Pengantar Labskill PF

8/10/2019 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


ischemia

metabolic


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pain

swelling

deformity

Soft

tissue

inflammation

degenerative

infection

trauma



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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



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Gerakan (MOVE)

Gerakan sendi secara aktif dan pasif

Tahanan ringan, sedang dan berat

Fungsi (FUNCTION)

Penilaian fungsi sendi

METODE REMS



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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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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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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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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


SKDI 2012



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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


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


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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Documents

Pengantar Labskill PF