Curyaanimada/Gacanta Arthritis-ka iyo Dhaawaca: Sawirka ogaanshaha | El Paso, TX.

Curcurka & Dhaawaca Gacanta

• Distal Radius & Ulnar Fractures (Colles, Smith's, Barton's, Chauffeur's, DiePunch) - ay ku adag tahay 50% ulnar styloid Fx, Waddada TFC, DRUJ kala-bax, kala qaybsanaan scapholunate lig, lunate/burburin
• Lafaha Carpal Jab & kala-bax (scaphoid, triquetrum, hamate Fx & Lunate/kala-bax xun)
• Kala-baxa ligaments ( Kala-baxa Scapholunate, xasilloonida Lunotriquetral)
• Jabka Metacarpal & Phalangeal (Bennett, Rolando, Ciyaar ilaaliyahaFx/ dhaawaca Stener, Boxer Fx)
• Dhakhaatiirta dhaawaca curcurka (Fx-usha cagaarka ah, Torus Fx, qalloocan Bowing/caaga ah, dhaawacyada Salter-Harris)
• Dhammaan kiisaska, gudbinta qaliinka gacanta ee Orthopedic ayaa loo baahan yahay

• Cols fx: m/cd/t FOOSH+jilicsanaan. m/c inOSP/dumarka. Naadirka ragga iyo haddii ay dhacdo waxay u baahan yihiin DEXA si ay uga fogaadaan sinta Fx iwm. Pts yar yar: dhaawac tamar sare leh. Caadi ahaan extra-articular.50% -xaasku waxay muujinayaan Ulna styloid (US) Fx.
• Dhibaatooyinka: qallafsanaanta fargeetada cashada, CRPS, DJD, xannibaadda dareemayaasha.
• Sawirka: x-rad ayaa ku filan, CT ee Fx adag, MRI waxay ka caawisaa ilmada seedaha iyo TFC.
• Rx: haddi articular-ka dheeriga ah iyo <5-mm dhexroorka fogaanayo gaabinayo iyo <5-degree xagasha dhabarka hoose ee xidhidh+dhimista ayaa ku filan. ORIF xaalado adag.
• Image Dx: Saamaynta fog ee fogaanta/gaabinaysa, xagasha dhabarka ee jajabka fog, si taxadar leh u baadh haddii kordhinta gudaha articular, 50% US Fx

• Smith Fx: Goyland ee suugaanta Faransiiska. Loo tixgeliyo inay yihiin Colles rogan, haddii kale ku dhawaad ​​isku mid, Ie, 85% dheeraad ah, 50% US Fx, OSP/haweenka da'da ah, da'da yar ee pts-tamarta tamarta sareeysa. Kala duwanaanshiyaha: farsamayntaFOOSH ee curcurka dabacsanaan m. In ka yar soo noqnoqda.
• Tallaabooyinka sawirka: (eeg Colles Fx) C
• Dhibaatooyinka: la mid ah Colles Fx
• Rad Dx: 85% dheeraad ah oo articular ah oo leh volar( hore) xagal googo'a fog, shucaaca gaabinaya. Si taxadar leh u baar jebinta kortikal ee looga shakisan yahay kordhinta articular-ka ah ee loo magacaabi karo sida Smith type 2 ama Reversed Barton Fx (ku xiga)
• Rx: hab la mid ah sida Colles.

• Barton fx: FOOSH, saamaynta raadiyaha fog ee la mid ah Colles laakiin xariiqda Fx waxa ay ka fidsan tahay dhinaca radial-ka laf dhabarta una gudubta isgoysyada radiocarpal taas oo ka dhalata silbasho/kala-baxa xubinta taranka.
• sawirka: Sebt 1-aad raajo raajo oo badanaa leh CT si ay u baarto fidinta Fx-ka-gaaban iyo qorsheynta hawlgalka
• Rad Dx: radius fog Fx oo ka soo bilaabmaya dhabarka ilaa laf-dhabarka shucaaca radiocarpal oo leh heerar kala duwanaansho ah oo barokac ah, silbashada u dhow ee carpus
• Haddii khadka Fx uu ka soo baxo dhinaca volar-ka una gudubta wadajirka curcurka ee loo yaqaan Reversed Barton aka Smith nooca 2 (Sawirka hoose ee kore)
• Dhibaatooyinka: oo la mid ah dhammaan raadiyaha fog ee Fx
• Rx: ku shaqeeya ORIF

• Chauffeur's/dabada dhabarka Fx aka Hutchinson Fx: Intra-articular Fx of Radial styloid. Magaca ayaa ka yimid markii gaariga lagu bilaabay a gacanta qallafsanaan kara dib u kicinta curcurka dhabar-jabka iyo leexashada shucaaca.
• Sawirka: raajada raajo ayaa ku filan. CT waxaa laga yaabaa inay ku caawiso haddii Fx aan si sahal ah loogu muujin raajo.
• Dhibaatooyinka: urur la'aan, malunion, DJD, kala qaybsanaan scapholunate, lunate/burburin
• Rx: ku shaqeeya lagscrew percutaneous dhammaan kiisaska d/t gudaha articularnature

• Die-Punch Fx: saamayn Fx by lafta Lunate galay articular fog Lunate fossa ee Radius ah. IntraarticularFx. Waxay magaceeda ka soo qaadatay farsamo si ay u qaabayso (soo jiidato) dalool mashiinnada warshadaha "die-punch." Dhaawaca FOOSH.
• Sawirka: raajada 1-aad, waxay noqon kartaa mid isku mid ah d/t niyad-jabka daahsoon ee Lunate fossa ka dibna CT scan-ga ayaa ah mid xog badan leh.
• Rad Dx: saameeyay lunate fossa gobolka oo leh fidinta Fx-ka-dhex-dhexaad ah. Tani waxay u soo bandhigi kartaa sidii Fxarticular Fx ee Radius Distal ah.
• Rx: qalliin d/t gudaha articular Fx

Dhis arcs of Gilula marka la qiimeeyo dhaawacyada carpal. Tallaabo muhiim ah ayaa loo baahan yahay si looga fogaado isbedellada daahsoon ee maqan ee toosinta carpal iyo sii wadida kortical

• Scaphoid lafta Fx: m/c Fx lafta carpal. D/tFOOSH curcurka oo fidsan si shucaac ah. Goobta Fx ayaa ugu muhiimsan saadaasha: dhexda-m/c goobta (70%). Waxay yeelan kartaa 70-100% fursad AVN. Cirifka u dhow ee Fx: 20-30% oo leh khatar sare oo aan midow ahayn. Cirifka fog-10% wuxuu muujinayaa saadaal wanaagsan. Cirifka fog ee Fx waa m/c carruurta. Calaamadda bukaan-socodka ee muhiimka ah; xanuunka santuuqa santuuqa.
• Sawirka: Talaabada 1aad-x-radiografi laakiin 15-20% seegay d/t occult Fx. Aragtiyo gaar ah ayaa loo baahan yahay. Markaa MRI waa tan ugu xasaasisan uguna gaarka ah hore ee occult Fx. Scintigraphy lafaha ayaa leh 98/100% gaar ah & dareenka esp. 2-3 maalmood ka dib bilawga. Raad fur. Dx: Khadka Fx haddii ay muuqato, barokac iyo madaw ee suufka dufanka leh ee scaphoid (navicular), ka baar kala-baxa scapholunate. Haddii lafta u dhow ay u muuqato sclerotic-AVN ayaa dhacay. MRI: hooseeya T1 & sare T2 / STIR / FSPD d/t bararka lafaha, calaamad hooseFx ayaa la xusi karaa.
• Rx: Kabka Spica waa in la mariyaa haddii bukaan-socod ahaan looga shakiyo xitaa natiijooyinka raajooyinka. Loogu talagalay dhexdaFx-kabka ee 3-mo ee prox pole 5-mo immobilization. ORIF ama ku dhejinta maqaarka ee Herbert.

Kala qaybsanaanta ligaments Scapholunate

• Curcurka SNAC: Scaphoid aan midow ahayn oo burburay. Badanaa d/t aan midow ahayn iyo kala-baxa seedaha scapholunate (SLL) oo leh radiocarpal horumarsan iyo intercarpalDJD. Jajabka scaphoid-ka Proximal wuxuu ku dheggan yahay Lunate oo leh calaamado kala fogaansho iyo wareeg ah oo giraanta raajada.
• Curcurka SNAC waxa laga yaabaa inuu badanaa keeno DISI
• Rx: DJD horumaray waxa ay u horseedi kartaa arthrodesis afar geesood ah

• Scapholonate horumarsan burburka ( gacanta SLAC): SLL-ku-xirnaanta horusocod ee isdhexgalka iyo radiocarpal DJD iyo barokaca carpal volar ama dorsal (DISI & VISI). Sababaha: trauma, CPPD, DJD, Kienboch disease (AVN of Lunate), Preiserdisease (AVN of Scaphoid).
• Kala qaybsanaanta SLL waxay u horseedi doontaa Dorsal ama VolarIntercarlate aka Intercarpal Segmental Insability (DISIor VISI).
• Rad Dx: Dx sababta hoose. Raajooyinku waxay muujinayaan xuubka lunate oo leh xagal scapholunate oo kordhay ama hoos u dhacday oo ku taal aragtida dambe. Dhinaca hore: calaamada Terry Thomas ama ballaadhinta masaafada scapholunate 3-4-mm sida xadka sare ee caadiga ah.
• �MRI waxa laga yaabaa inay ka caawiso qiimaynta seedaha iyo qorshaynta qalliinka ka hor
• Rx: badiyaa la shaqeeya DJD daahay. arthrodesis afar geesood ah

• Triquetrum Fx: 2aad m/c lafta carpal Fx. Dhinaca dhabarka M/C waxa ka gilgilay xuubka radiocarpal ee adag ee Dorsal. Sababta: FOOSH.
• Sawirka: taxanaha gacanta ee raajo ayaa ku filan. Sida ugu fiican ayaa lagu muujiyay aragtida dambe sida jajab lafo fidsan oo ku dheggan dorsum ee Triquetrum. CT ayaa laga yaabaa inay ku caawiso haddii shucaac ahaan isu dhigma.
• Rx: daryeelka muxaafidka
• Dhibaatooyinka: naadir, waxay u sii jiri karaan sida xanuunka dhabarka gacanta

• Hook ee Hamate Fx: m/c waxay ku dhacdaa ciyaaraha fiidista (cricket, baseball, hockey, saamaynta ay leedahay naadiga golfka, iwm) 2% ee carpusFx.
• Sawirka: raajada waxaa laga yaabaa inay ku guuldareysato in la ogaado Fx ilaa "muuqaalka tunnel-ka carpal" la isticmaalo. CT ayaa laga yaabaa inay ku caawiso haddii raajadu aanay faa'iido lahayn.
• Kiliinik ahaan: xanuunka, tijaabada jiidashada togan, daciifnimo, xajin xanuun leh. Ulnar qoto dheer n. Laanta waxa laga yaabaa inay saamayso gudaha kanaalka Guyon.
• Rx: sida caadiga ah kuwa aan qalliin ahayn, laakiin urur la'aan joogto ah ayaa laga yaabaa inay u baahdaan goyn.
• DDx: hamate laba geesood ah

• Lunate vs. Kala-bax xun: Lunate waa m/c lafta carpal oo kala go'day. Guud ahaan dhaawaca carpal aan soo noqnoqon. Si kastaba ha ahaatee, inta badan waa la waayay!
• Waxay ku dhacdaa FOOSH iyo curcurta oo fidsan iyo ul naarada oo leexday. sawirka: raajada 1-aad Abaalmarinta ama waxay u baahan tahay qiimaynta dhaawaca kakan ee CT scan.
• Furaha Rad DDx: DDx Lunate oo ka yimid meel-ka-bax halis ah. Meesha Lunate: Lunate waxay lumisay xidhiidhkii ay la lahayd raadiyaha fog ee shaaha daatay ee dhinaca. Kala-bax xun: Lunate waxay sii wadaa xidhiidhka ay la leedahay raadiyaha fog inkastoo Capitatedorsally ay kala guurtay. Kala-baxa Lunate waxa kale oo laga caawiyaa in lagu garto calaamadda �pie
• Rx: dhimista degdega ah iyo hagaajinta qalliin ee seedaha jeexan

Metacarpal & Dhaawacyada Phalangeal

• Bennett Fx: Intra articular laakiin nooca saamaynta Fx ee saldhigga 1st MC ee suulka. Sawir-qaade ayaa ku filan.
• Rad Dx: jajab saddex xagal ah oo sifo ah oo lafta ah oo ku taal dhinaca ulnar ee 1st MCbase, inta badan leh subluxation radial ee dhinaca soo hadhay ee shucaaca ee 1st MC
• Dhibaatooyinka: DJD, urur la'aan, iwm.
• Rx: waxay u nugushahay degenaansho la'aan/urur la'aan u baahan daryeel qalliin
• Rolando Fx: aka comminuted Bennett Y ama T-qaabaynta. Dhaawac aad u adag Waa mid aan degganayn oo u baahan daryeel qalliin

• Ciyaartoyga suulka: Dhaqan ahaan waxaa lagu tilmaamaa inay tahay jeex dabadheer oo ah seedaha dammaanadda ah ee 1stMCP ee Ingiriisiga Gamekeepers' kuwaas oo sameeyay qoor leexinta/dilka ugaadh yar. Dhaawac ba'an waxaa sidoo kale loo magacaabi karaa suulka Skier. Dhaawacan wuxuu noqon karaa ligamentous w/oa jab iyo dhaawac avulsion ah ee saldhiga 1aad ee u dhow phalanx.
• Cilaaqaadka: Nabarka stener ama barokaca seedaha jeexjeexay ee korka muruqa pollicis Adductor oo aan bogsiin karin hagaajinta qalliinka. MRI Dx ayaa loo baahan yahay.
• Ka fogow aragtida diiqada suulka ee keeni karta Stenerlesion
• Sawirka: raajo raajo oo ay ku xigto MRI ilaa Dx Stenerlesion. MSK US waa la isticmaali karaa haddii MRI la waayo.
• �Nabarka Stener ee MRI & MSUS: Jirrid dammaanad ah oo ulnar ah ayaa aad uga muuqda Adductor policis aponeurosis waxayna u muuqataa sidii kurno cufan oo la mid ah calaamad hoose oo samaysa waxa loogu yeero "yo-yo on the string calaamadda" ayaa laga soo sheegay MRI iyo MSK US.
• Rx: badiyaa shaqeeya

• Feeryahan Fx: m/c MC Fx. Farsamayn dheeraad ah oo caadi ahaan aan la soo koobin ama yar ayaa la dhammeeyay Fx iyada oo loo marayo m/c 5th iyo mararka qaarkood 4th MCneck-madaxa isku xidhka (mararka qaarkood iyada oo loo marayo shaft) taasoo keentay in madaxa galooto. Farsamaynta: saamayn toos ah sida feedh isku dheggan oo feeray oog adag (tusaale, lafaha wejiga/ feedhaha gidaarka) markaa 95% ragga da'da yar.
• sawirka: Taxanaha gacanta ee raajo ayaa ku filan
• Rad Dx: Fx line transverse ama oblique iyada oo loo marayo MCneck oo leh xagasha madaxa volar. Qiimee heerka barakaca, oo muhiim u ah warbixinta.
• Rx: Caadi ahaan kuwa aan qallin oo leh kabno gacan gaaban oo gacan gaaban iyo tiro lafo-laaban. (www.aafp.org/afp/2009/0101/p16.html)
• NB Haddii isla farsamadu uu jebiyo 2ndnd 3d MC ee isla aagga anatomic, waxay u baahan kartaa daryeel qalliin.

• Gacan Fx: m/c qalfoofka Fx (10% dhammaan Fx). Dhaawacyada isboortiga iyo warshadaha ayaa badan
• sawirka: raajada oo leh taxane gacmeed ama PA/aragtida farta dambe ayaa ku filnaan doonta
• Rad Dx: Haddii prox phalanx Fx, jajabka fogaana wuxuu u janjeeraa si toos ah oo leh jajab prox ah. Farsamaynta fog waxa laga yaabaa in dhabarka loo leexiyo. U fiirsashada muhiimka ah: dhaawaca sariirta ciddiyaha, kaas oo tixgeliyey Fx furan oo leh khatar caabuqa.
• Rx: haddii <10-degree xagal-saalax-saaxiib-ku-duubid dib-u-habayn dhaqdhaqaaq leh. CRPP vs. ORIF waxa loo tixgalin karaa xaalado adag-u-diridda dhakhtarka gacanta ee lafaha
• Cilaaqaadka: luminta dhaqdhaqaaqa, necrosis, caabuq. Waxay keeni kartaa goynta
• Dhaawacyada caadiga ah ee dheeraadka ah: PIP waa m/c kala go'an. Farta Mullet (Baseball), farta Jersey iyo dhaawaca kale waxaa loola jeedaa:
• www.aafp.org/afp/2012/0415/p805.html

 

 

• Dembiile: caabuqa septic ee saxarka caarada faraha sida caadiga ah Staph.Aureus. Sababaha: cirbadda muddada (macaanka), paronychia, kabka cidiyaha, iwm. m/c ee tusmada iyo suulka, oo soo bandhigaya xanuun, barar, iwm.
• D/t qaas ahaan saxarka anatomy caabuqa>bararku wuxuu keenaa qaybta saxarka-cadaadiska iyo necrosis.
• Rx

Dhaawaca Cuncunka Carruurta

• Fx aan dhamaystirnayn: Greenstick Fx, Torus (Buckle)Fx, Bowing (Caag) qalloocan/Fx. D/t FOHe.g. ka dhacay bartii daanyeer. m/c wuxuu saameeyaa 10-sano jir.
• Cilad-sheegid furaha: heerka xagasha/barakaca, dhaawaca saxanka korriinka ee epiphyseal (classification Salter-Harris)
• Rx: inta badan aan qalliin (dhimista xiran iyo tuurista)

• Distal Radioulnar Joint (DRUJ) Degenaansho la'aan-dhaawaca caadiga ah ka dib dhaawac soo gaaray sida FOOSH oo leh cudud kacsanaan iyo wareeg iyo carqalad ku ah seedaha DRUJ iyo TFCcomplex. Kacsiga ulnar styloid oo leh ursal ama barakicin aan fiicneyn ee ulnar fog waa in la xuso.
• Talaabooyinka sawirka: raajada marka hore, MRI waxay aqoonsan kartaa seedaha iyo dhaawaca TFC, MSKUScan waxay ka caawisaa jeexjeexa seedaha.
• Fiiro gaar ah: go'doonsan DRUJ volar (sawirka sare) iyo dhabarka (sawirka hoose) oo leexsan.

Curcurka & Arthritis-ka gacanta

• Curcurka DJD-sida caadiga ah waa ka labaad ee dhaawacyada, kala-baxa scapholunate, SLAC, curcurka SNAC, CPPD, Keinboch ama Preiser Disease iyo kuwa kale.
• Waxay u horseedi kartaa luminta shaqada ee weyn
• Sawirka: caadi ahaan wuxuu soo bandhigaa sida radiocarpal JSL, subchondral sclerosis, osteophytosis, cysts subcortical, iyo jidh dabacsan. Caadi ahaan dheeraadka ah ayaa keena hoos u dhac ku yimaada wadnaha iyo gaar ahaan wadajirka Tri-scaphe.
• MRI waxaa laga yaabaa inay ku caawiso aqoonsiga hore ee kala-baxa scapholunate, Lunate/Navicular AVN.
• Rx: muxaafid vs. hawlwadeen.

• Gacanta DJD: Aad ugu badan. OA aasaasiga ah ee runta ah. MCP- waligeed ma saamaysay DIP & PIP
• Haddii la go'doomiyay MCP OA la xuso ka fiirsoCPPD & Hemochromatosis (osteophytes-ka u eg osteophytes)
• Caafimaad ahaan:
• Dumarka da'da dhexe
• Caadi ahaan xanuun la'aan marka laga reebo 1st CMC OA
• noodhadhka DIPs-Heberden, noodhka PIPs-Bouchard
• Erosive OA (mararka qaarkood loo yaqaan �inflammatory OA�)
• Spectrum ee OA laakiin soo saarta nabaad-guurka udhaxeeya DIPs iyo PIPs taasoo keentay muuqaal aad u qurux badan. Ma jiro caabuq habaysan (ma jiro CRP, RF, Anti-CCP Ab) sida caadiga ah dumarka da'da dhexe/waayeelka ah, sida Hand OA, oo inta badan lagu arko qoysaska

Arthritis rheumatoid

• Rheumatoid Arthritis (RA-Cudurka bararka nidaamka daba-dheeraada ee etiology aan la garanayn, oo lagu beegsanayo kala-goysyada synovial, seedaha leh qaybo badan oo nidaamsan (sambabada, CVS, Ocular, Maqaarka, iwm.) Pathology: Tcell>Macrophage / APC> dhexdhexaadinta habka autoimmune taasoo keentay sameynta pannus iyo burburin tartiib tartiib ah ee ST , carjawda, lafaha, iyo unugyo kale. 3% DumarVS.1% Ragga. Kiciyeyaasha deegaanka: caabuqa, dhaawacyada, sigaarka, iyo kuwa kale ee shakhsi ahaan u nugul. 20-30% ayaa laga yaabaa inay naafo noqdaan 10-sano kadib.
• Dx: kiliinikada, shaybaadhka, imaging.Symmetrical Polyarthritis esp. gudaha MCP, curcurada (2aad & 3RD MCP)