OA Lutut Rehabilitasi Medis

dr Wikha Aprian
 Diagnosa Banding Nyeri lutut
• Sistem Saraf
– Sindroma Radikular
– Reffered pain
– Nyeri Neuropatik
• Sistem Muskuloskeletal
– Artritis, OA (3A) ,,
• Rujuk : Gangguan Pola Jalan ,atrofi pada otot , harus aspirasi ,
injeksi steroid sinovitis .
– Fraktur terbuka , tertutup
– Dislokasi sendi ekstrimitas
– Trauma sendi
• Impairment > nyeri lutut
• Disabilitas > toileting, sholat (ADL)
• Handicap > tidak bisa berkerja ,
• OA > degenerative joint disesase .
 OA lutut
• Hanya bisa terjadi terdiri Sendi sejati,
– Adanya membran sinovial ,
– Sendi facet ( oa lumbal
 OA Lutut
• Chronic
• Slowly Progressive
• Gak bisa ditekuk
– Cartilage degradasi
– Muscle Weakness
 OA Lutut
• Mayor Disability
– Stiffness
– Knee Pain
– Quadriceps Muscle Weakness
 OA
• History taking
– Joint pain, stiffness<30, Joint locking
• Physical exam
– Pain on Rom, swelling
• Radiography
– Bony sclorosis , osteophytes , joint space narrowing
• Laboratory
– Inflamatory marker
• MRI
– Intraarticular
 ICD 10 M17
• Klinis , sensivitas 95,+spesifitas 69
– Nyeri sendi lutut
• Paling sedikit 3 dari 6
– Krepitus saat gerakan aktif
– Kaku sendi < 30 menit
– Umur > 50 tahun
– Pembesaran tulang sendi lutut
– Nyeri tekan tepi tulang
– Tidak teraba hangat pada sinovium sendi lutut
 Grading
• 0
– Normal
• 1
– Penyempitan joint space
• 2
– Osteofit , gangguan pola jalan , angulasi
• 3
– Deformitas tulang
• 4
– Definite deformity of bone contour
 Treatment
• 1. Exercise and strenghen local Muscles
• 2. Weight Loss
• 3. Physical theraphy : improve Function+ reduce
pain
• 4.Pharmalogical , pct nsaid
• 5. Intra articular corticosteroid : short term relief
• 6. Hyaluronic Acid +PRP (dektrose 5-20%)
• 7. Surgery , grade 4
 Farmakologi
• PCT 3000 gram sehari
• Topical Capcasin
• NSAID jangka pendek (komplikasi extra/intra
articular ).
• Opiod ringan (traxxmaxxxxxdol)
 Pemilihan Medikomentosa
• Nociceptive
– Noninflamatory : Acetaminophen
– Inflamatory : steroid , Nsaid
– Opiod : Traxxxxxxxmaxxxxxdol
• Neuropatic
– Gabapentin
– Pregabalin
• Mixed
 Isometric quadricep exercise
• Tahan 5 detik, repetisi 3x8 , kontraksi .
Minimal seminngu 2 kali
 Straight Leg Raise Exercise
• Diangkat 10 cm
 Komplikasi extraarticular
• Interventional Pain management
– Cortisosteroid > hyaluronic acid >PRP> Dextrose