The varied influences to which medicine has been subjected,
and the ages that it has endured, have produced a language that
is in constant flux. The language of orthopaedics includes corruptions
that, while they defy the rules of philology, have gained acceptance essentially
because they are familiar. An awareness and understanding of such
corruptions is useful, both for restoring consistency and accuracy
of communication and for providing a window into history.
Greek and Latin are inflected languages. Endings are appended
to nouns and verbs to confer distinct senses. Nouns belong to declensions
and are said to be declined; verbs belong to conjugations and are
said to be conjugated. What is achieved by inflection in Greek and
Latin is achieved principally by word order and prepositions in English.
In Greek and Latin, the endings of nouns identify gender, number, and
case. The gender may be masculine, feminine, or neuter. The number may
be singular or plural. (A third form of numerical designation, dual,
is reserved for things that naturally occur as pairs; this nomenclature
does not exist in orthopaedics.) Cases of relevance are the nominative,
indicating the subject; the genitive, indicating possession; and
the accusative, indicating the object.
In Latin, nouns are grouped into five declensions. Excessive
inclination toward the midline of the shaft relative to the neck
of the os femoris is known by the Latin term coxa
vara. In contrast, the Latin term for abnormal shortening
of the neck is coxa brevis (and not coxa
breva, which has the appeal of being more melodious). The
adjectives describing the hip belong to different declensions, so
their endings differ1,2.
In the Nomina anatomica3, the
thigh bone is designated as the femur. In Latin, femur signifies "the
thigh." The "bone of the thigh" is properly
referred to as the os femoris, derived from os, which
means "bone," and from femoris, which
is the singular possessive (genitive) of femur.
This is an error of case. Perhaps the most frequent source of such
error is the plural form: the Latin pelvis gives
the plural pelves; the Latin acetabulum, the
plural acetabula; and the Greek sa???µa ("sarcoma"), the
plural sa???´ µata ("sarcomata").
The term "musculus psoas," introduced by
the French anatomist Riolanus4,
refers to one of two muscles, designated major ("larger")
and minor ("smaller"), that arise
from the spine and insert into the os femoris and
the pelvis, respectively. The term is derived from the
Greek ?ó a ("muscle of the loins"), the
name coined by Hippocrates. In the plural, the nominative is ?óa?,
or psoai, and the accusative is ?ó a?,
or psoas. Thus, the correct appellation for this muscle
is psoa;musculus is redundant,
and psoas is an error of number.
While the formation of mixed compounds, or hybrids, is common
in English, it is more accurate to reserve Greek for Greek words
and Latin for Latin words; hence, "tetraplegia" from the
Greek prefix tet?a- ("four") and p????´ ("stroke")
is more accurate than "quadriplegia" from the
Latin quadri- ("four"), and "peri-arthric" from
the Greek ?e??´ ("around") and ’a???o? ("joint")
is more accurate than "peri-articular" from the
Latin articulus ("joint"). Deviation
from this pattern follows the general rule that Latin is reserved
for anatomy while Greek is reserved for disease; hence, "os
pubis" from the Latin os ("bone")
and pubis ("groin") is used for "bone
of the groin," but "osteitis pubis" from
the Greek ’oste´o? ("bone") and the ending -?t??
("disease or inflammation of") is used for "inflammation
of the bone of the groin."
"Slipping of a vertebra" relative to an adjacent
vertebra, such as the fifth lumbar vertebra relative to the first
sacral vertebra, is known as "spondylolisthesis." The
term is derived from the Greek spó?d??os ("bone that forms
a joint of the spine"), which is equivalent to the Latin "vertebra," and ’ó??´s??s?? ("slipping
and falling, a sliding or gliding down a slippery path"),
which has entered into English as "olisthy." The "o" at
the beginning often is dropped. This practice stems from the recognition
that, in composition, when one word that ends in a consonant is
joined with a word that begins with a consonant, the first word
is reduced to its stem, and a connecting vowel—most often, "o";
less often, "i"; and, rarely, "a"—is
inserted. In this case, the "o" is not a connection
but a part of the stem of the second word. Curiously, the opposite
frequently occurs when combining the Greek word stóµa ("mouth")
with other anatomic terms to indicate an aperture in a cavity or
canal. Thus, the opening in the stomach through which a patient
who has cerebral paralysis receives nutrition is known as a gastrostomy,
from the Greek ?ast?´? ("stomach"). The
aperture may be referred to as a "stoma" and
not an "ostomy," as the "o" follows the
convention of compounds.
In Latin, adjectives may be derived from a noun or from the past
participle of a verb. The former denotes a relationship (typically
physical) to the noun. The latter describes a structure that is
in some way an object of the verb. This sense can be conveyed by such
expressions as "furnished with" or "shaped
like." The artery that contributes to the vascular network
around the knee is properly designated "genual" (from
the Latin noun genu ["knee"])
or "genicular" (a diminutive form, as this vessel
is small in contrast with the other artery of the knee, the popliteal),
after its course around and its supply of the knee. The term "geniculate" would
imply derivation from a verb based upon genu, as
though the artery were somehow distinguished by a sharp bend (so
it could be anywhere in the body) and not by its location. By comparison,
the medial and lateral geniculate bodies of the metathalamus appear
bent like a knee on cross section.
In the wrist, the bone that is "shaped like the moon" is
known as the "lunate," and the one that is "furnished with
a hook" is known as the "hamate." These
adjectives are formed as past participles from presumed verbs derived from
the Latin nouns luna ("moon")
and hamus ("hook"), respectively.
If the former bone were physically related to the moon, then the
proper adjectival form would be "lunar," derived
directly from the noun without an interceding verb.
In Greek and Latin, vowels may be paired to produce a long compound sound,
which is known as a diphthong. While diphthongs occur in English,
as in the word "aisle," Greek and Latin diphthongs
may be contracted into a single vowel. This is typical of American
usage. Thus, "paediatrics," a compound of the
Greek pa?˜? (stem, pa?d- ["child"])
and ’?at?ó? ("physician"), has evolved
into "pediatrics," which is concerned with "the
medical treatment of children." ?a?˜?
gives the diminutive pa?d?´o? ("young child").
The practice of contracting diphthongs has been reversed in the
term "orthopaedics," a compound of the Greek ’o??ó? ("straight, correct") and pa?d?´o;?.
This formation was adopted by the American Academy of Orthopaedic
Surgeons in 1933. The term was conceived in the title of a treatise, L’Orthopédie
(Orthopaedia), by the French physician Nicholas Andry de
Bois-Regard5. Retention of the
diphthong avoids the suggestion that the discipline is limited to
correction of deformities of the foot (after the Latin pes [stem, ped-] for "foot").
Despite its origins, orthopaedics now encompasses the treatment of
musculoskeletal disease in adults as well as children. Consistency
thus dictates that the branch of the specialty that pertains to
children be designated "paediatric orthopaedics" and
not "pediatric orthopaedics."
In Latin, "anulus fibrosus" refers to the "small
filamentous ring" that surrounds the "fleshy center," or "nucleus
pulposus," of the intervertebral disc. Anulus,
with a single "n," is the diminutive of anus ("ring").
More often than not, the term is spelled incorrectly as "annulus fibrosus" (with
a double "n"), as though it were derived from
the Latin annulus, which is the diminutive of annus ("year");
this term thus signifies "a small fibrous year"!
The persistence of the use of annulus may result
from the veneer of learnedness that a longer spelling confers or from
a desire to distance this structure from the terminus of the gastrointestinal
tract.
The "upper part of the head," which encloses
the brain and is distinct from the bones of the face and jaw, is
known in Latin as calvaria. This is the feminine
singular nominative form of a noun that belongs to the first declension.
The plural is calvariae. The use of "calvarium" to
designate this structure is incorrect, as it implies that the word
is the neuter singular nominative form of a second-declension noun,
of which "calvaria" would be the plural. The usage
no doubt arose after the example of the medieval Latin cranium, derived
from ??a?? ó?, which is the Greek equivalent of the Latin calvaria.
The German surgeon F. König introduced the term "osteochondritis
dissecans" to describe "cutting away or dissection" of
bone and cartilage into a joint cavity6.
This term is derived from the Latin verb seco ("I
cut") and the Latin inseparable particle dis-
("apart, away"). A vascular insult coupled with
trauma is the causative factor. There is no evidence that the condition involves "drying
out," or desiccation, of bone and cartilage, as the term "osteochondritis
desiccans" suggests. This term is derived from the Latin
verb sicco ("I make dry"), as
in the term "sicca syndrome," to describe dryness
of mucous membranes, and from the preposition de ("out,
thoroughly").
The term "bursa" is derived from the Greek
ß?´?sa ("a sack, pouch"); hence, the English word "purse." Thus,
the pouch formed by the synovial membrane in a diarthrodial joint
is known as "bursa synovialis." This entity is
commonly referred to as the "bursa sack."
The Greek physician Philagrius7 used
the word ?a´????o? to describe an "encysted
tumor under the skin that contains liquid." The cystic
nature of the mass is implicit, so the term "ganglion cyst" is
redundant. Galen compared this tumor with a nerve-knot, particularly
one that arises from a dorsal nerve of the spinal cord8. Thus, the term "ganglion
cyst" developed to distinguish a myxoid or synovial
ganglion from a neural one, a distinction that usually is apparent
from the context.
An expression that is frequently found in the introductory statements
of manuscripts is "retrospective review." This phrase,
derived from the Latin adverb retro ("backward")
and verb specto ("I look") and
from the Latin inseparable particle re ("again")
and verb video ("I see"), explains
how the author or authors looked backward in order to see again.
It would be preferable to speak of a retrospective study, or simply
to indicate that a review was conducted.
"Patella alta" refers to "a knee-pan
that is high." In Latin, alta is a feminine
singular nominative adjective that signifies "grown great," whence,
when an object is viewed from below, "high." This
term describes the abnormal proximal location of the knee-pan relative
to the distal aspect of the thigh. In Latin, the opposite of altus is humilis ("related
to the ground, low in a physical sense"), which is derived
from humus ("the earth, ground, soil")9. Thus, "patella alta" is
correctly contrasted with "patella humilis," which signifies "a
low knee-pan." Alternatively, "patella alta" may
be referred to as "patella supera," from the Latin superus ("above,
on top"), of which the opposite is inferus ("below,
under, low"). In this case, a low-riding patella would
be designated "patella infera." The term "patella
baja" is a hybrid of Latin and Spanish.
Some errors evade classification. The lateral head of the gastrocnemius
muscle variably lodges a sesamoid bone. This bone articulates with
the posterior aspect of the lateral condyle of the thigh. The English
anatomist and paleontologist Sir Richard Owen introduced the term "fabella" to
describe this structure, likening its form to that of "a small
bean."10 In Latin, fabella signifies "a
brief narrative, a short history or story." It is the diminutive
of fabula, which signifies "the subject
of common talk, history, a narration, account, story, tale, conversation,
play"; hence, the term "fable." The correct
Latin term for "bean" is faba.
Thus, the Swedish natural scientist Linnaeus gave the name Vicia
faba to the broad bean11.
This entity is responsible for acute hemolytic anemia in persons
of Mediterranean stock who have deficient or defective function
of erythrocyte enzymes that are protective against oxidative injury,
in particular glucose-6-phosphate dehydrogenase12.
This disorder is known as "fabismus," or "the
condition" caused by consumption "of beans." The
diminutive of faba is fabulus, which
is doubtless what Owen intended.
In Latin, valgus signifies "having
the knees bent outward"; hence, the term "bow-legged." In
contrast, varus signifies "bent or grown
inward"; hence, the term "knock-kneed"6. Thus, valgus originally
was used to describe the knee when it was pointed away from the
midline such that the leg pointed toward the midline. The opposite
type of deformity was termed varus. This convention
has been reversed, so that "genu valgum" is applied
to deformity of the knee joint characterized by an angle in which
the apex is directed medially and "genu varum" is
used to describe the opposite type of deformity, in which the angle
at the knee joint opens medially. The confusion appears to have
arisen from a shift of the application of the word from the affected joint
to the distal articulating element in the deformity. In the original
sense, valgus indicated direction of a joint outward from
the midline, and varus indicated direction of a
joint inward toward the midline; the former came to signify outward
direction and the latter, inward direction of the distal articulating
element.
Errors of language may be viewed pragmatically, as terms that
are familiar and therefore comfortable and that may be retained
as long as they convey the information that is intended. They also may
serve as points of historical interest.
Alternatively, a more critical posture may be assumed toward
errors of language. Precedent for this view already exists in the
English language as a whole. Perhaps the best example of a usage
that has the support of tradition but that is being more widely
and more forcefully rejected is that of "man" as
a generic appellation for any or all of the human race, irrespective
of gender. Its rejection stems from a recognition that it is discriminatory,
exclusive, and simply inaccurate, as women represent a majority
of humankind and are increasingly playing roles once regarded as
the exclusive domain of men (as in "businesswoman"),
and also because words such as "person" and "people" are
more inclusive (for example, of children). Furthermore, while in
other branches of linguistics (such as fiction), ambiguity may be
pursued deliberately in order to liberate the imagination, carelessness may
be interpreted as creativeness, and what is novel may be viewed
as fresh and exciting, these characteristics generally are not desirable
in the language of science.
In every discipline of medicine today, information is being disseminated
globally, through both multinational publishers and the electronic
media. More and more physicians whose native tongue is not English
are accessing and contributing to the English-language literature,
which remains the universal language of science. Because
it is so widely used and so widely influenced, English is evolving
disparately in different countries. The majority of medical terms
have their roots in classical Greek and Latin. The very
thing that makes these languages "dead" also makes
them constant and not subject to local influence. This constancy
in turn makes them universally recognized and ideally suited for
consistent and accurate communication, a fundamental and indisputable
objective, the importance of which is becoming increasingly apparent
in our global information age. Thus, so-called "accepted
usage," which all too often serves as a euphemism for entrenched
jargon, ought not to be offered as a defense or justification for
persistence of errors.
Lewis C, Short C. A
Latin dictionary. Oxford: Oxford University Press; 1989.
Liddell H, Scott R. A
Greek-English lexicon. Oxford: Oxford University Press; 1989.
Nomina anatomica. 6th ed.
Authorized by the Twelfth International Congress of Anatomists in London,
1985. With Nomina histologica (3rd ed).
Revised and prepared by subcommittees of the International Anatomical
Nomenclature Committee. New York: Churchill Livingstone;
1989.
Riolanus J.Opera omnia. Paris:
Hadrianvm Perier; 1610.
Andry de Bois-Regard N.L’Orthopédie,
ou l’art de prévenir et de corriger dans les enfants,
les difformités du corps. Le tout par des moyens a la portée
des pères et des mères, et des personnes qui ont
des enfants a élever. Paris: Lambert and Durand;
1741.
König F. Über freie Körper in den Gelenken. Deutsch Zeitschr Chir,1887;27: 90-109. 2790
1887
Philagrius. Frammenti. Masullo
R, editor. Naples: Bibliopolis; 1999.
Galen C.Opera omnia. Kühn
CG, editor. Hildesheim: G Olms; 1964.
Riddle J, Arnold TK.English-Latin
lexicon. Anthon C, editor. New York: Harper; 1859.
Owen R.On the nature
of limbs. London: J van Voorst; 1849.
Linnaeus C.Genera
plantarum eorumque characteres naturales secundum numerum, figuram,
situm, & proportionem omnium fructificationis partium.
Stockholm: C Wishoff; 1737.
Beutler E. Glucose-6-phosphatase
dehydrogenase deficiency. In: Stanbury J, Wyngaarden JB, Fredrickson
DS, Goldstein JL, Brown MS, editors. The metabolic basis
of inherited disease. New York: McGraw-Hill; 1983.