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Asesmen Klinis
Trauma Tangan
Robertus Arian Datusanantyo (EAN)
Plastic Surgeon – RSUD Prof. Dr. W. Z Johannes Kupang
https://www.watchrepairco.com/
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2
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3
(Littler, 2007)
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Pokok Bahasan
• Anatomi dasar
• Anamnesis dan pemeriksaan fisik
• Case-based specifics
4
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5
PALMAR
VOLAR
ULNAR
RADIAL RADIAL
FINGERS
THUMB
Distal palmar
crease
Proximal palmar
crease
Thenar crease
Interthenar crease
Distal wrist crease
Thenar
Hypo-
thenar
DISTAL
PROXIMAL
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Pemeriksaan Sistematis
• Pemeriksaan awal
– Listen, look, feel, move
• Pemeriksaan lanjutan
– Tendon dan otot; saraf; vaskular; tulang dan sendi
• Diagnosis awal dan diferensial
• Pemeriksaan penunjang
• Pemeriksaan tersier
• Diagnosis final
6
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• Anamnesis:
– AMPLE
– Mode of injury
• Mechanism
• Hand position
• Prior treatment(s)
– Hand dominance
– Occupation
– Prior problem(s)
• Position
7
Listen – Look – Feel - Move
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• Palmar
– Fingers extended
– Fingers flexed
• Dorsal
– Hand
– Forearm
– Wrist
8
Listen – Look – Feel - Move
Swelling,
Erythema,
Bruising.
Active range of
joint motion,
Abnormal finger
posture.
Deformity,
Abnormal finger
posture,
Amputation.
Active range of
wrist motion.
Look
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9
Listen – Look – Feel - Move
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10
Listen – Look – Feel - Move
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11
ABDUCTION
ADDUCTION
Listen – Look – Feel - Move
EXTENSION
FLEXION
HYPEREXTENSION
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12
Listen – Look – Feel - Move
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13
FLEXION EXTENSION
Listen – Look – Feel - Move
PRONATION SUPINATION
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14
ULNAR DEVIATION RADIAL DEVIATION
Listen – Look – Feel - Move
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Feel
• Vascularity
• Sensation
• Motor function
• Autonomic
function
• Tenderness
Move
Passive range of motion
• Thumb: interphalang joint,
metacarpophalangeal joint.
• Fingers: DIP, PIP, MCP
• Wrist: flexion, extension, radial
– ulnar deviation, prosupination
15
Listen – Look – Feel - Move
#bedahplastikntt @robertusarian
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Range of Motion 16
Listen – Look – Feel - Move
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Pemeriksaan Lanjutan
• Four groups:
– Muscle & tendons
– Vascular
– Nerve
– Bone & Joint
• Both hands &
compare
17
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
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Extrinsic Muscles
Flexors
• Flexor digitorum
profundus (FDP)
• Flexor digitorum
superficialis (FDS)
• Flexor pollicis longus
(FPL)
• Flexor carpi ulnaris (FCU)
• Flexor carpi radialis (FCR)
Extensors
• Abductor pollicis brevis (APB)
• Extensor pollicis longus (EPL)
• Extensor carpi radialis (longus &
brevis)
• Extensor digitorum communis
(EDC)
• Extensor indicis proprius (EIP)
• Extensor digiti minimi
• Extensor carpi ulnaris
18
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
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Intrinsic Muscles
• Thenar muscles: abductor pollicis brevis,
opponens pollicis, flexor pollicis brevis
• Abductor pollicis: pinching
• Hypothenar muscles: abductor digiti minimi,
opponens digiti minimi, flexor digiti minimi
• Interosseus muscles: MCP flexion, IP extension
• Lumbricales muscles: MCP flexion, IP
extension
19
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
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20
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
21
#bedahplastikntt @robertusarian
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22
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
23
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
24
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
25
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
26
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
27
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
28
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
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Nerve & Vascular
Nerve
• General assessment
– Two-point discrimination
– Autonomic function
– Wrinkle test
– Tender muscle
• Individual assessment
– Radial nerve
– Median nerve
– Ulnar nerve
Vascular
• General assessment
– Compare both sides
– Fingertip: color, CRT, turgor, nail
changes
– Palpation and/or auscultation
• Specific maneuvers
– Peripheral pulsation
– Allen test
– Digital Allen test
29
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
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30
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
31
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
Allen Test
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32
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
Finger Allen Test
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Bone and Joint
General Assessment
• Fractures and Dislocation
• Pain – swelling
• Gentle palpation
• Local anaesthetic è joint
stability & radiographic
Specific Assessment
• Bone
• Joint
– Wrist joint
– Scapholunate instability
– Lunotriquetral instability
– DRU / distal radioulnar joint
instability
– Ulnocarpal instability
– Midcarpal instability
33
Tendon, Otot, Saraf, Vaskuler, Tulang, Sendi
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34
Pemeriksaan Penunjang
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35
Pemeriksaan Penunjang
#bedahplastikntt @robertusarian
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36
Pemeriksaan Penunjang
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37
Case-Based Specifics
Do not routinely elevate
(extract) nail plate in every
case of nail bed injury!
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38
Case-Based Specifics
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39
Case-Based Specifics
#bedahplastikntt @robertusarian
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40
Case-Based Specifics
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
41
Case-Based Specifics
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
42
Case-Based Specifics
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
43
Case-Based Specifics
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
Take Home Message
• Hands make men.
• Basic anatomy & physiology is important in
hand clinical examination.
• Clinical examination:
– Primary
– Secondary
– Supportive (based on primary – secondary)
• Careful – honest examination is paramount.
44
#bedahplastikntt @robertusarian
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Bacaan Lanjutan (1)
• Bates, S. J. and Chang, J. (2007) ‘Repair of the Extensor Tendon System’, in Thorne, C.
H. et al. (eds) Grabb and Smith’s Plastic Surgery. 6th edn. Philadelphia: Lippincott
Williams & Wilkins, pp. 810–816.
• Bullocks, J. M. et al. (2017) Plastic Surgery Emergencies: Principles and Techniques. 2nd
edn. New York: Thieme Medical Publisher, Inc.
• Chang, B. (2007) ‘Principles of Upper Limb Surgery’, in Thorne, C. H. et al. (eds) Grabb
and Smith’s Plastic Surgery. 6th edn. Philadelphia: Lippincott Williams & Wilkins, pp.
741–745.
• Golimbu, C. N. (2007) ‘Radiologic Imaging of the Hand and Wrist’, in Thorne, C. H. et
al. (eds) Grabb and Smith’s Plastic Surgery. 6th edn. Philadelphia: Lippincott Williams
& Wilkins, pp. 746–770.
• Kraan, R. B. et al. (2017) ‘Emergency and Trauma of Hand and Wrist’, Seminars in
Musculoskeletal Radiology, 21(3), pp. 240–256. doi: 10.1055/s-0037-1602414.
45
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
Bacaan Lanjutan (2)
• Lin, P.-Y. and Sebastin, S. J. (2012) ‘Nail Bed Repair’, in Chung, K. C. (ed.) Operative
Techniques: Hand and Wrist SurgeryHand and Wrist Surgery. 2nd edn. Philadelphia:
Saunders.
• Littler, J. W. (2007) ‘Plastic Surgeon and the Development of Hand Surgery’, in
Thorne, C. H. et al. (eds) Grabb and Smith’s Plastic Surgery. 6th edn. Philadelphia:
Lippincott Williams & Wilkins, pp. 737–740.
• Sebastin, S. J. and Chung, K. C. (2012) ‘Examination of the Hand and Wrist’, in Chung,
K. C. (ed.) Operative Techniques: Hand and Wrist Surgery. 2nd Editio. Philadelphia:
Saunders.
• Zidel, P. (2007) ‘Tendon Healing and Flexor Tendon Surgery’, in Thorne, C. H. et al.
(eds) Grabb and Smith’s Plastic Surgery. 6th edn. Philadelphia: Lippincott Williams &
Wilkins, pp. 803–809.
46
#bedahplastikntt @robertusarian
arian9677@gmail.com @eanplastic
dr. Robertus Arian D. (EAN), M.P.H.,M.Ked.Klin.,Sp.B.P.R.E.
Dokter Spesialis Bedah Plastik Rekonstruksi & Estetik
RSUD Prof. Dr. W. Z. Johannes; RS St. Carolus Borromeus; RS Leona
WA: +62 818 04 245 382; Instagram: @eanplastic;
E-mail: arian9677@gmail.com; #bedahplastikntt;
Presentations: http://bit.ly/ean_slideshare
47

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