MUSCULOSKELETAL REHABILITATION

By : I MADE WIDAGDA (PHYSIATRIST)

MUSCULOSKELETAL
A. Upper Limb Musculoskeletal B. Lower Limb Musculoskeletal C. Spine - Cervical - Thoracal - Lumbar - Sacral

Structures :
Aphophysis Bone Bursa Epiphyseal Plate
Physical Examination

Ligament Joint Muscle Tendon

n Observation the functional status

n Try to localize tenderness n Swelling n Any redness or warm implies n Deformities n Test and record the range of motion n Check distal neurologic
- Strength - Sensation

n Of course

: x rays, EMG, myelography CT scanning, bone scanning Blood test.

Pathology

: Acute musculoskeletal Chronic musculoskeletal

A. Upper Limb Musculoskeletal 1. Shoulder Anatomy Biomechanic ROM : flexion 1800 extension 600 abduction 1800 adduction 600 internal rotation 900

external rotation 900 Provocative tests :

n Disorders

: Rotator cup disease Bicipital tendinitis Bicep rupture Adhesive capsulitis

n Rehabilitation treatment :
Modalities Occupational therapy Proper body mechanic Education

2. Elbow Anatomy Biomechanic

ROM

: flexion 1350 extension 0 50 supination 900 pronation 900

Provocative test :

Disorders Lateral : lateral epicondylitis, Bone trauma Medial Posterior : Medial epicondylitis : Olecranon bursitis Tricep tendinitis

3. Wrist & Hand Anatomy ROM : - Range of motion at the wrist : Flexion 800 Extension 700 Ulnar Deviation 300 Radial Deviation 200

Range of Motion of the Digits :

Flexion - MCP : 900 - PIP : 900 - DIP : 900 - Thumb : MCP 500, IP 900 Extension - MCP : 300 - PIP: 00 - DIP : 0-100 - Thumb : MCP 00, IP 200 Abduction - Finger : 200 - Thumb : 700 Apposition - Thumb: approximation between the tumb and other digit not using the palmar aspect Provocative tests : Opposition - Thumb : approximation of the palmar aspect of the thumb and fifth digit Adduction - Finger : 00, return of abduction - Thumb : 00, return of abduction

Wrist disorders

n De Quervains tenosynovitis n Acute and occult wrist injuries n Scaphoid injuries n Kien bock disease n Osteoarthritis

Hand disorders

n Trigger finger n Dupuytrens contracture

Rehabilitation treatment

n Modalities n Orthotic prostetic n Occupational therapy n Strapping taping

B. Lower Limb Musculoskeletal
1. HIP - Anatomy - Biomechanic - ROM : Flexion : 1200 Extension : 300 Abduction : 45-500

Adduction : 0 300 External Rotation : 350 Internal Rotation : 450 - Gait Analysis : - Provocative Test :

Hip Disorders : - Piriformis syndrome - Throchanteric Bursitis - Ischial Bursitis - Coxitis - Hip fracture 2. Specific problem in the thigh Anterior : - Quadricep Strain - Quadricep Contusions - Myositis ossificans traumatica Medial : - Adductor strain - Osteitis pubis Posterior Lateral : - Hamstring Strains : - Meralgia parestica

Fracture and amputation

3. Knee

n n n

Anatomy ROM Provocative test

Disorders of the knee : Patello femoral pain syndrome Pes anserinus bursitis Cruciate, collateral ligament injuries

4. Disorders of the leg

n Achilles tendinitis n Stress fractures, amputation n Ankle injuries n Foot injuries : - Plantar fasciitis
- Calcaneal bursitis

Rehabilitation treatment :

n Modalities

n Orthotic prosthetic n Strapping taping

C. Spine Rehabilitation

n Cervical Spine n Thoracic Spine n Lumbar Spine n Sacral Spine

Patient Related Factors Age Sex Anthropometric factors Postural factors Spine mobility Muscle strength Phisical fitness Smoking Psycho social factors

Function :

n Direct vertebral motion n Resist shearing and rotational forces n Wheigh bearing

Cervical Spine - Anatomy - Biomechanic

n ROM : - Ante / retrofleksi 45 n

- Latero fleksi 45
- Rotasi 50

- Provocative test : Spurlings test Compression test

Lumbar spine - Anatomy

n Biomechanic n ROM : - retro / antefleksi 30 / 80 n n

- Latero fleksi 35 - Rotasi 45

- Provocative test : SLR test Bowstring test Femoral stretch test Sitting root test

Disorders : Low Back Pain Causes of Low Back Pain

1. Degenerative 2. Inflamatory 3. Infections 4. Metabolic 5. Neoplastic 6. Traumatic 7. Congenital

Disc disorders

8. Musculoskeletal 9. Viscerogenic 10. Vascular 11. Psychogenic 12. Post operative

n Herniated Nucleus Pulposus (HNP) n Cauda Equina Syndrome n Myelopathy

Bone disorders

n Spinal stenosis n Spondilolysis n Spondilolisthesis n Scoliosis n Scheuermanns disease n Compresion fracture

Joint disorders - Facet syndrome - Sacroiliac joint dysfunction/sacroiliitis

Soft tissue disorders - Sprain/strain - Myofacial pain syndromes

Other infectious disorders - Vertebral body osteomyelitis

Non organic sources

n Malingering

Rehabilitation Treatment n Modalities n Orthotic/Bracing n Educational n Proper Body Mechanic n Psichology

n Home exercise program

Recommended Reading 1. Birnbaum Jacob S. The Musculosekeletal Manual. 1983 2. Braddom RL. Physical Medicine and Rehabilitation. WB. Saunders. 1996. 3. Cuccurullo Sara. Physical Medicine and Rehabilitation Board Review. Demos Medical Publishing. 2004.