Radicular pain dan paresthesia

C6 akibat HNP Cervical

Oleh:
Sugijanto

HNP cervicalis
Constextual factors

Functioning and disability

Anatomic impairment

Disc
Rupture
annulus
Intability

Muscle
Guarding
spasm

Ischemic

Nucleus
nonjol dorsal

Nerves

Capsels
Autonom
system

Weakatrophy

Nocisensoric

Vascular

Tightness

Muscle
imbalance

External
factors

Motoric

Nerve root

Postural
tight

Pain

Internal
factors

Micro circular
constriction

Functional
impairment

Activity
limitation

Participation
restriction

Neuropathic
pain

Iriasi jar. dorsal

Hypomobility
Nyeri
sentral

Long period
sitting

Active
instability

Work
Driving

Nyeri
lateral

Pain
Nyeri
radicular

Flat neck
deformity

Sport
Recreation
Sugijanto, 2015

PEMERIKSAAN FISIOTERAPI YG
DIBUTUHKAN
Diutamakan pemilihan evidence untuk:
Pemeriksaan Cervical Posture
Cervical deviation; Flat neck

Pemeriksaan Discus Intervertebralis:

Spurlings test; Traction-distraction test;
Valsava maneouvre;

Pemeriksaan Nerve Root:

Dermatome test; Upper Limb Tension Test

Pemeriksaan Disabilitas
Sugijanto, 2015

PROSEDUR PEMERIKSAAN
Anamnesis:
Nyeri ngilu cervical hingga lengan dan paresthesia
sd tangan pd area dermatome
Posisi menunduk & grk fleksi cervical nyeri/
paresthesia meningkat ekstensi lebih nyaman
Observasi:
Flat neck atau deviasi
Tes orientasi:
Orientasi fleksi cervical nyeri, bila ditahan timbul
paresthesia lengan/tangan
Gerak eskensi 3 dimensi cervical nyeri leher,
interscapular dan paresthesia hingga
lengan/tangan
Sugijanto, 2015

PROSEDUR PEMERIKSAAN
Spurling test (test 1)
Tes kompresi saraf dgn step by step: 3Dextension
Tahapan:
1. Kompresi posisi netral
2. Kompresi posisi ekstensi
3. Kompresi posisi 3D ekstensi
Hasil
Test + nyeri timbul mulai dr leher dan
menyebar ke sisi dorsal bahu,
dorsolateral lengan atas, dan tangan
Sugijanto, 2015

PROSEDUR PEMERIKSAAN
Traction and distraction test
(test 2)
Pasien terlentang
Lakukan traction leher
Hasil:
Test + bila nyeri hilang oleh traksi
dan timbul saat dilepaskan
Sugijanto, 2015

PROSEDUR PEMERIKSAAN
Valsava manoeuvre (test 3)
Posisi terlentang, tutup hidung
Pasien meniup dgn mulut ditutup.
(a forced expiration meningkatkan
tekanan intraspinal).
Hasil:
Test + bila nyeri timbul pd lengan.
Sugijanto, 2015

Upper Limb Tension Test (ULTT)

Lateral fleksi-rotasi kontralateral,
diikuti gerakan bertahap sbb:
Depresi dr girdle
Abduksi bahu
Lateral rotasi bahu
Ekstensi siku
Supinasi lengan bawah
Ekstensi perg tangan
Ekstensi jari2
Hasil:
Test + bila muncul nyeri radiks.
Sugijanto, 2015

The neurological examination consists of testing

sensibility, strength and tendon reflexes.
Sensibility, compare left and right

Kennmuscles, compare left and right

C1: short neck flexors and extensors

C2: short neck flexors and extensors
C3: trapezius pars descendens
C4: trapezius pars descendens
C5: deltoideus, supraspinatus
C6: biceps, extensors wrist
C7: triceps,flexors wrist
C8: adductor pollicis, extensor pollicis
Th1: abductor digitiminimi
Manuele diagnostiek, A vd El, 2002

Sugijanto, 2015

Neurologisch
onderzoek
Tendon
reflexes
- Biceps reflex (C6). Bandingkan kanan-kiri
- Triceps reflex (C7), Bandingkan kanan-kiri
- Hasil:
Test + bila hiporefleksia arefleksi 1 atau
lebih
Babinski reflex, Bandingkan kanan-kiri

Sugijanto, 2015

INTERVENSI FISIOTERAPI YG
DIBUTUHKAN
MODALITAS DAN METODA
Anatomic Impairment target:
Disc: Intermittent traction in lordosis,
segmental mobilization /Natural
Apophyseal Glide in lordosis; Mc.
Kenzie extension exc.
Nerve: Neural mobilization, Nerve
gliding technique

Functional Impairment target:

Postural correction, stabilization exc.

Disability target:
Proper neck mechanic
Sugijanto, 2015

Prosedur Intervensi
1. Cervical oscillated traction in lordotic
position.
2. Natural apophyseal gliding technique
(Mulligan concept)
3. Mobilisasi nucleus grk segmental
extension
4. Mc. Kenzie Extension exc
5. Neural mobilization / nerve gliding
technique
6. Postural correction & proper neck
mechanic/ergonomic

Sugijanto, 2015

ALAT UKUR/EVALUASI FISIOTERAPI YG

DIBUTUHKAN

Pengukuran nyeri
Pengukuran Posture
Pengukuran ROM,
Pengukuran movement disfunction
Pengukuran disabilitas

Sugijanto, 2015