Musculoskeletal Rehabilitation
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Transcript of Musculoskeletal Rehabilitation
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MUSCULOSKELETAL
A. Upper Limb Musculoskeletal
B. Lower Limb Musculoskeletal
C. Spine - Cervical
- Thoracal
- Lumbar- Sacral
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Structures :
Aphophysis Ligament
Bone Joint
Bursa MuscleEpiphyseal Plate Tendon
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Physical Examination
Observation the functional status Try to localize tenderness
Swelling
Any redness or warm implies
Deformities
Test and record the range of motion Check distal neurologic
- Strength
- Sensation
Of course : xrays, EMG, myelographyCT scanning, bone scanning Blood test.
Pathology : Acute musculoskeletal
Chronic musculoskeletal
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A. Upper Limb Musculoskeletal
1. Shoulder
Anatomy
Biomechanic
ROM : flexion
180
0
extension 600
abduction 1800
adduction 600
internal rotation 900
external rotation 900
Provocative tests :
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Disorders : Rotator cup disease
Bicipital tendinitis
Bicep rupture
Adhesive capsulitis
Rehabilitation treatment :Modalities
Occupational therapy
Proper body mechanicEducation
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2. Elbow
Anatomy Biomechanic
ROM : flexion 1350
extension 050
supination 900
pronation 900
Provocative test :
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DisordersLateral : lateral epicondylitis, Bone
trauma
Medial : Medial epicondylitis
Posterior : Olecranon bursitis
Tricep tendinitis
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3. Wrist & Hand
AnatomyROM :
- Range of motion at the wrist :
Flexion 800
Extension 700
Ulnar Deviation 300
Radial Deviation 200
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Range of Motion of the Digits :
Flexion Adduction- MCP : 900 - Finger : 00, return of abduction
- PIP : 900 - Thumb : 00, return of abduction
- DIP : 900
- Thumb : MCP 500, IP 900
Extension Opposition
- MCP : 300 - Thumb : approximation of the
- PIP: 00 palmar aspect of the thumb and
- DIP : 0-100 fifth digit
- Thumb : MCP 00, IP 200
Abduction Apposition
- Finger : 200 - Thumb: approximation between- Thumb : 700 the tumb and other digit not
using the palmar aspect
Provocative tests :
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Wrist disorders- De Quervains tenosynovitis- Acute and occult wrist injuries
- Scaphoid injuries
- Kien bock disease
- Osteoarthritis
Hand disorders
- Trigger finger
- Dupuytrens contracture
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Rehabilitation treatment
- Modalities
- Orthotic prostetic
- Occupational therapy- Strappingtaping
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B. Lower Limb Musculoskeletal1. HIP
- Anatomy
- Biomechanic
- ROM : Flexion : 1200
Extension : 300Abduction : 45-500
Adduction : 0300
External Rotation : 350
Internal Rotation : 450
- Gait Analysis :
- Provocative Test :
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Hip Disorders : - Piriformis syndrome- Throchanteric Bursitis
- Ischial Bursitis
- Coxitis- Hip fracture
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2. Specific problem in the thigh
Anterior : - Quadricep Strain
- Quadricep Contusions
- Myositis ossificans traumatica
Medial : - Adductor strain
- Osteitis pubis
Posterior : - Hamstring Strains
Lateral : - Meralgia paresticaFracture and amputation
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3. Knee
- Anatomy
- ROM
- Provocative test
Disorders of the knee :
Patello femoral pain syndrome
Pes anserinus bursitis Cruciate, collateral ligament injuries
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4. Disorders of the leg
Achilles tendinitis Stress fractures, amputation
Ankle injuries
Foot injuries : - Plantar fasciitis
- Calcaneal bursitis
Rehabilitation treatment :
- Modalities- Orthotic prosthetic
- Strappingtaping
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C. Spine Rehabilitation- Cervical Spine
- Thoracic Spine
- Lumbar Spine
- Sacral Spine
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Patient Related Factors
Age Muscle strength
Sex Phisical fitness
Anthropometric factors Smoking Postural factors Psycho social
Spine mobility
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Function :
- Direct vertebral motion
- Resist shearing and rotational forces
- Wheigh bearing
Cervical Spine- Anatomy
- Biomechanic
- ROM : - Ante / retrofleksi 45
- - Latero fleksi 45 - Rotasi 50
- Provocative test :
Spurlings test
Compression test
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Lumbar spine
- Anatomy- Biomechanic
- ROM : - retro / antefleksi 30/ 80
- - Latero fleksi 35
- - Rotasi 45
- Provocative test :
SLR test
Bowstring test
Femoral stretch test
Sitting root test
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Low Back Pain
Causes of Low Back Pain
1. Degenerative 8. Musculoskeletal
2. Inflamatory 9. Viscerogenic
3. Infections 10. Vascular
4. Metabolic 11. Psychogenic
5. Neoplastic 12. Post operative6. Traumatic
7. Congenital
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Disc disorders- Herniated Nucleus Pulposus (HNP)- Cauda Equina Syndrome
- Myelopathy
Bone disorders- Spinal stenosis
- Spondilolysis
- Spondilolisthesis
- Scoliosis
- Scheuermanns disease
- Compresion fracture
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Joint disorders
- Facet syndrome
- Sacroiliac joint dysfunction/sacroiliitis
Soft tissue disorders- Sprain/strain
- Myofacial pain syndromes
Other infectious disorders- Vertebral body osteomyelitis
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Non organic sources
- Malingering
Rehabilitation Treatment
- Modalities
- Orthotic/Bracing
- Educational
- Proper Body Mechanic
- Psichology
- Home exercise program
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Recommended Reading
1. Birnbaum Jacob S. The Musculosekeletal
Manual. 1983
2. Braddom RL. Physical Medicine andRehabilitation. WB. Saunders. 1996.
3. Cuccurullo Sara. Physical Medicine and
Rehabilitation Board Review. Demos MedicalPublishing. 2004.