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Jenis Nyeri Jenis nyeri dapat dinyatakan dalam beberapa hal, seperti: berdasarkan mekanisme
nyeri, berdasarkan kemunculan nyeri dan berdasarkan klasifikasi nyeri wajah.
Berdasarkan Mekanisme Nyeri Nyeri dapat diklasifikasikan dalam 3 jenis yaitu
1. Nyeri fisiologis, terjadinya nyeri oleh karena stimulasi singkat yang tidak merusak
jaringan, misalnya pukulan ringan akan menimbulkan nyeri yang ringan.
2. Nyeri inflamasi, terjadinya nyeri oleh karena stimuli yang sangat kuat sehingga merusak
jaringan. Kebanyakan pasien mengeluhkan nyeri bila jaringan atau organ yang mendapat
stimuli, misalnya: sakit gigi semakin berat bila terkena air es atau saat makan, sendi yang
sakit semakin hebat bila digerakkan.
3. Nyeri neuropatik adalah nyeri yang didahului dan disebabkan adanya disfungsi primer
ataupun lesi pada sistem saraf yang diakibatkan: trauma, kompresi, keracunan toksin atau
gangguan metabolik. Timbul akibat gangguan pd jalur sensorik di semua tingkat mulai dari
saraf tepi sampai ke sistim Saraf Pusat ->Nyeri Sentral, kerusakan serabut saraf perifer

Berdasarkan Kemunculan Nyeri

1. Nyeri akut, nyeri yang biasanya berhubungan dengan kejadian atau kondisi yang dapat
dideteksi dengan mudah. Nyeri akut merupakan suatu gejala biologis yang merespon stimuli
nosiseptor (reseptor rasa nyeri) karena terjadinya kerusakan jaringan tubuh akibat penyakit
atau trauma.13,14 Nyeri ini biasanya berlangsung sementara, kemudian akan mereda bila
terjadi penurunan intensitas stimulus pada nosiseptor dalam beberapa hari sampai beberapa
minggu. Contoh nyeri akut ialah nyeri akibat kecelakaan atau nyeri pasca bedah. ~ sering
disertai : * kontraksi otot * aktivasi ss otonom
~ prototipe nyeri akut : nyeri pasca bedah

2. Nyeri kronik, nyeri yang dapat berhubungan ataupun tidak dengan fenomena patofisiologik
yang dapat diidentifikasi dengan mudah, berlangsung dalam periode yang lama dan
merupakan proses dari suatu penyakit. Nyeri kronik berhubungan dengan kelainan patologis
yang telah berlangsung terus menerus atau menetap setelah terjadi penyembuhan penyakit
atau trauma dan biasanya tidak terlokalisir dengan jelas. Nyeri wajah atipikal adalah salah
satu nyeri kronik. ~ bersumber dari peny.kanker  Nyeri kanker ~ tidak bersumber dari
peny.kanker  Nyeri kronik.
Gejala menetap melampaui proses penyembuhan normal  > 1 - 6 bln.
* patofisiologi tidak jelas  sering ditemukan gangguan pd sistim inhibisi  disertai gangguan
emosional : depresi berat sampai putus asa.

Berdasarkan Klasifikasi Nyeri Wajah

1. Nyeri somatik, nyeri yang dapat dihasilkan dari stimulasi reseptor-reseptor neural ataupun
saraf-saraf periferal. Nyeri Somatik diartikan sebagai nyeri yang disebabkan oleh cedera
pada kulit, otot, tulang, sendi, dan jaringan ikat.

2. Nyeri neurogenik, nyeri yang dihasilkan dalam sistem sarafnya sendiri, reseptor saraf
ataupun stimulasi serabut yang tidak diperlukan. Karakteristik klinis dari nyeri neurogenik,
yaitu: nyeri seperti membakar dengan kualitas 10 Universitas Sumatera Utara
menstimulasikan, lokalisasi baik, adanya hubungan yang tertutup diantara lokasi dari nyeri
dan lesi, pengantaran nyeri mungkin dengan gejala-gejala sensorik, motorik dan autonomik.
1. Adalah nyeri yang tidak ditimbulkan oleh stimulus,gangguan fungsi tranmisi nyeri atau
gangguan modulasi neuron. Mekanisme nyeri psikogenik lebih mirip dengan
 mimpi,halusinasi atau memori dan sama sekali berbeda dengan nyeri atau sensasi yang
datang dari nosiseptor.

Berdasarkan proses terjadinya, nyeri dikategorikan menjadi tiga jenis, yaitu:

2. Nyeri nosiseptif
Nyeri Nosiseptif Timbul akibat terangsangnya nosiseptor oleh adanya kerusakan
jaringan.
3. NON NOSISEPTIF : neuropatik sentral psikogenik periferal
4. Berdasarkan TEMPORAL (kaitannya dg waktu ) a. Akut b. Kronik : malignan non
malignan : neuropatik non neuropatik
5. Berdasarkan ETIOLOGI Nyeri kanker  Post herpetic neuralgia (PHN)  Pain of
sickle cell disease  Pain of arthritis
6. Berdasarkan NYERI REGIONAL Headache Orofacial pain  Low back pain 
Pelvic pain
7. Nyeri Viceral adalah nyeri yang mengacu pada rasa sakit yang berasal dari cedera
berkelanjutan untuk organ atau jaringan. Ketika jaringan terluka, seperti usus atau
kandung empedu, rasa sakit yang terjadi adalah timbulnya nyeri lokal dan
kram. terutama organ visceral yang disebabkan karena trauma atau nyeri punggung bawah
karena jepitan/benturan.
8. NYERI SENTRAL
Adalah nyeri yang disebabkan oleh karena rusaknya serabut perifer pada nyeri sentral yang
rusak adalah sistem saraf pusat sendiri (otak)

Development of limb bones is via endochondral ossification

 Mesenchyme begins to condense into chondrocytes

 Chondrocytes form a model of the prospective bone
 Blood vessels invade the center of the model, where osteoblasts localize, and proliferation
is restricted to the ends (epiphyses)
 Chondrocytes toward the shaft (diaphysis) undergo hypertrophy and apoptosis as they
mineralize the surrounding matrix.
 Growth of the long bones continues into early adulthood and is maintained by FGF-
dependent proliferation of chondrocytes in the growth plates (long bones have two
growth plates, in smaller bones (phalanges), there is only one at the tip).
Limb formation[edit]
Limb bud[edit]
Main article: Limb bud
Limb formation begins in the morphogenetic limb field. Limb formation results from a series
of epithelial-mesenchymal inductions between the mesenchymal cells of the lateral plate
mesoderm and the overlying ectodermal cells. Cells from the lateral plate mesoderm and
the myotome migrate to the limb field and proliferate to the point that they cause
the ectoderm above to bulge out, forming the limb bud. The lateral plate cells produce
the cartilaginous and skeletal portions of the limb while the myotome cells produce
the muscle components.
The lateral plate mesodermal cells secrete fibroblast growth factors (FGF7 and FGF10) to induce
the overlying ectoderm to form an organizer at the end of the limb bud, called the apical
ectodermal ridge (AER), which guides further development and controls cell death.[7] The AER
secretes further growth factors FGF8 and FGF4 which maintain the FGF10 signal and induce
proliferation in the mesoderm.[citation needed] The position of FGF10 expression is regulated by
two Wnt signaling pathways: Wnt8c in the hindlimb and Wnt2b in the forelimb. The forelimb and
the hindlimb are specified by their position along the anterior/posterior axis and possibly by
two transcription factors: Tbx5 and Tbx4, respectively

I. Limb development
1. The first primordium of the upper limb appears about the 24th day and that of the
lower limb at about day 2 The essential basic constituents of the limbs are
distinguishable at day 3
2. The distal ends of the limb buds flatten into paddle-shaped hand or foot plates, and
the respective digits form at the margins of these plates
3. The limb acquires its distal segment in week Shortly after this, a groove divides the
proximal segment, and the limb now consists of its 3 definitive segments.
Development of the upper limb is more advanced than that of the lower
4. Chondroblasts appear in the precartilaginous matrix which fragments to form the
various skeletal parts. Between them, the first joint structures make their appearance
toward week
5. As the bones form and limbs elongate, myoblasts aggregate and form the large
muscle masses in each limb
a. The muscle masses separate into dorsal (extensor) and ventral (flexor)
components
6. Early in week 7, the limbs move ventrally, and the developing arms and legs rotate to
different degrees and in opposite directions
a. Initially, the flexor surface of the limbs is ventral and the extensor surface is
dorsal, with the preaxial and postaxial borders being cranial and caudal,
respectively
b. With rotation, the upper limbs rotate laterally through 90 degrees on their
long axes, the elbows come to face posteriorly, and the extensor muscles
come to lie on the outer or dorsal aspect of the arm
c. With rotation, the lower limbs rotate medially through 90 degrees on their
long axes, the knees face forward or ventrolaterally, and the extensor
muscles come to lie on the ventral aspect of the legs

EMBRYOLOGY
Stages in Development of Upper Limb • 29 days: appearance of limb buds • 33 days:
hand plate forearm, arm & shoulder • 37 days: digital plate (thick distal ridge) carpal
region (central) forearm and arm distinct • 38 days: finger rays (indentations outline
 finger tips) • 42 days: deep notches separate fingers • 52 days: fetal pads (distal
swellings) on fingers
Stages in Development of Lower Limb • Lags behind upper limb by 3 to 7 days • 32
days: appearance of lower limb buds • 37 days: thigh, leg and foot plate • 44 days:
tarsal region and toe rays • 52 days: indentations outline toes • 56 days: toes fully
formed.

Spine and Spinal Cord Development

 Somites
o the spinal column originates from pairs of mesodermal structures known as
somites
o somites develop in a cranial to caudal direction on either side of the
notochord and neural tube
 this process is dependent on the presence of the paraxis gene
o somite layers
 sclerotome
 layer will become the vertebral bodies and annulus fibrosus
 myotome
 will lead to myoblasts
 dermatome
 becomes skin
 Dorso-vental patterning
o dorso-vental patterning of the neural tube determined by counteracting
activities of
 Sonic Hedgehog (Shh)
 in the floor plate and notochord (ventral)
 canonical Wnt/β-catenin
 in the roof plate (dorsal)
 Metameric shift phenomenon
o the phenomenon of how the spinal nerves, which originally ran in the
center of the sclerotome, exit between the two vertebral bodies at each
level.
 Progression
o neural crest
 forms PNS, pia mater, spinal ganglia, sympathetic trunk
o neural tube
 forms spinal cord
o notochord
 forms anterior vertebral bodies and nucleus pulposus
 Ossification centers
o vertebrae have 3 primary ossification centers
 centrum (anterior vertebral body)
 neural arch (posterior elements, pedicles, small portion of
anterior vertebra)
  costal element (anterior part of lateral mass, transverse
process, or rib)
 Intervertebral disc
o nucleus pulposus forms from notochord
o annulus fibrosus forms from sclerotome
Development of the spine and spinal cord begins during the third week
of gestation. Early development includes formation of primitive neural
tissue, notochord develop- ment, and of the axes of the embryo. The
axial skeleton eventually arises from the somites, while the central ner-
vous system (CNS) arises from primordial mesoderm. Neurons within
the CNS sprout axons form mixed spi- nal nerves that extend to the
appropriate end organs cre- ating the peripheral nervous system
(PNS). Mesodermal vertebrae eventually give way to a cartilaginous
anlage, which is then progressively ossified (mengeras jadi tulang),
forming the mature vertebrae. Secondary vertebral ossifi cation centers
and the neurocentral synchondroses persist(bertahan) until the third
decade of life and allow growth of the spinal canal during development.

The 13 Major Muscle Groups of the Body and their Functions

CHEST
The main muscle group of the chest is the pectorals.

1. Pectorals
The pectorals or pecs are the large chest muscles. They are full of thick muscle
fibers and add size to the upper body. The chest is divided into two parts, pectoralis
major, and pectoralis minor. They provide support when you hold objects in front of
your body and they are activated when you reach across your body. The pecs are
activated many everyday movements, mainly at the shoulder joint

BACK
The back is the most complex major muscular structure in the entire body. It is a
perfect combination of multiple muscles working in harmony and complementing
each other in various physical activities. The back rises from the buttocks and
stretches until the neck and shoulders. There are essentially five muscle groups
present in the back. They are:

2. Latissimus Dorsi
It is a large, flat muscle on the back that stretches to the sides, behind the arm, and
is partly covered by the trapezius on the back near the midline. It is called as ‘lats’ or
the‘wings’.

The lats facilitate the body in pulling movements and compliment the arms in
pursuing various physical activities like pulling something into your body, or when
you take something down from a shelf above your head. Also, they are heavily
involved in many swimming movements.

3. Rhomboid
The rhomboids are located in the upper back. They are underneath the trap muscles
and not visible from outside. They originate from the spinal cord and merge into the
scapular bone. These muscles can’t be seen but they play a vital role in
strengthening the scapulae and all the back movements.

4. Trapezius
Also known as, the traps, that are located between shoulders and the neck. The
traps can further be classified into three divisions- the upper traps, middle traps, and
the lower traps,

The traps control the scapulae or the shoulder blades and play an important role in
shrugging and neck movements. They are used to tilt and turn the head and neck
and shrug the shoulders. They also provide support when you lift items over your
head.

5. Teres Muscle

This muscle lies underneath the ‘lats’. It works with the lats as well as the rotator
cuffs.

6. Erector spinae
The erector spinae or spinal erectors is a set of muscles that straighten and rotate
the back. They are actually deep muscles that help to extend the spine and are key
in posture. They are also important when bending forward, and sideways.
ARMS AND SHOULDERS

7. Biceps
This muscle is found in the front of the upper arm. The biceps help control the
motion of both the shoulder and elbow joints. At the elbow, the biceps are essential
in lifting, and at the shoulder, they help with moving the arms sideways, forward and
upwards. Basically, this muscle helps bend or curl the arm toward your body.

8. Triceps
The triceps are muscles in the back of the upper arm. These muscles help stabilize
the shoulder joint and allow the elbow joint to be straightened. The triceps are
utilized in passing and shooting a basketball, and help with finite movements such as
in writing, drawing or even push and pull.

9. Deltoids
The deltoids, or delts, are known as the shoulder muscles. This muscle group is
used on all side of body lifting motions. They provide support when you carry things
and help keep carried items away from the motion path of the thighs. The deltoid
muscle consists of 3 parts: anterior deltoid, medial deltoid, and posterior deltoid.

ABDOMINAL

10. Obliques
The muscle group on the sides of the abdominals are the obliques. Movement of
these muscles may result in several actions, but they are best known for their lateral
flexion and rotation of the trunk known as a side bend. The obliques help support the
spine from the front. They are also vital in keeping a good posture.

Other important abdominal muscles include:

 Gluteus medius: One of three gluteal muscles, the gluteus medius connects
the ilium to the top of the femur. It controls the level of the hips and allows the
thighs to rotate.
  Gluteus maximus: The largest and outermost muscle of the buttock, the
gluteus maximus attaches to several places in the pelvis and thigh. It allows
you to extend your upper leg, spread it, and turn it outward.

 Serratus anterior: A group of muscles connected to the rib cage, which help
stabilize the shoulder.

 Psoas major: These muscles connect the lower part of the spine to the ilium
and the femur and aids in flexing the hips.

LEGS AND BUTTOCKS

11. Hamstrings
The hamstrings are the huge muscle group in the upper back part your thighs. Its
main function is to bend your knees and help propel your body forward in such
activities as walking, running, jumping, or doing a Krav Maga kick. They are also
used during squats and deadlifts.

12. Gluteals
The glutes are muscles of your buttocks and the largest muscles in your body. They
are key muscles in the movement of the legs backward and sideways. The glutes
also help you maintain balance in walking or running.

13. Gastrocnemius
Commonly called as the calf muscles. The calves are located in the lower back part
of your legs. They are key muscles when you lift your heels up, such as when you
walk, run, and go upstairs. They are also important for explosive moves such as
sprinting, jumping and climbing.

Dermatome Edit

The dermatome is the dorsal portion of the paraxial mesoderm somite which gives
rise to the skin (dermis). In the human embryo it arises in the third week of
embryogenesis.[2] It is formed when a dermamyotome (the remaining part of the
somite left when the sclerotome migrates), splits to form the dermatome and the
myotome.[2] The dermatomes contribute to the skin, fat and connective tissue of the
neck and of the trunk, though most of the skin is derived from lateral plate
mesoderm.[2]

Myotome Edit

The myotome is that part of a somite that forms the muscles of the animal.[2] Each
myotome divides into an epaxial part (epimere), at the back, and a hypaxial part
(hypomere) at the front.[2] The myoblasts from the hypaxial division form the
muscles of the thoracic and anterior abdominal walls. The epaxial muscle mass
loses its segmental character to form the extensor muscles of the neck and trunk of
mammals.

Sclerotome Edit

The sclerotome forms the vertebrae and the rib cartilage and part of the occipital
bone; the myotome forms the musculature of the back, the ribs and the limbs; the
syndetome forms the tendons and the dermatome forms the skin on the back. In
addition, the somites specify the migration paths of neural crest cells and the axons
of spinal nerves. From their initial location within the somite, the sclerotome cells
migrate medially towards the notochord. These cells meet the sclerotome cells from
the other side to form the vertebral body. The lower half of one sclerotome fuses with
the upper half of the adjacent one to form each vertebral body.[10] From this
vertebral body, sclerotome cells move dorsally and surround the developing spinal
cord, forming the vertebral arch. Other cells move distally to the costal processes of
thoracic vertebrae to form the ribs
12. The Branchial Region

The lumbar plexus is a web of nerves

(a nervous plexus) in the lumbar region of the
body which forms part of the larger lumbosacral
plexus. It is formed by the divisions of the first
four lumbar nerves (L1-L4) and from
contributions of the subcostal nerve (T12), which
is the last thoracic nerve.
The nerves of the lumbar plexus pass in front of
the hip joint and mainly support the anterior part
of the thigh. The anterior divisions of the lumbar
nerves, sacral nerves, and coccygeal nerve form
the lumbosacral plexus, the first lumbar nerve
being frequently joined by a branch from the
twelfth thoracic. For descriptive purposes this
plexus is usually divided into three parts:

 lumbar plexus
 sacral plexus
 pudendal plexus