LAPORAN STATUS KLINIK S1 FISIOTERAPI

FISIOTERAPI MUSKULOSKELETAL
PROGRAM STUDI FISIOTERAPI
UNIVERSITAS MUHAMMADIYAH SURAKARTA
Nomor Urut : / /

NAMA MAHASISWA : Nadia Irawan

N.I.M. : J120190136
TEMPAT PRAKTIK : Klinik Umi Salmi
PEMBIMBING : Umi Salmi, S.Ft.,FTR
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Tanggal Pembuatan Laporan : Jumat, 12 Agustus 2022

I. KETERANGAN UMUM PENDERITA

Nama : Tn S
Umur : 48 tahun
Jenis Kelamin : Laki-Laki
Agama : Islam
Pekerjaan : Swasta
Alamat : Boyolali
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II. DATA-DATA MEDIS RUMAH SAKIT

A. DIAGNOSIS MEDIS :
tgl, Piriformis Syndrome (Sinistra)

B. CATATAN KLINIS :
(Hasil : Foto Rontgen, uji Laboratorium, CT-Scan, MRI, EMG, EKG, EEG, dll yang
terkait dengan permasalahan fisioterapi).
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C. TERAPI UMUM ( GENERAL TREATMENT ) :

D. RUJUKAN FISIOTERAPI DARI DOKTER :

III. SEGIFISIOTERAPI
tgl: 1 Agustus 2022
A. A N A M N E S I S (AUTO / HETERO *))

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 1. KELUHAN UTAMA:
Pasien mengeluhkan nyeri pada area bokong kiri dan sekitarnya saat digunakan
untuk duduk yang lama, atau saat beraktivitas seperti mengendarai motor. Pasien
juga mengeluhkan menjadi gampang capek.

2. RIWAYAT PENYAKIT SEKARANG:

Pasien merasakan nyeri pada pantat sebelah kiri setelah pernah jatuh semenjak 2
bulan yang lalu. Nyeri dirasakan atau bertambah saat duduk lama dan melakukan
aktivitas.

3. RIWAYAT PENYAKIT DAHULU:

Pernah kepleset tapi sudah lama sekali.
4. RIWAYAT PENYAKIT PENYERTA:
Tidak ada.

5. RIWAYAT PRIBADI DAN KELUARGA:

Tidak ada.

6. ANAMNESIS SISTEM:
Sistem Keterangan
(tdk dikeluhkan, dalam batas normal)
Kepala dan Leher Tidak dikeluhkan
Kardiovaskuler Tidak dikeluhkan
Respirasi Normal
Gastrointestinalis Normal
Urogenital Tidak dikeluhkan
Muskuloskletal Spasme otot piriformis
Nervorum Tidak dikeluhkan

B. PEMERIKSAAN
1. PEMERIKSAAN FISIK
1.1. TANDA - TANDA VITAL:
a) Tekanan darah : 150/90 mmHg
b) Denyut Nadi : 85x/menit
c) Pernapasan : 24x/menit
d) Temperatur : normal
e) Tinggi Badan : -
f) Berat Badan :-

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1.2. INSPEKSI (STATIS & DINAMIS) (Posture, bengkak, gait, tropic change,
dll):

1.3. PALPASI (nyeri, spasme, suhu lokal, tonus, bengkak, dll):

- terdapat nyeri tekan pada otot- otot piriformis
- terdapat spasme otot piriformis kiri
- suhu local normal
- tidak terdapat bengkak

1.4. PERKUSI (refleks fisiologis):

-

1.6. GERAKAN DASAR:

a Gerak Aktif :
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b Gerak Pasif:
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c Gerak Isometrik Melawan Tahanan:
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1.7. KOGNITIF, INTRA PERSONAL & INTER PERSONAL:

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1.8. KEMAMPUAN FUNGSIONAL & LINGKUNGAN AKTIVITAS:

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1.9. PEMERIKSAAN
a. Nyeri
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b. MMT
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c. LGS
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d. Antropometri
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e. Test Khusus sesuai kelainan/penyakit/gangguan
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f. Dll.
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2.0 DIAGNOSIS FISIOTERAPI

a. Impairment
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b. Functional Limitations
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c. Disability
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C. PROGRAM/RENCANA FISIOTERAPI
1. Tujuan
a. Jangka Pendek
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b. Jangka Panjang
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2. TINDAKAN FISIOTERAPI:
a. Teknologi Fisioterapi:
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b. E d u k a s i:
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3. R E N C A N A E V A L U A S I:
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F. PELAKSANAAN FISIOTERAPI:
1. Hari: Tgl:
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G. E V A L U A S I:
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H. HASIL EVALUASI TERAKHIR:
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J. CATATAN PEMBIMBING PRAKTIK:

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_______________, ______________20….
PEMBIMBING

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NIP/NIK.

K. CATATAN TAMBAHAN:
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L. Underlying Process

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