assessment manual terapi cervical spine
TRANSCRIPT
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ASSESSMENT MANUAL TERAPI ASSESSMENT MANUAL TERAPI CERVICAL SPINECERVICAL SPINE
OlehSugijanto
Disampaikan pada: Kuliah MK Manualterapi III 2008
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TUJUAN INSTRUKSIONAL
Mahasiswa memahami assessment ManualterapiCervical spine dgn cara:
Mampu menjelaskan proses assessment melaluisekuensis untuk menentukan diagnosisMampu memperagakan assessment Cervical spine Mampu merinci tentang temuan assessment dihubungkan dengan struktur jaringan spesifik, patologidan gangguan NMSVM.Mampu menghubungkan temuan assessment dengan diagnosis manualterapi, prognosis dan target hasil
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PERTANYAAN STUDI
Sebutkan Sistematika assessment manualterapi umumsecara sekuensisUraikan dan praktekkan anamnesis yang tepat padaCervical spine .Uraikan dan praktekkan inspeksi serta jelaskankemungkinan temuan lokal maupun quadrantUraikan dan praktekkan Quick test pada Cervical spine .Uraikan dan praktekkan Tes pasif pada Cervical spine .Uraikan dan praktekkan Tes isometrik pada Cervical spine .
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Uraikan dan praktekkan palpasi pada: RegiocervicalUraikan tes dan praktekkan Joint play movement pada sendi cervical spineUraikan dan praktekkan tes panjang otot Regiocervical Jelaskan diagnosis manualterapi pada Cervical spine .Jelaskan tentang Capsular pattern; Non Capsular pattern, Hypermobility; Instability, Muscle tightness/contracture dan Nerve entrapment
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ASSESSMENTASSESSMENT•• ANAMNESIS ANAMNESIS →→ R/R/sementarasementara•• INSPECTION QUADRANT INSPECTION QUADRANT →→ R/R/sementarasementara•• QUICK TEST QUADRANTQUICK TEST QUADRANT→→ R/R/sementarasementara•• PEMERIKSAAN FUNGSI GERAK DASARPEMERIKSAAN FUNGSI GERAK DASAR
–– Active Active →→ R/R/sementarasementara–– Passive Passive →→ R/R/sementarasementara
–– Isometric Isometric →→ R/R/sementarasementara
•• PEMERIKSAAN KHUSUS PEMERIKSAAN KHUSUS →→ R/R/sementarasementara•• DATA DATA medik/kesehatanmedik/kesehatan lain lain →→
R/R/sementarasementara•• KESIMPULAN AKHIR KESIMPULAN AKHIR →→ R/ R/ sbgsbg diagnosis diagnosis
manualterapimanualterapi
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ANAMNESISANAMNESIS
•• KeluhanKeluhan nyerinyeri, , dipilahdipilah ::–– JenisJenis nyerinyeri pegalpegal, , linulinu, , ngilungilu, , nyerinyeri tajamtajam, , nyerinyeri
berdenyutberdenyut dlldll–– DistribusiDistribusi nyerinyeri: : perkiraanperkiraan segmentasisegmentasi dermatomdermatom, ,
nervinalnervinal zone, vegetative zone.zone, vegetative zone.–– ProvokasiProvokasi dandan peringananperinganan nyerinyeri: : oleholeh posisiposisi, , gerakgerak, ,
hubunganhubungan dgndgn waktuwaktu. . –– AnalisisAnalisis neuroneuro--musculomusculo--sceletalsceletal--vegetativevegetative
mechanism.mechanism.
•• KeluhanKeluhan gangguangangguan mobilitasmobilitas::–– Kaku/terbatasKaku/terbatas: : satusatu atauatau beberapabeberapa araharah, , –– NyeriNyeri gerakgerak dandan pd ROM pd ROM tertentutertentu–– KelemahanKelemahan otototot penggerakpenggerak–– AnalisisAnalisis quadrantquadrant
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NYERINYERIPseudoradicularPseudoradicular pain:pain:•• InflamasiInflamasi jar. jar. lunaklunak facets (arthritis) facets (arthritis) •• InflamasiInflamasi kronikkronik jar. jar. otototot ((myofascialmyofascial pain, pain, myositismyositis, ,
myofibrosismyofibrosis))•• InflamasiInflamasi jar. ligament jar. ligament dlmdlm spine (spine (liglig longitlongit
posterior/anterior)posterior/anterior)RadicularRadicular dandan neural painneural pain•• InflamasiInflamasi jar. jar. srbtsrbt sarafsaraf periferperifer pd radix (pd radix (radicularradicular pain = pain =
dermatomaldermatomal zone)zone)•• InflamasiInflamasi jar. jar. srbtsrbt sarafsaraf periferperifer (neural pain (neural pain →→
neuropraxianeuropraxia, neuritis/a, neuritis/aksonotmesis ksonotmesis ––neurotmesis = neurotmesis = nervinal zonenervinal zone))
•• InflamasiInflamasi jar. jar. duramaterduramater (neural pain = bilateral)(neural pain = bilateral)Nyeri rujukanNyeri rujukan•• Nyeri viscera terasa pd bag badan segmen yg samaNyeri viscera terasa pd bag badan segmen yg sama
Nyeri jantung = T1Nyeri jantung = T1--5, Hati/intestin = T65, Hati/intestin = T6--12, 12, •• Sering lokalisasi kaburSering lokalisasi kabur•• Dipilahkan: Kompresi pd radix dgn nyeri rujukan pd organ Dipilahkan: Kompresi pd radix dgn nyeri rujukan pd organ
dalamdalam
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Nyeri pd lesi Med Sp Nyeri pd lesi Med Sp & Batang otak& Batang otak
• Lesi pd tract spinothalamikus/rgs neuronal paroksismal
• Nyeri membakar pd ½ badan kontralateral lesi
• Lesi pd tabes – nyeri visceral hebat• Nyeri n.V (trigeminal neuralgia)
/glosopharingeal: nyeri kilat repetitif• Lesi thalamik – nyeri difus + hiperpatia
(“nyeri thalamik ”)
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NyeriNyeri rujukanrujukan
Bisa berasal dr berbagai organ/jar. interna.
Bila pemeriksaan gerak dasar dan tes khusus pd alat gerak negatif → dr organ interna
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ASSESSMENT QUICK TESTASSESSMENT QUICK TEST
•• TMJ DEPRESSI TMJ DEPRESSI -- ELEVASI ELEVASI •• PerhatikanPerhatikan aluralur gerakgerak: C/L/S, : C/L/S,
ritmeritme gerakgerak: painful arc/ : painful arc/ terbatasterbatas/ / crepitasicrepitasi ..
•• Disc/Capsular Joint/Muscular.Disc/Capsular Joint/Muscular.•• PatologiPatologi TMJ TMJ nyerinyeri
pseudoradikulerpseudoradikuler kepalakepala –– wajahwajahsp sp leherleher..
•• BilaBila gejalagejala samasama dgndgn keluhannyakeluhannya→→ patologipatologi berasalberasal drdr TMJTMJ.
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ASSESSMENT ASSESSMENT POSTUREPOSTURECERVICAL A.P & PCERVICAL A.P & P--AA
•• DEVIASI LATERAL: DEVIASI LATERAL: KompresiKompresisatusatu sisisisi facet facet dandanuncovertebraleuncovertebrale ipsilatipsilat..
•• TORSI: TORSI: PemendekanPemendekan jar jar lunaklunakdandan otototot sub sub occypitaloccypital
•• GABUNGAN: Scoliosis.GABUNGAN: Scoliosis.•• POSISI PUNDAK, TORAKAL: POSISI PUNDAK, TORAKAL:
Upper Upper trapeziustrapezius, , levatorlevatorscapulaescapulae
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ASSESSMENT PORTURE ASSESSMENT PORTURE CERVICAL LAT KI &KA CERVICAL LAT KI &KA
• ANTERIOR POSITION: Sub occypital tissue tight/contracture; bebanbesar pd cervicothoracal
• HIPER LORDOSE CERVICALIS Iritasi facet mid cervical, erector spine tight/ contracture
• FLAT NECK: disc problem• KYPHOSIS: disc/corpus probl
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ASSESMENT QUICK ASSESMENT QUICK TESTTEST
QUICK TEST CERVICALQUICK TEST CERVICALFleksiFleksi--ekstensiekstensi cervical cervical dandan 3 3 DimensiDimensiekstensiekstensi cervicalcervical
PerhatikanPerhatikan::Rhythm: Painful arc? Flexion pain? Disc Rhythm: Painful arc? Flexion pain? Disc problemproblemExtension pain? Extension pain? CrepitationCrepitation? ? ArthrosisArthrosisKlikKlik (hyper mobile (hyper mobile -- unstable)unstable)BilaBila keluhankeluhan ygyg munculmuncul samasama dgndgn →→patologipatologi berasalberasal drdr Cervical.Cervical.
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QUICK TEST: SHOULDER
Gerak: Abduksi-Elevasi ShoulderScapulohumeral rhythm
Reverse scapulohumeral rhythm contracture glenohumeral joint
Pinfu arc? suprahumeralpathologyScapular crepitation myofascialscapulothoracal
Keterlibatan sendi2 dlm shoulder complex
Bila Keluhan yg muncul sama → patologiberasal dr Shoulder complex.
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PFGD PASIFPFGD PASIFFLEKSI: ROM End feel: elasticFLEKSI: ROM End feel: elastic
KompresiKompresi pilarpilar anterior, anterior, reganganregangan jar. posterior jar. posterior pilarpilar --sub sub occypitaloccypital--extensor muscle. extensor muscle.
NyeriNyeri radicularradicular: : iritasiiritasi radix, radix, nyerinyeri menyebarmenyebar bilateral: bilateral: stenosisstenosis, , nyerinyeri interscapularinterscapular: muscle tightness.: muscle tightness.
EKSTENSI: ROM End feel: hardEKSTENSI: ROM End feel: hardKompresiKompresi pilarpilar posterior, posterior, reganganregangan otototot suprahyoidsuprahyoid, , liglig. . longitudinalelongitudinale anterioranterior
NyeriNyeri occyputoccyput: C0: C0--C1C1
NyeriNyeri lokal/menyebarlokal/menyebar keke girdlegirdle--lenganlengan-- interscapularinterscapular: : arthrosisarthrosis
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PFGD PASIFPFGD PASIFFLEKSI LATERAL KI FLEKSI LATERAL KI -- KAKA
–– Springy Springy efef.: m. Upper .: m. Upper trapeziustrapezius
kontrakontra lat (lat (psspss lenganlengan luruslurus))
–– Springy Springy efef M. M. LevatorLevator scapulae scapulae
kontrakontra lat (lat (psspss lenganlengan abdabd))
–– NyeriNyeri neckneck--shoulder: shoulder: UncinateUncinate joint joint
ipsiipsi latlat
ROTASI KI ROTASI KI -- KAKA
–– Firm e f.: Firm e f.: capsulocapsulo--ligamentairligamentair
contracturecontracture
–– Springy e f: muscle Springy e f: muscle tigthnesstigthness
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PFGD ISOMETRIKPFGD ISOMETRIK
DilakukanDilakukan dlmdlm stretched position.stretched position.
UntukUntuk group muscles. group muscles. NyeriNyeri / / tegangtegang::
EkstensorEkstensor: erector spine muscles: erector spine muscles
RotasiRotasi: Rotator muscles: Rotator muscles
Lateral Lateral fleksifleksi: Lateral flexor muscles: Lateral flexor muscles
RotasiRotasi: : hatihati--hatihati vertebrovertebro basilerbasilerinsufficiency insufficiency
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PFG ISOMETRIKPFG ISOMETRIK
• UNTUK MYOTOME–C1-2 Neck flexion–C3 – Neck side flexion–C4 Shoulder elevation–C5 Shoulder abduction–C6 Elbow flexion & wrist extension–C7 Elbow extension & wrist flexion–C8 Thumb extension & ulnar
deviation–T1 Hand intrinsic
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ISOMETRIC TEST
SHOULDER ABDUCTIONPosisi MLPP: lengan bawah abd,Hati2 kompresi bursa subdeltoidPatologi tendinitis m. supraspinatus
SHOULDER INTERNAL ROTATIONPosisi MLPP: lengan bawah internal rotation,Patologi tendinitis m. sbscapularis
SHOULDER EXTERNAL ROTATIONPosisi MLPP: lengan bawah external rotation,M. infraspinatus
ELBOW FLEXIONPosisi siku fleksi 900 , siku flexion Tendinitis long head Biceps m.
Dilakukan bila tes shoulder positif
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TEST KHUSUSTEST KHUSUSPALPASI PALPASI POSTERIORPOSTERIOR
SpinousSpinous proc. Cproc. C2,6,72,6,7, C, C33--44--55Proc Proc transversustransversus
TemporoTemporo mandibularmandibularjointjointTrapeziusTrapezius m.m.
PALPASIPALPASI ANTERIORANTERIORCarotisCarotis tub tub --> > StelateStelate glngln
SternocleidoSternocleido mastoid mmastoid mSupra Supra clavicularclavicular fossafossa
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SPESIFIC TEST SPESIFIC TEST PALPATIONPALPATIONM. SUPRASPINATUSM. SUPRASPINATUS
PosisiPosisi AddAdd--Internal rot Internal rot penuhpenuhtangantangan belakangbelakang punggungpunggung..PalpasiPalpasi ventrocaudalventrocaudal acromionacromion, , araharah lateromediallateromedial..LokasiLokasi tendoperiostealtendoperiosteal; tendon.; tendon.
M. INFRASPINATUSM. INFRASPINATUSPosisiPosisi SphynxSphynx, horizontal Add , horizontal Add --external rot.external rot.PalpasiPalpasi tuberculumtuberculum minus minus araharahcraniocranio--caudal.caudal.
M. SUBSCAPULARISM. SUBSCAPULARISPosisiPosisi netralnetral sedikitsedikit external external rotasirotasiPalpasiPalpasi medial medial tuberculumtuberculum minus minus sambilsambil gerakgerak externalexternal--internal rotinternal rot
TENDON M. BICEPS CAPUT TENDON M. BICEPS CAPUT LONGUMLONGUM
PosisiPosisi netralnetral sedikitsedikit external external rotasirotasiPalpasiPalpasi sulcussulcus bicipitalisbicipitalis sambilsambilgerakgerak externalexternal--internal rotinternal rot
BURSA SUBDELTOIDEABURSA SUBDELTOIDEAPosisiPosisi extensionextensionPalpasiPalpasi ventrocaudalventrocaudalacromionacromion diatasdiatas tuberculumtuberculummayusmayus humerihumeri..
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TEST KHUSUSTEST KHUSUS
TRAKSI DAN KOMPRESI TRAKSI DAN KOMPRESI CERVICALCERVICALKOMPRESI POSISI NETRAL: KOMPRESI POSISI NETRAL: BilateralBilateral
KOMPRESI POSISI SPESIFIK KOMPRESI POSISI SPESIFIK UnilateralUnilateral
FleksiFleksi: Disc : Disc dandan corpus.corpus.
EkstensiEkstensi: Facets,: Facets,
Lateral Lateral fleksifleksi: : UncovertebralUncovertebral
BilaBila positifpositif: : TraksiTraksi araharahberlawananberlawanan. .
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TEST KHUSUS TEST KHUSUS Segmental CSegmental COO--CC11
Self test: Active Flexion Self test: Active Flexion seluruhseluruhcervical: cervical: GerakGerak FleksiFleksi--ekstensiekstensi kepalakepalaPasifPasif: : TranslasiTranslasi OccyputOccyput kekedorsocranialdorsocranial
Segmental CSegmental C11--CC22
Self test: Active Flexion Self test: Active Flexion seluruhseluruh
cervical cervical dandan ekstensiekstensi kepalakepala, , gerakgerak
rotasirotasi kepalakepala..
PasifPasif: : PosisiPosisi CPP, CPP, kepalakepala ekstensiekstensi, ,
RotasiRotasi melaluimelalui proc. proc. TransversusTransversus CC11
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Test Test khususkhusus LOWER CERVICALLOWER CERVICAL
Segmental Segmental Lat.flexionLat.flexion testtest: :
CC22--33, C, C33--44, C, C44--55, C, C55--66, C, C66--77 dandan
CC77--ThTh11. .
TekananTekanan proc proc transversustransversus
kontralatkontralat gerakgerak ipsilatipsilat
Gapping Gapping uncinateuncinate joint joint dandanfacet facet kontralateralkontralateral
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TEST KHUSUSTEST KHUSUSP.A.C.V.P TESTP.A.C.V.P TEST CC22 sdsd.. CC77
ProvokasiProvokasi segmental segmental
HanyaHanya untukuntuk testes
SEGMENTAL GAPPING TESTSEGMENTAL GAPPING TEST
Segment Segment tertentutertentu
RotasiRotasi ipsilatipsilat, , fleksifleksi lat lat kontralatkontralat
dandan fleksifleksi
PerhatikanPerhatikan: pain, (range), : pain, (range), dandan
end feel.end feel.
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TEST KHUSUSTEST KHUSUS
UPPER THORACAL VERT:UPPER THORACAL VERT:PACVPPACVP
Bilateral facet gapping test Bilateral facet gapping test
Test Test hiperalgesiahiperalgesia segmentalsegmental
LPAVPLPAVP
Unilateral facet gapping testUnilateral facet gapping test
CatatCatat: : NyeriNyeri, range , range dandan end feel. end feel. Firm end feel Firm end feel indikasiindikasi hypomobilityhypomobility..
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TEST KHUSUSTEST KHUSUS
11STST COSTAECOSTAEScalenusScalenus syndromesyndrome
Pd Pd scalenusscalenus spasm spasm dptdpt sublukasiosublukasio
CostoCosto VertebralVertebral--Transversal JointTransversal JointMobilizarionMobilizarion test test costovertcostovert dandan gapping gapping test test costotransversalcostotransversal
NyreiNyrei dandan firm end feel firm end feel indikasiindikasi adanyaadanyaHypomobilityHypomobility
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TEST KHUSUSTEST KHUSUSMUSCLE LENGTH TESTMUSCLE LENGTH TEST
Contract relax stretch testContract relax stretch test
Upper cervical ms.Upper cervical ms.
DominanDominan otototot--otototot sub sub occypitaloccypital →→
springy end feel.springy end feel.
JugaJuga terjaditerjadi translasitranslasi posterior Cposterior C00--CC1 1
→→ firm firm indikasiindikasi hypomobilityhypomobility..
Pd forward head positionPd forward head position
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TEST KHUSUSTEST KHUSUS
MUSCLE LENGTH TESTMUSCLE LENGTH TEST
Contract relax stretch testContract relax stretch test
UPPER TRAPEZIUS MUPPER TRAPEZIUS M
FleksiFleksi lateral cervical lateral cervical kontralatkontralat, ,
depresidepresi girdle girdle ipsilatipsilat
LEVATOR SCAPULAR MLEVATOR SCAPULAR M
PosisiPosisi dandan pelaksanaanpelaksanaan sptspt Upper Upper
trapeziustrapezius m. m. tangantangan belakangbelakang kepalakepala
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MUSCLE LENGTH TESTMUSCLE LENGTH TEST
SCALENUS MSCALENUS M
Contract relax stretch testContract relax stretch test
Cervical Cervical fleksifleksi lateral lateral
kontralatkontralat, , CostaICostaI depresidepresi
dandan rotasirotasi kepalakepala
PerhatikanPerhatikan bilabila clicking clicking
costacosta II
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MUSCLE LENGTH TESTMUSCLE LENGTH TESTContract relax stretch testContract relax stretch test
PECTORALIS MAYOR M. PECTORALIS MAYOR M. PosisiPosisi glenohumeralglenohumeral Abduction Abduction --horizontal abduction.horizontal abduction.Expiration Expiration dandan horizontal horizontal abdabd..
PECTORALIS MINOR M. PECTORALIS MINOR M. PosisiPosisi girdle retractiongirdle retractionExpiration Expiration dandan girdle retractiongirdle retraction
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DATA MEDIK LAINDATA MEDIK LAIN
• X Ray AP, MRI, CT SCAN, ATHROSCOPY.
• Data dr Orthopaedi, bedah, bedahrahang, internist, dll
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DIAGNOSISDIAGNOSIS
GangguanGangguan neuroneuro--musculoskeletalmusculoskeletal--vegetative mechanism vegetative mechanism atauatau gerakgerakdandan fungsifungsi ::Pada Struktur jaringan spesifik : Pada Struktur jaringan spesifik : PenyebabPenyebab PatologiPatologi ::
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ContohContoh diagnosisdiagnosis
Capsular pattern/Capsular pattern/HypomobilityHypomobility lower lower cervical joint sec. cervical joint sec. spondylospondylo arthrosisarthrosisCervical flexion limited sec. sub Cervical flexion limited sec. sub occypitaloccypitalmuscle tightness/ contracturemuscle tightness/ contractureNeck and arm pain sec. C3Neck and arm pain sec. C3--4 disc bulging4 disc bulgingUpper cervical pain sec unstable C1Upper cervical pain sec unstable C1--22Neck and arm pain sec Neck and arm pain sec multifidusmultifidus myofascialmyofascialpainpain
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PROGAMMING
Penetapan target,Program intervensi jangkapendek - jangka panjangPersetujuan klienMetoda dan teknikintervensiDosis pengobatan.Kriteria pengukuran
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KONTRA INDIKASI
Acute cervical disc herniation.Vascular vertigo akibatVertebrobasiler insufficiency. Osteoporotic atau tendensi fraktur.Ankylosing spondylitis.Inflamatory processes.Post traumatic hypermobility.Tumor dan metastasis
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Terima kasih atasperhatiannya
See you to the next session