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GRUP 15

Nerve and muscle pain

PRATIWI 11020160006
ANUGRAH FEBRIANTI AZIS 11020160033
INDAH DIAN LARASATI HUSADA 11020160061
ANDI MUH. RIFLAN ASTAR 11020160089
RHIZKY SHASQIA PUTRI NUR 11020160091
EMA MAGFIRAH 11020160156
MEISY GITA SILVA 11020160161
ANDI YUSNA KHAERUNNISA P. 11020160164
ROSDIANA BAHARSA 11020160170
SHAVIRA MD 11020160172
NUR RAHMA AMIRUDDIN 11020160173
SCENARIO 1
NERVE AND MUSCLE PAIN

A woman, 45 years old, to come in clinic


complaining right thumb weakened
suddenly I week earlier accompanied by
ache on index and middle finger. There
is numbness feeling on the thumb and
the pain is less if hand is wagged.
DIFICULT WORD
-Numbness
-Pain
-Wagging

KEY WORD
A woman 45 years old
Complain weakened on right thumb
One week earlier accompanied by ache on index
and midlle finger
Numbness feeling on the thumb
And the pain is reduced if the hand is wagged
THE QUESTION
What the organ involved causes nerve and muscle
pain on the scenario?
Why the pain just only on the middle and index
finger?
How to patomekanism of pain?
Why the pain reduced when a woman wagging her
hand?
How to step the diagnose?
What is Defferential Diagnose of the scenario?
What is appropriate diagnose from the scenario?
How the management of the diagnose?
How the preventation from diagnose?
The answer
What the organ involved causes nerve
and muscle pain on the scenario?
What make this woman feeling numbness just in middle and
index thumb

radialists
Saraf lengan medial tunnel sensory
ulnar
fingers continuous movement
long time stress on the network
degeneration tunnel narrowed
clinical symptoms amusement
N. Medial pain hand strength
decreased and stiff
Mechanism of pain
the process of pain stimulus by the nociceptor stimulation start noxious to the
occurrence of the subjective experience of pain is a series of electrical and
chemical events.
Transduction/recepto
r activation

Transmission

Modulation

Perception
Why does a little pain if hand wag

It is because the median nerve is suppressed


by the flexor retinaculum then if wiggles a
shift occurs so that there is space in the
median nerve.
Step Diagnosa

ANAMNESIS

Physical
examination Supporting
investigation
Patient identity
Anamnesis
Location
of pain
Quality of pain
Quantity or severity. Circumstances that trigger
a complaint
Other factors that relieve and aggravate the
symptoms
Other symptoms that accompany the main
complaint
Physical examination
Tinnels Test

Phalens Test

Sensibilitys Test
Laboratory
examination
Supporting investigation
Neurophysiology
examination

Supporting investigation

Radiological
Examination
Differential Diagnose
Symptoms Carpal Tunnel Tenosynovitis De StenosingTenosivitis (
Disease Syndrome Quervain Tringger Finger )

Etiology Increased pressure on Inflammation and Vascular-collagen


the median nerve thinning of the disease, including
retinaculum rheumatoid arthritis,
DM, psoariasis
arthritis, amyloidosis,
hypothyroidism,
sarcoidosis, and
sepsis

Predileksi On the fingers, The wrist joint The base of the finger
especially the thumb, and the base of usually occurs on the
forefinger, and middle the thumb middle finger, ring
finger finger, and little
finger
Symptoms Carpal Tunnel Tenosynovitis De StenosingTenosivitis (
Disease Syndrome Quervain Tringger Finger )

Clinical Found a sense of Tenderness and Fingers can not be


manifestations numbness, thick, sore, swelling on the straightened after
pain and punctured on wrist grasping and
the fingers, especially accompanied by pain
the thumb, index finger at the base of the
and the middle finger finger
Symptoms Morning and the Pain when The usual stiffness
symptoms get great at grasping and worsens in the
night, when you wake twisting the wrist morning and there is a
up, and when you raise klik when the sore
your hand fingeris bent and
straightened
Age 40-60 30-50 40-60
Gender Woman > Man Woman > Man Woman > Man
What is appropriate diagnose from the scenario?
The management of the diagnose
Take a rest for
wirst NSAID
Surgery
therapy

Installation of
splints in the
Phisiotherapy Therapy Management of neutral position
aimed at repairing Carpal Tunnel Syndrome of the wirst
vascularization

Vit B6 Steroid
Fluid control,
(Piridoksin) injection
for example
by giving the
pacient
diuretics
Preventation to avoid carpal tunnel
syndrome

Rest 15-20 minutes hand while doing the


activity
Keep your hands warn
Improve posture
Thank You

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