新光醫院 復健 新光醫院 復健 科科 謝霖芬 醫師 謝霖芬 醫師

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(1)Rehabilitation of Common Musculoskeletal Disorders. 新光醫院 復健 科 謝霖芬 醫師. 1.

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(3) Classification of Common Musculoskeletal Disorders  Soft tissue lesion – Muscle: strain, myofacial pain sydrome – Tendon: tendinitis, tear – Ligament: sprain, rupture – Bursa: bursitis – Cartilage: degeneration, herniation, injury  Bone and joint lesion. – Arthritis – Fracture and/or dislocation 3.

(4) Muscle strain  Damage to the musle fibers  Due to overstretch or too much. contraction  Classification: 1st, 2nd, and 3rd degree. 4.

(5) Myofacial pain syndrome  Local and referred pain patterns  Muscle stiffness and shortening  Taut bands in muscle  Presence of trigger points  Local twitch response or jump sign  Autonomic dysfunction. 5.

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(7) Tendinitis or tendosynovitis  Local pain & tenderness  Resisted isometric contraction. induces pain  Tendon stretch induces pain  May have local swelling or crepitus  May have tendon shortening or adherence (triggering) 7.

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(9) Bursitis  Pain on motion and at rest  Local tenderness and/or swelling  Regional loss of active movement. 9.

(10) Arthritis: joint inflammation  Local findings – redness, swelling, heat, tenderness  Impairment of joint function. – ROM restriction – Impairment of force transmission. 10.

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(12) Major Problems of Musculoskeletal Disorders  Pain  Contracture  Muscle weakness, atrophy  Instability  Functional impairment. 12.

(13) Definition of Pain (IASP)  “An unpleasant sensory and. emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”. – Acute pain vs chronic pain – Individual variations – Psychological factors 13.

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(15) Quantitation of Pain  Visual. analogue scale (VAS) – 10cm line  Likert scale. 15.

(16) Pain Generator       . Bone Joint Muscle Tendon Ligament Nerve Vessel 16.

(17) Contracture  Arthrogenic: arthritis, capsular fibrosis  Myogenic: trauma, inflammation,. degeneration  Other soft tissue: tendinitis, ligamentous tear  Mixed  Most common cause: lack of joint. mobilization throught full alowable range. 17.

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(19) Muscle weakness or atrophy  Disuse  Pain inhibition  Muscle or tendon lesions  Neuropathy  Side effect of drugs. 19.

(20) Instability  Bone and cartilage damage  Muscle atrophy  Relative lengthening of tendon,. ligament. 20.

(21) Evaluation of Musculoskeletal Disorders  History taking  Physical examination  Special examinations. 21.

(22) History Taking  Location  Disease duration  Cause  Course  Severity  Factors relieving or worsening the. symptom  Other sensory complaints 22.

(23) Physical Examination  Inspection: redness, swelling, atrophy,.    . ecchymosis, discoloration, deformity, physical defect Palpation: tenderness, local heat or coldness, swelling, atrophy, mass, local defect Neurological examination: sensory, motor, DTRs Check ROM, joint stability, soft tissue flexibility Special tests:. 23.

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(31) Special Examinations         . Conventional radiography Ultrasound Computed tomography Magnetic resonance imaging Bone scan Arthrography Arthroscopy EMG & NCS Motion analysis (gait laboratory). 31.

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(38) Goals of Rehabilitation  Symptom relief  Mobility and strength  Sense of self-worth  Maximal functional ability  Maximal independence. 38.

(39) Therapeutic Exercise  Mobility exercise  Strengthening exercise  Aerobic exercise  Recreational exercise. 39.

(40) Mobility Exercise  Range of motion – active – active-assistive – passive  Stretching – ballistic – PNF (proprioceptive neuromuscular facilitation) – static  Joint mobilization. 40.

(41) Strengthening Exercise  Isometric - same length  Isotonic - same load  Isokinetic -same speed. 41.

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(45) Aerobic Exercise  Mode: swimming, bicycle, walking  Frequency: 3-5 times/week  Duration: 20-60 min  Intensity:. – 55-90% maximal HR – 40-85% HR reserve . 2 reserve – 40-85% VO – 12-16 RPE (rate of perceived exertion) 45.

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(48) Purposes of Orthoses (splints)  Unweigh joints  Stabilize joints  Decrease joint motion  Improve joint function. 48.

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(51) Basic function of assistive devices  Compensate for lost function  Alleviate joint stress  Decrease energy demands  Increase safety. 51.

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(55) Treatment and Rehabilitation of Common Musculoskeletal Disorders  Acute stage  Subacute stage  Chronic stage. 55.

(56) Acute Stage        . PRICE Physical agents: TENS, low power laser Medications: NSAIDs, analgesics Local steroid injection (c or s xylocain) Local xylocain injection Acupuncture` Manipulation Therapeutic exercise: – ROM exercise – Isometric exercise. 56.

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(58) Hyperstimulation Analgesia. 58.

(59) Subacute Stage  Heat or cold therapy  Hydrotherapy(contrast bath)  Local massage  ROM exercise  Strengthening exercise. – isometric, isotonic, isokinetic  Other physical agents 59.

(60) Chronic Stage  Heat therapy  Hydrotherapy (Spa therapy)  Stretch exercise  Strengthening exercise  Aerobic exercise  Mobilization and manipulation  Other physical agents (USD, SWD, TENS). 60.

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(62) Psychologist. Physician Nurse. Social worker. PT. Patient Family. OT. Orthotist. Bioengineer Pedorthist. 62.

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