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NBCOT: Musculoskelet
Information from Ch. 6- Musculoskeletal System Disorders
| Question | Answer |
|---|---|
| What intrinsic muscles do the median nerve innervate? | -abductor pollicis brevis (palmar abduction) -opponens pollicis -flexor pollicis brevis -lumbricals (MCP flexion & IP extension) |
| What intrinsic muscles do the ulnar nerve innervate? | -abductor digiti minimi -opponens digiti minimi -flexor digiti minimi -lumbricals (ulnar side) (MCP flexion & IP extension) -palmar interossei (adduction, assists w/ MP flex & IP extend) -dorsal interossei (abduction, assists w/ MP flex & IP extend) |
| What are extrinsic hand muscles innervated by the median nerve? | -flexor digitorum superficialis (FDS) (PIP flexion) -flexor digitorum profundus (FDP) (DIP flexion II & III) -flexor pollicis longus (FPL) (thumb IP flexion) |
| What are extrinsic hand muscles innervated by the ulnar nerve? | -flexor digitorum profundus (FDP) (DIP flexion IV & V) |
| What are extrinsic hand muscles innervated by the radial nerve? | -extensor digitorum communis (EDC) (MCP extension, IP extension) -extensor digiti minimi -extensor indicis proprius -extensor pollicis longus -extensor pollicis brevis -abductor pollicis longus (CMC abduction/extension) |
| What are wrist muscles innervated by the median nerve? | -flexor carpi radialis -palmaris longus (flexion of wrist) |
| What are wrist muscles innervated by the ulnar nerve? | -flexor carpi ulnaris |
| What are wrist muscles innervated by the radial nerve? | -extensor carpi radialis brevis -extensor carpi radialis longus -extensor carpi ulnaris |
| What are forearm muscles innervated by the median nerve? | -pronator teres (forearm pronation) -pronator quadratus (forearm pronation) |
| What are forearm muscles innervated by the radial nerve? | -supinator (forearm supination) |
| What muscles assist in elbow flexion? | -biceps-w/ forearm supinated: musculocutaneous nerve -brachialis-w/ forearm pronated: musculocutaneous nerve -brachioradialis-w/ forearm neutral: radial nerve |
| What muscles assist in elbow extension? | -triceps: radial nerve -anconeus: radial nerve |
| What are the rotator cuff muscles? | -subscapularis: subscapular nerve- internal rotation -supraspinatus: suptrascapular nerve- abduction & flexion -infraspinatus: suprascapular nerve- external rotation -teres minor: axillary nerve- external rotation |
| What muscles assist in shoulder flexion? | -anterior deltoid: axillary nerve -coracobrachialis: musculocutaneous nerve -supraspinatus: suprascapular nerve |
| What muscles assist in shoulder abduction? | -middle deltoid: axillary nerve -supraspinatus: suprascapular nerve |
| What muscle assists in horizontal abduction? | -posterior deltoid: axillary nerve |
| What muscle assists in horizontal adduction? | -pectoralis major: lateral pectoral nerve |
| What muscles assist in shoulder extension? | -latissimus dorsi: thoracodorsal nerve -teres major: subscapular nerve -posterior deltoid: axillary nerve |
| What muscles assist in upward rotation of the scapula? | -upper trapezius: spinal accessory nerve -middle trapezius: spinal accessory nerve -serratus anterior: long thoracic nerve -lower trapezius: spinal accessory nerve |
| What muscles assist in downward rotation of the scapula? | -levator scapulae: C3-C4 nerves -rhomboids (major & minor): dorsal scapular nerve -serratus anterior: long thoracic nerve -latissimus dorsi: thoracodorsal nerve |
| What muscles assist in scapular adduction? | -middle trapezius: spinal accessory nerve (CNXI) -rhomboid major: dorsal scapular nerve |
| What muscles assist in scapular abduction? | -serratus anterior: long thoracic nerve |
| What muscles assist in scapular elevation? | -upper trapezius: spinal accessory nerve (CNXI) -levator scapulae: C3-C4 nerves |
| What muscles assist in scapular depression? | -lower trapezius: spinal accessory nerve (CNXI) |
| What is the treatment for Dupuytren's Disease? | surgical release required: -wound care: dressing changes, whirlpool -edema control -extension splint: all times except ROM & bathing -A/PROM, progress to strenghening -scar management -grip & release tasks |
| What is skier's thumb (gamekeeper's thumb), and what does OT treatment entail? | rupture of ulnar collateral ligament of MCP jt. of thumb -thumb splint -AROM & pinch strengthening -focus on ADL that requires opposition & pinch -post op tx: thumb splint, followed by AROM. PROM @ 8 wks, strengthening @ 10 wks |
| What is OT treatment for Complex Regional Pain Syndrome? | -modalities to decrease pain -edema management -AROM to involved jts. -ADL to encourage pain-free active use -stress loading -splinting to prevent contractures & enable particip. in activity -encourage self-management -PROM, jt. mobilization |
| What is a Colles' fracture? | fracture of the distal radius w/ dorsal displacement |
| What is a Smith's fracture? | fracture of the distal radius w/ volar displacement |
| What is the most common carpal fracture? | scaphoid fracture: has poor blood supply, may become necrotic |
| What is a common complication of metacarpal fractures? | rotational deformities |
| What are complications of humerus fractures? | -fractures of the greater tuberosity may result in rotator cuff injuries -humeral shaft fractures may cause injury to the radial nerve resulting in wrist drop |
| What are OT goals during the immobilization phase when treating a fracture? | stabilization & healing -AROM of jts. above & below stabilized jt. -edema control: elevation, retrograde massage, compression garments -light ADL and role activities w/ no resistance, progress as tolerated |
| What are OT goals during the mobilization phase when treating a fracture? | consolidation -edema control: elevation, retrograde massage, contrast baths, & compression garments -AROM, progress to PROM when approved by doc (4-8 wks) -light occupation-based activity -pain management -strengthening: isometrics when doc. approved |
| What are risk factors for cumulative trauma disorders? | -repetition, static position, awkward postures, forceful exertions, vibration -acute trauma, pregnancy, diabetes, arthritis, wrist size & shape |
| What is DeQuervain's tenosynovitis & what are the symptoms? | stenosing tenosynovitis of the abductor pollicis longus & extensor pollicis brevis -pain & swelling over radial styloid -+ finkelstein's test |
| What is conservative treatment for DeQuervain's tenosynovitis? | -thumb spica splint (IP jt. free) -activity/work modification -ice massage over radial wrist -gentle AROM of wrist & thumb to prevent stiffness |
| -What is post-op treatment for DeQuervain's tenosynovitis? | -thumb spica splint & gentle AROM: 0-2 wks -strengthening, ADL, & role activities: 2-6 wks -unrestricted activity: 6 wks |
| What are lateral & medial epicondylitis? | -degeneration of tendon origin as a result of repetitive microtrauma -lateral epicondylitis: overuse of wrist extensors, esp. the extensor carpi radialis brevis -medial epicondylitis: overuse of wrist flexors |
| What is conservative treatment for medial & lateral epicondylitis? | -elbow strap, wrist splint -ice & deep friction massage -stretching -activity/work modification -as pain decreases, increase strengthening. begin w/ isometric exercises, progress to isotonic & eccentric |
| What is trigger finger? | -tenosynovitis of the finger flexors; most commonly is A1 pulley -caused by repetition & use of tools that are placed too far apart |
| What is conservative treatment for trigger finger? | -trigger finger splint (MCP extended, IP jts. free) -scar massage -edema control -tendon gliding -activity/work modification: avoid repetitive gripping activities & using tools w/ handles too far apart |
| What are goals for tendon repair patients? | -increase tendon excursion -improve strength at repair site -increase jt. ROM -prevent adhesions -facilitate resumption of meaningful roles, occupations, & activities |
| What are the two most common early mobilization programs for flexor tendons? | Kleinert & Duran Protocols |
| What is the Kleinert protocol? | passive flexion using rubber band traction & active extension to the hood of the splint |
| What does an OT do during the early phase (0-4 wks) of the Kleinert protocol? | -0-4wks: dorsal block splint, wrist in 20-30deg. flex, MCPs in 50-60deg. flex, IPs extended -passive flexion, active extension within confines of splint |
| What does an OT do during the intermediate phase (4-7 wks) of the Kleinert protocol? | 4-7 wks: continue dorsal block splint, adjust wrist to neutral -place & hold exercises & differential flexor tendon gliding exercises -scar management |
| What does an OT do during 6-8 wks of the Kleinert protocol? | 6-8 wks: differential tendon gliding, light purposeful occupation-based activities -D/C splint |
| What does an OT do during 8-12 wks of the Kleinert protocol? | -8-12 wks: strengthening & work & leisure activities |
| What is the Duran protocol? | passive flexion & extension of digit |
| What does an OT do during 0-4.5 wks of the Duran protocol? | dorsal blocking splint-exercises in splint include passive flexion of PIP jt, DIP jt and to DPC, 10 reps every hr. |
| What does an OT do during 4.5-6 wks of the Duran protocol? | active flexion & extension within limits of splint |
| What does an OT do during 6-8 wks of the Duran protocol? | tendon gliding & differential tendon gliding, scar management, and light purposeful and occupation-based activities |
| What does an OT do during 8-12 wks of the Duran protocol? | strengthening & work activities |
| What is the early mobilization program for zone I-II extensor tendon injuries (mallet deformity)? | -0-6 wks: DIP extension splint |
| What is the early mobilization program for zone III-IV extensor tendon injuries (Boutonniere deformity)? | -0-4 wks: PIP extension splint (DIP free), AROM of DIP while in splint -4-6 wks: begin AROM of DIP and flexion o digits to the DPC |
| What is the early mobilization program for zone V-VII extensor tendon injuries? | -0-2 wks:volar wrist splint w/ wrist in 20-30. ext., MCPs in 0-10. flex, IPs full extend. -2-3 wks:shorten splint-allow flex&extens of IP jts. -4 wks:remove splint, MCP active flex & extens -5 wks: wrist AROM, splint btw. exercise -6 wks: D/C splint |
| What is carpal tunnel syndrome, & what are the symptoms? | median nerve compression- numbness & tingling of thumb, index, middle, & radial half of ring fingers -paresthesias usually @ night -person complains of dropping things -+ Tinel's sign @ wrist, + Phalen's -ms atrophy @ thenar eminence (advanced) |
| What is conservative treatment for carpal tunnel syndrome? | -wrist spint in neutral- should be worn @ night, during day when performing repetitive activity -median nerve gliding exercises -activity modification -ergonomics |
| What is post-op treatment for carpal tunnel syndrome? | -edema control -AROM -nerve & tendon gliding -sensory reeducation -strengthening of thenar muscles (6 wks. post-op) -work/activity modification |
| What is pronator teres syndrome & what are the symptoms? | median nerve compression btw. the 2 heads of the pronator teres -same symptoms as CTS -aching pain in proximal forearm |
| What is the conservative treatment for Pronator teres syndrome? | -elbow splint at 90 deg. w/ forearm in neutral -avoid activities that include repetitive forearm pronation & supination |
| What is the post-op treatment for Pronator teres syndrome? | -AROM -nerve gliding -strengthening (2 wks. post-op) -sensory reeducation -work/activity modification |
| What is Guyon's canal syndrome & what are symptoms? | ulnar nerve compression @ wrist -numbness & tingling in ulnar nerve distribution of hand -motor weakness of ulnar nerve innervated musculature -+ Tinel's at Guyon's canal -atrophy of ulnar nerve innervated musculature (advanced) |
| What is the conservative treatment for Guyon's canal? | -wrist splint in neutral -work/activity modification |
| What is post-op treatment for Guyon's canal? | -edema control -AROM -Nerve gliding -Strenthening (2-4wks): focus on power grip -sensory reeducation |
| What is cubital tunnel syndrome & what are symptoms? | ulnar nerve compression @ elbow -numbness/tingling along ulnar aspect of forearm & hand -pain @ elbow w/ extreme elbow flexion -weakness of power grip -+ Tinel's sign @ elbow -atrophy of FCU, FDP to digits IV-V & ulnar nerve-innervated muscles (adv) |
| What is conservative treatment of cubital tunnel syndrome? | -elbow splint-prevents positions of extreme elbow flex (esp @ night) -elbow pad to decrease compression of nerve when leaning on elbows -activity/work modification |
| What is post-op treatment of cubital tunnel syndrome? | -edema control -scar management -AROM & nerve gliding (2 wks post-op) -strengthening (4 wks post-op) -MCP flexion splint if clawing is noted |
| What is radial nerve palsy, & what are symptoms? | a radial nerve compression (associated w/ Saturday night palsy) -weakness or paralysis of extensors to wrist, MCPs, & thumb -wrist drop |
| What is conservative treatment for radial nerve palsy? | -dynamic extension splint -work/activity modification -strengthening wrist & finger extensors when motor function returns |
| What is post-op treatment for radial nerve palsy? | -ROM -Nerve gliding -strengthening (6-8 wks post op) -ADL & meaningful role activities |
| What is the sensory loss for a median nerve laceration? | -central palm (thumb to radial half of ring finger) -palmar surface of thumb, index, middle, & radial half of ring finger -dorsal surface of index, middle, & radial half of ring fingers (middle & distal phalanges) |
| What is motor loss for a low median nerve laceration @ wrist? | -lumbricals I & II (MCP flexion) -opponens pollicis -abductor pollicis brevis -flexor pollicis brevis |
| What is motor loss for a high median nerve laceration @ or proximal to the elbow? | -lumbricals I & II (MCP flexion) -opponens pollicis -abductor pollicis brevis -flexor pollicis brevis -FDP to II and III -FPL -FCR |
| What is the deformity associated with a median nerve laceration? | -flattening of thenar eminence - "ape hand" -clawing of index & middle fingers (low lesion) -Benediction sign for high lesion |
| What is the functional loss for a median nerve laceration? | -loss of thumb opposition -weakness of pinch |
| What are OT interventions for a median nerve laceration? | -dorsal protection splint- wrist in 30deg. flexion (low lesion), elbow included (90deg. flex) (high lesion) -A/PROM of digits w/ wrist flexed - 2 wks post-op -scar management -wrist AROM - 4 wks (w/ elbow- high lesion) -strengthening - 9 wks |
| When do you begin sensory reeducation for a median nerve laceration? | when individual demonstrates level of diminished protective sensation - 4.31 on semmes-weinstein |
| What is the sensory loss for a ulnar nerve laceration? | -ulnar aspects of palmar & dorsal surfaces |
| What is motor loss for a low ulnar nerve laceration @ wrist? | -palmar & dorsal interossei (MCP ab/adduction) -lumbricals III & IV (MCP flexion of digits IV & V) -FPB & adductor pollicis -ADM, ODM, FDM |
| What is motor loss for a high ulnar nerve laceration @ or above the wrist? | -palmar & dorsal interossei (MCP ab/adduction) -lumbricals III & IV (MCP flexion of digits IV & V) -FPB & adductor pollicis -ADM, ODM, FDM -FCU -FDP IV & V |
| What is the deformity associated with a ulnar nerve laceration? | -claw hand -flattened metacarpal arch -+ Froment's sign |
| What is the functional loss for a ulnar nerve laceration? | -loss of power grip -decreased pinch strength |
| What are OT interventions for a ulnar nerve laceration? | -splint: MCP flexion block splint -Begin A/PROM of digits w/ wrist in flexed position- 2 wks post-op -Scar management -AROM of wrist - 4 wks -strengthening- 9 wks |
| When do you begin sensory reeducation for a ulnar nerve laceration? | when individual demonstrates level of diminished protective sensation - 4.31 on semmes-weinstein |
| What is the sensory loss for a radial nerve laceration? | -medial aspect of dorsal forearm -radial aspect of dorsal palm, thumb, index, middle, & radial half of ring phalanges |
| What is motor loss for a low radial nerve laceration @ forearm? | -loss of wrist extension due to absent or impaired innervation to ECU -EDC, EI, EDM (loss of MCP extension) -EPB, EPL, APL (loss of thumb extension) |
| What is motor loss for a high radial nerve laceration @ the humerus? | -loss of wrist extension due to absent or impaired innervation to ECU -EDC, EI, EDM (loss of MCP extension) -EPB, EPL, APL (loss of thumb extension) -ECRB, ECRL, & brachioradialis -loss of triceps (if level of axilla) |
| What is the deformity associated with a radial nerve laceration? | wrist drop |
| What is the functional loss for a radial nerve laceration? | -inability to extend digits to release objects -difficulty manipulating objects |
| What are OT interventions for a radial nerve laceration? | -dynamic extension splint -ROM -sensory reeducation if needed -instruct in home program -activity modification |
| What is conservative treatment for rotator cuff tendonitis? | -activity modification (avoid above shoulder level) -educate in sleeping posture (no overhead, combined adduct/int.rotate) -decrease pain -restore pain free ROM -strengthening below shoulder level -occupation & role specific training |
| What is post-op treatment for rotator cuff tendonitis? | -0-6 wks: PROM, progress to AA/AROM -Decrease pain- begin w/ ice, progress to heat -6 wks: strengthening- isometrics, progress to isotonic (below shoulder level) -activity modification -8-12 wks: leisure & work activities |
| What can adhesive capsulitis be linked to? | -diabetes mellitus -Parkinson's disease |
| What is adhesive capsulitis? | restricted PROM of shoulder -greatest limitations in ext. rotation, abduction, int. rotation, flexion |
| What is conservative treatment for adhesive capsulitis? | -encourage active use through ADL & role activities -PROM -modalities |
| What is post-op treatment for adhesive capsulitis? | -PROM immediately following surgery -Pain relief-modalities -encourage use of extremity for all ADL & role activities |
| What is treatment for shoulder dislocations? | -regain ROM: avoid combined abduction & ext. rotation w/ anterior dislocation -pain-free ADL & role activities -strengthen rotator cuff |
| What is rheumatoid arthritis, and what are symptoms? | -systemic, symmetrical, affects many jts, characterized by remissions & exacerbations -most commonly attacks jts. of hands -symptoms: pain, stiffness, limited ROM, fatigue, weight loss, limited ADL, ability to perform life roles, swelling, deformity |
| What are common deformities of rheumatoid arthritis? | ulnar deviation, subluxation of wrists & MCP jts, boutonniere deformity, swan neck deformity |
| What is osteoarthritis, and what are symptoms? | -degenerative jt. disease (not systemic, but wear & tear), commonly affects large, weight-bearing jts -attacks hyaline cartilage -symptoms: pain, stiffness, limited ROM, bone spurs |
| What are types of bone spurs associated with osteoarthritis? | -Heberden's nodes @ DIP jts. -Bouchard's nodes @ PIP jts. |
| What should be avoided during evaluation of someone with arthritis? | PROM, especially during the inflammatory phase, muscle testing -evaluate AROM -Document strength in relation to function -Other things to note during eval: deformities & nodules, edema, ADL/role activities, pain, grip using sphygmomanometer |
| What does OT intervention involve for individuals with arthritis? | jt. protection, energy conservation, pain free ROM (focus on AROM), heat modalities (not during inflammatory stage), strengthening, occupation-based activities, splinting (resting hand splint-acute phase, ulnar drift splint to prevent deformity) |
| What is osteogenesis imperfecta, and what are the symptoms? | -fractures in utero/during birth process -brittle bones that fracture easily -multiple fractures as child grows -deformities of arms & legs -developmental growth problems -eye abnormalities -risk of hearing impairments |
| What is is OT intervention for osteogenesis imperfecta? | -activity adaptation, assistive devices for safe participation in activity -environmental modifications -preventative positioning, protective splinting -increase muscle strength -weightbearing activities to facilitate born growth -caregiver education |
| What is OT intervention for hip fractures? | -bed mobility, bedside ADL, UE strengthening, functional ambulation & transfers w/ appropriate WB status, training w/ assistive devices, practice occupation-based activities |
| What are are precautions to keep in mind when working with individuals with hip fractures? | -weight bearing status, amt. of ROM allowed at hip -time frames for beginning OT determined by surgeon |
| What should be included in an evaluation for a patient with a total hip arthroplasty? | -review precautions & WB status -occupational profile -ADL (dressing, bathing, transfers) -ROM, UE strength -Any other assessments as needed |
| What are the hip precautions after a total hip arthroplasty? | -do not flex beyond 90* -don't adduct/cross legs -don't internally rotate (no ext. rotation for anterolateral approach) -do not pivot at hip -transfer sit to stand by keeping operated hip in slight abduction & extended in front |
| What is OT intervention for individuals with a total hip arthroplasty? | -educate in hip precautions -instruct in use of long-handled equipment -provide transfer training (tub bench, raised toilet seat, car, bed to chair) -practice occupation based activities using proper WB status & ambulatory device |
| What are advantages/disadvantages of a hook as a terminal device for someone with an amputation? | -lightweight -lowest cost -lower pinch force-- more effort with higher pinch force -good durability, reliability -difficult for high plane amputations -poor cosmesis |
| What are the advantages/disadvantages of an externally powered hand as a terminal device for someone with an amputation? | -strong grip -heavy in weight -not very durable -reliable if not used for rugged activities -easy to use -good cosmesis -highest cost |
| What are complications of amputations? | -neuromas -skin breakdown -phantom limb syndrome/pain: sensation of presence of amputated limb -infection -knee flexion contractures in transtibial amputation -psychological impairments due to shock/grief |
| What are aspects of preprosthetic treatment? | -change of dominance activities if needed -ROM of uninvolved jts -prepare limb for prosthesis-desensitization, wrapping (distal to proximal) to shape & shrink residual limb -ADL & skin care training -supportive counseling |
| What are aspects of prosthetic treatment? | -functional training w/ prosthesis -donning & doffing prosthesis -increase prosthetic wearing tolerance |
| What are aspects of treatment for LE amputations? | -wrapping to shape residual limb & decrease swelling -desensitization -UE strengthening w/ focus on triceps -transfer training, stand pivot -ADL training -standing tolerance -W/C mobility |
| What is a superficial, 1st degree burn? | involves the epidermis only, minimal pain & edema, no blisters -healing time is 3-7 days |
| What is a superficial partial thickness, 2nd degree burn? | -involve epidermis & upper portion of dermis -red, blistering, & wet -no grafting necessary, heals on its own -healing time is 7-21 days |
| What is a deep partial thickness, 2nd degree burn? | -deep burn involving epidermis & deep portion of dermis; hair follicles & sweat glands -appears red, white, & elastic -sensation may be impaired -potential to convert to full thickness burn due to infection -healing time is 21-35 days |
| What is a full thickness, 3rd degree burn? | -burn involving epidermis & dermis; hair follicles, sweat glands, & nerve endings -appears white, waxy, leathery, & non-elastic -sensation is absent, requires skin graft -hypertrophic scar -healing time can take months |
| What is a 4th degree burn? | -involves fat, muscle, & bone -electrical burn; destruction of nerve along pathway |
| What is the rule of 9? | a method of assessing burn wound size |
| What is the evaluation procedure for superficial & deep partial-thickness burns? | -occupational profile -ROM- 72 hrs post-op -sensation when wounds are healed -strength when wounds are healed -ADL & meaningful activity, as soon as possible |
| What are OT interventions for superficial partial-thickness burns? | -wound care & debridement, dressing changes -gentle AROM / PROM to indiv's tolerance -edema control -splinting -ADL, role activities |
| What are OT interventions for deep partial-thickness burns? | -wound care & debridement -gentle AROM & PROM -edema control -splinting -occupational role activities & ADL -strengthening when wounds are healed |
| What is different about the burn evaluation procedure for full thickness burns? | ROM is completed 5-7 days after the skin grafting procedure |
| What is post-op interventions for full thickness burns? | -72 hrs: dressing changes, splint @ all times -5-7 days: begin AROM, light ADL -7+ days: PROM as tolerated, ADLs -massage when wounds are healed -compression garments -otoform/elastomer inserts -strengthening |
| How should a splint be constructed for burns to the hand? | -wrist in 20-30* extension -MCP jts in 50-70* flexion -IP jts. in full extension -thumb abducted & extended |
| How should a splint be constructed if burns to the volar hand develop flexion contractures? | -wrist in 0-30* extension -MCP jts in neutral, slight extension & abduction -IP jts in full extension -thumb abducted & extended |
| What splint should be used for a web space burn? | C-splint |
| What is a hypertrophic scar and what are interventions used to treat them? | -most common w/ deep 2nd & 3rd deg. burns -appears 6-8 wks after wound closure, take 1-2 yrs to mature -compression garments should be worn 24hrs/day for 1-2 yrs -ROM, skin care, ADLs, patient/family education |
| What is myofascial pain? | -pain specific to muscles, tendons, or fascia |
| What is fibromyalgia? | musculoskeletal pain & fatigue disorder that can vary in intensity-widespread pain accompanied by tenderness of muscles & adjacent soft tissues |
| What are some pain scales that commonly address function? | -McGill Pain Questionnaire -Pain Disability Index -Functional Interference Estimate |
| What are OT interventions for pain? | -modalities, massage -teach proper positioning, posture -splint in resting position -gentle ROM -relaxation exercises -body mechanics -modify activities, environment -alternative exercise programs |
Created by:
Jbardenw