MANUALTERAPI SHOULDER COMPLEX INTERVENSI Pertemuan ke 6 Oleh : Sugijanto

TUJUAN INSTRUKSIONAL Mahasiswa memahami Intervensi pada kasuistik shoulder complex dengan cara : Mampu menjelaskan metoda dan dosis intervensi manualterapi kasus shoulder complex Mampu membedakan indikasi antara metoda dengan pemeriksaan khusus. Mampu mempraktekan intervensi manualterapi kasus shoulder complex Mampu menilai tentang hasil intervensi manualterapi kasus shoulder complex.

PERTANYAAN STUDI Sebutkan indikasi intervensi metoda manualterapi bila dijumpai patologi muscle pain sec. Tendinitis, Muscle tightness/contracture, Capsular pattern hypomobility, Joint hypermobility, Joint instability, dan sensoric deficit sec nerve entrapment. Uraikan dan praktekkan Teknik transverse friction pada: Bursa subdeltoidea; m. Supraspinatus, m. Infraspinatus, m. Subscapularis dan Biceps caput longus. Uraikan dan praktekkan teknik mobilisasi translasi caudal dan terapi latihan pada patologi Bursa subdeltoidea; m. Supraspinatus, m. Infraspinatus, m. Subscapularis dan Biceps caput longus.

Uraikan dan praktekkan Joint mobilisation traksi, translasi dan roll slide pada sendi Glenohumeralis, Acromioclavicularis, Sternoclavicularis, Intervertebralis dan costovertebralis-transversalis. Uraikan dan praktekkan mobilisasi otot dan contract relax stretching pada tightness/contracture m. Trapezius ascendens, m. Levator scapulae, m Pectoralis mayor dan Pectoralis minor Jelaskan dan praktekkan terapi latihan pada shoulder complex. Jelaskan dan praktekkan pengukuran hasil pada intervensi shoulder complex diatas.

INTERVENSION TECHNIQUE MUSCLE MOBILIZATION AND TRANSVERSE FRICTION Upper Trapezius m (lihat assessment) Levator scapulae (lihat assessment)

MUSCLE MOBILIZATION AND TRANSVERSE FRICTION Pectoralis major m. (lihat assessment) Pectoralis Minor m. (lihat assessment) Latissimus dorsi

TRANSVERSE FRICTION Supraspinatus m Infraspinatus m. Subscapularis m. Posisi Add-Internal rot penuh lengan bawah belakang punggung. Friction ventrocaudal acromion, arah lateromedial Infraspinatus m. Posisi Sphynx, friction tuberculum minus arah cranio-caudal. Subscapularis m. Posisi netral sedikit external rotasi, friction medial tuberculum minus Long head Biceps m Friction sulcus bicipitalis sambil gerak external-internal rot

JOINT MOBILIZATION GLENOHUMERAL JOINT Traction in MLPP Posisi bonnet, traction ke lateral

TRACTION IN LIMITED ROM GLENOHUMERAL JOINT Traction in Abduction Arah traction kelateral pada pembatasan ROM Abd;

TRACTION IN LIMITED ROM GLENOHUMERAL JOINT Traction external rotation Arah traction kelateral pada pembatasan ROM External rotation. Traction horiz Abd Arah traction kelateral pada pembatasan ROM

TRACTION IN LIMITED ROM GLENOHUMERAL JOINT Traction internal rotation Arah kelateral pembatasan ROM Internal rot. Traction in horizontal adduction Arah kelateral pembatasan ROM Horizontal add.

GLENOHUMERAL JOINT TRANSLATION IN LIMITED ROM Translation in Abduction Arah Caudal, utk pembatasan Abd

GLENOHUMERAL JOINT TRANSLATION IN LIMITED ROM Ventral translation utk pembatasan External rotation Ventral translation utk pembatasan Horizontal abduction

GLENOHUMERAL JOINT TRANSLATION IN LIMITED ROM Dorsal translation utk pembatasan Internal rotation Dorsal translation utk pembatasan Horizontal adduction

GLENOHUMERAL JOINT ROLL SLIDE Gerak angular fisiologis bersamaan translation seperti diatas. Penting untuk mengarahkan gerak fisiologis Diberikan akhir mobilisasi

JOINT MOBILIZATION ACROMIOCLAVICULAR JOINT Lateral traction MLPP: utk awal mobilisasi atau aktualitas tinggi Permbatasan retraction: Stretching yg membatasi retraction

ACROMIOCLAVICULAR JOINT TRANSLATION IN MLPP Awal mobilisasi / aktualitas tinggi TRANSLATION IN ELEVATION Stretching serabut oblique capsule yg membatasi elevation

ACROMIOCLAVICULAR JOINT TRANSLATION IN RETRACTION & PROTRACTION Stretching serabut oblique capsule yg membatasi retraction Stretching serabut oblique capsule yg membatasi Protraction

JOINT MOBILIZATION STERNOCLAVICULAR JOINT Lateral traction MLPP: utk awal mobilisasi atau aktualitas tinggi Permbatasan retraction: Stretching yg membatasi retraction

STERNOCLAVICULAR JOINT TRANSLATION IN ELEVATION Stretching serabut oblique capsule yg membatasi elevation

STERNOCLAVICULAR JOINT TRANSLATION IN RETRACTION Stretching serabut oblique capsule yg membatasi retraction

JOINT MOBILIZATION SCAPULOTHORACAL DORSAL TRACTION TRANSLATION Membebaskan perlekatan scapulothoracal TRANSLATION Lateral translation Cranial translation Caudal translation

MOBILIZATION EXERCISE CODMANN’S PENDULAR EXERCISE OVERHEAD PULLEY EXC ETC.

STABILIZING EXC PNF BUGNET DLL

Capsular pattern glenohumeral joint Nyeri & kaku bahu Massage Reverse humeroscapular rhythm Joint mobilization ROM: extern rot < Abd < intern rot Firm end feel Contract relax stretcing Joint play movement: Nyeri akhir ROM / Firm end feel Active mobilization exc

Bursitis subdeltoidea Nyeri posisi abd mid range Ultra sound pss ekstensi Painful arc Transverse friction pss ekstensi Non capsular pattern Caudal traction Palpasi lengan ekstensi Codmann pendular exc Cranial compression

Cuff tendinitis US dan Transverse friction pada posisi Nyeri posisi abd mid range Non capsular pattern Isometric under caudal traction Painful arc Isometric Abduction: Supraspinatus Isometric extr rot: Infraspinatus Isometric intr rot: Subscapulariss Isometric elbow flx: Long head biceps US dan Transverse friction pada posisi Lengan bawah blk punggung Sphynx: Add horiz-external rotation Netral: medial sulcus b.c.l. Netral: pd sulcus b.c.l. Grk lengan

KEPUSTAKAAN Dvorak, J and Dvorak, V, Medical checklists Manual Medicine, Gerg Thieme Verlag Stuttgart, New York, 1991. Donatelly R, Orthopaedic Physical Therapy, WB Saunders and co, 1998. Goodman, c.c. and Boissonault, W.G., Pathology, implication for the hpysical therapist, WB Saunders Co, Philadelphia, 1998. Kapanji, IA. Physiology of joint Vol I Upper extremity, Churchill Livingstone, Eidinburgh, 1986. Magee DJ, Orthopaedic physical assessment, WB Saunders and co, 2000. Mink, AJF, Extremiteiten, Bohn, Scheltema-Holkema, Utrecht, 1999. Maitland GD, Peripheral joint manipulation,