Musculoskeletal module

Case presentation

Subjective Examination Name – Mrs.weerasinghe Age – 65yrs old Occupation- retired nursing sister Civil status – Married Has two children

History of complaints – pain occurred 6 months ago. -Pain started in the upper aspect of the posterior side of the leg . -Pain radiated into lower aspect of the leg and heel.-Pain occurred gradually

Present Complaints

severe pain occurred in heel and posterior aspect of the right lower limb when walking

Pain in the medial side of the right calf area Felt numbness in the fingers of the right side foot . Morning stiffness more than 30 mints

Pain aggravating factors- During weight bearing activities (walking ,running..)

Relieving factors – during lying down, rest

Past medical history Hypertension – take medicationsPast surgical history - No

Objective Examination

Observation ( Pt is standing) Posture

1 Anterior - swelling in upper aspect of the Right foot2) posterior – swelling around the Right Achilles tendon 3) Lateral- Foot arch is reduced Gait : Abnormal, patient is walking while

limping on right leg

Palpation Tenderness over the right calf muscles & sole of the foot Pitting edema on the fat pad around the Achilles tendon Jump sign when palpating the Calf muscles of right

lower leg ( Trigger points) Right calf muscle tightness

Test - ROM

Movement AROM PROM

Dorsiflexion 10 15

planterflexion 45 50

EversionInversion

1530

2234

Muscle power testing- According to MRC Scale

Special tests Thompson Test – Negative (No any Achilles tendon rupture)

Muscle Group Muscle Power

Dorsi flexors 5

Plantar flexors 4

Pronators 4

Supinators 4

Physiotherapy Diagnosis Right Ankle movements are limited due

to pain, swelling and stiffness..

Treatment plan & Justification

Physiotherapy goals -1)Pain relief

2) Restoration and maintain the ROM

3)Strengthen the weak muscles

To relief pain Ultra sound therapy - 1 MHz , 4 mnts , 3 times per week Micro massage, Heat causes vasodilation and increase circulation, remove waste products and promote healing .Pain is

reduced prior to exercises

Soft tissue MobilizationEffleurage and kneading (To reduce swelling & increase circulation) - Static friction (To release trigger points)Deep transverse friction To restoration of movements -Active mobility exercises – 5 minutes -Active calf stretching exercises - (3-5 times per week)- To reduce muscle tightness

To strengthen the muscles - Eccentric loading - Standing on toes - Thera band resisted exercises for ankle planter flexors, Invertors & evertors

Thank You.Pathum Asanka UCP/AL/11/210