disc.
Leg Length Discrepancy: The measured difference between the lengths of two legs.
L.E.I: Lower Extremity Impairment.
Mastication: Chewing.
MAA Guidelines: The Guidelines for the Assessment of Permanent Impairment developed by the Motor Accidents Authority NSW, 1 October 2007.
Muscle Atrophy: Muscle wasting (see Atrophy).
Muscle Guarding: Spasm (contraction) of a muscle or group of muscles to minimise motion of the injured site.
Muscle Spasm: A sudden involuntary contraction (shortening) of a muscle or group of muscles.
M.R.I: Magnetic Resonance Imaging - a special imaging technique, particularly useful for the soft tissues. It uses a large magnet to polarise hydrogen atoms in the tissues and then monitors the summation of the spinning energies within living cells.
Nerve root tension signs: Indicators of irritation of nerve roots. The most commonly used test is the straight leg raising test. Sciatic nerve tension signs are indicators of irritation of the lumbosacral nerve roots.
Non verifiable radicular Complaints: Symptoms in the distribution of a nerve root but no objective physical findings of nerve root dysfunction.
Non-Uniform loss of Spinal Motion: See Dysmetria.
Olfaction: The sense of smell.
O.R.I.F: Open Reduction, Internal Fixation.
Passive Motion: How far the examiner/Assessor can move the person’s injured joint (see Active Motion).
Paraesthesia: Numbness or tingling associated with nerve damage.
Peripheral Nerves: Nerves (motor and sensory) running through upper and lower extremities.
Permanent Impairment: An impairment is permanent if it has been present for a prolonged period of time, is static, well-stabilised, and unlikely to change substantially regardless of treatment (that is, by more than 3% WPI in the next year with or without medical treatment).
P.I.R.S: Psychiatric Impairment Rating Scale.
Pronation: Facing downwards, as with palm of the hand.
Post-traumatic Amnesia:

An early stage in the recovery process from a Traumatic Brain Injury. A transitory state, intermediate between coma and return of full consciousness, the patient is confused, disoriented and unable to lay down new memories. Duration of PTA is variable from a few minutes to many months.

A daily assessment is carried out using a PTA scale. When the person can answer all the questions correctly on three consecutive days they are considered to have emerged from PTA on the first of these three days.

Some patients are unable to achieve a perfect score on the PTA scale and this usually occurs because the patient is left with a severe memory impairment after the injury.

Severity of injury is determined as follows:

  • PTA less than one hour = a mild injury
  • PTA of 1 - 24 hours = a moderate injury
  • PTA of 1 - 7 days = a severe injury
  • PTA 1 - 4 weeks = a very severe injury
  • PTA more than 4 weeks = an extremely severe injury.
Posterior: Towards the back of the body.
Prosthesis: Artificial replacement for part of the body.
Proximal: Nearer to the centre of the body.
Radial Deviation: Bending the wrist toward the thumb side.
Radiculopathy:

Malfunction of a spinal nerve, at the nerve root. Radiculopathy is present when a claimant has two or more of the following objective physical findings:
Loss or asymmetry of reflexes;

  • Positive sciatic nerve root tension signs;
  • Muscle atrophy / decreased limb circumference;
  • Muscle weakness which is anatomically localised to an appropriate spinal nerve root distribution; or
  • Reproducible sensory loss which is anatomically localised to an appropriate spinal nerve root distribution.

The pattern of symptoms must conform with the relevant anatomical distribution. Imaging studies (C.T, M.R.I) must also support the clinical findings and be consistent with the distribution of the radicular abnormality. Reports of global pain or altered sensation throughout all of the upper or lower limbs do not follow an anatomical distribution and do not constitute radiculopathy.

Range of Motion: The range, measured in degrees, through which a joint may be moved.
Reflexes: An involuntary response elicited by a defined stimulus. Reflexes may be normal, increased, absent or reduced. In muscles, this motor response is best demonstrated by the knee jerk.
Scheurmanns Disease: Spinal disease that occurs mainly in children, usually apparent by school age. Some deformity of spine, back curve becomes more exaggerated. Backache and stiffness is aggravated by sitting.
Spinous Process: Part of the vertebrae. A spinous process protrudes from each vertebra. The spinous processes create the palpable “bumps” up and down the spine.
Splenectomy: Removal of the spleen.
Spondylolisthesis: The forward slipping of one vertebra upon another. This is normally due to a defect of the joints that normally bind the vertebrae together (facet/zygapophyseal joints). It is often congenital but can occur following a very large traumatic force.
Spondylosis: Refers to degeneration of the vertebrae and discs. Spondylosis produces a characteristic appearance on x-ray including a narrowing of the disc space and the presence of osteophytes (bony outgrowth).
Sprain: An injury to a ligament, caused by sudden over stretching.
Strain: An injury to a muscle that has been abnormally stretched or torn.
Supination: Facing upwards (as with palm of hand)
T.B.I: Traumatic Brain Injury
Tinnitus: Ringing in the ears, due to nerve damage.
Transverse Process: Part of the vertebra: protrusions (wings) on each side of a vertebra to which muscles and ligaments attach.
Ulnar Deviation: Bending the wrist towards the little finger.
U.E.I: Upper Extremity Impairment.
Unilateral: On one side only.
Vertebral fracture: Any break of the vertebral body, or of the posterior elements forming the ring of the spinal canal (e.g. lamina, pedicle, transverse processes or spinous process).
W.A.D: Whiplash Associated Disorder.