PEMERIKSAAN

SARAF PERIFER
EKSTREMITAS
ATAS
 Plexus Brachialis

Berasal dari divisi anterior (ventral ramii) dari 4 nervus cervicalis bagian bawah (C5-C8)
dan nervus thorakalis pertama (T'I)

Nervus keluar dari foramen cervicalis dan thorakalis lalu menyatu membentuk
percabangan dengan urutan akar, trunkus, dan devisi

Peran utama dari plexus brachialis adalah persarafan ke ekstremitas atas

 al
x im
pro
ial
med

rior
infe
 al
x im
pro
ial
med

rior
infe
 al
x im
pro
ial
med

rior
infe
 Gerakan Muskulus Ekestremitas Atas

Nervus Muskulus Gerakan

Dorsalis Scapulae (C5) Rhomboid Stabilisasi scapula

Thoracicus Longus (C5) Serratus Anterior Abduksi scapula

Supraspinatus Abduksi bahu

Suprascapularis (C5)
Infraspinatus Rotasi eksternal bahu

Pectoralis Medial (C8), dan Pectoralis Mayor Adduksi bahu

Pectoralis Lateral (C7) Pectoralis Minor Stabilisasi scapula

Subscapularis (C5) Subscapularis dan Teres Mayor Rotasi internal bahu

Thoracodorsalis (C7) Latissimus Dorsi Adduksi bahu

 Gerakan Muskulus Ekestremitas Atas

Nervus Muskulus Gerakan

Musculocutaneous (C5) Biceps Brachii dan Brachialis Fleksi elbow

Flexor Carpi Ulnaris Flexi wrist dan jari

Ulnaris (C8, T1)
Muskulus intrinsic tangan Abduksi jari

Pronator Antebrachii dan Flexors Pronasi Antebrachii dan Fleksi pergelangan

Medianus (C6, C7, C8, T1)
pergelangan tangan dan jari tangan dan jari-jari

Triceps, Supinator, Ekstensor Supinasi Antebrachii dan Ekstensi siku,

Radialis (C6,7,8)
pergelangan tangan dan jari-jari pergelangan tangan dan jari-jari

Axillaris (C5) Deltoid dan Teres Minor Abduksi Bahu

Pemeriksaan Lesi Nervus
Perifer Ekstremitas Atas
 Manifestasi defisit neurologis pada
lesi plexus brachialis

motorik sensorik

Kelemahan atau Rasa tebal atau

kelumpuhan kesemutan
 PEMERIKSAAN
FISIK

1. Inspeksi
Gejala Horner Syndrome :
2. Tes Sensorik
• Anhidrosis
3. Palpasi • Ptosis
• Enopthalmus
4. Tes Motorik • Miosis

5. Tes Provokasi
 NERVUS MEDIANUS

Lokasi kompresi

Pronator Syndrome carpal tunnel syndrome

ligamentum Struthers
dibawah ligamentum tranversum carpi

lacertus fibrosus

lacertus fibrosus

musculus pronator teres

arcus fibrous musculus flexor digitorum superficialis

 NERVUS MEDIANUS

Inspeksi (look) Tes Sensorik (Feel) Palpasi (Feel)

Nyeri tekan pada

antebrachium

Wasting pada otot thenar khususnya Uji sensasi pada ujung jari telunjuk dan
musculus abductor pollicis brevis basis eminensia thenar

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.
 NERVUS MEDIANUS

Tes motorik (move)

m. flexor digitorum superficialis m. flexor carpi radialis m. opponens pollicis

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.
 NERVUS MEDIANUS

Tes motorik (move)

m. abductor pollicis brevis OK sign

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.
 NERVUS MEDIANUS

Tes provokatif (move) Pronator Syndrome

Carter GT, Weiss MD. Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment. Phys Med Rehabil Clin N Am. 2015 Aug 1;26(3):539–49.
 NERVUS MEDIANUS

Tes provokatif (move) Carpal Tunnel Syndrome

Tinel’s sign Phalen test

Andrews R, Isaacson A, Kanzer D. Carpal Tunnel Syndrome. In: Musculoskeletal Sports and Spine Disorders. Cham: Springer International Publishing; 2017. p. 121–4.
 NERVUS RADIALIS

Inspeksi (look) Tes Sensorik (Feel) Palpasi (Feel)

• Amati postur pergelangan tangan Palpasi pada area peradangan

• Identifikasi adanya luka yang relevan

• Identifikasi dropped wrist

• Identifikasi penggunaan splint

pengekstensi pergelangan tangan
Tes sensorik pada first web space dorsum
manus dapat mengidentifikasi patologi di
truncus n. radialis utama atau cabang
nervus sensorik superficial

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge University Press; 2013. p. 73–84.
Carter GT, Weiss MD. Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment. Phys Med Rehabil Clin N Am. 2015 Aug 1;26(3):539–49.
 NERVUS RADIALIS

Tes motorik (move)

sendi metacarpophalanges (MCP) m. brachioradialis m. extensor carpi radialis longus

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.
 NERVUS RADIALIS

Tes motorik (move)

m. extensor carpi ulnaris m. extensor pollicis longus m. extensor indicis

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.
 NERVUS RADIALIS

Tes provokatif (move) Radial Tunnel Syndrome

Carter GT, Weiss MD. Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment. Phys Med Rehabil Clin N Am. 2015 Aug 1;26(3):539–49.
 NERVUS ULNARIS

Inspeksi (look)

Gross wasting musculus Area yang dites sensibilitas

interosseous dorsalis pertama di n.ulnaris
Wartenberg’s sign. valgus cubiti
tangan kanan pasien lemah n.
ulnaris

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.

Tes Sensorik (Feel)
Pemeriksaan pada ujung jari kelingking
dan dorsal metacarpal kelima
NERVUS ULNARIS
Palpasi (Feel)
Nyeri tekan dapat dirasakan pada
canalis cubital atau canalis
Guyon’s, sebelumnya perlu
dibedakan dengan epikondilitis
medial.
 NERVUS ULNARIS

Tes motorik (move)

m. flexor carpi ulnaris m. flexor digitorum profundus m. abductor digiti minimi

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.
 NERVUS ULNARIS

Tes motorik (move)

m. interosseous dorsalis I Froment’s test

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.
 NERVUS ULNARIS

Tes provokatif (move)

Cubital Tunnel Syndrome

Wright JED, Bainbridge LC. Examination of The Peripheral Nerves in The Hand and Upper Limb. In: Harris N, Ali F, editors. Examination Techniques in Orthopaedics: Second Edition. Cambridge: Cambridge
University Press; 2013. p. 73–84.
Pemeriksaan Lesi Nervus
Perifer Ekstremitas Atas
Lainnya
 N. Dorsalis Scapulae N. Thoracicus Longus

Musculus Rhomboid Musculus Serratus Anterior

Panah : penonjolan otot dapat terpalpasi M. serratus anterior mengalami kelemahan

dan terkadang tampak dan tampak winging scapulae

Riddoch G, Bristow WR, Cairns H, Carmichael E, Critchley M, Greenfield J, et al. Aids to The Examination of The Peripheral Nervous System . 1st ed. London: Medical Research Council; 1976. 1–60 p.
 N. Pectoralis Lateral N. Pectoralis Lateral dan Medial

Musculus Pectoralis Mayor Musculus Pectoralis Mayor

Panah : caput scapulae dari pectoralis mayor Panah : caput sterno-costae dapat terlihat
dapat terlihat dan teraba dan teraba

Riddoch G, Bristow WR, Cairns H, Carmichael E, Critchley M, Greenfield J, et al. Aids to The Examination of The Peripheral Nervous System . 1st ed. London: Medical Research Council; 1976. 1–60 p.
 N. Thoracodorsalis

Musculus Latissimus Dorsi

Panah atas : m. teres mayor. Penonjolan otot dapat teraba berkontraksi

Panah bawah : penonjolan otot dapat terlihat saat pasien batuk
dan teraba

Riddoch G, Bristow WR, Cairns H, Carmichael E, Critchley M, Greenfield J, et al. Aids to The Examination of The Peripheral Nervous System . 1st ed. London: Medical Research Council; 1976. 1–60 p.
 N. Suprascapularis

Musculus Supraspinatus Musculus Infraspinatus

Panah : penonjolan otot dapat terlihat dan Panah : penonjolan otot dapat terlihat dan
teraba teraba

Riddoch G, Bristow WR, Cairns H, Carmichael E, Critchley M, Greenfield J, et al. Aids to The Examination of The Peripheral Nervous System . 1st ed. London: Medical Research Council; 1976. 1–60 p.
 N. Subscapularis N. Musculocutaneous

Musculus Teres Mayor M. Biceps

Panah : penonjolan otot dapat terlihat dan teraba Panah : penonjolan otot dapat terlihat dan teraba

Riddoch G, Bristow WR, Cairns H, Carmichael E, Critchley M, Greenfield J, et al. Aids to The Examination of The Peripheral Nervous System . 1st ed. London: Medical Research Council; 1976. 1–60 p.
 N. Axillaris

Musculus Deltoid

Panah : Serabut anterior dan medial dari otot dapat terlihat Panah : Serabut posterior dari otot dapat terlihat
dan teraba dan teraba

Riddoch G, Bristow WR, Cairns H, Carmichael E, Critchley M, Greenfield J, et al. Aids to The Examination of The Peripheral Nervous System . 1st ed. London: Medical Research Council; 1976. 1–60 p.
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