HUMERUS FRACTURE

Coba di isi ya
 Capsular pattern – PASCA
IMMOBILISASI
Trauma

Frakture

Non operatif/gips Pemasangan ORIF

Perhatikan
Imobilisasi : median n
Fracture,
Capsel-
lesion,
capsular pattern contracture,
Osteogen
Muscle-
blockade,
weakness
Myositis
Passive: terbatas oscificans
elastic-firm end feel
X ray: Posisi?
J P M: terbatas konsulidasi?
elastic-firm end feel Sugijanto, 2015
 HUMERUS FRACTURE INTERNAL
FIXATION
Functioning and Contextual
disability factor
Anatomic impairment Internal External
factor factor
Shoulder joint Elbow joint NERVE

Capsels Muscle Joint surface May Entrapment

Fracture Motori Sensoric

Contractur Weak- c deficit deficit
Atroph Functional
e Osteogen
y impairment
block Activity
Tightness-
contracted limitation
Participation
Capsular Strength and restriction
pattern /non endurance

ADL Work
Hyomobility
Hand Sport
activity
Pain Recreation
Sugijanto, 2015
PEMERIKSAAN FISIOTERAPI YG
DIBUTUHKAN
Diutamakan pemilihan evidence untuk:
 Pemeriksaan Capsels
◦ Shoulder joint passive test: External rot
< Abduct < Internal rot with elastic end
feel.
◦ Elbow Joint Passive test : Flexion <
Extention; Pronation = supination with
elastic end feel.
◦ Joint Play Movement Test: Traction at end
range position  elastic end feel

Sugijanto, 2015
 Pemeriksaan Otot stabilisator:
◦ Isometric test pd MLPP
◦ Contract relax stretch test
 Pemeriksaan saraf tepi:
◦ Sensoric test pd nervinal area
◦ Motoric: Kenn muscle
◦ Nerve tension/adhesion: Upper
Limb Tension Test
Sugijanto, 2015
 Process of Manualtherapy for Capsel
impairment
Pasif: fleksi
lebih terbatas
dari ekstensi
 capsular
pattern elastic-
Nyeri & gerak firm Bila
Fleksi-ekstensi negatif  Bila Capsular
terbatas ganti positif contracture
JPM test: Nyeri, hipotesis
lain
elastic-firm

Sugijanto, 2015
INTERVENSI FISIOTERAPI YG
DIBUTUHKAN
 MODALITAS DAN METODA
◦ Anatomic Impairment target:
 US / SWD contra planar tepat utk
capsel yg tegang
 Joint mobilization utk peregangan
capsul sendi bahu/siku
◦ Functional Impairment target:
 Latihan mobilisasi sendi
 Latihan stabilisasi sendi
◦ Disability target

Sugijanto, 2015
Art. cubiti
 Humeroulnar joint
 Humeroradial joint
 Radioulnar joint

Couple movements by
extension and flexion: Sugijanto, 2015
Pro- en supination
Fexion + Supination
Extension + pronation

In pronation: couple
movements
 The radius make an
adduction
 The ulna make an
abduction.
Ketika ektensi siku terjadi gerak
traksi radius ke arah distal

Sugijanto, 2015
Elbow Joint Capsular Pattern

 Tes fungsi
◦ Nyeri dan terbatas pada gerak
fleksi, ekstensi siku, dan pronasi,
supinasi lengan bawah dalam
capsular pattern.

Sugijanto, 2015
TES KHUSUS
JPM test:
 Traksi pada pembatasan ROM timbul
nyeri dan keterbatasan ROM dgn
elastic-firm end feel.
 Translasi pada pembatasan ROM timbul
nyeri dan keterbatasan ROM denngan
firm end feel.
Pain free grip strength test
Kekuatan menggenggam pada posisi
netral dan posisi translasi medial
Sugijanto, 2015
INTERVENSION
 Capsels: Joint mobilization,
◦ Humero ulnar:
 Gerak fleksi-ekstensi traksi 450 dorsodistal
 Gerak valgus-varus glige berlawanan arah
◦ Humero radial:
 Traksi distal
 Valgus + traksi distal
 Muscle:
◦ Pain free grip strengthening exc
 Active exercise

Sugijanto, 2015
Roll-glide movements humero-ulnar joint &
humeroradial joint.

Sugijanto, 2014
ALAT UKUR/EVALUASI
FISIOTERAPI YG DIBUTUHKAN
 Pengukuran nyeri
 Pengukuran fleksibilitas/ekstensibilitas
otot
 Pengukuran ROM,
 Pengukuran movement disfunction
 Pengukuran disabilitas

Sugijanto, 2015