Musculoskeletal Disorders

of the Extremities
General Medical Background
Definition
musculoskeletal disorder
is a condition where a part of
musculoskeletal system is injured over time.
The disorder occurs when the body part
is called on to work harder, stretch
farther, impact more directly or
otherwise function at a greater level
then it is prepared for.
The immediate impact may be minute, but
when it occurs repeatedly the constant
trauma cause damage.
The term musculoskeletal disorder
identifies a large group of conditions
that result from traumatizing the body
in either a minute or major way over a
period of time. It is the build up of
trauma that causes the disorder.
These conditions are often focused on a
joint and affect the muscle and bone.
However other areas can be strained
and their response to that trauma can
be an injury.
Other terms used interchangeably with
Musculoskeletal Disorder are:
Repetitive stress injury (RSI)
Repetitive stress disorder (RSD)
Repetitive strain injury (RSI)
Repetitive strain disorder (RSD)
Repetitive motion injury (RMI)
Repetitive motion disorder (RMD)
Repetitive Injury
Overuse Syndrome
Cumulative Trauma Disorder (CTD)
This group of conditions may
encompass the following:
Work-related musculoskeletal disorders
Sports injuries
Performing artists occupational disorders
Classification
Musculoskeletal disorders may be
classified as to the specific structure(s)
affected. Some of which are:
Bones
Bursae
Cartilage
Joint capsules
Ligaments
Muscles (including fascia and
compartments)
Nerves
Synovia
Tendons
Epidemiology
Estimated that occurrence in individual
companies may run from 0-40%
Carpal tunnel syndrome is the most well
known of these disorders occurring at a
ratio of 2:1000
Etiology
The specific cause of musculoskeletal
disorders is dependent on the actual
injury type.
However, most have similar contributing
factors, such as:
Trauma
Weakening
Reinforcement
Repetition
Posture and Body Mechanics
Body in Motion
Overall Health
Mental Stress
The Problem Task
Pathophysiology / Pathomechanics
As stated previously, each
musculoskeletal disorder has its own
specific cause.
Clinical Manifestation(s)
Specific problems regarding
musculoskeletal disorders tend to be the
same, which are:
Pain
Signs of inflammation (swelling,
hyperthermia, erythema)
Limitation of motion / contractures
Edema
Atrophy
Muscle weakness
Complication(s)
These are specific to their type of injury
Diagnosis
Diagnostic tests are rarely indicated in
musculoskeletal disorders
However, if there is a history of trauma,
x-rays or MRI may be necessary
In compartment and nerve impingement
syndromes, EMG-NCV may be indicated
Differential Diagnosis
X-rays or MRI may be indicated to rule
out other conditions
In carpal tunnel syndrome, additional
diagnostic tests may be considered to
rule out:
Occult thyroid disease
Diabetes mellitus
Inflammatory arthritis
May also occur in the 2nd and 3rd
trimesters in pregnancy
Prognosis
Prognosis of a condition is dependent on
the type and severity of injury
Medical Management
Pharmacologic
NSAIDs
most often
Corticosteroids
rarely and only when in severe pain
Muscle relaxants
usually only in conditions with severe
muscle spasm
Medical / Surgical
Splinting
usually for immobilization
Surgery
rarely and only as a last resort
Physical Therapy Examination,
Evaluation & Diagnosis
Points of Emphasis in Examination
Subjective information
Chief complaint
characteristics of the condition
History of present injury
including any contributing factors and previous
treatments
Patients lifestyle
recreational and work activities
Objective information
Inspection
note for signs of inflammation and any change in
posture
Palpation
note for spasm and tenderness
Musculoskeletal system assessment
most data are taken here
Joint play
if decreased intraarticular movement is
evident
Range of motion
always
PROM is the most important indicator of the
extent of actual joint limitation
Muscle strength
when muscle weakness is evident
Limb girth measurements
when edema is evident
Muscle bulk measurements
when atrophy is evident
Leg length measurements
if any leg length discrepancy is evident
Some LE conditions may present with
functional, but not actual limb shortening
Functional assessment
particularly the effect of the signs and symptoms
on function
For UE conditions
Upper garment dressing
Lower garment dressing
Feeding
Toileting & bathing
Grooming
For LE conditions
Sitting tolerance
Standing tolerance
Gait
Special tests
when indicative of a particular musculoskeletal
disorder
Problem List
As stated before, specific problems
regarding musculoskeletal disorders
tend to be the same, which are:
Pain
Signs of inflammation (swelling,
hyperthermia, erythema)
Limitation of motion / contractures
Edema
Atrophy
Muscle weakness
Physical Therapy Diagnosis
PT diagnosis may fall into any of the
following, if present:
Impaired posture
Impaired muscle performance
Impaired joint mobility, motor function,
muscle performance, and range of motion
associated with localized inflammation
Impaired joint mobility, muscle
performance, and range of motion
associated with fracture

If surgical correction was necessary,
may fall into:
Impaired joint mobility, motor function,
muscle performance, and range of motion
associated with joint arthroplasty
Impaired joint mobility, motor function,
muscle performance, and range of motion
associated with bony or soft tissue surgery
Physical Therapy Prognosis (including
Plan of Care) & Intervention
Plan of Care
Basing on the common problem list for
these disorders:
Relieve pain
Reduce swelling
Prevent onset of joint and/or soft tissue
contractures
Reduce edema
Retard atrophy
Maintain muscle strength
Interventions
Non-modality
Temporary immobilization
Use of an assistive device
Alteration of body mechanics and
modification of daily habits
Limb elevation
Exercises
ROM exercises
Muscle strengthening exercises
Manual therapy techniques
Soft tissue mobilization
Centripetal massage
Modality
Thermal agents
Ice
Deep heating
Superficial moist heat
Electrical stimulation
Pressure bandaging