OR14.1-4 | Counselling and Rehabilitation Skills — Glossary

Bacterial infection of bone arising from blood-borne seeding, most common in the metaphyses of long bones in children aged 2–12 years, caused predominantly by Staphylococcus aureus; presents with fever, localised bony tenderness, and systemic illness.

The clinician's duty to provide sufficient information about a proposed procedure — including its nature, purpose, material risks, benefits, alternatives, and consequences of refusal — in language and format the patient can understand.

Artificial Limbs Manufacturing Corporation of India — a public sector enterprise providing subsidised prosthetics (including PTB sockets and SACH feet) and orthotic devices to persons with disabilities under government schemes; a key resource for lower-income patients requiring prosthetic rehabilitation.

A tricyclic antidepressant used at low doses (10–75 mg nocte) as a first-line treatment for neuropathic pain including phantom limb pain; mechanism includes sodium channel blockade and noradrenaline/serotonin reuptake inhibition; also aids sleep, which is commonly disrupted by phantom pain.

The specific consent process required before amputation surgery, which must include explicit disclosure of the irreversible nature of the procedure, the reasons amputation is preferred over limb salvage in the specific case, the anticipated functional outcome, and the prosthesis and rehabilitation pathway.

Death of the femoral head due to loss of blood supply; a devastating complication of septic arthritis of the hip in children, caused by elevated intracapsular pressure compressing the retinacular vessels; also occurs after femoral neck fractures and hip dislocation.

India's flagship government health insurance scheme providing cashless hospitalisation cover at empanelled government and private hospitals for eligible beneficiaries; relevant to referral counselling as a mechanism to address the financial barrier to higher-centre transfer for orthopaedic emergencies.

A psychological consequence of disfiguring surgery (especially amputation or joint replacement in young patients) in which the patient's internal representation of their body is altered, leading to grief, identity adjustment challenges, and sometimes body dysmorphic sequelae — anticipatory counselling and psychological support are components of the rehabilitation plan.

Damage to the brachial artery, a recognised complication of displaced supracondylar fractures in children, caused by tenting of the artery over the proximal spike of the distal fragment; presents with pallor, absent radial pulse, and median or anterior interosseous nerve signs; requires emergency orthopaedic reduction and vascular surgery on standby.

The standard surgical technique for below-knee amputation in which a long posterior myocutaneous flap incorporating the gastrocnemius-soleus muscle and posterior calf skin is preserved to cover the distal tibia and fibula; preferred because the posterior calf has superior vascularity and the muscle provides padding over the bone ends.

A validated framework for clinical communication training that maps the medical consultation into five tasks (initiating the session, gathering information, physical examination, explanation and planning, closing) with specific learnable communication skills at each stage.

Compression of the sacral nerve roots below the conus medullaris, causing bladder and bowel dysfunction (retention, incontinence), saddle anaesthesia, and bilateral leg weakness; a same-day neurosurgical emergency — decompression within 24–48 hours preserves sphincter function; after 72 hours, permanent incontinence is likely.

A pus collection arising from tuberculosis, characterised by absent inflammatory signs (no warmth, no erythema, often no fever) because the granulomatous reaction of TB is non-pyogenic; may track along fascial planes away from the primary site in Pott's disease.

A condition in which raised pressure within a closed muscle compartment compromises perfusion, causing ischaemic muscle necrosis; the earliest reliable sign is pain out of proportion to injury and pain on passive stretch of muscles in the compartment; treated by urgent fasciotomy.

Congenital foot deformity characterised by equinus (plantar flexion), varus (inversion), adductus (forefoot adduction), and cavus; the most common congenital foot disorder, managed by Ponseti serial casting followed by tenotomy and Dennis-Brown splint.

Indian legislation under which medical negligence and deficiency of service claims against healthcare providers are adjudicated, replacing the 1986 Act; establishes that deficient consent-taking and inadequate information disclosure constitute a deficiency of medical service.

The plastic remodelling of the somatosensory cortex following amputation, in which the deafferented cortical zone representing the amputated limb is progressively invaded by adjacent cortical representations; this process underlies both phantom limb pain and the gradual reduction in phantom pain with prosthetic use and time.

The cognitive and legal ability to understand information relevant to a healthcare decision, appreciate its implications for one's own situation, reason about alternatives, and communicate a choice — assessed at the time of the specific decision.

In the context of breaking bad news, a patient's protective psychological mechanism of refusing to accept the reality of a distressing diagnosis or prognosis — a normal response that requires empathic acknowledgment, not confrontation.

A spectrum of hip abnormality ranging from mild acetabular dysplasia to complete dislocation, detected clinically by Ortolani and Barlow tests in neonates, confirmed on ultrasound (preferred under 6 months) or X-ray (after 6 months), and treated with Pavlik harness in infants or surgical reduction in older children.

A prosthetic foot incorporating a carbon fibre keel that stores energy during the loading phase and releases it at toe-off, mimicking the energy return of the Achilles tendon; allows faster walking and recreational activity; more expensive than SACH; examples include Seattle Foot and Flex-Foot.

A surgical procedure in which the fascial envelope of a muscle compartment is incised longitudinally to relieve elevated intracompartmental pressure and restore muscle perfusion; the definitive treatment for compartment syndrome; must be performed within 6–8 hours of onset to prevent irreversible muscle necrosis.

An anticonvulsant that modulates voltage-gated calcium channels (at the α2δ subunit), reducing central sensitisation; used as a first-line pharmacological treatment for neuropathic pain including phantom limb pain; also used in diabetic neuropathy and post-herpetic neuralgia.

A fixed deformity of the hip in partial flexion, arising in above-knee amputees if the residual thigh muscles are not actively exercised and the patient rests with the stump elevated or in a flexed position; prevents proper prosthetic socket fitting and gait; prevented by prone positioning and active hip extension exercises postoperatively.

A shell of new reactive periosteal bone that forms around a sequestrum in chronic osteomyelitis; it is the periosteum's attempt to wall off the dead bone and maintain structural continuity, but it traps the sequestrum and perpetuates chronic infection.

Oncological surgical technique for bone tumours in which the tumour is resected with wide margins and the limb reconstructed using endoprostheses, allografts, or biological reconstruction, aiming to preserve function while achieving local tumour control.

A risk of a medical procedure that a reasonable patient in the same circumstances would consider significant in deciding whether to proceed — the legal threshold for disclosure; includes rare but serious risks and common but less severe risks.

A non-pharmacological treatment for phantom limb pain in which a mirror is placed at the stump to reflect the intact contralateral limb, creating a visual illusion of the absent limb moving; exploits visual feedback to modulate cortical representations and reduce central sensitisation; has Level II evidence for efficacy.

A bulb of regenerating axons that forms at the proximal end of a divided peripheral nerve after amputation; may become symptomatic (painful on percussion, spontaneously painful) and is a cause of stump pain; prevented by burying the nerve in muscle at the time of amputation; treated by injection or surgical excision if symptomatic.

The most common primary malignant bone tumour, arising predominantly in the metaphyses of long bones (distal femur, proximal tibia, proximal humerus) in adolescents and young adults, characterised by the production of osteoid by tumour cells; treated with neoadjuvant chemotherapy followed by wide excision.

Clinical test for compartment syndrome in which the examiner passively moves the digit or foot to stretch the muscles in the suspected compartment; severe pain on stretch (disproportionate to the movement) is the earliest reliable sign, preceding loss of pulse.

The standard prosthetic socket for below-knee amputation, in which the primary load-bearing areas are the patellar tendon (infrapatellar region), the tibial condylar flares, and the popliteal fossa, with pressure relief over bony prominences; custom-moulded to the patient's stump.

Pain perceived as arising from an amputated limb, experienced by 60–80% of amputees; arises from cortical reorganisation in the somatosensory cortex and central sensitisation after deafferentation; managed with amitriptyline, gabapentin/pregabalin, and mirror therapy; it is a neurophysiological phenomenon, not a psychiatric disorder.

The non-painful perception that the amputated limb is still present, experienced by 70–80% of amputees; arises because cortical representation of the limb does not immediately reorganise after amputation; may be beneficial in prosthetic rehabilitation by providing positional awareness.

A physician specialising in Physical Medicine and Rehabilitation (PM&R), who coordinates prosthetic prescription, rehabilitation programme design, and management of post-amputation syndromes including phantom limb pain and stump complications in the multidisciplinary amputation rehabilitation team.

The standard of care for idiopathic congenital talipes equinovarus (clubfoot), using a series of serial corrective plaster casts applied weekly, followed by percutaneous Achilles tenotomy and bracing, achieving excellent functional outcomes in the majority of cases when started in infancy.

Arterial damage occurring in approximately 20–35% of knee dislocations, caused by tethering of the popliteal artery at the adductor hiatus above and at the fibrous arch of the soleus below; may present with intact distal pulses due to collateral flow, masking the extent of injury.

Degenerative joint disease developing after intra-articular fracture, arising from articular cartilage damage at the time of injury, residual joint incongruity after reduction, and altered biomechanics; a common long-term sequela of calcaneal, tibial plateau, and ankle fractures.

Tuberculosis of the spine, most common in the lower thoracic and thoracolumbar junction; indolent onset (distinguishing from pyogenic infection); destruction of anterior vertebral body leads to wedging and gibbus deformity; cold abscess may track along fascial planes; managed with anti-tubercular therapy ± surgical decompression.

Clinical features in low back pain that suggest a serious underlying cause — malignancy, infection, fracture, or neurological emergency — including age >50 with new pain, history of cancer, unexplained weight loss, fever, bladder/bowel dysfunction, progressive neurological deficit, night pain, and pain unrelieved by rest.

Solid Ankle Cushion Heel — the most basic prosthetic foot design, using a cushioned heel wedge for energy absorption at heel strike and a rigid keel for push-off; no moving parts; durable, low-maintenance, and widely available; the standard prosthetic foot in Indian government rehabilitation services.

See SACH foot above — the standard prosthetic foot in the Indian ALIMCO prosthetic scheme, recommended as first-line for community-level ambulation in below-knee amputees without specific high-activity requirements.

A structured verbal handover framework used in clinical communications: Situation (what is happening now), Background (relevant clinical context), Assessment (what you think the problem is), Recommendation (what you need the receiver to do); used for telephone referrals to higher centres.

Bacterial infection of a joint space, constituting an orthopaedic emergency because bacterial proteases destroy articular cartilage within 8 hours of infection onset; presents with a hot, swollen joint with globally restricted movement and fever; managed by urgent aspiration and washout.

A fragment of dead, avascular bone that has separated from viable bone during chronic osteomyelitis; enclosed in a fibrous wall and surrounded by new periosteal bone (involucrum); cannot be sterilised by antibiotics alone and requires surgical removal (sequestrectomy).

A six-step structured communication framework (Setting, Perception, Invitation, Knowledge, Emotion, Strategy) used to deliver difficult news, developed originally for oncology and now widely applied in all specialties requiring prognostic disclosure.

The application of graduated compression bandaging to the residual limb after amputation, applied distal to proximal (firm at the tip, reducing toward the base), to reduce post-operative oedema and reshape the stump from a bulbous to a cylindrical form in preparation for prosthetic fitting; incorrect technique (proximal-to-distal) causes distal oedema and a conical stump.

A collection of pus between the periosteum and the bony cortex, a complication of acute osteomyelitis in which infection has penetrated the cortex; it elevates and strips the periosteum, compromising blood supply to the underlying cortex and risking sequestrum formation.

Ankle disarticulation with preservation of the heel pad to provide end-bearing coverage of the distal tibia and fibula; indicated for severe forefoot injuries and distal diabetic foot gangrene with an intact heel pad; produces a bulbous but end-bearing stump that fits inside a Syme's prosthesis.

A health literacy verification technique in which the clinician asks the patient to explain in their own words what they have understood, enabling the clinician to identify and correct gaps in comprehension before the patient leaves.

A now narrowly construed exception to full disclosure in which a clinician may withhold information only if disclosure itself would cause immediate, severe psychological harm — it does not justify withholding information merely because the news is distressing.

A modified below-knee prosthetic socket using a silicone liner to distribute load across the entire stump surface rather than selectively; associated with lower skin breakdown rates; often used with a pin-lock suspension system; more expensive than the standard PTB design.

Amputation through the femoral shaft, sacrificing both the tibia and knee joint; associated with the highest energy cost of prosthetic ambulation (~60–70% above normal) requiring a prosthetic knee unit; indicated when the distal femur or knee is involved by disease or injury.

Amputation through the tibial shaft, preserving the knee joint; the most functionally desirable lower limb amputation level because knee preservation reduces prosthetic energy consumption; ideal tibial length 12–18 cm from the tibial plateau.

A legally and ethically binding agreement to undergo a medical procedure, which is valid only when the patient has decision-making capacity, has received adequate disclosure, acts voluntarily without coercion, and the agreement is properly documented.

A clinician's spoken acknowledgment of a patient's emotional state that validates their experience without deflecting or minimising it — for example, 'I can see this is very difficult to hear' — a core technique in therapeutic communication.

The principle that consent must be given freely, without coercion, undue influence from clinicians or family members, or conditions of desperation that distort autonomous decision-making.

A clinical finding that indicates a pathological process likely to cause irreversible harm if managed with standard primary care resources or with delayed specialist review; synonymous with 'red flag' for spinal pathology and 'limb-threatening sign' for vascular emergencies.