Ischialgia Traumatik

Oleh:
dr. Athira
Pembimbing:
dr. I Made Dwi Jayantara, Sp.S
PROGRAM INTERNSHIP DOKTER
INDONESIA
RSUD RATU ZALECHA KAB. BANJAR,
MARTAPURA
PROVINSI KALIMANTAN SELATAN

Definisi dan Etiologi

Ischialgia :

rasa nyeri menjalar sepanjang

perjalanan n. Ischiadicus dan
kedua cabangnya yaitu nervus
peroneus & nervus tibialis
Trauma

Cedera fisik
( lakalantas-jatuh- sport injuryiatrogenik dll )

Hip dislocation
Trauma to low back/buttock, injection site

trauma
Trauma to sciatic nerve
Vertebral fracture, hip fracture, pelvic
fracture, femur fracture
Muscle injury including: hematoma, strain,
tear

Trauma pada n peroneus lebih sering

dikarenakan vaskularisasi dan jaringan

pelindung yang lebih sedikit
level gluteus : Injeksi IM, fraktur pelvis,
dislokasi sendi panggul, post op pelvis,
piriformis muscle entrapment
level femur : Luka tembak, luka tusuk,
fraktur/dislokasi femur

Mekanisme
Trauma

menyebabkan
saraf, terputus, hancur,
terkompresi atau
teregang.
Fraktur kompresi,
spondilestesis
penekanan tulang ke saraf
Trauma tumpul
reaksi
inflamasi ligamen,
tendon,otot
konstriksi lorong
keluarnya saraf

Diagnosis
Anamnesis
Nyeri/ parestesia unilateral
Spasme otot/ Kelemahan
Komplikasi neurologis ? Gangguan
defekasi/miksi
Riwayat trauma : Onset ? mekanisme?
Progresifitas?
Riwayat operasi/ tindakan medis lain

Pemeriksaan Fisik
Inspeksi :
Vulnus ? Hematom ?
Alignment spinal ( posterior/ lateral), pelvis, ekstrimitas
inferior ? Deformitas?
Palpasi :
Krepitasi
Spasme otot
Nyeri tekan
Pain: Use VAS to assess sciatica during exam, and
compare to its best and worst
Range of motion (ROM): Nilai ROM aktif pasif
thoracolumbar, Ekstrimitas bawah (forward flexion, lateral
flexion, rotation,and extension).

Reflexes: Assess bilateral patellar and

Achilles tendon reflexes and compare sides

for symmetry.
Sensation: Assess pressure, temperature,
sharp/dull, and sensation to light touch in
distribution of sciatic nerve.
Strength: Assess for weakness in the
involved leg using manual muscle testing
(MMT) and compare to unaffected side.
Lasegue Tes

Pemeriksaan Penunjang
1. Foto polos
2. mylogram
3. MRI
4. CT scan
5. Elektromyografi

Red flags include cauda equina symptoms

(e.g., loss of bowel and bladder control,

saddle anesthesia of the perineum,
bilateral lower extremity
pain/numbness/weakness).Patients with
these symptoms should be referred
immediately to emergency medicine to rule
out cauda equina
Other red flags that indicate prompt
referral to emergency medicine are
worsening symptoms, hyperalgesic
sciatica, and sciatica with severe motor
deficits that might represent more severe

Tatalaksana
Penatalaksanaan

1. Obat-obatan: analgetik, NSAID, muscle

relaxan, dsb.
2. Program Rehabilitasi Medik.
3. Operasi: dilakukan pada kasus yang
berat/ sangat mengganggu aktifitas dimana
dengan obat-obatan dan program
rehabilitasi Medik tidak dapat membantu.

Terimakasih