Pengantar Labskill PF
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Transcript of Pengantar Labskill PF
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Pengantar Keterampilan
Pemeriksaan Fisik
Sistem Muskuloskeletal
Dr Surya Darma SpPD
Bagian Penyakit Dalam
FK Unsri/RSMH Palembang
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Musculoskeletal system
Anatomy
Joint
Bone
Muscle
Soft tissue
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Musculoskeletal Presenting
Complaints
Pain
Stiffness
(subjective feeling or inability to move freely,stiffness that can be worn off suggest inflammation)
Swelling
Weakness Deformity
Non specific symptoms reflecting acute phase
response (fatigue, fever, disability)
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Anamnesis
Major complaints in chronological order
Pain e.g. onset, site, duration, severity, radiation,
character, diurnal variation, aggravating or relieving
factors Ask whether joint pain is recurrent, (involves the
same joint every time), episodic? fleeting (moves
from one joint to other)? Pattern of joint involvement e.g. single or multiple
joints, symmetric or asymmetric involvement, small
joints or large joints or both
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Anamnesis
Time relationships e.g. duration, frequency of
attacks
Other associated symptoms such as swelling,
stiffness (early morning) and deformity.
Past history
Family history
Social history
Drug history
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Differential diagnosis
of joint disorder
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pain
deformity
Bone
metabolic
infection
genetic
trauma
Anatomy Complaint Pathophysiology
neoplasma
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pain
weakness
deformity
Muscle
inflammation
repetative
infection
trauma
Anatomy Complaint Pathophysiology
ischemia
metabolic
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pain
swelling
deformity
Soft
tissue
inflammation
degenerative
infection
trauma
Anatomy Complaint Pathophysiology
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Physical examination
The GALS (Gait, Arms, Leg, Spine) system has been devised to
screen rapidly for musculoskeletal disease
Systematically inspects the patients gait, arms, legs, and spine,
first with the patient standing still and then responding toinstructions
Abnormalities detected on this screening are followed up with a
more detailed regional or generalized musculoskeletal
examination. REMS (Regional examination of musculoskeletal system)
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METODE REMS
(Regional Examination of Musculoskeletal System)
Mengucapkan salam, lalu pemeriksa berdiri,
melakukan jabat tangan dan memperkenalkan diri.
Menjelaskan prosedur , tujuan dan hasil
pemeriksaan yang akan didapatkan
Meminta izin kepada pasien untuk melakukan
pemeriksaan fisik. Mencuci tangan sebelum dan sesudah pemeriksaan
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Lihat (LOOK)
Scar
Bengkak (swelling)
Kemerahan (rash)
Atrofi otot
Raba (FEEL) Temperatur
Bengkak (swelling)
Nyeri pada perabaan (tenderness)
METODE REMS
(Regional Examination of Musculoskeletal System)
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Gerakan (MOVE)
Gerakan sendi secara aktif dan pasif
Tahanan ringan, sedang dan berat
Fungsi (FUNCTION)
Penilaian fungsi sendi
METODE REMS
(Regional Examination of Musculoskeletal System)
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Physical Examination of Joint
Pemeriksaan nyeri tekan
Four-point compression technique
Two-point compression technique
Two-thumb technique
Single thumb pressure technique
Four finger technique
Two fingger technique Pemeriksaan nyeri gerak
Fleksi-ekstensi pada LGS
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Physical Examination of Joint
Four-point compression technique
DIP, PIP, MCP dan thumb (IP, MCP articulation), MTP
dan IP joint of the great toe, Two-point compression technique
CMC 1st, IP joint
Two-thumb technique
Dorsal intercarpal joint, dorsal wrist joint, mid tarsaljoint, ankle joint
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Physical Examination of Joint
Single thumb pressure technique
Elbow, GH joint anterior, AC joint, SC joint
Two-finger technique
TMJ
Four-finger technique
Knee joint.
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Four-point technique
Four-point technique for testing DIP joint tenderness
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Two-point technique
Two-point technique for testing 1stCMC joint tenderness
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Two-thumb technique
Two-thumb technique for testing mid tarsal joint
tenderness
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Single-thumb technique
Elbow hal 200
Single thumb pressure technique for testing elbow joint
tenderness
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Two-finger technique
Two-finger technique for testing TMJ joint tenderness
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Four-finger technique
Four-finger technique for testing knee joint tenderness
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Goniometer
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Goniometer
A standard device for measuring angles
The body: the circular or semi-circular base
with degree markings Two arms :
stationary arm is fixed to the body
moving arm The moving arm is moved in concert with
the patients joint movement and points to
the readings on the goniometer body
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Measuring Shoulder Flexion
with a Goniometer
Normal ROM: 160-1800
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Measuring Shoulder Extension
with a Goniometer
Normal ROM: 50-600
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Measuring Shoulder External
rotation
Normal ROM: 80-900
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Measuring Shoulder Internal
Rotation
Normal ROM: 60-1000
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Measuring Knee Flexion with a
Goniometer
Normal ROM: 1350
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Use of goniometer to measure joint range of motion
Daftar Penyakit Sistem Muskuloskletal
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Daftar Penyakit Sistem Muskuloskletal
SKDI 2012No Daftar Penyakit Kompetensi
Tulang dan Sendi
1 Artritis, osteoarthritis 3A
2 Fraktur terbuka, tertutup 3B
3 Fraktur klavikula 3A
4 Fraktur patologis, 2
5 Fraktur dan dislokasi tulang belakang 2
6 Dislokasi pada sendi ekstremitas 2
7 Osteogenesis imperfekta 1
8 Ricketsia, osteomalasia 1
9 Osteoporosis 3A
10 Akondroplasia 1
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11 Displasia fibrosa 1
12 Tenosinovitis supuratif 3A
13 Tumor tulang primer, sekunder 2
14 Osteosarkoma 1
15 Sarcoma Ewing 116 Kista ganglion 2
17 Trauma sendi 3A
18 Kelainan bentuk tulang belakang
(skoliosis, kifosis, lordosis)
2
19 Spondilitis, spondilodisitis 2
20 Teratoma sakrokoksigeal 2
21 Spondilolistesis 1
Daftar Penyakit Sistem Muskuloskletal
SKDI 2012
Daftar Penyakit Sistem Muskuloskletal
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22 Spondilolisis 1
23 Lesi pada ligamentosa panggul 1
24 Displasia panggul 2
25 Nekrosis kaput femoris 1
26 Tendinitis Achilles 127 Ruptur tendon Achilles 3A
28 Lesi meniskus, medial, dan lateral 3A
29 Instabilitas sendi tumit 2
30 Malformasi kongenital (genovarum,
genovalgum, club foot, pes planus)
2
31 Claw foot, drop foot 2
32 Claw hand, drop hand 2
Daftar Penyakit Sistem Muskuloskletal
SKDI 2012
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Otot dan Jaringan Lunak
33 Ulkus pada tungkai 4A
34 Osteomielitis 3B
35 Rhabdomiosarkoma 1
36 Leiomioma, leiomiosarkoma, liposarkoma 1
37 Lipoma 4A
38 Fibromatosis, fibroma, fibrosarkoma 1
Daftar Penyakit Sistem Muskuloskletal
SKDI 2012
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Daftar Keterampilan Klinis
Sistem Muskuloskletal SKDI 2012
1 Inspeksi gait 4A2 Inspeksi tulang belakang saat berbaring 4A
3 Inspeksi tulang belakang saat bergerak 4A
4 Inspeksi tonus otot ekstremitas 4A
5 Inspeksi sendi ekstremitas 4A
6 Inspeksi postur tulang belakang dan pelvis 4A
7 Inspeksi posisi skapula 4A
8 Inspeksi fleksi dan ekstensi punggung 4A
9 Penilaian fleksi lumbal 4A
10 Panggul: penilaian fleksi dan ekstensi,
adduksi, abduksi dan rotasi
4A
11 Menilai atrofi otot 4A
12 Lutut: menilai ligamen krusiatus dan kolateral 4A
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13 Penilaian meniskus 4A
14 Kaki: inspeksi postur dan bentuk 4A
15 Kaki: penilaian fleksi dorsal/plantar, inversi dan eversi 4A
16 Palpation for tenderness 4A
17 Palpasi untuk mendeteksi nyeri diakibatkan tekanan
vertikal
4A
18 Palpasi tendon dan sendi 4A
19 Palpasi tulang belakang, sendi sakro-iliaka dan otot-ototpunggung
4A
20 Percussion for tenderness 4A
21 Penilaian range of motion (ROM) sendi 4A
22 Menetapkan ROM kepala 4A
23 Tes fungsi otot dan sendi bahu 4A
24 Tes fungsi sendi pergelangan tangan, metacarpal, dan
jari-jari tangan
4A
25 Pengukuran panjang ekstremitas bawah 4A
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Terapetik
26 Reposisi fraktur tertutup 3
27 Stabilisasi fraktur (tanpa gips) 4A
28 Reduksi dislokasi 3
29 Melakukan dressing (sling, bandage) 4A
30 Nail bed cauterization 2
31 Aspirasi sendi 2
32 Mengobati ulkus tungkai 4A
33 Removal of splinter 3
Daftar Keterampilan Klinis Sistem
Muskuloskletal SKDI 2012
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QUESTIONS
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A, Proximal interphalangeal joints.
B, Metacarpophalangeal joints.
C, Radiocarpal groove and wrist.
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Orthopaedic Surgery
To improve the well-being of humankind who suffer fromorthopedic conditions
Examples abound:
Joint replacement of major and non major joints, ligamentreconstruction
effective trauma care
correction of deformities in children
surgical treatment of musculoskeletal oncologic conditions
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