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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 Muscle Epiphyseal 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 : x rays, 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 0 50

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

Anatomy ROM :

- 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- Strapping taping

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B. Lower Limb Musculoskeletal1. HIP

- Anatomy

- Biomechanic

- ROM : Flexion : 1200

Extension : 300Abduction : 45-500

Adduction : 0 300

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

- Strapping taping

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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

factors

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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Disorders : 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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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.