Physical therapy for orthopedic
and rheumatology
Salameh Al dajah PhD PT
Types of Pathology
Principles of musculoskeletal pathology
Four levels of diagnosis
1. Pathology
Tissue abnormality such as Fracture, avulsion, dislocation, DJD
(any disease)
2. Impairment
Manifestation of the tissue abnormality such as, motion
limitation, strength deficits, neurological abnormalities,
3. Functional limitation
Activity limitation such as limitation in ability of walking,
climbing, lifting
4. Disability
Inability to perform a desired social role such as working,
interacting with friends, going to school
Evaluation
Evaluation in Physical Therapy include
Subjective findings
1. Taking History of present illness and past
medical history
- directly from the patient or his family
- from patient record
2. Observation, Body appearance, tilting,
limping, bending
• 3. Palpation: palpate the area of complaint, touch for
swelling, redness, warmness, deformity
• Objective findings
• 1. Taking measurement
• ROM
• MMT
• neurological test for sensation, pain and temperature
• Specific test to differentiate specifically
Assessment
• Assessment include
Problem list What patient can do and cannot
do and the level of assistant
Goals list: Achievable and reachable goals,
Patient must understand and agree on the
goals
• Plan: what we need to do to achieve the
goals, Treatment plan, ways of treatment, and
home treatment plan
Differential Diagnosis of Musculoskeletal
pathology
• Bone pathology may results from direct or indirect
trauma to the area or due metabolic
• Diagnosis of fractures and medical management
falls within the practice area of orthopedic surgery.
Other bone pathology include
• Avulsion (Osgoid process)
• Dislocation (Shoulder dislocation)
• Metabolic bone diseases (Osteoporosis)
Notes from the history of musculoskeletal
injuries
Pain with any contraction palpable muscle tenderness
Unaccustomed overuse and Unaccustomed violent
contraction
• Muscle: Pain with isometric contraction, Palpable tendon
tenderness, Recent repetitive activity, Painful arc
• Tendon: Pain at rest Palpable bursa tenderness, Due recent
unaccustomed overuse, or recent weight bearing overuse.
• Bursa: Pain with unidirectional movement, Due trauma in
Unguarded movement
• Capsule: Pain with ligament stress Palpable ligament
tenderness Trauma Prolonged static position.
• Ligament: Symptom location change with repeated
movement Recurring episodes Worse with flexion
activities
• Disc: Positive nerve tension tests Palpable nerve
tendernessParasthesia/ numbness/weakness
Lancinating pain
• Nerve/ Dura: Positive slum test Multisegmental pain
reference
Grading tenderness on palpation
• Grade 1. Patient complain of pain
• Grade 2. Patient complains of pain and wines
• Grade 3. Patient complains of wines and
withdraws the joint
• Grade 4. Patient will not allow palpation of the
injured area or joint