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50: SCLERODERMA

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • CREST syndrome

  • Localized scleroderma

  • Systemic sclerosis

ICD-9-CM CODES

  • 701.0 Circumscribed scleroderma

  • 710.1 Systemic sclerosis

  • Associated physical therapy diagnoses

    • 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

ICD-10-CM CODES

  • L94.0 Localized scleroderma [morphea]

  • L94.3 Sclerodactyly

  • M34.0 Progressive systemic sclerosis

  • M34.1 CR(E)ST syndrome

  • M34.9 Systemic sclerosis, unspecified

PREFERRED PRACTICE PATTERNS

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissues Dysfunction1

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation2

  • 7B: Impaired Integumentary Integrity Associated with Superficial Skin Involvement3

  • 7E: Impaired Integumentary Integrity Associated With Skin Involvement Extending Into Fascia, Muscle, or Bone, and Scar Formation4

FIGURE 50-1

Scleroderma: claw-like hand deformity and shiny, tight skin. It can be linked with myocardial fibrosis. (From Fuster V, Walsh RA, Harrington RA. Hurst’s The Heart. 13th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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PATIENT PRESENTATION

A 40-year-old female who is a CrossFit competitor, is referred to OP PT with low back pain and generalized stiffness. While you are conducting the initial interview, you notice that her hands are getting mottled and her fingers red. She constantly rubs her fingers and periodically scratches her forearms and face. She has had some recent weight loss without dieting, and is happy about it, but not that her legs look skinnier. Upon questioning, she does describe that she is eating less because of intermittent heartburn not necessarily relieved with antacids. Observation reveals some red spots on her face, which she states have appeared over the past year or so.

KEY FEATURES

Description

  • 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 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, ...

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