Nyeri dan paraesthesia pada

TOS jenis scalenus syndrome

 Nyeri dan paraesthesia sc
TOS scalenus syndrome
Functioning, disability and
Contextual factors
health

Anatomic impairment Internal factors External factors

Scalenus m Brachial plexus Brachial a.

spasm
Circulatory
restriction
Compression
Spasm
& entrapment inflamation
- Tight
Functional
Neuropraxia Neural impairment
Activity
Contracted adhesion limitation
Participation
1strib Sub Forward head restriction
posture Carrying
luxation
Pain &
Paresthesia Dressing
Work
Cervicothoracal
pain syndrome Dll Sport
Cervical spine
hypomobility Recreation
PEMERIKSAAN FISIOTERAPI YG
DIBUTUHKAN

 Diutamakan pemilihan evidence

untuk:
◦ Pemeriksaan
◦ Pemeriksaan
◦ Pemeriksaan Sensoris
◦ Pemeriksaan Motoric
◦ Pemeriksaan
◦ Pemerikisaan disabilitas
FISIOTERAPI YG DIBUTUHKAN
 MODALITAS DAN METODA
◦ Anatomic target
◦ Functional target
◦ Impairment target
◦ Disability target
 Contoh:
◦ Electrical stimulation NMES
◦ Strengthening exercises
◦ Stabilization exc
◦ Dll
 ALAT UKUR/EVALUASI
FISIOTERAPI YG DIBUTUHKAN

 Pengukuran
 Pengukuran Integritas sensoric
 Pengukuran
 Pengukuran movement disfunction
 Pengukuran disabilitas
Scalenus vs pectoralis minor
syndrome TOS
 Gangg somestesia/brachialgia
 Gejala terbalik hiper abduksi lengan
dan depresi bahu
 Kompresi/neuropraksia posisi ttt
 Pilahkan dgn costoclavicular dan
cervical ribs syndrome
 Gangguan somestesia dan/protopatik
pd posisi vs menetap
 Forward head position vs girdle
protracted
 → psudoradicular pain
Sugijanto, 2015
 NYERI & PARESTHESIAS PD
SCALENUS VS PECTORALIS MINOR
SYNDROME TOS

Gangg somestesia/ Contract relax stretching

brachialgia

Gejala terbalik hiper

Muscle autostretching
abduksi lengan dan
depresi bahu Muscle
contracture Neural mobilization
Kompresi/neuropraksip Peripheral nerve
d posisi ttt
entrapment Postural correction &
Forward head posture Neurofibrosis proper neck – body
vs girdle protracted mechanic

Sugijanto, 2015
Assessment
 Paraesthesia lengan-tangan kdg dgn nyeri pd area
nervina
 Meningkat bl menjinjing barang (scalenus) atau
tidur lengan kekepala (pectoralis minor)
 Posisi kepala forward head position (scalenus)
girdle protracted (pectoralis minor)
 Orientasi abduksi-elevasi saat hiper abduksi
ditahan tmbul paresthesia (pectoralis minor)
 Lateral fleksi kontralat pasif paresthesia
(scalenus)

Sugijanto, 2015
Tes khusus dan data medik
 Adson test (scalenus) positif atau
hyperabduction test (pect minor)
positif
 Palpasi scalenus dan nerve trunk nyeri
semutan hingga ke tangan
 Tinnel test
 Neurodinamic test via:
◦ N. Radialis
◦ N. Medianus,
◦ N. Ulnaris

Sugijanto, 2015
TES & INTERVENSI

Intervensi Scalenus Syndrome

 Contract relax stretching m. scalenus
 Mobilisasi costa1
 Neural mobilization nerve trunk via:
 N. radialis
 N. Medianus
 Postural correction retraksi cervical (scalenus)
Reevaluasi: Pain, paresthesia

Sugijanto, 2015
Intervensi Pectoralis minor Syndrome

 Contract relax stretching m. Pectoralis minor (dan pectoralis

mayor)
 Neural mobilization nerve trunk via:
 N. Medianus
 N. Ulnaris
 Postural correction girdle retraction (pect minor).

Sugijanto, 2015