REVISI

D E Q U E RVA I N
T E N O S Y N O V I T I S PA D A
AT L Pembimbing
E T A: N G K AT B E
dr. Magdalena Wartono,MKK.
S I
Kelompok 1

KEPANITERAAN KLINIK ILMU KESEHATAN KERJA

FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI
PERIODE 19 OKTOBER- 13 NOVEMBER 2020
 ANATOMICAL SNUFFBOX

Depresi segitiga di sisi radial pergelangan tangan 

terlihat saat ekstensi ibu jari
Batas lateral: tendon m. abduktor pollicis longus +
ekstensor pollicis brevis
Batas medial: tendon m. ekstensor pollicis longus.
Batas proksimal: processus styloid radialis
Batas distal: dibentuk oleh pertemuan tendon m.
ekstensor pollicis longus + ekstensor pollicis brevis.
Dasar: os scaphoid, os trapezium, os metacarpal I

Cerda A, Sol M. Anatomical Snuffbox and it Clinical Significance: A Literature Review.

International Journal of Morphology. 2015;33(1):1355–60.
 Kepentingan Klinis

• Nyeri tekan di Anatomical Snuffbox  Fraktur os scaphoid / DQT / intersection syndrome

• DQT  e.c. peradangan tendon m. APL + m. EPB  keduanya merupakan batas lateral Anatomical
Snuffbox
• Pasien DQT  biasanya menggambarkan nyeri tekan pada Anatomical Snuffbox

Cerda A, Sol M. Anatomical Snuffbox and it Clinical Significance: A Literature Review.

International Journal of Morphology. 2015;33(1):1355–60.
PATOGENESIS (22)
 TATALAKSANA
MEDIKAMENTOSA (30,31,32)

NSAID : diberikan sebagai antiinflamasi dan anti nyeri pada pasien dQT. Pemberian penghambat non selective

COX inhibitors lebih dianjurkan pada cedera tendon karena memberikan hasil yang lebih baik pada proses

penyembuhan tendon.

Ibuprofen sebagai obat pilihan terapi pada de Quervain’s Tenosynovitis

Ibuprofen merupakan satu-satunya diantara 4 jenis NSAID lain (naproxen, proxicam, celecoxib,
valdecoxib) dan acetaminophen yang tidak menimbulkan kerusakan saat proses
penyembuhan tendon
 TATALAKSANA POST
OPERATIF
Prinsip rehabilitasi meliputi:

1. Pengawasan status luka operasi

2. Mengawasi pembengkakan dan peradangan
3. Latihan ROM aktif dan pasif
4. Remodelling skar
 TATALAKSANA POST OPERATIF
(37,38,39)

• 2-3 hari imobilisasi tangan, terapi kompres es

• 1-2 minggu hindari aktivitas membebani area operasi, gunakan splint thumb spica, jaga luka tetap bersih
• 10-14 hari splint dilepas dan jahitan dilepas
• Setelah 2 minggu, mulai latihan fisik dengan meregangkan bagian thenar musculature dan forearm
extensor/flexor untuk melatih mekanisme gliding tendon m. APL dan EPB pada kompartemen dorsal
pertama selama 6 hingga 8 minggu
 TATALAKSANA POST
OPERATIF
• Latihan harus bertahap mulai dari beban ringan sampai berat pada atlet angkat besi
• Pada umumnya setelah 12 minggu gejala nyeri (saat gerak aktif maupun pasif) dan bengkak hilang
dan tentunya pasien dapat kembali menjadi seorang atlet
 PENGENDALIAN DAN
PENCEGAHAN TERBAIK
Pengendalian administratif, berupa:

-Edukasi teknik
-Pengaturan waktu latihan
-Intensitas latihan secara bertahap
-Istirahat diluar jadwal latihan
 PEMBAHASAN
• Pada kasus ini tidak didapatkan adanya data mengenai faktor risiko DQT lainnya. Faktor risiko lain yang
harus ditanyakan diantaranya:
-Penggunaan growth hormone
-Frekuensi dan durasi melakukan gerakan mengangkat besi selama latihan (frekuensi >30 kali/menit, durasi
lebih atau sama dengan 4 jam per hari)
-Kebiasaan lain seperti mengetik handphone dan komputer, menjahit, mengangkat beban selain angkat
besi saat latihan, mencuci pakaian (gerakan memeras)
-Memiliki hobi seperti bermain PlayStation dan bermain alat musik (gitar, piano)
 PEMBAHASAN

-Riwayat pekerjaan sebelumnya yang memerlukan gerakan berulang khusunya pada pergelangan tangan dan ibu
jari, seperti penggunaan alat perkakas tangan, alat yang bergetar selama lebih atau sama dengan 2 jam per hari
-Riwayat trauma atau cedera sebelumnya pada pergelangan tangan dan riwayat penyakit inflamasi pada
radang sendi, seperti rheumatoid athritis

Seharusnya pada anamnesis, faktor risiko diatas juga ditanyakan untuk mencari etiologi lain
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TERIMA KASIH