﷽

‫صلی ہللا علیہ و آلہ وسلم‬

MUSCULOSKELETAL TREATMENT

Bilal Umar
Assistant Professor

FACULTY OF ALLIED HEALTH SCIECNES

University Institute of Physical Therapy
University of Lahore
CYRIAX CONCEPT
THE DIAGNOSTIC APPROACH
Clinical Examination is the key.

. • History
• Assessment by
.
Function
 HISTORY TAKING
Depends on 2 factors.
a. Probable lesion
b. Condition it has reached
Referred pain pattern, Always consider;
a. Dermatome occupied.
b. Referred pain pattern and place
HISTORY TAKING
Site of interference

• Spinal Cord • No pain, pins and needles

• Nerve root sheath • Pain, pins and needles,
numbness
• Nerve trunk • No pain, weakness, pins and
needles

• Small nerve • No pain, no weakness,
numbness
HISTORY
Referred pain
PRELIMINARY EXAMINATION
Begin with rough outline of active movements to figure
out faulty joint.
Then go for complete examination via incremented and
passive movts.
PASSIVE MOVEMENTS
For inert structures, joint capsule, bursa, fascia,
displacements, dura mater and nerve roots.
Examine for:
Pain

Limitatio
n

End Feel
PASSIVE MOVEMENTS
Principal Findings
a) Capsular Pattern; capsular lesion
b) Non- capsular pattern for ligamentous sprain, or internal
derangement.
c) Extra-articular limitation
RESISTED MOVEMENTS:
For contractile structures such as muscle, tendons and ligaments.
Examine for:

Pain Weakness
RESISTED MOVEMENTS:
Principal findings : pain lesion of structure
painless weakness due to interference in
conduction pattern of nerve
PRINCIPLES OF TREATMENT
Joints of Upper limb and lower limb.
Disorders:

Muscl Tendon Joint Ligament

e s capsule s

Strained Strained Intra-articular Ligamentous sprain

Muscle Tendon displacement
TREATMENT FOR PERIPHERAL
JOINTS
Disorder Strained Strained Capsular Intraarticula Ligamentous Tenosynoviti
muscle tendon Inflammatio r sprain s
n displacement

Treatment Deep Deep Traumatic: Manipulative Deep Steroid

massage and massage and injection and reduction massage and injection,
muscle rehab injection stretch. injection massage

Rheumatoid:
steroid
injection
 TREATMENTS:
Deep massage:

Administer to the site of lesion.

The digit is rubbed across the region under treatment.
Friction is necessary not pressure
Position of patient is easily accessible and muscle relaxed
6-12 sessions, 20 minutes and alternate days.
Manipulation:
Purpose: to reduce displacement.
 TREATMENT FOR SPINE:
Cervical Thoracic Lumbar
Displacement Displacement displacement
Manipulative Manipulative Manipulative
reduction reduction reduction
To forestall relapse : Traction if nuclear
Sclerosants Epidural local
anesthesia
To forestall relapse:
posture, corset,
sclerosants
Only less proportion
for operation
THE SHOULDER
THE SHOULDER:
C4 dermatome

C5 dermatome

C4 dermatome
 THE SHOULDER:
Referred pain: Pain in C4- C5 C6 dermatome.
C5,6,7 for lateral disc protrusion.

History: Age, site of pain, trauma

and capsular pattern.
Examination: Active, passive,
and restricted movements.
MECHANISM OF ARM
ELEVATION
THE SHOULDER:
Findings:
Capsular lesions
Traumatic arthritis
Alydrodistropic arthritis
Monoarthritis
CAPSULAR LESION
TREATMENT
Stretching
Elevation
Injection
Distraction technique
CAPSULAR LESION
TREATMENT
Distraction technique treatment

Distraction techniques
NON CAPSULAR LESIONS
 Acute Subdeltoid Bursitis
Chronic Subdeltoid Bursitis
Sublaxation

Steroid suspension for acute subarachnoid bursitis

INFRASPINATUS AND
SUBSCAPULARIS
Treatment
1. Injection
2. Massage

Infraspinatus Supraspinatus
ACROMIOCLAVICULAR JOINT
Treatment
Injection
BICEPS
Treatment
1. Massage
2. Injection
BICEPS
STERNOCLAVICULAR JOINT
Treatment
Injection therapy