Habka Sawirka Garabka Garabka | El Paso, TX.

Dulmarka Anatomy ee garabka

Dhaawac Ba'an

• Humeral Fx waxay ku xisaabtamaysaa 4-6% dhammaan Fxs. Lafo-jileeca (OSP) Fx in>60 yo oo la xidhiidha dhaawaca ugu yar ee F: M 2:1 saamiga. Bukaannada da'da yar, dhaawaca tamarta sare ee degdega ah ayaa u badan.
• Dhibaatooyinka: AVN madaxa xumeral, Axillary N curyaan.
• Kala-soocidda Neer: waxay tixgelisaa jabka ay la socdaan 4-xariiqo anatomical ah oo leh ama baro-kac> 1-cm & xagasha 45-degree
• Hal qayb Neer Fx- ma jiraan baro-kac ama aad ugu yar <1-cm/45-degree. Waxay saameyn kartaa 1-4 xariiqo iyo M/C marka loo eego tuberosity weyn. 80% ee xumeral Fx u dhow waa hal qayb Neer.
• Laba qaybood oo Fx: 1-qayb ayaa la barakiciyey>1-cm/45-degrees. m/c waxay ku lug leedahay qoorta qaliinka
• Saddex qaybood oo Fx: 2-qaybood ayaa la barakiciyey>1-cm/45-degrees.
• Afar-qaybood Fx: dhammaan 4-qaybood waa la barakici karaa. Wax aan caadi ahayn <1%
• sawirka: Talaabada 1-aad-radiography, CT waxaa loo isticmaali karaa xaalado aad u adag. gudbinta lafaha
• Maamulka: Neer-hal-qayb Fx waxaa lagu daaweeyaa Dhaqdhaqaaq la'aanta Sling iyo baxnaanin horusocod ah
• Inta badan Fx ee dadka da'da ah waxaa loola dhaqmaa si aan qaliin ahayn
• Bukaannada da'da yar (40-65) ayaa laga yaabaa inay marmar u baahdaan hemiarthroplasty haddii 3 ama 4-qayb Neer Fx ay joogaan. Khatar weyn oo AVN ah

Jabka Humerus Proximal

• Fiiro gaar ah: Sawirka bidix: Fx ku lug leh qoorta anatomical iyo tuberosity weyn oo leh barokaca ugu yar <1-cm/45-degree markaa Dx sida hal qayb Fx. Sawirka saxda ah: Fx yar yar oo tuberosity weyn leh oo leh barokac weyn (> 45-degrees & 1-cm) sidaas darteed Dx oo ah laba qaybood Fx

• Fiiro gaar ah: Saddex qaybood oo Neer Fx (bidix) ah iyo afar qaybood Neer Fx (midig)> Maareynta: hawlwadeennada xaaladaha badankood ee bukaannada da'da yar (40-65)

Kala-baxa garabka aka Glenohumeral kala-bax wadajir ah (GHJD)

• Waxa loola jeedaa kala-soocidda buuxda ee humerus iyo scapula glenoid. 20-40s M: F 9:1 saamiga, gudaha 60-80S M: F 3:1
• Habdhaqanka: garabka xasilloonida ayaa loo huraa dhaqdhaqaaqa, iyo guud ahaan GHJD waa m/c ka mid ah xubnaha waaweyn ee jirka
• Dhacdooyinka ilaalinta (tusaale, FOOSH) iyo MVA ayaa ah sababaha m/c. GHJ waxay aad ugu nugul tahay afduubka, fidinta iyo wareegga dibadda. Qodobbada anatomical: glenoid gacmeed, kaabsal quraanjada hoose oo jilicsan iyo seedaha GH. GHJD waxay keeni doontaa jeexjeex daran ee xakamaynta GHJ. Dhaawacyada laf-dhabarka iyo xuubka xuubka ayaa ah kuwo caadi ah waxayna u horseedi karaan xasillooni darro joogto ah, DJD, iyo isbeddellada shaqada
• 3-nooc: GHJD hore (95%)
• GHJD danbe (4%) gaar ahaan la xidhiidha suuxdinta suuxdinta, korantada oo waxay ku dhici kartaa b/l
• Inferior GHJD aka Laxatio Erecta (<1%) oo la xidhiidha jug daran
• Caafimaad ahaan: AGHJD waxay soo bandhigtaa xanuun aad u daran, cududku waa mid dibadda ah oo wareeg ah oo soo jiidanaya, xaddidaad daran oo dhaqdhaqaaqa. GHJD waxa laga yaabaa inay u sii jirto sida kala-bax joogto ah.
• Maamulka: hoos u dhigista degdega ah ee ED marka la suuxiyo ama suuxdin culus oo leh Kocher farsamada sawirka sare (aan la isticmaalin), Habka wareegga dibadda (dhexe) ama farsamada caanaha (waxaa loo isticmaali karaa suuxinta) iyo dhowr habab oo kale. Dib u dhigista dhimista waxay la xiriirtaa khatarta weyn ee dhibaatooyinka degdegga ah iyo kuwa mustaqbalka fog

Habka Sawirka ogaanshaha

• Raajo-raajada garabka ee taxanaha ah ayaa ku filan. Sawir dheeraad ah oo leh CT scan iyo MRI ayaa laga yaabaa inay ku caawiyaan Dx osseous, carjawda, shaybaarka / seedaha.
• GHJD hore (95%). Booska Subcoracoid (midig sare) ee humerus waa m/c
• GHJD hore waxa kale oo laga yaabaa inuu u dhaco sida subglenoid (bidix hoose) iyo marar dhif ah sida subclavicular
• Furaha raadinta shucaaca waa in la qiimeeyo dhaawacyada Bankart iyo Hill-Sachs ee la xiriira

Dhaawaca Bankart

• Waxay dhacdaa inta lagu jiro hore ee GHJD d/t saamaynta madaxa ee hore-inferior glenoid. Kala duwanaansho ayaa jirta (eeg bogga soo socda). BonyBankart waxa lagu arki karaa raajada. Waxa loogu yeero unug jilicsan Bankart wuxuu u baahan yahay MRI. Carjawda (jilicsan) Bangigu waa m/c.
• Hill-Sachs aka Hatchet deformity (dhib-dhis fallaadho) dhaca inta lagu guda jiro habka la mid ah sida Bankart, ie, cadaadis iyo saamaynta dhinaca dambe ee madaxa ee ka dhanka ah glenoid soo saara qaab jeexan Fx. Dhaawaca Hill-Sachs waxa laga yaabaa inuu u saadaaliyo GHJD soo noqnoqota/soo noqnoqota.
• Dhaawaca bankiga ayaa laga yaabaa inuu bogsado, laakiin barroosinnada tolitaanka qalliin ayaa loo baahan yahay mararka qaarkood
• CT arthrogram iyo MRI ayaa laga yaabaa inay ku caawiyaan

Noocyada Dhaawaca Bankart

• Ogow noocyada kala duwan ee dhaawaca Bankart. Onlyosseous Bankart waxa lagu arki karaa shucaac ahaan. Unug jilicsan Bankart wuxuu u baahan yahay MRI oo leh iyo la'aanteed gadolinium-ka-goysyada (arthrogram).

Kala-baxa dambe

• Fiiro gaar ah: GHJD danbe oo leh calamadaha lagu garto:
• Calaamada Trough aka reverse Hill-Sachs. Waxay dhacdaa d/t saamaynta madaxa geesaha ee Fx
• Calaamadda cirifka: kaliya waxay ku dhacdaa PGHJD d/t booska dambe ee madaxa iyo glenoid-ka hore ee madaxa masaafada 6-mm ama ka weyn
• Calaamadda nalka: d/t wareeg degdeg ah gudaha humerus (madaxa)

Hoosta GHJD

• Inferior GHJD aka Laxatio Erecta
• Afduub daran iyo barokac hoose oo humerus ah. Fursadaha waaweyn ee dhaawaca daran ee neerfaha iyo acromial Fx
• Cududda kala go'day ayaa si weyn loo afduubay oo lagu hagaajiyay iyada oo xusulku leexsan yahay iyo cudud ka sarreysa madaxa.

Kala-baxa ACJ (ACJD)

• ACJD: dhaawaca caadiga ah, 9% dhaawacyada guntiga garabka ee esp. Ciyaartoyda ragga ah dharbaaxo toos ah
• Qoondaynta Rockwood (bidix) waxay qiimeysaa jeexjeexyada AC iyo seedaha CC iyo murqaha gobolka
• Nooca 1, 2, 3 ee m/c
• Nooca 1: murgacashada ACL w/o jeexjeexid
• Nooca 2: Jeexitaanka ACL iyo murgacashada CCL
• Nooca 3: Jeexitaanka AC & CCL. Xuubka ayaa ka sarreeya acromion. Haddii <2-cm natiijadu wanaagsan tahay Rx konserfatifka.
• sawirka: raajo leh b/l ACJ oo leh iyo w/o miisaan si loo barbardhigo labada ACJ. Xaaladaha adag CT scanning esp. haddii Fx la tixgeliyo
• Maareynta: Nooca 3 (> 2-cm) & Noocyada 4-6 Hawlgelinta

Nooca 3 ACJ Kala Saarida

• Nooca 3 ACJ kala soocida (bidix sare)
• ACJD oo aad muhiim u ah (sawirrada hoose) oo leh calaamad caafimaad oo ah acromion maqaarka hoostiisa iyo natiijada ORIF

Muruqa Rotator Cuff (RCM) Pathology

• RCM tendinopathy: Hoosudhaca kolajka ee RCM gaar ahaan Supraspinatus M. tendon(SSMT) d/t si xad dhaaf ah u isticmaal/waxyeelo-yar oo jeexjeexaya beddelka kolajka. Impingement syndrome waa sababta 2aad ee dibadda ka ah. Waxaa loo soo bandhigay bukaan ahaan xanuun iyo ROM xaddidan
• Sawirka Dx: MSK US waxa ay noqon kartaa mid sax ah sida MRI oo kale oo ka fiican xaaladaha qaarkood d/t qiimayn firfircoon v. kharash waxtar leh
• Tilmaanta muhiimka ah ee MRI waxay sii dhumuc weyn tahay SSMT aan toos ahayn oo leh calaamad kordhaysa dhammaan heerarka garaaca wadnaha d/t dufanka dufanka leh iyo bararka (Sawirada bidix: T1 & T2 FS)
• Natiijooyinka MSKUS: dhumucnaanta walxaha SSMT oo leh isbeddel ku yimaadda echogenicity caadiga ah.MSKUS waxay u fiican tahay DDx iyadoo SSMT ay la ilmayso. Faa'iidooyinka Maraykanku waa in ay ogolaato qiimeyn firfircoon ee qaababka xanuunka leh

• Jeexitaanka qayb ka mid ah SSMT: Jeexitaanka qayb (aan dhammaystirnayn) ee SSMT waxa laga yaabaa inay ka dhacdo bursalka iyo dusha sare ee articular ama interstitial, ie, walaxda gudaha/aan la isgaadhsiin. Etiology: is-hortaag hoose, cadaadis ba'an, iyo tendinosis microtrauma raaga
• Caafimaad ahaan: Xanuunka caloosha iyo laablaabashada, tijaabooyinka impingement, imtixaanada Hawkins-Kennedy, iwm
• Sawirka Dx: MSKUS waxay u fiican tahay MRI (Daraasadaha NB qaar ayaa tilmaamaya in MSKUS uu aad uga sarreeyo MRI). Natiijooyinka muhiimka ah ee MRI: farqiga / ilmada aan dhamaystirnayn ee SSMT oo ay ka buuxaan dareeraha wadajirka ah +/- nudaha granulation
• MSKUS: hoos u dhaca echogenicity ee SSMT, khafiifinta iyo jeexjeexa qayb ka mid ah oo ay ka buuxaan dareere Isku-xidhnaanta lumay ee bursal seedaha ama is-dhexgalka articular.

• Dhumucda buuxda Jeexitaanka SSMT jeexjeexid/jeexid katiinad qudhuntay. 2nd si ay u hor istaagto Hooked acromion, isticmaalka xad dhaafka ah ama dhaawac ba'an. 7-25% xanuunka garabka ee dadweynaha guud. Caafimaad ahaan: xanuun ku dhaca shaybaarada xannibaadda.
• Sawirka Dx: MSKUS waxay u fiican tahay MRI. Xaddidaad: Dx liidata ee cudurada shaybaarka. USDx furaha ah: kala goysyada xudunta u ah, kala goysyada anechoic (dareere ayaa buuxsamay), tendon hypoechoic, seedaha dib u gurashada, calaamad carjawda oo aan daboolin (bidix hoose, A: US B: MRI)
• MRI: furaha Dx: Jeexitaanka jeexjeexa oo ku fidsan dhammaan bisha SSMT, dib u gurasho leh hoos u dhac dufan ah oo SSMT ah iyo muruqa. Haddii dib-u-celinta ay tahay 12 saac ama ka weyn (sawirrada sare), waxa laga yaabaa inaan si hawl-gal ah loogu xidhin.

• Rotator Cuff (RTC) Tendinitis Calcific: badiyaa d/t kalsiyum HADD crystals. Dumarka da'da dhexe ayaa ugu badan ee ay dhibaatadu saameysey. Waxay u dhexeysaa helitaan sawir asymptomatic ah ilaa arthropathy burbur daran ama garabka Milwaukee (aan dhif ah)
• HADD waxay leedahay wejiyada 3-pathological: formation resting-resorption. Xanuun yar-ilaa-dhexdhexaad ah esp. marxaladda nasashada.
• sawirka: x-radiography: macdanta ovoid-ka isku midka ah ee gudaha RTCMT, m/c gudaha SSMT. MRI: ovoid/globular ayaa hoos u dhac ku yimid calaamada dhammaan heerarka garaaca wadnaha oo badanaa leh bararka ku wareegsan (bidix hoose)
• Rx: is-xalin ayaa dhacaya. Xaalado horumarsan: hammi hawleed iwm.

Sare ilaa Hore ee Shaybaarka (SLAP) Nabaro/Ilin

• Ilmo dhirbaaxo: FOOSH iyo tuurista ciyaaraha ama degenaansho la'aanta garabka ee joogtada ah aka degenaansho la'aanta garabka Multidirectional (20%). Nooca 1-9 ayaa jira laakiin M/C waa nooca 1-4
• Dhammaan 4-ta nooc ee shaybaarka sare ayaa saameeya ama w/oLHBMT jeexjeexa (fiiri sawirada). Caafimaad ahaan: xanuunka, xaddidaadda AROM ee leh tijaabooyinka cadaadiska firfircoon, sida caadiga ah natiijooyin aan gaar ahayn oo ku dayanaya RTCpathology
• Sawirku waa muhiim: sawirka ugu fiican waa MRI arthrography. Calaamadaha furaha: calaamada dareeraha toosan ee hyperintense ee gudaha labrum sare +/- ku fidaya LHBT sawir-qaadista dareeraha xasaasiga ah ee dufanka leh iyo FS T1 arthrogram. Sida ugu wanagsan ee loo arko jeexjeexyada wadnaha
• Rx: ilmo yar ayaa laga yaabaa inay bogsato, laakiin ilmada aan degganayn waxay u baahan tahay daryeel qalliin.
• Furaha DDx: kala duwanaanshiyaha anatomical sida Buford complex iyo shaybaar-hoosaadka

• jeexjeexa SLAP oo leh cyst is barbar socda (midig hoose)
• Kala duwanaanshiyaha caadiga ah DDx: shaybaar hoosaadka (bidix hoose) note: MR arthrography oo leh isbarbardhig hoos u dhigaya shaybaarka laakiin w/o ku sii fidaya xagga dambe ee LHBT

Arthritis garabka

• GHJ DJD: Caadi ahaan waxay la xiriirtaa sababta 2aad: dhaawac, xasillooni darro, AVN, CPPD, iwm Cudurka RTC ee la xidhiidha ayaa laga yaabaa inuu jiro. Sawirka; raajada raajada ayaa ku filan oo bixisa darajaynta/qorshaynta daryeelka. Natiijooyinka ugu waaweyn: cidhiidhi wadajir ah, osteophytosis esp. madaxa hoose ee dhexe ( falaarta orange), subchondral sclerosis/cysts. Inta badan waxaa la xusay guuritaanka madaxa sare d/t cudurka RTC.
• ACJ OA: caadiga ah iyo sida caadiga ah aasaasiga ah ee gabowga. Waxay soo bandhigtaa lumis ACJ iyo osteophytes. Osteophytes oo ku yaal dusha sare ee ACJ �keel osteophytes Bursitis-goboleedku waa sifo kale oo caafimaad oo ACJ arthrosis ah.
• Maareynta: inta badan waa muxaafid iyadoo ku xiran calaamadaha/calaamadaha bukaan socodka

• Rheumatoid Arthritis GHJ: RA waa cudur bararka nidaamka badan oo saameeya kala-goysyada badan ee ay ku daboolan yihiin synovium. GHJ RA waa caadi (m/c kala goysyada waaweyn ee jilbaha/garbaha RA). Kiliinik ahaan: xanuun, ROM xaddidan iyo xasillooni darro, muruq daciifnimo / lumis. Gacmaha, cagaha, iyo curcurada ayaa saameeya m/c. Sawirka: raajo-raajo ayaa daaha ka qaadaysa nabaad-guurka periarticular, luminta booska wadajirka ah ee wadajirka ah, lafo-jileeca-articular osteoporosis, subluxations, iyo bararka unugyada jilicsan. MRI waxay kaa caawin kartaa in la ogaado jeexjeexa RTC-da ee sida caadiga ah la xidhiidha iyo xasilloonida. Isbeddelada hore waxa lagu ogaan karaa MSKUS esp. Isticmaalka awoodda Doppler ee muujinaysa hyperemia/barar.
• Fiiro gaar ah: raajada garabka L oo muujinaysa burburka carjawda iyo luminta wadajirka summeedka, nabaad guurka badan, iyo luminta taageerada RTCM ee socdaalka madaxa sare, ST effusion ayaa jooga.
• Fiiro gaar ah: PDFS coronal iyo axial MRI jeexjeexyada GHJ RA oo tilmaamaya dheecaan wadajir ah oo barar ah, nabaad-guur/ barar, samaynta pannus synovial iyo jeexjeexa ay u badan tahay RTC m. Maareynta: Gudbinta Rheumatological iyo daawaynta farmashiyaha ee DMARD. Daryeelka hawlgalka asRTCM dayactirka. 10% bukaanada waa naafo d/t RA

• Neuropathic Osteoarthropathy aka Charcot garabka: d/t dhaawaca xididdada dhiigga iyo xididdada dhiigga. Sababo badan ayaa jira.M/c wuxuu ku soo baxaa dadka sokorowga lugaha dhexe. Garabka Charcot waa m/c gudaha Syringomyelia (25%), curyaannimada dhaawacyada, MS, iwm. Dx: bukaan-socod (50% xanuun / barar 50% burbur aan xanuun lahayn). Sawirku waa muhiim. Raajo-raajo ayaa ku filan kiisas si wanaagsan loo aasaasay, laakiin Dx hore waa mid adag. MRI waxaa laga yaabaa inay ku caawiso hore Dx iyo dhibaatooyinka dib u dhaca. Rad Dx: Garabka Charcot waa m/c loo soo bandhigay sida atrophic nooca arthropathy burburiyaha leh madaxa xumeral u muuqda sida haddii qaliin la gooyey oo ay la socdaan qashinka intra-articular, cufnaanta, kala-baxa, kala-baxa, iyo sifooyinka kale ee muhiimka ah

• Garabka Septic: garabku waa jilibka 3aad m/c jilibka soo socda. Bukaanada halista ugu jira: kuwa macaanka qaba, RA pts, immunocompromised, IV dadka isticmaala daroogada, kateetarka guryaha, iwm Staph. Aureus (> 50%) m/c.
• Caafimaad ahaan: kalagoysyada xanuunka iyo Dec. ROM, qandho 60% kaliya, toxemia, inc. ESR/CRP Dx: sawirka iyo hamiga/dhaqanka wadajirka ah. RadDx: raajo hore ayaa inta badan aan la arki karin marka laga reebo ST effusion/diyaaradaha dufanka leh oo mugdi ku jira, ballaarinta wadajirka ah. Ka dib 7-12 maalmood osteopenia oo bararsan, aboor-cunida/lafaha lafo-soo-baxa, burbur articular, cidhiidhi wadajir ah. Waxaa laga yaabaa inay u gudubto burbur daran oo wadajir ah iyo ankyloses. Dawooyinka hore ee Dx & IV waa muhiim xitaa dhaqanka ka hor. Waraabka shaqada iyo dheecaanka wadajirka ah xaaladaha qaarkood. Dhibaatooyinka waa suurtagal esp. haddii Rx dib loo dhigo. MSKUS oo leh rabitaan irbad ayaa laga yaabaa inay ku caawiso. Fiiro gaar ah: (sawirka sare) kala-goysyada aan dhaawac ahayn oo balaadhinta madaxa ka-soo-baxa d/t septic A dx: irbada hamiga Staph. Aures

Osteonecrosis ischemic

• Osteonecrosis ischemic ee madaxa xumeral waxaa laga yaabaa inay ku dhacdo d/t trauma (Neer four-part Fx), Steroids, Lupus, Sickle cell, Alcoholism, Sonkorowga, iyo xaalado kale oo badan. Sawirku waa muhiim: MRI waxay ogaataa isbeddelada ugu horreeya sida bararka gudaha gudaha. Astaamaha raajada ayaa soo daahay, oo loo soo bandhigay sida burburka lafta-hoosaadka oo leh sclerosis �snow cap� calaamad, jajab, iyo DJD daran oo sii socda.
• Maareynta: gudbinta lafaha, niyad-jabka asaasiga ah ee kiisaska hore, hemiarthroplasty ee dhexdhexaad ah iyo wadarta arthroplasty ee xaaladaha daran.

Neoplasms garabka

• Dadka qaangaarka ah> 40, lafaha Mets d/t sambabada, naaska, unugyada kelyaha, tayroodh CA & prostate waa sababaha m/c. Kiliinik ahaan: waxa laga yaabaa in ay ku ekaato xanuunka u eg RTC/isbeddellada wadajirka ah. Waa in si taxadar leh loo qiimeeyaa. Furaha Dx: Hx, PE iyo Imaging esp.in pts oo leh aasaas la yaqaan
• sawirka: Raajooyinka 1st, MRI waxay ku caawin kartaa, Tc99 scintigraphy lafaha waxay caawisaa in la ogaado cudurka gobolka iyo kan fog. Astaamaha raajada: isbeddellada lytic ee wax burburiya sida caadiga ah prox humerus(dhuuxa cas) oo leh ama w/o jidka Fx. DDx: Mets, MM, lymphoma
• Kiliinik ahaan: xanuunka habeenkii, xanuunka nasashada, iwm. Tijaabada shaybaadhka: aan faa'iido lahayn, xaaladaha daran hypercalcemia ayaa laga yaabaa in la ogaado.

• Neoplasms lafaha aasaasiga ah ee malignantiga ah (garabka) Dadka waaweyn: M. Myeloma ama Plasmacytoma Keli ah, Chondrosarcoma waxa laga yaabaa inay isu beddesho enchondroma iyo qaar kale. Carruurta/Dhalinyarada: OSA vs. Ewing�s
• Neoplasms lafaha aasaasiga ah ee aan fiicneyn (garabka). Dadka waaweyn: Enchondroma (bukaanada 20-30s) GCT. Carruurta: Cyst lafo fudud (Unicameral Cyst), Osteochondroma, Aneurysmal Bone Cyst, Chondroblastoma (naadir)
• Sawirka: raajada 1-aad
• MRI waxay lagama maarmaan u tahay Dx. Gaar ahaan xaaladaha neoplasms malignant aasaasiga ah Qiimee xadka, soo galitaanka unugyada jilicsan, qorshaynta ka hor qalliinka, diyaarinta, iwm.