39155 - Phyisiotherapy in Muscle Skeletal Desease (BO)

Learning outcomes

After completing this module the student will reach the ability to apply knowledge and understanding regarding the musculoskeletal system diseases that are susceptible to physiotherapy treatment, the identification of the preventive and rehabilitative needs of the subject through the evaluation of clinical data and the individual features, the appropriate treatment modalities in orthopedic field, the designing, planning and implementation of the physiotherapy intervention.

Course contents

1. CLINICAL REASONING

• Definition
• Phases of the clinical reasoning: medical history-taking with its clinical diagnosis made by the doctor, functional assessment, identification of therapeutic targets, planning rehabilitative intervention (project, physiotherapy program), revaluation.

1. SHOULDER

• Functional assessment:

  - Assessment of impairment made through observation, inspection, palpation, administration of tests and rating scales. Outcome measures:

  - pain assessment by interview and administration VAS scale

  - Assessment of edema through perimetry and fovea sign

  - Assessment of thermotouch through palpation of the affected area and comparison with the contralateral district

  - assessment of joint range through joint Test and Apley test

• assessment of muscle strength through muscle testing (MRC Medical Research Council)
• assessment of sensibility (if necessary)

Specific tests useful to functional differential diagnosis:

Neer test, Hawkins, Jobe, Erls, Drop Sign, Lift of test, Belly – Press Sign, Yergason, Speed, wrinkle sign, drawer test, Appression Test, Relocation Test, O'Brien test, assessment of disability: Constant Murley scale, therapeuticgoals, Physiotherapy strategies suitable for achieving the objectives

Physiotherapy treatment in major diseases of rehabilitative interest (fracture, impingement and rotator cuff reconstruction outcomes, slap lesion, instability, shoulder prosthesis, adhesive capsulitis)

1. ELBOW

• Functional assessment:

- Assessment of impairment made through observation, inspection, palpation, administration of tests and rating scales. Outcome measures:

Assessment of pain through interview and administration of VAS scale

- Assessment of edema through perimetry and fovea sign

- Assessment of thermotouch through palpation of the affected area and comparison with the contralateral district

- Assessment of joint range through joint Test

• Evaluation of muscle strength through muscle testing (MRC Medical Research Council)
• Assessmentof sensibility (if necessary)
• Specific tests: test for the ligament stability, Mills test, tennis elbow sign, test for underline the medical epicondylitis
• Assessmentof disability: DASH scale
• therapeutic goals
• Physiotherapy strategies suitable for achieving the objectives

Physiotherapy treatment in

• major diseases of rehabilitative interest (dislocation and fracture outcomes)

1. HAND

• Functional assessment:

  - Assessment of impairment made through observation, inspection, palpation, administration of tests and rating scales. Outcome measures:

  - Assessment of pain through interview and administration of VAS scale

  - Assessment of edema through perimetry and fovea sign

  - Assessment of thermotouch through palpation of the affected area and comparison with the contralateral district

  - Assessment of joint range through joint Test

• Assessment of muscle strength through muscle testing (MRC Medical Research Council)
• Assessment of sensibility (if necessary)
• Assessment of disability: DASH scale

• therapeutic goals
• Physiotherapy strategies suitable for achieving the objectives
• Physiotherapy treatment in major diseases of rehabilitative interest (fracture and tenorrhaphy of flexor and extensor tendons outcomes)

1. HIP

• Functional assessment:

- Assessment of impairment made through observation, inspection, palpation, administration of tests and rating scales. Outcome measures:

- assessment of pain through interview and administration of VAS scale

- assessment of edema through perimetry and fovea sign

- assessment of thermotouch through palpation of the affected area and comparison with the contralateral district

- assessment of joint range through joint Test

assessment of muscle strength

• through muscle testing (MRC Medical Research Council)
• assessment of sensibility (if necessary)
• Specific functional tests: Ober test, Thomas test, Trendelenburg test, Craig test (for assessment of the femur anteversion), Patrick test, Piriformis test, test for assessment of the lower limbs heterometry)
• assessment of disability: Harris Hip scale
• therapeutic goals
• Physiotherapy strategies suitable for achieving the objectives
• Physiotherapy treatment in major diseases of rehabilitative interest (pelvis and femur fractures, hip arthroprosthesis)

1. KNEE

• Functional assessment:

- Assessment of impairment made through observation, inspection, palpation, administration of tests and rating scales. Outcome measures:

- assessment of pain through

interview and administration of VAS scale

- assessment of edema through perimetry and fovea sign, patellar ballottement test

- assessment of thermotouch through palpation of the affected area and comparison with the contralateral district

- assessment of joint range through joint Test

• assessment of muscle strength through muscle testing (MRC Medical Research Council)
• assessment of sensibility (if necessary)
• Specific tests: anterior and posterior drawer test, Lachman test, lateral drawer test, patella femoral grinding test, McMurry test, compression and distraction test, Smillie test
• assessment of disability: Tegner scale, Lysholm Knee Scoring scale, Womac
• therapeutic goals
• Physiotherapy strategies suitable for achieving the objectives

Physiotherapy treatment in

• major diseases of rehabilitative interest (knee distortion outcomes, ACL and PCL reconstruction outcomes, patellar tendon reconstruction outomes, knee arthoprosthesis)

1. ANKLE AND FOOT

• -- Functional assessment:

  - Assessment of impairment made through observation, inspection, palpation, administration of tests and rating scales. Outcome measures:

  - Assessment of pain through interview and administration of VAS scale

  - Assessment of edema through perimetry and fovea sign

  - Assessment of thermotouch through palpation of the affected area and comparison with the contralateral district

  - Assessment of joint range through joint Test

• Assessment of muscle strength through muscle testing (MRC Medical Research Council)
• Assessment of sensibility (if necessary)

• Specific tests: drawer test, differential test between tibia-tarsal joint and subastraligic joint (useful for understand which is the area responsible for pain), Thompson test, Homann sign, tibia-tarsal joint dorsal flexion test (differentiation between gastrocnemius and soleus), flat foot contract test
• Assessment of disability: Ankle Functional Score scale and FADI (Foot Ankle Disability Index)
• Treatment goals
• Physiotherapy strategies suitable for achieving the objectives

  Physiotherapy treatment in major diseases of rehabilitative interest (ankle distortion and Achilles tendon reconstruction outcomes)

1. GAIT

• Reasons of pathological gait: foot drop, flexed knee, knee jerk in extension, knee recurvatum, positive trendelenburg sign, circumduction gait, steppage gait
• Gait observation

• Assessment of disability: Tinetti scale and Time Walking test
• Physiotherapy strategies

• Assessment of disability: Tinetti scale and Time Walking test
• Physiotherapy strategies

Readings/Bibliography

S. Hoppenfield - L'esame obiettivo in ortopedia - Ed. Aulo Gaggi

Coppola L, Masiero S, Riabilitazione in Ortopedia, 2005 Piccin, Padova

Mancini A, Morlacchi C, Clinica Ortopedica, 2003 Piccin, Padova

Fusco A, Foglia A, Musarra F, Testa M, La Spalla nello Sportivo, 2005, Masson Milano

Ferrari S, Pillastrini P, testa M, Vanti C, Riabilitazione post-chirurgica nel paziente ortopedico, 2010, Elsevier Masson, Milano

Giannini S, Faldini C, Manuale di Ortopedia e Traumatologia, 2008, Edizioni Minerva Medica, Torino

Brent Brotzman S, Riabilitazione in ortopedia e traumatologia. Protocolli terapeutici, 2002, Utet, Torino

Brent Brotzman S, Manuale di Riabilitazione Ortopedica, 2008, Elsevier Masson, Milano

Teaching methods

Lectures and practical exercises

Assessment methods

Theoretical and practical evaluation

Teaching tools

PC and projector

Scientific articles

Lecture notes

Office hours

See the website of Daniele Tosarelli