Personal Injury and Clinical Negligence Terminology 9

CHAPTER 2

Personal Injury and Clinical

Negligence Terminology

2.1 Introduction 9
2.2 Common injuries, conditions and medical terms 10
2.3 Areas of medical speciality 15
2.4 Common abbreviations used in medical records 17
2.5 Diagrammatic representation of the human skeleton 23
2.6 Conclusion 24
2.7 Further reading 24

LEARNING OUTCOMES
After reading this chapter you will be able to:
• appreciate the importance to the personal injury/clinical negligence solicitor of
acquiring a working knowledge of medical terms and abbreviations, and of
understanding the nature of the most common injuries that arise and the scope of
different types of medical expertise
• know where to find assistance to acquire such information and knowledge.

2.1 INTRODUCTION
A trainee solicitor who enters the personal injury/clinical negligence department of a legal
firm has to cope not only with the pressures of being able to understand fully and advise
accurately on the law, but also with a barrage of unfamiliar medical terms. If a trainee is faced
on his first day with his colleagues referring to claims dealing with work-related upper limb
disorders (WRULD), vibration white finger (VWF), post-traumatic stress disorder (PTSD),
etc, and he is unfamiliar with the terminology, he will obviously be at a disadvantage.
There can be no doubt that proficient solicitors who practise in this area have extensive
medical knowledge and a detailed understanding of the terms used. This knowledge enables
them to comprehend fully clients’ complaints, experts’ reports and medical notes, and also
enables them to explain matters thoroughly to clients. For example, upon receipt of a medical
report obtained following a simple road traffic accident, the solicitor must read the report
carefully and then send it to the client. If the client subsequently contacts his solicitor stating
that he does not understand the terms used in the medical report, it is not acceptable for the
solicitor to say, ‘Neither do I’!
In addition, it is important for the trainee solicitor to have some knowledge of the areas of
medical specialisation, so that appropriate experts can be instructed.
The purpose of this chapter is to assist in the understanding of the terms and abbreviations
commonly found in personal injury/clinical negligence work, and of the main areas of
specialisation. It should be noted, however, that a medical dictionary is an essential
requirement for the personal injury solicitor, and more detailed medical texts may also be of
use.
10 Personal Injury and Clinical Negligence Litigation

2.2 COMMON INJURIES, CONDITIONS AND MEDICAL TERMS

2.2.1 Orthopaedic injuries
Orthopaedic (bone) injuries are the most common injuries encountered in a personal injury
claim. They are normally incurred as a result of falling, or from being involved in a road traffic
accident.
The most common terms found in orthopaedic medical reports are as follows:
(a) Arthrodesis – means a joint that has been fused, either because of pre-existing joint
disease or because of injury as a result of trauma to the joint.
(b) Arthroplasty – means that the joint has been reconstructed, often by the use of a joint
implant to replace one or more parts of the components of a joint.
(c) Contusion – means an injury to the skin and the deeper tissues in the surrounding area
which is accompanied by bleeding from damaged blood vessels. The skin, however, is
not broken. The simplest form of contusion is a bruise, developing through to a
contusion accompanied by a large haematoma, which is a collection of blood under the
surface of the skin.
(d) Dislocation – means an injury which results in the bones of a joint being out of alignment
or connection with one another. There is usually associated ligament and soft tissue
damage.
(e) Fracture – means a break in the continuity of a bone.
(f ) Sprain – means an injury in the region of a joint with associated ligament and soft tissue
damage.
(g) Subluxation – a joint which has subluxed has undergone a partial dislocation, and
subluxation is a term which is sometimes used to describe a sprain.
A client who has an orthopaedic injury may also undergo traction, ie a system of weights and
pulleys is used to pull muscle groups, so as to reduce/immobilise fractures and put the bones
back into alignment.
In general, the most common fractures occur to:
(a) The clavicle (collar bone) – these fractures are especially common in children and young
adults, and are almost always due to falls or direct trauma to the point of the shoulder.
Treatment involves wearing a sling until the pain has subsided. Surgical intervention is
very rarely required and is usually indicated only if there is a risk to nearby nerves or
blood vessels.
(b) The surgical neck of the humerus (the long bone stretching from the shoulder to the elbow) – these
fractures are usually treated with a sling; but if badly displaced, are surgically treated
and fixed with metal pins.
(c) The shaft of the humerus – these fractures can occur at any point along the humerus and are
usually treated by immobilising the fracture in a plaster of Paris cast for six to eight
weeks.
(d) The radius (the bone running from the elbow to the base of the thumb) – there are many different
types of radial fracture but the most common is the Colles fracture.
(e) The femur (the thigh bone) – these fractures can occur at any point along the length of the
femur. The most common sites are the neck or the shaft of the femur. Treatment tends
to be surgical. Clients with fractures of the shaft of the femur will be placed in a Thomas
splint, which immobilises the fracture.
(f ) The tibia and fibula – these two bones make up the part of the leg from beneath the knee
to the ankle. Fracture of these two bones can result from direct or indirect trauma.
(g) The pelvis – a number of bones which together form a ring-like structure at the base of the
spine. The pelvis contains the vertebrae of the sacral spine and the hip joints, and
 Personal Injury and Clinical Negligence Terminology 11

fractures can occur at any point. Fractures to the pelvis are of two main types: first,
isolated fractures of one of the bones which make up the pelvis; and, secondly, double
fractures of the bones which make up the pelvic rim.

2.2.2 Hand injuries

In interpreting medical reports regarding hand injuries, a basic understanding of the
anatomical position of the hand is required.
The functional parts of the hand are the wrist and the fingers. If the wrist is flexed, the hand is
brought forward; if the hand is positioned as if to push someone away, it is said to be
extended. The wrist is described as being ‘pronated’ if the palm of the hand is pointing
towards the floor, and is described as being ‘supinated’ if the hand is positioned to receive
something.
If the hand is made into a fist, the fingers are described as flexed; if the hand is opened out as
if to receive something, the fingers are described as extended.
The fingers are described as the distal half of the hand, and are made up of three joints.
Working from the palm of the hand out towards the end of the fingers, the three joints are the
metacarpo-phalangeal joint (the knuckles), the proximal interphalangeal joint, and the distal
interphalangeal joint, which is the joint nearest to the finger nails. The thumb has the same
number of joints, but appears shorter because it attaches to the hand lower down; 70% of the
function of the hand is provided by the thumb.

2.2.3 Head injuries

The following terms are used in relation to head injuries:
(a) aphasia – the loss of power of speech;
(b) anosmia – the loss of the sense of smell;
(c) cerebral oedema – a swelling of the brain;
(d) closed head injury – a head injury in which there is no open skull fracture;
(e) concussion – instantaneous loss of consciousness due to a blow on the head;
(f )diffuse axonal injury – a brain injury which involves shearing of the brain tissue itself;
(g) dysphasia – a difficulty in understanding language and in self-expression;
(h) extradural haematoma – a blood clot which lies immediately above the brain and its
protective membranes and below the surface of the skull;
(i) Glasgow Coma Scale – a system of assessing neurological function;
(j) hydrocephalus – a condition which arises due to an increase in the amount of cerebro-
spinal fluid within the cranial cavity;
(k) hemiplegia – paralysis of one side of the body;
(l) intracerebral – within the substance of the brain itself;
(m) monoplegia – a paralysis of one limb;
(n) open head injury – a head injury with an associated depressed skull fracture;
(o) subdural haematoma – a blood clot lying in-between the brain and its protective
membranes.

2.2.4 Injuries to the skin

The following terms are used to describe injuries to the skin:
(a) abrasion – occurs when the surface of the skin is rubbed off due to a mechanical injury;
(b) hypertrophy – the overgranulation of scar tissue which can lead to disfigurement;
(c) laceration – a wound to the skin which has jagged, irregular edges.
12 Personal Injury and Clinical Negligence Litigation

2.2.5 Whiplash injuries

The term ‘whiplash injury’ is not a medical term at all, but it is one which is used by lawyers
and the general public to describe a whole range of symptoms suffered, in the main, by
someone whose head is thrown forward in a sudden forceful jerk – literally whipped forward –
and back. Medical practitioners may prefer to use the terms ‘cervical sprain’ or
‘hyperextension injuries of the neck’. This type of injury is commonly associated with road
traffic accidents, but it can also result from other accidents (such as tripping and slipping),
sporting activities (such as biking and diving), and assaults.
The cause of the injuries associated with whiplash is the stretching and straining of the soft
tissues – the tendons, ligaments and muscles – supporting the cervical spine (ie in the neck
region). Symptoms can be of widely varying severity, and may include pain and stiffness in the
neck, backache, tingling and numbness in the arms and possibly in the hands, headaches,
dizziness, ringing in the ears, tiredness, inability to concentrate, memory loss, blurred vision,
nausea and reduced libido. Typically, symptoms will not be present immediately after the
accident but will develop over one or two days, and may gradually get worse before they start
to improve. Most people make a full recovery within days or weeks, but where symptoms are
severe, it may take months or even years for them to subside.
As these injuries are to the soft tissues, they cannot be detected by means of an MRI scan, CT
scan or an x-ray, and they are otherwise difficult to diagnose accurately. This means that it is
sometimes difficult to assess whether a claim is spurious or not.

2.2.6 Work-related upper limb disorders

The term ‘repetitive strain injury’ is commonly used by the general public to describe
musculoskeletal problems of the arm and hand associated with repetitive activity, such as
typing or assembly work. However, this term does not accurately reflect the fact that the
condition may not be due to repetitive work and may not be the result of a strain.
Consequently, the term ‘work-related upper limb disorder’ (WRULD) is to be preferred.
WRULDs, which are common across a wide range of occupations, may be caused by repetitive
or forceful activities, including lifting or carrying heavy objects, poor posture and/or carrying
out activities for long periods without adequate breaks. In some cases, a WRULD may be
caused by a single strain or trauma resulting, for example, from carrying a heavy load. In other
cases, problems are caused by vibration, due to the use of tools such as chainsaws, grinders or
drills.
Symptoms include aches, pain, weakness, numbness, tingling, stiffness, swelling and cramp
in the arm and hand, including the fingers, wrist, forearm, elbow, shoulder and neck. In many
instances, rest or adjustments to the working environment (the desk layout or assembly line)
or the way that work is managed will alleviate the symptoms, but in some cases the condition
is permanent.
It may be possible for a precise medical diagnosis to be made, for example, carpal tunnel
syndrome, tenosynovitis or vibration white finger.
Controversy surrounds claims for WRULDs due to the fact that some specific conditions, such
as carpal tunnel syndrome, may be caused by factors not related to the workplace and because
some WRULDs are non-specific (ie, a medical diagnosis is not possible).

2.2.7 Industrial deafness

Industrial deafness claims are brought by those who have suffered hearing loss due to
exposure at work to a high level of noise for a long period of time. For example, employees
working in the steel industry, shipbuilding or other manufacturing industry may suffer from
industrial deafness. Expert medical evidence is required to prove the loss of hearing, and
evidence relating to the employees’ working conditions is also required. Employers should,
 Personal Injury and Clinical Negligence Terminology 13

for example, have a system of assessing the risk from noise, provide ear protectors and have
clearly marked zones where ear protection must be worn.

2.2.8 Asbestos related conditions

Where people are exposed to asbestos, dust or fibres may be inhaled which can move to the
lungs or to the pleura, which is the membrane surrounding the lungs. Where this occurs, a
number of conditions of varying severity may arise.
Asbestosis is a form of pneumoconiosis, which is a general term applied to any chronic form of
inflammation of the lungs affecting people who are liable to inhale irritating substances or
particles at work. Asbestosis occurs due to the inhalation of mainly blue or brown asbestos
dust, which leads to the development of widespread scarring of the lung tissue and causes
severe breathing difficulties. The main hazard, however, is the potential for the development
of a type of cancer called mesothelioma, which affects the lungs, the pleura or, more rarely,
the ovaries.
Pleural plaques are areas of fibrosis, sometimes partly calcified, on the pleura. Typically, there
are no symptoms, but there is evidence to conclude that individuals who have pleural plaques
have an increased risk of developing mesothelioma.
Where these areas of fibrosis are more widespread, they can prevent the lungs from working
properly and thereby cause difficulties with breathing. This is known as pleural thickening

2.2.9 Occupational asthma

Occupational asthma may develop following exposure to a precipitating factor in the
workplace, for example flour.
Asthma is a breathing disorder characterised by a narrowing of the airways within the lungs.
The main symptom is breathlessness and an associated cough. It is an extremely distressing
condition and, if left untreated, can be fatal.

2.2.10 Occupational dermatitis

Dermatitis is an inflammation of the skin, which is usually caused by direct contact with some
irritating substance.
Occupational dermatitis is the most common of all the occupational diseases.

2.2.11 Occupational stress

Following the case of Walker v Northumberland County Council [1995] 1 All ER 737, in which a
social services officer received compensation for stress induced by his employment (he
suffered a nervous breakdown), a number of occupational stress claims have been brought
before the courts. Careful consideration needs to be given as to whether the particular client
will satisfy the necessary criteria to persuade the court to award damages in these
circumstances. Occupational stress is considered in more detail in Chapter 6.

2.2.12 Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) has become more prominent in recent years. This
expression refers to a psychological illness in which the claimant suffers from a variety of
symptoms, which may include flashbacks, panic attacks, palpitations, chest pain, nausea,
constipation, diarrhoea, insomnia, eating disorders, extreme fatigue and loss of libido.
It is important that medical evidence is obtained to support the injury, so that the defendants
cannot make the allegation that the claimant has simply been ‘shaken up’. This type of injury
must be considered by the claimant’s solicitor, even if the client concentrates only on his
physical injuries when he is asked at the first interview what injuries he has suffered as a result
of the accident. Post-traumatic stress is considered in more detail in Chapter 6.
14 Personal Injury and Clinical Negligence Litigation

2.2.13 Obstetrics
A normal labour and delivery take place in three stages. The first stage refers to the period of
time it takes the cervix to dilate fully to 10 cms, and this is the longest stage of labour. The full
dilation of the cervix is also associated with the rupture of the amnion, which is the tough
fibrous membrane lining the cavity of the womb during pregnancy, containing amniotic fluid
which supports the foetus. The rupture of the amnion is often referred to as ‘the breaking of
the waters’. The second stage of labour is the actual birth of the baby. The third stage is the
delivery of the placenta.
If a baby is deprived of oxygen, it is said to have become ‘hypoxic’. Hypoxia refers to a state
where there is an inadequate supply of oxygen to maintain normal tissue function. If a baby is
deemed to be in danger, it will be intubated and ventilated. This involves the insertion of an
endotracheal tube into the baby’s trachea to facilitate the maintenance of the baby’s airway.
Once a baby is born, it is assessed using the Apgar score. This is a method of assessing a
baby’s condition by giving a score of 0, 1 or 2 to each of five signs: colour, heart rate, muscle
tone, respiratory effort, and response to stimulation. A total score of 10 is the best Apgar
score. If a baby is described as ‘apnoeic’, it means that it is not breathing; ‘bradycardia’ refers
to the fact that the baby’s heart is beating too slowly.
Perinatal mortality refers to the death of a foetus after the 28th week of pregnancy and to the
death of the newborn child during the first week of life.

2.2.14 Cerebral palsy

Cerebral palsy is a general term used by medical practitioners to refer to a set of neurological
conditions occurring in infancy or early childhood which affect movement and coordination.
There are several different types of varying severity, the main ones being:
(a) Spastic cerebral palsy – some of the muscles in the body are tight, stiff and weak, making
control of movement of the affected arm or leg difficult. The degree of spasticity can
vary significantly from case to case, but in the most severe cases the muscles in the
affected limb may become permanently contracted.
(b) Athetoid (dyskinetic) cerebral palsy – characterised by involuntary slow, writhing movements
of the limbs and sometimes sudden muscle spasms. Sufferers have difficulty holding
items or staying in one position.
(c) Ataxic cerebral palsy – problems include difficulty with balance, causing unsteadinesss
when walking, shaky movements of the hands, making writing difficult, and speech
difficulties.
(d) Mixed cerebral palsy – a combination of two or more of the above.
In addition to the above symptoms, there may a lack of coordination of the muscles of the
mouth, causing speech and feeding problems, visual and hearing problems, and epilepsy. The
symptoms often lead others to conclude that the sufferer has learning difficulties, but the
condition does not, of itself, affect intelligence.
In a minority of cases (thought to be about 1:10) cerebral palsy is caused by problems during
labour and birth, such as lack of oxygen or trauma. In the majority of the remaining cases, the
damage arises while the baby is developing in the womb, as a result of genetic problems,
malformations of the brain or maternal infection, such as rubella or toxoplasmosis. Infantile
infections (especially encephalitis or meningitis) can also be causative.
Cerebral palsy is not a progressive condition, but the strains it places upon the body can lead
to further problems in later life. There is no cure, but sufferers can benefit greatly from
physiotherapy, occupational therapy, speech therapy and conductive education.
 Personal Injury and Clinical Negligence Terminology 15

2.3 AREAS OF MEDICAL SPECIALITY

In dealing with his caseload, the personal injury and clinical negligence lawyer may require
expert evidence to be given by a wide range of medical specialists. The following are amongst
the most common areas of expertise. In order to avoid offending medical experts, it is useful
to remember that consultant surgeons are known as ‘Mr’ ‘Mrs’ or ‘Ms’, rather than ‘Dr’.
(a) Anaesthesia – either renders the patient unconscious (general anaesthesia) or removes
sensation in a specific area (local anaesthesia), thereby enabling surgery or other
procedures to be performed without the patient incurring pain and distress. An
anaesthetist assesses the patient’s fitness to undergo anaesthesia, chooses and
administers the appropriate drugs, monitors the patient during the operation or
procedure, and supervises the recovery period. He also plays a major role in pain
management. A consultant anaesthetist will usually have ‘FRCA’ (Fellow of the Royal
College of Anaesthetists) after his name.
(b) Cardiology – the study of the diseases of the heart. A cardiologist is a physician who
specialises in this branch of medicine. A cardiac surgeon carries out surgical procedures
in relation to the heart. If a cardiac surgeon has also been trained in the field of vascular
surgery (relating to diseases affecting the arteries and veins) and/or thoracic surgery
(relating to diseases inside the thorax – the chest – including the oesophagus and the
diaphragm), he will be a cardiovascular, cardiothoracic or cardiovascular thoracic
surgeon. A consultant cardiologist will usually have ‘MRCP’ or ‘FRCP’ (Membership or
Fellowship of one of the Royal Colleges of Physicians) after his name. A cardiac surgeon
will have ‘FRCS’ (Fellow of the Royal College of Surgeons) after his name.
(c) Dermatology – deals with the diagnosis and treatment of disorders of the skin, such as
eczema, psoriasis, dermatitis and skin infections, and those affecting the hair and nails.
A consultant dermatologist will usually have ‘MRCP’ or ‘FRCP’ after his name.
(d) Geriatric medicine – relates to disorders and diseases associated with old age (usually over
65) and their social consequences. A consultant geriatrician will usually have ‘MRCP’ or
‘FRCP’ after his name.
(e) Gynaecology – deals with the female pelvic and urogenital organs in both the normal and
diseased state. It encompasses aspects of contraception, abortion and in vitro
fertilisation (IVF). Practitioners may also specialise in obstetrics (see below). A
consultant gynaecologist will have ‘MRCOG’ or ‘FRCOG’ (Membership or Fellowship of
the Royal College of Obstetricians and Gynaecologists) after his name.
(f ) Haematology – the study and treatment of blood and blood disorders, such as blood
clotting deficiencies, leukaemia, myeloma, lymphoma, and Hodgkin’s Disease. A
haematologist also deals with blood transfusions and treatments involving warfarin and
heparin. A consultant haematologist will have FRCPath’ (Fellowship of one of the Royal
Colleges of Pathologists) after his name.
(g) Medical oncology – the treatment of cancer. Clinical oncologists are largely concerned
with radiotherapy, whilst medical oncologists deal with the medical management of
those suffering from the disease. They liaise with primary care providers, clinical
oncologists and other health professionals, and providers of palliative care. The
consultant oncologist may have ‘MRCP’ or ‘FRCP’, or ‘FRCR’ (Fellow of the Royal
College of Radiologists) or ‘FRCS’ after his name.
(h) Neurology – the study of the nervous system and its disorders, ie the patient’s nerves,
sensory and motor functions and reflexes, and will cover injuries to the brain, neck and
back, neurodegenerative disorders, epilepsy and multiple sclerosis. A consultant
neurologist will have ‘MRCP’ or ‘FRCP’ after his name. A neurosurgeon operates on the
brain and spine, and deals with trauma and injuries to both, with brain tumours and
haemorrhages, and with spinal nerve problems. A consultant neurosurgeon will have
‘FRCS’ after his name.
16 Personal Injury and Clinical Negligence Litigation

(i) Obstetrics – covers pregnancy and birth, and is concerned with the health of the mother
and of the foetus from conception to delivery. The obstetrician will also deal with
sterilisations and infertility, cervical cancer, tumours of the ovaries and endometriosis.
Both doctors and nurses can specialise in obstetrics. A consultant obstetrician will have
‘MRCOG’ or ‘FRCOG’ after his name.
(j) Occupational health – this deals with the effect of work on the individual’s health, both
mental and physical, and the effect of ill-health on the individual’s work. Specialists
identify and treat specific occupational illnesses and diseases, and deal with the
prevention of ill-health caused by chemical, biological, physical and psychological
factors arising in the workplace. The term ‘occupational health’ covers a number of
areas, and therefore there are various specialists, including occupational physicians,
occupational psychologists, occupational health nurses, occupational hygienists,
disability managers, workplace counsellors, health and safety practitioners, and
workplace physiotherapists. The consultant occupational physician will usually have
‘FFOM’ (Fellow of the Faculty of Occupational Medicine) after his name. Others
specialising in this area may have a Diploma in Occupational Medicine (DOccMED).
(k) Ophthalmology – the diagnosis and treatment of disorders of the eye. The consultant
ophthalmologist will usually have ‘FRCOphth’ (Fellow of the Royal College of
Ophthalmologists) after his name.
(l) Orthopaedics – this is concerned with injuries to and disorders of the bones and muscles.
Surgeons who work in this area may specialise in certain parts of the body – the knee,
the hip, the spine etc. The orthopaedic surgeon will have FRCS after his name, possibly
followed by (Orth) and/or (Tr & Orth) signifying his specialism in orthopaedics and
trauma.
(m) Paediatrics – diseases and illness affecting children. A paediatrician may have a sub-
speciality, eg a paediatric neurologist, a paediatric surgeon, etc. The consultant
paediatrician will normally have ‘MRCP’ or ‘FRCP’ after his name, and may have
‘FRCPCH’ (Fellow of the Royal College of Paediatrics and Child Health).
(n) Palliative care – the care of patients suffering from a terminal illness, including pain
control and psychological and spiritual care, and the provision of services either at
home or in a hospital, hospice or day centre. It also encompasses support for the family
of the patient, which continues into the bereavement period.
(o) Pathology – the science of the changes which the body goes through as a result of disease.
A pathologist examines body samples in order to diagnose disease and undertakes post-
mortem examinations in order to determine the cause of death. The consultant
pathologist will have ‘FRCPath’ after his name.
(p) Physiotherapy – the use of exercise, manipulation, and heat in the treatment of disease or
injury, which is often essential in the rehabilitation process. All physiotherapists will
have either ‘MCSP’ (Member of the Chartered Society of Physiotherapy) or ‘FCSP’
(Fellow of the Chartered Society of Physiotherapy) after their names, and must be
registered with the Health Professions Council, the regulatory body for
physiotherapists.
(q) Psychiatry – the branch of medical science which treats mental disorder and disease, and
which helps with the management of individuals with learning disabilities. A
psychiatrist deals with depression, PTSD, drug and substance abuse, schizophrenia, etc.
A consultant psychiatrist will have ‘MRCPsych’ or ‘FRCPsych’ (Member or Fellow of the
Royal Colleges of Psychiatrists) after his name.
(r) Psychology – the scientific study of how people think, how and why they act, react and
interact as they do. It covers memory, rational/irrational thought, intelligence, learning,
personality, perception and emotions. Psychology is used in promoting rehabilitation
and assessing rehabilitation needs following an accident. There are a number of
different branches, including educational psychology (concerned with children’s
 Personal Injury and Clinical Negligence Terminology 17

learning and development), clinical psychology (concerned with reducing psychological

stress in those suffering from depression, mental illness, brain injuries and the after
effects of trauma), health psychology (concerned with behaviour relating to health,
illness and care) and occupational psychology (relating to how people perform at work).
Psychologists are not medically qualified but rather have a graduate degree in
psychology plus an accredited postgraduate qualification leading to chartered status.
(s) Rheumatology – medical speciality concerned with the study and management of diseases
of the joints and connective tissue, including rheumatoid arthritis, osteoarthritis,
osteoporosis, whiplash and repetitive strain injury. A consultant rheumatologist will
have ‘MRCP’ or ‘FRCP’ after his name.

2.4 COMMON ABBREVIATIONS USED IN MEDICAL RECORDS

AAL Anterior axillary line
ACTH Adrenocorticotrophic hormone
ADH Antidiuretic hormone
AE Air entry
AF Atrial fibrillation
AFB Acid fast bacillus (TB)
AFP Alpha-fetoprotein
AJ Ankle jerk (reflex)
Alk Alkaline (phos = phosphatase)
An Anaemia
ANF Antinuclear factor
Anti-D This gamma globulin must be given by injection to Rhesus negative mother who delivers/
aborts Rhesus positive child/foetus to prevent mother developing antibodies which could
damage a subsequent Rhesus positive baby
Apgar Apgar score: means of recording baby’s condition at and shortly after birth by observing and
‘scoring’ (0, 1 or 2) 5 parameters
AP Anteroposterior
APH Antepartum haemorrhage
ARM Artificial rupture of membranes (labour)
ASO Antistreptolysin O
ATN Acute tubular necrosis
A/V (a) Anteverted
(b) Arterio venous
AXR Abdominal x-ray (plain)
Ba Barium
BD To be given/taken twice a day
BJ Biceps jerk (reflex, see AJ)
BMJ British Medical Journal
BMR Basal metabolic rate
BO Bowels open
BP British Pharmacopoeia
BP Blood pressure
BS (a) Breath sounds
(b) Bowel sounds
(c) Blood sugar
C2H5OH Alcohol
ca Carcinoma/cancer
Ca Calcium
Caps Capsules
CAT scan Computed axial tomograph scan
CBD Common bile duct
cc (a) Carcinoma (cancer)
(b) Cubic centimetre
18 Personal Injury and Clinical Negligence Litigation

CCF Congestive cardiac failure

Ch VS Chorionic villus sampling
CI Contraindications
Cl Clubbing (of finger or toe nails)
CLL Chronic lymphocytic leukaemia
CML Chronic myeloid leukaemia
CMV Cytomegalovirus
CN I-XII Cranial nerves 1 – 12
CNS Central nervous system
C/O Complaining of
CO2 Carbon dioxide
COETT Cuffed oral endotracheal tube
COT Cuffed oral tube (an endotracheal tube used for ventilating a patient who cannot breathe
unaided)
CPD Cephalo-pelvic disproportion (baby too large to fit through pelvis)
CSF Cerebro-spinal fluid
CT Computerised tomography
CTG Cardiotocograph (trace during labour of baby’s heart and mother’s contractions)
CVA Cardiovascular accident (stroke)
CVP Central venous pressure
CVS Cardiovascular system
Cx Cervix
CXR Chest x-ray
Cy Cyanosis
DB Decibel
D&C Dilation (cervical) and curettage
DM Diabetes mellitus
DNA Deoxyribonucleic acid (also ‘did not attend’)
DOA Dead on arrival
D&V Diarrhoea and vomiting
DVT Deep venous thrombosis
D/W Discussed with
Dx Diagnosis
ECG Electrocardiography
ECT Electroconvulsive therapy
EDC Expected date of confinement
EDD Expected date of delivery
EEG Electroencephalogram/graph (brain scan)
ENT Ear, nose and throat
ERCP Endoscopic retrograde choledochopancreatico/graphy/scope
ERPC Evacuation of retained products of conception
ESR Erythrocyte sedimentation rate (blood)
ETR Examined through clothes
EtoH Alcohol
ET(T) Endotracheal (tube)
EUA Examined under anaesthesia
FB (a) Finger’s breadth
(b) Foreign body
FBC Full blood count
FBS Foetal blood sampling (a procedure which is carried out during labour to check on the baby’s
condition)
FH Family history
FHH Foetal heart heard
FHHR Foetal heart heard regular
FHR Foetal heart rate
FMF Foetal movements felt
 Personal Injury and Clinical Negligence Terminology 19

FSE Foetal scalp electrode

FSH Follicle-stimulating hormone
G gram
GA General anaesthesia
GB Gall bladder
GFR Glomerular filtration rate
GI Gastro-intestinal
GIT Gastro-intestinal tract
G6PD Glucose 6 phosphate dehydrogenase
GP General practitioner
GTT Glucose tolerance test (for diabetes)
GU Genito-urinary
GUT Genito-urinary tract
h Hour
Hb Haemoglobin
Hct Haemocrit
HOCM Hypertrophic obstructive cardiomyopathy
HPC History of presenting complaint
HRT Hormone replacement therapy
HS Heart sounds
HVS High vaginal swab
Hx History
ICP Intracranial pressure
ICS Intercostal space
IDA Iron deficiency anaemia
IDDM Insulin dependent diabetes mellitus
Ig Immunoglobulin
IJ Internal jugular vein
IM Intramuscular
ISQ In status quo
IT Intrathecal
ITP Idiopathic thrombocytopenic purpura
ITU Intensive therapy unit
iu International unit
IUCD Intrauterine contraceptive device
IV Intravenous
IVC Inferior vena cava
IVI Intravenous infusion (drip)
IVU Intravenous urography
Ix Investigations
J Jaundice
ºJACCO No jaundice, anaemia, cyanosis, clubbing or oedema
JVP Jugular venous pressure
K+ Potassium
kg Kilogram
KJ Knee jerk (reflex, see AJ)
kPa Kilopascal, approximately 7.5 mmHg
L (a) Litre
(b) Left
LA Local anaesthesia
LBBB Left bundle branch block
LFTs Liver function tests
LH Luteinising hormone
LIF Left iliac fossa
LIH Left inguinal hernia
20 Personal Injury and Clinical Negligence Litigation

LMN Lower motor neurone

LMP First day of the last menstrual period
LN Lymph node
LOA Left occiput anterior (position of baby’s head at delivery, see also LOP, ROA, ROP, LOL, ROL,
OA, OP)
LOC Loss of consciousness
LOL Left occipitolateral (see LOA)
LOP Left occiput posterior (see LOA above)
LP Lumbar puncture
LS Letter sent
LSCS Lower segment caesarean section (the ‘normal’ type of caesarean section)
LSKK Liver, spleen and kidneys
LUQ Left upper quadrant
LVF Left ventricular failure
LVH Left ventricular hypertrophy
mane In the morning
mcg Microgram
MCL Mid clavicular line
MCV Mean cell volume
μg Microgram
mg Milligram
mist mixture
mitte 1/12 Supply/give/send/provide
ml Millilitres
mmHg Millimetres of mercury (pressure)
mMol Millimol
MRI Magnetic resonance imaging (=NMRI)
MS Multiple sclerosis
MSU Mid stream urine
N&V Nausea and vomiting
Na Sodium
NaHCO3 Sodium bicarbonate
NAD Nothing abnormal diagnosed/detected
NBM Nil by mouth
ND Notifiable disease
ng Nanogram
NG (a) Naso-gastric
(b) Carcinoma/cancer (neoplastic growth)
NMCS No malignant cells seen
NMR Nuclear magnetic resonance (scan)
noct/nocte At night
NOF Neck of femur
N/S Normal size
NSAID Non-steroidal anti-inflammatory drugs
O2 Oxygen
OA (a) Occipito-anterior (see LOA)
(b) Osteoarthritis
OCP Oral contraceptive pill
OE On examination
OP Occipito-posterior (see LOA)
Orthop. Orthopnoea (breathlessness on lying flat)
P Pulse
P or π Period
PA Posteroanterior
PAN Polyarteritis nodosa
 Personal Injury and Clinical Negligence Terminology 21

PC Post cibum (after food)

pCO2 Partial pressure of carbon dioxide (normally in blood)
PCV Packed cell volume
PERLA Pupils are equal and react to light and accommodation
PE (a) Pulmonary embolism
(b) Pre eclampsia
PEFR Peak expiratory flow rate
PET Pre-eclamptic toxaemia
pg Picogram
pH Acidity and alkalinity scale. Low is acidic. High is alkaline. pH7 is about neutral
PH Past/previous history
PID (a) Pelvic inflammatory disease
(b) Prolapsed intervertebral disc
PIP Proximal interphalangeal
PL Prolactin
PMH Past/previous medical history
PND Paroxysmal nocturnal dyspnoea
PN (R) Percussion note (resonant)
po Per os (by mouth)
pO2 Partial pressure of oxygen (normally in blood)
POH Past/previous obstetric history
POP Plaster of Paris
PoP Progesterone only pill
PPH Post-partum haemorrhage
pr Per rectum (by the rectum)
prn As required – of eg, pain killers
PRV Polycythaemia rubra vera
PTH Parathyroid hormone
PTT Prothrombin time
PU Peptic ulcer
PV Per vaginam (by the vagina)
QDS To be given/taken 4 times a day
R Right or respiration
RA Rheumatoid arthritis
RBBB Right bundle branch block
RBC Red blood cell (erythrocyte)
RE Rectal examination
Rh Rhesus factor
RIC Raised intracranial pressure
RIF Right iliac fossa
RIH Right inguinal hernia
ROA Right occiput anterior (see LOA)
ROL Right occipito-lateral (see LOA)
ROM Range of movement
ROP Right occiput posterior (see LOA)
RS Respiratory system
RT Radiotherapy
RTA Road traffic accident
RTI Respiratory tract infection
RUQ Right upper quadrant
SB Serum bilirubin
S/B Seen by
SBE Subacute bacterial endocarditis
SC Subcutaneous
S/D Systolic/diastolic (heart and circulation)
22 Personal Injury and Clinical Negligence Litigation

SE Side effects
SH Social history
SJ Supinator jerk (reflex: see AJ)
SL Sub linguinal (under the tongue)
SLE Systemic lupus erythematosus
SOA Swelling of ankles
SOB (OE) Shortness of breath
SOS (a) if necessary
(b) see other sheet
SROM Spontaneous rupture of membranes
stat Immediately
Supp Suppositories
SVC Superior vena cava
SVD Spontaneous vaginal delivery
SVT Supraventricular tachycardia
SXR Skull x-ray
Ts and As Tonsils and Adenoids
TCI 2/52 To come in (to be admitted to hospital), in 2 weeks’ time
tds To be given/taken 3 times a day
TGH To go home
THR Total hip replacement
TIA Transient ischaemic attack
TJ Triceps jerk (reflex: see AJ)
TPR Temperature, pulse and respiration
TSH Thyroid stimulating hormone
TTA To take away
TVF Tactile vocal fremitus
TX Transfusion
UC Ulcerative colitis
U&E Urea and electrolytes (biochemical tests)
UG Urogenital
UMN Upper motor neurone
URTI Upper respiratory tract infection
USS Ultra sound scan
UTI Urinary tract infection
VA Visual acuity
VE Vaginal examination
VF Ventricular fibrillation
VT Ventricular tachycardia
V/V Vulva and vagina
VVs Varicose veins
WBC White blood corpuscle/white blood cell count
WCC White blood cell count
WR Wasserman reaction
wt Weight
XR X-ray
 Personal Injury and Clinical Negligence Terminology 23

2.5 DIAGRAMMATIC REPRESENTATION OF THE HUMAN SKELETON

24 Personal Injury and Clinical Negligence Litigation

2.6 CONCLUSION
A basic understanding of the medical terms involved in personal injury and clinical negligence
cases can assist the trainee when reading medical reports, and also provides an insight into
the client’s problems which can often be useful in the negotiation of any settlement.

2.7 FURTHER READING

Kemp and Kemp, The Quantum of Damages (Sweet & Maxwell)
Black’s Medical Dictionary (A & C Black Publishers Ltd)
Dorland’s Medical Abbreviations (W B Saunders Company)
Other appropriate medical textbooks.