MUSCULOSKELETALREHABILITATION

By : I MADE WIDAGDA

(PHYSIATRIST)

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

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 cup 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 factors

Spine mobility

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 : Spurling’s test Compression test

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

Disorders : Low Back PainCauses 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 - Myelopathy Bone disorders - Spinal stenosis - Spondilolysis - Spondilolisthesis - Scoliosis - Scheuermann’s disease - 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 - Malingering

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

- 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.