materi npb
TRANSCRIPT
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KELAINANNYERI PUNGGUNG
BAWAHMedstudBlok XIV -Neurology
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Defnisi
• Perasaan nyeri di punggung bawah
(lumbosacral dan sacroiliacal) yang
disebabkan macam-macam stimulus
pada ruas-ruas collumna vertebra.
• Dapat menjalar ke tungkai sampai kaki!
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LBP
Bangunan peka nyeri tersebut adalah !igamentum spinal (!igamentumlongitudinalis post and ant)
"apsul sendi apophyse
Periosteum Dinding PD #adiks nervous $tot spasme %acet articuler cartilago !apisan synovia dari &acet Duramater
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. • De'sit neurologis progresi& • g BB dan B"• *addle anesthesia • +sia , tahun• !elaki dengan osteoporosis di&us atau &rakturkompresi
• #iwayat neoplasma/trauma• Nyeri tidak berkurang dg istirahat atauberbaring
• Disertai gejala lain demam0pe BB↓• *upresi imun0 riwayat penggunaan steroid• #iwayat pembedahan
Red Flgs dr! LBP "
Fraser, 2000
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Viserogenik
:
Vaskulogeni
k :
Neurogenik
:
Spondiloge
nik
Psikogenik
:
Proses
pato
1. ginjal
2. $rgan
pelvis
3. tumor
retroperit
oneal.
Proses
pato
aneurisma
atau
penyakit
vaskuler
peri&er
Proses
pato
pada sara&
Penyebab
1. neoplas
ma0
2. rakhnoi
ditis
proses
pato
kolumna
vertebralis
tulang
(osteogenik
)
5arang
ditegakkan
dg
menyingkirk
an
pnyebab
organik0 pp
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Pain Specifcs:
• Kualitas : tajam , tumpul , menembak ,membakar , dll
• Lkasi ! Distribusi : – "adikuler : distribusi dermatm , d#sest$esias
– %emancar : &ndermatmal• Seran'an:
– Berta$ap : DDD (pen#akit de'enerati) disc *
– +kut : Disc abnrmalit# , strain , )raktur kmpresi
• Kepara$an ! ntensitas Frekuensi : -nstant s
ntermittent• Laman#a
• Faktr : pemberat at perin'an
• Faktr /ime ) Da# : ika malam $ari ,
pertimban'kan mali'nanc
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Inspeksi Palpasi ROM Neuro TEST
symmetry -
Pelvic
$bli7uity
pelvic rotation0
leg length
discrepancy
!ordosis or
kyphosis
8uscle spasm
- prone
position
paraspinals0
piri&ormis
*pinous
process step-
o9
%orward
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Special /ests
• SL" and -rssed SL" (1ell Le' SL"*tests
• er /est (%alin'erin'*• Kerni' /est (indicates menin'eal
irritatin, rt inlement r duralirritatin*
• 3alsala %aneuer (increases intradiscalpressure*
• Femral Stretc$ /est (L2, L4 r L5
radiculpat$#* 6 nte F ti'$tness
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-linical /ests )r Sciatic /ensin
• Strai'$t le' raisin'(SL"* test
– Pain must bet#pical
– "adiate bel7knee
– 8ccur at eleatin
9 0;• Lase'ue test
• Sittin' kneee
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Special /ests Sacriliac int• Pelic "ck /est (anterir pressure n
+SS t ealuate S instabilit#*
• =illet /est (Strk /est* 6 S mbilit#
• =aenslen>s /est 6 psilateral Spat$l'#
• F+B?" (Patrick* /est 6 psilateral S
pat$l'#• Direct Palpatin ) S jint 6 #HE best
test@
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/es Lase'ue (Straight Leg Raising Test *
-ara : 6 dilakukan secara pasi) pada tun'kai
6 sendi lutut tetap lurus kemudian dilakukan Aeksipada sendi pan''ul
6(* : n#eri sepanjan' perjalanan n.iskiadikus
pada pen'an'katan tun'kai 9C0
E C0 : n#eri daera$ lumbal dan sakriliaka Prses patl'ik di sendi pan''ul atau kete'an'an tt
$amstrin' : n#eri nn radikuler
Knfrmasi : tes Bra'ard
tun'kai #an' diperiksa diturunkan 4 G H cm sampai n#eri
$ilan' kemudian didrsAeksikan akan timbul n#erikembali
I men#in'kirkan n#eri #an' berasal dari li'amen dan tt
(Karppinen 200J De# dkk., J2 %a'ee JM Finnesn, JMJ*
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Constant burning,stabbing, or deep achinggroin or leg pain
/reatment Strate'ies )r LBP
%sk7itN %. Curr Pain Headache Rep. 2004:JM6JM.
Clinical Presentation Possible Cause of LBP Treatment Strategies
Intermittent unilateral legpain, numbness,weakness radiating to
foot
Intermittent nerveentrapment with nerveroot inflammation
• Short-acting opioids
• NSAIs
• !opical analgesics
"ermanent nerve damage • #pioids
• !ric$clic antidepressants
• Anticonvulsants
• !opical analgesics
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nterentinal /reatment 8ptins
Neurl $lo%kde
selectie nere rt blcks
)acet jint blcks, medial branc$ blcks Neurolyt!% te%&'!(ues
radi)reOuenc# neurtmies
pulse radi )reOuenc# )t!*ultory te%&'!(ues
spinal crd stimulatin
perip$eral nere stimulatin I'trt&e%l *ed!%t!o' +u*+s
delier# int spinal crd and brain ia -SF
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P$#sical /reatment 8ptins
?