12.3 Medical Terminology & Anatomy for Reporters

12.3 Medical Terminology & Anatomy for Reporters

Quick Summary: Personal injury, workers' compensation, and medical malpractice depositions demand flawless lexical mastery of anatomical coordinates, body systems, surgical procedures, and pharmacology. Court reporters must deconstruct complex medical terminology using Greek and Latin roots, accurately identify anatomical planes and orientations, transcribe orthopedic fracture classifications and spinal pathologies verbatim, and follow pharmaceutical capitalization conventions—capitalizing proprietary brand names while keeping non-proprietary generic compounds in lowercase.

The Structural Anatomy of Medical Vocabulary: Greek & Latin Roots

Medical terms are listed under Domain 2 (Industry Practices) of the RPR job analysis, in the task "Demonstrate a broad knowledge of vocabulary." Modern biomedical terminology is not arbitrary; most anatomical and clinical terms are built from classical Greek and Latin components. Deconstructing unfamiliar spoken words into prefixes, combining forms (roots), and suffixes allows the stenographer to decipher, stroke, and transcribe complex expert medical testimony with precision.

[Prefix: Position/Number/Condition] + [Root: Organ/Tissue] + [Suffix: Condition/Procedure]
              │                                │                           │
            PERI-                            CARD-                       -ITIS
          (Around)                          (Heart)                  (Inflammation)
                                               │
                                               ▼
              "PERICARDITIS" = inflammation of the sac around the heart

1. Common Medical Prefixes

Prefixes appear at the beginning of a medical term, modifying direction, quantity, timing, or condition:

• ante- (before, forward) | post- (after, behind) | pre- (before, in front of)
• sub- (under, below) | supra- / super- (above, over) | infra- (beneath, below)
• intra- (within, inside) | inter- (between) | extra- (outside, beyond)
• brady- (slow: bradycardia) | tachy- (fast, rapid: tachycardia)
• hypo- (deficient, below normal: hypotension) | hyper- (excessive, above normal: hypertension)
• dys- (painful, difficult, abnormal: dyspnea, dysphagia) | eu- (normal, good: eupnea)
• hemi- (half: hemiplegia) | peri- (around, surrounding: pericardium)

2. Essential Anatomical Combining Forms (Roots)

The root is the foundational core that identifies the organ, tissue, or physiological system involved:

3. Key Medical Suffixes: Pathologies & Surgical Procedures

Suffixes attach to the end of a root, denoting a pathology, diagnostic test, or surgical intervention:

• -ectomy: Surgical excision, surgical removal (cholecystectomy - gallbladder removal; laminectomy - removal of vertebral lamina).
• -tomy: Surgical incision, cutting into (arthrotomy - cutting into a joint; laparotomy - surgical incision into abdominal wall).
• -ostomy: Surgical creation of an artificial opening (colostomy, tracheostomy).
• -plasty: Surgical repair, plastic reconstruction (arthroplasty - total joint replacement; rhinoplasty).
• -itis: Inflammation (tendinitis, bursitis, radiculitis, synovitis).
• -algia / -dynia: Pain (arthralgia - joint pain; neuralgia - nerve pain; cephalalgia - headache).
• -pathy: Disease, disorder (radiculopathy - nerve root disorder; retinopathy).
• -malacia: Abnormal softening (chondromalacia patellae).
• -sclerosis: Abnormal hardening (atherosclerosis).
• -stenosis: Abnormal narrowing (spinal stenosis - narrowing of spinal canal).
• -paresis: Partial paralysis, weakness (hemiparesis - weakness on one side).
• -plegia: Complete paralysis (paraplegia - lower limbs; quadriplegia/tetraplegia - all four limbs).

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Anatomical Directional Coordinates & Cardinal Planes

In personal injury litigation, expert witnesses use standardized directional terminology to establish anatomical locations relative to the standard anatomical position (standing erect, facing forward, arms at sides, palms turned forward).

                      [SUPERIOR / CEPHALIC]
                               ▲
                               │
        [PROXIMAL]             │             [PROXIMAL]
        (Nearer Trunk)         │             (Nearer Trunk)
             │                 │                  │
   [LATERAL] ◀── [MEDIAL] ──[MIDLINE]── [MEDIAL] ──▶ [LATERAL]
 (Away Midline)  (Near Midline)│        (Near Midline) (Away Midline)
             │                 │                  │
         [DISTAL]              │              [DISTAL]
       (Farther Trunk)         │            (Farther Trunk)
                               ▼
                      [INFERIOR / CAUDAL]

         ANTERIOR (VENTRAL)  ◀───▶  POSTERIOR (DORSAL)
             (Front of Body)           (Back of Body)

1. Directional Pairs

• Anterior (Ventral) vs. Posterior (Dorsal): Anterior refers to the front surface of the body; posterior refers to the back surface (e.g., the patella is on the anterior surface of the knee; the scapula is posterior).
• Medial vs. Lateral: Medial means closer to the midline dividing the body into left and right halves; lateral means farther from the midline (e.g., the adductor muscles are on the medial thigh; the fibula is lateral to the tibia).
• Proximal vs. Distal: Proximal indicates closer to the trunk or point of attachment; distal indicates farther from the trunk or origin (applied primarily to extremities: the elbow is proximal to the wrist; the ankle is distal to the knee).
• Superior (Cephalic/Cranial) vs. Inferior (Caudal): Superior means situated toward the head or upper body; inferior means situated toward the feet or lower body.
• Superficial vs. Deep: Superficial refers to structures toward the outer surface of the body; deep refers to structures situated inward, away from the surface.
• Prone vs. Supine: Prone describes a patient lying horizontally face down; supine describes a patient lying horizontally on their back, face upward.

2. The Three Cardinal Planes of the Body

When diagnostic imaging studies (MRI, CT scans, X-rays) are admitted as deposition exhibits, radiologists describe pathology across three anatomical planes:

1. Sagittal Plane: A vertical plane dividing the body into right and left portions. The midsagittal (median) plane divides the body into equal right and left halves.
2. Coronal (Frontal) Plane: A vertical plane passing longitudinally from side to side, dividing the body into anterior (front) and posterior (back) portions.
3. Transverse (Axial / Horizontal) Plane: A horizontal cross-sectional plane dividing the body into superior (upper) and inferior (lower) portions. This is the standard cross-sectional orientation for axial CT and MRI slices.

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Major Body Systems in Civil Litigation

1. The Musculoskeletal System & Spinal Architecture

The human spinal column is the primary anatomical focus of personal injury and workers' compensation litigation. The spine contains 33 vertebrae organized into five regional curves:

+-----------------------------------------------------------------------------------------+
|                           The Human Vertebral Column Anatomy                            |
+-----------------------------------------------------------------------------------------+
|  1. CERVICAL SPINE (C1–C7)   : 7 Vertebrae. Highly mobile. C1 is Atlas; C2 is Axis (Dens)|
|  2. THORACIC SPINE (T1–T12)  : 12 Vertebrae. Articulate with 12 pairs of thoracic ribs  |
|  3. LUMBAR SPINE (L1–L5)     : 5 Massive Vertebrae. Weight-bearing; primary locus of HNP|
|  4. SACRUM (S1–S5)           : 5 Fused Vertebrae forming pelvic posterior wall          |
|  5. COCCYX                   : Usually 4 Fused Segments (tailbone)                      |
+-----------------------------------------------------------------------------------------+

• Intervertebral Discs: Fibrocartilaginous pads positioned between vertebral bodies, acting as shock absorbers. Each disc consists of an outer tough fibrous ring, the annulus fibrosus, encasing a soft, gelatinous inner core, the nucleus pulposus.
• Herniated Nucleus Pulposus (HNP): When trauma or degenerative disc disease ruptures the annulus fibrosus, the nucleus pulposus extrudes into the spinal canal, compressing the spinal cord or exiting nerve roots (often described as disc protrusion, extrusion, or sequestration).
• Radiculopathy: Nerve root irritation or impingement producing sharp radiating pain, sensory numbness (paresthesia), and muscle weakness along a specific sensory nerve pathway (dermatome). Lumbar radiculopathy frequently manifests as sciatica (radiating down the sciatic nerve into the leg and foot).
• Range of Motion (ROM): Measured in degrees using a goniometer during orthopedic independent medical examinations (IMEs): flexion (bending forward), extension (bending backward), lateral flexion (side bending), and rotation for the spine, and abduction (moving away from the midline) and adduction (moving toward the midline) for the limbs.

2. Joints, Ligaments & Tendons

Orthopedic trauma involves the mechanical connective structures holding the skeleton together:

• Ligaments: Dense bands of tough, fibrous connective tissue that connect BONE TO BONE across a joint, stabilizing the skeletal framework.
  • Knee Ligaments: Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL), Lateral Collateral Ligament (LCL).
• Tendons: Strong, inelastic fibrous cords that attach MUSCLE TO BONE, transmitting muscular contractions to move bones.
  • Key Tendons: Achilles tendon (attaches calf muscles to calcaneus/heel bone); Rotator cuff tendons (SITS: Supraspinatus, Infraspinatus, Teres minor, Subscapularis).
• Sprain vs. Strain Distinction:
  • Sprain: A stretch or tear of a ligament (e.g., ankle sprain, torn ACL). Graded I (mild stretch), II (partial tear), or III (complete rupture).
  • Strain: A stretch or tear of a muscle or tendon (commonly termed a "pulled muscle").

3. Orthopedic Fracture Classifications

When transcribing orthopedic surgeon depositions, court reporters must capture precise fracture types:

[Bone Fracture Taxonomy]
  ├── Closed (Simple) ──▶ Skin intact; no external penetration
  ├── Open (Compound) ──▶ Bone fragment pierces skin (Severe infection risk / Osteomyelitis)
  ├── Comminuted      ──▶ Bone shattered/splintered into three or more fragments
  ├── Greenstick      ──▶ Incomplete bend fracture (Common in pediatric/pliable bones)
  ├── Hairline/Stress ──▶ Thin crack without displacement (may not show on early X-rays)
  ├── Compression     ──▶ Bone collapses under axial load (Common in thoracic/lumbar spine)
  └── Spiral / Oblique──▶ Rotational torsion or diagonal fracture across the shaft

• Fracture Treatment Mechanics:
  • Closed Reduction: Realignment of fractured bone fragments through manual external manipulation by the physician without surgical incision, followed by cast immobilization.
  • Open Reduction Internal Fixation (ORIF): Surgical procedure where an incision is made, the fracture fragments are realigned under direct visualization, and held in place with internal hardware (titanium plates, screws, intramedullary rods, or pins).

4. The Nervous System & Neurotrauma

• Central Nervous System (CNS): Comprises the brain and spinal cord, protected by the meninges (dura mater, arachnoid mater, pia mater) and cerebrospinal fluid (CSF).
• Peripheral Nervous System (PNS): Comprises 12 pairs of cranial nerves and 31 pairs of spinal nerves transmitting motor commands and sensory input between the CNS and the rest of the body.
• Traumatic Brain Injury (TBI): Ranging from mild TBI (concussion) characterized by brief altered mental status, to severe intracranial hemorrhage:
  • Epidural Hematoma: Arterial bleed (often middle meningeal artery) between the skull and dura mater; marked by a brief "lucid interval" followed by rapid neurological decline.
  • Subdural Hematoma: Venous bleed beneath the dura mater, frequently seen in elderly slip-and-falls or motor vehicle whiplash trauma.
• Glasgow Coma Scale (GCS): Standard clinical score evaluating acute coma and level of consciousness across three parameters: Eye Opening (1–4), Verbal Response (1–5), and Motor Response (1–6). Scores range from 3 (deep coma or brain death) to 15 (fully awake, alert, and oriented).

5. Cardiovascular & Respiratory Systems

• Cardiovascular System:
  • Myocardial Infarction (MI): Heart attack caused by blocked blood flow in a coronary artery (e.g., Left Anterior Descending [LAD] artery, known colloquially as the "widow maker"), leading to ischemic myocardial necrosis.
  • Deep Vein Thrombosis (DVT): Formation of a blood clot (thrombus) in deep veins, typically the calf or thigh. If the clot breaks loose, it can travel through the veins and the right side of the heart to the lungs, forming a life-threatening Pulmonary Embolism (PE).
• Respiratory System: Trachea branches into bronchi, bronchioles, and microscopic alveoli where gas exchange occurs. Trauma can cause pneumothorax (air trapped in the pleural cavity compressing the lung) or hemothorax (blood accumulation in the pleural cavity).

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Pharmacology Rules for Verbatim Reporters

In pharmaceutical product liability, medical malpractice, and toxic tort litigation, transcribing drug nomenclature requires strict adherence to capitalization and orthographic rules.

+-----------------------------------------------------------------------------------------+
|                    Standard Pharmaceutical Capitalization Rules                         |
+-----------------------------------------------------------------------------------------+
|  PROPRIETARY / BRAND NAMES  : ALWAYS CAPITALIZED (e.g., Lipitor, Plavix, OxyContin)    |
|  GENERIC CHEMICAL COMPOUNDS : ALWAYS LOWERCASE   (e.g., atorvastatin, clopidogrel)      |
+-----------------------------------------------------------------------------------------+

1. Proprietary Brand Names vs. Non-Proprietary Generic Names

• Proprietary (Brand) Names: The trademarked commercial name assigned by the pharmaceutical manufacturer. Brand names are capitalized in transcripts (e.g., Tylenol, Advil, Celebrex, Lyrica, Xanax, Ambien, Valium, Norco, Coumadin, Neurontin).
• Generic Names: The standardized, non-proprietary active chemical compound. Generic names are lowercase unless they begin a sentence (e.g., acetaminophen, ibuprofen, celecoxib, pregabalin, alprazolam, zolpidem, diazepam, hydrocodone, warfarin, gabapentin).

2. Look-Alike / Sound-Alike (LASA) Drug Pitfalls

Many medications have similar names but completely different therapeutic classes. Transcribing the wrong medication can alter the entire factual basis of a medical malpractice lawsuit:

3. Medical Homophones & Spelling Pitfalls for Reporters

Stenographers must distinguish phonetically identical or similar medical words based on anatomical context:

• ileum vs. ilium:
  • ileum (with an e): The distal third portion of the small intestine ("The surgeon resected three centimeters of ischemic ileum").
  • ilium (with an i): The superior, broad, flared bone of the pelvis ("The X-ray revealed a nondisplaced fracture of the left ilium").
• peroneal vs. perineal vs. peritoneal:
  • peroneal: Pertaining to the fibula or lateral aspect of the lower leg (peroneal nerve).
  • perineal: Pertaining to the perineum (the pelvic floor between the anus and genitalia).
  • peritoneal: Pertaining to the peritoneum (the serous membrane lining the abdominal cavity).
• prostate vs. prostrate:
  • prostate: The male reproductive gland surrounding the urethra (prostate gland).
  • prostrate: Lying prone, flat on the ground, or physically incapacitated (prostrate with grief).
• mucus vs. mucous:
  • mucus (noun): The thick lubricating secretion ("The patient coughed up blood-tinged mucus").
  • mucous (adjective): Pertaining to or secreting mucus ("The mucous membrane was inflamed").

4. Common Medical & Latin Prescription Abbreviations

Physicians and nurses frequently read from medical charts during depositions using standardized Latin abbreviations:

• b.i.d. (bis in die) = twice daily | t.i.d. (ter in die) = three times daily | q.i.d. (quater in die) = four times daily
• p.r.n. (pro re nata) = as needed | p.o. (per os) = by mouth, orally | NPO (nil per os) = nothing by mouth
• stat (statim) = immediately | q.h. (quaque hora) = every hour | s/p = status post (following/after)
• Dx = diagnosis | Hx = medical history | Sx = symptoms | Tx = treatment | Rx = prescription