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  • Systemic sclerosis
  • Localized scleroderma
  • CREST syndrome

  • 701.0 Circumscribed scleroderma
  • 710.1 Systemic sclerosis

  • 315.4 Developmental coordination disorder
  • 718.03 Articular cartilage disorder, forearm
  • 718.04 Articular cartilage disorder, hand
  • 718.07 Articular cartilage disorder, ankle and foot
  • 718.45 Contracture of joint, pelvic region and thigh
  • 719.39 Palindromic rheumatism involving multiple sites
  • 719.4 Pain in joint
  • 719.70 Difficulty in walking
  • 728.2 Muscular wasting and disuse atrophy
  • 728.89 Other disorders of muscle, ligament, and fascia
  • 729.1 Myalgia and myositis, unspecified
  • 729.9 Other disorders of soft tissue
  • 736.9 Acquired deformity of limb
  • 780.7 Malaise and fatigue
  • 781.2 Abnormality of gait
  • 782.3 Edema
  • 786.0 Dyspnea and respiratory abnormalities
  • 786.05 Shortness of breath

  • L94.0 Localized scleroderma [morphea]
  • L94.3 Sclerodactyly
  • M34.0 Progressive systemic sclerosis
  • M34.1 CR(E)ST syndrome
  • M34.9 Systemic sclerosis, unspecified


  • Autoimmune skin disorder
  • Chronic, commonly progressive connective tissue disease considered an autoimmune rheumatic disease
  • Skin hardening
  • Intense fibrosis
  • Finger sensitivity to cold
  • Decreased sweating
  • Multiple body system involvement
  • Onset often vague, misdiagnoses common

Essentials of Diagnosis

  • Etiology unknown
  • Systemic scleroderma
    • Prolonged history of Raynaud’s phenomenon before presenting with swollen fingers, heartburn, shortness of breath
  • Localized scleroderma
    • Morphea: oval-shaped skin patches with purplish borders that may fade over time
    • Linear scleroderma: bands of hardened skin on extremities or forehead, usually on one side of body

General Considerations

  • May result in secondary problems indicating need for PT intervention depending on severity: aerobic capacity and muscle endurance impairment, sarcopenia, weakness, musculoskeletal problems, neuromuscular problems, weight loss
  • Because scleroderma frequently refers or causes pain in various body areas, individuals may be inappropriately referred to PT, such as when referred to low back, upper back, chest
  • History of heartburn or indigestion may be related to scleroderma or may indicate GI or cardiac problem
  • Individuals with scleroderma have twice the incidence of breast and bronchoalveolar cancer than rest of population


  • Females-to-male ratio: 7:1
  • Systemic scleroderma more common in adults; localized scleroderma most common in children
  • Between 2 and 20 cases per million people
  • Can affect individuals of any age; most frequent onset between 25 to 55 years of age, average onset in 40s
  • Decreased incidence after age 60 years
  • Some indication of genetic familial tendency
  • More common in Caucasians
  • More severe in African and Native Americans

Signs and Symptoms

  • Raynaud’s phenomenon
  • Gastroesophageal reflux disease (GERD)
  • Skin changes: change in color or thickening (sclerodactyly) usually on ...

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