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MUSCULOSKELETAL

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

Ligament
Joint
Muscle
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
Medial
Posterior

: lateral epicondylitis, Bone


trauma
: 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
Provocative tests :

Adduction
- Finger : 00, return of abduction
- Thumb : 00, return of abduction
Opposition
- Thumb : approximation of the
palmar aspect of the thumb and
fifth digit
Apposition
- Thumb: approximation between
the tumb and other digit not
using the palmar aspect

Wrist disorders
-

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

Hand disorders
- Trigger finger
- Dupuytrens 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 traping

C. Spine Rehabilitation
-

Cervical Spine
Thoracic Spine
Lumbar Spine
Sacral Spine

Patient Related Factors

Age
Sex
Anthropometric factors
Postural factors
factors
Spine mobility

Muscle strength
Phisical fitness
Smoking
Psycho social

Function :
- Direct vertebral motion
- Resist shearing and rotational forces
- Wheigh bearing
Cervical Spine
- Anatomy
- Biomechanic
- ROM
- Provocative test :
Spurlings test
Compression test

Lumbar spine
- Anatomy
- Biomechanic
- 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

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

Disc disorders
Herniated Nucleus Pulposus (HNP)
- Cauda Equina Syndrome
- Myelopathy
Bone disorders
- Spinal stenosis
- Spondilolysis
- Spondilolisthesis
- Scoliosis
- Scheuermanns 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.