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General Principles and

Spesific Methods of
Musculoskeletal
Treatment
Debora Lusiana Herman
11 2014 052

General Principles of Treatment

Cooperate with the laws of nature


Be realistic and practical in your treatment
Select treatment for your patient as an
individual

Form of Treatment

Psychological consideration

Therapeutic drugs

Orthopaedic apparatus and appliances

Physical and occupational therapy

Surgical manipulation

Surgical repair and reconstruction

Electrical stimulation

Continuous passsive motion

Radiation therapy

Therapeutic Drugs

Analgesics

NSAID

Chemotherapeutic
Agent

Corticosteroid

Vitamin

Specific Drugs

Orthopaedic Apparatus and Appliances

Rest

Support for
Muscle
weakness and
Joint Instability
Prevention and
Correction of
Deformity

Rest
Prolonged and
continuous bed
rest
Relative rest
Continuous
Traction

Disuse atrophy of muscle with resultant generalized weakness


Disuse atrophy of bone
Increased calcium excretion
Deep vein thrombosis with the threat of pulmonary embolism
Decubitus ulcers

Sling (Upper limb)


Crutches (lower limb)

To Stretch gradually soft tissue that have become shortened secondary to a


long standing joint deformity or dislocation
To relieve painful muscle spasm associated with joint inflammation or injury
To maintain length of the limb and alignment of fracture fragments in
unstable fractures of the shaft of long bones

Support for Muscle

Functional
braces

Spinal
braces

Adhesive
tape
strapping

Physical and Occupational Theraphy

Joint Motion

Muscle strength

Improvement of
musculoskeletal
Function

Surgical Manipulation

To correct deformity and to regain motion

Surgical Operation

General methods of operation :

Repair

Release

Resection

Reconstruction

Replacement

Operation on Muscles, Tendons and


Ligament

Compartment syndrome

A cut tendon is repaired by suture

Tendon tethered by adhesions

Shortened muscle that wants to be


lengthened

Fasciotomy

Tenorrhaphy

Tenolysis

Tenotomy or Tendon lengthening

Operation on Nerves

A cut nerve

If the gap is too large

Spinal nerve root get continued


pressure fro a protruded
intervertebral disc

Nerve suture

Nerve graft
Laminectomy

Operation on Joints

An opened joint ( Arthrotomy) and


explored a remove a loose body

The elongated fibrous capsule of


the joint is tightened and repaired
(Capsulorraphy)

Altering or replacing one or both


joint surfaces ( Arthroplasty)

Replacement of one or both joint


surfaces (Prosthetic joint
replacement)

Fused of bone or unite to each


other (Arthrodesis)

Operation on Bones

Sequestrectomy

Osteotomy

Transplantation of bone or bone


grafting

Removed a piece of infected dead bone

to Correct either an angular or rotational deformity in a bone

Removal of bone from one location to other location

Electrical Stimulation of Fracture


Healing

As an alternative to bone grafting to stimulate osteogenesis in the treatment


of established non union of fractures.
3 electrical systems:

Constant direct current through percutaneous wire cathodes (semi invasive)


(Brighton )

Constant direct current through implanted electrodes and power pack ( invasive)
(Dwyer and also Paterson)

Inductive Coupling through electromagnetic coils (non invasive) (Bassett and also
de Haas)

Continuous Passive Motion

Indications

Arthrotomy, Capsulotomy, debridement, artholysis of joints with painful restriction of motions


secondary to post- traumatic arthritis

Open reduction of intra articular fractures as wll as metaphyseal and diaphyseal fractures

Patellectomy

Repair of ligament injuries

Synovectomy for rheumatoid arthritis and hemophilic arthropaty

Arthrotomy and drainge for acute septic arthritis

Biological resurfacing for a major defect in a joint surface

Surgical repair of a complete laceration of a tendon

Rigid internal fixation of a metaphyseal osteotomy


Total prosthetic joint replacement