PDF PPT Pleno Pemicu 3 Kelompok 10

KELOMPOK 10
PLENO
DISKUSI KELOMPOK
PEMICU 3
MODUL MUSKULOSKELETAL
FAKULTAS KEDOKTERAN
UNIVERSITAS TANJUNGPURA
KELOMPOK 10
TRIGGER
A 75-year-old white woman presents to the emergency
room with right wrist pain after a fall at home that
happened 2 hours ago at her home. She tripped and fell
while preparing dinner, and she says that she tried to
stop her fall with her outstretched right hand. She
heard a “snap” and felt immediate pain. Her medical
history is remarkable only for three normal
pregnancies, menopause at age 50 years, and
hypertension that is well controlled with diuretics. She
has a 50-pack-year history of smoking. Her weight is
45kg, and her height is 168cm. Her examination is
remarkable for normal vital signs; a swollen,
deformed right distal forearm and wrist, with
limited mobility because of pain; and good radial
pulses and capillary refill in the right fingernail
beds. An x-ray confirms a fracture of the right distal
radial, and the radiologist notes osteopenia.
CLARIFICATION AND DEFINITION
Hypertension Menopause Diuretic

systolic blood pressure (SBP) values of Menopause is one point in a Diuretics are drugs that
130 mm Hg or more and/or diastolic pharmacologically tilt the renal fluid
blood pressure (DBP) of more than 80
continuum of life stages for
regulation in favor of the excretion of
mm Hg. Hypertension ranks among the women and marks the end of water and electrolytes. Thus,
most common chronic medical their reproductive years. diuretics are substances that
condition characterized by a persistent increase the production and volume
elevation in arterial pressure.. of urine.
Iqbal AM, Jamal SF. Essential Hypertension. [Updated 2023 Jul 20]. In: StatPearls Sapra A, Malik A, Bhandari P. Vital sign Assessment. InStatPearls [Internet] 2021 May Arumugham VB, Shahin MH. Therapeutic Uses of Diuretic Agents. Treasure Island
[Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: 12. StatPearls Publishing. (FL): StatPearls Publishing; 2023.
CLARIFICATION AND DEFINITION
X-ray Osteopenia Normal vital signs (TTV)

a form of high-energy clinical term used to describe a is an objective measurement of the
electromagnetic radiation that has decrease in bone mineral density essential physiological functions of
the ability to penetrate solid objects (BMD) below normal reference living organisms. They have the
and produce internal images of name "vital" because their
values, yet not low enough to
objects or bodies subjected to X- measurement and assessment is an
meet the diagnostic criteria to be important first step to any clinical
rays. considered osteoporotic evaluation
Berger M, Yang Q, Maier A. X-ray Imaging. In: Lecture Notes in Computer Science. Varacallo M, Pelaut TJ, Jandu JS, dkk. Osteopenia. [Diperbarui 2023 Agustus 4]. Di: Sapra A, Malik A, Bhandari P. Vital sign Assessment. InStatPearls [Internet] 2021 May
Cham: Springer International Publishing; 2018 StatPearls [Internet]. Pulau Harta Karun (FL): Penerbitan StatPearls; 2023 Januari-. 12. StatPearls Publishing.
Keyword
1. women 75 years old 7. hypertension(+), diuretics (+)

2. tripped and fall since 2 hours ago 8. good radial pulses
3. a 50 pack years history of smoking 9. capillary refill in the right fingernail
4. limited mobility because of pain bed
5. right wrist pain 10. a fracture of the right radial head
6. menopause at 50 11. osteopenia
12. weight 45kg, height 168 cm
Problem Formulation
How is the management of a 75 year old
woman experiencing right wrist pain
after falling at home 2 hours ago, with
examination showing normal vital signs;
swelling, deformed right distal forearm
and wrist, limited mobility due to pain,
good radial pulse and normal capillary
refill in the fingernails of the right hand,
and an x-ray examination which revealed
a fracture in the right radial head and the
radiologist noted osteopenia?
Problem Analysis
Hypothesis
Based on anamnesis and physical

examination, it was suspected that a 75
year old woman had suffered a radial
head fracture and osteopenia which
requires immediate treatment.
Learning Issue
Oss Membri Superior
a. Anatomi
Oss Membri Superior
b. Normal bone mineral density
Bone mineral from birth to adulthood follows a specific pattern based on a

person's age and gender. During puberty, bone mineral accrual increases
to its maximum level shortly after reaching the peak height during
adolescence. The greatest rate of bone mineral accrual occurs in both men
and women for about four years after the peak growth rate is achieved,
and 95% of adult bone mass is typically attained at the age of 17 for women
and 21 for men.
The most common bone mineral density test is central
dual-energy x-ray absorptiometry (DXA or DEXA).
DXA uses radiation to measure how much calcium and
other minerals are in certain areas of your bones.
AjlouniKamel, M. (2017). Prevalence and risk factors of osteoporosis among jordanian postmenopausal women attending the
national center for diabetes, endocrinology and genetics in Jordan. BioResearch open access.
Porter JL, Varacallo M. Osteoporosis. 2023. https://www.ncbi.nlm.nih.gov/books/NBK441901/
Oss Membri Superior
c. Common fracture
1. Fractures and dislocations of the clavicle

and scapula. 2. humerus
Dislocation of the humeral joint. proximal humeral fracture
Dislocation of the acromioclavicular joint. humeral shaft fracture
Subdeltoid bursitis.
Strain of the muscles at the shoulder's supracondylar fracture (extension)
roof. supracondylar fracture (flexion)
Elbow injury. internal epicondyle fracture
Injuries to the tibia, radius, ulna,
metacarpals, and phalanges. external epicondylar fracture
3. Ulna
4. Radius olecranon fracture
radial head fracture coronoid process fracture
radial neck fracture Monteggia fracture-dislocation
Essex Lopresti fracture dislocation night stick fracture
Galeazzi fracture dislocation ulnar styloid fracture
distal ulna fracture
Oss Membri Superior
d. Kinesiology of upper extremities
A. Humeral Elevation
When the elbow is raised to shoulder level in any
plane, the humerus elevation angle is 90°. When
the arm is by the side, the elevation angle is 0°.
B. Humeral plane of elevation

The humerus elevation plane is represented by
vertical lines, viewed from the "North Pole."
C. Neutral position
The movements of all joints and segments
(shoulder, elbow, and wrist) are measured relative
to the position shown by the avatar, with the
humerus in a neutral position by the side, the
elbow extended, and the palm facing the midline.
Osteopenia
a. Etiologi
Failure to achieve peak bone mass as a young adult results in early-onset conditions of
decreased bone mass (osteopenia or osteoporosis) and increased risk of fragility fractures even
in adolescence and young adulthood. After age 30, there is a gradual and natural bone mass
reduction that takes place over the ensuing decades into later life.
Bone mass levels depend on :
heritable factors
weight-bearing exercises
nutrition status (adequate calcium and vitamin D daily intake)
body mass
hormonal milieu.
b. Epidemiology
By 2020, projections estimate that over 47 million Americans will be afflicted with
osteopenia. The greatest number of fragility fractures occur in Europe, followed by
the Western Pacific region, Southeast Asia, and the Americas. Overall, women
have a four-fold higher prevalence of osteopenia compared to men.
Osteopenia
c. Pathophysiology d. Histopathology
Osteopenia may be defined as too little bone
tissue with decreased thickness of bone cortex or
diminished thickness or number of bone
trabeculae that may be due either to suboptimal
mineralization or to decreased quantity of bone
matrix collagen type I.
The pathogenesis of osteopenia and osteoporosis
is not completely known; however, numerous
studies have highlighted a number of factors, Histologic specimens
including severe malnutrition, poor calcium showed very thin
intake, excessive exercise patterns despite trabeculae, decreased
osteon size, and
malnutrition, hypoestrogenism, increased serum
enlargement of the
cortisol levels, and hormonal imbalances, such as
haversian space and
decreased progesterone levels and decreased marrow.
IGF-1 levels.
Osteopenia
e. Clinical manifestation
Osteopenia, as defined by the World Health Organization (WHO), is a T-score
between -1 and -2.5, while a value less than -2.5 is diagnostic for osteoporosis.
Decreased BMD values reflect underlying disturbances in bone
microarchitecture, and osteopenia is considered a quantitative disorder of bone
mineralization, rather than a qualitative one.
f. Diagnosis
Osteopenia is a clinical term used to describe a decrease in bone mineral
density (BMD) below normal reference values, yet not low enough to meet
the diagnostic criteria to be considered osteoporotic. BMD is diagnosed via
dual-energy x-ray absorptiometry (DXA) bone scans. Decreasing BMD values are
reflective of an underlying disruption in the microarchitecture of bone and
osteopenia, and osteoporosis is considered quantitative, not qualitative,
disorders of bone mineralization.
Osteopenia
g. Differential diagnosis
Homocystinuria Mastocytosis
Hyperparathyroidism Multiple myeloma
Imaging in osteomalacia Paget disease
Sickle cell anaemia Scurvy
h. Risk factor
Significant risk factor for sarcopenia is advancing age. Sarcopenia is
significantly higher among the middle-aged group between the ages of
70-79 and the very elderly group aged ≥ 80 years. Other risk factors
(gender, BMI, history of falls, depression, knee osteoarthritis,
Charlson comorbidity index, malnutrition, and protein intake) do
not differ significantly between those with and without sarcopenia.
Osteopenia
i. Examination j. Treatment
The WHO has established DXA scans as the There’s no cure for osteopenia, but it’s
gold standard for assessing BMD levels. DXA important to preserve bone density as much as
scans utilize a single x-ray beam to measure possible. Treatment involves simple strategies to
calcified tissue in select regions of the body. keep your bones as healthy and strong as
Measurements are reported with 1% to 2% possible and prevent progression to
precision rates, and DXA scans are considered osteoporosis:
the most accurate diagnostic imaging modality
1. Calcium treatment.
with the least amount of radiation exposure.
2. Exercise.
The lumbar spine (L2 to L4), the hip (compiled
3. Healthy diet.
from the femoral neck, trochanters, and
intertrochanteric regions), and the wrist are 4. Supplements for vitamin D deficiency and
routinely included in the scan. exposure to the sun to help your body
absorb vitamin D.
5. Your healthcare provider will also want to
monitor your bone density over time in case
you develop osteoporosis
Osteopenia
k. Prognosis
Osteopenia can caused fracture. Fragility fractures significantly compromise a patient's
quality of life and financially devastate the healthcare system. Roughly 2 million
fragility fractures occur each year in the United States. In addition, fragility fractures
significantly decrease the quality of life, and hip fractures alone are associated with a
one-year mortality rate of greater than 20%.
l. Complication
The major complication of this condition is its progression to

osteoporosis, which is a condition wherein there is a greater risk
of bone deterioration and bone fracture.
Osteopenia
m. Education n. Prevention
Core treatment options for osteopenic patients Osteopenia and osteoporosis, along with their
involve early education on how to achieve and associated complications, are significant sources
maintain healthy bone mass levels and extensive of morbidity and mortality for patients, and the
counseling on relevant social, environmental, and treatment of their complications places a
lifestyle risk factors that can endanger bone substantial financial and resource burden on
health. the healthcare system. The key is to prevent
1. Lifestyle modification osteopenia. Therefore, it is essential for
2. Fall prevention
healthcare providers to educate, especially
3. Risk Stratification of Osteopenic Patients
regarding the morbidity of osteopenia.
4. Fracture Risk Considerations
5. Pharmacotherapy Recommendations Nurses, pharmacists, and primary care
6. Treatment and Follow-Up Considerations providers should encourage patients to
consume a healthy, calcium-rich diet.
Additionally, patients should be encouraged to
exercise, quit smoking, and avoid alcohol.
Pharmacists should educate patients about
bisphosphonates, their benefits, and side effects.
Osteoporosis
a. Pathophysiology b. Risk factor
Risk factors associated with

osteoporosis include age, female sex,
ethnicity, family history of
osteoporosis, smoking, vitamin D
deficiency, low calcium and high
caffeine intake, immobilization,
increased age at menarche, early
menopause, and underweight.
Osteoporosis
c. Treatment
1. Non pharmacological management
Nonpharmacological management of
osteoporosis includes adequate calcium and
vitamin D intake, weight-bearing exercise,
smoking cessation, limitation of
alcohol/caffeine consumption, and fall-
prevention techniques.
2. Pharmalogical treatment
The goal of pharmacological therapy is to
reduce the risk of fractures. Medications to
treat osteoporosis are categorized as either
antiresorptive (i.e., bisphosphonates, estrogen
agonist/ antagonists [EAAs], estrogens,
calcitonin, and denosumab) or anabolic (i.e., 1. Tu, K. N., Lie, J. D., Wan, C. K. V., Cameron, M., Austel, A. G., Nguyen, J. K., Van, K., & Hyun, D. (2018). Osteoporosis: A Review of
Treatment Options. P & T : a peer-reviewed journal for formulary management, 43(2), 92–104.
teriparatide).
2. buku robbins and cotran pathologic basis of disease 10th ed 2020
Fracture
a. Definition
Fracture is a breach in the structural continuity of the bone cortex, with a degree of
injury to the surrounding soft tissues.
b. Classification
Fractures can be classified into closed fractures and open fractures. Closed
fractures have intact skin over the injury site, while open fractures are
characterized by skin tearing over the bone injury. Tissue damage can be
extensive in open fractures, which are categorized based on their severity.
a. Grade 1: Wound less than 1 cm, minimal contamination.
b. Grade 2: Wound more than 1 cm, moderate contamination.
c. Grade 3: Wound exceeds 6 to 8 cm, extensive damage to soft tissues, nerves,
tendons, significant contamination. Grade 3 open fractures should be managed
promptly due to the risk of infection.
1. Corsino CB, Reeves RA, Sieg RN. Distal Radius Fractures. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2023 Jan-. Available from:
2. Warwick D, Blom A, Whitehouse MR. Apley & Solomon’s system of orthopaedics and trauma, 10th ed. New York: CRC press.
2018, p 711, 797-803.
Fracture
c. Pathophysiology
Osteolytic lesions in the bone occur as a secondary result of osteoclast activation triggered by a
tumor through increased regulation of the RANK ligand. Osteoblastic lesions occur as a secondary
result of endothelin 1, which is secreted by the tumor. Pathological fractures occur through these
lesions due to biomechanical changes. For example, lytic lesions or open defects may lead to
stress concentrations that cannot withstand normal or low-demand activities.
d. Risk factors
1. Smoking
2. alcohol
3. steroids
4. rheumatoid arthritis
5. other chronic disorders
Sheen, J. R., & Garla, V. V. (2022). Fracture healing overview. In StatPearls [Internet]. StatPearls Publishing.
Brunner LS, Smeltzer SC, Suddarth DS. Brunner & Suddarth's textbook of medical-surgical nursing; Vol. 1. Language.
6. diabetes
2010;27:1114-2240p. Available : (accessed 02.11.2023)
https://www.brainkart.com/article/Fracture-Healing-and-Complications--Early-and-Dela yed-_32596
7. previous fracture
Fracture
e. Complication
Early complications Late complications
Shock Delayed union, malunion, nonunion
Fat embolism Avascular necrosis of bone
Compartment syndrome Reaction to internal fixation devices
Other early complications include infections,
thromboembolism, and intravascular
coagulopathy.
f. Treatment
1. immobilization
2. closed reduction
3. bone fracture surgery
4. internal fixation
1. Monica. (2021). Gambaran Penyembuhan Tulang Sekunder pada Fraktur dengan Anatomical Reduction Fixation Tipe Plate
and Screw di RSUP Prof. Dr. R. D Kandou Periode 2019-2020. e-Clinic, 149-153.
2. Marx JA, et al., eds. General principles of orthopedic injuries. In: Rosen's Emergency Medicine: Concepts and Clinical Practice.
8th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. https://www.clinicalkey.com. Accessed Jan. 30, 2018.
5. external fixation
6. arthroplasty
Fracture
g. Healing
Bone healing consists of primary bone healing
(direct fracture healing) and secondary bone
healing (indirect fracture healing). Secondary
bone healing (indirect fracture healing) most
commonly occurs in fractures involving a
combination of intramembranous and
endochondral ossification. The healing process is
characterized by the formation of a callus.
Primary bone healing allows for direct fracture
healing without callus formation and is the goal in
open reduction and internal fixation (ORIF)
surgery using a plate and screw compression
technique.
1. Sheen JR, Mabrouk A, Garla VV. Fracture Healing Overview. [Updated 2023 Apr 8]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551678/
Distal Radius Fracture
a. Etiology
The etiology of distal radius fractures is primarily due to trauma. Trauma can be
categorized based on its energy level into low-energy and high-energy trauma:
Low-energy trauma typically occurs in the elderly population.
High-energy trauma occurs in younger patients, often in children due to sports-related
injuries. Examples of high-energy mechanisms include accidents. High-energy trauma
can result in comminuted fractures, which tend to be unstable.
b. Risk Factors
1. Pediatric, In the pediatric population, epidemiological data indicate a
relatively high incidence during the puberty period.
2. Elderly, Individuals over 50 years of age are prone to distal radius
fractures, particularly Colles' fractures when they fall. This is associated
with postmenopausal osteoporosis and senile osteoporosis.
2018, p 711, 797-803.
b. Pathophysiology c. Diagnosis
The three most common types of distal radius The essential elements in the evaluation of
fractures are Colles fractures, Smith fractures, and distal radial fractures are history and physical.
Barton fractures. Colles fractures are the most These will guide a clinician in deciding what
common type of wrist fracture, accounting for
further imaging to obtain. X-rays are the
90% of all distal radius fractures.
standard imaging modality in the diagnosis
Distal radius fractures are most commonly caused
by falling onto an outstretched hand (FOOSH). Due of DR fractures.
to osteoporosis, the risk of these fractures
increases with age (referred to as 'fragility
fractures'). However, children between the ages of
5-15 are also susceptible to these fractures.
The distal radii bear 80% of the axial load beneath
the scaphoid fossa and the lunate. FOOSH results
in forced supination or pronation of the carpus,
which, in turn, increases the impact load on the
distal radius.
d. Differential diagnosis
Colles’ fracture
Smith’s fracture
Barton fracture
Chauffeur’s fracture/radial styloid fracture
Isolated distal radial fracture
Both bone/radial and ulnar fracture
Scaphoid/carpal bone fracture
Scaphoid/carpal bone dislocation
Distal radioulnar joint dislocation
Carpal ligamentous disruption/TFCC injury
Die-punch fracture
Proximal metacarpal fracture
Monteggia fracture
Galeazzi fracture
Greenstick fracture
Torus/Buckle fracture 1. Corsino CB, Reeves RA, Sieg RN. Distal Radius Fractures. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL):
Salter-Harris/growth plate fracture of radius (pediatric)

2018, p 711, 797-803.
e. Treatment
Reduction is performed to realign the bone to its anatomical position. The choice of
reduction method takes into account the type of fracture (involvement of the articular
surface, bone displacement), the patient's functional level, and the risk and
complications associated with each procedure. In cases of distal radius fractures, the
reduction options include closed reduction and immobilization with a cast.
f. Management
The treatment required for all confirmed distal radius fractures
involves pain management, immobilization, and evaluation
for open fractures or neurovascular disturbances. Patients
with decreased sensation, motor deficits, neuropathy, or
tense forearm compartments should immediately receive
orthopedic consultation.
1. Corsino CB, Reeves RA, Sieg RN. Distal Radius Fractures. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
2. Warwick D, Blom A, Whitehouse MR. Apley & Solomon’s system of orthopaedics and trauma, 10th ed. New York: CRC press. 2018, p 711, 797-803.
g. Prognosis
The main objectives in radial head fractures are fracture healing with a functional
elbow range of motion. The prognosis is in relationship with associated injuries like
lateral and medial ligaments and complex fractures.
h. Management
1. Malunion, is the most common complication that occurs after
distal radius fractures. Malunited distal radius fractures can be
extra-articular, intra-articular, or a combination of both and
happen when the fracture heals with improper alignment,
articular incongruity, incorrect length, or a combination of
these elements.
2. infection
3. tendon complications'
Patiño JM, Saenz VP. Radial Head Fractures. StatPearls. Januari 2023. Available from:
How is the mechanism of bone remodelling?
Bone modeling and remodeling are carried out by three

essential types of bone cells, namely:
Osteoclasts, responsible for bone resorption.
Osteoblasts, involved in bone formation.
Osteocytes, buried within the bone matrix,
controlling bone physiology, capable of both bone
resorption and deposition, or modulating bone
remodeling activity.
bone remodelling cycle
Bone undergoes continuous remodeling throughout life.
The bone remodeling cycle involves these four phases:
1. Activation Phase
2. Resorption Phase: Osteoclasts absorb the exposed
bone portion left by bone lining cells.
3. Transition Phase
4. New Bone Formation Phase Malianawati. (2022). Tulang. Tinjauan secara Komprehensif dalam Bidang Kedokteran Gigi. Universitas Brawijaya Press.
What is the correlation between osteopenia
and fracture?
Among the 271,197 women screened, 44.0% had osteopenia and 35.2% had
osteoporosis. The 10 year cumulative incidence of fragility fractures was 31.1%,
37.5%, and 44.3% in women with normal BMD, osteopenia, and osteoporosis,
respectively. Fracture risk was higher in women with osteopenia (HR, 1.31; 95%
CI, 1.28 to 1.34) and osteoporosis (HR, 1.68; 95% CI, 1.64 to 1.72) than in women
with normal BMD. Women with osteopenia and women with osteoporosis, identified
by the national BMD screening program, demonstrated a substantially elevated risk of
fracture.
What does the “snap” sound indicate?
Crepitus is a term derived from Latin, "crepitus," which means crackling. This sound
can manifest as a creaking sound due to the rubbing of the fractured bone ends or
from joint movement. Additionally, the sound of air bubbles in subcutaneous
emphysema when pressed is also considered crepitus. This sound occurs due to
abnormal air (gas) beneath the skin being compressed, which can produce both a
sound and a sensation of air bubble friction.
1. Baek, Y. H., Cho, S. W., Jeong, H. E., Kim, J. H., Hwang, Y., Lange, J. L., & Shin, J. Y. (2021). 10-Year Fracture Risk in Postmenopausal Women with
Osteopenia and Osteoporosis in South Korea. Endocrinology and metabolism (Seoul, Korea), 36(6), 1178–1188. https://doi.org/10.3803/EnM.2021.1215
2. Shadily, Hassan (1984). Ensiklopedi Indonesia Volume 3. Ichtiar Baru-Van Hoeve. hlm. 1884
What is the difference between osteoporosis
and osteopenia?
Bone mass and bone mineral density both decrease as people age. Osteopenia is a
condition where people's bone density is lower than is usual for their age.
Osteoporosis is a more severe case of bone loss that weakens the bones and
makes them more likely to fracture.
Osteopenia, as defined by the World Health Organization (WHO), is a t-score between
-1 to -2.5, while values less than -2.5 are diagnostic for osteoporosis.
How to interpret decreased bone density with

x-ray?
Bone density is measured with dual-energy X-ray absorptiometry (DEXA). DEXA is a
quick and painless imaging test that uses X-rays to determine whether someone have
healthy bones, osteopenia or osteoporosis. It provides a score called a T-score:
• +1 to –1 indicates normal bone density.
• –1 to –2.5 indicates osteopenia.
• –2.5 or lower means osteoporosis.
1. Osteopenia [Internet].
2. Al-Bashaireh AM, Haddad LG, Weaver M, Chengguo X, Kelly DL, Yoon S. The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic
Mechanisms. J Osteoporos. 2018 Dec 2;2018:1206235. doi: 10.1155/2018/1206235. PMID: 30631414; PMCID: PMC6304634.
What is the correlations between smoking What are the physical examination of the
and osteopenia? musculoskeletal system?
Recent research indicates that smoking The musculoskeletal system (MSK) forms the
causes an imbalance in bone turnover, structural components of the body; muscles,
resulting in reduced bone mass and bones, joints, and connective tissues like
making bones susceptible to tendons and ligaments surrounding these
structures. The musculoskeletal
osteoporosis and fractures. Tobacco
examination is composed of several clinical
can indirectly affect bone mass tests. Broadly, a musculoskeletal system
through changes in body weight, the exam could classify as a:
parathyroid-vitamin D hormone axis, Screening MS exam- a quick assessment
adrenal hormones, sex hormones, of overall structure and function
and increased oxidative stress in Comprehensive MS exam - detailed exam
bone tissue. is typically done by rheumatologists
Regional/focused MS exam - more
specific evaluation of particular joint or
other structure
1. Vilella RC, Reddivari AKR. Musculoskeletal Examination. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551505/
2. David M. Blaustein MD, Edward M. Phillips MD, in Essentials of Physical Medicine and Rehabilitation (Fourth Edition), 2020
KELOMPOK 10
THANK YOU
FAKULTAS KEDOKTERAN
UNIVERSITAS TANJUNGPURA

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KELOMPOK 10

Hypertension Menopause Diuretic

X-ray Osteopenia Normal vital signs (TTV)

1. women 75 years old 7. hypertension(+), diuretics (+)

Based on anamnesis and physical

b. Normal bone mineral density

Bone mineral from birth to adulthood follows a specific pattern based on a

1. Fractures and dislocations of the clavicle

d. Kinesiology of upper extremities

B. Humeral plane of elevation

The major complication of this condition is its progression to

a. Pathophysiology b. Risk factor

Risk factors associated with

Salter-Harris/growth plate fracture of radius (pediatric)

Bone modeling and remodeling are carried out by three

How to interpret decreased bone density with

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