Learning Objective Week 5

1. Pain
- Pain is an unpleasant sensory and emotional experience that is associated with
actual or potential tissue damage or described in such terms.
- Primarily a protective mechanism meant to bring to conscious awareness the
fact that tissue damage is occurring or is about to occur
- Has instensity (scale), character.

2. Physiology of Pain
- injury terasa, immune cells ya tahu
- Cells damaged – keluarin cytokine dan prostaglandine

3. Different characteristic of pain

Myelinated - fast
Unmyelinated - slow

4. Yang nentuin severity of pain (dari bone, organ, dll)

5. Kenapa pada saat inflamasi fibrinogen lebih banyak dihasilkan

6. Bursitis
Bursae are small sacs lined with synovial membrane and lled with synovial uid; they
are located between tendons, muscles, and bony prominences. Their primary
function is to separate, lubricate, and cushion these structures. Acute bursitis occurs
primarily in the middle years and is caused by trauma. Chronic bursitis can result
from repeated trauma. Septic bursitis is caused by wound infection or bacterial in-
fection of the skin overlying the bursae. Bursitis commonly occurs in the shoulder,
hip, knee, and elbow.

Symptoms
If you have bursitis, the affected joint might:

 Feel achy or stiff

 Hurt more when you move it or press on it
 Look swollen and red
When to see a doctor
Consult your doctor if you have:

 Disabling joint pain

 Sudden inability to move a joint
 Excessive swelling, redness, bruising or a rash in the affected area
 Sharp or shooting pain, especially when you exercise or exert yourself
  A fever
Causes
The most common causes of bursitis are repetitive motions or positions that put pressure
on the bursae around a joint. Examples include:

 Throwing a baseball or lifting something over your head repeatedly

 Leaning on your elbows for long periods
 Extensive kneeling for tasks such as laying carpet or scrubbing floors
Other causes include injury or trauma to the affected area, inflammatory arthritis such as
rheumatoid arthritis, gout and infection.

Risk factors
Anyone can develop bursitis, but certain factors can increase your risk:

 Age. Bursitis becomes more common with aging.

 Occupations or hobbies. If your work or hobby requires repetitive motion or pressure
on particular bursae, your risk of developing bursitis increases. Examples include
carpet laying, tile setting, gardening, painting and playing a musical instrument.
 Other medical conditions. Certain systemic diseases and conditions — such as
rheumatoid arthritis, gout and diabetes — increase your risk of developing bursitis.
Being overweight can increase your risk of developing hip and knee bursitis.
Prevention
While not all types of bursitis can be prevented, you can reduce your risk and the severity of
flare-ups by changing the way you do certain tasks. Examples include:

 Using kneeling pads. Use some type of padding to reduce the pressure on your knees
if your job or hobby requires a lot of kneeling.
 Lifting properly. Bend your knees when you lift. Failing to do so puts extra stress on
the bursae in your hips.
 Wheeling heavy loads. Carrying heavy loads puts stress on the bursae in your
shoulders. Use a dolly or a wheeled cart instead.
 Taking frequent breaks. Alternate repetitive tasks with rest or other activities.
 Maintaining a healthy weight. Being overweight places more stress on your joints.
 Exercising. Strengthening your muscles can help protect your affected joint.
 Warming up and stretching before strenuous activities to protect your joints from
injury.

Diagnosis
Doctors can often diagnose bursitis based on a medical history and physical exam. Testing,
if needed, might include:
• Imaging tests. X-ray images can't positively establish the diagnosis of bursitis, but they
can help to exclude other causes of your discomfort. Ultrasound or MRI might be
used if your bursitis can't easily be diagnosed by a physical exam alone.
• Lab tests. Your doctor might order blood tests or an analysis of fluid from the inflamed
bursa to pinpoint the cause of your joint inflammation and pain.

Treatment
Bursitis generally gets better on its own. Conservative measures, such as
rest, ice and taking a pain reliever, can relieve discomfort. If conservative measures
don't work, you might require:
• Medication. If the inflammation in your bursa is caused by an infection, your doctor
might prescribe an antibiotic.
• Therapy. Physical therapy or exercises can strengthen the muscles in the affected area to
ease pain and prevent recurrence.
• Injections. A corticosteroid drug injected into the bursa can relieve pain and
inflammation in your shoulder or hip. This treatment generally works quickly and, in
many cases, one injection is all you need.
• Assistive device. Temporary use of a walking cane or other device will help relieve
pressure on the affected area.
• Surgery. Sometimes an inflamed bursa must be surgicall

Synovitis
Synovitis is an inflammation of the tissues that line a joint. It is commonly associated with specific
diseases, such as arthritis or gout, but it may also be the result of overuse or trauma. Symptoms
of synovitis may include redness, swelling, warmth and pain with joint motion.

Evaluation by a foot and ankle surgeon will help confirm the diagnosis and will help rule out other
possible concerns, such as fractures or infections. The surgeon may sample fluid from the joint to
analyze for inflammatory cells or may order x-rays or other advanced imaging tests to better
evaluate the affected joint.

Treatment for synovitis includes rest, ice, immobilization and oral nonsteroidal anti-inflammatory
drugs (NSAIDs), such as ibuprofen, and may include steroid injections into the joint. Surgery may
be indicated in longstanding cases.

7. Kenapa osteomyelitis bisa dibilang no sign?

8. X-ray Bursitis

X-ray Synovitis

X-ray Osteomyelitis