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Hello, readers. I guess if you are stopping in at this site, you share either my interest in or concern for the issue of nomenclature in our professional publications and communication. (Or maybe you're just curious to see what that Cusick is up to now....)
Searching for developmental musculoskeletal norms and trends, I've cast a wide net across several clinical disciplines. I discovered that most normative studies lack a rigorous application of the fundamental research principles of replicability of the study, inter-rater reliability, and established validity. A significant and related problem is the lack of standardization of both the terminology and of assessment methods.
The persistent use of nonstandardized, vague, or inaccurate nomenclature to describe pathomechanical and pathokinesiological conditions has contributed to several difficulties that might be alleviated with more clarity and consistency. For example, I've experienced nomenclature-related difficulties in the following endeavors:
- Identifying and communicating clinical observations and concerns
- Achieving acceptable levels of reliability and validity in the execution of numerous musculoskeletal assessments
- Acquiring meaningful normative data from published literature
- Searching for topic-related information in the literature.
Illustrating the last point, for example, the term metatarsus adductus seems to universally describe a medially-directed alignment of the metatarsals, occurring in the transverse plane. However, hallux valgus is commonly used to describe a hallux that deviates laterally (abducts) in the (same) transverse plane. The accurate descriptor for an abducted hallux is hallux abductus. A comprehensive literature search for information about hallux abductus must currently include both descriptors, though one of them is incorrect.
The following terms are often used interchangeably, though they describe distinctly different phenomena:
Torsion -- A feature of osseous geometry
Version -- The act of turning or deviating
Rotation -- A motion that occurs about an axis.
To address this long-term problem of discrepancies in the use of one group of terms, the Pediatric Orthopaedic Society's Subcommittee on Torsional Deformity - headed by Lynn T. Staheli, MD - compiled and published a list of terms and definitions. The author introduced the list with an invitation to other societies and organizations to offer input that could lead to changes. Since no society or organization has apparently done so in the past 20 years, I'll step up to the plate with the following questions and suggestions for improving the accuracy and clarity of many of the definitions that the subcommittee has so far agreed to recommend.
I copied the sucomittee's list verbatim from the publication, dividing the terms and statements into numbered paragraphs for reference by readers, and for addressing questions to those terms or statements that provoke them. If a numbered paragraph is not followed by a question or suggestion, then the reader may surmise that I do not challenge or contend it. All of my comments are italicized and indented, and follow the terms or statements that warranted discussion in my opinion. You are welcome to participate in this discussion, of course.
Thanks for your interest. I look forward to hearing from you.
"Billi" (Beverly) Cusick, PT, MS, COF
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