Chapter 8 - PT for Musculoskeletal Conditions

Question 1

Dysfunction of MSK system caused by:

Answer 1

• trauma or repeated stress/overuse
• structural imbalances of muscle or bone
• congenital conditions
• surgery
• degenerative changes

Question 2

Common patient/client symptoms

Answer 2

P: Pain
S: Stiffness
S: Swelling
W: Weakness or Fatigue
L: Loss of motion

Question 3

Overuse injuries (BTNS)

Answer 3

Bursitis: inflammation of bursae (fluid-filled save that decrease friction)

Tendinopathy: tendinitis or tendinosis (degenerative changes from overuse)

Nerve entrapment: pressure on peripheral nerve from surrounding structures

Stress fractures/reactions: bone related overuse injuries

Question 4

Traumatic Injuries (FLM)

Answer 4

Ligament sprain: overstretched
Fracture: bone breaks
Muscle strain: tear of muscle fiber

Question 5

Surgical Conditions (TJA/A)

Answer 5

Total Joint Arthroplasty: replacement of joint with artificial surfaces
Amputation

Question 6

Medical Conditions (ROC)

Answer 6

Rheumatoid arthritis
Obesity
Cancer
May cause pain, weakness, and loss of function

Question 7

Examination

Answer 7

Patient/client history: includes Visual Analog Scale (VAS) to measure pain

Systems Review: brief exam on cardio/pulm, NM, and integ systems; info on pt’s cognitive, communication and preferred learning style

Tests and Measures: Observation
Active Range of Motion (AROM): pt’s ability to move a limb through arc of motion
Passive Range of Motion (PROM): therapist moves limb through arc of motion
Strength: amount of force produced during voluntary movement; measured by manual muscle testing (MMT); scale from 0 (no contractions) to 5 (holds against strong pressure)
Flexibility: ability to move limb through specific ROM; influenced by soft tissues surrounding the joint and ability of muscle to lengthen
Functional test: assess ability to perform ADLs
Outcome measures: standardized tests measure activity limitations or participation restrictions
Special test: examine specific joints for problems; reinforces diagnosis
Palpation: touch to assess what is occurring below skin

Question 8

Evaluation, Diagnosis, Prognosis

Answer 8

Evaluation: clinical judgment based on findings of exam
- impairments, activity limitations, participation restrictions
- exam = data gathering, eval = synthesis of data to make decisions
Diagnosis: categorization of findings
Prognosis: prediction level of improvement
- creating POC
- short term goals: decrease pain and edema, increase strength and motion
- long term goals: achieve an optimal level of function

Question 9

Interventions (biophysical agents goals)

Answer 9

Biophysical agents:

- Goals: used to manage pain, increase flexibility, ROM, strength, and for wound healing

Question 10

Electrical stimulation

Answer 10

parameters depend on diagnosis and intended outcome

Question 11

Thermal agents:

Answer 11

modify temp and metabolism of surrounding tissue (ie. hot/cold packs, paraffin, fluidotherapy, ultrasound, short-wave diathermy, whirlpool)

Question 12

Manual Therapy techniques

Answer 12

• Goals: ROM, pain-reduction, flexibility, improved joint mechanics
• Soft tissue mobilization: massage, myofascial release techniques
• Joint mobilization

Question 13

Therapeutic exercises

Answer 13

ROM: active assisted, active free, and active resisted

Question 14

Resistance exercise

Answer 14

Goals: Strength (force produced), endurance (sustain over time), and power (speed)
Types:
- Isometric: contraction against resistance with no movement at joint
- Isotonic: contraction with movement at joint (concentric = shortening; eccentric = lengthening)
- Isokinetic: constant speed

Question 15

Core strengthening

Answer 15

Deep postural muscles of lumbar and cervical spine

Question 16

Functional Exercise

Answer 16

Closed kinetic chain: end of limb stationary

Open kinetic chain: end of limb moves