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Dr. Andreas Siagian, SpOT
Kelainan SistemGerak
8/21/2019 Dr. Andreas (Muskulo) Kelainan Sistem Gerak Atas & Bawah
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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
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Terminology
• Torsi
• Valgus
•
Varus• Recurvatum
• Planus
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•
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
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Reference axis
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*n ligamentous laxity
notelatidening -f &nee %oints
*n .lount angulation at
medtib meta'ysis
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*n coxa vara ,angulation at t'e
nec& s'aft level
*n cong Pseudart'rosis of
tibia,t'e angulation is in t'edistal⅓
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)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
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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
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<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
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=ormal $eveloment
5ost c'ildren are >bowlegged? from birt'until around years old, t'en become >&noc&
&need? until age @ to , and straig'tentowards adult alignment by age B to C
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*nvestigations 7
• 5easurement of intermalleolar distance iedistance between two malleoli w'en t'e&nees are gently touc'ing wit' legs inadduction
• D to and a 'alf inc'es (E centimeters!wit' c'ild lying down is accetable
• CF of c'ildren aged " @ years 'avesome degree of intermalleolar searation
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• *ntermalleolar searation under inc'es is normal at any age
• Periodic observation andmeasurement if less t'an inc'es
• *f G inc'es, need AP )Ray wit'bot' legs on same Hlm for &needeformity, 'i and an&le %oints andview of bot' long bones
*nvestigations"
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*ndicators of #erious$isease
• Pronouncedasymmetry
• #'ort stature
• -t'er s&eletalabnormalities
• *ntermalleolar
searation greatert'an inc'es
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• 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
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• #urgical otions:
–
5edial ei'yseal staling at 7I to 77years
– Jorrective osteotomy at maturity
Treatment
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4AT 4OOT
Klat foot(Pes Planus!Absent or deressedlongitudinal arc'
Pes Planovalgus:associated 'indfoot
eversion, forefootabd and everted
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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!
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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
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5ela&u&an emeri&saan ling&ugera& sendi (range of motion!
dengan benar ; sistematis
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