Name: El Paso Back Clinic | Spine Specialists - El Paso, TX
Price range: $$

Kufungidzira & Diagnostics

Back Clinic Imaging & Diagnostics Team. Dr. Alex Jimenez anoshanda nepamusoro-rated diagnosticians uye imaging nyanzvi. Mukubatana kwedu, nyanzvi dzekufungidzira dzinopa nekukurumidza, zvine ruremekedzo, uye zvemhando yepamusoro mhedzisiro. Mukubatana nemahofisi edu, tinopa kunaka kwesevhisi zvakatemerwa nevarwere vedu uye zvakakodzera. Diagnostic Outpatient Imaging (DOI) inzvimbo-ye-the-art Radiology centre muEl Paso, TX. Ndiyo chete nzvimbo yerudzi rwayo muEl Paso, ine uye inoshandiswa neRadiologist.

Izvi zvinoreva kana iwe uchiuya kuDOI yekuongororwa radiologic, zvese zvese, kubva mukugadzirwa kwemakamuri, sarudzo yemidziyo, inotorwa nemaoko tekinoroji, uye software inomhanyisa hofisi, inosarudzwa kana kugadzirwa neRadiologist. uye kwete neakaunzi. Yedu yemusika niche ndiyo imwe nzvimbo yekunaka. Tsika dzedu dzine chekuita nekutarisirwa kwevarwere ndeidzi: Tinotenda mukurapa varwere nenzira yataizobata nayo mhuri yedu uye tichaita zvese zvatinogona kuti tive nechokwadi chekuti une chiitiko chakanaka kukiriniki yedu.

Chikonzero nei Chiropractors Vanoshandisa X-Rays Sechizivo Chekushandisa Kurapa

by Dr Alex Jimenez | Kufungidzira & Diagnostics, Injury Care

Vakawanda vanopa utano hwezvehutano vanoshandisa x-rays sechirongwa chekutsvaga kuporesa mhando dzakasiyana-siyana dzevarwere, kusanganisira chiropractors. Vanogona kubatsira vanachiremba kuziva kuti chii chinokonzera dambudziko kana kana pane chimwe chinhu chinowedzera. X-rays inogonawo kubatsira chiropractors kuti ione nzira yakanakisisa yekuita kurapwa. Kuti tinyatsonzwisisa, ngatinyatsoongororei zvavari uye kuti vanoshandiswa sei mune dzakawanda chiropractic mahofisi.

Chii chinonzi x-rays?

X-ray inzira ine simba kwazvo yemagetsi emagetsi ayo akafanana nemasaisai eredhiyo, radiation yeayurovi, microwaves, kana mwenje unooneka uyo unoshandiswa kuona kuumbwa kwemukati memunhu kana chinhu. Danda rinotarisana nechimwe chikamu chemuviri wemunhu, senge kumashure, rinogadzira mufananidzo wedhijitari weiyo skeletal chimiro.

Danda rinopfuura zviri nyore kuburikidza neganda uye nezvimwe zvinyoro nyoro asi haikwanise kupfuura nepfupa nemeno. Zvinyoro zvakapfava izvo zvinonyorovesa, senge nhengo, ligaments, uye mhasuru, zvichave zvichioneka asi zvichabatwa mumumvuri we grey. Nzvimbo senge ura kana mapapu anoonekwa pafirimu serima.

Kushandiswa kwechiropractic x-rays

Chiropractic x-rays inopa ruzivo rwakakosha runogona kukanganisa nzira iyo chiropractor inosarudza kurapa murwere. Mune zvimwe zviitiko, kuchengetwa kwechiropractic kana kushandiswa kwepamuviri kungasava nzira yakakodzera yekuita panguva iyoyo, uye murwere angangotanga pane imwe nzira, iyo inorapa mahara.

Dzimwe nguva, inogona kuratidza chiropractor kuti inogona sei kupfuurira mukurapa murwere. Muchidimbu, varwere vanogona kugamuchira zviri nani, zvakanyatsochengetwa zvakanaka izvo zvingaita zviri nani kuporesa nekuporesa.

Zvimwe zvezvibatsiro zve chiropractic x-rays dzinosanganisira:

Ziva mamiriro kana chiratidzo, senge bundu remusana kana lesion izvo zvinopa chikonzero chekurapa kuti imwe nzira yekutarisirwa haifanire kuitwa.
Tsvaka kukosha biomechanical ruzivo runogona kubatsira pakuronga kurapwa.
Kugara uchizivikanwa uye chengetedza zvinyorwa zvehurwere hwekudzora maitiro.
Mibatsiro pakutsanangura kusagadzikana mumutsana uye masangano angakanganisa kurapwa.
Inobvumira vateereri kuti vanzwisise mararamiro avo uye hurongwa hwehutano hwakanaka, vachivabvumira kutora huwandu hwehutano uye kuva nehuwandu hwavo mukurapa kwavo nekuporesa.

x-rays sechinoshandiswa chekushandisa e paso tx.

Chii chinonzi chiropractor chinotarisa pa x-radhi firimu?

Apo a chiropractor inotora x-ray yemurwere, ivo vari kutsvaga zvinhu mune dzimwe nzvimbo dzakasiyana. Chinhu chokutanga chavanotarisa ndechekuti vave nechokwadi chekuti hapana mararamiro, fractures, kenza, zvirwere, matumire, kana zvimwe zvinogona kuipa.

Ivo vanobva vatarisa kureba kwe diski uye zvimwe zviratidzo zvekudzikira kwe disk, bone density, bone spurs, nzvimbo dzakabatana, uye kurongeka. Izvi zvinovabvumira kuziva mamiriro akaita sa scoliosis uye mamwe mamiriro ezvinhu anogona kudikanwa maitiro chaiwo ekurapwa.

Vakawanda vanoita chiropractors vanosarudza kuti murwere ari mune chinzvimbo chinorema kana achitora spinal x-rays. Izvi zvakasiyana nekuwanda kwezvipatara izvo murwere anorara pasi.

Mukana wekutakura huremu x-rays sechinhu chekuongorora chirwere - iyo inobvumira kuyera, kureva, kushomeka kwemakumbo, scoliosis, uye kuderera kwenzvimbo yekubatana. Inogona zvakare kuratidza kuti mamwe mapfupa, senge tibia uye fibula, ari kupatsanura izvo zvinogona kuve chiratidzo chetabhenakoni yakabvaruka kana dambudziko nejojo. Iyo isiri-huremu inotakura x-ray haigone kupa iwo iwo maonero akafanana, uye uye zvakakosha zviratidzo kune mamiriro emurwere zvinogona kupotsa.

Epain Pain Treatment

Wrist / Hand Arthritis Uye Trauma: Kuona Kufananidza | El Paso, TX.

by Dr Alex Jimenez | Kufungidzira & Diagnostics

Wrist & Ruoko Ruoko

Distal Radius & Ulnar Fractures (Colles, Smith's, Barton's, Chauffeur's, DiePunch) - yakaoma ne50% ulnar styloid Fx, TFC nzira, DRUJ dislocation, scapholunate lig dissociation, lunate / perilunate dislocation)
Carpal mapfupa Kutsemuka & dislocations (scaphoid, triquetrum, hamate Fx & Lunate / perilunate dislocation)
Ligamende kuyananisa (Scapholunate dissociation, Lunotriquetral kusagadzikana)
Metacarpal & Phalangeal kutsemuka (Bennett, Rolando, Mutariri wemutamboFx / Stener lesion, Boxer Fx)
Chiremba kukuvadzwa kwemaoko (girinhi-tsvimbo Fx, Torus Fx, Kukotama / kuremara kwepurasitiki, kukuvara kweSalter-Harris)
Mune mamiriro ese ezvinhu, maOrpoppedic ruoko rwokuvhiya kunotarisirwa

ruoko rwemaoko ruoko rwekufungidzira imaging el paso tx.

Colles fx: m / cd / t FOOSH + chirevo. m / c inOSP / vakadzi vakuru. Kazhinji mumarume uye kana zvichida rubatsiro DEXA kudzivisa hip Fx nezvimwewo. Young pts: tsvina yakawanda-simba. Kazhinji zvakanyanya-articular.50% -cases inoratidza Ulna penhi (US) Fx.
Matambudziko: kudya kwemanheru kwemafuro, CRPS, DJD, kupinda mumutsipa.
Kufananidza: x-rad yakakwana, CT inowanda Fx, MRI inobatsira ne ligament misodzi neTFC.
Rx: kana yakawedzera-articular uye <5-mm distal radius kupfupisa uye <5-degree dorsal angulation yakavharwa kudzikisira + kukanda kwakaringana. ORIF mumatambudziko akaoma.
�Mufananidzo Dx: distal rad impaction/kupfupisa,dorsal angulation of distal fragment, nyatsoongorora kana intra-articular extension, 50% US Fx

Smith Fx: Goyrand mumabhuku echiFrench. Inoonekwa seyakadzoserwa maColles, neimwe nzira yakada kufanana, kureva, 85% yakawedzera-articular, 50% US Fx, OSP / vakadzi vakwegura, vechidiki pts-high-energy trauma. Misiyano: mechanismFOOSHine chanza chakachinjika kudaro m. Kashoma kazhinji.
Kufungidzira matanho: (ona Colles Fx) C
Matambudziko: akafanana neColles Fx
Rad Dx: 85% yakawedzera-articular ne volar (anterior) kuongororwa kweparal fragment, kupfupisa kweredhizha. Ngwarira kuongorora kukanganisa kwekortical kukanganisa kushandiswa kwemashoko anokwanisa kutumidzwa sa Smith type 2 kana Kudzorerwa Barton Fx (inotevera)
Rx: kufanana kwakafanana seChese.

Barton fx: FOOSH, kushandiswa kwemharaunda yakasiyana-siyana yakafanana neChese asi fline yeFx inowedzera kubva mumhepo inonzi radialaral inobatanidza ichibva kune dorsaal slip / dislocation ye carpus.
kuri: 1st Sept-x rayography kazhinji neCCTto ichiongorora fra-futi yekuwedzera yeFx nekugadzira basa
Rad Dx: radial distal Fx ichibva kubva kune dorsal kusvika mujoka raRaocarpal nedhigirii yakasiyana-siyana yekuparadzanisa, chidimbu chinotakura chechiputi
Kana Fx line inowedzera kubva pane volar pane mubatanidzwa wechirangaridzo ainzi Reversed Barton aka Smith type 2 (kumusoro kwemufananidzo wezasi)
Matambudziko: yakafanana nezera rose rekutarisana Fx
Rx: inoshanda neOIFIF

Chauffeur's / backfire Fx aka Hutchinson Fx: inonzi-ftic Fx yeRadial penhodhi. Zita racho rinobva panguva iyo motokari yaifanira kutanga ne ruoko crank iyo inogona kukonzera kupinza simba rekudzikisa kwemaoko uye kuparara kwemazuva.
Kufungidzira: x-radiography yakakwana. CT inogona kubatsira kana Fx isingakuratidzi kuratidzwa nema-ray.
Matambudziko: kusina kubatana, malunion, DJD, scapholunate dissociation, lunate / perilunate dislocation
Rx: kushandiswa nekutengesa kwekunze kwezvinhu zvose d / t intra-articularature

Die-Punch Fx: impaction Fx neLunate bone mune distal articularLunate fossa yeRadius. IntraarticularFx. Inotora zita rayo kubva kuhunyanzvi hwekuumba (kunakidza) gomba mumaindasitiri machining "die-punch."FOOSH kukuvara.
Kufananidza: 1st danho x-rays, inogona kunge iri equivocal d / t kuora mwoyo kwakaoma kweLunate fossa uye CT kuongorora kunonyanya kudzidzisa.
Rad Dx: yakagadzirirwa lunate fossa nzvimbo neyokuwedzera yeFx intra-articular. Izvi zvinogona kuunza saiye akatemerwa Fxarticular Fx weValal Radius.
Rx: operative d / t intra-articular Fx

Gadzira arcs yeGilula apo uchitarisa kukuvara kwecarpal. Nhanho inokosha inotarisirwa kuti urege kusina kuchinja kusina kumira mu carpal kuenzanisa uye cortical kupfuurira

Scaphoid bone Fx: m / c Fx carpal bone. D / tFOOSH chivimbo chakaenderera mberi chakasvibiswa. Nzvimbo yeFx inonyanya kukosha kufungidzira: Chiuno-m / c nzvimbo (70%). Itai kuti 70-100% mukana weAVN. Nhamba yepamusoro Fx: 20-30% ine ngozi yakanyanya yekusabatana. Distal pole-10% inoratidza zviri nani kutengesa. Distal pole Fx m / c kuvana. Chiratidzo chekliniki; kurwadziwa mu snuffbox.
Kufananidza: 1st nhanho-x-radiography asi 15-20% yakapotsa d/t zvemashiripiti Fx. Maonero akakosha anodiwa. Nokudaro MRI ndiyo inonyanya kunzwisiswa uye yakananga kune yekutanga zvemashiripiti Fx. Bone scintigraphy ine98/100% chaiyo & senitivity esp. 2-3 mazuva mushure mekutanga. Key rad. Dx: Fx mutsara kana zviri pachena, kutama uye kuvharwa kwe scaphoid (navicular) mafuta pad, chengetedza scapholunate dissociation. Kana proximal bone ichiita sclerotic-AVN yakaitika. MRI: yakaderera paT1 & yakakwirira paT2 / STIR / FSPD d/t bone edema, chiratidzo cheFx mutsara chinogona kuonekwa.
Rx: Spica yakagadziriswa inofanira kushandiswa kana kliniki ichifungidzirwa kunyange w / o x-raiwanikwa. For WaistFx-cast for 3-mo for prox pole 5-mo immobilization. ORIF kana pineeringaneous pinning neHerbert screw.

Scapholunate Ligaments Dissociation

SNAC wrist: scaphoid isiri-mubatanidzwa yakawedzera kudonha. Kazhinji d/t isiri-mubatanidzwa uye kuparadzaniswa kwe scapholunate ligaments (SLL) ine inofambira mberi radiocarpal uye intercarpalDJD. Iyo Proximal scaphoid fragment inonamirwa kuLunate ine distal dissociating uye inotenderedzwa � sigineti yechiratidzo � pa x-ray.
SNAC yenjaya inogona kuunza maDII
Rx: DJD inofambira mberi inogona kutungamirira kumakona mana ekupedzisira arthrodesis

Scapholunate kupera mberi (SLAC wrist): SLL dissociation ine inofambira mberi intercarpal uye radiocarpal DJD uye volar kana dorsal carpal displacement (DISI & VISI). Zvinokonzera: kushungurudzika, CPPD, DJD, Kienboch chirwere (AVN yeLunate), Preiserdisease (AVN yeScaphoid).
SLL kuparadzana kunotungamirira kuDorsal kana VolarIntercarlate aka Intercarpal Segmental Instability (DISIor VISI).
Rad Dx: Dx inokonzera chikonzero. X-rays inoratidza kurara kana kuraira kwemaira yeLunate kuwedzerwa kana kuderera kwechinyorwa chenguva pfupi pamaonero ekupedzisira. Pamberi pekutarisa: Terry Thomas chiratidzo kana kupararira kwemafuro e scapholunate 3-4-mm semuganhu wepamusoro wezvakanaka.
MRI inogona kubatsira nekuongorora ligament uye kuronga pre-kuvhiya
Rx: kazhinji inoshanda ne DJD yakapera. Four-corner arthrodesis

Triquetrum Fx: 2nd m/c carpal bone Fx. M/C dorsal aspect inonyudzwa neinooma Dorsal radiocarpal ligament. Chikonzero: FOOSH.
Kufananidza: x-radiography wrist series yakakwana. Zvakanyanya kuratidzwa pakuona kwepashure sechimedu chebhonzo chakanyungudika chiri padhuze nedorsum yeTriquetrum. CT inogona kubatsira kana radiographically equivocal.
Rx: kuchengetedza kwekuchengetedza
Zvinetso: hazviwanzoiti, zvinogona kuramba zvichiita marwadzo pamubhedha wekristani

haka yeHamate Fx: m/c inoitika mumitambo yekubheta (cricket, baseball, hockey, kukanganiswa nekirabhu yegorofu, nezvimwewo) 2% yecarpusFx.
Kufungidzira: x-radiography inogona kukundikana kuona Fx kunze kwekuti "carpal tunnel view" inoshandiswa. CT inogona kubatsira kana x-ray isingadzoki.
Kliniki: kurwadziwa, kudhonza kwakanaka bvunzo, isina simba, inorwadza kubata. Deep ulnar n. Bazi rinogona kukanganiswa mukati meGuyon canal.
Rx: kazhinji isiri kushanda, asi kusagadzikana kusingaperi kunogona kudikanwa.
DDx: bipartite hamate

�Lunate vs. Perilunate dislocation: Lunate m / c akaparadzaniswa carpal bone. Kuwandisa kwepamusoro kunokonzerwa necarpal kukuvara. Zvisinei, kazhinji kashaya!
Inoitika neFOOSH uye wrist yakawedzerwa uye ulnar yakatsauka. kuri: 1st danho x-rays. Ifunrewarding kana kuti zvinoda kuoma kwakaoma kukuvadza scan CT scanning.
Key Rad DDx: DDx Lunate kubva kune perilunate dislocation. Lunate dislocation: lunate yakarasa kubata kwayo nedistal radius �yakadirwa teacup� padivi. Perilunate dislocation: Lunate inochengetedza kusangana kwayo nedistal radius kunyangwe iyo Capitatedorsally yabviswa. Lunate dislocation inobatsirwawo kuziva chiratidzo che �pie d/t Lunate inopindirana neCapitate.
Rx: kuderedzwa kwekukurumidzira nekugadzirisa kushanda kwemiromo yakabvaruka

Metacarpal & Phalangeal Kukuvara

Bennett Fx: intra-articular but noncomminuted impact-type Fx yenheyo ye1st MC bone yechigunwe. X-radiography yakakwana.
Rad Dx: chimiro chechikamu chetatu chepfupa pane zvakasikwa zveC1st MCbase, kazhinji nehuwandu hwemhepo yakasara yehutachiona hwema 1st MC
Matambudziko: DJD, isiri-mubatanidzwa, nezvimwe.
Rx: inowanzoita kusagadzikana / kusina kubatana kunoda kushanda
Rolando Fx: Aka akatumidzwa Bennett ne Y kana T-sarudzo. Kukuvadza kwakaoma. Iyo isina kugadzikana inoda kuchengetedzwa kwekushandira

Gamekeeper thumb: yagara ichirondedzerwa semisodzi isingaperi yeulnar (medial) collateral ligament pa1stMCP muChirungu Vachengeti vemitambo' avo vaimonyorora mitsipa/kuuraya mhuka diki. Kukuvara kwakanyanya kunogona zvakare kunzi Skier's thumb. Kukuvara uku kunogona kuva ligamentous w/oa fracture uye kukuvara kweavulsion pa 1st proximal phalanx base.
Kugadzirisa: Simba rekudzivirira kana kuparadzaniswa kwegomba rinoputika pamusoro peAdductor pollicis muscle isingagoni kuporesa w / o kugadziriswa kwekugadzira. MRI Dx inodiwa.
Dzivisa maziso ekumanikidzwa kwepfungwa anogona kukonzera Stenerlesion
Kufananidza: x-radiography inoteverwa neMRI kuDx Stenerlesion. MSK US inogona kushandiswa kana MRI isipo.
�Stener lesion paMRI & MSUS: ulnar collateral stump inonyanya kukwira kuAdductor pollicis aponeurosis uye inoita senge yakaderera chiratidzo-yakafanana nehunde inogadzira inonzi "yo-yo pachiratidzo chetambo" yakashuma zvese paMRI uye MSK US.
Rx: inowanzoshanda

Boxer Fx: m/c MC Fx. Iyo yakawedzera-articular kazhinji isiri-yakagadziriswa kana kuti shoma inotumirwa Fx kuburikidza nem / c iyo 5th uye dzimwe nguva 4th MCneck-musoro junction (dzimwe nguva kuburikidza neshaft) zvichikonzera volar musoro angulation. Mechanism: kukonzeresa kwakananga semukupfumbata chibhakera kurova pasi pakasimba (semuenzaniso, mapfupa kumeso/kurovera pamadziro) nokudaro 95% muvarume vechidiki.
kuri: x-radiography ruoko rutsva runokwana
Rad Dx: Fx mutsara unotenderera kana oblique kuburikidza ne MCneck ne volar head angulation. Ongorora kudii kwekuparadzanisa, kutsvaga kuudza.
Rx: kazhinji isiri-inoshanda ine pfupi �kugeta kweguta yeruoko uye manhamba anochinjika. (www.aafp.org/afp/2009/0101/p16.html)
NB Kana iyo nzira imwechete ikatsemura 2ndand 3d MC munzvimbo imwechete yeanatomic, inogona kuda kuvhiyiwa kutarisirwa.

Phalangeal hand Fx: m / c skeleton Fx (10% yezvose Fx). Mitambo uye kukuvara kwemaindasitiri kunotungamirira
kuri: x-radiography neruoko rwakatambanudzwa kana PA / lateral finger maonero achawana
Rad Dx: kana prox phalanx Fx, distal fragment inotenderedzwa nemhepo ine prox fragment dorsally. Distal phalanx inogona kutenderedzwa kumashure. Kucherechedza kwakakosha: kukuvara kwembambo yembambo, iyo yaifunga kuti Fx yakazaruka ine njodzi yehutachiona.
Rx: kana <10-degree angulation-buddy-taping ine motion rehab. CRPP vs. ORIF inogona kufungwa mumatambudziko akaoma-Orthopedic hand surgeon referral
Kugadzirisa: kurasikirwa kwekufamba, necrosis, utachiona
Kuwedzera kukuvara kwakajairika: PIP is m/c dislocated joint. Mullet (Baseball) chigunwe, Jersey chigunwe uye kumwe kukuvara kunoreva:
www.aafp.org/afp/2012/0415/p805.html

Felon: septic utachiona hwemunwe pulp kazhinji neStaph.Aureus. Zvinokonzera: kubaya tsono(diabetics), paronychia, mbambo dzezvipikiri, etc. m/c in index and thumb, kuratidza kurwadziwa, kuzvimba, etc.
D / t yakatarwa pulp anatomy theinfection> kuzvimba kunotungamira kune pulp compartment syndrome-kumanikidza uye necrosis.
Rx: kushandiswa nekokudzikisa kuDIP, kudiridza / kukonzera

Chiremba Wrist Kukuvara

Haikwanisi Fx: Greenstick Fx, Torus (Buckle) Fx, Kukotama (Plastiki) kuora / Fx. D / t FOSHe.g. akawira pasi petsoko. m / c inobata <10-makore-okuberekwa.
Chinyorwa Chikufungidzira: dhigirii yekutsvaga / kushanduka, epiphyseal kukura kweplate kuipa (Salter-Harris classification)
Rx: kazhinji isiri-operative (yakaderedzwa kupera uye kukanda)

Distal Radioulnar Joint (DRUJ) Kudzika-kukuvara kwakajairika kunotevera kushungurudzika senge muFOOSHne wrist hyperextension uye kutenderera uye kukanganisa kweDRUJ ligaments uye TFCcomplex. Avulsion ye ulnar styloid ine the dorsal kana volar displacement ye distal ulnar inofanira kucherechedzwa.
Kufananidza matanho: x-rays pakutanga, MRI inogona kuona zviratidzo uye kuora kweTFC, MSKUScan inobatsira nemirasi inoputika.
Cherechedza: kurega DRUJ volar (top image) uye kuregera (mufananidzo wezasi) kusununguka.

Wrist & Ruoko Arthritis

Wrist DJD-kazhinji ndeyechipiri kune kushungurudzika, scapholunate dissociation, SLAC, SNAC wrist, CPPD, Keinboch kana Preiser Disease nevamwe.
Inogona kutungamirira kukurasikirwa kwekushanda kwakanyanya
Kufananidza: inowanzopa sarodarpal JSL, subchondral sclerosis, osteophytosis, subcortical cysts, uye miviri yakasununguka. Zvimwe zvinowedzera zvinokonzera kusagadzikana kwemukati uye kunyanya Tri-scaphe pamwe.
MRI inogona kubatsira pakubvuma kwekutanga kwekudzikana kwemaitiro, Lunate / Navicular AVN.
Rx: kuchengetedza zvinoshandiswa nevashumiri.

DJD Hand: Zvakanyanya zvakajairika. Chokwadi chikuru OA. MCP-haina kumbobvira yakanganisa w / o DIP & PIP
Kana yakasarudzika MCP OA yakacherekedza fungaCPPD & Hemochromatosis (Hook-senge maosteophytes)
Clinically:
Mid-age females
Inorwadza zvakanyanya kunze kwe1st CMC OA
DIPs-Heberden nodes, PIPs-Bouchard nodes
Erosive OA (dzimwe nguva inonzi �inflammatory OA�)
A Spectrum of OA asi ichigadzira central proximal erosions kuDIPs nePIPs zvinokonzeresa zvine hunhu �gullwing� chitarisiko. Hapana systemic kuzvimba (hapana CRP, RF, Anti-CCP Ab) kazhinji muzera repakati/vakadzi vechikuru, seHand OA, inowanzoonekwa mumhuri.

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) -chronic systemic inflammatory disease ye etiology isingazivikanwe, yakanangana ne synovial joints, tendons ine akawanda systemic kubatanidzwa (mapapu, CVS, Ocular, Skin, etc.) Pathology: Tcell> Macrophage/APC> mediateddautoimmune process inokonzeresa kuumbwa kwepannus uye kuparadzwa zvishoma nezvishoma kwe ST. , cartilage, bhonzo,�nemamwe matishu. 3% VakadziVS.1% Varume. Zvikonzero zvezvakatipoteredza: kutapukira, kukuvadzwa, kusvuta, nezvimwe mumunhu ane hutachiona. 20-30% inogona kuremara mushure memakore gumi.
Dx: kiriniki, marabhasi, imaging.Symmetrical Polyarthritis esp. mune MCP, mawoko (2nd & 3RD MCP)

The Elbow: Kuongorora Kufananidza Nzira Pedyo | El Paso, TX.

by Dr Alex Jimenez | Kufungidzira & Diagnostics

Yakanaka Elbow Trauma

Muvanhu vakuru: Radial head Fx ndiyo m / c (33%) uye nhoroondo dze 1.5-4% yezvese zvakaputsika. Etiology: FOOSH ine forearm inonzi pronated. Kushamwaridzana kwakasanganiswa: elbow collateral ligaments tears. EssexLoprestiFx ine kuputika kwemuviri kunoputika uye kuparadzaniswa kweValal Radio-Ulnar Joint (DRUJ)
Terrible triad: ye Radial musoro Fx, zvigaro zvisingabvumirwi uye Coronoid mushonga Fx (inowanzovhiringidzwa neBrachialis M)
Kufananidza: 1st danho i x-radiography ine mutsara, CT kuongorora kunogona kubatsira mumatambudziko akaoma, MRIif kugamentous injury.
Muvana: Supracondylar Fx yeiyo distal humerus inoverengera makumi mapfumbamwe kubva muzana yenhamo yakaoma. Iyo inogara iri d / t tsaona nenjodzi neFOOSH uye gokora rakawedzerwa, kashoma <90% ine gokora rakachinjika. MazhinjiSupracondylar Fx inoitika muvana <5 yo Vanhurume> Vakadzi. Matambudziko: malunion mu cubitus varus aka Gunstock deformity, kukuvara kwevascular uye acute ischemic compartment syndrome ine Volkmann contracture
Kufananidza: 1st step x-radiography inogona kukwana. CT dzimwe nguva inoshandiswa mumatambudziko akaoma.

Radial head (RH) Fx: Mason classification inobatsira kuziva kuti yakaoma sei uye nzira yekurapa
Nyora 1- undisplaced ndiyo m / c uye yakagadzikana iri nemirairo. Pasi radiographs inogona kunge yakajeka uye kuongororwa kwemafuta asina kukodzera mashizha kunokosha uye kazhinji kacho chete kuongororwa
Tora 2- yakadzingwa ne2-mm kana> ine rotational block
Tora 3- comminuted> 2-3 zvidimbu uye
Type4 inoratidzwa neRH fx, posterior elbow dislocation uye dzimwe nguva Coronoid inopera fracture d / t Brachialis M avulsion
Rx: Tora 1 yakagadzirirwa kwete kushanda nekudzikisa uye kushandiswa kwemaitiro. Tora 2- ORIF kana rotational block. Tora 3 uye 4, ORIF uye RH resection kana RH arthroplasty

Cherechedza zvisiri izvo zvakasununguka kubva kune anterior mafuta pad (machungetwe museve) uye kubuda kwemazuva ekupedzisira mafuta (ruvara rwemagetsi) iro rinowanzodzika mukati me olecranon fossa uye risingaonekwi kunze kwokuti acute hemarthrosis kana zvimwe zvakasikwa zvinokonzeraFat pad zviratidzo ndezvenzira dzakawanda dzechokwadi dze intra-articular gokora Fx

Mason yerudzi 1 RH Fx inogona kuve v. isinganzwisisike uye ikarasika. Kutsvaga kweRadioographic kunofanirwa kusanganisira kuongorora kweiyo yakanaka mafuta pad zviratidzo. Cherekedza anterior mafuta pad kusuduruka aka Sail chiratidzo uye kuvapo kwepositi mafuta pad d / t rakanyanya kubuda ropa

Monteggia kupwanya-dislocations: prox 1 / 3ulnar shaft Fx. pamwe nekusagadzikana kwechirwere chePRUJ (mutsipa werufu). Kukuvara kweFOOSH. Vana4-12 yo Inopera mune vanhu vakuru.
X-rays anonyatsobudisa ulnar Fx, asi kubuda kwemashizha kunogona kunge kusingaoneki uye dzimwe nguva kunosuwa. Uku ndiko kukuvara kwakakomba kunokonzera kuremara kwehuta kana DX ikambomira vhiki dze2-3 kana kuti dzisiyiwa dzisingateereri. X-ray inowanzokwanika: Rx: kukanda vs. kushanda.

Supracondylar Fx: iyi ndiyo M / C elbow Fx kuvana.
Kunyanya, the-displaced types 1 (kumusoro kurudyi) zvakaoma Dx. Kuipa kwe "mafuta pads" uye anterior humeral line uye radiocapitella mhirizhonga inowanzovimbika
Rudzi rwe3 runonyanya kukanganisa zvikuru Volkmann mikangano (vascular ischemic-necrosis ye anterior forearm muscle compartment

Mahombekombe eEgobho mumutambo wechidiki

Epicondyle Fx: chirwere chinowanzokonzerwa nevana, pamusoro pe10% .Chiratidzo chekuvhiringidza Fx uye kuchema kwe MUCL. Pakati pe epicondyle m / c Fx. FOOSH ndiyo m / c mechanism.M> F. Kana zvishoma nezvishoma zvakasununguka kana kuti zvisingaverengeki zvinogona kurapwa nekukanda esp. mune zvisiri simba guru. Kana vakadzingwa sezviri munyaya iyi, vanoda ORIF.
Medial epicondyle avulsive Fx mune yechidiki baseball pitcher yakagadzirwa little ligi elbow muma60sand ikozvino inofanirwa kudzivirirwa kudzivirira kuvhiringidzika
OCD yeCapitellum inowanzoitika kukuvara kwemitambo kunokonzerwa nekudzokorora kumanikidza / kurira. OCD inofanira kunge iri DDx kubva kuchirwere chePanner kana osteochondritis inowanzo kuoneswa kuvarwere vadiki
Zvakaoma pakuongororwa zvinogona kutangira kubva kune dzakawanda apophysis nezvegokora (ona CRITOE)
Kufungidzira: 1st step: x-rays rinotevera neMRI uye MRarthrogramme kana zvichiratidzwa.
CT inogona kubatsira neyakaomarara kukuvara kuongororwa. MRI uye MSKUS inogona kubatsira nekukuvara kwechimiro.

Elbow Arthritis

DJD yekona hazvishamisi uye kazhinji 2nd kunotambudza, basa, CPPD, OCD yeCapitellum kana zvimwe zvirwere. Zviratidzo: kurwadziwa, kuderedza ROM esp. mune simba guru, kuora kwe ADL. Kurasikirwa kwemajeri ekuguma uye kuwedzera. 50% inoita Ulnarcompressive neuropathy. Rx: kuchengetedza, arthroscopic debridement / osteophytes kubviswa, capsular release. Muvatana vakwegura uye vasingashandi varwere Total Elbow Arthroplasty (TEA) inogona kushandiswa
Kufungidzira: x-radiography yakakwana, CT inobatsira nekugadzirira kushanda

Inflammatory Arthritis: RA yekona inowanzoitika (20-50%) uye inoparadza d / t synovitis, pannus, bone / cartilage, uye ligamentous kuparadza / kuregeredza. Kiriniki: inotanga mushure mekutanga kwemaoko zviratidzo ne, kuenzana kuzvimba, kurwadziwa, kuderedzwa ROM, kubhururuka chibvumirano. Kuvapo kwerumatoid maqhumu kunogona kucherechedzwa pamwe neolecranon uye kumberi kwepamberi. Rx: DMARD, mashandiro ematoni ekugadzirisa.
Kufananidza: x-radiography nekutanga kusinganzwisisiki (mafuta pads), gare gare: matanho, JSL yakafanana, osteopenia. MSK US inobatsira kare Dx. MRI inoratidza synovitis; bone edema correlates ne-pre-erosive x-ray kuwana, synovial kukurudzira pa FS T1 + C.
Gouty Arthritis: inogona kukanganisa gokora asi zvishoma pane kumucheto wezasi. Olecranon bursitis inokonzera kubuda kwezuva chiratidzo pa x-ray pamwe kana w / o bone kukanganiswa. Aspiration uye polarized microscopy inoratidzira tsono-yakaumbwa zvisina kunaka birefringent monosodium urate makristasi. Rx: colchicine, mamwe meds.
Septic Arthritis: funga kune vanhu vane chirwere cheshuga, vashandisi veVV, varimi vane chirwere chinotapukira, vane gonococcal vari vaduku. Chipatara chinopa se monoarthritis kana kuti w / o mabumbiro ehurumende. X-radhi: kuonekwa kusina kunaka mumatanho ekutanga. US inogona kuratidzira effusion uye yakakwirira Doppler.MRI: effusion, osseous edema. Bone scintigraphy inogona kubatsira. Labs: CBC, ESR, CRP. Kuongorora chirwere chemafuro ne gram kudonha uye tsika zvakakosha. Rx: Prompt IV ma antibiotics

Juvenile Idiopathic Arthritis (JIA) inofungidzirwa M / C chirwere chisingaperi chehudiki uye yakatangira IBD infrequency. Dx iri kiriniki uye imaging: Maitiro: Kurwadziwa pamwe chete uye kuzvimba mumwana 0-16-makore kwevhiki-matanhatu kana kupfuura. Mafomu mazhinji aripoM / C pauciarticular (oligoarticular) 6%, F> M, inosanganiswa neye ocular kubatanidzwa (iridocyclitis) uye kungangoita bofu. Polyarticular uye Systemic mafomu.
Gokora rinowanzo kubatwa pamwe chete nemabvi, mawoko, maoko nemaoko, kunyanya mu polyarticular dz.
Labs: ESR / CRP RF-VE kakawanda
Kufananidza: pakutanga x-ray zvinhu hazvisi izvo. Gare gare: kudengenyeka kusina simba, kuparadzwa kwemajoka ejoka, kuwedzerwa kwearticular epiphyses, kugadzirirwa kwepisitini kare. Zvishoma nezvishoma zvinoshandiswa: 2nd DJD, kubatanidza ankyloses.DDx: hemophilic arthropathy. Cervical radiographs inokosha.
Rx: DMARD, kutarisirwa kwekuchengetedza

Kusiyana kwematambudziko

Supracondylar process: 2% yevanhu. Yakatsanangurwa na Sir SirStruthers mu1854. Fibrous band (Ligament yaStruthers) inogona kutungamirira kukudzvinyirira kweMedan N. DDx kubvaOsteochondroma iyo inowanzoisa kubva kune imwe
Primary synovial chondrometaplasia (Reichel Syndrome). Kufananidza: akawanda osseocartilaginous akasununguka miviri yeakaenzana masize mune yakabatana cavityDDx neDDD uye 2ndosteochondromatosis. MRI-yakaderera chiratidzo paT1 uye T2 ine inogona kubatanidzwa effusion. Ina yakasimba yakabatana segokora inogona kuuya nehukuru hwakabatana kubatana
Panner's Disease: osteochondrosis yeCapitellum kazhinji mu5-10 yo mutambi wechidiki DDX kubva kuOCD weCapitellum (yakurukurwa) inoitika mune vechidiki.Clinical: kurwadziwa pane chiitiko. Kudzoreredza kunoitika muzviitiko zvakawanda nekuporesa kwepamoyo. Kufungidzira: x-rays inoratidza sclerosis uye kupatsanurwa kudiki kweCapitellum w / o muviri wakasununguka. MRI: yakaderera T1uye yakakwira T2 chiratidzo muCapitellum yese.
Myositis Ossificance:

Nyoro Nyama & Bone Neoplasms nezve Elbow

Lipoma: zvinyorwa, subcutaneous. Nyaya dzakawanda dzakawanda dzinowanikwa dzakapfava neoplasms. Yakagadzirwa nemafuta asi nhamba yakawanda inogona kuisa mafuta necrosis-calcification-fibrosis. Kazhinji zvinoramba zvichirwara. Dzimwe nguva zvakaoma kuDDx kubva kune liposarcoma yakanyatsosiyaniswa. Kufananidza: x radiography: chironda chinoputika zvakanaka-cirscribed kana w / o calcification. US uye MRI zvakakosha. Pa MRIT1high, T2 pasi SI.
Hemangioma: benign vascular lesion, kazhinji inoumbwa nemazhinji vaseru chiteshi. Capillary vs. cavernous. Zvakawanda zvakajairika muvana, asi zvinowanikwa mune chero zera. Inogona kazhinji kuumba phleboliths (calcification). Kufungidzira: x-rays inoratidzira zvinyoro zvinyama zvine phleboliths. MRI: T1-yakakwira kana inoshanduka chiratidzo. T2-yakakwira chiratidzo munzvimbo dzinononoka kuyerera. bhegi rehonye chikwangwani. Biopsy yakanyanya kudzivirirwa. Rx: zvakaoma: kudzvanywa kwenzvimbo vs. embolization vs.kutarisa. Kudzokororazve.
Peripheral Nerve sheath tumor (PNST): benign vs.malignant. Kurwisana kukuru muNF1 ine ngozi yakanyanya yePNST yakaipa. Benign PNST: Schwannoma vs.Neurofibroma. Mharapara inopikisana nemisungo yeropa. Histology: Schwann masero anoputirwa ne fibroblast nemidziyo.Clinically: pts mu20s uye 30s, mashoma ane simba kana kuti w / o mamiriro emunharaunda. Kufananidza: MRI: T1: chiratidzo chinoparadzaniswa, T2: chinangwa chinangwa. T1 + C kuwedzera
Soft Tissue Sarcomas: MFH, Synovial sarcoma, (yakakurukurwa), Liposarcoma (kakawanda mu retroperitoneum) Dx: MRI. Muchipatara: Dx inononoka d / t isingaverengeki kuwedzera kukura kazhinji isingatauri. Chirwere chinokonzerwa nehutachiwana chinokodzera MRI kuongorora, US inogona kubatsira. Biopsy inotsigira Dx.
Malignant bone Neoplasms: Vana: OSA, Ewing s sarcoma (inokurukurwa) Vakuru: Mets, Myeloma (inokurukurwa)

The Elbow

Kunyatsoona Kuona Kufananidza Nzira | El Paso, TX.

by Dr Alex Jimenez | Kufungidzira & Diagnostics

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.

Kuongororwa uye Kutungamirirwa kweRheumatoid Arthritis

by Dr Alex Jimenez | chirwere chemumajoini, Arthropathies, Chiropractic, Chiropractic Examination, chisingaperi Pain, Mamiriro Ekutongwa, utano, Kufungidzira & Diagnostics, Research Studies, Kuongorora Maedzo, Mishonga, Wellness

Nezvevanhu vane mamiriyoni e1.5 muUnited States vane rheumatoid arthritis. Rheumatoid chearthritis, kana RA, chirwere chisingagumi, chirwere chinotapira muviri chinoratidzwa nekurwadziwa nekuputika kwezvibatanidzwa. NeA RA, maitiro ezvirwere zvezvirwere, izvo zvinochengetedza hupenyu hwedu nekurwisa zvinhu zvekunze zvakadai sebhakitiriya uye mavairusi, vachirwisa zvisiri izvo mapurisa. Rheumatoid arthritis inowanzokonzera manotsi emaoko, tsoka, maziso, zvigaro, mabvi uye maziso. Nyanzvi dzakawanda dzehutano dzinokurudzira kutanga kufungidzirwa uye kurapa RA.

ngovepo

Rheumatoid arthritis ndiyo inonyanya kufarirwa systemic kupisa arthritis. Vakadzi, vanosvuta, uye avo vane nhoroondo yemhuri yechirwere vanowanzo kanganiswa. Maitiro ekuongororwa anosanganisira kuve nenhengo imwechete pamwe nekuzvimba chaiko kusingatsanangurwe nechimwe chirwere. Iko mukana weiyo rheumatoid arthritis kuongororwa kunowedzera pamwe nenhamba yediki majoini akabatanidzwa. Mune murwere ane hutachiona hweArthritis, kuvapo kwerheumatoid factor kana anti-citrullinated protein antibody, kana kukwidziridzwa kweC-inoshanda mapuroteni level kana erythrocyte sedimentation chiyero chinoratidza kuongororwa kwerheumatoid arthritis. Pakutanga kuongorora kwerabhoritari kunofanira kusanganisira huwandu hweropa hwakazara nemusiyano uye kuongororwa kweiyo renal uye hepatic basa. Varwere vanotora biologic vamiririri vanofanirwa kuongororwa hepatitis B, hepatitis C, uye tibhii. Pakutanga kuongororwa kwerheumatoid arthritis inobvumira kurapwa kwekutanga nezvirwere-kugadzirisa antirheumatic agents. Kubatanidzwa kwemishonga kunowanzo shandiswa kudzora chirwere. Methotrexate inowanzo iri yekutanga-mutsara mushonga we rheumatoid arthritis. Biologic vamiririri, senge bundu necrosis factor inhibitors, inowanzoonekwa seyechipiri-mutsara vamiririri kana inogona kuwedzerwa kune maviri marapirwo. Izvo zvinangwa zvekurapa zvinosanganisira kudzikisira kwekutambudzika kwekubatana uye kuzvimba, kudzivirira kweiyo radiographic kukuvara uye kuoneka kwekuremara, uye kuenderera kwebasa uye zviitiko zvevanhu. Joint kutsiva inoratidzirwa kune varwere vane zvakakomba kwemajoini kukuvara vane zviratidzo zvisina kutarisirwa zvakanaka nevekurapa manejimendi. (Ndini Chiremba weNzara. 2011; 84 (11): 1245-1252. Copyright 2011 American Academy yeMhuri Varapi.) Rheumatoid arthritis (RA) ndiyo inonyanya kurwisa arthritis, ine kupararira kwoupenyu hwepamusoro kusvika ku1 muzana munyika yose.1 Inset inogona kuitika chero ipi zvayo, asi inokwira pakati pe30 ne50 makore.XVUMX Kuremara kwakajairika uye kunokosha. Muchikwata chikuru cheUnited States, 2 muzana yevarwere vane RA vakave nekuremara kwebasa mushure memakore 35.10

Etiology uye Pathophysiology

Kufanana nezvakawanda autoimmune hosha, iyo etiology yeRA ine multifactorial. Kugadziriswa kweGenetic kunoonekwa mukubatana kwemhuri uye monozygotic mapatya zvidzidzo, ne50 muzana yeRA njodzi inokonzerwa nemajini zvinhu. 4 Sangano reGenetic reRA rinosanganisira munhu leukocyte antigen-DR45 uye -DRB1, uye akasiyana maeleles anonzi epitope yakagovaniswa. 6,7, 4 Zvidzidzo zveGenome-wide musangano zvakaratidza mamwe masiginecha echisimba ayo anowedzera njodzi yeRA uye zvimwe zvirwere zvekuzvimiririra, kusanganisira STAT40 geni uye CD5 locus.8 Kusvuta ndiko kukonzera kukuru kwezvakatipoteredza kweRA, kunyanya kune avo vane maitiro ekuzvarwa. inogona kuburitsa mhinduro yekuzvimiririra, hapana imwe pathogen yakaratidza kuti inokonzeresa RA.9 RA inozivikanwa nenzira dzinopisa dzinotungamira mukuwanda kwemasero e synovial mumajoini. Yakazotevera pannus kuumbwa kunogona kutungamira kune ari pasi pekartilage kuparadzwa uye bony erosions. Kuwedzeredza kwepro-inflammatory cytokines, kusanganisira bundu necrosis factor (TNF) uye interleukin-6, inotungamira yekuparadza.

Risk Factors

Kukwegura, nhoroondo yemhuri yechirwere, uye bonde rechikadzi zvinosanganisirwa nenjodzi yakawedzera yeRA, kunyangwe mutsauko wepabonde usinga nyanyozivikanwa muvarwere vakura.1 Zvese zviripo uye pamberi pekusvuta fodya zvinowedzera njodzi yeRA (zvine ngozi [RR] = 1.4, inosvika ku2.2 yevanopfuura makumi mana-mapaketi-gore vanoputa) .40 Kubata kunowanzo kukonzera RA kuregererwa, pamwe nekuda kwekubvumidzwa kwema immunologic.11 Parity inogona kuve neyakareba kukanganisa; RA kashoma kuti ionekwe mumadzimai ane parous pane vakadzi vasina maturo (RR = 12) .0.61 Kuyamwisa kunoderedza njodzi yeRA (RR = 13,14 mumadzimai akayamwisa kweanenge mwedzi makumi maviri nemana), nepo kutanga kuenda kumwedzi (RR = 0.5 kune avo vane kuenda kumwedzi pazera remakore gumi kana mudiki) uye nguva dzisina kujairika dzekuenda kumwedzi (RR = 24) kuwedzera njodzi.1.3 Kushandisa mapiritsi ekudzivirira kubata pamuviri kana vhitamini E hakukanganisa njodzi yeRA.10

kuongorora chirwere

Mharidzo Yakafanana

Varwere vane RA vanowanzova nemarwadzo uye kuoma mumanyoro akawanda. Izvo zvinoputika, zvinopindira interphalangeal joints, uye metacarpophalangeal joints inowanzobatanidzwa. Kushushikana kwamangwanani kunogara kweawa imwe chete kunoratidzira etiology inopisa. Boggy kuzvimba nemhaka ye synovitis inogona kuonekwa (Mufananidzo 1), kana kuti mashura synovial thickening angave akarembera pamubvunzo wokubatana. Vashandi vanogonawo kuisa nehuwandu husinganzwisisiki arthralgias vasati vatanga kuonekwa kwechirwere chemajoini. Zviratidzo zvekuneta, kuora kurasikirwa, uye kutsika-grade fever zvinogona kuitika nehosha inoshanda.

Zviratidzo Zvokuziva

Mu2010, iyo American College yeRheumatology uye European League Against Rheumatism yakabatana kugadzira matsva maitiro eRA (Tafura 1) .16 Maitiro matsva aya kuedza kwekupima RA pakutanga kune varwere vangangosangana ne1987 American College yeRheumatology classification. maitiro. Maitiro e2010 haasanganise kuvepo kwerheumatoid nodules kana radiographic erosive shanduko, ese ari maviri ari mashoma mukana mukutanga RA. Symmetric arthri- tis haidiwe mumatanho e2010, ichibvumidza mharidzo yekutanga asymmetric. Mukuwedzera, vaDutch vatsvakurudzi vakagadzira uye vakagadzirisa mutemo wekufanotaura kwekliniki yeRA (Tafura 2) .17,18 Chinangwa chemutemo uyu ndechokubatsira kuziva varwere vane chirwere chisina kukodzera cheArthritis chinonyanya kufambira mberi kuRA, uye kutungamira zvinotevera- kumusoro uye kutumira.

Miedzo yekuongorora

Zvirwere zvekuzvimiririra senge RA zvinowanzo kuve nekuvapo kwe autoanti- miviri. Rheumatoid chinhu hachisi chakanangana neRA uye chinogona kunge chiripo kune varwere vane zvimwe zvirwere, zvakaita sehepatitis C, uye mune vakwegura vane hutano. Anti-citrullinated protein antibody yakanyanya kujeka kuRA uye inogona kutora chikamu muchirwere chepathogenesis.6 Inosvika- makumi mashanu kusvika makumi masere muzana muzana yevanhu vane RA vane rheumatoid factor, anti-citrullinated protein antibody, kana ese ari maviri. 50 Varwere vane RA vanogona yakanaka antinuclear antibody bvunzo mhedzisiro, uye muyedzo ndewekufungidzira kukosha mune vechidiki mafomu echirwere ichi.80 C-inoshanda mapuroteni mazinga uye erythrocyte sedimentation mwero zvinowanzo kuwedzerwa neRA inoshanda, uye aya akanyanya chikamu maatomu chikamu chikamu chetsva RA yekumisikidza maitiro. 10 C-inoshanda mapuroteni mazinga uye erythrocyte sedimentation mwero inogona zvakare kushandiswa kutevera chirwere chiitiko uye kupindura kumushonga. Baseline izere huwandu hweropa nemusiyano uye kuongororwa kweiyo renal uye hepatic basa zvinobatsira nekuti mhedzisiro inogona kukanganisa nzira dzekurapa (semuenzaniso, murwere ane kusakwana kweitsvo kana akakosha thrombocytopenia angangodaro asina kupihwa nonsteroidal anti-inflammatory drug [NSAID]). Kupfava kweanemia kwechirwere chisingaperi kunoitika mu19 kusvika 16 muzana yevarwere vese vane RA, 33 kunyangwe mudumbu kurasikirwa kweropa kunofanirwa kutariswa kune varwere vanotora corticosteroids kana NSAIDs. Methotrexate inopesana nevarwere vane hepatic chirwere, senge hepatitis C, uye nevarwere vane hurema hwakakomba. 60 Biologic Therapy, senge TNF inhibitor, inoda yakaipa tuberculin bvunzo kana kurapwa kweanodzimba tibhii. Hepatitis B kugadziriswazve kunogona kuitika neTNF inhibitor kushandiswa.20 Radiography yemaoko nemakumbo inofanira kuitwa kuti iongorore maitiro eaperiarticular erosive shanduko, iyo inogona kunge iri chiratidzo cheinotyisa RA subtype.21

Kusiyanisa Kuziva

Kuwanikwa kweganda kunoratidzira systemic lupus erythematosus, systemic sclerosis, kana psoriatic arthritis. Polymyalgia rheumatica inofanirwa kutariswa mumurwere akura ane zviratidzo kunyanya mubendekete nemuchiuno, uye murwere anofanirwa kubvunzwa mibvunzo ine chekuita neyakabatana temporal arteritis. Chest radiography inobatsira kuongorora sarcoidosis seyetiology yeArthritis. Varwere vane kuzvimba kumashure zviratidzo, nhoroondo yehutachiona hwechirwere, kana chirwere cheziso chinoputira vanogona kunge vane spondyloarthropathy. Vanhu vane mavhiki asingasviki matanhatu ezviratidzo vanogona kuve nehutachiona maitiro, senge parvovirus. Zvazvino zvoga-zvikamu zvishoma zvekubatana kwakabatana kuzvimba zvinoratidza kristaro arthropathy, uye arthrocentesis inofanirwa kuitirwa kuongorora monosodium urate monohydrate kana calcium pyrophosphate dihydrate makristasi. Kuvapo kweakawanda myofascial trigger mapoinzi uye somatic zviratidzo zvinogona kuratidza fibromyalgia, iyo inogona kugara pamwe neRA. Kubatsira kutungamira kuongororwa uye kuona nzira yekurapa, varwere vane hutachiona arthritis vanofanira kukurumidza kutumidzwa kune rheumatology subspecialist.16,17

Rheumatoid arthritis, kana kuti RA, ndiyo inonyanyozivikanwa yeArthritis. RA chirwere chinotarisa muviri, chinokonzerwa apo masimba ezvirwere zvemuviri, muviri wemudziviriri wezvidziviriro, anorwisa masero ayo uye masukisi, kunyanya masangano. Rheumatoid arthritis inowanzozivikanwa nezviratidzo zvekutambudzika nekuputika, kazhinji kunobata zviduku zviduku zvemaoko, maziso nemakumbo. Maererano nehuwandu hwehutano hwezvehutano, kutanga kuongororwa uye kurapwa kweRA kunokosha kuti kudzivirira kuwedzera kwekubatana pamwe nekuderedza zviratidzo zvinorwadza. Dr. Alex Jimenez DC, CCST Insight

mabatiro

Mushure meR RA yave ichiongororwa uye yekutanga kuongorora yakaitwa, chirwere chinofanira kutanga. Nhungamiro yemazuva ano yakataura nevatungamiri veRA, 21,22 asi zvisarudzo zvevarwere zvinoitawo basa rinokosha. Kune zvikonzero zvakakosha zvevakadzi vezera rekubereka nekuti mishonga yakawanda inobvisa zvinetso pahutumbi. Zvinangwa zvekurapa zvinosanganisira kuderedza marwadzo pamwe chete nekudzivirira, kudzivirira kusvibiswa (zvakadai sokutsauka kwekupedzisira) uye kuora kwemashoko (zvakadai sekushandura), kuchengetedza hupenyu hwehupenyu (hwega uye basa), nekudzora zviratidzo zvekare. Dendaase-modifying antirheumatic drugs (DMARD) ndiyo inonyanya kushandiswa neR RA.

DMARDs

DMARDs inogona kunge iri biologic kana nonbiologic (Tafura 3) .23 Biologic vamiririri vanosanganisira monoclonal antibodies uye recombinant receptors kuvharira cytokines inosimudzira iko kuputika kuputika kunoitisa RA zviratidzo. Methotrexate inokurudzirwa semutsetse wekutanga kurapwa kune varwere vane RA inoshanda, kunze kwekunge zvisingabvumirwe kana kusashivirirwa.21 Leflunomide (Arava) inogona kushandiswa seimwe nzira kune methotrexate, kunyangwe mudumbu mhedzisiro inokanganisa zvakanyanya. Sulfasalazine (Azulfidine) kana hydroxychloroquine (Plaquenil) pro-kuzvimba seyemonotherapy kune varwere vane yakaderera chirwere activity kana vasina zvakashata zvekufungidzira maficha (semuenzaniso, seronegative, isiri-erosive RA) .21,22 Musanganiswa wekurapa pamwe maviri kana anopfuura maDMARD anoshanda zvakanyanya kupfuura monotherapy; zvisinei, mhedzisiro inokanganisa inogona zvakare kuve yakakura.24 Kana RA isina kunyatso kudzorwa neiyo nonbiologic DMARD, biologic DMARD inofanirwa kutangwa.21,22 TNF inhibitors ndiyo yekutanga-line biologic kurapa uye ndiyo yakanyanya kufunda yeava vamiririri. Kana TNF inhibitors isingabatsiri, mamwe marapirwo ebiologic anogona kutariswa. Kushandiswa panguva imwe chete kweanopfuura imwe biologic therapy (semuenzaniso, adalimumab [Humira] ine abatacept [Orencia]) haina kukurudzirwa nekuda kweyakagamuchirwa muyero wemhedzisiro.

NSAIDs uye Corticosteroids

Kushandisa zvinodhaka kweR RA kunogona kusanganisira NSAID uye muromo, muromo, kana intra-articular corticosteroids yekudzivirira marwadzo nekuputika. Zvakakodzera, NSAIDs uye corticosteroids zvinoshandiswa chete kwekutora kwenguva pfupi. DMARD ndiyo chirongwa chinosarudzwa.21,22

Complementary Therapies

Kupindira kwechikafu, kusanganisira kudya kwezvirimwa uye zveMediterranean, zvakadzidzwa mukurapa RA pasina humbowo hunogutsa hwekubatsira. 25,26 Kunyangwe paine mhedzisiro inofadza, pane kushaikwa kweuchapupu hwekubudirira kweacupuncture mune placebo-inodzorwa miedzo yevarwere. neRA.27,28 Pamusoro pezvo, thermotherapy uye yekurapa Ultrasound yeRA haina kudzidza zvakaringana. 29,30 Ongororo yeCochrane yemishonga yemakwenzi yeRA yakagumisa kuti gamma-linolenic acid (kubva manheru Primrose kana mafuta e currant mbeu yemafuta) uye Tripterygium wilfordii (mutinhimira mwari muzambiringa) ane zvingabatsire.31 Zvakakosha kuzivisa varwere kuti zvakakomba mhedzisiro yakaipa yakataurwa nekushandiswa kwemishonga yekurapa.31

Kudzidzira uye Kurapa Kwepanyama

Migumisiro yemitambo yakarongedzwa yakasarudzwa inotsigira muviri wekuita muviri kunatsiridza hupenyu hwehupenyu uye simba remasimba kune varwere vane RA.32,33 Kudzidzira maitiro ekudzidzisa maitiro asina kuratidzika kuti ane zvinokanganisa zvinokonzerwa nezvirwere zvezvirwere zveR RA, zvikamu zvinorwadza, kana kuparara kwemavara emunharaunda.34 Tai Chi yakaratidzwa kuvandudza zvinyorwa zvemafambiro kune vanhu vane RA, kunyange zvazvo miedzo isina kukwana yakawanda.35 Dambudziko rekuchengetedzwa kweYiengar yoga kune vechidiki vane RA vari kufamba.36

Nguva yekurapa

Kuregererwa kunowanikwa mu10 kusvika 50 muzana yevarwere vane RA, zvinoenderana nekuti kuregererwa kunotsanangurwa sei uye kusimba kwerapi.10 Kuregererwa kunowanzoitika muvanhurume, vasingasvuti, vanhu vadiki pane makore makumi mana, uye mune avo vane chirwere chekunonoka kutanga ( varwere vakura kupfuura makore makumi matanhatu nemashanu), iine pfupi nguva yechirwere, iine chirwere chakakomba chiitiko, isina kukwidziridzwa kwechikamu chakakomba chemagetsi, uye isina yakanaka rheumatoid factor kana anti-citrullinated protein antibody zvakawanikwa.40 Mushure mekurwara kwechirwere, madosi emishonga anogona kuderedzwa nekuchenjera kusvika kuhuwandu hushoma hunodiwa. Varwere vanozoda kugara vachiongororwa kuti vaone zviratidzo zvakagadzikana, uye nekukurumidza kuwedzerwa kwemushonga kunokurudzirwa nezvirwere zvinoputika.65

Joint Replacement

Kushandurwa kunobatanidzwa kunoratidzwa apo kune hutano hwakanyanya hukuvadza uye kusagutsikana kuronga kwezviratidzo nekurapa. Mhedziso dzenguva refu ndeyekutsigirwa, ine 4 chete kusvika ku13 yezana yekupindira kukuru kwekubatanidza kunoda kuongororazve mukati me10 years.38 Chiuno nemabvi ndiyo inowanzosimbiswa majointsiti.

Yenguva Yakareba Kuongorora

Kunyangwe RA ichionekwa sechirwere chemajoini, iri zvakare chirwere chehurongwa chinokwanisa kusanganisira akawanda masisitimu enhengo. Zvimwe zvinoratidzika-kuratidzwa kweRA zvinosanganisirwa muTafura 4.1,2,10 Varwere vane RA vane njodzi yakawedzera mbiri ye lymphoma, iyo inofungidzirwa kuti inokonzereswa neyakaipisisa maitiro, uye kwete mhedzisiro yekurapwa.39 Varwere vane RA zvakare iri panjodzi yekuwedzera yecoronary arteri chirwere, uye varapi vanofanirwa kushanda nevarwere kugadzirisa njodzi, zvakadai sekusvuta, kuwedzerwa kweropa, uye cholesterol yakawanda. 40,41 Kirasi III kana IV congestive moyo kutadza (CHF) ndeye contraindication yekushandisa TNF inhibitors, iyo inogona kukuvadza mhedzisiro yeCF.21 Muvarwere vane RA uye malignancy, chenjedzo inodikanwa nekuenderera mberi kwekushandisa maDMARD, kunyanya TNF inhibitors. Biologic DMARDs, methotrexate, uye leflunomide hazvifanirwe kutanga kune varwere vane herpes zoster inoshanda, hutachiona hwakakura hwehutachiona, kana hutachiona hutachiona hunoda mishonga inorwisa mabhakitiriya. 21 Matambudziko eRA nemarapirwo ayo akanyorwa muTafura 5.1,2,10

Prognosis

Varwere vane RA vanorarama makore matatu kusvika ku12 pasi pehuwandu hwevanhu vakawanda.40 Kuwedzera kwekufa kwevarwere ava kunonyanya kukonzerwa nekuwedzerwa kwehutano hwehutano hwemoyo, kunyanya kune avo vane chirwere chepamusoro uye chirwere chisingaperi. Izvo zvitsva zvinodhaka zvehupenyu zvinogona kuderedza kufambira mberi kwehutachiona hwehutachiona uye kuwedzera upenyu kune avo vane RA.41 Data Sources: Tsvakurudzo yakawanikwa kubva kuPM yakagadzirirwa muCliniki Queries vachishandisa mazwi anokosha rheumatoid arthritis, zvimwe zviratidzo zvinoshamisa, uye zvirwere-kuchinja antirheumatic agents. Kutsvakurudza kwaisanganisira meta-kuongorora, maitiro anongorongedzwa nema randomized, makiriniki, nekuongororwa. Yakatsvagawo iyo Agency for Healthcare Research uye Quality uchapupu hunoshuma, Clinical Evidence, database yeCchrane, Essential Evidence, uye UpToDate. Tsvaga musi: September 20, 2010. Munyori kuzivisa: Hapana hukama hwakakodzera hwemari hwekuburitsa. Mukupedzisa, rheumatoid arthritis chirwere chisingaperi, chemoto chinokonzera zviratidzo zvinorwadza, sekurwadziwa uye kusagadzikana, kuzvimba uye kuzvimba kwemajoini, pakati pevamwe. Iko kukuvara kwekubatana kunozivikanwa seRA kwakaenzana, zvichireva kuti inowanzo bata mativi ese emuviri. Early diagnosis yakakosha pakurapa RA. Chiyero cheruzivo rwedu chinogumira kuchiropractic uye musana nyaya dzehutano. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kuti tibate isu pa 915-850-0900 . Yakapetwa naDr.Alex Jimenez

Zvimwe Zvinyorwa Kukurukurirana: Relieving Knee Pain pasina Surgery

Kurwadziwa kwemabvi chiratidzo chinozivikanwa chinogona kuitika nekuda kwekukuvara kwemabvi kwakasiyana uye / kana mamiriro, kusanganisira mitambo yakakuvara. Mabvi ndeimwe yenhengo dzakaoma kwazvo mumumuviri womunhu sezvo zvichiitwa-kwemaketani emapfupa mana, mitsetse ina, toni dzakasiyana-siyana, menisci mbiri, uye cartilage. Maererano neAmerican Academy of Family Physicians, zvinonyanya kukonzera kurwadziwa kwemabvi zvinosanganisira patellar subluxation, patellar tendinitis kana jumper, uye Osgood-Schlatter chirwere. Kunyange zvazvo kurwadziwa kwemabvi kunowanzoitika kune vanhu pamusoro pemakore emakore e60, kurwadziwa kwemabvi kunogonawo kuitika kune vana nevechiri kuyaruka. Kurwadziwa kwepamusoro kunogona kurapwa pamusha kutevera nzira dzeRICE, zvisinei, kukuvara kwakanyanya kwemabvi kunogona kudiwa kurapwa kwekurumidza, kusanganisira chiropractic kuchengetedza.

EXTRA EXTRA | NHAURWA INOKOSHA: El Paso, TX Chiropractor Inokurudzirwa

***

Hazvina kuchena

References

1. Etiology uye pathogenesis ye rheumatoid arthritis. Mune: Firestein GS, Kelley WN, eds. Kelley's Bhuku reRheu- matology. 8th ed. Philadelphia, Pa.: Saunders / Elsevier; 2009: 1035-1086.
2. Bhation J, Tehlirian C. Rheumatoid arthritis kliniki uye
laboratori zviratidzo. Mu: Klippel JH, Stone JH, Crofford LJ, et al., Eds. Primer paRheumatic Dis- eases. 13th ed. New York, NY: Springer; 2008: 114-121.
3. Allaire S, Wolfe F, Niu J, et al. Mazuva ano zvinokonzerwa nehutachiona hwebasa hunobatanidza nerheumatoid arthritis. Arthritis Rheum. 2009; 61 (3): 321-328.
4. MacGregor AJ, Snieder H, Rigby AS, et al. Kufananidza kuwanda kwemajini ekupa rheumatoid arthritis uchishandisa data kubva kumapatya. Arthritis Rheum. 2000; 43 (1): 30-37.
5. Orozco G, Barton A. Tsanangudzo pamusoro pehutachiona hwehutachiona hwehutamu hutachiona. Nyanzvi Rev Clin Immunol. 2010; 6 (1): 61-75.
6. Balsa A, Cabezo? N A, Orozco G, et al. Kufuridzirwa kweLALA DRB1 alleles mukukanganisa rheumatoid arthritis uye kudzora kwemaantibio anorwisa macroteine mapuroteni uye rheumatoid factor. Arthritis Res Ther. 2010; 12 (2): R62.
7. McClure A, Lunt M, Eyre S, et al. Kuongorora kuburikidza ne- bhizimusi yekuongorora maitiro / kuongororwa kweA RA kunzwisisika kushandisa kusanganiswa kwezvishanu zvakasimbiswa ngozi. Rheuma- ology (Oxford). 2009; 48 (11): 1369-1374.
8. Bang SY, Lee KH, Cho SK, et al. Kusvuta kunowedzera rheu- matoid arthritis kugadziriswa kune vanhu vanotakura HLA-DRB1 epitope yakagoverwa, pasinei nedheumatoid factor kana anti-cyclic citrullinated peptide antibody sta stausus. Arthritis Rheum. 2010; 62 (2): 369-377.
9. Wilder RL, Crofford LJ. Zvinotapukira zvinokonzera rheu- matoid arthritis here? Clin Orthop Relat Res. 1991; (265): 36-41.
10. Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010; 376 (9746): 1094-1108.
11. Costenbader KH, Feskanich D, Mandl LA, uye al. Kusvuta kusimba, nguva, uye kupera, uye ngozi yehutroid arthritis muvakadzi. Am J Med. 2006; 119 (6): 503.e1-e9.
12. Kaaja RJ, Greer IA. Kuratidzwa kwezvirwere zvisingaperi munguva yekuzvitakura. JAMA. 2005; 294 (21): 2751-2757.
13. Guthrie KA, Dugowson CE, Voigt LF, uye al. Does preg-
nancy kupa chirwere-chakadzivirirwa kurwisa rheuma-
toid arthritis? Arthritis Rheum. 2010; 62 (7): 1842-1848.
14. Karlson EW, Mandl LA, Hankinson SE, et al. Kuyamwisa uye zvimwe zvinhu zvekubereka zvinokanganisa ramangwana renjodzi yerheumatoid arthritis? Mhedzisiro kubva kuNurses Hutano Kudzidza. Arthritis Rheum. 2004; 50 (11): 3458-3467.
15. Karlson EW, Shadick NA, Cook NR, et al. Vitamin E mukudzivirira kwekutanga kwerheumatoid arthritis: iyo Yevakadzi Yehutano Kudzidza. Arthritis Rheum. 2008; 59 (11):
1589-1595.
16. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid
arthritis classification criteria: American College of Rheumatology / European League Against Rheumatism [shanduro] yakabudiswa kuratidzika inowanikwa muna Ann Rheum Dis. 2010; 69 (10): 1892]. Ann Rheum Dis. 2010; 69 (9): 1580-1588.
17. van der Helm-van Mil AH, le Cessie S, van Dongen H, et al. Kufanotaurira kutonga kwemagumisiro ezvirwere kune varwere vane nguva-ichangobva kubuda isinafferentiated arthritis. Arthritis Rheum. 2007; 56 (2): 433-440.
18. Mochan E, Ebell MH. Kufanotaurira rheumatoid arthritis ngozi kune vanhu vakuru vane unferentiated arthritis. Am Fam Physi- cian. 2008; 77 (10): 1451-1453.
19. Ravelli A, Felici E, Magni-Manzoni S, et al. Varwere vane antinuclear-anti-positive vana vechidiki idiopathic arthri- titi vanoita seboka rakasiyana-siyana zvisinei nokuti chii chakabatana nechirwere. Arthritis Rheum. 2005; 52 (3): 826-832.
20. Wilson A, Yu HT, Goodnough LT, et al. Kuwandisa uye kubudirira kweanemia mu rheumatoid arthritis. Am J Med. 2004; 116 (suppl 7A): 50S-57S.
21. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 mazano ekushandiswa kwee nonbiologic uye biologic-chirwere-anti antihehematic drugs mu rheumatoid arthritis. Arthritis Rheum. 2008; 59 (6): 762-784.
22. Deighton C, O Mahony R, Tosh J, et al .; Nongedzo Yekusimudzira- Boka. Management ye rheumatoid arthritis: pfupiso yeNICE nhungamiro. BMJ. 2009; 338: b702.
23. AHRQ. Kusarudza mishonga yerheumatoid arthritis. Kubvumbi 9, 2008. www.effectivehealthcare.ahrq.gov/ ehc / zvigadzirwa / 14/85 / RheumArthritisClinicianGuide.pdf. Yakasvika munaJune 23, 2011.
24. Choy EH, Smith C, Dore? CJ, et al. Meta-ongororo yehunoshanda uye huturu hwekusanganisa chirwere-kugadzirisa- anti-rheumatic zvinodhaka mu rheumatoid arthritis zvichibva pakurapa kwevarwere. Rheumatology (Oxford). 2005; 4 4 (11): 1414 -1421.
25. Smedslund G, Byfuglien MG, Olsen SU, et al. Kubudirira nekuchengeteka kwezvokudya zverheumatoid arthritis. J Ndokudya Assoc. 2010; 110 (5): 727-735.
26. Hagen KB, Byfuglien MG, Falzon L, et al. Mishonga yezvokudya ye rheumatoid arthritis. Cochrane Database Syst Rev. 2009; 21 (1): CD006400.
27. Wang C, de Pablo P, Chen X, et al. Kugadziriswa kwekurwadziwa kunorwadza kune varwere vane rheumatoid arthritis: kugadzirisa kuongorora. Arthritis Rheum. 2008; 59 (9): 1249-1256.
28. Kelly RB. Kugadziriswa kwekurwadziwa. Ndiye Chiremba weNzara. 2009; 80 (5): 481-484.
29. Robinson V, Brosseau L, Casimiro L, et al. Thermother- apy mukurapa rheumatoid arthritis. Cochrane Data-base Syst Rev. 2002; 2 (2): CD002826.
30. Casimiro L, Brosseau L, Robinson V, et al. Therapeutic ultrasound pakurapa rheumatoid arthritis. Cochrane Database Syst Rev. 2002; 3 (3): CD003787.
31. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy pakurapa rheumatoid arthritis. Cochrane Database Syst Rev. 2011; (2): CD002948.
32. Brodin N, Eurenius E, Jensen I, uye al. Kudzidzisa varwere vane maitiro ekutanga rheumatoid arthritis kune hutano hwakanaka. Arthritis Rheum. 2008; 59 (3): 325-331.
33. Baillet A, Payraud E, Niderprim VA, et al. Chirongwa chekurovedza muviri chine simba rekuvandudza kuremara kwevarwere mu rheumatoid arthritis: inotarisirwa kutongwa nemaitiro akasarudzika. Rheumatology (Oxford). 2009; 48 (4): 410-415.
34. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, et al. Dynamic Exercise programs (aerobic simba uye / kana musimba simba kudzidziswa) kune varwere vane rheumatoid arthri- tis. Cochrane Database Syst Rev. 2009; (4): CD006853.
35. Han A, Robinson V, Judd M, uye al. Tai chi pakurapa rheumatoid arthritis. Cochrane Database Syst Rev. 2004; (3): CD004849.
36. Evans S, Cousins L, Tsao JC, et al. Chiitiko chinongororwa chisingatauri chekuongorora Iyengar yoga kuvanhu vaduku vane rheumatoid arthritis. Miedzo. 2011; 12: 19.
37. Katchamart W, Johnson S, Lin HJ, et al. Zvinyorwa zvekare zvekuregererwa mu rheumatoid arthritis patients: kurongwa kwekugadzirisa. Arthritis Care Res (Hoboken). 2010; 62 (8): 1128-1143.
38. Wolfe F, Zwillich SH. Maitiro ekureba kwenguva refu ehethroid arthritis: anonzi 23 ane makore, anotora nguva yakareba yekubatanidza kubatanidza uye kushandiswa kwavo muVIHNUMX varwere vane rheumatoid arthritis. Arthritis Rheum. 1,600; 1998 (41): 6-1072.
39. Baecklund E, Iliadou A, Askling J, et al. Kushamwaridzana kwekusingaperi kusuruvara, kwete kurapa kwayo, nekwakawedzera lymphoma pangozi mu rheumatoid arthritis. Arthritis Rheum. 2006; 54 (3): 692-701.
40. Friedewald VE, Ganz P, Kremer JM, et al. Kubvumirana kweAJC mupepeti: rheumatoid arthritis uye atherosclerotic yemwoyo chirwere. Ndiri J Cardiol. 2010; 106 (3): 442-447.
41. Atzeni F, Turiel M, Caporali R, et al. Izvozvo zvinoshandiswa nehutachiona hwehutachiona hwehutano hwehutano hwevarwere vane zvirwere zvehurmatic systemic. Autoimmun Rev. 2010; 9 (12): 835-839.

Close Accordion

Ankle & Foot Kuongorora Kufananidza Arthritis & Trauma II | El Paso, TX.

by Dr Alex Jimenez | chirwere chemumajoini, Kufungidzira & Diagnostics

Lisfranc Yakaputsika-Dislocation

maziso echikwata cheArthritis uye chirwere chepachika che paso tx.

M / C kuparadzaniswa kwetsoka pane tarsal-metatarsal kutaurirana (musungo weLisfranc). Kutungamira zvakananga kana kumhanyira uye kudyara kana kudonhedzera kufambisa netsoka. Lisfranc ligament inobata 2nd MT base uye 1st Cu yakabvaruka. Inoratidza kana kuti w / o kuputsika-kuvhiringidzwa.
Kufananidza: 1st nhanho: tsoka radiography muzviitiko zvakawanda zvakakwana kuDx. MSK US inogona kubatsira: ratidza yakavhiringidzwa Cu1-Cu2. Ligament uye nzvimbo yakawedzera> 2.5mm. MRI inogona kubatsira asi isingakoshi. Huremu-inotakura maonero anobatsira Dx.
2-mhando: homolateral (1st MTP yakabatana mukubata) uye inosiyana (2-5 MT yakadzingwa padivi uye 1st MT pakati)
Kutungamira: kugadzirisa basa kunokosha
NB Atraumatic Lisfranc dislocation inowanzotaurirana nezvechirwere cheshuga Charcot rutsoka

Osteochondral Kukuvara kweTalus (OCD)

Kazhinji. Kwete kushungurudza kunowanikwa mumutambo mukuru-medial talar dome. Kushungurudzika kunogona kukanganisa supero-lateral dome.
Muchipatara: kurwadziwa / kupusa / kuvhara. Kufungidzira kunokosha.
1st danho: radiography inogona kujekesa pfungwa yakasimba yehudhi / halo, fragment.
MRI inobatsira esp. kana OCD ari chikwata uye kuratidza bone edema.
Kutungamira: kwete-operative: pfupi-gumbo rakagadzirwa / kutapisa-4-6 wk. operative: arthrocsopic kubviswa.
Matambudziko: nguva isati yasvika 2nd DJD

Makuvara eMetatarsal

Acute & Stress kutsemuka kunowanzoitika: m / c 5th MT & 2nd, 3rd MT.
Jones Fx: yakawedzera-articular Fx yeproximal metaphysis ye5th MT. Yakakomba kune isiri-mubatanidzwa. Kazhinji inogadziriswa inoshanda.
Pseudo-Jones: intra-articular avulsion ye5th MT styloid/base ne eccentric contraction yePeroneus Brevis M. Inotungamirirwa nekuchengetedza: boot-cast immobilization. Vose Jones & Pseudo-Jones Dx netsoka dzakatevedzana radiography.
Kushungurudzika Fx. Calcaneus, 2nd, 3rd, 5th MTs. Kudzokororwa kurodha (kumhanya) kana "Kurume tsoka" 2nd / 3rd MT. Clinically: kurwadziwa pamabasa, kuderedzwa nekuzorora. Dx: x-rays kazhinji haibatsiri kare. MRI kana MSK US inogona kubatsira. Inotungamirirwa: Conservatively. Matambudziko; kufambira mberi muFx yakakwana
Turf toe: anowanzoita mitambo yekutengesa kwe1st MTP-sesamoid/ plantar plate complex iri kubvaruka. 1st MTP isina kugadzikana/yakasununguka. Inotungamirirwa nekushanda.

Arthritis yetsoka & Ankle

DJD yemakumbo: zvisingawanzoitiki pakutanga OA. Kazhinji inokura se2nd kune trauma / AVN, RA, CPPD, Hemophilic arthropathy, Juvenile Idiopathic Arthritis, etc. inoratidza seDJD: osteophytes, JSL, subchondral cysts zvose zvinoonekwa pa x-rays.
Inflammatory Arthritis: RA inogona kukura mune ankle kana chero synovial joint. Will anowanzo kuunza ane symmetrical Maoko/tsoka RA pakutanga (2nd, 3rd MCP, wrists, MTPs mutsoka) kazhinji nekukukurwa, yunifomu JSL, juxta-articular osteopenia, uye kunonoka subluxations.
HLA-B27 spondyloarthropathies: inowanzokanganisa kumucheto kwepasi: chitsitsinho, ankle esp muReactive (Reiter). Erosive-inogadzira bhonzo kuwedzera kwakakosha Dx.
Gouty Arthritis: inowanikwa mumucheto wezasi. Ankle, yepakati-tsoka tsoka esp 1st MTPs. Kutanga kwekutanga: acute gouty arthritis ine ST effusion uye pasina erosions / tophi. Chronic tophaceous gout: peri-articular, intra-osseous punched-out erosions nemicheto yakarembera, hapana yekutanga JSL/osteopenia, ST. Tofi inogona kuonekwa.
Zvimwe zvinhu zvakasiyana-siyana: PVNS. Hazvishamisi. Inobata 3-4th makumi emakore ehupenyu. Mhedzisiro ye synovial proliferation neMacrophages uye yakawanda-nucleated Giant Cells yakazadzwa nehemosiderin uye kuunganidza mafuta kunogona kutungamirira kukuputika, kukuvara kwecartilage, kuputika kwemapfupa ekunze. Dx: x-rays hainzwisisi, MRI modality yekusarudza. Synovial biopsy. Kutarisira: kushanda, kunogona kuva kwakaoma.

Neuropathic Osteoarthropathy

(mubatanidzwa waCharcot) Zvakajairwa uye pakuwedzera d/t denda murudzi rwechipiri DM. Inogona kuunza nekurwadziwa pakutanga (2% yezviitiko) uye isingarwadze inoparadza arthropathy sekunonoka kuratidzwa. Early Dx: kunonoka. Kufungidzira kwakakosha: x-rays: pakutanga isingabhadhare, imwe SF effusion inoonekwa. MRI inobatsira nekutanga Dx uye kupera-kurodha. Late Dx: kusagadziriswa kuparadzaniswa, kuputsika, kuremara. Cherechedza: Lisfrance dislocation muCharcot joint
M / C pakati petsoka (TM joint) mu 40% yematambudziko, chikwama 15%. Kufambira mberi: Rocker-bottom tsoka, maronda, utachiona, kuwedzera kwehurwere, uye kufa.
Pakutanga Dx: neMRI inokosha. Kuzvitsivira kune varwere vane chirwere chechirongwa che 2 DM kunyanya kana kutanga kusingagadziki tsoka / marwadzo emakumbo anotaurwa.

Ankle & tsoka Kufananidza

Iyo Arthritis Inogona Kuita Knee

by Dr Alex Jimenez | chirwere chemumajoini, Arthropathies, Chiropractic, Chiropractic Examination, chisingaperi Pain, Mamiriro Ekutongwa, utano, Kufungidzira & Diagnostics, Kuongorora Maedzo, Mitambo Injodzi, Mishonga, Wellness

Arthritis inozivikanwa sekuputika kweimwe kana akawanda majoini. Zviratidzo zvakajairika zveArthritis zvinosanganisira kurwadziwa uye kusagadzikana, kuzvimba, kuzvimba, uye kuomarara, pakati pevamwe. Arthritis inogona kukanganisa chero kubatana mumuviri wemunhu, zvisinei, inowanzo kukura mumabvi. Knee arthritis inogona kuita kuti zviitiko zvemuviri zvezuva nezuva zviome. Mhando dzakakurumbira dzeArthritis ndiyo osteoarthritis uye rheumatoid arthritis, kunyange paine anopfuura mazana zana mafomu eArthritis, anokanganisa vana nevakuru zvakafanana. Kunyange pasina mushonga weArthritis, nzira zhinji dzekurapa dzinogona kubatsira kubata zviratidzo zve knee arthritis.

Anatomy yeKnee

Ibvi ndiro mubatanidzwa mukurusa uye wakasimba mumuviri wemunhu. Iyo inoumbwa nemucheto wezasi wepfupa rechidya, femor femur, iwo mugumo wepamusoro weshin bone, kana tibia, uye kneecap, kana patella. Iwo magumo emapfupa matatu akafukidzwa nearticular cartilage, yakatetepa, inotsvedza chimiro chinodzivirira nekusunga mapfupa kana ichikotama uye ichisimudza ibvi.

Parts Zvikamu zviviri-zvakaumbika-zvidimbu zvekartilage, inozivikanwa seye meniscus, inoshanda seyakavhundutsa anopinza pakati pemapfupa emabvi kubatsira kubatsira kubatanidza mubatanidzwa uye nekupa kugadzikana. Kubatana kwemabvi kwakakomberedzwa neketeni nhete inozivikanwa se synovial membrane. Iyi membrane inoburitsa chinoyerera chinozorodza shwashwa uye zvakare chinobatsira kudzikisa kukweshera mumabvi. Iwo akakosha marudzi eArthritis anokanganisa mabvi - anosanganisira osteoarthritis, rheumatoid arthritis, uye post-inoshungurudza arthritis.

Osteoarthritis

Osteoarthritis ndiyo mhando yakajairika yeArthritis iyo inobata mabvi akabatanidzwa. Iyi fomu yeArthritis ndiyo inodzora, yekupfeka-uye-kubvarura nyaya yehutano iyo inowanzoitika muvanhu vane makore makumi mashanu ekuberekwa nekure, zvisinei, inogona zvakare kukura mune vechidiki.

Mune osteoarthritis, shwashwa mumabvi akabatanidzwa zvishoma nezvishoma inopera. Sezvo shwashwa inopera, chinhambwe pakati pemabhonzo chinoderera. Izvi zvinogona kukonzeresa kukwizwa kwemapfupa uye zvinogona kuumba marwadzo emabhonzo. Osteoarthritis inowanzo kukura zvishoma nezvishoma asi kurwadziwa kwacho kunogona kutowedzera nekufamba kwenguva.

Rheumatoid Arthritis

He Rheumatoid arthritis chirwere chisingaperi chinokanganisa majoini akawanda mumuviri wese, kunyanya ibvi rakabatana. RA zvakare yakaenzana, zvichireva kuti inowanzo bata kubatana kumwechete kune rumwe rutivi rwemuviri wemunhu.

Mu rheumatoid arthritis, iyo synovial membrane iyo inovhara mabvi akabatana inova inopisa uye kuzvimba, zvichikonzera kurwadziwa kwemabvi, kusagadzikana, uye kuomarara. RA chirwere chemuviri, izvo zvinoreva kuti immune system inorwisa ayo akapfava matishu. Ma immune immune anorwisa hutano hwakanaka, kusanganisira tendon, ligaments uye shwashwa, pamwe nekunyorovesa bhonzo.

Post-traumatic Arthritis

Posttraumatic arthritis inzira yeArthritis inokura mushure mekukuvara kana kukuvara kumabvi. Nenzira, semabvi akabatanidzwa anogona kukuvadzwa nefupa rakatyoka, kana kutsemuka, uye zvichizoguma neyakaitika-inoshungurudza arthritis makore mushure mekukuvara kwekutanga. Meniscal misodzi uye ligament kukuvara zvinogona kukonzera kuwedzera kupfeka-uye-kuchema pamabvi akabatanidzwa, ayo nekufamba kwenguva anogona kutungamira kuArthritis nemamwe matambudziko.

Zviratidzo zveKnee Arthritis

Zviratidzo zvakajairika zvemabvi arthritis zvinosanganisira kurwadziwa uye kusagadzikana, kuzvimba, kuzvimba, uye kuomarara. Kunyangwe kutanga kamwe kamwe kungangoitika, zviratidzo zvinorwadza kazhinji zvinokura zvishoma nezvishoma nekufamba kwenguva. Zvimwe zviratidzo zvebvi arthritis zvinogona kuzivikanwa seinotevera:

Nhengo yacho inogona kuva yakasimba uye ichibvunda, zvichiita kuti zvive zvakaoma kukotama uye kururamisa mabvi.
Kuzvimba nekuputika kungave kwakaipa mangwanani, kana kuti kana wakagara kana kuzorora.
Basa guru rinogona kuita kuti marwadzo apararire.
Zvimedu zviduku zvekateti nedzimwe nyuchi dzakapfava zvinogona kukanganisa kufamba kwakanyatsobatana kwezvibatanidza, zvichiita kuti bhudzi rivhare kana kuti rirambe richifamba. Inogonawo kugadzira, kuvhara, kuvhara kana kuita mutsindo, unonzi crepitus.
Urombo hunogona kukonzera pfungwa yekuneta kana kuputika kubva pamabvi.
Vanhu vazhinji vane arthritis vanogonawo kurondedzera huwandu hwakanyanya huri pamwe nemvura yekudenga uye kuchinja kwemamiriro ekunze.

Kuongororwa kweKnee Arthritis

Panguva yekugadzwa kwemurwere kuti aongororwe nebvi arthritis, nyanzvi yehutano ichataura nezvezviratidzo uye nhoroondo yezvekurapa, pamwe nekuongorora muviri. Chiremba anogona zvakare kuraira imaging yekuongorora bvunzo, senge X-rays, MRI kana kuongororwa kweropa kuti uwedzere kuongororwa. Munguva yekuongororwa kwemuviri, chiremba anotsvaga:

Kuvhiringidza pamwe chete, kuzvimba, kupisa, kana kubwinya
Unhu hwakakomba pamabvi akabatanidzwa
Assortment yekusimudzira uye kushandiswa kwesangano
Kusagadzikana kwemabvi akabatanidzwa
Crepitus, chirwere chegumbo mukati memubatanidzwa, nekufamba
Marwadzo kana uremu huiswa pamabvi
Matambudziko ane maitiro, kana nzira yekufamba
Chero zviratidzo zvekukuvadza kana kukuvadza kumisungo, tete, uye mitsipa yakakomberedza bhandi
Kubatanidzwa kwezvimwe zvikamu (chinoratidza rheumatoid arthritis)

Kufungidzira Kuongorora Kuongororwa

X-rays. Aya mafungiro ekuongorora maitiro anogadzira mifananidzo yezvikwata zvakagadzirwa, zvakadai semapfupa. Vanogona kubatsira kusiyanisa pakati pemhando dzakasiyana-siyana dzeArthritis. X-rays yemabvi arthritis inogona kuratidza chikamu chemajoni akabatanidzwa, kuchinja mumapfupa pamwe nekuumbwa kwepa bone spurs, inozivikanwa seosteophytes.
Mimwe miedzo yekuwedzera. Dzimwe nguva, imaginetic resonance imaging, kana MRI, scans, computed tomography, kana CT, scans, kana mapfupa anoonekwa anodiwa kuti uone mamiriro ezvinhu epfupa uye akapfava materu emabvi.

Dambudziko reRopa

Doctor Chiremba wako anogona zvakare kukurudzira kuongororwa kweropa kuti aone kuti ndechipi mhando yemaarthritis yauinayo. Nedzimwe mhando dzeArthritis, senge rheumatoid arthritis, kuongororwa kweropa kunogona kubatsira nekuzivikanwa kwakakodzera kwechirwere.

Kunyange zvazvo mabvi akabatana ari imwe yezvisungo zvakasimba uye zvakakura mumuviri womunhu, zvinowanzotarisana nekukuvadzwa kana kukuvadzwa, zvichiguma nemhando dzakasiyana-siyana. Mukuwedzera, zvisinei, zvimwe zvehutano, zvakadai seArthritis, zvinogona kukanganisa mabvi akabatanidzwa. Mukubatanidza mari yakawanda yeEl Paso, TX, chiropractic kuchengetedza inogona kubatsira kuderedza zviratidzo zvinorwadza zvakabatana nemabvi arthritis, pakati pezvimwe zvehutano. Dr. Alex Jimenez DC, CCST Insight

Kurapa kweKnee Arthritis

Non-chirurgical Treatment

Nzira dzisiri-dzekuvhiya nzira dzekurapa dzinowanzo kukurudzirwa usati wafunga kurapwa kwekuvhiya kwemabvi arthritis. Vashandi vezvehutano vanogona kukurudzira akasiyana marapirwo, kusanganisira chiropractic, kurapwa kwemuviri, uye kugadzirisa mararamiro, pakati pevamwe.

Lifestyle modifications. Imwe nzira yehupenyu yekugadzirisa inogona kubatsira kuchengetedza kubatana kwebvi uye kudzivisa kufambira mberi kweArthritis. Kuderedza zvinhu zvemuviri izvo zvinowedzera chiitiko chacho, zvichanyanya kuoma pamabvi. Kurasikirwa uremu kunogonawo kubatsira kuderedza kushungurudzika uye kumanikidzwa pamabvi akabatanidzwa, zvichiita kuti zviratidzo zvishoma zvinorwadza uye kuwedzera basa.

Chiropractic kuchengetedza uye kurapa muviri. Chiropractic kuchengetedza inoshandisa yakazara muviri chiropractic kugadzirisa kuti inyatso kudzorera chero musana musalignments, kana subluxations, izvo zvinogona kunge zvichikonzera zviratidzo, kusanganisira arthritis. Chiremba anogona zvakare kukurudzira kurapa kwemuviri kugadzira chirongwa chakazvimiririra uye chirongwa chemuviri chezvaunoda murwere. Specific Exercise inobatsira kuwedzera kuwanda kwekufamba uye kutsungirira, pamwe nekubatsira kusimbisa mhasuru mumucheto wezasi.

Zvishandiso zvekushandisa. Kushandisa zvigadzirwa zvekugadzirisa, zvakadai sedhaka, shangu dzinotyisa-kuvhara kana kuisa, kana bhandi kana saga, rinogona kuderedza zviratidzo zvinorwadza. Bhande rinobatsira nebasa uye rakasimba, uye rinogona kunyanya kubatsira kana arthritis inobva kune rumwe rutivi rwemabvi. Kune mhando mbiri dzemakumbo anowanzoshandiswa pamabvi arthritis: "Kudonhedzera" kubvisa kushanduka kwemazivi kubva kune chikamu chakakanganiswa chebvi, asi "rutsigiro" rukabatsiri runobatsira kutsigira mabote ose.

Zvinodhaka uye / kana mishonga. Mhando dzakawanda dzemishonga inobatsira mukurapa arthritis yemabvi. Sezvo vanhu vari kupindura zvakasiyana nemishonga, chiremba wenyu achashanda pamwe chete newe kuti asarudze mishonga uye madhesi ayo akachengeteka uye anobatsira kwauri.

Kurapa Kwokuvhiya

Nyanzvi yehutano inogona kukurudzira kurapwa kana murwere wemabvi arthissi achikonzera kuremara kwakanyanya uye chete kana dambudziko rikasagadziriswa nekurapwa kusiri kwekuvhiya. Kufanana nekuvhiya kwese, kune mashoma njodzi uye matambudziko nekurapwa kwekuvhiya kwemabvi arthritis. Chiremba anokurukura matambudziko anogona kuitika nemurwere.

Arthroscopy. Munguva yeArthroscopy, vanachiremba vanoshandisa zviridzwa uye zviduku zvisinganzwisisi kuti vaongorore uye vabate zvinetso zvekubatanidza mabvi. Kuvhiya kweArthroscopic hakuwanzoshandiswa mukurapa arthritis yemabvi. Mumamiriro ezvinhu apo osteoarthritis inofambidzana nehutachiona hwemhuka, chirwere che arthroscopic chingave chakachenjera kurapa meniscus yakabvaruka.

Cartilage grafting. Kazhinji maronda etikititi angatorwa kubva kubhandi renyama kana kuti nechepamusi webvi kuti azadzise gomba muchetirati. Izvi zvinowanzotaridzirwa chete kuvarwere vaduku.

Synovectomy. Chibato chakakanganiswa neRheumatoid arthritis chinobviswa kuti kuderedze kuzvimba uye kurwadziwa.

Osteotomy. Mune mabvi osteotomy, ingave iyo tibia (shinbone) kana femur (thighbone) inotemwa yobva yagadziriswa kugadzirisa kushushikana uye kumanikidza pamabvi akabatanidzwa. Knee osteotomy inoshandiswa apo yekutanga-nhanho osteoarthritis yakanganisa chikamu chimwe chemabvi akabatanidzwa. Nekuchinja iko kugoverwa kwekurema, izvi zvinogona kusunungura uye kusimudzira mashandiro emabvi.

Kushandiswa kwebvi rose kana kusasarudzwa (arthroplasty). The doctor achabvisa rakakanganiswa pfupa uye shwashwa, uye woisa mapurasitiki matsva kana esimbi maficha ekudzoreredza mashandiro emabvi nezvayo zvakapoteredzwa zvivakwa.

Kutevera chero rudzi rwekuvhiya kwemabvi rthritis kunosanganisira nguva yekupora. Kudzoreredza nguva uye kugadziridza kunoenderana nerudzi rwekuvhiya kunoitwa. Izvo zvakakosha kuti utaure neyako nyanzvi yehutano kuti uone yakanakisa yekurapa sarudzo yeako knee arthritis. Chiyero cheruzivo rwedu chinogumira kuchiropractic uye musana nyaya dzehutano. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa us915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Zvimwe Zvinyorwa Kukurukurirana: Relieving Knee Pain pasina Surgery

Kurwadziwa kwemabvi chiratidzo chinozivikanwa chinogona kuitika nekuda kwekukuvara kwemabvi kwakasiyana uye / kana mamiriro, kusanganisira conditionsmitambo yakakuvara. Mabvi ndeimwe yenhengo dzakaoma kwazvo mumumuviri womunhu sezvo zvichiitwa-kwemaketani emapfupa mana, mitsetse ina, toni dzakasiyana-siyana, menisci mbiri, uye cartilage. Maererano neAmerican Academy of Family Physicians, zvinonyanya kukonzera kurwadziwa kwemabvi zvinosanganisira patellar subluxation, patellar tendinitis kana jumper, uye Osgood-Schlatter chirwere. Kunyange zvazvo kurwadziwa kwemabvi kunowanzoitika kune vanhu pamusoro pemakore emakore e60, kurwadziwa kwemabvi kunogonawo kuitika kune vana nevechiri kuyaruka. Kurwadziwa kwepamusoro kunogona kurapwa pamusha kutevera nzira dzeRICE, zvisinei, kukuvara kwakanyanya kwemabvi kunogona kudiwa kurapwa kwekurumidza, kusanganisira chiropractic kuchengetedza.

EXTRA EXTRA | NHAURWA INOKOSHA: El Paso, TX Chiropractor Inokurudzirwa

«Zvekare Mapinda

Zvinotevera »

IFM's Tsvaga Yekushandisa chishandiso ndiyo hombe yekutumira network muKushanda Mushonga, yakagadzirirwa kubatsira varwere kuwana Vanoshanda veMishonga varapi chero kupi pasi. IFM Certified Varapi vakanyorwa kutanga mumhedzisiro yekutsvaga, vachipihwa yavo yakazara dzidzo muKushanda Mushonga

Kubhuka kwepamhepo & Kugadzwa 24/7 *

Certified Functional Medicine Chiremba El Paso — Certified Functional Medicine Provider*
Vese Vanopa vanoshanda mukati mehutongi hwemutemo uye vakamisikidzwa kliniki chiyero chekudzidzira.

Iyo Injury & Trauma Rehabilitation Nyanzvi

PUSHAsRx® Trauma Rehabilitation Center

Health, Wellness & Nutrition Nyanzvi

Chii chinonzi x-rays?

Kushandiswa kwechiropractic x-rays

Chii chinonzi chiropractor chinotarisa pa x-radhi firimu?

Epain Pain Treatment

Scapholunate Ligaments Dissociation

Metacarpal & Phalangeal Kukuvara

Chiremba Wrist Kukuvara

Wrist & Ruoko Arthritis

Rheumatoid Arthritis

Mahombekombe eEgobho mumutambo wechidiki

Elbow Arthritis

Kusiyana kwematambudziko

Nyoro Nyama & Bone Neoplasms nezve Elbow

The Elbow

Acute Trauma

Proximal Humerus Fractures

Akabatwa Akabatana aka Glenohumeral Joint dislocation (GHJD)

Kuongororwa Kufananidza Kwenzira

Bankart Lesion

Aina dzeBartart Lesion

Kushamiswa kwemashure

Inferior GHJD

ACJ Dislocation (ACJD)

Tora 3 ACJ Separation

Rotator Cuff Muscle (RCM) Pathology

Superior Labrum Anterior ku Posterior (SLAP) Zvipembenene / Misodzi

Akabatisa Arthritis

Ischemic Osteonecrosis

Neoplasms

ngovepo

Etiology uye Pathophysiology

Risk Factors

kuongorora chirwere

Mharidzo Yakafanana

Zviratidzo Zvokuziva

Miedzo yekuongorora

Kusiyanisa Kuziva

mabatiro

DMARDs

NSAIDs uye Corticosteroids

Complementary Therapies

Kudzidzira uye Kurapa Kwepanyama

Nguva yekurapa

Joint Replacement

Yenguva Yakareba Kuongorora

Prognosis

Zvimwe Zvinyorwa Kukurukurirana: Relieving Knee Pain pasina Surgery

Hazvina kuchena

References

Close Accordion

Osteochondral Kukuvara kweTalus (OCD)

Makuvara eMetatarsal

Arthritis yetsoka & Ankle

Neuropathic Osteoarthropathy

Ankle & tsoka Kufananidza

Anatomy yeKnee

Osteoarthritis

Rheumatoid Arthritis

Post-traumatic Arthritis

Zviratidzo zveKnee Arthritis

Kuongororwa kweKnee Arthritis

Kufungidzira Kuongorora Kuongororwa

Dambudziko reRopa

Kurapa kweKnee Arthritis

Non-chirurgical Treatment

Kurapa Kwokuvhiya

Zvimwe Zvinyorwa Kukurukurirana: Relieving Knee Pain pasina Surgery

Kubhuka kwepamhepo & Kugadzwa 24/7 *

YAKAZADZWA NEMAHARA Nhoroondo

Clinic Nzvimbo

Kuwedzera Nzvimbo dzeKutarisira Dzinopihwa

ZVAKAITIKA CALENDAR: LIVE ZVAKAITIKA & WEBINARS