3 Punctuation: Hyphens
Hyphens and Prefixes
Do NOT use a hyphen after these common prefixes except when they precede a proper noun (i.e. a name of a person, place, or organization), a capitalized word, or an abbreviation:
| Ante | Micro | Semi |
| Anti | Mid | Super |
| Bi | Non | Supra |
| Co | Over | Trans |
| Contra | Pre | Tri |
| Counter | Post | Ultra |
| De | Pro | Un |
| Infra | Pseudo | Under |
| Intra | Re |
Exceptions
If the absence of a hyphen changes the meaning of the word, use a hyphen
Example: re-creation vs recreation
If the absence of a hyphen creates an awkward combination of letters such as two of the same vowel, or three of the same consonant, use a hyphen
Examples: anti-inflammatory, semi-invalid
Hyphens and Adjectives
Use a hyphen when 2 words are used as an adjective to describe a noun AND THESE WORDS IMMEDIATELY PRECEDE THE NOUN THEY ARE DESCRIBING.
Examples
He has a full-thickness tear of his ACL.
The patient also has new-onset hypertension.
She complains of left-sided pain and numbness.
The patient is a well-developed male.
This is the result of gas-forming bacteria.
There are a few incidentally-noted cysts on the right ovary.
Most of his pain is on the right-hand side of his lower abdomen.
EXCEPT: Some describing words like right, left, upper, lower, deep are so common that people automatically associate them with the word that follows, making the hyphen unnecessary.
Want to know more? Click here for more hyphenation rules.
Wait a minute! 
Comma or Hyphen?
Remember in the comma chapter, it was stated that if there are 2 adjectives describing the same noun, we separate the adjectives with a comma. How do you decide when to use a comma between the two adjectives that describe the noun, and when to use a hyphen?
Temporarily insert the word ‘and’ between the two adjectives (describing words).
If the sentence makes sense, replace the ‘and‘ with a comma.
If the sentence does NOT make sense, replace the ‘and‘ with a hyphen.
×A hard-round lesion was removed from the scalp.
♥A hard, round lesion was removed from the scalp.
(“A hard and round lesion…” makes sense, so use a comma!)
×A high, grade tumour was identified by biopsy.
♥A high-grade tumour was identified by biopsy.
(“A high and grade tumour…” does not make sense, so use a hyphen!)
Hyphens and Units of Measurement
If you are describing a noun that follows the measurement:
NO hyphen with Metric units (cm, g, mL)
YES, use a hyphen with Imperial units (pounds, feet, inches, ounces)
Examples
She has a 3 cm scar on her knee.
To irrigate the wound, 4 L of saline was used.
During the surgery, a 6 x 8 x 12 cm tumour was removed.
She delivered a 6-pound baby girl.
An 8-inch incision was made.
The patient is 5 feet 4 inches. (No hyphens in this example because the measurement comes after the noun! Also, notice that there is no comma between feet and inches!)
Hyphens and Needle Gauges
Needle gauges: Use a hyphen with needle gauges.
Example: We had to use a 25-gauge angiocatheter because the patient had very small veins.
Hyphens and Units of Time
Use a hyphen with units of time when they PRECEDE the noun they are describing.
Examples
The patient has a 3-week history of migraines.
He reports a 2- to 3-year history of palpitations.
The patient claims he experienced a 20-minute blackout.
♦Fifty years ago, we didn’t even have MRI scanners. (no hyphen!)
♦The newborn is 12 hours old. (no hyphen!)
Hyphens and Ranges
Hyphens are frequently used to express a range.
EXCEPT: if any of these 5 criteria apply, use the word ‘to’ instead of a hyphen
- The range is expressed using the words ‘from…to’ or ‘from…through’ or ‘between…and’
- There are decimals or commas in the numbers
- There are four or more digits in either number
- Either number is a negative value
- Either number is accompanied by a symbol
Examples
Office hours are 1-4 p.m. on Mondays and Wednesdays.
His pulse was in the 60-80 range.
There were 8-10 people in line at the clinic.
Both lower extremities exhibit 3+ to 4+ edema
He weighs between 140 and 150 pounds.
His ejection fraction is in the 20% to 30% range (NOTE: add the % symbol after each number in the range)
Try it!
References
Sims, L. M. (2008). The Book of Style for Medical Transcription (3rd ed.). Modesto, California, United States of America: Association for Healthcare Documentation Integrity.
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