Listyani Gunawan

-405090258-
LO
MM anatomi & histologi otot ekstremitas bawah
MM fisiologi kontraksi & kerja otot
MM epidemiologi
MM kelainan tendon
Etiologi, tanda&gejala,patfis, pem fisik&penunjang,
Tatalaksana(farmako&non Farmako)
MM DD
MM komplikasi dan prognosis
Muscular Tissue
3 types of muscular tissue : skeletal, cardiac, and
smooth.
4 important function : producing body movement,
stabilizing body positions, moving substances within
the body & regulating organ volume, and producing
heat
4 properties of muscular tissue : electrical excitability,
contractility, extensibility, elasticity
Histologi
Klasifikasi otot
berdasarkan ciri
morfologi dan
fungsional :
Otot skelet
Otot jantung
Otot polos
Otot Rangka
Otot Jantung
Otot Polos
Muscle
Sceletal muscle that produce movement do so by pulling on
bones
The attachment to the more stationary bone is the origin;
the attachment to the more movable bone is insertion
Fascicular arrangement include parallel, fusiform, circular,
triangular, and pennate. Fascicular arrangement affects a
muscle’s power and range of motion
A prime mover produces the desired action; an antagonist
produces an opposite action. Synergist assist a prime mover
by reducing unnecessary movement. Fixators stabilize the
origin of a prime mover so that it can act more efficiently
 Otot extremitas inferior

1. Otot-otot pangkal paha

2. Otot-otot tungkai atas

3. Otot-otot tungkai bawah

4. Otot-otot kaki
OTOT PANGKAL PAHA
1. Otot bagian luar

2. Otot bagian dalam

1. Otot bagian luar
a. M. gluteus maximus

b. M. gluteus medius

c. M. gluteus minimus

d. M. piriformis

e. M. obturator internus

f. M. gemellus superior

g. M. gemellus inferior

h. M. quadratus femoris

i. M. obturator externus

j. M. tensor fasciae latae e+f+g = M. triceps coxae

1. Otot bagian luar
i. M. obturator externus
a. M. gluteus maximus

j. M. tensor fasciae latae

2. Otot bagian dalam

a. M. psoas minor

b. M. psoas major

c. M. iliacus

b+c = M. iliopsoas
OTOT TUNGKAI ATAS
1. Otot-otot ventral

2. Otot-otot medial / penggerak

ke tengah

3. Otot-otot dorsal
1. Otot-otot ventral

a. M. sartorius

b. M. quadriceps femoris
 M. rectus femoris
 M. vastus medialis
 M. vastus lateralis
 M. vastus intermedius

c. M. articularis genu*
2. Otot-otot medial / penggerak ke
tengah

a. Lapis luar
 M. pectineus
 M. adductor longus
 M. gracilis
b. Lapis dalam

 M. adductor brevis

 M. adductor minimus

 M. adductor magnus
3. Otot-otot dorsal

a. M. semitendinosus

b. M. semimembranosus

c. M. biceps femoris
i. Caput longum

ii. Caput breve

a+b+c = M. ischiocrurales

a+b+c(i) = M. hamstring
 OTOT TUNGKAI BAWAH
1. Otot-otot ventral

a. M. tibialis anterior

b. M. extensor digitorum longus

c. M. extensor hallucis longus

d. M. peroneus/fibularis tertius
2. Otot-otot dorsal

a. Lapis dangkal
i. M. plantaris

ii. M. gastrocnemius
 Caput mediale
 Caput laterale

iii. M. soleus
• ii + iii = M. triceps surae
b. Lapis dalam

i. M. popliteus

ii. M. flexor digitorum longus

iii. M. tibialis posterior

iv. M. flexor hallucis longus

c. Otot-otot lateral

i. M. peroneus / fibularis longus

ii. M. peroneus / fibularis brevis

 OTOT KAKI
1. Otot-otot bagian dorsal

a. M. extensor hallucis brevis

b. M. extensor digitorum brevis

2. Otot-otot plantar
a. Otot-otot sisi medial
i. M. abductor hallucis

ii. M. flexor hallucis brevis

iii. M. adductor hallucis

 Caput obliquum
 Caput transversum
b. Otot-otot sisi lateral

i. M. abductor digiti minimi pedis

ii. M. flexor digiti minimi brevis pedis

iii. M. opponens digiti minimi *

c. Otot-otot tengah kaki

i. M. flexor digitorum brevis

ii. M. quadratus plantae

iii. Mm. lumbricales pedis

iv. Mm. interossei pedis

 Mm. interossei plantares
 Mm. interossei dorsales pedis
Contraction
1. Myosin ATPase hydrolyzes ATP and becomes
energized
2. The myosin head attaches to actin, forming a
crossbride
3. The crossbridge generates force as it rotates toward
the center of the sarcomere(Power Stroke)
4. Binding of ATP to the myosin head detaches it from
actin. The myosin head again hydrolyzes the ATP,
returns to its original position and binds to a new
site on actin as the new cycle
data collected from Finland estimates that it occurs in
18 per 100,000 people yearly.
 The male-to-female ratio of rupture is estimated
from 1,7:1 to 12:1.
Etiology & Risk Factor
Overuse Misalignment
 Too fast of an increase in athletic activities such  Examples:
as:  Unequal leg length
 Running or walking longer
 Over or under pronation
 Running or walking faster
 Short or tight Achilles tendons or calf
 Running or walking up and down more or
muscles
steeper hills or stairs
 Disproportionably weak calf muscles
 More or more powerful “explosive”
movements such as lunges, jumps, or  push  Misshapen heel or other foot bones.
off’s.   Types of injuries caused:
 The athletic activity by itself is not the  Achilles tendinosis
problem, the problem is doing too much too  Achilles tendonitis
quickly or resuming too quickly after a layoff.
 Types of injuries caused:   Achilles tenosynovitis

 Achilles tendinosis  Tennis Leg, or in the most severe cases:

 Achilles tendonitis Achilles tendon rupture
 Achilles tenosynovitis
 Tennis Leg, or in the most severe cases:
Achilles tendon rupture.
Improper Footwear Medication Side Effects
 The Quinolone group of antibiotics
 Examples:
 Example: Ciprofloxacin
 Shoes or sports shoes with too much or
 Type of injuries caused:
too little:
 Achilles tendinosis,
 Arch support
 Achilles tendonitis,
 Cushioning
 Achilles tenosynovitis,
 Motion control
 Tennis Leg, or in the most severe
 Heel support
cases: Achilles tendon rupture.
 High heels; and
 Cortisone
 Worn out shoes or sports shoes.
 Cortisone is an indirect, rather than a
 Types of injuries caused: direct causes of Achilles tendon injury.
 Achilles tendinosis, Cortisone can make a weakened Achilles
 Achilles tendonitis, tendon feel too comfortable.  A patient
 Achilles tenosynovitis, who has received cortisone shots in or near
the Achilles tendon may be able to overly
 Tennis Leg, or in the most severe cases:
stretch or strain their Achilles tendon
Achilles tendon rupture. without any pain – until they stretch or
strain it to the point of rupture
 Contributing factor: the injury for which
cortisone was prescribed.
 Type of injury caused: Achilles tendon
rupture.
 
Accidents
 Examples:
 Crushed in a car or work
accident
 Cut (lacerated) by a lawn
mower or in a work accident.
 Type of injuries caused:
 Crushed Achilles tendon
 Lacerated Achilles tendon.
Tanda & Gejala
Pada pem tendon achilles tampak pembengkakan
Nyeri tekan
Nyeri pada gerakan dorsofleksi
Teraba krepitasi tepat di atas kalkaneus
Nyeri pada keadaan aktif & pasif
Pem.Fisik & Penunjang
Pem. Fisik
Inspeksi
Palpasi
Pem. Penunjang
Pem.radiologis
Terapi
Farmakoterapi
OAINS
Analgetik
Non-Farmakoterapi
Istirahat
Koreksi keadaan dan ukuran sepatu
Tungkai bawah lebih ditinggikan waktu tidur
Fisioterapi
Selfcare at home RICE
Rest the injured part. Pain is the body’s signal to not
move an injury.
Ice the injury. This will limit the swelling and help with
the spasm.
Compress the injured area. This again, limits the
swelling. Be careful not to apply a wrap so tightly that it
might act as a tourniquet and cut off the blood supply.
Elevate the injured part. This lets gravity help reduce
the swelling by allowing fluid and blood to drain
downhill to the heart
Medial Gastrocnemius strain
Etiology & risk factor
 Age/activity status: medial calf injuries occur more
commonly in the middle-aged recreational athlete.
 Deconditioned/unstretched muscles: The cold and
unstretched muscles that recreational athletes often use to
compete with are very likely to rupture when challenged
compared with conditioned and stretched muscles.
 Previous injury: The athlete with recurrent calf strains is
likely to have healed with fibrotic scar tissue, which absorbs
forces differently and is thus more likely to result in rupture
when the muscle is challenged.
An audible pop when the injury to the medial
calf occurred is usually reported, and the patient
complains of feeling like a stick struck his/her calf.
The patient complains of pain in the area of the
calf, which also radiates to the knee or the ankle. In
addition, the patient complains of pain with range of
motion (ROM) of the ankle.
The patient complains of a swollen leg that extends
down to the foot or ankle, as well as the associated
color changes of bruising
 Inspection
 Asymmetric calf swelling and discoloration, potentially spreading to the ankle and
foot, is noted on physical examination.
 If the stage of swelling has resolved, a visible defect in the medial gastrocnemius
muscle may be evident.
 Palpation
 Tenderness is noted upon palpation in the entire medial gastrocnemius muscle, but
this tenderness is observed to be exquisitely more painful at the medial
musculotendinous junction.
 Depending on the degree of swelling, a palpable defect may be evident at the medial
musculotendinous junction; however, with extreme swelling, this finding may not
be appreciable.
 Palpation of the Achilles tendon should demonstrate an intact tendon.
 The peripheral pulses should be present and symmetric.
 Provocative maneuvers: Moderate to severe pain is demonstrated with passive ankle
dorsiflexion (due to stretching of the torn muscle fibers), as well as with active
resistance to ankle plantar flexion (due to the firing of the torn muscle fibers).
Achilles tendon injury X medial
gastrocnemius rupture
 An Achilles tendon rupture results in an inability to plantar flex the
foot, and a more distal defect of the tendon is usually palpable.
 A Thompson test can be used to differentiate the 2 injuries.
 The test is performed with the patient prone and the knee held in flexion.
 Then, the gastrocnemius muscle is squeezed.
 A negative sign results in normal plantar flexion of the foot and ankle.
 If the flexion is not appreciated, the test is positive and due to a disrupted
Achilles tendon.
Achilles Tendinosis Achilles Tendonitis
There is no evidence of Achilles tendonitis is an
inflammation inflammation: the Achilles
The injured areas of the tendon becomes filled with
Achilles tendon have lost their inflamed cells
normal glistening appearance
Microscopic analysis of the
collegen and related fibers
that make up the Achilles
tendon reveal that the cells
are disorganized, degenerated,
and scarred.
Achilles Rupture
 Patients with an Achilles tendon rupture frequently present with
complaints of a sudden snap in the lower calf associated with acute
severe pain.
 The patient may be able to ambulate with a limp, but he or she is
unable to run, climb stairs, or stand on their toes.
 There is a loss of plantar flexion power in the foot.
 There may be swelling of the calf.
 A gap or depression may be felt and seen in the tendon about 2 inches
above the heel bone.
Etiology & Risk Factor
Recreational athlete (weekend warrior)
Relatively older age (30-50 y)
Previous Achilles tendon injury or rupture
Previous tendon injections or fluoroquinolone use
Abrupt changes in training, intensity, or activity level
Participation in a new activity
Test
 Examine the entire length of the gastrocsoleus-Achilles complex, nothing any
tenderness, swelling, ecchymosis, and tendon defects. A palpable gap in the
Achilles tendon may be appreciated.
 The patient will be unable to stand on the toes on the affected side.
 Clinical tests
 “Hyperdorsiflexion” sign – With the patient prone and knees flexed to 90º,
maximal passive dorsiflexion of both feet may reveal excessive dorsiflexion
of the affected leg.
 Thompson test – With the patient prone, squeezing the calf of the
extended leg may demonstrate no passive plantar flexion of the foot if its
Achilles tendon is ruptured.
 O’Brien needle test – Insert a needle 10 cm proximal to the calcaneal
insertion of the Achilles tendon. With passive dorsiflexion of the foot, the
hub of the needle will tilt rostrally when the Achilles tendon is intact.
Complication
 Following nonoperative treatment, the incidence of rerupture is higher (up to 40%).
 Surgical repair results following rerupture are poorer when compared with the initial
operative treatment of an acute tendon rupture.
 Operative treatments have several complications, including wound complications
(eg, infection, skin slough, sinus formation), adhesions, and possible sural nerve
injury (especially through a lateral longitudinal approach).

Prognosis
With proper treatment and rehabilitation, the prognosis following an Achilles
tendon rupture is good to excellent. Most athletes are able to return to their
previous activity levels with either surgical or conservative treatment.
However, individuals who undergo surgical treatment are less likely to experience
rerupture of their Achilles tendons. The rerupture rate for operative treatment is 0-
5%, compared with nearly 40% in those who opt for conservative treatment.
DafPus
http://www.achillestendon.com/CausesofInjury.html
http://emedicine.medscape.com/article/91687-overvi
ew
http://emedicine.medscape.com/article/85024-overvi
ew
http://www.emedicinehealth.com/tendinitis/article_
em.htm#Tendinitis%20Overview