2.d etiologi swelling?

1. Decreased colloid osmotic pressure. When plasma proteins are in the blood thinning, inward
strength decreases, which allows inward movement network. This results in accumulation of fluid in
the tissue with a decrease central plasma volume. The kidneys respond to decreased circulation
volume through activation of the aldosterone-renin-angiotensin system, which results additional
reabsorption of sodium and water. Intravascular volume increases while. However, because the
deficiency of plasma proteins has not been repaired, the decline Colloidal osmotic pressure remains
low in proportion to hydrostatic pressure capillary. As a result intravascular fluid moves into the
tissue, worsening edema and circulation status.

2. Increased capillary hydrostatic pressure. The most common causes of increased capillary pressure
is congestive heart failure where improvement Systemic venous pressure combined with increased
blood volume. This manifestation is characteristic for right ventricular failure, or failure right heart. If
this pressure exceeds 30mm, pulmonary edema occurs. Cause Another increase in hydrostatic
pressure is kidney failure with increase total blood volume, increased gravity due to long standing,
venous circulation damage, and liver obstruction. Usually venous obstruction cause local edema
rather than general edema because only one vein or affected group of veins.

3. Increased capillary permeability. Direct damage to blood vessels, such as burn trauma, can cause an
increase permeability of endothelium relationships. Local edema can occur in response against
allergens, such as bee stings. In certain individuals, this allergen can trigger an anaphylactic response
with extensive edema caused by histamine type reaction. Inflammation causes hyperemia and
vasodilation, which causing accumulation of fluids, proteins, and cells in the affected area. This
resulting in swelling of the associated edema (exudation) area.

4. Lymphatic obstruction. The most common causes of lymphatic obstruction is surgical removal of
lymph nodes and blood vessels for prevent the spread of malignancy. Radiation therapy, trauma,
metastatic malignancy, and inflammation can also cause extensive obstruction of blood vessels.
Lymphatic obstruction results in retention of excess fluid and plasma protein in interstitial fluid.
When proteins accumulate in the interstitial space, more water moves into the area. Edema is usually
local.

5. Excess body water and sodium. In congestive heart failure, bulk the heart decreases when the
strength of the contraction decreases. To compensate, an increase in the amount of aldosterone causes
the reaction of sodium and water. Volume plasma increases, as does intervascular capillary venous
pressure. The heart This failure is not able to pump up this venous return, and fluid forced into the
interstitial.

(Referensi: Price, Sylvia A. 2003. Patofisiologi Volume II Edisi 6. Jakarta: EGC)

1.d. clasification of pain?

1. Acute Pain and Chronic Pain

Acute pain occurs due to acute tissue damage and does not last long. While chronic pain, continues
even though the lesion has healed. Some use a 3-month time limit as pain chronic. To distinguish
acute pain and chronic chronic pain. Pain intensity can be assessed by using Visual Analog Scale
(VAS). This scale is easy to use for examiners, efficient and easier for patients to understand.
Classification based Pain intensity assessed by the Visual Analog Scale (VAS) is number 0 means no
pain and 10 means the most pain intensity weight.

Based on VAS, the pain is divided into: 14

a. Mild pain with VAS values: <4 (1-3).

b. Moderate pain with VAS values: (4 -7).

c. Severe pain with VAS values:> 7 (8-10).

2. Nociceptive Pain and Neuropathic Pain

Pathophysiological pain can be divided into nociceptive and neuropathic pain. Nociceptive pain is the
inflammation pain produced by chemical, mechanical and temperature stimuli that cause activation
and sensitization to peripheral nociceptors (nerves responsible) against pain stimuli). Nociceptive pain
usually responds against opioid or non-opioid analgesics. Neuropathic pain is a result of pain neural
damage to the peripheral nerves and the central nervous system includes central and peripheral
afferent nerve pathways, usually described with a burning and piercing feeling. Patients who
experience pain neuropathic often responds poorly to analgesics opioid.

(sumber: Meliala L, Suryamiharja A,Purba JS. 2001. Nyeri neuropatik: patofisiologi dan
penatalaksanaan. Yogyakarta:Medikagama Press)

1.b jenis gerakan ekstremitas superior??

Movement in the joint is divided into osteokinetics and arthrokinematics.

1. Osteokinetic movements are movements in the bones, which are the movements represented
by changes in the articular angle and voluntary. This movement consists of flexion, extension,
abduction, adduction, internal rotation, and rotation external.

 Flexion

Is a bending movement between one bone to another, causing both parts to approach. Usually occurs
on the surface anterior bone (except in the knee)

 Extensions

It is a straightening / removing one bone movement with one other. This movement is usually used to
restore body parts to the anatomical position after being bent. Hypertension is a continuation from
anatomically outside capabilities.

 Abduction and Adduction

Abduction is the movement away from the midline of the body, being adducted is the movement
towards the center line. Shoulder and hip joints can perform abduction and adduction movements. On
the middle finger on the hand and feet, the reference point for this movement is the second finger.

 Horizontal and horizontal adduction

Shoulder movements that cannot occur in anatomical positions. Shoulders should flex or abduct 90 °
so that the arm is parallel to the shoulder (and upright straight with the ground). From this position,
the shoulder movement back is horizontal abduction, and forward shoulder movement is adduction
horizontally.

 Radial and ulnar deviation

Radial deviation is a term used to refer to abduction the wrist when the hand moves laterally, or
toward the side of the thumb. Ulnar deviation is a term used to refer to adduction wrist. When the
hand moves medially in position anatomically or toward the little finger, the movement is deviation
ulnar.

 Circumduction

It is a circular motion; combination of flexion movements, abduction, extension and adduction

 Internal and external rotation

Rotation is the movement of bones around the longitudinal axis. Rotation internal (medial rotation)
occurs when the anterior surface performs rotation inward towards the center line. External rotation
(lateral rotation) occurs when the anterior surface rotates outward, away from diameter.

2. Arthrokinematic movements are movements that occur on the joint surface, his movements cannot
be seen, and cannot be controlled. This movement an accessory movement. Arthrokinematic
movements consist of movements:

 Rolling

Rolling motion between one joint surface and another.

 Gliding

The linear movement of joints that are parallel to the surface of the joint plane close together

 Spinning

Is a rotating / rotating motion with fixed moving joints with other surfaces so that it remains in touch
at the same point. Movement in the joints is partly a combination of the three movements that.

(sumber: Lippert, LS. Clinical Kinesiology and Anatomy, 5 ed Phildelphia PA: F.A.
Davis,2011:8-36)

6. how to diagnosis?

1. anamnesis

Main complain, Jojo complain of pain and inability to move his right shoulder since 2 hours ago.

Additional complain, Jojo complains that he cant move his right shoulder and sustains his ached arm
with his left hand.

2. Physiscal examination
General appearance:
Respiratory Rate: Takipnue
Pulse Rate: Takikardi
VAS: Moderate Pain
3. Spesific Examination
Hematome (+)
Tenderness (+)
Right shoulder skins was tense if palpated
Move: painif the right shoulder was moved (+)
ROM: shoulder joints range of motion was undetermined due to the pain
Radialis artery pulsation was palpable
4. Radiological Examination
Dislocation articulatio glenohumeral