pbl

1. JOINT PAIN
Group 14 English Class
dr. Ogirahma

2. MEMBER OF GROUP 14
110 2016 0004 ANDI M. SHOFWATUL ISLAM HAFID
110 2016 0018 MUHAMMAD SOFHYAN FAJRIN
110 2016 0046 NURUL FITRIAH JUNAID
110 2016 0060 MUSTIKA
110 2016 0076 MUTMAINNA
110 2016 0110 NUR FITRIANY LIHAWA
110 2016 0118 NINADIYAH NURUL AZIZAH
110 2016 0125 S. AHMAD GUFRAN IDRUS
110 2016 0131 ANDI SESARINA TENRI OLA SAPADA
110 2016 0160 NUR AKHSAN DIANA A.R.
110 2016 0171 FIRMAWATI. AR

3. SCENARIO
A woman, 60 years old, come to community
health center with chief complain pain on
left flank after slipped on the floor 2 hours
earlier. The pain also spread to left hip joint
so that she can’t walk because of the pain.

4. KEYWORDS
• Woman
• 60 years old
• Complain pain
• On the left flank
• After slipped
• Pain spread
• To the left hip joint
• Can’t walk
• Because of the pain

5. DIFFICULT WORDS
Pain
The sensation of discomfort that is more or less localized due to
stimulation on the classify nerve endings. It serves as a
protective mechanism because it allows us to withdraw or away
from its source
Dorland, W.A Newman. 2002. Kamus Kedokteran Dorland. Jakarta : EGC. Edisi 29

6. QUESTIONS
1. Explain about the anatomy and physiology of
joint include the physiology formation of bone!
2. Explain the mechanism of pain and the types of
mechanical and inflammation pain!
3. Explain About Rotating Motion!
4. The Differential Diagnosis based on the scenario!

7. ANATOMY OF HIP JOINT
Syarifuddin. (2006). Anatomi Fisiologi untuk Mahasiswa Kedokteran, Edisi 3. Jakarta: EGC.

8. HISTOLOGY OF THE BONE
Vincent J. Vigorita. Orthophaedic Phathology 2nd Edition

9. PHYSIOLOGY OF THE BONE
Smeltzer, C.S., Bare, G.B., (2001). Buku Ajar Keperawatan Medical Bedah Brunner& Suddarth, Edisi 8, Volume 3, Penerbit EGC,
Jakarta.

10. MECHANISM OF PAIN
•
Setiyohadi, Bambang, Dkk. 2014. Buku Ajar Ilmu Penyakit Dalam. Jakarta: Interna Publishing.

11. MECHANISM OF INFLAMMATION
PAIN

12. MECHANISM OF MECHANICAL
PAIN

13. ROTATING MOTION
Hip Joint
• Flexion : 130’
• Extension : 30’
• Abduction : 45’
• Adduction : 20’
• Internal Rotation : 40’
• External Rotation : 40’
Nelson Arnold, Kokkonen Jouko,Stretching Anatomy,Human Kinetics,Edition 3,2012, Page 21

14. 4. The Differential Diagnosis based on the
scenario!
OSTEOARTHRITIS TROCHANTERIC
BURSITIS
FRAKTUR CAPUT
FEMORIS
GOUT RA
Definition OA is a
degenerative
joint disease
associated with
joint cartilage
damage.
Irritation or
inflammation of
the trochanteric
bursa
a disconnected
state of the
relationship of
the head of the
femur or the
neck of the
femur caused
by trauma.
is a metabolic
disorder
characterized
by increased
uric acid
concentration
in the
extracellular
fluid
Chronic systemic
inflammatory
disease of
unknown cause

15. Epidemiology • Men >
woman
• Prevalence
man 15,5 %
and woman
12,7%
• About
people who
aged > 40 th
predominantly
male (80%) with
a mean age of
52 years.
Anserine bursitis
is thought to be
more common in
middle-aged
women, but
there is no
evidence to
substantiate this.
most of these
fractures
occur in
elderly
women
whose bones
are already
osteoporosis
Gout is a
dominant
disease in adult
men and in
women who
have
monopouse
• The
prevalence
rate is
approximatel
y 1%
• between the
ages of 35
and 50
years.
OSTEOARTHRITIS TROCHANTERIC
BURSITIS
FRAKTUR
CAPUT
FEMORIS
GOUT RA

16. Etiology Age,
(genetic,
nutricional),
obesity,
malaligment,
joint injury,
excessive
joint use, and
muscle
weakness,
degradation of
articular
cartilage
The
trochanteric
bursa may be
inflamed by a
group of
muscles or
tendons
rubbing over
the bursa and
causing friction
against the
thigh bone.
Soft tissue
trauma
(injury
bleeding,
bruising,
partial tear
(sprain),
rupture,
blood vessel
and nerve
disorder
Abnormalities of
uric acid levels
in serum with
accumulation of
crystalline
deposits of
monosodium
urate.
An external
trigger or trauma
that triggers an
autoimmune
reaction, leading
to synovial
hypertrophy and
chronic joint
inflammation
along with the
potential for
extra-articular
manifestations,
OSTEOARTHRITI
S
TROCHANTERIC
BURSITIS
FRAKTUR
CAPUT
FEMORIS
GOUT RA

17. Mechanism
of injury
Degradation
(failure) of
cartilage,
inflammation
of joint fluid
Inflammation
of the bursa
increases
thinning in the
synovia
Fractures,
factors where
one side of the
bone is
cracked /
swollen / italic
when
monosodium
crystals have
been formed
on the joints.
OSTEOARTHRITI
S
TROCHANTERIC
BURSITIS
FRAKTUR CAPUT
FEMORIS
GOUT RA
hyperplasia of
joint fluid cells
and endothelial
cell activation
are the
incidence of
early
pathological
processes that
develop into
uncontrolled
inflammation
and result in
bone and
cartilage
destruction.
Mansjoer, Arif. 2000. Kapita Selekta Kedokteran. Edisi Ketiga. Jakarta: Media Aesculapius. Page 355-356

18. Signs of
symptoms
Joint pain, bone
enlargement,
crepitation,
morning
stiffness lasting
< 30 minutes
Pain, swelling of
the bones, heat
and red,
tenderness over
lateral pelvic
region and the
buffer radiating
downward to the
legs / knees.
Pain at night and
more pain if bent
or pressed.
There is a
history of
trauma, pain,
swelling in the
fractured
bone,
deformity,
musculoskelet
al dysfunction
due to pain,
bone
centraction
and
neurovascular
disorders.
Sweeling,
severe pain
Fever,
malaise,
arthalgias,
joint
inflammation
and
sweeling
OSTEOARTHRITIS TROCHANTERIC
BURSITIS
FRAKTUR CAPUT
FEMORIS
GOUT RA

19. Therapy NSAID
therapy,
health edu,
compress,
surgical
intervention
Local
injections of
corticosteroid
s, NSAIDs,
weight loss,
strengthening
and flexing
gluteus
medius and
iliotibial
muscles.
Bone
grafting
surgery.
NSAID Corticosteroid,
NSAID, surgical
treatment.
OSTEOARTHRITI
S
TROCHANTERIC
BURSITIS
FRAKTUR CAPUT
FEMORIS
GOUT RA
Noor, Zairin. Musculoskeletal Disorders Teachers. Jakarta: Salemba Medika. Page 506-507

20. Supporting
Examination
Complete
blood tests
include
hemoglobin
and
leukocyte
levels,
synovial test
and X- Ray
Erythrocyte
Sedimentation
Rate test, C-
reaktive
protein test
and X- Ray
X- Ray Synovial
test,
serum
uric acid
test,
complete
blood
tests
and X-
Ray
Erythrocyte
Sedimentation
Rate test, C-
reaktive protein
test and X- Ray,
MRI, Bone
Scanning
OSTEOARTHRITI
S
TROCHANTERIC
BURSITIS
FRAKTUR CAPUT
FEMORIS
GOUT RA
Noor, Zairin. Musculoskeletal Disorders Teachers. Ed. 2. 2015. Jakarta: Salemba Medika.

21. OSTEOARTHRITIS TROCHANTERIC
BURSITIS
FRAKTUR CAPUT
FEMORIS
GOUT RA
COMPLICATION Pharmacology:
1. NSAIDs
2. Analogues
such as
tramadol.
3. Muscle
relaxants
(muscle
relaxants).
4. Intraarticular
glucocorticoid
injection.
 Nonpharmacolo
gy:
1. Surgical
intervention
2. Atroscopy
3. Osteotomy
4. Fusion
(arthrodesis)
5. Joint
replacement
(arthroplasty)
Pharmacology:
NSAIDs,
acetaminophen,
and corticosteroid
injections
Non
pharmacology:
1. Protection by
debate or by
brace
2. Rest to avoid
the activity of
the joints to
reduce pain
3. Compress with
ice packs
4. Compression
with elastic
bandage
5. Elevation
6. Surgical
therapy
 Pharmacology
1. Antibiotics
2. Analgetic
3. Drugs that
contain lots
of calcium 
triocol
 Nonpharmaco
logy
1. Surgery
internal fixation 
in spongiosum
mounting pen,
wire, or nail
externa fixation 
on the skin
2. Non surgery
Installation of a
cast
Skin tractionn
skelet traction
Pharmacology:
1. NSAID's :
2. Colsichine.
3. Corticosteroi
d.
4. Probenecid
5. Allopurinol.
6. Uricosuric.
 Nonpharmaco
logy:
Surgical
intervention
 Pharmacologic
therapy
1. DMARD's
2. Glucocorticoids
3. NSAIDs
4. Analgesic
 Nonpharmacolo
gic therapy
1. Fasting therapy
2. Spa and
exercise
3.Supplementation
of essential fatty
acids
4. Provision of fish
oil supplements
5. Provide
education and
multidisciplinary
approach in patient
care
6. Surgery

22. • X- Ray
• Computed Tomography (Ct-scan)
• Magnetic Resonance Imaging (MRI)
• Angiography
• Digital Subtraction Angiography (DSA)
• Venogram
• Mielography
• Discography
• Artography
Sukman, Ningsih Nurna. 2009. Asuhan Keperawatan Pada Klien Dengan Gangguan Sistem Muskuloskeletal. Jakarta : Salemba Medika.

23. RADIOGRAPH IMAGE
Fraktur Collum Femoris Gout

24. KOREKSIAN!
• KATA KUNCI, BUKAN KALIMAT KUNCI
• EX : - WOMAN
• - 60 YEARS OLD
• - etc
• CANTUMKAN SEMUA PERTANYAAN DLM 1 SLIDE, KMDIAN JWBN
DIBELAKANG
• LENGKAPI EPIDEMIOLOGI
• PEMERIKSAAN PENUNJANG MASUKKAN DI TABEL MASING-MASING DD
• PISAHKAN TERAPI NONFARMAKOLOGI&FARMAKOLOGI
• MASUKKAN KOMPLIKASI PENYAKIT & PREVENTIVE