Physical Medicine and rehabilitation

1. DR.R.Balamurugan,M.D(PMR),2nd yr pg

2.  PHYSICAL MEDICINE AND REHABILITATION HAS ITS ROOTS IN
MAINTENANCE &RESTORATION OF FUNCTION AS WELL AS
PREVENTION OF DYSFUNCTION
 FORMULATION OF INDIVUALIZIED TREATMENT PLANS TO
MAXIMIZE PATIENT FUNCTION BY UTILIZING EDUCATION
 OBJECTIVES
 pain relief
 increased range of motion (ROM)
 increased strength and endurance
 prevention and correction of deformities
educational services

3. 1. Physiatrist
2. Pt &family
3. Pt educator
4. OT
5. PT
6. Pharmacist
7. Nurse
8. Psychologist
9. Dietician
10. Social worker
11. Vocational counselor

5. CERVICAL SPINE
1. ATLANTO-AXIAL JOINT SUBLUXATION
2. TENOSYNOVITIS OF C1 TRANSVERSE LIGAMENT

6. HANDS & WRIST :
1.BOUTONNEIRE’S DEFORMITY
2.SWAN NECK DEFORMITY
3.ULNAR DEVIATION OF FINGERS
4.TENOSYNOVITIS OF FLEXOR TENDON SHEATH
5.CARPAL BONES ROTATE IN ZIG-ZAG PATTERN
6.FLOATING ULNAR HEAD
7.RESORPTIVE ARTHROPATHY
8.PSEUDOBENEDICTION SIGN

7. ELBOW
1.SUBCUTANEOUS NODULES
2.OLECRANON BURSITIS
3.ULNAR NEUROPATHIES
4.LOSS OF FULL ELBOW EXTENSION

8. SHOULDER
1.GLENOHUMERAL ARTHRITIS
2.EFFUSIONS
3.ROTATOR CUFF INJURIES

9. HIP
PROTRUSIO ACETABULUM
 Inward bulging of the acetabulum into the pelvic
cavity.
 Occurs in about 50% of patients with RA
 Symmetric involvement

10. KNEE
1.FLEXION CONTRACTURE
 Due to loss of full knee extension
2.QUADRICEPS ATROPHY
 Leads to increased amount of force though the patella
3.BAKER’S CYST
 Increased intra-articular pressure in the knee joint causes the
synovial fluid to drip into the popliteal space

11. 1. HAMMER TOE
 Hyperextension of the MTP and DIP joints with flexion
of the PIP joint
2. CLAW TOE
 Hyperextension at the MTP joint and flexion of the PIP
and DIP joints
3. HALLUX VALGUS
 Lateral deviation of the toes

12.  Disease and co-morbidities
 Body Function and structure
 Activities-Execution of a task or action
 Participation-Involvement in life situations
 Environmental factors-External features of the physical, social
& attitudinal world
 Personal factors

13.  MEDICATIONS
 PATIENT EDUCATION
 ENERGY CONSERVATION
 JOINT PROTECTION & RELATIVE REST
 EXERCISES
 ORTHOTICS,ASSISTIVE DEVICES
 PHYSICAL MODALITIES &TECHNIQUES
 VOCATIONAL PLANNING

14. Goals of exercise
 Preserve or improve ROM
 Increase strength of selected muscles
 Improve endurance
 Improve co-ordination
 Improve function
 Relax tense muscles
 Improve posture
 Increase bone density
 Increase aerobic capacity

15. Key muscles to be strengthened
 Foot Intrinsics,
 Quadriceps,
 Finger&Wrist extensors
 Key muscles to be stretched
 Toe extensors,
 Peroneus,
 Gastrocnemius,
 Hamstrings,
 Hip flexors,
 IllioTibial band
 Hand Intriniscs

16. Superficial moist heat
 Subacute or chronic stages
 Increases range of motion &tendon extensibility
 Decreases pain
 Should not be used in acutely inflamed joints, impaired
sensation & malignancy
 Increases collagenase enzyme activity
 Heat penetration to depth of 1 cm
Other superficial heating/modalities:
 Paraffin,
 Fluidotherapy,cryotherapy-Acute
inflammation

17.  A low potential electric
stimulus is transported in the
skin in a periodical or
continuous manner after the
activation of the appliance,
which can be sustained in the
patient’s belt and functions
with batteries.
 The patient can activate and
regulate the intensity of the
stimuli depending on his
needs.

18.  Effective in reducing pain and morning stiffness.
 No known side effects.

19.  Decrease pain and inflammation
 Reduce weight through joint
 Decrease joint motion—stabilization
 Joint rest
 Splinting of the wrist in RA will most likely help decrease
pain and inflammation

20.  Hand and Wrist Immobilization

22.  Boutonniere ring splint/Bunnel splint

23.  Swan neck ring splint orthosis
 Prevents Proximal Interphalangeal Hyperextension&allows
flexion

26. Forefoot
 Widening of extra-depth foot
wear,soft-lined, custom molded
orthosis with MTP relief
MidFoot
 Crepe bandage or conventional heel-
shoe combination with a shank
support system
Hind foot
 Footwear with a firm heel counter,
custom orthosis with full medial
column support.