Misnegation or term of art?

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Roni Caryn Rabin, "No Easy Choices on Breast Reconstruction", NYT Blogs 5/20/2013:

A syndrome called upper quarter dysfunction — its symptoms include pain, restricted immobility and impaired sensation and strength — has been reported in over half of breast cancer survivors and may be more frequent in those who undergo breast reconstruction, according to a 2012 study in the journal Cancer. [emphasis added]

Reader E.S.M. wondered whether "restricted immobility" should have been "restricted mobility" or "partial immobility" or something else.

Some evidence for this view comes from Margaret L. McNeely, et al., , "A prospective model of care for breast cancer rehabilitation: postoperative and postreconstructive issues", Cancer 2012 (which appears to have been one of Ms. Rabin's sources):

The presence of upper quarter dysfunction (UQD), defined as restricted upper quarter mobility, pain, lymphedema, and impaired sensation and strength, has been reported in over half of survivors after treatment for breast cancer.

And in general, "restricted mobility" seems to be quite common in scientific and technical writing, whereas "restricted immobility" is rare.

Logically, "restricted mobility" is also "restricted immobility". "Restricted X" obviously has less of the natural properties of X than unrestricted X does, while still having some of them, and "restricted lack of X" also places us somewhere in the middle of the X scale. So perhaps this should be a free choice.

But in phrases of the form "restricted X", we generally think of X as unrestricted in the normal state, with the restrictions as something added on in certain cases. The commonest nouns following restricted in the COCA corpus are

stock, access, area, range, areas, airspace, use, zone, diet, model, shares, mobility, space, air, immigration, movement, sense, opportunities, set, data, ranges, …

With the partial exception of "immigration", these collocates seem to confirm the notion that the unrestricted case is the normal one, with the restricted case being special. Combining this observation with the usage patterns in the technical literature, I'll tentatively conclude that E.S.M. is right.


  1. Faldone said,

    May 21, 2013 @ 9:09 am

    IANAD, but what occurs to me is that the immobility is restricted to a certain part of the body. I would take restricted mobility or partial immobility to mean that there was some mobility, just not the normal range. Restricted immobility would suggest to me that mobility was completely lacking in one area but the rest of the body could operate normally.

  2. MattF said,

    May 21, 2013 @ 9:39 am


    Considering that the sentence in question is a definition of "upper quarter dysfunction", your reading makes sense.

  3. Sniffnoy said,

    May 21, 2013 @ 11:54 am

    Taken literally, I guess "restricted immobility" would mean "a restricted ability to hold still"?

  4. Howard Oakley said,

    May 21, 2013 @ 11:56 am

    IAD, and it would appear to me to be a simple error. "Restricted mobility" is a widely used term with a long history of medical use. The very rare occasions that I have heard someone say "restricted immobility" have always been errors. It makes no sense either – immobility is not being mobile, and therefore cannot be restricted (except perhaps in the case of alcohol-induced restricted immobility, perhaps!).

  5. Ellen K. said,

    May 21, 2013 @ 12:22 pm

    Sniffnoy, I don't see that. Immobility does not mean "ability to hold still". Nothing of the sort.

  6. Howard Oakley said,

    May 21, 2013 @ 12:46 pm

    Tracked back to the original paper, at doi: 10.1002/cncr.27468, it is clearly an error in the reporting of that study. In the summary of the paper, upper quarter dysfunction is defined as "restricted upper quarter mobility, pain, lymphedema, and impaired sensation and strength". Now that makes sense.

  7. Royko said,

    May 21, 2013 @ 1:14 pm


    I would think "isolated immobility" or "limited immobility" would be better choices for that meaning. "Restricted" to me implies that an external factor is acting upon the object causing the limitation, so it doesn't seem appropriate here.

    Whatever modifier is used, the negation is likely to cause confusion or misunderstand and probably should be avoided.

  8. KevinM said,

    May 21, 2013 @ 2:34 pm

    There's a Kliban cartoon I couldn't find online, an anatomical illustration of the "Anti-Jump Muscles." The first panel, titled "Tensed," shows a guy just standing there. The second, titled "Relaxed," shows him flying through the air.

  9. Faldone said,

    May 21, 2013 @ 2:41 pm

    Isolated immobility works. Localized immobility might work better. I think, in this case, it has been pretty well settled that the term as used in the original that sparked this whole discussion was an error.

  10. Faldone said,

    May 21, 2013 @ 3:16 pm

    Anti-jump muscles

  11. Bobbie said,

    May 21, 2013 @ 5:22 pm

    I have had this condition after treatment for breast cancer. It usually consists of restricted mobility which may or may not be temporary. Severe swelling and muscular contractions can lead to some immobility which often can be relieved by MLD (manual lymph drainage) massage and exercises to increase range of motion. "Restricted immobility" in not correct.

  12. Faldone said,

    May 23, 2013 @ 6:48 am

    I had occasion yesterday to ask a cardiac nurse about the term restricted immobility. I put it in terms of a stroke cause immobility in only one part of a body. She had never heard the term and would have used something else, but I don't remember what she offered.

  13. ===Dan said,

    February 21, 2014 @ 5:08 pm

    Is there something about medicine or health care that lends itself to misnegation? I just found on a bottle of Zinc lozenges the advice "Do not take for more than three (3) days or as directed by a health care provider." And I remember a drug commercial saying "—- is not for everyone, including women who are nursing….."

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