Kunyatsoona Kuona Kufananidza Nzira | El Paso, TX.

Kuratidzwa Kwemafupa Anowedzera

Acute Trauma

• Proximal humeral Fx nhoroondo ye4-6% yezvose Fxs. Osteoporotic (OSP) Fx mu> 60 iyo inobatanidza nekutambudzika kwakanyanya ne F: M 2: 1 chiyero. Muvatachiri vaduku, simba guru rekutsvaira simba rinowedzera.
• Matambudziko: AVN humeral head, Axillary N kuparara.
• Neer Kuisa chikamu
• Rimwe chikamu Neer Fx- hapana kutama kana kushomeka <1-cm / 45-degree. Inogona kukanganisa 1-4 mitsara uye M / C pakakura kutapira. 80% yeiyo proximal humeral Fx imwe-chikamu Neer.
• Zvikamu zviviri-chikamu Fx: 1-chikamu chinotapukira> 1-cm / 45-degree. m / c inosanganisira mutambo wokuvhiya
• Nhatu-chikamu Fx: 2-zvikamu zvakasununguka> 1-cm / 45-degree.
• Zvikamu zvina-chikamu Fx: ese mana-mativi anogona kutamiswa. Zvisingawanzo <4%
• kuri: 1st nhanho-radiography, CT inogona kushandiswa mumatambudziko akaoma. Orthopedic referral
• Kutungamira: Neer imwe chikamu Fx inobatwa neSling Immobilisation uye progressive rehab
• Huru zhinji yeFx kune vakwegura inobatwa pasina kushanda
• Vachiri vaduku (40-65) dzimwe nguva vangada hemiarthroplasty kana 3 kana 4-chikamu Neer Fx iripo. Dambudziko guru reAVN

Proximal Humerus Fractures

• Ongorora: Mufananidzo wekuruboshwe: Fx inosanganisira iyo anatomical mutsipa uye yakakura tuberosity ine kushomeka kushomeka <1-cm / 45-degree saka Dx seimwe-chikamu Fx. Mufananidzo wakarurama

• Tarira: matatu-chikamu Neer Fx (kuruboshwe) uye ina-chikamu Neer Fx (kurudyi)> manejimendi: inoshanda muzviitiko zvakawanda mune vadiki (40-65) varwere

Akabatwa Akabatana aka Glenohumeral Joint dislocation (GHJD)

• Rinotsanangura kupedzisa kupatsanurwa kwemaserosi kubva ku scapula glenoid. Mu 20-40s M: F 9: 1 chiyero, mu60-80S M: F 3: 1
• Anatomy: bipito kugadzikana kunopiwa nokuda kwekufamba, uye GHJD yakawanda ndiyo m / c pakati pezvisungo zvakakura mumuviri
• Kudzivirira kudonha (semuenzaniso, FOOSH) uye MVA ndizvo m / c zvinokonzeresa. GHJ inonyanya kushupika mukutapwa, kuwedzerwa uye kutenderera kwekunze. Anatomical zvinhu: isina kudzika glenoid, laxed ant-yakaderera capsule uye GH ligaments. GHJD inokonzeresa kubvarura kwakanyanya kwekudzora kukuru kweGHJ. Yakabatana osseous uye labral kukuvara zvakajairika uye zvinogona kutungamira mukusingaperi kusagadzikana, DJD, uye shanduko yekushanda
• 3-marudzi: Anterior GHJD (95%)
• Posterior GHJD (4%) kunyanya inobatanidza nehutano hwekurwadziwa, electrocution uye inogona kuitika b / l
• Akaderera GHJD aka Laxatio Erecta (<1%) inosangana nekutambudzika kwakanyanya
• Clinically: AGHJD inopa kurwadziwa kwakakomba, ruoko rwakatenderera kunze uye ruderedzwa, kukanganisa kwakanyanya kwekufamba. GHJD inogona kupfuurira sekusingaperi kusununguka.
• Kutungamira: kukurumidza kudzikisira muED pasi peanesthesia kana inorema sedation neKocher tekinoroji yepamusoro mufananidzo (isina kushandiswa), nzira yekunze yekutenderera (yepakati) kana yeMilch nzira (inogona kushandiswa w / o anesthesia) uye dzimwe nzira shoma. Kunonoka mukuderedza kuwirirana pamwe nenjodzi huru yekukurumidza uye kwenguva refu- matambudziko

Kuongororwa Kufananidza Kwenzira

• Mhemberero dzakasiyana x-radiography yakakwana. Kuwedzera Kufananidza neC CT scanning uye MRI inogona kubatsira Dx osseous, cartilage, labral / ligaments pathology
• Anterior GHJD (95%). Nzvimbo yekasikoni (kumusoro kwekurudyi) ye-humerus ndiyo m / c
• Anterior GHJD inogonawo kuitika sa subglenoid (pasi nechokuruboshwe) uye zvisingaiti se subclavicular
• Chinhu chekutsvakurudza ruzivo rwekutsvaga ruzivo ndechekuongorora maitiro akanganisa eBartart uye Hill-Sachs

Bankart Lesion

• Inoitika panguva ye anterior GHJD d / t kushandiswa kwemukoko mu anterior-inferior glenoid. Kusiyana kunovapo (ona slide inotevera). BonyBankart inogona kuonekwa pa-x-rays. Izvozvo zvinodanwa kuti zvinyoro zvishoma Bankart inoda MRI. Cartilage (soft) Bankart ndiyo m / c.
• Hill-Sachs aka Hatchet deformity (arrow postreduction) inowanikwa panguva imwechete yeBanartart, kureva, kudzvinyirira uye kugadzirisa kwemashure ekusimudza maruva emusoro pamusoro pechiratidzo chebhenekeri chinogadzira Fx. Gomo-Sachs lesion rinogona kutaridzika kuRHDD.
• Bhengi yeBartart inogona kuporesa, asi inoshanda suture anchors inodiwa dzimwe nguva
• CT arthrogram uye MRI inogona kubatsira

Aina dzeBartart Lesion

• Cherechedza mhando dzakasiyana dzeBhanart lesion. Onlyosseous Bankart inogona kuonekwa mupasimusi. Bhuku rinoshandiswa Bankart inoda MRI pamwe uye isina in-articular gadolinium (arthrogram).

Kushamiswa kwemashure

• Cherechedza: posterior GHJD ine zviratidzo zvayo:
• Trough sign aka reverse Hill-Sachs. Inoitika d / t anterolateral musoro impaction Fx
• Rim chikwangwani: chete chinowanikwa muPGHJD d / t nzvimbo yepamusoro yepamusoro yemusoro uye anterior glenoid-kuvhara musoro musoro 6-mm kana kupfuura
• Chiedza chechiedza-dhi: d / t yakajeka mukati mokudzoka kwemaseruri (musoro)

Inferior GHJD

• Inferior GHJD aka Laxatio Erecta
• Kuwedzera kwehutachiona uye kushanduka kwepasi kwakanyanya kwemashurusi. Mikana yakawanda yekukuvara kwakakomba kwehutano uye acromial Fx
• Ruoko rwakatambanudzwa rwakarongedzwa uye rwakagadzirirwa nehutenderedzwa hwakatsinhirwa uye ruoko rune pamusoro pemusoro

ACJ Dislocation (ACJD)

• ACJD: zvinowanzovhiringidza, 9% yemakumbo bhandi majoka esp. mune vatambi vechidiki nekurova zvakananga
• Rockwood classification (kuruboshwe) inotarisa kubvarura kweAAC neC CC ligaments uye nzvimbo dzomunyika
• Type1, 2, 3 pakati pe m / c
• Tora 1: sprain ye ACL w / o tearing
• Tora 2: kuchema kweAAC uye sprain yaCCL
• Type 3: kuchema kwe AC & CCL. Iyo clavicle yakakwidziridzwa pamusoro peacomic. Kana <2-cm mhedzisiro yakanaka ine inochengetedza Rx.
• kuri: x-radiography ine b / l ACJ maonero uye uye w / o mashizha kuenzanisa zvose ACJs. Mumatambudziko akaoma CT scanning esp. kana Fx inofungidzirwa
• Manejimendi: Type 3 (> 2-cm) & Mhando 4-6Operative

Tora 3 ACJ Separation

• Tora 3 ACJ kuparadzanisa (kuruboshwe)
• Zvimwe zvakakosha ACJD (mifananidzo yakadzika) nechipatara chiratidzo cheacromion pasi peganda uye zvinogumira ORIF

Rotator Cuff Muscle (RCM) Pathology

• RCM tendinopathy: kuparara kwechikwata cheRCM kunyanya Supraspinatus M. tendon (SSMT) d / t kudzvinyirira / kupera-kusvinikana nekugadzirisa kushandiswa kweganda. Impingement syndrome inonzi 2nd inokonzera chikonzero. Yakapiwa kliniki sezvinorwadza uye zvishoma ROM
• Kufananidza Dx: MSK US inogona kunge yakajeka seMRI uye iri nani pane dzimwe nguva d / t kushandiswa kwevhenekeri v
• Chinokosha MRI clue yakasimbiswa mune SSMT isina kugadzikana neakawedzera chiratidzo pane ese maficha akateedzana d / t mafuta kupera uye kuzvimba (kuruboshwe mifananidzo: T1 & T2 FS)
• MSKUS zvakawanikwa: kuwedzera kweiyo SSMTsubstance ine shanduko in yakajairwa echogenicity.MSKUS yakanaka kune DDx ine SSMT misodzi. Zvakanakira US ndezvekuti zvinobvumidza zvine simba kuongororwa kwezvimiro zvinorwadza

• Kusarura kweruzhinji rweSIMM: kusagadzikana (kusina kukwana) kusvimha kweSSSM kunogona kuitika pane bursal uye articular pamusoro kana mukati-kati, kureva, intra-substance / isina kutaurirana. Etiology: sub-acromial impingement, kuoma kwakanyanya, uye kusingaperi microtrauma tendinosis
• Clinically: kurwadziwa pamusoro pebd uye kuruka, kupindira mutsva, kuongorora kwa Hawkins-Kennedy, nezvimwewo. Pearls: kusvimha misodzi kunogona kurwadza kudarika misodzi yakakwana
• Kufananidza Dx: MSKUS yakanaka seMRI (NB dzimwe dzidzo dzakaratidza kuti MSKUS inopfuura yakanyanya kuMRI). Miridzo yeMRI inowanikwa: kupera / kusina kukwana kweSIMMT yakazadzwa nemashiripiti ejoka +/- granulation tissue
• MSKUS: yakaderera echogenicity yeSSMT, kuponda uye kusarura zvishoma nezvakazara nemvura (anechoic mitsetse). Yakashata convexity ye tendon bursal kana articular interface.

• Kunyanya Kuzara SSMT (kubata tsvina) kuchema: kupera / kuputika kwehutu. 2nd kusvika kumusangano neHooked acromion, kunyanya kushandiswa kwepamusoro kana kushungurudzika kwakanyanya. 7-25% yemarwadzo epafudzi muvanhu vakawanda. Clinically: kurwadziwa pamusoro pekugadzirisa miedzo.
• Kufananidza Dx: MSKUS yakanaka seMRI.Limitations: Dx yakashata ye labral pathology. Muchidimbu USDx: kurara kwetendon kukanganiswa, anechoic gap (mvura yakazara), hypoechoic tendon, tendon retraction, isina kuvharwa kwetikititi (pasi kuruboshwe, A: US B: MRI)
• MRI: key Dx: misodzi yekuwedzera inowedzera kuburikidza neese SSMT crescent, kudzoreredza nemafuta kuora kweSSMT uye mhasuru. Kana kudzoreredza kuri pa12 o clock kana yakakura (yepamusoro mifananidzo), inogona kunge isina kusungirirwa zvinoshanda

• Rotator Cuff (RTC) Calcific Tendinitis: kazhinji d / t calcium HADD makristasi. Vakadzi vepakati-vakadzi vanobatwa zvikuru. Ranges kubva pakufungidzira kusinganzwisisiki kutsvaga kukuvadza kwakanyanya kunoparadza kana Miriwaukee gumbo (risinganzwisisiki)
• HADD ine 3-pathological phases: maitiro ekuzorora-resorption.Makumbo-to-modered pain esp. mukuzorora chikamu.
• kuri: x-radiography: maitiro evanhu vanoita mineralization mukati me RTCMT, m / c muSSMT. MRI: ovoid / globular inoderedza zviratidzo pamagumisiro ose emapurisa kakawanda neevema yakakomberedza (pasi kuruboshwe)
• Rx: kuzvidzora kwakaitika. Maitiro akafambisa

Superior Labrum Anterior ku Posterior (SLAP) Zvipembenene / Misodzi

• SLAP misodzi: FOOSH uye kukanda mitambo kana kusagadzikana kusagadzikana aka aka Multidirectional shoulder instability (mu 20%). Tora 1-9 iripo asi M / C areType 1-4
• Mune zvose 4-mhando dzakakwirira dzakasvibiswa zvine hutano kana w / oLHBMT anchor kuchema (ona mifananidzo). Clinically: kurwadziwa, kukanganisa kweA AROM nekuedza kushandiswa kuongororwa, kazhinji zvisingawaniki zvakawanikwa zvinomirira RTCpathology
• Kufungidzira kunokosha: best imaging is MRI arthrography. Zviratidzo zvinokosha: hyperintense linear fluid signal mukati yebramu yakakura +/- inotenderera mberi neLHBT pamafuta-akavharirwa mafungiro ekufungidzira ane firimu uye FS T1 arthrogram. Yakanakisisa yakaonekwa pamakona emakoroni.
• Rx: misodzi miviri inogona kuporesa, asi misodzi isina kugadzikana inoda kushanda.
• Chinokosha DDx: maitiro akasiyana-siyana seBuzford complex uyeSub-labral foramen

• CHENGA kusvimha ne paralabral cyst (pasi kurudyi)
• Kusiyana kwakasiyana-siyana DDx: sub labral foramen (pasi kuruboshwe) chinyorwa: MR arthrography nechokusiyanisa undercutting the labrum asi w / o achiendesa mberi kwepamusoro kune LHBT

Akabatisa Arthritis

• GHJ DJD: kazhinji inobatanidza ne 2nd chinokonzera: kushungurudzika, kusagadzikana, AVN, CPPD, nezvimwewo. Yakapiwa nemarwadzo, chikwata uye kupera kweROM / basa. Associated RTC chirwere chinogona kuvapo. Imaging; x-radiography yakakwana uye inopa chirongwa chekuchengetedza / kuchengetedza. Zvakawanda zvitsva: kubatanidza kuderedza, osteophytosis esp. pamusoro-pasi-mumusoro (museve wemaruva), subchondral sclerosis / cysts. Kazhinji inonzi yakanakisa musoro kutama d / t RTC chirwere.
• ACJ OA: zvakajairika uye zvakajairwa kutanga nekukwegura. Inopa ne ACJ kurasikirwa uye maosteophytes. Osteophytes padhuze nepasi peiyo ACJ keel osteophytes (museve webhuruu) inogona kutungamira kuRTC mhasuru kuchema. Regional bursitis imwe kiriniki ye ACJ arthrosis.
• Kutarisirwa: kazhinji kunononoka zvichienderana nekliniki zviratidzo / zviratidzo

• Rheumatoid Arthritis GHJ: RA chirwere chakasiyana-siyana chinoputira chinokanganisa majoini akawanda akarongedzwa ne synovium. GHJ RA yakajairika (m / c majoini mahombe muRA mabvi / mapfudzi). Kiriniki: kurwadziwa, mashoma ROM uye kusagadzikana, mhasuru kushaya simba / kuparara. Maoko, tsoka, uye mawoko zvakakanganiswa m / c zvakakanganiswa. Kufungidzira: x-radiography inoratidza periarticular erosions, yunifomu yekubatana nzvimbo kurasikirwa, juxta-articular osteoporosis, subluxations, soft uye zvakapfava zvinyama kuzvimba. MRI inogona kubatsira kuona inowanzoenderana neRTC kubvarura uye kusagadzikana. Shanduko dzekutanga dzinogona kuwanikwa neMSKUS esp. ine simba Doppler shandisa inoratidza hyperemia / kuzvimba.
• Cherechedza: L futi ye-x-ray inoratidzira kuurayiwa kwetikara uye kurasana kwakakosha kwemajeri, kukanganisa kwakawanda, uye zvichida kurasikirwa kweRTCM kutsigira nepamusoro-soro kumhanya, ST inoshandiswa ikozvino.
• Cherechedza: PDFS coronal uye axial MRI zvikamu zveGHJ RA zvinoratidza kuvhara kwemafupa ekubatana, kuputika kwetema / edema, synovial pannus formation uye zvichida kubvarura mu RTC m. Kutarisira: Rheumatological kutumira uye pharmacotherapy neDMARD. Basa rekushanda seRTCM kugadzirisa. 10% yevarwere vakaremara d / t RA

• Neuropathic Osteoarthropathy aka Charcot's shoulder: d / t neurovascular uye neural periarticular kukanganisa. Zvikonzero zvakawanda zvinowanikwa.M / c inowanikwa muvanhu vane chirwere cheshuga mukatikati. Shoulder Charcot m / c muSyringomeria (25%), trauma paralysis, MS, nezvimwewo. Dx: kliniki (50% kurwadziwa / kuvhara 50% kuparadzwa kusina kunaka). Kufungidzira kunokosha. X-radiography inokwana mumatambudziko akaiswa zvakanaka, asi kutanga Dx inonetsa. MRI inogona kubatsira nekutanga Dx uye kunonoka kunetseka. Rad Dx: Shoulder Charcot m / c inoratidzirwa seatrophic inoparadza arthropathy nemhepo inotyisa ichiita sokuti inoputirwa nechokuita ne-intra-articular kukanganiswa, kuwanda, kusagadzikana, kusagadzikana, nezvimwe zvinhu zvinokosha

• Septic Shoulder: bendekete ndiyo 3rd m / c inoteveraknee> chiuno. Varwere vari panjodzi: vane chirwere cheshuga, RA pts, vasina kugadzikana, vashandisi vezvinodhaka IV, vanogara mukati makateti, nezvimwewo Nzira: hematogenous (m / c), inoculation yakananga (iatrogenic, trauma etc.) padyo nekupararira (eg OM). Staph. Aureus (> 50%) m / c.
• Clinically: kurwadziwa pamwe uye dec. ROM, fever 60% chete, toxemia, inc. ESR / CRP. Dx: imaging uye kubatana aspiration / tsika. RadDx: kutanga x-rays kazhinji isingashamisike kunze kweiyo ST effusion / mafuta ndege kufukidza, kubatanidza kuwedzera. Gare gare7-12 mazuva patchy osteopenia, chipfukuto-chakadyiwa / chinozadza pfupa resorption, articular kuparadza, kubatana kubatana. Dai kufambira mberi kune kwakakomba kubatana kuparadzwa uye ankyloses. Pakutanga Dx & IV mishonga inorwisa mabhakitiriya yakakosha kunyangwe pamberi petsika. Inoshanda yekudiridza uye yekubatana drainage mune zvimwe zviitiko. Zvinetso zvinokwanisika esp. kana Rx yakanonoka. MSKUS ine tsono aspiration inogona kubatsira. Ongorora: (yepamusoro mufananidzo) isiri-inoshungurudza mubatanidzwa ichikura ne inferolateral musoro kusuduruka d / t septic A dx: nesono yekuda Staph. Aures.

Ischemic Osteonecrosis

• Ischemic Osteonecrosis yemusoro wemusoro zvinogona kuitika d / t kushungurudzika (Neer ina-chikamu Fx), Steroids, Lupus, Sickle cell, Kunwa doro, Chirwere cheshuga, uye mamwe akawanda mamiriro. Kufungidzira kwakakosha: MRI inoona yekutanga shanduko se intraosseous edema. X-ray maficha anonoka, akaunzwa sekudonha kwe subchondral bone ine sclerosis chiratidzo chekapu cap, kupatsanurwa, uye inofambira mberi yakaoma DJD
• Kutungamira: mazita ekutsvaga, maitiro ekudzivirira mukati memazuva ekutanga, hemiarthroplasty muyero yakawanda uye yakazara arthroplasty mumatambudziko akaoma.

Neoplasms

• Muvanhu vakuru> 40, bone Mets d / t mapapu, chifuva, renal cell, thyroid CA & prostate ndizvo m / c zvinokonzeresa. Kiriniki: inogona kutevedzera kurwadziwa sengeRTC / shanduko dzekubatana. Inofanira kuongororwa zvakanyatso. Kiyi kuDx: Hx, PE uye Kufananidza esp.in pts ine inozivikanwa inozivikanwa
• kuri: 1st step x-rays, MRI inogona kubatsira, TC99bone kupenya kunobatsira kuona mamiriro ekuma uye kure. X-radhi inoshandiswa: kuchinja kwehutano hwekunyengedza kunowanzo mu prox humerus (marrow mutsvuku) kana kana w / o nzira Fx. DDx: Mets, MM, lymphoma
• Kumuviriro: kurwadziwa kweusiku, marwadzo ekuzorora, nezvimwe. Maitiro ekuongorora: kusingabatsiri, muzviitiko zvakanyanya hypercalcemia zvinogona kuonekwa.

• Primary Malignant bone neoplasms (fudzi) Vakuru: M. Myeloma kana Solitary plasmacytoma, Chondrosarcoma inogona kushanduka kubva enchondroma nevamwe vamwe. Muvana / vechidiki: OSA vs. Ewing s
• Kunyanya kubata mafupa mapfupa (epfudzi). Vakuru: Enchondroma (varwere vari mu 20-30s) GCT. Muvana: Simple bone cyst (Unicameral Bone cyst), Osteochondroma, Aneurysmal Bone Cyst, Chondroblastoma (asingawanzo)
• Kufungidzira: 1st step x-radiography
• MRI inokosha kuDx. Kunyanya muzviitiko zvepamusoro zvinouraya neoplasms Kuyera mukana, kushandiswa kwemaviri mutsvuku, urongwa hwekugadzirira, kushambadzira, nezvimwewo.