Tiêu đề [COMPILED] CHOC Learning Module AY 2023 - 2024.pdf ✅

1 Full Residential Track Charity Out-Patient Clinic Rotation Learning Module MUSCULOSKELETAL
MUSCULOSKELETAL FRT - CHOC LEARNING MODULE 2 This material is a property of UP PGH Department of Rehabilitation Medicine, Division of Physical Therapy. Please obtain permission prior to use for other purposes. OBJECTIVES At the end of this learning activity, the intern will: ● Discuss theoretical basis for management of musculoskeletal cases ● Discuss common assessment procedures for musculoskeletal cases ● Discuss common treatment approaches for musculoskeletal cases OUTLINE 1. Postural Assessment 2. Movement Analysis/Selective Tissue Tension Testing a. Knee b. Shoulder c. Back 3. Special Tests for the Back, Shoulder and Knee a. Test Clusters b. Special Tests 4. The Scapula a. Scapulohumeral Rhythm b. Observation and Examination of the Scapula c. Muscle Testing of Scapular Muscles 5. Joint Mobility Assessment 6. Treatment Approaches for the Back, Shoulder and Knee
MUSCULOSKELETAL FRT - CHOC LEARNING MODULE 3 This material is a property of UP PGH Department of Rehabilitation Medicine, Division of Physical Therapy. Please obtain permission prior to use for other purposes. POSTURAL ASSESSMENT Posture “is a position or attitude of the body, the relative arrangement of body parts for a specific activity, or a characteristic manner of bearing one’s body” (Kisner, 2007). It is also described by Magee (1997) as “the relative disposition of the body at any moment, is a composite of the position of the different joints of the body at that time. It is alignment of the body parts whether upright, sitting, or recumbent. It is described by the positions of the joints and body segments and also in terms of the balance between the muscles crossing the joints (Kisner, 2020). ● “In human species’ the BASE OF SUPPORT, defined by an area bounded posteriorly by the tips of the heels and anteriorly by a line joining the tips of the toes is considerably smaller than the quadrupedal base” (Norkin, 1985). ● “Gravity places stress on the structures responsible for maintaining the body upright in posture. For a weight- bearing joint to be stable or in equilibrium, the gravity line of the mass must fall exactly through the axis of rotation, or there must be a force to counteract the force of gravity. In the body, the counterforce is either a muscle or inert structures. Upright posture usually involves a slight anterior-posterior swaying of the body of about 4 centimetres, so the muscles are necessary to control the sway and maintain equilibrium.” (Magee, 2014) ● “Ligaments, fasciae, bones, and joints are inert structures that support the body, whereas muscles and their tendinous attachments are the dynamic structures that maintain the body in a posture or move it from one posture to another” (Kisner, 2007). Factors Affecting Posture Structural (Anatomic) Factors Other Factors ● Bony contours (e.g., hemivertebrae) ● Leg length discrepancy (bone length) ● Extra or less vertebra (e.g., lumbarization, sacralization) ● Laxity of ligamentous structures ● Fascial and musculotendinous tightness (e.g., tensor fasciae latae, pectorals, hip flexors) ● Muscle tonus (e.g., gluteus maximus, abdominals, erector spinae) ● Pelvic angle (normal is 30°) ● Joint position and mobility ● Neurogenic outflow and inflow ● Age (e.g., young vs. old) ● Psychological (emotional) changes (e.g., mood, fear avoidance) ● Pathological (e.g., illness, pain, malalignment) ● Occupational (e.g., manual worker, office worker) ● Recreational (e.g., different sports) ● Environmental (e.g., temperature ● Social/cultural (e.g., kneeling) ● Causes of Poor Posture
MUSCULOSKELETAL FRT - CHOC LEARNING MODULE 4 This material is a property of UP PGH Department of Rehabilitation Medicine, Division of Physical Therapy. Please obtain permission prior to use for other purposes. Postural (positional) Factors Structural Factors ● Poor postural habits ● Muscle imbalance ● Muscle contractures ● Pain ● Respiratory condition ● General weakness ● Excess weight ● Loss of proprioception ● Muscle spasm ● Congenital anomalies ● Developmental problems ● Trauma ● Disease Postural Assessment GENERAL CONSIDERATIONS ● Patient must be adequately undressed. ● Patient must not wear shoes or stockings. ● If patient uses walking aids, braces, collars or orthosis, they should be noted after the patient has been assessed in “natural” state to determine the effect of the appliances. ● The patient should be examined in the habitual, relaxed posture that is usually adopted. STANDING POSTURAL ASSESSMENT Anterior View Posterior View ● The tip of the nose is in line with the manubrium, sternum, xiphisternum and umbilicus. This line is the ANTERIOR LINE OF REFERENCE. ● The head is straight on the shoulder (in midline) ● The tips of the ears are level ● The acromion processes are level ● The clavicles are level ● The nipple line is level ● Check for rib humps ● There are no chest deformities such as pectus carinatum or pectus excavatum ● The waist angles are equal ● The antecubital fossae are level ● The spinous process of the 7th cervical vertebra is in line with the gluteal cleft, this is the POSTERIOR LINE OF REFERENCE. ● The spines are straight ● The spines and inferior angles of the scapula are level ● The medial border of the scapula are equidistant from the spine ● Muscle bulk of the trapz are equal ● Presence of posterior rib hump ● The olecranon processes are level ● The waist angles are level ● The arms are equidistant from the body and equally rotated