Bahu Beku / Frozen Shoulder 1
May 21, 2019 | Author: Estu Mahendra | Category: N/A
Short Description
Download Bahu Beku / Frozen Shoulder 1...
Description
BABI PENDAHULUAN
Dalam Dalam konsep konsep paradi paradigm gmaa sehat sehat menuj menuju u Indon Indonesi esiaa sehat sehat 2010, 2010, tujua tujuan n pembang pembangunan unan kesehata kesehatan n diarahkan diarahkan untuk untuk meningkat meningkatkan kan kesadar kesadaran, an, kemauan, kemauan, dan kemampuan hidup sehat bagi setiap orang agar terwujud derajat kesehatan masyarakat masyarakat yang optimal optimal,, melalui melalui tercipta terciptanya nya masyara masyarakat, kat, bangsa bangsa dan negara negara Indonesi Indonesiaa yang ditandai oleh penduduknya hidup dalam perilaku dan lingkungan yang sehat, memiliki kemampuan untuk menjangkau pelayanan kesehatan yang bermutu secara adil dan merata, serta memiliki derajat kesehatan yang optimal (SKN, 1991) Bukan hal baru lagi mestinya dalam penyelenggaraan kesehatan, fisioterapi memp mempun unya yaii pera perana nan n pent pentin ing, g, dala dalam m upay upayaa menu menuru runk nkan an angk angkaa kesa kesaki kita tan n dan dan kecacatan serta optimalisasi dan pemeliharaan kondisi normal pada semua umur untuk meningkatkan produktivitas. Fisi Fisiot otera erapi pi adala adalah h bentuk bentuk pelay pelayana anan n keseh kesehat atan an yang yang dituju ditujukan kan kepada kepada individu atau kelompok untuk mengembangkan, memelihara dan memulihkan gerak dan fungsi tubuh sepanjang daur kehidupan dengan menggunakan penanganan secara manual, peningkatan gerak, peralatan peralatan (fisik, (fisik, elektroterapeutis elektroterapeutis dan mekanis), mekanis), pelatihan pelatihan fungsi, komunikasi (MENKES RI, 2001).
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
A. Latar Belakang 1 Masalah
Setiap manusia mampu menggerakkan anggota tubuhnya untuk beraktivitas. Hal ini dapat dilakukan bila keadaan tulang, otot, persendian maupun sistem-sistem lain lain tidak tidak menga mengalam lamii ganggu gangguan an atau atau kelai kelainan nan pada pada perse persendi ndian an dimana dimana terjad terjadii pergeseran pergeseran letak sendi ataupun terjadi terjadi pemantapan tulang maka akan timbul timbul masalah yang dapat menyebabkan seseorang terganggu aktivitasnya (Iskandar, 2003). Frozen shoulder shoulder adalah suatu suatu gangguan bahu yang sedikit atau atau sama sekali tidak menimbulkan rasa sakit, tidak memperlihatkan kelainan pada rontgen, tetapi menunjukkan adanya pembatasan gerak. Nyeri bahu terjadi pada 4,5% dari populasi yang ada, 60% adalah wanita, 2,4% adalah pria. Umumnya berusia sekitar 40-60 tahun (Soekarno, 1989). Sa1a Sa1ah h satu satu peny penyeb ebab ab yang yang dapa dapatt meng mengga gang nggu gu sese seseor oran ang g mela melaku kuka kan n aktivitasnya adalah apabila seseorang tersebut mengalami nyeri bahu. Nyeri bahu bany banyak ak dialam dialamii oleh oleh seseo seseora rang ng dengan dengan adanya adanya ganggu gangguan an gerak gerak atau atau aktivi aktivitas tas fungsiona fungsionall seharisehari-hari hari yang membeban membebanii struktu strukturr persendi persendian an bahu, bahu, misalny misalnyaa pada karya karyawan wan tukan tukang g cat, cat, pemai pemain n tenis tenis,, juru juru ketik ketik dan aktivi aktivitas tas lain lain yang yang berkai berkaitan tan dengan aktivitas gerak bahu. Nyeri bahu terjadi karena adanya nyeri dibagian depan dan samping dari bahu. Nyeri di daerah tersebut terasa juga pada saat lengan diangkat untuk melakukan aktivitas baik gerak aktif maupun gerak pasif yang melibatkan sendi sisi abduksi -
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
terutama otot supraspinatus, supraspinatus, sering terjadi penjepitan terutama di daerah caput humeri dan acromion atau ligamentum caraco acromile. Keadaan seperti itu dapat menimbulkan pada otot supraspinatus sehingga yang bersangkutan sering mengeluh pegal dan nyeri. Penyebab Penyebab nyeri gerak dan fungsi sangat erat kaitannya dengan mekanisme gerak yang terjadi pada sendi bahu baik secar secaraa osteoki osteokinema nematik tika. a. Nyeri Nyeri bahu yang yang terjad terjadii dapat dapat disebab disebabkan kan oleh oleh karena karena capsulitis adhesive. Masalah-masalah yang sering dijumpai pada kasus nyeri bahu yaitu nyeri di daerah bahu, adanya keterbatasan lingkup gerak terutama saat melakukan aktivitas seharisehari-har hari, i, misalk misalkan an tidak tidak bisa bisa menyis menyisir ir rambut rambut,, tidak tidak bisa bisa mengonde mengonde rambut, rambut, kesulitan dalam berpakaian dan semua gerak yang melibatkan sendi bahu sehingga penderita ketakutan menggerakkan sendi bahu. Pada Pada kondisi kondisi nyeri nyeri bahu fisiot fisiotera erapis pis mempuny mempunyai ai peranan peranan penting penting untuk untuk mengurangi mengurangi nyeri dan mencegah kekakuan dan mengembalikan mengembalikan aktivitas fungsional fungsional bagi bagi pender penderit ita. a. Untuk Untuk menga mengata tasi si masa masala lah h nyer nyerii bahu bahu pada pada kasus kasus ini ini penul penulis is menggunakan modalitas fisioterapi Ultra Sound (US) dan terapi manipulasi.
B. Rumu Rumusa san n Masal Masalah ah
Berdasarkan data diatas rumusan masalahnya adalah (1) Apakah dengan US dapat dapat mengura mengurangi ngi nyeri nyeri pada bahu? (2) Apakah dengan dengan terapi terapi manipul manipulasi asi dapat dapat mengurangi kekakuan dan meningkatkan LGS sendi bahu ?
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
C. Tuj Tujuan uan Penul Penulisa isan n
Berdasarkan Berdasarkan dari permasalahan-pe permasalahan-permasal rmasalahan ahan yang, timbul, maka tujuan penuli penulisan san ini adalah adalah (1) Untuk Untuk menget mengetahui ahui seberap seberapaa besar besar manfaat manfaat US didala didalam m mengur mengurang angii nyer nyeri, i, (2) (2) Untuk Untuk menge mengeta tahui hui manf manfaat aat tera terapi pi mani manipul pulas asii dalam dalam mengurangi kekakuan dan meningkatkan LGS bahu.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
BAB II TINJAUAN PUSTAKA
A. Anatomi 1. Definisi
Frozen shoulder adalah suatu gangguan bahu yang sedikit atau sama sekali tidak meni menimb mbul ulka kan n
rasa rasa saki sakit, t, tida tidak k
memp memper erli liha hatk tkan an kela kelain inan an pada pada ront rontge gen, n, teta tetapi pi
menunjukkan adanya pembatasan gerak.(Suharto,2006). 2. Anatomi Fungsional sendi
Shoulder merupakan sendi yang kompleks pada tubuh manusia. Di bentuk oleh tulang-tulang, yaitu tulang clav icula, scapula, sternum, dan humerus. Daerah persendian bahu mencakup 4 sendi, yaitu sendi glenohumeral, acromioclaviculare, sternoclaviculare, dan scapulothoracic. a. Send Sendii gle gleno nohu hume mera rall Dibent Dibentuk uk oleh oleh caput caput humeri humeri yang yang bulat bulat dan cavita cavitass glenoi glenoidal dalis is scapul scapulaa yang yang berbentuk ball and socket joint dan mempunyai kebebasan gerak yang lurus. Dimana cavit cavitas as gleno glenoid idal alis is dikua dikuatk tkan an oleh oleh fibr fibroc ocar arti tila lagi gino nous us yang yang meny menyat atu u di ligam ligament ent glenohumerale dan tendon m.biceps caput langum. Sendi Sendi ini ini dipe diperk rkua uatt oleh oleh kaps kapsul ul send sendii yang yang diba dibagi gian an depan depan dipe diperk rkua uatt oleh oleh ligament glenohumeral (superior,middle, dan inferior) yang biasanya ada lipatan-lipatan kapsul sendi. Dibagian atas diperkuat oleh ligament coracohumerale bersama acromion
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
b. b. Send Sendii Acrom Acromio iocl clav avic icula ulare re Merupakan jenis sendi synovial menghubungkan antara tulang clavicula dengan acro acromi mion on.. Send Sendii ini ini dipe diperk rkua uatt oleh oleh fibr fibros osus us caps capsul ulee tert tertut utup up oleh oleh liga ligame ment ntum um acromioclaviculare superior dan inferior, conoid dan trapezoid. c. Send Sendii Ster Sterno no Cavi Cavicu cula lar r Merupakan sendi synovial yang merupakan hubungan antara manibrium sterni dengan bagian medial clavicula. Dilengkapi dengan discus articularis. Sendi ini juga diperkuat oleh ligamen costoclavicular yang berfungsi untuk mengontrol gerak sliding clavic clavicula ula terhad terhadap ap manibr manibrium ium sterni sterni ketika ketika terjad terjadii gerak gerak should shoulder. er. Geraka Gerakan n antero antero poster posterior ior terjad terjadii dianta diantara ra manibr manibrium ium dengam dengamn n discus discus,, sedang sedang antara antara discus discus dengan dengan clavicula pada gerakan elevasi dan depresi scapula. d. Send Sendii Sca Scapu pulo loth thor orac acic ic Selain Selain bersen bersendi di pada acromi acromiocl oclavi avicul cular ar dan sterno sternocla clavic vicula ular, r, scapul scapulaa jugta jugta bersendi dengan thorax. Gerakan sendi ini terkait dengan gerak protaksi, retraksi, elevasi, dan depresi depresi
serta serta rotasi. rotasi. Sliding Sliding terjad terjadii dianta diantara ra m. Serattus Serattus anterio anteriorr dengan dengan m.
Subscapularis. Gerakan flexi dan abduksi 120º terletak pada glenohumeral, sedangkan flexi dan abduksi 60º terjadi pada sedi scapulohumeral. 3. Innervasi
Sedangk Sedangkan an sendi sendi bahu bahu dipers dipersara arafi fi oleh oleh plexus plexus brachi brachiali alis, s, plexus plexus brachi brachiali aliss merupakan anyaman serat saraf yang berjalan dari tulang belakang C5-T1, kemudian melewati bagian leher dan ketiak, dan akhirnya keseluruh bagian lengan atas dan bawah.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Plex Plexus us brac brachi hial alis is dimu dimula laii dari dari rami rami vent ventra rall sara saraff spin spinal al,, dima dimana na rami rami berg bergab abung ung membentuk membentuk 3 truncus, truncus, yaitu yaitu trunkus trunkus superior superior (C5-C6), trunkus inferior (C7), trunkus medialis(C8-T1). (Chusid,1993). 4. Vaskularisasi
Peredaran darah arteri yang memelihara sendi bahu adalah arteri axillaris yang merupa merupakan kan lanjut lanjutan an dari dari arteri arteri subsla subslavia via lalu bercab bercabangang-cab cabang, ang, antara antara lain lain
: arteri arteri
subscapularis, dan arteri brachialis. Sedangkan pembuluh darah vena pada sendi bahu anata anatara ra lain lain vena vena axill axillar aris is yang yang berc bercab aban ang-c g-cab aban ang g menj menjadi adi vena vena cepha cephali lica, ca, vena vena brachilica.(Parjono,1973). 5. Biomekanik
Range of movement dari movement dari shoulder sangat kompleks, yaitu pada bidang sagital (gerak flexi) 180º, sedangkan gerak extensi mencapai 60º. Pada bidang frontal, gerak abduksi abduksi mencap mencapai ai 180º, 180º, sedangk sedangkan an gerak gerak adduksi adduksi mencapa mencapaii 45º. 45º. Untuk Untuk gerak gerak rotasi rotasi bervariasi, apabila shoulder dalam keadaan flexi 90º, maka total external & internal rotasi adalah 150º.(Mudatsir,2002).
B. Patologi
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
menemp menempel el pada caput caput humeru humerus. s. Penyeb Penyebabn abnya ya tidak tidak diketa diketahui hui.. Diduga Diduga penyak penyakit it ini merupakan merupakan respon respon terhadap terhadap hasil-hasil hasil-hasil rusaknya jaringan jaringan lokal. lokal. Meskipun Meskipun penyebabnya penyebabnya biasanya biasanya idiopatik, idiopatik, keadaan yang serupa terlibat terlibat setelah hemiplegia hemiplegia atau infark infark jantung. jantung. (Apley,1995). 2. Patofisiologi
Imobilisasi yang lama karena adanya nyeri pada sendi shoulder menyebabkan stati statiss pembul pembuluh uh vena vena
dan menimbul menimbulkan kan reaksi reaksi timbunan timbunan protein, protein, akhirnya akhirnya terjad terjadii
fibrosus pada sendi glenohumeral. Fibrosus mengakibatkan adhesi antar lapisan didalam sendi, sehingga terjadi perlengketan kapsul sendi dan terjadilah keterbatasan gerak pada sendi sendi bahu. bahu. Frozen Frozen should shoulder er sendir sendirii kondisi kondisi dimana dimana terjad terjadii keterb keterbata atasan san pada sendi sendi glen glenohu ohume mera rall yang yang dida didahul hului ui oleh oleh adany adanyaa nyer nyeri. i. Sedan Sedangk gkan an nyer nyerii ters terseb ebut ut dapat dapat dikarenkan oleh tendinitis bicipitalis, inflamasi rotator cuff, fraktur atau kelainan dari ekstra clavicular, yaitu angina. Akibat dari frozen shoulder adalah adanya nyeri kesemua gerakan, terutama gerak exorotasi, abduksi, dan endorotasi. Jika exorotasi lebih terbatas dari gerak abduksi, dan endorotasi maka membentuk pola kapsuler.(Suharto,2006). 3. Tanda dan gejala
Tanda dan gejala klinis yang sering timbul pada penderita frozen shoulder akibat
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
6-12 bulan. Setelah itu beberapa bulan kemudian nyeri mulai berkurang, tetapi kekakuan semakin menjadi. Setelah berapa bulan kemudian pasien dapat bergerak, tetapi tidak normal.(Appley,1993). Nyeri dirasakan pada daerah otot deltoideus. Bila terjadi pada malam hari sering dijump dijumpai ai mengga mengganggu nggu tidur. tidur. Pada Pada pemeri pemeriksa ksaan an fisik fisik ditemu ditemukan kan adanya adanya kesuli kesulitan tan penderita dalam mengangkat lengannya (abduksi), sehingga penderita akan melakukan gerakan kompensasi dengan mengangkat bahu pada saaqt gerakan mengangkat lengan yang sakit, yaitu saat flexi dan abduksi sendi bahu diatas 90º atau di sebut dengan shrugging mechanism. mechanism. Juga dapay dijumpai adanya atrofi otot gelang bahu.(Heru,2004). b. b. Kete Keterb rbat atas asan an LGS LGS Frozen sholder karena capsulitis adhesiva ditandai dengan adanya keterbatasan lingkup gerak sendi glenohumeral pada semua gerakanyang nyata, baik gerakan yang aktif maupun pasif. Sifat nyeri dan keterbatasan gerak sendi bahu terjadi pada semua gerakan sendi bahu, tetapi sering menunjukkan pola yang spesifik, yaitu pola kapsuler. Pola gerak sendi bahu ini adalah gerak exorotasi lebih terbatas dari gerak abduksi dan lebih terbatas dari gerak adduksi.(Heru,2004). Pen
nan kekua kekuatan tan otot otot dan arof arofii otot otot
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
penurunan penurunan kekuatan kekuatan otot, dan atrofi atrofi maka secara langsung langsung akan mempengaruhi mempengaruhi aktifitas aktifitas fungsional yang dijalani. (Heru,2004). 4. Komplikasi
Pada kondisi frozen shoulder akibat capsulitis adhesiva yang berat dan tidak dapat mendapatkan penanganan yang tepat dalam jangka waktu yang lama maka akan timbul problematik yang lebih berat antara lain : (1) Kekakuan saendi bahu, (2) Kecenderungan terjadinya penurunan kekuatan otot-otot bahu, (3) Potensial terjadinya deformitas pada sendi bahu, (4) Atrofi otot-otot sekitar sendi bahu, (5) adanya gangguan aktifitas seharihari. 5. Prognosis
Apabila dilakukan tindakan sendiri mungkin secara tepat maka prognosis gerak dan fungsi fungsi dari kasus frozen sholder adalah baik. Penderita Penderita sebaiknya sebaiknya diberitahu diberitahu bahwa akan dapat dapat mengger menggerakka akkan n bahu kembal kembalii tanpa tanpa rasa rasa nyeri nyeri tetapi tetapi memerl memerlukan ukan waktu waktu beberapa bulan.(Setiawan,1991). 6. Diagnosis banding
a. Tendinitis bicipitalis Tendon Tendon otot otot bic
dapat dapat
galami galami ker
kan
ter
diri, diri,
kip
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
pada tendon otot bisep, tes yorgason disamping timbul nyeri juga didapat penonjolan pada samping medial tuberkuluminus humeri, berarti tendon otot bisep tergelincir dan berada di luar sulcus bisipitalis sehingga terjadi penipisan tuberkulum (Heru, 2004). b. Bursitis Subacromialis Bursitus subacromialis merupakan peradangan dari bursa sub acromialis, keluhan utaman utamanya ya
adalah adalah tidak dapat mengangka mengangkatt lengan lengan ke sampin samping g (abduk (abduksi si aktif) aktif),, tetapi tetapi
sebelumnya sudah merasa pegal-pegal di bahu. Lokasi nyeri yang dirasakan adalah pada lengan atas atau tepatnya pada insertion insertion otot deltoideus deltoideus di tuberosita tuberositass deltoidea deltoidea humeri. Nyeri ini merupakan nyeri rujukan dari bursitis sub acromialis yang khas sekali, ini dapat dibuktikan dengan penekanan pada tuberkulum humeri. Tidak adanya nyeri tekan berarti nyeri rujukan. “Panfull arc sub acromialis” 700-1200, Pada pemeriksaan fisik dijumpai adanya “Panfull tes fleksi siku melawan tahanan pada posisi fleksi 900 terjadi rasa nyeri (Heru, 2004). c. Tendinitis Supraspinatus Tendon otot supraspinatus sebelum berinsersio pada tuberkulum mayus humeri, akan melewati terowongan pada daerah bahu yang dibentuk oleh kaput humeri (dengan pembungkus kapsul sendi glinohumeral) sebagai alasnya, dan acromion serta ligamentum
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
7.Problematika Fisioterapi
Adapun berbagai macam gangguan yang ditimbulkan dari frozen shoulder adalah sebagai berikut : a. Impairment Pada Pada kasu kasuss froze frozen n shoul shoulde derr akiba akibatt caps capsul ulit itis is adhes adhesiv ivee perm permas asal alah ahan an yang yang ditimbulkan antara lain adanya nyeri pada bahu, keterbatasan lingkup gerak sendi dan penurunan kekuatan otot di sekitar bahu. (Sidharta, 1994) b. b. Funct Functio ional nal Lim Limit itat atio ion n Masalah-masalah yang sering ditemui pada kondisi-kondisi frozen sholder adalah keterbatasan gerak dan nyeri, karena itu dakam keseharian sering ditemukan keluhankeluhan keluhan sepert sepertii tidak tidak bisa bisa menyi menyisir sir rambut rambut,, tidak tidak bisa bisa mandi mandi dengan dengan menggun menggunaka akan n gayung dan aktifitas lainnya yang menggunakan tangan sehari-hari.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
ambang ambang rangsa rangsang. ng. Sedang Sedangkan kan pengaru pengaruh h nonterm nontermaln alnya ya adalah adalah efek efek micro micro massag massage. e. Adanya Adanya geraka gerakan n searah searah dengan dengan rambat rambatan. an. Hal ini dapat dapat mening meningkat katkan kan termib termibil ilita itasa sa jaringan dan meningkatkan proses metabolisme. (Sri Mardiman, 1998 ) b.Efek Fisiologi dan Terapiutic Gelombang ultrasonic mencapai jaringan sesuai dengan ukuran tranboser. Daya tembus tembus tergant tergantung ung frekue frekuensi nsi.. Pada Pada frekue frekuensi nsi 1 MHz, intens intensit itasn asnya ya sedala sedalam m 5 cm. Pengaruhnya antara lain : *.Panas dapat meningkatkan aktifitas ak tifitas sel, fasodilatasi yang melancarkan peredaran darah. *.Mengurangi nyeri dengan gelombang pulsa rendah intensitasnya. *.Dapat melancarkan perubahan klinis (Sri Mardiman, 1998) b.Metode Terapi Menurut Sri Mardiman, 1998 ada beberapa media yang dapat digunakan untuk
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
air, air, sert sertaa meto metode de langs langsun ung g juga juga tida tidak k sesu sesuai ai.. Penan Penanga ganan nannn nnya ya yait yaitu u tran tranduc ducer er di masukkan dalam air, dan suatu reflector dipasangkan untuk memantulkan gelombang US kearah permukaan air, bagian yang diterapi harus tegak lurus dengan permukaan air. Dan metode yang lain adalah “water bag”,dengan cara kantong karet yang berisi air masak ditaruh diatas area yang diterapi, tranduser ditempel dan bergerak diatas kantong. Jadi gelombang akan melalui air dulu baru ke area yang diterapi. Metode ini untuk area yang banyak tonjolan. (Sri Mardiman,1998) c.Indikasi dan kontra indikasi Ultrasonic di indikasikan untuk kontraktur, nyeri, spasme, penyembuhan jaringan, kerobekan tendon. Sedankan kontra indikasi adalah neoplasma ,aplikasi yang dekat organ seksual, jantung. 2. Untuk mengurangi nyeri dan meningkatkan LGS dengan terapi manipulasi
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
gerakan aktif. Terapi manipulasi manipulasi harus diakhiri diakhiri bila sendi telah mecapai mecapai LGS maksimal tanpa nyeri dan pasien dapat melakukan gerakan aktif dengan normal. (Heru,2004) Sebelu Sebelum m melaku melakukan kan mobili mobilisas sasii sendi sendi bahu maka maka harus harus dipaha dipahami mi pengert pengertian ian permukaan sendi “concav “concav dan convex” sebagai dasar arthrokinematik. Pada sendi bahu, permukaan caput humeri convex sementara cavitas glenoidalis bersifat concav, glidding akan berlawan berlawanan an dengan dengan arah gerak gerak tulang tulang
(osteo (osteokin kinemat ematik) ik).. Sedang Sedang sendi dengan
permukaan concave, arah glidding ( slidding) searah dengan tulang yang bergerak. Untuk traksi sendi bahu arahnya ke lateral, ventral, cranial atau tegak lurus untuk permukaan sendi pada posisi
“loose packed position” . pelaksanaan traksi bisa ke segala arah
menurut daerah keterbatasan sendi (Heru,2004) Sebelum melakukan terapi menggunakan teknik-teknik mobilisasi manual, ada aturan-aturan yang harus diketahui terlebih dahulu, atau yang disebut dengan treatmen
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Untuk memfiksasi bagian tubuh tertentu dapat menggunakan tangan terapis, serta dengan dengan bantuan orang lain. Fiksasi dilakukan sedekat mungkin dengan ruang sendi tanpa menimbulkan nyeri. d.Tangan terapis Tangan terapis yang bergerak memegang bagian tubuh sedekat mungkin dengan tulang sendi. Untuk menghindari nyeri kadang-kadang perlu merubah pegangan. e. Arah gerakan Arah translasi selalu tegak lurus atau sejajar dengan bidang terapi. Untuk traksi sendi bahu yaitu yaitu kearah latero latero ventro cranial. cranial. Karena sendi bahu terdiri terdiri dari sendi caput humerus berbentuk cembung bergerak pada glenoidolus yang berbentuk cekung, maka searah dengan gerakan yang akan diperbaiki, yaitu lateral cranial untuk memperbaiki gerakan gerakan abduksi abduksi,, ventral ventral medial medial untuk untuk geraka gerakan n exorot exorotasi asi,, dan caudal caudal latera laterall untuk untuk
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
BAB III PENATALAKSANAAN STUDI KASUS
I.
KETERANG ANGAN UMUM PENDERITA
Nama Umur
: Tn. SH : 52 th
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
II.
SEGI FISIOTERAPI Tanggal : 15 April 2008 a.
Anam Anamne nesi siss (Aut (Auto o Anam namnesi nesis) s) 1.
Keluhan Utama
Pasien mengeluh bahu kiri tidak bisa digerakkan sampai maksimal, karena adanya nyeri. 2.
Riwayat Penyakit Sekarang
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Tidak ada anggota keluarga yang mempunyai riwayat penyakit yang sama dengan pasien.
7.
Anamnesis Sistem
(a )
Kepa epala da dan le leher
Tidak ada keluhan pusing. (b) (b)
Kar Kardiov diovas asku kuller
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
a) b)
Tekanan darah Denyut nadi
: 120/80 mmHg. : 86/menit.
c)
Pernafasan
: 18/menit.
d)
Temperatur
: tidak lakukan.
e)
Tinggi badan
: 167 cm.
f)
Berat badan
: 70 kg.
1.2 Inspe Inspeks ksii
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
1.8 Kemampuan Kemampuan Fungsional Fungsional dan Lingkungan Aktifitas Aktifitas
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
R(F0) : 40.0.40 (b) VAS (Visual (Visual Analogue Analogue Scale) Scale) Untuk mengukur tingkat nyeri pasien.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
(b) Jangka Jangka Panjan Panjang g
: Mengem Mengembal balika ikan n aktifi aktifitas tas sehari sehari-ha -hari ri pasien pasien secara secara mandiri, tanpa gangguan.
2
Tindakan Fisioterapi
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
(c ) e.
Drop Arm test
Prognosis
Quo ad Vitam
: baik
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
View more...
Comments
