PELAYANAN PRIMER SINDROM KARPAL TUNEL/SKT (CARPAL TUNNEL SINDROME/CTS)

PENDAHULUAN

Sindrom karpal tunel (SKT) adalah gejala neuropati saraf medianus akibat adanya penekanan di daerah pergelangan tangan sisi palmer. Penekanan tersebut akibat adanya peningkatan tekanan di dalam tunel sehingga fungsi saraf medianus berkurang (fig.1). Adapun saraf medianus berasal dari akar/root C6. C7 dan T1 dengan serabut saraf sensoris menginervasi ibu jari (1), jari telunjuk (2), jari tengah (3) sisi palmer dan separoh jari manis (4) sisi palmer dengan sisi dorsal dari ujung jari-jari tersebut.

Fig. 1 Anatomi saraf medianus yang berada dalam tunel karpal yang berbentuk oval bersama-sama dengan tendondon fleksor sublimis dan profunda. Saraf medianus berada di radial dan superfisial dalam tunel tersebut

PELAYANAN PRIMER FRAKTUR TERBUKA

A.     PENDAHULUAN

1.      Batasan (definisi)

Fraktur terbuka (open fractures) adalah diskontinuitas struktur tulang yang berhubungan dengan dunia luar (external environment) akibat kerusakkan jaringan lunak dan kulit penutup tulang yang mengalami lesi tersebut.Oleh karena itu, fraktur terbuka rentan infeksi.

2.      EPIDEMIOLOGI

Insidensi fraktur terbuka di UK 36.0 per 100.000 populasi (2002 – 2004) dengan didominasi oleh pria, tapi diatas umur 55 tahun didominasi oleh wanita.Berdasarkan RISKESDAS (riset kesehatan dasar) di Indonesia 2013 dengan hasil fraktur terbuka 5.8% dari seluruh kasus di Rumah Sakit. Penyebab kecelakaan lalu lintas adalah terbanyak (42.8%) dari seluruh fraktur terbuka yang didominasi oleh  akibat kecelakaan sepeda motor (40.6%) dan kemudian diikuti jatuh (40.9%).

ABILITY TO UNDERSTAND THE CARPAL TUNNEL SYNDROME (CTS) ON ORTHOPAEDIC BOARD EXAMINATION

1.    The Candidate should be able to understand carpal tunnel syndrome or definition (CTS):

Carpal tunnel syndrome (CTS) is a symptomatic compression neuropathy of the median nerve at the wrist area with characterized physiologically by the increasing of pressure within the carpal tunnel and decreased function of the median nerve.

SCENARIO OR CLINICAL SIGNS OR INVESTIGATION FINDING OF ORTHOPAEDIC AND TRAUMATOLOGIC EXAMINATION

WHAT IS THE CLINICAL FEATURES PROBLEM?

A feature of clinical problem is the issue related to the context of clinical medicine and it is more a tool. The summary of clinical feature problem is one or some trigger clinical signs for discussion between the Candidate and the Examiners. These triggers are always relevant, interesting and provocative at the discussion in the orthopaedic and traumatologic exam. The clinical problem could be documented in writing, photos of clinical sign, audio or video tape.

Adequate discussion of the trigger clinical features is important and there are a number of strategies to ensure the objectives and transparent, valid and reliable marks achieved. Therefore, the discussion of the key feature of clinical problem is a fundamental aspect for the Candidate passing in orthopaedics and traumatologic examination objectively. The discussion may be extended the basic medical and clinical sciences questions by the Examiners (illustration 4).

OSTEOARTHRITIS OF THE KNEE (KNEE OA)

Case Examination:

A 65-year-old female came to orthopaedic consultation with chief complaint of the right knee pain and stiffness since 5 years especially after walking. She consumed NSAIDs routinely based on general practitioner’s recommendation since 6 months ago but no improvement. She denied infection, trauma, past surgery, family and malignancy history. Physical examination on the right knee showed a bit swelling of the right knee and valgus deformity of right lower extremity (Fig. 4). Feeling examination of the right knee revealed tenderness on the margin of the knee joint, crepitus on patella and swelling. Range of the right knee motion was limited actively compared the left knee.

ORTHOPAEDICS EMERGENCIES

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ORTHOPAEDICS EMERGENCY (Primary Management)