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

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