Kuliah Pakar Peroneus Communis Palsy
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COMMON PERONEUSPALSY
UTOYO SUNARYODEPARTEMEN NEUROLOGI
FK UWK SURABAYA
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NAMA ALTERNATIF
• PERONEUS PALSY• NEUROPATHY COMMON
PERONEAL NERVE• PERONEAL NERVE INJURY
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FREKWENSI
• PALING BANYAK PERONEALPALSY DROP FOOT
• 90 % UNILATERAL.• LAKI > WANITA.
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DEFINISI
• DROP FOOT: ADALAHKELEMAHAN YG SIGNIFIKANPADA DORSIFLEKSORPERGELANGAN KAKI DAN JARIKAKI.
• KELEMAHAN NERVUSPERONEUS PROFUNDUS.
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DEFINISI ( CON’T)
• DORSIFLEKSOR JARI KAKI DANPERGELANGAN KAKI ADALAH :- M. TIBIALIS ANTERIOR.- M. EKSTENSOR HALUCIS
LONGUS.- M. EKSTENSOR DIGITORUM
LONGUS
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ANATOMI.
• LUMBO SACRAL PLEXUS -> L 4 – S2 SCIATIC NERVE MELEWATI FORSCIATIC MAYOR SAMPAI DIATASPOPLITEA MEMBENTUK DIVISI:
• LATERAL : NERVUS PERONEUSCOMMUNIS
• MEDIAL : NERVUS TIBIALIS.
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ANATOMI ( CON’T)
NERVUS PERONEUSCOMMUNIS BERCABANG:
• N. PERONEUS SUPERFISIALIS.UTK SENSASI KE DORSUMPEDIS & ANTEROLATERALTUNGKAI
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ANATOMI
• NERVUS PERONEUS PROFUNDUS.1. MENSARAFI M. TIBIALISANTERIOR, M. EKSTENSORHALLUCIS LONGUS, M. EKSTENSORDIGITORUM LONGUS.
2. SENSASI DAERAH DORSAL DIANTARA JARI KAKI 1 & 2
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ANATOMI
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ANATOMI
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ANATOMI
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ETIOLOGI
• TRAUMA PADA BELAKANG LUTUT.• FRAKTUR FIBULA• PEMAKAIAN PLESTER JANGKA
LAMA PADA TUNGKAI BAWAH.• DUDUK LAMA BERSILA /DUDUK
MENYILANG KAKI YANG LAMA• TEKANAN PADA LUTUT SELAMA
TIDUR /COMA• MEMAKAI SEPATU “HIGH BOOTS”
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ETIOLOGI
• ORANG YANG KURUS.• DIABETES MELLITUS.• KELAINAN BAWAAN : CHARCOT
MARIE TOOTH• TRAUMA N. ISHIADIKUS
( dislokasi sendi panggul)• MONONEUROPATI.• TRAUMA LANGSUNG PD
DORSIFLEKSOR.• COMPARTMENT SYNDROME.
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ETIOLOGI
• STROKE• AMYOTROPHY LATERAL
SCLEROSIS.• MULTIPLE SCLEROSIS.• CEREBRAL PALSY.
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GEJALA KLINIS
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PERONEAL NEUROPATI
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GEJALA KLINIS
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ANTERIOR COMPARTMENTSYNDROME
• NYERI PASIF FLEKSI JARI KAKI• KELEMAHAN EKSTENSI JARI
KAKI.• GG SENSORIK PADA JARI KAKI
1 DORSAL.• PENGOBATAN DENGN
FASCIOTOMY.
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DEEP COMPARTMENTSYNDROME• NYERI DAN KELEMAHAN PADA JARI
KAKI DAN PERGELANGAN KAKI.• NYERI EKSTENSI PASIF JARI KAKI
MENJALAR KE BETIS.• GG SENSORIK PADA TELAPAK KAKI
SISI MEDIAL.• PENGOBATAN DNG FASCIOTOMY
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CHRONIC COMPARTMENSYNDROM
• NYERI YG TIMBUL PADA WKTLATIHAN TUNGKAI BAWAH.
• GEJALA MENGHILANGSETELAH ISTIRAHAT.
• GG SENSORIK PADA JARI KAKI1 DORSAL
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CHARCOT-MARIE-TOOTH DISEASE
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DIAGNOSIS• ANAMNESIS• SESUAIKAN PERTANYAAN DENGAN
GEJALA KLINIS.• KELUHAN UTAMA• RIWAYAT PENYAKIT SEKARANG.• RIWAYAT PENYAKIT DAHULU.• RIWAYAT PENGOBATAN• RIWAYAT KELUARGA• RIWAYAT INTOKSIKASI• PSIKOSOSIAL.
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PEMERIKSAAN FISIK
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video
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“THE MEDICAL RESEARCHCOUNCIL”
• 5= KEKUATAN OTOT NORMAL.• 4= GERAKAN OTOT MODERAT TERHADAP
TAHANAN.• 3= OTOT MASIH DPT MELAWAN
GRAVITASI , TAPI TDK DPT MELAWANTAHANAN.
• 2= OTOT TDK DPT MELAWAN GRAVITASI.• 1= “FLICKER” TAMPAK KONTRAKSI OTOT.• 0= TIDAK ADA GERAKAN SAMA SEKALI
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MANIFESTASI“DROP FOOT”• STEPPAGE GAIT.• CARA BERJALAN NYA DENGAN
FLEKSI YG BERLEBIHAN PADAPINGGUL DAN LUTUT. SPYTIDAK JATUH UTK MENJAGAKESEIMBANGAN PAHA HARUSMENAIKAN PAHA BERLEBIHAN
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video
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PEMERIKSAANPENUNJANG.
• BILA PERLU PEMERIKSAANLANJUT: gula darah, elektrolit,BUN, Kreatinin.
• Radiologi: MRI, foto polos• EMG : Electromyografi.
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DIAGNOSIS BANDING
• LUMBAL RADIKULOPATI ( HNP)• LUMBOSACRAL PLEKSOPATI.
( fraktur pelvis).• SCIATIC NEUROPATI.• PERONEAL NEUROPATI PADA
KEPALA OS FIBULA
http://www.medmerits.com/index.php/article/peroneal_neuropathy/P 7
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Penatalaksanaan
• Non Bedah
1.Ankle foot orthosis ( AFO)Untuk dorsofleksi jari kaki wktmengayun.Untuk kestabilan pada wkt berdiri.
2.PHYSICAL TERAPI3.Elektro stimulasi
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Penatalaksanaan
• Pembedahan1. Dekompresi saraf perifer.2. Tendon transfer.3. Pemanjangan tendon achilles.4. Artrodesis ( tujuan melakukan
pembedahan denganmelakukan fixasi danimmobilisasi sendi )
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PENATALAKSANAAN
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OPERASI
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KOMPLIKASI.
• INFEKSI• KEGAGALAN PERTUMBUHAN
SARAF• DEFORMITAS YANG
RECCURENT• DELAYED UNION.
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PROGNOSIS
• Pada neuropati periferdiharapkan penyembuhan baiksetelah 3 bln bila tdk adakompresi lebih lanjut.
• Partial peroneal palsy, Biladilakukan total kneereplacement hasilnya baik.
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PROGNOSIS.
• BILA TERDPT KOMPRESI SARAFDPT BURUK KALAUKELEMAHAN MOTORIK LEBIHDARI 6 BLN, DAN USIA LANJUT.
• RECOVERY DPT 1 THN – 18 BLN( ibu jari kaki yg paling akhir)
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