TABLE OF CONTENTS

TITLE PAGE iPREFACE iiTABLE OF CONTENTS iiiCHAPTER I. SCENARIO 1CHAPTER II. KEYWORDS 2CHAPTER III. PROBLEM 5CHAPTER IV. DISCUSSION 8I.1. LIMITATIONS 8I.2. Anatomy / Histology / Physiology / Pathophysiology /PATOMEKANISME 14I.3. TYPE - TYPE OF DISEASE ASSOCIATED 20I.4. CLINICAL SYMPTOMS 22I.5. PHYSICAL EXAMINATION OF DISEASE 21I.6. SUPPORTING DISEASE DIAGNOSIS 21CHAPTER V. INITIAL HYPOTHESIS (Differential Diagnosis) 22CHAPTER VI. ANALYSIS OF Differential Diagnosis 23VI.1. CLINICAL SYMPTOMS 23VI.2. 23 PHYSICAL EXAMINATIONVI.3. EXAMINATION OF SUPPORTING 25CHAPTER VII. HYPOTHESIS END (DIAGNOSIS) 27CHAPTER VIII. MECHANISMS DIAGNOSIS 28CHAPTER IX. STRATEGY FOR RESOLVING THE PROBLEM 31XI.1. MANAGEMENT 31XI.2. MEDICAL ACTION PRINCIPLE 32CHAPTER X. Prognosis AND COMPLICATIONS 33X.1. HOW TO PATIENT SUBMISSION Prognosis /FAMILY PATIENT 33X.2. SIGNS TO CONSULT 33X.3. ROLE OF PATIENT / FAMILY IN HEALING `34      X.4. DISEASE PREVENTION 34CHAPTER XI. CONCLUSIONS AND SUGGESTIONS 36REFERENCES 37

CHAPTER ISCENARIO 2

Ali Prabowo 20 years, complained of right thigh pain and knee pain when walking, was also weak, so he went limp.Began to feel pain from weightlifting exercises participated in the campus two days ago because he was forced to lift weights heavier than the recommended coach.CHAPTER IIKEYWORDS

1. Painful2. Lame3. Limp4. Weight lifting

Classification Keywords1. PainfulIt is an unpleasant feeling is conveyed to the brain by sensory neurons. Wound signals actual or potential discomfort to the body, pain is also included subjective perception or interpretation of anxiety. Type of pain:a. Acute pain: caused by damaged tissue such as skin burning or presence of damaged tissue. This type of pain usually disappears when the injury healed or the cause of the pain disappeared.b. Chronic pain: the pain that remains after a wound is healed, the pain is caused by the body's response to acute pain chronic pain can be intermittent or sustained because of an ongoing tissue injury or becomes ill, it can cause a decrease in body weight, insomnia, fatigue and Other symptoms of stress. Pain is the most common symptom of injury and illness and can include the intensity of the pain until the pain was so unbearable. Nociceptor have the ability to greet [passed on information to the brain that the location, nature and intensity of pain.2. LameIs due to lack abnormalan something and the most common is happening in the feet, so foot walk is not natural.3. LimpIs a state in which the body in a state of the drop due to certain factors.

4. Weight liftingIt is a competitive sport to lift the heavy burden called the barbell, which is done by a combination of strength, flexibility, concentration, ability, discipline (very important), athletic, fitness, technique, mental and physical strength. The word "weightlifting" is usually used unofficially as weight training.

CHAPTER IIIPROBLEM

1. Why is Mr Ali Prabowo had a limp?2. Where is the pain?3. Starting when feel pain?4. What causes pain?5. What Ali Prabowo disease diagnosis?

PROBLEM DESCRIPTION

1. Mr Ali Prabowo had a limp because he forced himself to lift the load exceeds the strength of his body and ignoring the advice his coach, causing thigh kananya spasm or cramping during training two days ago.2. Pain experienced by Mr Ali Prabowo is on the right thigh.3. Mr Ali Prabowo feel pain from weightlifting exercises participated in the campus two days ago.4. Pain experienced by Mr Ali Prabowo due to the occurrence of tearing of several ligaments and skeletal muscle (striated) as well as lifting weights in excess of the power of his body without offset by the heating process prior to exercise, causing a sudden contraction of muscles but does not eliminate and reduce joint function tersebut.Sehingga occur pain, pain, swelling of the small, little bleeding but did not happen leksitas abnormal.5. Muscle spasms or cramping right thigh level 1.

CHAPTER IVDISCUSSION

IV. 1 LIMITATIONS1. Understanding PainPain is defined as a condition that affects a person and extensions in mind if someone ever experienced it (Samsuri, 2007).According to the International Association for the Study of Pain (IASP), pain is a subjective sensory and emotional obtained unpleasant associated with actual or potential tissue damage, or described the condition of the damageIV. 2 Anatomy / Histology / Physiology / Pathophysiology / PATOMEKANISMEA. ANATOMY Lame Pain Weak

B. Histology1. Muscle SystemIncludes the tools the body, by way of contraction (shortened) and relaxation (again like its original state) will cause movement of the body as a whole or in part.2. Muscle Function

A. Volunteer FUNCTION IS DUE à DR MUSCLE WORK ORDER1. MAINTAINING BODY POSITION à SIT, STAND, SLEEP2. IMPLEMENTING Diverse GERAKANàBODY MEMBERS: MOVEMENT JARI-JARI: to hold diaphragm: respiration (BREATH) pharyngeal: swallowing food ALOE & Lips: MOVE FOOD and vocalizationsB. FUNCTION involuntary (not influenced DISCRETION) A RESULT OF HEART MUSCLE smooth muscle PROPULSION Master Theses (PUSH) SUBSTANCE variety DLM-2 CHANNELS, SUCH AS: FOOD WALK ALONG THE LINE DIGESTION; BLOOD IS RUNNING IN ALL THE TUBE OF BLOOD; EGG CELL LINES ARE WALKING IN ALL THE EGG (oviduct); sperm WALKING IN LINE SPANJANG MANI expulsion (EXPENDITURE) SUBSTANCE STORED IN BAGS (gallbladder) à bile, urine, feces REGULATIONS (CONTROL) DIAMETER HOLE SET à pupil size, pylorus of the stomach, rectum (anus)

C. PHYSIOLOGICAL1. SHAPE: Consist of many fibers, the point is located at the edge (edge), there are dark lines and bright (very clear), the length of skeletal muscle varies between 1-40 mm, while the thickness between 10-100 microns; every skeletal muscle fibers coated by sarkolema (in Dlm sarkolema there miofibril = elements that can be contracted), the muscle fibers, each coated sarkolema 15-30 berkelopok form muscle fibers and coated fasikulus. Each fasikulus perimisium coated by connective tissue. Connective tissue covering called endomisium skeletal muscle fibers. Each endomisium coated again by epimisium. In skeletal muscle there is an à myoglobin pigment called myoglobin. LOCATION: all the muscle attached to bones, muscles of the tongue, the sky-rainbow (palatinum), pharing, the end of the esophagus INNERVASI: kraniospinal à nervous system to work according to the will of the individual ACTION: rapid contractions, lasted for a while

2. Muscle properties 1. Muscle contractility à capability to conduct response (shortened) when stimulated (smooth muscle sixth time; skeletal muscle 1 / 10 times) 2. Extensibility = DISTENSIBILITAS à ability to elongate the muscle if the muscle is pulled or no forces acting on the muscle à if given the expense of skeletal muscle, uterus containing fetal 3. ELASTICITY à muscles ability to return to its original shape and size after having extensibility / distensibilitas (lengthwise) or contractility (shortened) 4. IRRITABILITAS = à excitability muscle ability to hold when the excitatory response

3. PathophysiologyClassification / Type Intensity Thigh Cramps:

a) mild Sprain / level 1: It is a tear of some ligaments but does not eliminate and reduce the function of these joints. Patients can take care of themselves during the rehabilitation process, or after getting a

diagnosis from a doctor. The period between 2-6 weeks of healing. Happened pain, swelling of the small, little bleeding but did not happen leksitas abnormal.b) Sprain moderate / level 2: Where there is damage to the ligaments that larger enough but not until there is a total break. Ligament rupture, causing a decrease in joint function. For recovery need help with a range of physiotherapy time 2-6 weeks. Pain / pain, swelling occurs more bleeding.c) Sprain level 3: There was complete rupture of the ligament resulting in complete separation of ligament from bone. To be able to recover the required surgery and physiotherapy and the average take 8-10 weeks. at this level has broken knee ligaments in total knee and can not be moved.

4. PATOMEKANISMEGenerally thigh spasms or cramps occur because of the withdrawal on striated muscles suddenly and rapidly, especially a fast and hard so hard to be moved:a. Symptoms sharp pain suddenly in front of the foot during a workout. quad muscles going into spasm may cause pain in the stretch and contraction. The swelling and bruising. weakness and difficulty walking.Cramps are muscle spasms that cause sudden pain. Muscle spasms often occur when we are sleeping, but can also be due to hard physical labor, such as running. Usually when we run our leg suddenly experiencing cramps. Muscle spasms also occur due to loss of body salt and fluid because of the sweat that comes out. Cramps can usually be cured by stretching and massaging the affected muscle.

Cramps and place the following classification: Cramps in legsVictims assisted standing and weight were detained by the forefoot. After the first seizure had passed, massage her feet. Cramps in calvesKnee victim straightened, feet pressed firmly and steadily upwards towards the shin. Massage the muscle. Cramps in thighsFor the strain on the back of the thigh, knee and leg straightened appointed victim. For the strain on the front thigh, knee bent. In both thighs, massage her muscles tightly.

IV. 3 TYPE OF DISEASE ASSOCIATEDa) Muscle FatigueMuscle fatigue is a condition in which muscle contraction can no longer do so resulting in muscle cramps or muscle spasms.b) Muscle AstrofiAstrofi muscle is the decline in muscle function due to a small muscle contractions and loss of function. Usually caused by the disease poliomyelitis.c) muscular dystrophyMuscular dystrophy is a muscle disorder that usually occurs in children due to chronic illness or congenital defect.

d) Hipotrofit MusclesHipotrofit muscle is a type of abnormality in the muscles that cause the muscles get bigger and looks strong due to excessive muscle activity is generally due to excessive work and sports.

IV. 4 CLINICAL SYMPTOMSIn individuals who suffered injuries which are classified, there are two symptoms of common symptoms and specific symptoms. Symptoms usually are pain that is felt, whereas in particular symptom of pain in the right thigh, pain in the knee when walking, body limp and hobble tersa.

IV. 5 DISEASE PHYSICAL EXAMINATIONViewing events that exist in the second scenario must be a physical examination to the patient at the bottom ekstermitas by inspection, palpation. While doing the inspection is to see how much swelling or keteganganya intensity. In performing palpation should be considered is whether there is any pain in the injury when pressed, then the excessive rigidity and also checking skin turgor pressure.

IV. 6 DISEASE DIAGNOSIS SUPPORTING1. For the investigation, which must be done is by x-rays in the region femoris dextra and Neurology Examination:• Sensory Nerve• Motor Nerves• Note the gradation of nerve damage

CHAPTER VINITIAL HYPOTHESES

   Based on data obtained in scenario 2, that the patients experienced seizures or cramping in the femur part dextra causing a little pain when walking and limping caused his net:

cramps or spasms often occur in skeletal muscle. Cramps can accompany motor system diseases, metabolic diseases, such as uremia, tetanus, and run out of electrolytes, particularly sodium, potassium, and calcium. Muscle cramps are often reported to occur at night or while resting, and can be caused by low blood sugar levels at night. Dehydration can also cause cramping. Cramps are involuntary spasms of specific muscle groups, which become hard and painful. There are at hetis, thighs, buttocks, or other muscle groups.

CHAPTER VIANALYSIS OF EARLY HYPOTHESIS

VI. I CLINICAL SYMPTOMS sharp pain suddenly in the thigh. Pain when stretching the thigh.

thigh pain during muscle contraction refused. quadeiseb muscles will go into spasm causing pain in the stretch and contraction. The swelling and bruising. weakness and difficulty walking.VI. 2 PHYSICAL EXAMINATION1. Anamnesis Disease History now (knee pain when walking, limp, limp, upper thigh pain) disease had no trauma history

2. Vital Sign:     Weight: 60 kgHeight: 170 cmTension: 120/80Nadi: 85 x / minRR: 17 x / minTemperature: 31 0 C

3. Physical examinationAt the initial examination note:a). Shock, lameness, swelling.b). Damage to other organs.

4. Circulationa) Hypertension (sometimes seen as a response to pain / anxiety) or hypotension (blood loss)b) Decrease in arteries of the distal injury, slow capillary fillingc) tissue swelling or hematoma on the injured side

5. Local Examinationa) Inspection minimal edema in the region of the femoral dextra Visible hematominimal in the region of the femoral dextra minimal deformities in the joints coxae Compare the healthy part Note the position of limb Situation vascularizationb) Palpation Minimum Palpation tenderness in the region of the femoral dextra Joint coxae somewhat disturbed There fungsiolesi

a) Movement Active Movement Passive Movement

VI. 3 EXAMINATION SUPPORTa. Arteriography examination performed if suspicion of vascular damage occurs due to spasm or cramp the femur part dextra.Complications: Causes of complications of convulsions or cramps femur part dextra generally divided into two: either the trauma itself, may also be due to spasms or cramps handling dextra femur section called iatrogenic complications.b. Neurological examination:• Sensory Nerve• Motor Nerves• Note the gradation of nerve damage

CHAPTER VIIEND OF HYPOTHESES

From the results obtained diagnosis in the first scenario: Mr. Ali Prabowo 20 years experience spasms or cramps in the dextra femur. Of the several factors that cause spasms or cramps femur part dextra, acquired four medical risk factors in Mr Ali Prabowo namely: right thigh pain, knee pain when walking, the Agency felt weak and Lame when walking.

And experienced by Mr Ali Prabowo is seizures or mild cramping / level 1: It is a tear of some ligaments but does not eliminate and reduce the function of these joints. Patients can take care of themselves during the rehabilitation process, or after getting the diagnosis from a doctor. The period between 2-6 weeks of healing. Happened pain, swelling of the small, little bleeding but did not happen leksitas abnormal.         For example: Spasms or cramps in the hamstring muscles that interfere with sprints and weight lifting athletes.

CHAPTER VIIIMECHANISMS DIAGNOSIS

CHAPTER IX STRATEGY FOR RESOLVING PROBLEMS

IX. I MANAGEMENT Management of convulsions or cramping thigh dextra including the following: There are 4 ways of handling spasms or cramping thigh dextra: c. Injury degrees I usually recover quickly with the provision of rest, ice, compression and elevation (RICE). Therapeutic exercise can help restore strength and flexibility. Cold Therapy: Ice is a vasoconstrictor so as to reduce internal bleeding and swelling.

It can also help to overuse injuries or chronic pain after each practice. heat therapy: Used in chronic injuries or injuries without swelling. Increasing the elasticity of joint connective tissue, blood memperbaikisirkulasi Do not be carried out after practice Example: pain, stiffness, joint pain. d. Injury same degree II treatment only added to the immobilization of the injured area. e. Third degree injury is usually done immobilization and possibly surgery to restore function. The key to healing is an early evaluation by a medical professional. Once the injury has been determined, treatment plans can be developed. With proper care, most seizures or thigh cramps dextra will heal without side effects. f. Rehabilitation: This is the process of returning to its original function and structure by carrying out active and passive ROM as optimal as possible in accordance with the ability of the patient. Isometric muscle exercises and settings. Endeavored to minimize disuse atrophy and increase blood circulation. IX. 2 PRINCIPLES OF MEDICAL ACTION In people who have given strain treatment as follows: 1. Place the patient in a comfortable position, rest the injured part. Immediately cease all activities, saying "no pain no gain" adopted by some athletes can not be justified in this case. Excessive activity in the affected parts of the body which will lead to further complications. 2. Elevate the injured area. The goal is to reduce excessive swelling. 3. Give a cold compress for 30 minutes, repeat every hour if necessary. When a new injury took place, there will be tears of blood vessels that lead to the release of "content" of blood vessels into the tissue around it so swollen blood vessels around the injury also will widen (dilate) in response to inflammation. Giving a cold compress / ice would be "narrow" which widen blood vessels, thereby reducing swelling. Cold compresses can be done 1-2 times a day, no more than 20 minutes because it would interfere with blood circulation. Conversely, when the injury is chronic, inflammatory tanda2 such as swollen, red, severe pain is gone, then the principle of warm compresses can be done. 4. Balut press (pressure bandage) and remain exalted. Compress / emphasis on the injury, could do with a bandage / bandaged. Not too tight, the aim to reduce the swelling and the pressure remains elevated. Press the injury until the pain disappeared (usually 7 to 10 days for minor injuries and 3 to 5 weeks for severe injuries. 5. Elevate the injured area. The goal is to reduce excessive swelling. 6. If needed, use crutches when walking. 7. If doubt do care as a broken bone x-rays and refer to health facilities. And avoid HARM, namely H: Heat, hot gift it will increase bleeding, A: Alcohol, will increase the swelling, R: Running, or exercise too soon will get worse injury, M: Massage, should not be given during the acute as it will damage the network . Handling the strain in general. Injury degrees I usually recover quickly with the provision of rest, ice, compression and elevation (RICE). Exercise therapy can help restore strength and flexibility. Injury same degree II treatment only added to the immobilization of the injured area. And degree III is usually carried out immobilization and possibly surgery fatherly restore function. The key to healing is an early evaluation by a medical professional. Once the injury has been determined, treatment plans can be developed. With proper care, most strains will heal without side effects.

CHAPTER X Prognosis AND COMPLICATIONS

1. How the delivery of prognosis in patients and patient families A doctor, has the goal of helping patients fight the disease. The doctor is not God that can determine one's life and death, He was only as an intermediary, made his profession to help fellow. Information provided by doctors to patients should be tailored to the patient's condition itself. Because not all patients were told specifically uncomfortable about the disease. There are quite satisfied with penjelasaan simple, some are asking more specific explanation. This usually depends on the level of education a person, usually a higher level of education make more patients ask about many things. Submission of prognosis may be giving advice to patients and reassure patients.

2. Signs to refer patients Cramps or spasms often occur in skeletal muscle. They can accompany motor system disease, metabolic disease. Some complications that may affect the health of patients is Uremia Is a toxic condition that caused kidney failure. This occurs when the kidney function can not remove the urea out of the body that accumulate urea in the blood. Uremia can cause disturbances in blood platelets and hypersomnia and other securities. Distonia  Is a movement disorder in which sustained muscle contractions causing repetitive movements or spin and causing the abnormal posture. Out of electrolytes, particularly sodium, potassium, and calcium. Inflammation at the attachment to bone (periostitis); or prolonged disability, especially weakness.

3. The role of the patient or family for healing We must give a correct understanding among the community, so as not to create a more severe illness or injury. For example, as in the case of Mr. Ali Prabowo where he suffered a work accident, when he joined the weightlifting exercises. And the family's role here can be expected to treat patients with patience and always carry out supervision of all recovery and handling if getting worse, the same goes with patients to continue to maintain the condition of his own body well and do not let excessive stress on cideranya because it can interfere with healing injuries experienced.

4. Prophylaxis Warming before sporting activities Cooling after making sporting activities Fill out carbohydrates during sporting activity with sufficient drinking water Wear shorts or pembidai Compressy thigh to maintain muscle warmth Do not lift loads beyond the limits of the body

CHAPTER XICONCLUSIONS AND SUGGESTIONS

I. CONCLUSIONSpasms or cramps are muscle tissue damage due to direct trauma (impact) or indirectly (overloading) due to the stretched beyond normal limits or tearing of muscles and tendons (connective tissue / forte linking yg connects muscle to bone or tail muscle) because it stretched beyond the limit normal and occur abruptly. Strains often occur in the groin muscles (in the groin), hamstrings (bottom of the thigh muscle), and quadriceps muscle.II. ADVICE Warming adequate prior to exercise or certain activities involving the muscle. Then do not forget cooling / pelemasan afterwards. Drink more fluids, especially those containing electrolytes, while exercising. Exercise with light intensity first, then gradually more severe.