PENYAKIT pd SISTEM MUSKULOSKELETAL1.OSTEOPOROSISOSTEOARTHRITISTUMORKONGENTAL*

Oleh :Muhamad Hasan,dr,MKes,SpOT

Lab. Anatomi, Orthopaedi & TraumatologiFK. UNIVERSITAS JEMBER*

OSTEOPOROSIS :

Osteo = tulangPorosis = porous = keropos

Massa tulang berkurang Akibat gangguan keseimbangan

Pembentukan Resorpsi tulangOsteoblas Osteoklas*

DefinisiKelainan skeletal generalisataMassa Tulang Rendah ( Low Bone Mass )Rusaknya arsitektur-mikro tulangTulang keropos ( fragility of bone )Mudah terjadi fraktur*

Apa fungsi tulang?Melindungi organ-organAlat gerakCadangan mineralhematopoitik*

Macam-macam osteoporosisPrimer- post menopause (tipe I)- sinilis (tipe II)2. Sekunder3. Idiopatik*

Siapa yang bisa menderita osteoporosis?Wanita * Post menopause - alami - post operatif, penyakit-penyakit (kelainan)2. Umur* > 50 tahun*

*Wanita > 50 tahun osteoprosis mudah frakturWanita (35-40) tahunmassa tulang turun 10%/dekadeLaki-laki massa tulang turun 5%/dekade

3. Genetik (keturunan) - asthenic, petite- berawak kecil, kurus, berat badan rendah- prevensi bila berperawakan asthenic- bila gemuk tidak usah khawatir akan terjadi osteoporosis karena = estrogen > = stress >4. Kurang bergerak- massa tulang meningkat dengan bergerak, olah raga dll- contoh = orang kota dibandingkan orang desa (petani)*

5. Makanan- bergizi [4 sehat 5 sempurna]- pemakan daging soft drink, soda, junk food air ledeng (chlorinaled)6. Obat-obatan [Medication used to treat one condition may cause an equally serious condition]- menggunakan absorpsi nutrisi- meningkatkan ekskresi nutrisi- mengurangi pemakaian nutrisicontoh = - obat diabetes = insulin- obat kortikosteroid- obat epilepsi = dilantin, barbiturat- obat pencahar = laxative- obat maag = mylanta- obat menurunkan cholesterol- obat tidur, dllMaka perlu suplement seperti Vit D, Kalsium*osteoporosis

7. Merokok (nikotin)- selain mengganggu jantung, pembuluh darah , syaraf, impotensi, bayi cacat, juga mengganggu tulang menjadi keropos - alkohol = sama jahatnya dengan merokok8. Aluminium- antasid, alat-alat masak, kosmetik- timah hitam = asap mobil9. Kontrasepsi oral- menurunkan Mg-serum- gangguan metabolisme, Vit B6, Vit C, B1210. Motherhood - hamil- menyusui11. Astronaut - gravitasi rendah -> massa tulang berkurang*perlu suplement Vit D, Calcium, lain vitamin

Osteoporosis resikonya ?Patah tulang!* tulang punggung* tulang panggul* tulang pergelangan tangan* tulang sendi bahu* dllBagaimana terjadinya patah tulang?* Orang tua :- gangguan keseimbangan- kekuatan otot-otot berkurang- sendi-sendi kurang stabiljatuhnya tidak sesuai dengan patahnya tulangmisalnya = kepleset -> patah*

Osteoporosis resikonya ?Tulang punggung* bungkuk!* tinggi badan berkurang* nyeri punggung!Apa akibat dari patah tulang?- nyeri sampai tidak bisa bergerak- resiko orang tua kalau tidak bisa bergerak!- tambah keropos- gangguan paru, sal kencing dan kulit- ada yang perlu perawatan (rumah sakit)- ada yang perlu tindakan operasi- bisa invalid- lingkungan (keluarga, masyarakat) ikut repot*

*NormalOsteoporosis

Arsitektur korpus vertebraNORMAL*

Arsitektur korpus vertebraNORMAL*

Arsitektur korpus vertebraOSTEOPOROSIS*

Kolaps vertebra akibatkan deformitas kolumna verteb.*

What is a vertebral fracture?Morphometric analysis

*Even with radiographs, vertebral fractures are not always easy to detectGenant et al. JBMR 1993; 8(9): 1137-48.

Center of gravity (CG) moves forwardLarge bending moment createdPosterior muscles and ligaments must counterbalance increased bendingOsteoporotic anterior spine must resist larger compressive stresses

*CGBIOMECHANICS OF VCF

Fraktur Vertebra Osteoporotik *

Fraktur Vertebra Osteoporotik *

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Penurunan tinggi badan yang progresif dan kyposis akibat osteoporosis

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Bagaimana menghindari terjadinya osteoporosis?Osteoprosis- penurunan massa tulang- terjadi mulai setelah maturitas- terjadinya pelan-pelan, tanpa disadari sebagai kayu dimakan rayap besi berkarat keroposKaplan = hypertension is the silent killer osteoporosis is the silent thief*

Kapan dimulai (prevensi) agar tidak terjadi osteoporosis?Mulai dari awal kehidupan- masa kehamilan janin (prenatal)- masa bayi (postnatal)- masa kanak-kanak- masa remaja- masa dewasaSekitar umur 40 tahun masa tulang maksimal*

*Wanita > 50 tahun osteoprosis mudah frakturWanita (35-40) tahunmassa tulang turun 10%/dekadeLaki-laki massa tulang turun 5%/dekade

Kapan dimulai (prevensi) agar tidak terjadi osteoporosis?Bila terjadi menopauseResiko tinggi terjadinya osteoporosis adanya faktor-faktor :(1) Keturunan(2) menopause dini(3) penyakit-penyakit kronis(4) perokok/alkohol(5) faktor makanan(6) habitus = asthenis(7) umur (tua)(8) kurang gerak *

PENYAKIT SENDI DEGENERATIF BERSIFAT KRONIS KERUSAKAN TULANG RAWAN SENDI OSTEOFIT FIBROSIS KAPSUL SENDI

DefinitionOA diseases are a result of both mechanical and biologic events that destabilize the normal coupling of degradation and synthesis of articular cartilage chondrocytes and extra-celular matrix, and sub-chondral bone (AAOS and NIH, 1994)

IntroductionMost common arthritisWHO: 40 million people in USFunctional limitations: 20% of OA community

BackgroundAge is the strongest determinant of OA. OA affects 25-30% of persons aged 45-64 years, 60% of persons older than 65 years, and affects more than 80% of persons older than 75 years.

CausesPrimary OA is idiopathicSecondary OA: Previous trauma (ie, posttraumatic OA)InfectionCrystal depositionAcromegalyPrevious rheumatoid arthritis (ie, burnt-out rheumatoid arthritis)Heritable metabolic causes (eg, alkaptonuria, hemochromatosis, Wilson disease)

Risk Factors Systemic Local- Genetic- Obesity - Dietary- Joint Mechanics- Race/Ethnicity- Muscle weakness- Age- Occupational stress- Smoking- Physical activity- Estrogen deficiency- Knee injury

Local Risk FactorsObesityVia biomechanical influences, load 3-7 times Strong risk factor for knee OABilateral stronger than unilateral, women>menPhysical activityFramingham study: heavy physical activity was associated w/ knee OAHigh-intensity contact sports was linked to development of knee OA

OA PRIMER

OA SEKUNDER

FAKTOR RESIKO1. UMUR2. SEX3. SUKU BANGSA4. GENETIK5. OBESITAS + PENYAKIT METABOLIK6. TRAUMA SENDI, PEKERJAAN, OLAH RAGA7. KELAINAN PERTUMBUHAN

GEJALA KLINISNYERI SENDIHAMBATAN GERAKAN SENDIKAKU PAGIPEMBESARAN SENDI / DEFORMITASPERUBAHAN GAYA BERJALANKREPITASIBENGKAKTANDA RADANG

TERAPI

TX. PENCEGAHAN :

BERAT BADAN MENURUNCEGAH TRAUMA BERULANGALAT BANTU PROTEKSI SENDIPERUBAHAN GAYA HIDUP

TERAPI

TX. FARMAKOLOGI

ANALGETIKATOPIKAL OAINSINJEKSI STREOID INTRAARTIKULERINJEKSI HIALURONAN INTRAARTIKULERDISEASE MODIFIYING OSTEOARTHRITIS DRUGS (DMOAD)

TERAPI

TX. BEDAH

OSTEOTOMI (HTO)ARTRODESISARTROPLASTY (TKR THR)

Successful Treatment program :* Reduce your symptoms* Increase joint movement* Lessen joint damaging effects

Osteoarthritic joints are not always painful.The response to arthritis pain is broad and very personal

Treatment include :Weight controlProper exerciseHeat and cold therapyPain medicatinOther pain relief optionsStress controlInjection into the jointSurgery

Exercise.1. Stretching exercise : ROM exercise2. Isometric exercise : muscles are tensed3. Aerobic (endurance) exercise :# Swimming.# Walking on level ground.Avoid : jogging, tennis, bicyclesBalance : daily exercise and rest.

Risk factorsAgeObesityFemale sexTraumaInfection Repetitive occupational trauma Genetic factors History of inflammatory arthritis Neuromuscular disorder Metabolic disorder

CausesSecondary OA:Neuropathic disorder leading to a Charcot joint (eg, syringomyelia,tabes dorsalis, diabetes)Underlying orthopedic disorders (eg, congenital hip dislocation, slipped femoral capital epiphysis)Disorders of bone (eg, Paget disease, avascular necrosis)

MANAGEMENTGoals of managing OA include:controlling pain, maintaining and improving the range of movement and stability of affected joints, limiting functional impairment.

Muhamad HasanBagian Anatomi-orthopedi FK UNEJJEMBER

II. KELAINAN KONGENITAL yang SERING DIJUMPAI :

CTEVSyndactily, polydactily, macrodactilyAchondroplasia (Skeletal dysplasia)Congenital dislokasi hip/dysplasia dislokasi hipArthrogryposis multiplex congenitaOsteogenesis imperfectaScoliosisProximal focal femoral defisiensi/PFFDExtrofia buli

III. CIRI-CIRI KELAINAN KONGENITAL :

1. Kelainan bentuk anatomi atau fungsi2. Tampak saat lahir atau tak lama setelah lahir3. Dapat single/lokal atau multiple/general4. Dapat menurun/herediter atau tidak/non herediter

IV. PENYEBAB :

Genetika. Sex atau autosomal khromosomb. dominan atau resesif2. Lingkungan selama proses kehamilana. obat-obatan (teratogen)b. infeksic. trauma mekanis, kimia (pahitan)d. anoxia/hypoxia3. Kombinasi genetik dan lingkungan

V. PROSES TERJADINYA KELAINAN dalam KEHAMILAN :

Trimester I : Organogenesis A .

2. Trimester II : Maturasi organ hypoplasia.

3. Trimester III : Depo

VI. PRINSIP THERAPY :

Bertujuan mencapai kesempurnaan fungsi organ dengan mengkoreksi kelainan anatomis sedini mungkin

VII. CTEV (Congenital Talipes Equinus Varus ) / Clubfoot1. Arti Talipes = Talus = ankle Pes = kakiEquinus = jari lebih rendahVarus = lateral kaki sebagai alas

2. Ciri-ciri : a. Saat lahirb. Lokal atau Generalc. Multifactoriald. Laki 2x perempuane. Bilateral 30% kasus

3. Diagnosisa.Klinis- Depan / anterior : - supinasi metatarsal - adduksi tarsal metatarsal- ankel : equinus- medial : cavus- belakan / posterior : - tumit kecil dan tinggi - Test dorso flexi (24 jam) -> ibu jari tidak pada crista tibia

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*The talocalcaneal angle in the lateral radiogram in the normal foot and in talipes equinovarus

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*DIAGNOSIS 1. Non rigid type (packing syndrome)2. Rigid type :ModerateSevere3. Resistance rigid type :AMCMyelomeningoceleConstriction band

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*The textbook definition of osteoporosis is of a disease which decreases bone strength and therefore increases the risk of fracture. As you look at these visuals, you can see that the healthy (normal) bone is comprised of thick, inter-linking trabeculae, while the osteoporotic bone is thin and some of the connectors are broken.

Importantly, the disease is no longer considered as just a low bone mineral density problem. There are multiple factors affecting the strength of bone and therefore fracture risk including BMD and bone architecture.

You can relate this to a steel bridge. A high quality bridge is not one with just a lot of steel. Both the steel and the way in which it is structured combine to make a bridge strong. The same could be said about bone mineral density and bone architecture.

One of the first thing you have to consider in osteoporosis is its consequences, mainly due to the fractures that can occur quickly with the time. The typical physical image of osteoporosis spiral is the cascade of fractures from the first, very early peripheral fracture to the first vertebral fracture and then, to the hip fracture. The progression of the disease from the first vertebral fracture to many subsequent vertebral fractures can be a fast one.

References:1. Consensus Development Conference: Osteoporosis prevention, diagnosis, and therapy, JAMA 2001; 285: 785-95.2. Dempster DW et al., A simple method for correlative light and scanning electron microscopy of human iliac crest bone biopsies: qualitative observations in normal and osteoporotic subjects, JBMR 1986; 1: 15-21.

*Even with an X-ray, vertebral fractures are not always easy to detect.

Genant proposed a quantitative method to diagnosed vertebral fracture. It can be easily done by 3 measurements: the posterior height, the height at the medium and the anterior height of the vertebrae. If one of these three measurements is 15% lower than comparable measurement at adjacent vertebral body, then the vertebral is morphometrically confirmed.

So on this picture, both radiographs show a fracture. The one on the right is obviously easy to miss, but both of these fractures have clinical consequences.

Reference:Genant et al., Vertebral fracture assessment using a semiquantitative technique, JBMR 1993, 8(9):1137-1148*With a VCF and increasing kyphosis, the center of gravity moves forward and away from the bending axis of the spine.

This results in: The creation of larger bending moment (defined as the force (CG) times the distance to the axis of bending)Posterior muscles and ligaments must work harder to counterbalance the increased bendingThe anterior spine that is already weakened by osteoporosis must resist larger compressive stresses.