MUSCULOSKELETAL

REHABILITATION
By :

dr. Dyah Gita Rambu Kareri, SpKF

R., M.Si.Med
 MUSCULOSKELETAL

A. Upper Limb Musculoskeletal

B. Lower Limb Musculoskeletal
C. Spine - Cervical
- Thoracal
- Lumbar
- Sacral
 Structures :
 Aphophysis  Ligament
 Bone  Joint
 Bursa  Muscle
 Epiphyseal Plate  Tendon
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, myelography
CT scanning, bone scanning, Blood test.

Pathology :  Acute musculoskeletal

 Chronic musculoskeletal
 INFLAMATION :
• Akut
• Kronik
 Cedera inflamasi akut :
 Tindakan :R esting
I ce ( ice packs, freeze spray, cryo )
C ompression
E levation
 Medikamentosa : analgesic & anti inflamations
 Kronik : ( > 3 hari – 5 hari ) : heat applications
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 :
 Disorders : Rotator cuff disease
Bicipital tendinitis
Bicep rupture
Adhesive capsulitis
 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 : Medial epicondylitis
Posterior : 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  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 :
Wrist disorders
- De Quervain’s tenosynovitis
- Acute and occult wrist injuries
- Scaphoid injuries
- Kien bock disease
- Osteoarthritis

Hand disorders
- Trigger finger
- Dupuytren’s contracture
Rehabilitation treatment

- Modalities
- Orthotic prostetic
- Occupational therapy
- 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 : - Hamstring Strains
Lateral : - Meralgia parestica
Fracture and amputation
3. Knee
- Anatomy
- ROM
- Provocative test

Disorders of the knee :

 Patello femoral pain syndrome
 Pes anserinus bursitis
 Cruciate, collateral ligament injuries
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
C. Spine Rehabilitation
- Cervical Spine
- Thoracic Spine
- Lumbar Spine
- Sacral Spine
 Patient Related Factors

 Age  Muscle strength

 Sex  Phisical fitness
 Anthropometric factors  Smoking
 Postural factors  Psycho social factor
s
 Spine mobility
Function :
- Direct vertebral motion
- Weight bearing

Cervical Spine
- Anatomy
- Biomechanic
- ROM : - Ante / retrofleksi 45 °
- - Latero fleksi 45 °
- Rotasi 50 °
- Provocative test :
 Spurling’s test
 Compression test
Lumbar spine
- Anatomy
- Biomechanic
- ROM : - retro / antefleksi 30° / 80 °
- - Latero fleksi 35 °
- - Rotasi 45 °
- Provocative test :
 SLR test / Laseque test
 Piriformis stretch test
 Femoral stretch test
 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 operative
6. Traumatic
7. Congenital
Disc disorders
- Herniated Nucleus Pulposus (HNP)
- Cauda Equina Syndrome

Bone disorders
- Spinal stenosis
- Spondilolysis
- Spondilolisthesis
- Scoliosis
- Compresion fracture
Joint disorders

- Facet syndrome
- Sacroiliac joint dysfunction/sacroiliitis

Soft tissue disorders

- Sprain/strain
- Myofacial pain syndromes

Other infectious disorders

- Vertebral body osteomyelitis
Rehabilitation Treatment
- Modalities
- Orthotic/Bracing
- Educational
- Proper Body Mechanic
- Psychology
- 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.