The purpose of this presentation is to discuss the important role of physiatrists in the management of musculoskeletal conditions in patients with neurological disorders. We will present a wide array of musculoskeletal pathology very commonly seen in these patients. We will review the epidemiological data on the prevalence of these diseases and discuss a clinical approach to the most common musculoskeletal diagnoses seen in the acute and chronic phases of neurological disability. For every diagnosis we will present a thorough clinical evaluation with important history, physical exam and imaging findings specific to patients with disabilities. This will be followed by a treatment algorithm which ranges from conservative measures such as therapeutic modalities, orthotics and exercise, to an update in interventional procedures such as ultrasound guided corticosteroid injections, capsular distentions and neurolytic injections, among others.

Learning Objectives

  • Provide 'pearls' on how to assess musculoskeletal problems in the background of an underlying neurologically-based problem.
  • Understand how to perform a thorough history and physical exam for a specific musculoskeletal diagnosis. Examples are gathering pertinent history regarding ambulation methods (type of wheelchair) and performing a biomechanical deficit evaluation.
  • Present the most useful conservative treatment modalities to treat these diagnoses. Examples are taping techniques, electrical stimulation, orthotics, graded motor imagery, mirror visual feedback and exercise prescription.