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 180
0

extension 60
0

abduction 180
0


adduction 60
0

internal rotation 90
0

external rotation 90
0

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 135
0

extension 0 5
0

supination 90
0

pronation 90
0

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 80
0

Extension 70
0

Ulnar Deviation 30
0
Radial Deviation 20
0





Range of Motion of the Digits :
Flexion Adduction
- MCP : 90
0
- Finger : 0
0
, return of abduction
- PIP : 90
0
- Thumb : 0
0
, return of abduction
- DIP : 90
0

- Thumb : MCP 50
0
, IP 90
0

Extension Opposition
- MCP : 30
0
- Thumb : approximation of the
- PIP: 0
0
palmar aspect of the thumb and
- DIP : 0-10
0
fifth digit


- Thumb : MCP 0
0
, IP 20
0

Abduction Apposition
- Finger : 20
0
- Thumb: approximation between
- Thumb : 70
0
the tumb and other digit not
using the palmar aspect
Provocative tests :
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 : 120
0

Extension : 30
0

Abduction : 45-50
0

Adduction : 0 30
0

External Rotation : 35
0

Internal Rotation : 45
0

- 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
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 :
Spurlings 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
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
- 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.