Nama: herdantiNpm 1102010 121LI 1. Memahami dan menjelaskan struktur makro dan mikro dari Tendo AchillesL0 1.1 letak dan fungsi anatomis ANATOMI Tendon Achilles berasal darigabungan tiga otot yaitu gastrocnemius,soleus, dan otot plantaris. Pada manusia,letaknya tepat di bagian pergelangankaki. Tendon Achilles adalah tendontertebal dan terkuat pada tubuh manusia.Panjangnya sekitar 15 sentimeter,dimulai dari pertengahan tungkai bawah.Kemudian strukturnya kian mengumpuldan melekat pada bagian tengah-belakang tulang calcaneus Fungsi anatomisSaat otot betis gastrocnemius berkontraksi, maka tendon akan ikut tertarik ke atas menarik kalkaneus sehingga kaki dapat berjinjit. Inilah yang memungkinkan kaki kita dapatdigunakan untuk sprinter,melompat,memanjat menaiki dan menuruni tangga. Dapat menahan beban tubuh hingga 12 kali lipat saat berlari

Lo 1.2 mengetahui dan menjelaskan sifat mikroskopik tendo achilles

Unsur-unsurdasar daritendonadalah bundelkolagen,sel-sel,dan substansi dasar berupa ekstraselularmatriks,suatu zatkentalkaya proteoglikan.kolagenmemberikantendonkekuatantarik,substansidasar memberikan dukungan struktural untukseratkolagen danmengaturperakitanprokolagen ekstraselularkekolagendewasa, Tenocytes, seldatar ujung meruncing,didistribusikan di antarafibrilkolagen,mensintesissubstansidasar danbangunanprocollagen. Tendon Achilles tidak memiliki banyak suplai darah.Pasokan darah lemah ditemukan di titik antara 2 dan 6 cm di atas penyisipan ke dalam kalkaneus1.3 KinesiologiTendo Achilles merupakan bagian dari kompleks unit. Myotendinous yang membentang di 3 sendi. Ketika otot otot dari tendo Achilles berkontraks maka lutut akan fleksi, pergelangan kaki plantar fleksi dan supinasi subtalus.

LI 2 memahami dan menjelaskan ruptur tendo achilles2.1 etiologiTendo mulai mengalami perubahan degenerasi pada umur 25-30 tahun. Robekan tendo kalkaneus biasnya terjadi 5 cm di atas insersinya atau tepat pada perlekatannya di kalkaneus, bisa bersifat total atau parsial. Robekan dapat pula terjadi hanya pada muskulus plantaris pada batas antara otot dan tendoPenyebab utama terjadinya ruptur adalah ketika kita mengabaikan rasa sakit dan memaksa terus menggunakan kaki tanpa istirahat. Ruptur biasanya diawali tendonitis yang overuse. Tendonitis adalah penebalan tendon dan rasa sakit saat disentuh akibat penggunaan berlebihan dan akan sangat terasa ketika dipakai berjalan. Pelatihan yang berlebihan misalnya pada penggunaan untuk berlari yang menanjak serta pemakaian sepatu berhak dapat menyebabkan tendoitis Tentu saja faktor utama adalah sesak yang berlebihan dari otot-otot kaki posterior, kontraksi terusmenerus otot-otot betis dan paha belakang dapat berkontribusi untuk tendonitis Achilles berkepanjangan. Juga penyebab2 lainya seperti Penyakit tertentu, seperti arthritis dan diabetes.Obat-obatan, seperti kortikosteroid dan beberapa antibiotik yang dapat meningkatkan risiko pecah

2.2 gejala klinis Rasa sakit mendadak dan berat dapat dirasakan di bagian belakang pergelangan kaki atau betis Terlihat bengkak dan kaku serta tampak memar dan kelemahan Sebuah kesenjangan atau depresi dapat dilihat di tendon sekitar 2 cm di atas tulang tumit Tumit tidak dapat digerakan turun atau naikKlasifikasia. Robekan pada ligamen lateral Robekan ligamen totalTrauma adduksi yang hebat dapat menyebabkan robekan total pada ligamen lateral. Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan klinik serta foto stres pada pergelangan kaki. Pengobatan dengan restorasi ligamen secara konservatif atau operatif. Robekan ligamen parsial (strain)Diagnosis dtrain ligamen lateral sama dengan yang total tetapi dengan pemeriksaan foto stres tidak ditemukan adanya robekan. Pengobatan dengan pemasangan verban elastis atau pemasangan gips dibawah lutut.b. Robekan pada ligamen medial (ligamen deltoid)Robekan terjadi karena adanya trauma abduksi. Robekan dapat bersama-sama dengan lepasnya fragmen kecil pada robekan ligamen lateral. Pengobatan seperti robekan ligamen lateral

Lo 3 memahami dan menjelaskan pemeriksaan ruptur tendo achilles3.1 pemeriksaan klinisPemeriksaan thompson (tes simond)Tes ini dilakukan untuk mengetahui kelainan tendon yang terjadi di tulang calcaneus. Cara melakukan tes ini, penderita tidur dengan posisi tengkurap, dengan kedua kaki dipinggir tempat tidur, lalu dilakukan kompresi pada otot betis. Pada otot yang normal, setelah dilakukan kompresi maka akan terjadi flexi plantar, sebaliknya jika setelah dilakukan flexi plantar dan tidak terjadi flexi plantar, maka telah terjadi ruptur tendon achilles

3.2 pemeriksaan radiologyMagnetic Resonance Imaging dapat menunjukkan secara rinci kondisi tendon yang benar-benar pecah.Achilles tendon orang yang normal dipandang sebagai daerah intensitas sinyal rendah pada semua urutan.Hal kemiringan lancar tanpa cacat fokus.Gelap band tendon sendiri dapat dibedakan dari tinggi intensitas sinyal pad lemak pra-achilles

Real-time, resolusi tinggi USG adalah murah, cepat, dan dinamis.Namun, sangat tergantung penafsir karena memerlukan pelatihan dan pengalaman untuk benar menafsirkan gambar..Gel USG digunakan untukmemastikan bahwa jumlah energi yang optimal dikembalikan ketransduser penyelidikan, memungkinkan gambar dinamis dan panorama baik dari tendon.Serat kolagen membujur diTendon Achilles mencerminkan energi ultrasonik, dan frekuensi tinggiprobe menunjukkan yang terbaik tendon.Sebuah tendon yang normal muncul sebagaisebuah, hypoechogenic pita seperti gambar yang terkandung di antara duahyperechogenic band.Band-band dipisahkan ketikatendon santai dan lebih kompak ketika tendondi bawah ketegangan.Ketika tendon Achilles pecah, ultrasonografi menunjukkan diskontinuitas tendon dengan echogenicity menurun atau meningkat, tergantung pada kronisitas dari pecah

Radiografi dapat lebih membantu dalam diagnosis oleh mengesampingkan diagnosis lain seperti avulsions kalkanealis atau lainnya

Li 4 memahami dan menjelaskan penatalaksanaan ruptur tendo achilles4.1 2 jenis operasi untuk ruptur tendo achilles There are two types of surgery to repair aruptured Achilles tendon In open surgery, the surgeon makes a single large incision in the back of the leg. In percutaneous surgery, the surgeon makes several small incisions rather than one large incision.In both types of surgery, the surgeon sews the tendon back together through the incision(s).Surgery may be delayed for about a week after the rupture, to let the swelling go down.What To Expect After SurgeryAfter either type of surgery, you will likely wear a cast, walking boot, or similar device for 6 to 12 weeks.At first, the cast or boot is positioned to keep thefootpointed downward as the tendon heals.The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down).Many health professionals recommend starting movement andweight-bearing exercises early, before the cast or boot comes off.Your total recovery time will probably be as long as 6 months.Why It Is DoneThis surgery is done to repair an Achilles tendon that has been torn into two pieces.How Well It WorksIn general: Both open and percutaneous surgeries are successful.More than 80 out of 100 people who have surgery for an Achilles tendon rupture are able to return to all the activities they did before the injury, including returning to sports.1 Although percutaneous surgery has traditionally been viewed as having higher rerupture rates than open surgery, studies now show that the rerupture rates are similar.About 5 out of 100 people who have surgery for an Achilles tendon rupture will rerupture after surgery.2 Open surgery is more likely than percutaneous surgery to result in wound healing problems.But damage to a nerve is more likely with percutaneous surgery.Newer techniques for percutaneous surgery may makenerve damageless likely than when older techniques are used.It is sometimes difficult to know how surgeries compare, because the ages and activities of those having the surgeries differ.The success of your surgery can depend on your surgeon's experience, the type of surgical procedure used, the extent of tendon damage, how soon after rupture the surgery is done, and how soon yourrehabilitation programstarts after surgery and how well you follow it.Talk to your surgeon about his or her surgical experience and success rate with the technique that would best treat your condition.RisksThe risks of Achilles tendon surgery include: Skin infection at the incision site. Normal complications of surgery oranesthesia, such as bleeding and side effects from medicines. Nerve damage. Risk of repeat Achilles rupture.This risk, though, is typically less than the risk after nonsurgical treatment. The possibility that the healed tendon will not be as strong as before the injury. Decreased range of motion.4.2 pencegahanAchilles Tendon Injury PreventionSpecific steps to minimize the risk of Achilles tendon injury include: Wear the right shoes and sports shoes.The way a person walks, runs, and jumps is related to their individual bio-mechanics: their bone, muscle, and tendon structure.Achilles tendon injuries can be caused by common bio-mechanical issues such as high arches, low arches, having legs of slightly different lengths, etc. Bio-mechanical issues can often be addressed by wearing the right shoes: seeFootwear.

Warm up before stretching or exercising.The term warm up should be taken literally: exercise muscles a little to heat them up just prior to stretching or exercise.Spend a minimum of ten minutes warming up.Warm up examples include: walking slowly at the beginning of a long or fast walk, slow cross court movements and volleys prior to playing tennis, a brisk walk before jogging, jogging before running, lifting lighter weights before lifting weights, etc. Focus on the leg muscles, with particular attention to the calf muscles.

Stretch between warming up and exercising, and then again after exercising.Although there is some controversy about the value of stretching, many professionals believe that stretching helps prevent injury and that flexibility is a key component of fitness.Stretch the back, hip, thigh, and calf muscles.Tightness in one can lead to undue strain and tightness on the others.

Pay particular attention to stretching the calf muscles because they are directly connected to the Achilles tendon.Stretching can be done lying down, sitting, or standing, and without any equipment.

However, some stretches are easier to do with an elastic band pull, when leaning against a wall or on an inclined surface.Stretches are usually named after the muscle being stretched, ie, gastroc (gastrocnemius) stretches and soleus stretches for the calf muscles.Stretch gently and slowly.Hold each stretch for half a minute to a minute.As part of a stretching program, also consider massage.Lightly massage the calf muscles before exercising and massage the calf muscles and Achilles tendons after exercising.Although there is some controversy as to the benefits of massage, many health professionals believe that massage: reduces muscle and tendon tightness, promotes healing, reduces the time muscles need to recover from exercise, and increases flexibility.Use the fingers to massage the Achilles tendons.Use a rolling pin (or similar commercial device) for the calf muscles.Apply ice therapy after massaging the Achilles tendons.

Flexibility is difficult for many people to achieve: it often takes weeks or months of consistent stretching to achieve greater flexibility.For the best results: read some exercise books, consult with a trainer at your gym, or consult with a physical therapist.

If you do aerobic and strengthening exercises on the same day, do the aerobic exercises first.In aerobic exercises, such as running or tennis, the leg muscles act as shock absorbers to protect the Achilles tendons, plus they work to keep the body aligned so that the Achilles tendons are not unduly twisted, stretched, or strained.Strengthening exercises, such as weight lifting, are done to the point of muscle exhaustion.If strengthening exercises are done first, then the muscles will be too tired to do a good job protecting the Achilles tendons during the aerobic activity, increasing the chance of injury.

Strengthen the leg muscles, particularly the calf muscles.Many people with Achilles injuries have disproportionately weak calf muscles.Leg exercises can be done without any equipment, with an elastic band pull, with free weights, or with exercise machines.Good leg strengthening exercises include: lunges, hip flexion band pulls, half (chair) squats, clean and press, leg press, inner and outer thigh band pulls, leg raises, leg extensions, and leg curls.

Of particular benefit to the calf muscles, and therefore to the Achilles tendons, are calf raises and ankle band pulls.In order to help the Achilles tendon,focus on strengthening the eccentric (calf lowering)rather than concentric (calf raising) motion.The anterior tibialis is the opposing muscle group to the calf muscles, so strengthening the anterior tibialis helps to stretch the calf muscles.The anterior tibialis is the small muscle group on the front of the lower leg: just to the right of the right leg's shin bone and just to the left of the left leg's shin bone.Its primary function is to flex the foot upward.All of these exercises can be done in a variety of ways.For example, calf raises can be done with one or two legs using: standing or sitting calf raise machines, various leg press machines, a stool, a block of wood, a stairway, or on a curb.If the exercises are done consistently and properly, muscle strength will improve in as little as two weeks.Proceed consistently and gradually.For the best results: read some exercise books, consult with a trainer at your gym, or consult with a physical therapist. Test for injuries after working out.Using the thumb and forefinger, lightly pinch different spots up and down the Achilles tendons.If the Achilles tendons are not sore, great.If they are sore, this may be an indication of Achilles tendinosis, which should be addressed right away.

Achilles Tendon Exercises and Stretches