PROSES PENGELOLAAN

FISIOTERAPI ANGGOTA
GERAK ATAS DAN BAWAH

Sugijanto
MK Proses fisioterapi
Pertemuan 7

Sugijanto 2022
 Tahapan Proses pelayanan
1. HISTORY TAKING Fisioterapi anggota gerak

2. INSPEKSI
3. REGIONAL SCREENING
& QUICK TEST

4. REVIEW OF SYSTEM
& RED FLAG

5. ASSESSMENT EVIDENCE
BASE CLINICAL PRACTICE
6. DIAGNOSIS AND
FUNCTIONAL PROGNOSIS

7. PLANNING

8. INTERVENTION
9. EVALUATION

10. DOCUMENTATION
Sugijanto, 2022
 SHOULDER DISABILITY AKIBAT IDIOPHATIC
FROZEN SHOULDER
FUNCTIONING, AND DISABILITY Constextual factors

Anatomic impairment
Internal External
GH Capsels Muscle Nerves factors factors

AC Capsels Autonom
Nocisensoric
system
Chronic Cuff ms
inflamation tightness Hyperalgesia Vascular

Inter fiber Scapulo thoracal Sympathic

adhesion muscle weakness hyperactivity Participation
Functional Activity restriction
Contracture, anterior limitation
- inferior capsel most Micro circular impairment
contracted constriction
Work
Stretched Muscle Activity with
Capsular
pain imbalance mobility/ADL Sport
pattern
Driving
Pain Recreation

Hypomobility
Sugijanto 2022
 Algoritma pemeriksaan Frozen shoulder
Anamnesis utk Klien dengan keluhan nyeri bahu- Ha: Frozen shoulder
menegakkan ICD lengan atas dan kaku bahu, Usia >
50 tahun, tidak jelas sebabnya Ganti hipotesis
tdk
Ya

Tampak gerak scapula lebih Ganti hipotesis

Inspeksi besar dari humerus tdk

Ya

Pada tes abduksi elevasi terlihat reverse Pemeriksaan red flag:

humeroscapular rhythm, gerak rotasi Pancoast tumor, Cervical
Tes 0rientasi tdk
eksternal bahu sangat terbatas instability/disc lesion, dll

Ya
FROZEN SHOULDER

H1: CAPSuLeS H2: MUSCLE H3: Girdle joint H4: Cervicothoracic

Ya junction
Ya Ya
Passive test: External rotation < Resisted Isometric test: Nyeri? Acronioclavicular Sternoclavicula
abduction < internal rotation r
Ya
Ya Passive test
Palpasi: Tonus tinggi/nyeri Passive test
Elastic end feel
Ya Ya
Tes khusus Ya
Ya
Contract relax stretch test: Joint play movement test: Joint play movement test:
Joint play movement test:
traksi pd akhir ROM nyeri

Ya Lentur setelah Tetap tegang

contraksi? setelah kontraksi
Nyeri dan Elastic end feel Capsular
Capsular
Diagnosis hypomobility
CAPSULAR PATTERN HYPOMOBILITY MUSCLE CONTRACTED MUSCLE SPASM hypomobility
Sugijanto 2021
 RESUME PEMERIKSAAN FISIOTERAPI PADA
FROZEN SHOULDER
Case History Inspection Regional Review of Specific test in Supporting PT
taking screening & system & red EBCP test Diagnosis
quick test flag
Idiopath Usia lanjut, Posisi Cervical flexion- Musculoskeleta Passive test: ‘X’ ray: (+) Shoulder
ic frozen Nyeri dan normal. extension-3D l capsular pattern MRI pain and
shoulde kaku bahu Kadang extension (-) Neuromuscular dgn end feel: disability
r dan asimetri Upper thoracic elastic-firm sec frozen
gerakterb Cardiovascular shoulder
spine LPAVP, Joint play
atas PACVP (-) Gall bladder movement test:
kesemua Indocrine nyeri, range
arah Shoulder abduct
elevation (+) Red flag turun, end feel:
reverse HSR. elastic-firm
Fracture (-)
Qt: Pada abduksi ACJ mobility
Angina (-)
elevasi test: terbatas,
Pancoast firm
ditemukan
Cancer (-)
reverse Scapular
humeroscapular mobility test
rhythm terbatas.
External rot
paling terbatas Sugijanto, 2022
 Competency base
approach
Frozen shoulder

Glenohumeral Shoulder arm

Capsular pattern Muscles Shoulder girdle disability
hypomobility
Humerus anterior-
superior glide
Joint Weakness Scapular position
mobilization mobilization
Functional activity
Muscle Acromioclavicular and participation
Tightness
strengthening joint mobilization education

Muscle 1. Static inferior traction-

1. Traksi osilasi pd endurance
MLPP posterior glide
2. Traksi end range 2. MWM ininferior- posterior
position Active Muscle glide correction
3. Roll glide stabilization exc Stretching

Functional
training Sugijanto 2022
 CLINICAL PATHWAY FROZEN SHOULDER
No Problem Assessment Intervensi Alat ukur/ Kondisi yg Jumlah
fisioterapi evaluasi diharap kedatangan
Glenohumeral Inspeksi dan palpasi: SWD/US, Nyeri: VAS, Nyeri Tahap pain
joint Capsular Antero posisi GHJ Scapulothoracal NRS, kurang, & freeze 3x
pattern GH joint passive test: mobilization, McGill’s Q ROM (3x/mgg)
hypomobility External rot < GHJ oscillated mob. ROM: meningkat dan 4x
sec. to Abduct < Internal In MLPP, end range Goniomet (2x/mgg)
Idiopathic rot with elastic-firm joint mobilization, er Tanpa Tahap
frozenshoulder end feel. MWM Outcome: nyeri, ROM thawing 6-
Joint Play CTJ mobilization, SPADI, & fungsi 8x (2x/mgg)
Movement Test: Nelson’s traction DASH pulih Tahap
traksi end renge and active frozen: 6-8x
position Nyeri, mobilization exc (2x/mgg)
elastic-firm end
feel
Scapulo thoracic
passive test
CTJ passive & JPM
test
Sugijanto 2022
 Nyeri bahu
CLINICAL Impingement syndrome
REASONING
Contextual
Fungsi dan disabilitas
factors
Internal External
Anatomic impairment factors factors
SLAP
Cuff muscle
Lesion
AC Bursa Functional
Joint subacromial Pectoralis minor,
Capsule/ Participation
levator scapulae impairment
lig laxity restriction
osteophyte Serratus anterior
Activity
Inflamation- Tightness limitation
Supraspinatus GH
calc formation
Instability
Weaknes
Subscapularis, s Over head
infraspinatus, Internal Work
impingement
activity
Inflamation Scapular
dyskinesis Carrying Sport
Inflamation
Tight- Lifting Recreation
hypertrophy

External The used of

impingement arm in ADL
Shoulder pain
Sugijanto 2022
Nyeri bahu dan lengan impingement syndrome
Ha: Shoulder Keluhan nyeri area deltoid,
terutama angkat lengan, crepitasi. Ganti hipotesis
Impingement syndrome
tdk
Ya
Pada tes abduksi elevasi tampak Ganti hipotesis
paiful arc humeroscapular rhythm, tdk
Ya
•Jobe’s test;
•Neer test Pemeriksaan red flag:
H5-7 Penyebab • Hawkin Kennedy test Pancoast tumor, Cervical
impingement •Isometric resisted external rot. tdk instability/disc lesion, dll

EXTERNAL SHOULDER IMPINGEMENT

Glenohumeral INTERNAL SHOULDER IMPINGEMENT
H1: Superior capsel
instability

H1: Supraspinatus H2: Subacromial

H3: Infraspinatus H4: Subscapularis H8: SLAP lesion
Traksi caudal: no pain bursa
and No sulcus sign Abdominal press
Empty can test, External rot
Neer-Hawkin test, Internal rot
Abduksi isometric isometric,
test, Crepitasi isometric, palpasi
dan Palpasi posisi Palpasi posisi
dan palpasi posisi netral
borgol sphynx
Superior capsule posisi ekstensi
contracture penyebab
impingement Tendinitis Subacromial Tendinitis Tendinitis
supraspinatus akibat bursitis akibat infraspinatus akibat subscapularis
impimgement impimgement impimgement impimgement

Scapulothoracal
dyskinetic

Scapular tiping Scapular shrugging Scapular winging

Sugijanto 2022
 RESUME PEMERIKSAAN FISIOTERAPI PADA
SHOULDER IMPINGEMENT SYNDROME
Case History Inspection Regional Review of Specific test in Supporting PT
taking screening & system & red EBCP test Diagnosis
quick test flag
Shoulder Nyeri Posisi Cervical flexion- Musculoskeleta 3 atau lebih Musculoskel Shoulder
external bahu normal. extension-3D l quick test (+) etal USG pain and
impingem pada Kadang extension (-) Neuromuscular Alignment test MRI disability
ent posisi asimetri Upper thoracic sec
syndrome tengah Cardiovascular Inferior traction external
spine LPAVP, Apprehension
(mid PACVP (-) Gall bladder impingem
ROM) test ent
Shpulder abduct Indocrine
dan Relocation test syndrome
elevation (+) Red flag
gerak Cuff muscle:
tertentu painful arc. Fracture (-)
Qt: 2 dari tes (+) Isometric abd +
Angina (-) palpasi borgol
Neer test,
Pancoast Isom. external
Jobe’s test, Cancer (-) rot + palpasi
Hawkin-Kennedy sphynx
test,
Isom, internal rot
External rotation + palpasi netral
again resisted Sugijanto, 2022
 Shoulder External Competency base
impingement approach

Penyebab Akibat
impingement impingement

Subacromial GH
space sempit Instability (a) Tendinitis
Scapular Supraspinatus
Bursitis (b) Tendinitis
dyskinesis
subacromial Subscapularis,
(c) infraspinatus,
1. Traksi statik ke caudal 1. Anteroposition:
2. Roll glide Abd + rotasi Strenghtening /MWM in
eksternal/ internal posterocaudal correction 1. Transverse friction
pss ekstensi 1. Transverse friction
3. Mobilization under 2. Instability: Glenohumeral pss (a) borgol/ (b)
caudal traction functional stabilization exc 2. Traksi statik ke
caudal netral/ (c) sphynx
3. Mobilization under 2. Contract relax
caudal traction stretching
1. Tipping: pectoralis
minor stretching
2. Shrugging: levator
scapula
1. Edukasi proper
stretcjhing
hand activity
3. Winging: Serratus
2. Stretching
anterior strength
3. Stabilization
exc
1. Edukasi: Postural correction
2. Joint stabilization exc
Sugijanto 2022
 CLINICAL PATHWAY SHOULDER IMPINGEMENT SYNDROME
No Problem Assessment Intervensi Alat ukur/ Kondisi yg Jumlah
fisioterapi evaluasi diharap kedatangan
Nyeri dan Pemeriksaan US/SWD Nyeri diukur Nyeri Ringan: 3x/
disabilitas bahu Impingement (positif subacromial, traksi – dgn VAS/ berukrang mgg, 1 sesi
akibat external minimal 3): translasi static NRS tiap
impingement Painful arc caudal, Mobilisasi Painful arc: kunjungan Sedang: : 3x/
syndrome Jobe’s test saat caudal goniometer mgg, 2 sesi
Neer test traction, MWM Disabilitas: Fungsi normal
Hawkin Kennedy test SPADI/ <2-4 mgg Berat: : 2x/
External rotation DASH/ mgg, 4 sesi
isometric test
+subacromial Bursa subacromial mobilization under
bursitis Neer & Hawkin test caudal traction,
+supraspinatus Palpasi pisisi ekstensi Contract relax
tendinitis M Supraspinatus stretching
Jobe’s/Empty can test
Isometric Abd pada
MLPP
Palpation posisi borgol

Sugijanto 2022
 HUMERUS FRACTURE INTERNAL FIXATION
Functioning and disability Contextual
factor
Anatomic impairment Internal External
factor factor
Shoulder joint Elbow joint NERVE

Capsels Muscle Joint surface May Entrapment

Fracture Motoric Sensoric

Contractur Weak- deficit deficit
Atrophy Functional
e Osteogen
impairment
block Activity
Tightness-
contracted limitatio
Participation
n
Capsular Strength and restriction
pattern /non endurance

Work
ADL
Hyomobility
Hand Sport
activity
Recreation
Pain
Sugijanto 2022
 Nyeri dan kaku sendi siku
Anamnesis utk Imobilisasi pasca cidera dan
menegakkan ICD patah tulang,
Ha: Contraktur
Ya pasca Fraktur
Ada keterbatasan ROM sendi
siku dlm pola fleksi < ekstensi Ganti hipotesis
Tdk
Ya

Posisi sendi: dislokasi? Patologi serius/

INSPEKSI Oedeme? Red flag?
Tdk
Ya
Tes Cepat: nyeri dan gerak
terbatas, (Fleksi < ekstensi,
Supinasi ~ Pronasi)
PEMERIKSAAN Test Gerak Pasif: Nyeri & Muskular? ALGORITMA PEMERIKSAAN
terbatas (Fleksi < ekstensi,
FUNGSI GERAK
Supinasi ~ Pronasi dengan Elastic
Tdk FISIOTERAPI PADA
- Firm End Feel)? CAPSULAR PATTERN
Ya Isometric test dan HYPOMOBILITY SENDI SIKU
palpasi
Joint Play Movement (Terbatas AKIBAT FRAKTUR HUMERUS
TEST KHUSUS Elastic - Firm End Feel) DISTAL
Penunjang: X-Ray

CAPSULAR PATTERN HYPOMOBILITY SIKU

DIAGNOSIS AKIBAT HUMERUS FRACTURE

Problem: Contracture pasca

fraktur humeri
Body structure impairment
Body function impairmen
Disabilitas Sugijanto 2022
 RESUME PEMERIKSAAN FISIOTERAPI PADA PASCA
FRAKTUR HUMERI
Case History Inspection Regional screening Review of Specific test in Supporting Diagnosis
taking & quick test system & EBCP test fisioterapi
red flag
Pain, Post operatif Luka Cervical flex-ext-3D Musculoskel Passive test: ‘X’ ray: (+) Pain,
Hypomob reduction. operasi extension (-) etal Shoulder/elbow capsular
ility and Keterbatasan Posisi Upper thoracic Neuromusc capsular hypomobilit
disability ROM sendi bahu spine LPAVP, ular pattern dgn y of the
sec to Bahu &/atau add-int rot PACVP (-) end feel: shoulder/
post siku dlm pola Cardiovasc elastic-firm elbow post
atau siku Shoulder abduct ular
humerus bahu: ext posisi fleksi operative
fracture rot< abd< int elevation (+) Indocrine reduction
rot atau siku reverse HSR. Joint play humerus
Red flag movement test:
leksi < Elbow Flex < ext fracture
ekstensi Fracture (-) nyeri, range
Qt: Pada abduksi turun, end feel:
elevasi ditemukan Angina (-)
elastic-firm
reverse Pancoast
humeroscapular Cancer (-) Disability
rhythm questionair (+)
External rot paling
terbatas
Elbow Flex < ext pro
∞ supin Sugijanto, 2022
 Shoulder/elbow contracture
posi humerus fracture

Shoulder
Elbow

Shoulder Glenohumeral Neck-Shoulder - Muscles

girdle Joint Joint girdle muscles Elbow joint (Lower arm /
radioulnar joint

1. Superio-anteroposition: traksi
1. Traksi statik ke 450 Contracture /
inferior-posterior Contracture /
ventrocaudal adhesion/
Strenghtening /MWM in adhesion/
2. Mobilization under weakness
posterocaudal correction weakness
2. Instability: Glenohumeral caudal traction
functional stabilization exc 3. caudal traction
1. Muscle static
Contracture / stretching
1. Traksi statik ke caudal adhesion/
2. Roll glide Abd + rotasi 1. Muscle static stretching 2. Contract relax
weakness stretching
eksternal/ internal 2. Contract relax stretching
3. Mobilization under 3. Muscle mobilization 3. Functional exercise
caudal traction 4. Strengthening/
stabilization exc
1. Edukasi: Joint
mobilization
2. Joint stabilization exc
1. Edukasi: Postural correction 3. Functonal exc
2. Joint stabilization exc
Sugijanto 2022
 Clinical pathway
No Problem Assessment Intervensi Jumlah Kondisi yang
fisioterapi kedatangan diharap
5 Glenohumeral Shoulder joint SWD/US, Tahap awal Nyeri kurang,
joint Capsular passive test: Scapulothoracal 3x (3x/mgg) ROM ningkat
pattern External rot < mobilization, GHJ dan 4x
hypomobility Abduct < Internal oscillated mob. In (2x/mgg)
post fracture rot with elastic MLPP, end range
end feel. joint mobilization, Tahap lanjut Tanpa nyeri,
Joint Play MWM and active 6x (2x/mgg) ROM & fungsi
Movement Test mobilization exc pulih
Elbow joint Elbow Joint US, Humeroulnar Tahap awal Nyeri kurang,
capsula Passive test : joint-humeroradial 3x (3x/mgg) ROM ningkat
pattern Flexion < joint-radioulnar joint dan 4x
hypomobility Extention; oscillated mob. in (2x/mgg)
Pronation = MLPP, end range
supination with joint mobilization, Tahap kronik Tanpa nyeri,
elastic end feel MWM and active 6x (2x/mgg) ROM & fungsi
Joint Play mobilization exc pulih
Movement Test
Sugijanto 2022
 tennis elbow tipe II

Functioning, and disability Constextual factors

Anatomic impairment

Muscle Capsels-Lig Internal factors External factors

Upper extremity ms
Capsular contracted
Extensor carpi- Elbow fault lig. Collateral
radialis brevis Alignment mediale/-laterale
Valgus Varus
Functional
impairment Activity
Repetitive injury limitation
Participation
Tendoperiosteal Movement restriction
inflammation disfunction Grip/dexterity

Adhesion Work

ADL Spor
Nyeri siku
t
Recreation
Hipomobility
Sugijanto 2022
 Nyeri siku sisi lateral
Anamnesis utk Nyeri saat menjinjing beban,
menegakkan ICD Nyeri kurang saat istirahat

Ya Ha: Tennis elbow

Nyeri pada epicondylus lateralis Ganti hipotesis

Ya Tdk

Inspeksi Posisi sendi: netral? Oedeme? Patologi serius/

Tdk Red flag?
Ya ALGORITMA PEMERIKSAAN
Tes orientasi: Nyeri gerak fleksi- FISIOTERAPI PADA
Tes gerak ekstensi siku Lig. Collateral
Test Gerak isometik dorsal fleksi lateral?
NYERI SIKU LATERAL AKIBAT
tangan: Nyeri sisi lateral siku Tdk TENNIS ELBOW
Ya
Varus test
•Mill’s test nyeri
Tes khusus •Palpasi epicondylus lateralis
• Pain free grip strength testnyeri
Penunjang: X-Ray
osteophete?

DIAGNOSIS NYERI SIKU LATERAL AKIBAT

TENNIS ELBOW

Problem: Nyeri akibat tennis

elbow
Body structure impairment:
Body function impaitmen:
Disabilitas

Sugijanto 2022
 RESUME PEMERIKSAAN FISIOTERAPI PADA
TENNIS ELBOW TIPE 2
Case History Inspection Regional Review of Specific test in Supporting PT
taking screening & system & red EBCP test Diagnosis
quick test flag
Nyeri Akibat Tidak Cervical flexion- Musculoskeletal Palpasi tipe: ‘X’ ray: (+) Nyeri siku
lateral main tampak extension-3D Neuromuscular I.periosteal EC MRI dan
siku tennis kelainan extension (-) disabilitas
akibat lama, spesifik Indocrine lengan
Upper thoracic
tennis ocer spine LPAVP, Red flag bawah
albow trainng, PACVP (-) Fracture (-) akibat
ganti tennis
Shoulder abduct Angina (-)
raket. elbow
elevation (+) Cancer (-)
Nyeri reverse HSR.
pada titik
epicondyl Qt: Isometric wrist
us lateral extension (+)
huleri nyeri
Mill’s test (+)
Palpasi (+) tipe 1,
2, 3 atau 4

Sugijanto, 2022
 Tennis elbow tipe 2

Penyebab Akibat
impingement impingement
Shoulder arm
Carpal disability
transverse lig Flexor tendon Lunate sub Median nerve
contracture thickening luxation entrapment
Intercarpal joint
Nerve Muscle atrophy
Capsular
Ligament tightness
hypomobility
stretching
Nerve Functional activity
1. Tendon stretching fibrosis and participation
Lunate
2. Tendon gliding education
reposition 1. Electrical muscle
exercise
stimulation
Lunate
1. Intercarpal joint reposition 2. Strangthening
mobilization exc

Lunate
reposition

1. Edukasi: Postural correction

2. Joint stabilization exc
Sugijanto 2022
 Clinical pathway tennis elbow
No Problem Assessment Intervensi Alat ukur Jumlah Kondisi yang
fisioterapi kedatangan diharap
Tendoperi Isometric wrist US Tendo periosteal Nyeri: 3x/Mgg Nyeri hilang
osteal extension Mill’s manipulation. VAS/VRS selama 4 Fungsi
inflammati Mill’s test Pain free grip Muscle mgg normal
on pain Painfree grip test strength strength:
sec. tennis Palpasi: Epicondylus DASH Dynamo
elbow Tipe lateralis perlekatan m. meter
II extensor carpi radialis
Tipe I dan Palpasi: perlekatan m. Idem 3x/mgg Idem
III extensor capri radialis selama 2
longus dan tendon m. mgg
extensor cari radialis
brevis
Palpasi m. extensor
cari radialis brevis idem idem
Tipe IV Selama 1
mgg

Sugijanto 2022
 Nyeri dan paraesthesia sc CTS
Functioning, and disability Contextual factors

Anatomic impairment
Internal External
Tendon Lig. Carpi Lunatum factors factors
flexor dig transversum n. Medianus

Inflamasi Contracture Subluxate

- odema

Penyempitan CT
Kompresi-
entrapment
Body function
Entrapment
impairment
dlm CT Activity
inflamation Muscle limitation Participation
Anoxia weakness
restriction
Neural Parestesia Carrying
adhesion
Dressing
Work

Dll Sport
Pain &
Muscle
Paresthesias
paresis Recreation
Sugijanto 2022
 Nyeri Parastesis Akibat
Anamnesis utk Inflamasi Tendons Fleksor Jari
menegakkan ICD Tangan Ha: Nyeri parastesis
Ya pada CTS akibat
inflamasi tendon
Nyeri dan kesemutan pada
tangan, sulit menggenggam Ganti hipotesis
Tdk
Ya

Atrofi otot thenar ? tanda Patologi serius/

INSPEKSI radang? Deformitas ? Red flag?
Tdk ALGORITMA PEMERIKSAAN
Ya
FISIOTERAPI PADA
Tes Cepat: pinch and grasp NYERI PARASTESIS PADA CTS
PEMERIKSAAN strength, pressure test, Phalen De quervain’s
test syndrome ??
AKIBAT INFLAMASI TENDONS
FUNGSI GERAK Tdk FLEKSOR JARI TANGAN
Test Gerak Pasif: kaku dan
bengkak pada hand dan wrist
Finkelsten’s test :
Ya
palpasi otot abduktor
ibu jari pada saat
TEST Pray test, eccentric test, Tinnel
abduksi pasif ibu jari →
KHUSUS Sign, Carpal Compression Test
nyeri (+)
Penunjang:
Tdk
EMG
DIAGNOSIS Nyeri parastesis pada CTS akibat inflamasi
tendons fleksor jari tangan

Problem: Nyeri dan kesemutan wrist dan tangan

Body structure impairment: fibrosis tendon fleksor digitorum komunis,
neuropraksia/perlengketan/fibrosis n.medianus, nyeri dan kesemutan,
hipotrofi otot thenar, pemendekan ligamentum carpi transversum
Body function impairment: pinch dan grasp,
Disabilitas: mencuci, menyapu, membuka pintu,
Sugijanto 2022
 RESUME PEMERIKSAAN FISIOTERAPI PADA
CARPAL TUNNEL SYNDROME
Case History Inspection Regional Review of Specific test in Supporting PT
taking screening & system & red EBCP test Diagnosis
quick test flag
Nyeri/ Nyeri/ Atrofi Cervical flexion- Musculoskeletal Stretch test lig ‘X’ ray: (+) Wrist and
semutan semutan thenar extension-3D Neuromuscular carpi MRI hand pain
perg area Wrist extension (-) transversum (+) and
tangan, nervinal Indocrine disability
tranverse Upper thoracic Pray test (+)
jari jari 1, 2, arc dalam spine LPAVP, Red flag sec to CTS
tangan 3, dan ½ Intercarpal joint
PACVP (-) Fracture (-) play movement
sisi palmar 4
Shoulder abduct Cancer (-) test (+/-)
jari 1, 2, 3, Pinch
dan ½ elevation (+) Lunate position
grip(+) reverse HSR.
medial (phrehen test (+/-)
jari 4 sion) Qt: Phalen test ULTT & Nerve-
(+), Sensoric gliding test (+)
nervinal test (+),
Tinnel test n.
medianus (+)

Sugijanto, 2022
 Carpal Tummel
Syndrome

Penyebab Akibat

Shoulder arm
Carpal disability
transverse lig Flexor tendon Lunate sub Median nerve
contracture thickening luxation entrapment
Intercarpal joint
Nerve Muscle atrophy
Capsular
Ligament tightness
hypomobility
stretching
Nerve Functional activity
1. Tendon stretching fibrosis and participation
Lunate
2. Tendon gliding education
reposition 1. Electrical muscle
exercise
stimulation
Lunate
1. Intercarpal joint reposition 2. Strangthening
mobilization exc

Lunate
reposition

1. Edukasi: Postural correction

2. Joint stabilization exc
Sugijanto 2022
 Clinical pathway

No Problem fisioterapi Assessment Intervensi Jumlah Kondisi yang

kedatangan diharap
7 Nyeri/paresthesia Pemeriksaan standar Transverse carpal lig. 3x/mgg selama 2 Hilang nyeri dan
telapak tangan & CTS: Stretching mgg paresthesia,
jari sisi lateral • Phalen’s test Eccentric stretching fungsi tangan
akibat CTS • Tinnel test 2x/mgg selama 2 normal
fingers flexor tendon
• Myotome test mgg
Pemeriksaan Lig. Carpi Mobilisasi sendi
transversum intercarpalia
Pemeriksaan Tendon Tendon gliding
fleksor jari technique
Pemeriksaan Inter
carpal joint
Pemeriksaan
disabilitas
Pemeriksaan n. Nerve gliding
Medianus: technique
• Neural tension test,
• Sensoris dan
Motoric

Sugijanto 2022
 Nyeri-mengunci jari akb trigger finger

Functioning, and disability Contextual factors

Anatomic impairment Internal External

factors factors
Tendon Synovial Muscle
flexor dig sheet

Inflamasi- Fibrosis Tendon Muscle

odema shorten weakness

Fibrosis- Penyempitan Kinetik Activity

lumen limitation Participatio
nodule impairment
n restriction

Stenosis Carrying

Dressing Work
MCP
blockade
Dll Sport Recreation

Finger Pain
Sugijanto 2022
 Nyeri dan mengunci Jari
Anamnesis utk Tanganke 3 atau 4 atau 1
menegakkan ICD Ha: Trigger finger akibat
Ya tendonsynovitis stenosans
Saat fleksi penuh kemudian
diluruskan nyeri dan/atau Ganti hipotesis
mengunci Tdk
Ya

Posisi jari fleksi takut Patologi serius/

INSPEKSI ekstensi Red flag?
Tdk
Ya

Tes Cepat: pinch and grasp De quervain’s

PEMERIKSAAN strength, syndrome ?? ALGORITMA PEMERIKSAAN
FUNGSI GERAK Test Gerak Pasif: Bunyi klik saat Tdk
jati di ekstensi kan FISIOTERAPI PADA
Ya
Finkelsten’s test : NYERI MENGUNCI TENDONS
palpasi otot abduktor FLEKSOR JARI TANGAN
ibu jari pada saat
TEST Palpasi tendon flksor setinggi AKIBAT TRIGGER FINGERS
abduksi pasif ibu jari
KHUSUS caput melacorpal
→ nyeri (+)

DIAGNOSIS Nyeri dan mengunci akibat tendosynovitis

stenosans jai 1 atau 3.4

Problem: Nyeri mengunci jari tangan 1 atau 3 atau 4

Body structure impairment: tendosynoveteis stenosans
Body function impairment: Nyeri kegiatan dengan jari tangan,
Disabilitas: mencuci, menyapu, membuka pintu,

Sugijanto 2022
 RESUME PEMERIKSAAN FISIOTERAPI
TRIGGER FINGER
Case History Inspection Regional Review of Specific test in Supporting PT
taking screening & system & red EBCP test Diagnosis
quick test flag
Trigger Nyeri jari Tidak jelas Cervical flexion- Musculoskeleta: Stretch test (+) ‘X’ ray: (+) Pain and
finger tangan ada extension-3D Neuromuscular: nyeri tendon
dan kelainan extension (-) Palpasi (+) blockade
macet Cardiovascular: sec to
Upper thoracic nodule diatas
bila dari spine LPAVP, Gall bladder: caput trigger
menekuk PACVP (-) Endocrine: metacarpal finger
di luruskan
Shoulder abduct Red flag Mobility test (+)
elevation (+) Fracture (-) snaping
reverse HSR.
Angina (-)
Qt: Mobilitas fleksi
Pancoast
– ekstensi
Cancer (-)
mengunci dan
bunyi

Sugijanto, 2022
 Carpal Tummel
Syndrome

Penyebab Akibat

Shoulder arm
Carpal disability
transverse lig Flexor tendon Lunate sub Median nerve
contracture thickening luxation entrapment
Intercarpal joint
Nerve Muscle atrophy
Capsular
Ligament tightness
hypomobility
stretching
Nerve Functional activity
1. Tendon stretching fibrosis and participation
Lunate
2. Tendon gliding education
reposition 1. Electrical muscle
exercise
stimulation
Lunate
1. Intercarpal joint reposition 2. Strangthening
mobilization exc

Lunate
reposition

1. Edukasi: Postural correction

2. Joint stabilization exc
Sugijanto 2022
 Clinical pathway Fisioterapi de
quervain syndrome
No Problem Assessment Intervensi Jumlah Kondisi yang
fisioterapi kedatangan diharap
8 Nyeri dan Tes de quervain: Inflamasi Ext. Pol brevis 3x/mgg Hilang nyeri
disabitas lateral • Finkelstein test dan Abd Pol longus: selama 2 mgg dan fungsi
wrist akibat de • What test • Ice, bandaging, tangannormal
Quervain • Palpasi Splinting
syndrome Tes kinetic: Wrist ulnar deviation
• Joint play movement:
movement test • Joint mobilization
utk wrist joint for lateral wrist
• Carpal Lateral capsules
glide test • Pain free grip
• Tes fungsional: strengthening
- Pain free grip exercise
strength test Taping/splinting lateral
wrist

Sugijanto, 2021
 Hip Osteo Arthritis

Functioning and disability Contextua

l factor
Anatomic impairment
Internal Lexternal
Rawan Capsul Otot/ Vascular factor factor
Sendi Ligamen Tendon
Micro
Erosi Sirculation
Laxity Kontraktur
Functional
Inflamasi tl Spasme Penumpukan
impairment
Subchondral Deformitas zat iritasi
Activity
limitation Participation
Osteofit Immobilisasi restriction
Nyeri
Iritasi Capsular pagi Bersila Work
Jaringan Pattern
Tightness/
Sport
Kontraktur
Antalgic gait
Inflamasi Recreation
Lemah
Kronis Nyeri Stair climbing
Regang
Hypomobility
Nyeri
kompresi Nyeri
Inguinal Sugijanto 2022
 PEMERIKSAAN FISIOTERAPI PADA HIP JOINT OA

Case History taking Inspection Regional Review of Specific test Supporting PT Diagnosis
screening & system & red in EBCP test
quick test flag

Hiop joint Usia lajut Antalgic Lumbal flex - ext Musculoskelet Passive test X ray (+) Inguinal
osteoarth Nyei inguinal standing (-) al: fracture (-) (+) pain and
ritis dan terbatas posture 3D extension (-) Neuromuscula Joint play hip capsular
gerak panggul Duchene r: cauda movement pattern
Regio lain (-) equina hypomobilit
Nyeri/kaku ait test (+)
Hip Patric & syndrome (-) y sec osteo
saat bangun contra patric’s Hydrops arthritis
tidur Red flag lain (- ballottement
(+) )
Nyeri test (+)
Qt: internal
inguinal/troch rotasi (+) nyeri & Traction &
anteris bila paling terbatas distraction
jalan jauh. (+) dan test (+)
Tidak bias
bersila Passive test
terbatas
dengan end
feel elastic-firm
Sugijanto, 2022
 HIP JOINT OA

Anatomic
Kinetic
impairment target
impairment
Joint surface Gluteal Muscle
inflammation/erosi weakness/tightness
Capsular Mal Femoro
pattern alignment acetabular

1. Traksi osilasi inferior 1. Active stabilization impingement

2. Pengurangan berat 2. Contract relax

badan stretching otot
3. Olah raga dalam contracture/tegang
kolam 3. Muscle strengthening
& Functional exc
1. Traksi osilasi MLPP Penggunaan AFO MWM dengan
2. Mobilisasi pada Penggunaan lateral glide
akhir pembatanan orthopaedic shoes reposition
rom
3. Roll glide
Sugijanto 2022
 Clinical pathway of Hip OA
Physiotherapy
No Problem fisioterapi Assessment Intervensi Jumlah Kondisi yang
kedatangan diharapkan
Hip joint Capsular Pemeriksaan alignment: Joint oscillated Kellgren 1: 3x Nyeri hilang,
pattern • Deformitas/Alignment: mob. in MLPP, end (3x/mgg) dan ROM dan fungsi
hypomobility valgus/ varus/ range joint 4x (2x/mgg) pulih
akibat knee recurvatum mobilization, MWM
osteoarthritis Pemeriksaan rawan sendi: and active Kellgren 2: 6x Nyeri kurang,
• Crepitasi mobilization exc, (2x/mgg) ROM & fungsi
• Compression nyeri MWM pulih
• Traction test nyeri -
Pemeriksaan Capsul: Kellgren 3-4: Capsules-
• Passive test: capsular pre operatif 3x muscle-Nerve
pattern; elastic e f. (seminggu) lentur
• Joint play movement Rehabilitatif 6x Fungsi membaik
nyeri dan elastic/firm end (2x/mgg)
feel
• Stability test: ligament
laxity

Sugijanto 2022
 Piriformis syndrome
Functioning and disability Contextual
factor

Anatomic impairment
Internal Lexternal
Otot/ Saraf Vascular
factor factor
Tendon
Tightness Micro
Spasme Sirculation
Entrapment
Tightness Penumpukan
Inflamasi zat iritasi
Anoxia

Tightness/ Functional Activity

Kontraktur Neuraladhesion impairment
Nyeri limitation
Participation
pagi
Neuraltension restriction
Hard chair siting
Work
Paresthesia Nyeri Antalgic gait Sport
neuropathic

Nyeri regang Stair climbing Recreation

Deficit
sensoric
Sugijanto 2022
 Klien dengan keluhan nyeri pantat
menjalar belakang paha.

ya Ha: Piriformis syndrome

Nyeri duduk terutama alas keras. Nyeri

History taking: Pemeriksaan red flag:
bila tertekan, menjalar ke paha
tdk Acute herniated, myelitis dll
ya ya
Tidak khas. Deformitas tampak pada Konsul dokter spesialis
Observasi:
penyebab primernya (missal HNP lumbal) yang kompeten Algoritme pemeriksaan
ya fisioterapi pada
Tes orientasi:
Fleksi trunki nyeri gluteal, fleksi-adduksi
Algoritme Nyeri gluteal dan belakang
panggul nyeri gluteal
tdk pemeriksaan lain paha akibat piriformis
Tes khusus: M.
ya
Palpasi pd persilangan SIAS-coccix dan SIPS- syndrome
trochanter; Contract relax stretch test posisi Algoritme
Piriformis
sendi panggul fleksi-adduksi-internal rotasi tdk pemeriksaan lain

ya

Tes khusus: n. Slump test positif; LLTT (Lower Limb Tension Test) Tanpa iritasi saraf
ischiadicus dan palpasi
tdk
ya
Pemeriksaan
Untuk menyisihkan patologi lain, missal Artritis
Penunjang MRI
butuh X Ray, HNP butuh MRI
Dan Pengukuran

Nyeri Gluteal menjalar ke paha belakang

Diagnosis
akibat Piriformis syndrome lumbale

Body structure Impairment: Discus and Nerve root

Body Function Impairment: Gluteal-posterior leg pain
Disabilitas:
Sugijanto 2022
 PIRIFORMIS SYNDROME

Anatomic
impairment target Kinetic
impairment
Muscle tightness Nerve
/ contracture entrapment
LumboSacral Wallet irritation
hyperlordoss

1. Myofascial release 1. Neural mobilization Tempat duduk

2. Contract relax 2. Nerve gliding keras/ terlalu lunak
stretching / MET technique
3. Home stretching
Koreksi duduk
exercise & auto MRT

Postural correction Pindahkan

Proper body dompet di
mechanic sakudepan

Sugijanto 2022
 Clinical pathway fisioterapi piriformis syndrome
No Problem Assessment Intervensi Alat ukur Kondisi yang
fisioterapi diharap
Pain and Pemeriksaan m. piriformis: MWD/US, gluteal Obyektif: Nyeri hilang,
paresthesias • Palpasi Myofascial Nyeri semutan
on hamstring • Contract relax stretch release (NRS/VAS/V hilang
regio sec test Contract relax DS) fungsi pulih
Piriformis stretching Outcome
syndrome Pemeriksaan n. measure:
Kode ICD:, ischiadicus: Neural Disabilitas/F
ICF: • Nervinal test mobilization/ ungsional
• LLTT nerve gliding
technique

Sugijanto 2022
 CLINICAL OA Lutut
REASONING
Functioning, and disability Contextual
factor
Anatomic impairment
Internal External
Rawan Capsul factor factor
Otot/ Vascular
Sendi Ligamen Tendon
Micro
Laxity Spasme Circulation
Erosi
Kontraktur
Inflamasi tl Penumpukan Functional
Subchondral zat iritan impairment Activity Participation
limitation restriction
Osteofit Deformitas Immobilisasi Nyeri
pagi
Antalgic gait
Iritasi Tightness/
Jaringan Kontraktur
Lemah Nyeri naik Recreation
Capsular Work
Inflamasi Pattern tangga
Kronis
Sport
Nyeri jongkok
Nyeri
kompresi Nyeri
Regang
Hypomobility Sugijanto 2022
 Nyeri inguinal dan kaku sendi
Anamnesis utk panggul akibat osteo atritis,
menegakkan ICD
Ya Ha: Contraktur
akibat OA panggul
Nyeri dan kaku panggul bangun
tidur, krepitasi, internal rotasi
sangat terbatas Ganti hipotesis
Tdk
Ya
Inspeksi Patologi serius/
Posisi sendi:
Red flag?
Tdk
Ya
Duchene gait; Posisi Tengkurap,
Tes Cepat:
rotasi internal terbatas ALGORITMA
Ya PEMERIKSAAN
Test Gerak Pasif :Nyeri & terbatas (rotasi internal < abduksi
Muskular? FISIOTERAPI PADA
< Fleksi dengan Elastic - Firm End Feel)?
Tdk
CAPSULAR PATTERN
Ya
Isometric test dan
HYPOMOBILITY SENDI
Joint Play Movement (Nyeri, Elastic - Firm
End Feel), Traksi pembatasan ROM abduksi, palpasi PANGGUL AKIBAT
Tes khusus rotasi internal dan rotasi eksternal
OSTEO ARTRITIS
Penunjang: X-Ray

CAPSULAR PATTERN HYPOMOBILITY OF

Diagnosis THEKNEE AKIBAT OSTEOARTRITIS

Problem: Contracture lutut aibat OA

Body structure impairment: Joint surface/capsules
Body function impaitmen: Capsular pattern Hypomobility
Disabilitas:
Sugijanto 2022
 PEMERIKSAAN FISIOTERAPI PADA KNEE OA

Case History taking Inspection Regional Review of Specific test Supporting PT Diagnosis
screening & system & red in EBCP test
quick test flag

Knee Usia lajut Knee Lumbal flex - ext Musculoskelet Passive test X ray (+) Knee pain
osteoarth Nyei dan varus/ (-) al: fracture (-) (+) and
ritis terbatas gerak valgus 3D extension (-) Neuromuscula Joint play capsular
sendi lutut Tampak r: cauda movement pattern
Hip Patric & equina hypomobility
Nyeri/kaku bengkak contra patric’s (- syndrome (-) test (+)
sec osteo
saat bangun ) Regio lain (-) Hydrops arthritis
tidur Red flag lain (- ballottement
Knee flexion- )
Kaku/nyeribila extension nyeri test (+)
berdiri setelah (+) terbatas (+) Traction &
duduk lama dan crepitasi distraction
Crepitsi lutut Passive test test (+)
terbatas
dengan end
fee: elastic-firm

Sugijanto, 2022
 OA LUTUT

Anatomic Kinetic
impairment target impairment

Joint surface Muscle

inflammation/erosi weakness/tightness
Tibial lateral
Capsular glide posture
Mal Tibial medial
pattern alignment glide position

1. Traksi osilasi 1. Active stabilization

inferior 2. Contract relax
2. Pengurangan stretching otot MWM dengan
berat badan contracture/tegang medial glide
3. Olah raga dalam 3. Muscle strengthening reposition
kolam & Functional exc
Penggunaan KAFO MWM dengan
1. Traksi osilasi MLPP
Penggunaan lateral glide
2. Mobilisasi pada akhir
orthopaedic shoes reposition
pembatanan rom
3. Roll glide
Sugijanto 2022
 Clinical pathway fisioterapi Knee OA
No Problem Assessment Intervensi Alat ukur Kondisi yang
fisioterapi diharapkan
2 Knee joint Pemeriksaan alignment: SWD/US, tibiofemoral Obyektif: Nyeri hilang,
Capsular • Deformitas/Alignment: joint and Nyeri ROM dan fungsi
pattern valgus/ varus/ recurvatum patellofemoral joint (NRS/VAS/VDS pulih
hypomobility Pemeriksaan rawan sendi: oscillated mob. in ); ROM ;
akibat knee • Crepitasi MLPP, end range joint Outcome Nyeri kurang,
osteoarthritis • Compression nyeri mobilization, MWM measure: ROM & fungsi
Kode ICD: • Traction test nyeri - and active Disabilitas/Fun pulih
719.56, ICF: Pemeriksaan Capsul: mobilization exc, gsional
S7500, b710, • Passive test: capsular MWM Capsules-
b720, d450, pattern; elastic e f. muscle-Nerve
d460, d530, d540 • Joint play movement nyeri lentur
dan elastic/firm end feel Fungsi membaik
• Stability test: ligament laxity

Dengan knee + medial glide varus idem

valgus mobilization
Dengan knee + lateral glide valgus
varus mobilization

Sugijanto 2022
 Nyeri lutut Akibat
Chondromalacie patella
Functioning and disability Contextual factors

Anatomic impairment
Internal External
factors factors
Rawan sendi Muscle Ligamen
patella
M C L Laxity

Erosi L C L Laxity
Valgus Functional Activity Participation
impairment limitation restriction
Varus
Inflamasi
Lemah m.Pes
Lemah vastus anserinus
Lemah I T B
medialis Work
Lemah vastus Antalgic
Osteofit
lateralis gait
Sport
Pain in
squat
Nyeri lutut Recreation
depan
Mal Alignment Knee Pain in
Knee
gerak Patella deformity instabiity running
Sugijanto 2022
 Anamnesis utk Nyeri dan disabilitas sendi lutut
menegakkan ICD akibat chondromalacia patella,

Ha: Contraktur
Ya akibat OA lutut

Nyeri lutut ventral terutama Ganti hipotesis

naik-turun tangga, crepitasi.
Tdk
ALGORITMA
Ya PEMERIKSAAN
Posisi sendi: valgus? Varus? Patologi serius/
INSPEKSI
Hydrops? Red flag? FISIOTERAPI PADA
Tdk
Ya
NYERI LUTUT AKIBAT
CHONDROMALACIE
Tes Cepat: nyeri lutut anterior
saat deep squat
Jumper knee?
PATELLA
PEMERIKSAAN Test Gerak Pasif: Nyeri dan gerak
FUNGSI GERAK fleksi-ekstensi crepitasi)? Tdk

Ya Isometric test dan

palpasi tendon
Joint Play Movement (Nyeri, patellae
Elastic - Firm End Feel)
TEST KHUSUS Valgus/varus test: deformitas

Penunjang: X-Ray

NYERI LUTUT AKIBAT CHONDROMALLACIE

DIAGNOSIS PATELLAE DENGAN DEFORMITAS
VARUS/VALGUS

Problem: Nyeri lutut akibat chondro malacie patellae

Body structure impairment:
Body function impaitmen:
Disabilitas: Sugijanto 2022
 Chondromalacie
patella
Anatomic
Kinetic
impairment target
impairment

Patello femoral oint Muscle

surface inflammation weakness/tightness

Ligament Valgus/ Tibial lateral glide Tibial medial glide

contracture varus posture position

1. Patellar glide mobilization 1. Strength VMO & pes

2. Pengurangan berat anserinus atau Vastus MWM dengan
badan lateralis dan iliotibial medial glide
3. Olah raga dalam kolam 2. Functional exc reposition

Penggunaan AFO MWM dengan

1. Glide osilasi MLPP Penggunaan lateral / medial
2. Mobilisasi pada akhir orthopaedic shoes glide reposition
pembatanan rom
3. Roll glide
Sugijanto 2022
 Clinical pathway physiotherapy
Chondromalacia patella
No Problem Assessment Intervensi Alat ukur Kondisi yang
fisioterapi diharapkan
2 Knee pain and Pemeriksaan alignment: SWD/US, Obyektif: Nyeri hilang,
disability akibat • Deformitas/Alignment: patellofemoral join. Nyeri ROM dan fungsi
Chondomalacie valgus/ varus Patellofemoral joint (NRS/VAS/VDS pulih
patella Pemeriksaan rawan sendi: oscillated mob. in ); ROM ;
Kode ICD: , ICF: • Crepitasi MLPP, end range joint Outcome Nyeri kurang,
S7500, b710, • Compression nyeri mobilization, measure: ROM & fungsi
b720, d450, Pemeriksaan ligament: MWM and active Disabilitas/Fun pulih
d460, d530, d540 • Passive test: contracted/ mobilization exc, gsional
laxity . Functional exc Capsules-
• Joint play movement nyeri muscle-Nerve
dan elastic/firm end feel lentur
• Stability test: ligament laxity Fungsi membaik

Sugijanto 2022
 LOWER LEG AMPUTATION

Functioning and disability Contextual factor

Anatomic impairment
Internal External
factor factor
Skin Hip joint Knee joint Sensible

Wound Muscle capsels/lig.

Pantom
Functional
Stump form sensation
Immobilization impairment Activity
limitation Participation
contour
Tone restriction
Panthom
edema
pain
Conus Tightness Prothetic Work
wear
Weakness Sport
Hypomobility
Walking
Cicatrix Recreation
Muscle ADL, with /
weakness without prosthesis Quality
of life

Stump pain Sugijanto 2022

 PEMERIKSAAN FISIOTERAPI PADA AMPUTASI
BAWAH LUTUT
Case History taking Inspection Regional Review of Specific test Supporting PT Diagnosis
screening & system & red in EBCP test
quick test flag

Pasca Amputasi Ketinggian Lumbal flex - ext Musculoskelet Hip joint Laporan Knee(and
amputasi karena Ca / amputasi (-) al: fracture (-) passive test operasi hip) joint
tungkai Diabeticum/ (1/3 atas/ 3D extension (-) Neuromuscula (+) hypomobility
bawah frakture dll bawah/ r: cauda Joint play and
trans knee Hip Patric & equina Disability sec
contra patric’s (- syndrome (-) movement
dll) test (+) to lower leg
) Regio lain (-) amputation
Luka Red flag lain (- Knee joint
amputasi Knee flexion- )
extension passive test
Bentuk terbatas (+/-) (+/-) & joint
amputasi muscle play
(conus) weakness (+/-) movement
test (+/-)
Sensitivitas
cicatric
Bengukuran
stump
Sugijanto, 2022
 Lower leg
amputatiion
Anatomic
Kinetic Activity limitation
impairment target
impairment & participation
restriction
Tibio femoral joint Hip joint Stump problems
capsules capsules
Knee and
Muscle weakness/ Knee and hip joint Prosthetic
tightness hip joint hypomobility wearing problems
alignment
1. Iliopsoas & Hamstring
1. Knee joint osilasi MLPP
muscle stretching
2. Mobilisasi pada akhir
2. Quadriceps -hamstring Gait training in
pembatanan rom Postural correction
strengthening exc prothetic
3. Roll glide programs
3. Stump muscle
strengthening exc
Postural correction Training and
1. Hip traksi osilasi MLPP programs education
2. Mobilisasi pada akhir 1. Stump
pembatanan rom manageme
3. Roll glide nt program
Sugijanto 2022
INTERVESI FISIOTERAPI
MODALITAS DAN METODA
 Anatomic Impairment target:
 Skin mobilization utk cicatrix hipersensitif
 Joint mobilization utk Capsular contracture
lutut/panggul
 Muscle strengthening exc. Utk otot berjalan
 Functional Impairment target:
 Balance exc
 Gait training dengan prosthetis
 Disability target

Sugijanto 2022
 Nyeri Tumit

Functioning and disability Contextual factors

Anatomic impairment Internal factors External factors

Tendon Plantar Fascia Periosteal Saraf

Inflamation irritation
Inflamation
Spike bone Neuropathic
Adhesion Functional
pain impairment Activity
Tendon Interior limitation
Participatio
osteophyte heel pain n restriction

Antalgic gait
Work
Dorsal hypomobility
heel pain
Sport
Squat
deficite
Recreation
Sugijanto 2022
 Klien mengeluh nyeri telapak
Ha: Plantar fasciitis kaki/tumit, bangun tidur lebih Ganti hipotesis
berat, Usia > 50 tahun, tdk
Anamnesis
Ya
Terlihat jalan antalgic dengan kaki
Ganti hipotesis
Inspeksi depan, tdk
Ya
Tes Orientasi
Palpasi nyeri tuberositas inferior Pemeriksaan red flag: ALGORITMA
calcanei tdk fraktur

Ya
PEMERIKSAAN NYERI
PLANTAR FASCIITIS KAKI AKIBAT PLANTAR
Functional test FASCIITIS
H1: Fascia H2: Tuberositas calcanei H3: Intrisich muscles

Ya Ya Ya
Passive test: Stretch pain Palpasi: Nyeri? Weakness/Imbalance?

Ya Ya
Ya
Palpasi: nyeri fascia plantaris Spike bone (osteofit) Instability

Ya Ya Ya
Kelemahan otot
Nyeri dan Elastic end feel
Nyeri kompresi calcaneal spur stabilizator

Muscle weakness

Diagnosis Calcaneal pain sec, fasciitis plantaris

Problema:
Body structure impairment:
Body function impairment
Sugijanto 2022
 PEMERIKSAAN FISIOTERAPI PADA PLANTAR
FASCITIS
Case History Inspection Regional Review of Specific test Supporting PT Diagnosis
taking screening & system & red in EBCP test
quick test flag

Plantar Usia lanjut > Early foot Lumbal flex - ext Musculoskeletal Palpasi (+) X ray (+) Heel pain
fascitis 50 flat gait (-) : fracture (-) Achilles and antalgic
Nyeri tumit 3D extension (-) Neuromuscular: length test gait sec to
bag inferior cauda equina (+/-) plantar
Hip Patric & syndrome (-) fascitis
Nyeri contra patric’s (- Calcaneal
meningkat ) Red flag lain (-) valgus test
bangun tidur Knee flexion- (+/-)
extension (-) Navicular
Foot heel off, JPM test (+/-)
toe off, inversion
& eversion (+)
Fascia stretched
(+)
Palpasi fascia
(+) tuberositas
inferior calcanei
(+) nyeri Sugijanto, 2022
 Competency base
approach
Plantar fasciitis-
Calcaneal spur
Anatomic
Kinetic
impairment target
impairment

Apponeurosis plantaris Anterior tibial and

inflamation peroneus dan toes
flexor weakness
Gastrocnemius Flat foot Equinus foot
tightness

1. US / ESWT, Transverse 1. Strengthening exc for

friction Anterior tibial m,
2. Pengurangan berat peroneal ms and toes Stretching for
badan flexos ms gastrocnemius
3. Olah raga dalam kolam 2. Functional exc

Stretching for Insole medial arc

gastrocnemius support

Sugijanto 2022
 Clinical pathway fisioterapi Plantar
fasciitis
No Problem Assessment Intervensi Alat ukur Kondisi yang
fisioterapi diharap
Nyeri tumit Gait analysis US atau ESWT Obyektif: Nyeri hilang,
akibat plantar Pemeriksaan tendon: diatas fascia nyeri jalan normal
fasciitis Palpasi pada tendon plantaris dan (VAS,VDS,NR
Kode ICD: achilles tuberositas S)
M72.2 Pemeriksaan Fascia calcanei Outcome
ICF : b2804, plantaris: Transverse friction measure:
b28015, Palpasi pada Peregangan Foot and
s75023, s75028, apponeurosis plantaris achilles Ankle Ability
d4500, d4501, dan tuberositas Penggunaan Measure,
d4154 calcanei nyeri tajam medial arc Patient
Stretched test support-donnut Specific
Pemeriksaan periosteal: pad Functional
Palpasi Scale
‘X’ ray tampak
osteophyte

Sugijanto 2022
TUGAS PROSES KASUS TERPILIH

Sugijanto 2022
Sugijanto 2022