Dr. Andreas (Muskulo) Kelainan Sistem Gerak Atas & Bawah

8/21/2019 Dr. Andreas (Muskulo) Kelainan Sistem Gerak Atas & Bawah

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Dr. Andreas Siagian, SpOT

Kelainan SistemGerak



Tabel KIPDI (Kurikulum Induk Pendidikan DokterIndonesia)

MataPelaaran

(MP)

Tuuan Instruksi!mum (TI!)

Tuuan perilakuk"usus (TPK)

TingkatKemampu

an

#entukPengalaman

#elaar

KelainanSistemGerak Atas$ #a%a"

&. Mema"ami'ara'arapemeriksaansendi pangguldan sendi alatgerak ba%a"

&.& Menelaskanpengertianalgus, arus,re'uratum, torsie*uinos planus

P+ K DK K

&.- Melakukanpemeriksaanlingkup geraksendi (range omotion) denganbenar $sistematis

P+ K DK K

-. Mema"amikelainan danpen/akit padaanggota alatgerak ba%a"

-.& Mengeta"uibeberapapen/akit dankelainan padapanggul $ gerakba%a" (+pen/akit)

0& K DK K

-.- Menelaskan 0- K DK K



Terminology

• Torsi

• Valgus

•

Varus• Recurvatum

• Planus



•

Version: normal twisting of long bone on itsanatomic longitudinal axis

• Torsion: Abnormal / deformity, version beyond

(+or!" #$

• Reference axis: a line %oining designated bonylandmar&s at t'e end of a long bone

• Anteversion: t'e rox ref axis is lat twistedrelative to t'e distal ()retroversion(

Terminology



Reference axis



*n ligamentous laxity

notelatidening -f &nee %oints

*n .lount angulation at

medtib meta'ysis



*n coxa vara ,angulation at t'e

nec& s'aft level

*n cong Pseudart'rosis of

tibia,t'e angulation is in t'edistal⅓



)ray

• years and older

• 0etting worse

• Abnormal site of

angulation• 1arge 'ysis and

ei'ysis

• 2istory 3 taruma,

infection, ossible metalintoxication(lead or 4oride!

5eta'ysial/dia'ysial angle 6 789



4inding

• P'ysis, t'ic& and frayed

in ric&ets

•

*n

'ysiologicgenu varum no

intrinsic bone disease,gentle curve, medialcortices t'ic&ening,

'oriontal %oit lines of t'e&nee ; an&le are tiltedmedially



<noc& <nees / 0enu

Valgum• 1egs are bowed

inwards in t'e

standing osition.owing occurs ator around t'e&nee -n standing

wit' &neestoget'er, t'e feetare far aart



=ormal $eveloment

5ost c'ildren are >bowlegged? from birt'until around years old, t'en become >&noc&

&need? until age @ to , and straig'tentowards adult alignment by age B to C



*nvestigations 7

• 5easurement of intermalleolar distance iedistance between two malleoli w'en t'e&nees are gently touc'ing wit' legs inadduction

• D to and a 'alf inc'es (E centimeters!wit' c'ild lying down is accetable

• CF of c'ildren aged " @ years 'avesome degree of intermalleolar searation



• *ntermalleolar searation under inc'es is normal at any age

• Periodic observation andmeasurement if less t'an inc'es

• *f G inc'es, need AP )Ray wit'bot' legs on same Hlm for &needeformity, 'i and an&le %oints andview of bot' long bones

*nvestigations"



*ndicators of #erious$isease

• Pronouncedasymmetry

• #'ort stature

• -t'er s&eletalabnormalities

• *ntermalleolar

searation greatert'an inc'es



• Age G C wit' &noc& &nee

• Dnilateral roblem ie Asymmetry oflegs

• *ntermalleolar distance G inc'es(E cms!

• Associated symtoms eg Pain, 1im

'en to refer



• #urgical otions:

–

5edial ei'yseal staling at 7I to 77years

– Jorrective osteotomy at maturity

Treatment



4AT 4OOT

Klat foot(Pes Planus!Absent or deressedlongitudinal arc'

Pes Planovalgus:associated 'indfoot

eversion, forefootabd and everted



T/pes

•

Klexible $evelomental 3 t'e

most common 2yermobile (ligamentous

'yerlaxityL M'lers$onlos,5arfan, $ownNNN!

=eurogenic( rare andusually cause t'e reversePesJavus!

• Rigid, very rare

Jongenital (Tarsalcoalition,Vertical talus!

AOuired ! in4ammatory!



P'ysiologic 4at foot is =-R5A1 u to B years ( t'efoot fat ad s'rin&s and ligaments become taut!

*f t'ere is ain loo& for ot'er at'ologic conditions

Koot ort'oses 3 not a ttt but relief strain, imrovegait attern,even s'oe wear, may revent

structural tarsal deformities#urgery very rare, not before 7" years

5anagement



5ela&u&an emeri&saan ling&ugera& sendi (range of motion!

dengan benar ; sistematis

Dr. Andreas (Muskulo) Kelainan Sistem Gerak Atas & Bawah

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