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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(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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