TULANG DAN SENDI

Sternoclavicular joint :
 stabilisasi oleh lig costoclavicular, interclavicular dan
sternoclavicular (anterior dan posterior)
 persarafan : N supraclavicular medial
 vaskularisasi: a suprascapular & thoracal interna
 Acromioclavicular joint
 Stabilisasi: lig acroimioclavicular dan coracoclavicular
 persarafan: N pectoralis lateral, supraclavicular, axillary
TULANG DAN SENDI
 Glenohumeral joint:
 sendi synovial (ball n socket)
 shallow cavity: dibatasi glenoid labrum
 flexible capsule
 Capsule diperkuat oleh tendon rotator cuff, tendo bisep
(long head) dan ligamen sekitarnya
 persarafan : N axillaris,subscapular, pectoralis lateral
 Vasc: a subscapular, a humeral circumflex ant & post
PEMERIKSAAN FISIS
Look :
 Anterior dan posterior : shoulder contour symetry
 Muscle wasting : frozen shoulder, rotator cuff pathology
 Swelling, redness and heat ; efusi, M deltoid
 Deformities : scapula winging, shoulder dislocation
 Prominent acromioclavicular or sternoclavicular joint
 Feel :
 Joint and soft tissue tenderness / swelling
 Crepitus on joint movement
 Sensation over the axillary nerve cutaneus innervation
(regimental patch sign)
PEMERIKSAAN FISIS
 Move :
 Pain on movement
 Hands behind head, push elbow back
 Hand together behind back
 Specific movements of the shoulder joint:
 medial and lateral rotation (range 180) w/ elbow flexed to 90 and the
shoulder in full adduction
 flexion(180) and extension(60)
 abduction (180) and adduction( 30)
Practical Assessment
 Lift your arm right up (demonstrates full abduction)
 Now let your arm down (painful arc often more
evident on downstroke)
 Put your hand behind your head(tests external
rotation)
 Put your hands behind your waist (test internal
rotation)
X-Rays
 AP view (the standard view in all hospitals)
 Articular surfaces of humerus and glenoid are parallel
 Interior aspects of acromium and clavicle should be at
the same level
 Humeral head looks like a walking stick
X-Rays
 The ‘Y’ view
 The ‘Y’ sits under the humeral head
 The stem of the ‘Y’ is the blade of the scapula
 The limbs of the ‘Y’ are the coracoid and acromium
process
Scapula Fracture
 Unknown injury; 0,5% all fracture
 High energy injury
 Usually direct blow
 Look for associated injuries
 X ray a trauma series: AP view, axillary view,scapular Y
view
Scapula Fracture
 Most scapula fracture are able to nonoperatif
treatment
 Surgical indication :
 Displaced intraarticular involve >25% of the articular
surface
 Scapular neck with >40 degree or >1 cm medial
translation
 Scapular fracture with clavicle fracture
Scapular Fracture
 Fracture of the coracoid process that result functional
acromioclavicular separation
 Comminuted fracture of the scapular spine
Proximal Humerus Fractures
 Epidemiology
 Most common fracture of the humerus
 Higher insidence in the elderly, thougt to be related
to osteoporosis
 Female : male= 2: 1
 Mechanism of Injury
 most commonly a fall onto an outstreched arm from
standing height
 younger patient tipically present after high energy
trauma such as MVA
Proximal Humerus Fractures
Clinical evaluation
 Patient typically present with arm held close to chest by
contralateral hand. Pain and crepitus detected on
palpation
 Carefull NV exam : essential, particularly the axillary
nerve. Test sensation over the deltoid. Deltoid atony
does not necesssarily confirm an axillary nerve injury
Proximal Humerus Fractures
 Treatment
 Minimally displaced fractures : sling immobilization, early
motion
 Two part fractures
 Anatomic neck fractures likely require ORIF. High insidence of
osteonecrosis
 Surgical neck fractures that minimally displaced can be treated
conservatively. Displacement requires ORIF
 Three part fractures
 Due to disruption of opposing muscle forces, these are unstable so
closed treatment is difficult. Displacement requires ORIF
 Four part fractures
 in general for displacement or unstable injuries ORIF in the young
and hemiarthroplasty in the elderly and those sever comminution.
High rate of AVN (13 – 34%)
Dislokasi Acromioclavicular Joint
Dislokasi Sternoclavicular Joint
 Klasifikasi : anterior dan posterior terhadap sternum
 Anterior lebih sering
 Treatment : Closed reduction under GA, open surgery,
sling for 3 months
DISLOKASI GLENOHUMERAL JOINT
GEJALA /GAMBARAN KLINIS
 Pembengkakan
 Numbness
 Weakness
 Bruising
 Nyeri bahu yang terus menerus dengan keterbatasan
ROM
 Deformitas
DIAGNOSIS
 Pemeriksaan fisik
 Pemeriksaan radiologi: AP atau Y view
Pemeriksaan fisik
Pemeriksaaan radiologi
PENANGANAN
Konservatif:
 Closed Reduction (Stimson, Hippocratic, Kocher)
 Rehabilitasi:
 Immobilisasi dgn sling selama beberapa minggu
 Fisioterapi
Pembedahan
KOMPLIKASI
1. Kerusakan N.axillaris
2. Fraktur caput humerus
3. Dislokasi rekuren
4. Robekan rotator cuff
5. Neuropraxia N axillaris
TERIMA KASIH