I-Wrist / Hand Arthritis kunye ne-Trauma: I-Diagnostic Imaging | El Paso, TX.

Isandla kunye noKonzakala kwesandla

• Ububanzi beRadiyo kunye ne-Ulnar Fractures (Iikholamu, iiSmith, iiBarton, iiChauffeur's, iDiePunch) -zintsonkothile nge-50% ye-ulnar styloid Fx, indlela ye-TFC, ukuhanjiswa kwe-DRUJ, ukusasazeka kwe-lig dissociation, i-lunate / perilunate dislocation)
• Amathambo eCarpal Ukophuka kunye nokususwa (i-scaphoid, i-triquetrum, i-hamate Fx kunye neLunate / i-perilunate dislocation)
• Ukudibanisa iziLigaments (ukuhlukana kwe-Scapholunate, ukungazinzi kwe-Lunotriquetral)
• Ukuqhekeka kweMetacarpal kunye nePhalangeal (iBennett, uRolando, umgcini weMidlaloFx / iSenerator lesion, iBoxer Fx)
• Lwezonyango ukwenzakala esihlahleni (intonga eluhlaza iFx, iTorus Fx, iBowing / iplastiki yokukhubazeka, ukulimala kweSalter-Harris)
• Kuzo zonke iziganeko, ukuthunyelwa kwe-orthopedic ukuhanjiswa kweenkonzo kuyadingeka

• Iiflethi fx: m / cd / t FOOSH + ukuvakalisa. m / c kwi -OSOS / abadala abafazi. Kuqhelekile kumadoda kwaye xa kwenzeka isidingo se-DEXA ukuphepha ukunyuka kwe-Fx njl. Ngokuqhelekileyo i-50% -cases ibonisa i-Ulna iplothi (US) Fx.
• Iingxaki: i-fork dek deform, i-CRPS, i-DJD, i-nervled entrapment.
• Ukucinga: i-x-rad yanele, i-CT ibe yinkimbinkimbi ye-Fx, i-MRI inceda ngeentlungu ze-ligament kunye ne-TFC.
• I-Rx: ukuba i-extra-articular kunye ne-5-mm distal radius shortening kunye ne-5-degree-dorsal angulation ukunciphisa ukuvalwa + kokuphosa kwanele. I-ORIF kwiimeko ezinzima.
• �Umfanekiso we-Dx: i-distal rad impaction / shortening, i-dorsal angulation ye-distal fragment, uhlolisise ngononophelo ukuba i-intra-articular extension, 50% US Fx

• Smith Fx: Goyrand kuncwadi lwesiFrentshi. Kuthathwa njengeeColles eziguquliweyo, kungenjalo ziphantse zifane, oko kukuthi, i-85% eyongezelelweyo, i-50% US Fx, i-OSP / abafazi abadala, i-pts-high-energy trauma. Umahluko: indlelaFOOSHenesihlahla esigotshweyo ngoko m. Ukunqaba rhoqo.
• Amanqanaba okucinga: (jonga ii-Colls Fx) C
• Iingxaki: ezifana ne-Colles Fx
• I-Rad Dx: I-85% eyongezelelweyo kunye ne-volar (yangaphakathi) ukukhutshulwa kweqhekeza elikude, ukunciphisa i-radial. Ngenyameko uhlolisise ukuphulwa kobuqhetseba obushushu obunokuthiwa nguSmith uhlobo 2 okanye u-Barton Fx (olandelayo)
• I-Rx: indlela efana neyokwahlula.

• Barton fx: I-FOOSH, ukuchithwa kwerhasi ejikelezayo efana ne-Colles kodwa umgca weFx uqhubeka ukusuka kumbindi we-radial kwi-joint radiocarpal okubangelwa isalathisi / ukuchithwa kwe-carpus.
• iMifanekiso: I-1 yesine x-radiography rhoqo i-CTto ihlola isandiso se-Fx intra-articular kunye nokucwangcisa ukusebenza
• Rad Dx: I-radial distal iFx isuka kwi-rorsal ibe yintlangano ye-radiocarpal kunye neqondo eliguquguqukayo lokufuduka, isalathisi esiphezulu se-carpus
• Ukuba umgca weFx uqhubeka ukusuka kwimbonakalo ye-volar kwisigxina somnxeba ogama linguReversed Barton aka Uhlobo lwe-Smith 2 (ngasentla umfanekiso)
• Iingxaki: efana nayo yonke indawo engafaniyo yeFx
• Rx: sebenza kunye ne-ORIF

• Umqhubi we-driver / u-Ff aka aka Hutchinson Fx: I-Fx ye-intra-articular ye-pendial pendial. Igama livela kwixesha apho imoto yafuneka iqaliswe ngayo ngesandla ikhonkco ekwazi ukutshaya i-dorsiflection kunye ne-radial deviation.
• Ukucingela: x-radiography iyanele. I-CT ingaba luncedo xa iFx ingabonakali ngokubonakalayo ngama-ray-ray.
• Iingxaki: engekho imibutho, i-malunion, i-DJD, i-scaplunate dissociation, intsuku / i-perilunate dislocation
• I-Rx: esebenzisana ne-cutter lagscrewin zonke iimeko d / t intra-intetho

• I-Die-Punch Fx: impembelelo Fx ngethambo leLunate kwi-distal articularLunate fossa yeRadius. IntraarticularFx. Ifumana igama layo kubuchule bokubumba (ukuchukumisa) umngxuma kumatshini wokwenza izinto "die-punch."FOOSH ukulimala.
• Ukucinga: I-1st inyathelo x-ray, inokuba yinto echanekileyo yed / t edibeneyo ye-Lunate fossa ngoko ukukhangela kwe-CT kukufundisa kakhulu.
• I-Rad Dx: igalelo le-fossa yesigxina se-fos extension nge-intra-articular extension Fx. Oku kungaboniswa njengeFxarticular Fx edityanisiweyo ye-Radiyous Distal.
• I-Rx: i-d / t ye-intra-articular Fx

Yakha ii-arcs zikaGilula xa uhlola ukulimala kwe-carpal. Isinyathelo esibalulekileyo esifanelekileyo ukukhusela utshintsho olungabonakaliyo kwimeko yokulungelelaniswa kweemoto kunye nokuqhubeka komzimba

• Ithambo leSaphofu Fx: m / c Fx ithambo le-carpal. I-D / i-tFOOSH isalathiswa ngokusasazekayo. Indawo ye-Fx ibaluleke kakhulu ukuxela izilwanyana: Indawo yesikhumba-m / c (70%). Ngamana unokuba ne-70-100% ithuba le-AVN. I-poximal pole Fx: 20-30% eneengozi enkulu yokungabambisani. I-Distal pole-10% ibonisa ukugqithisa okungcono. I-Pole ye-Distle yeFle im m / c kubantwana. Uphawu olubalulekileyo lweklinikhi; intlungu kwi-snuffbox.
• Ukwenza umfanekiso: Inyathelo lokuqala-x-radiography kodwa i-1-15% yaphoswa d/t yobugqi Fx. Iimbono ezizodwa ziyafuneka. Ngaloo ndlela i-MRI yeyona nto ibuhlungu kwaye ichanekileyo kwi-Fx yokuqala yemimoya. I-Bone scintigraphy ine-20 / 98% ingcaciso kunye novakalelo esp. 100-2 iintsuku emva kokuqala. Key rad. I-Dx: Umgca we-Fx ukuba uyabonakala, ukufuduka kunye nokufihla i-scaphoid (i-navicular) ye-fat pad, uhlolisise i-scapholunate dissociation. Ukuba i-proximal bone ibonakala i-sclerotic-AVN yenzekile. I-MRI: iphantsi kwi-T3 kunye ne-T1 / STIR / FSPD d/t bone edema, umgca we-signalFx ophantsi unokuqatshelwa.
• I-Rx: I-Spica cast ifanele ifakwe xa ikhunjulwa ngonyango nakwii-x / ray iziphumo. I-WaistFx-cast for 3-mo nge prox pole 5-mo immobilization. I-ORIF okanye i-pinning nge-cutter nge-Herbert screw.

I-Scapholunate Ligaments Dissociation

• Isihlahla se-SNAC: i-scaphoid non-union iqhubela phambili ukuwa. Ngokuqhelekileyo i-d/t engeyiyo yomanyano kunye nokwahlukana kwemigqa ye-scapholunate (SLL) kunye ne-radiocarpal eqhubekayo kunye ne-intercarpalDJD. Iqhekeza le-scaphoid elilingeneyo lincanyathiselwe kwi-Lunate kunye nophawu lwe-distal oluzahlulayo kunye nolujikelezayo �isiginali yeringi � kwi-x-reyi.
• Isandla se-SNAC sinokubangelwa kwi-DISI
• I-Rx: i-DJD eqhubekayo inokukhokelela kwi-arthrodesis enekona ezine

• Ukuwa kwe-Scapholunate ephezulu (i-SLAC isikhonkwane): I-SLLdissociation ne-intercarpal eqhubekayo kunye ne-radiocarpal DJD kunye ne-volar okanye i-dorsal carpal displacement (DISI & VISI). Izizathu: ukuxhwaleka, i-CPPD, i-DJD, isifo se-Kienboch (i-AVN ye-Lunate), i-Preiserdisease (AVN ye-Scaphoid).
• Ukuhlukana kwe-SLL kuya kukhokelela kwiDorsal okanye i-VolarIntercarlate i-Intercarpal Segmental Instability (i-DISIor VISI).
• Rad Dx: Dx. I-ray-ray ibonisa ukukhwabanisa okanye i-volar angulation ye-Lunate ngokunyuka okanye ukunciphisa i-scapholunate angle kwi-viewal lateral. Ngombono wangaphambili: uphawu lweTerry Thomas okanye ukwandisa umgama we-scandlunate 3-4-mm njengomda ophezulu oqhelekileyo.
• I-MRI inokunceda ngovavanyo lwe-ligament kunye nocwangciso lwangaphambi kotyando
• I-Rx: ngokuqhelekileyo isebenzisana ne-DJD ekupheleni. I-arthrodesis yekota

• Triquetrum Fx: 2nd m/c carpal ithambo Fx. Umba we-M/C womqolo ucatshukiswa yi-Dorsal radiocarpal ligament eqinile. Unobangela: FOOSH.
• Ukwenza umfanekiso: Uthotho lwesihlahla se-x-radiography lwanele. Eyona nto ityhilwe kumbono osecaleni njengeqhekeza lethambo elisecaleni elikufuphi nedorsum yeTriquetrum. I-CT inokunceda ukuba i-radiographically equivocal.
• I-Rx: ukunakekelwa okulondolozayo
• Iingxaki: ezinqabileyo, zingaphikelela njengentlungu kwi-back of the wrist

• umkhala yeHamate Fx: i-m/c yenzeka kwimidlalo yokubheja (iqakamba, ibaseball, ihoki, impembelelo yeklabhu yegalufa, njl. njl.) I-2% ye-carpusFx.
• Ukucinga: x-radiography ingahle ikwazi ukufumana iFx ngaphandle kokuba "i-viewpal tunnel view" isetyenziswe. I-CT inokunceda ukuba i-x-ray ayibuyiseli.
• Klinikhi: intlungu, uvavanyo oluhle lokutsala, ubuthathaka, ukubamba okubuhlungu. nzulu ulnar n. Isebe linokuchaphazeleka ngaphakathi komjelo waseGuyon.
• I-Rx: ngokuqhelekileyo ayiyiyo imisebenzi, kodwa umanyano ongapheliyo unokufuna ukulungiswa.
• I-DDx: iHatate yomhlaba

• �Lunate vs. I-lunate i-m / c ichithe ithambo le-carpal. Ukulimala ngokubanzi kweerpal. Nangona kunjalo, ngokusoloko ephosiwe!
• Ivela nge-FOOSH kunye nesilanga esongeziweyo kwaye i-ulnar iguqukile. iMifanekiso: 1st inyathelo x-ray. Ifunrewarding okanye ifuna ukuphononongwa koluhlungu kunzima.
• I-Rad DDx engundoqo: I-DDx Lunate ukusuka kwi-perilunate dislocation. Ukususwa kwenyanga: inyanga iphulukene noqhagamshelwano lwayo neradiyasi ekude �ichithelwe i-teacup� ecaleni. I-Perilunate dislocation: I-Lunate igcina uqhagamshelwano lwayo kunye ne-distal radius nangona i-Capitatedorsally dislocated. Ukushenxiswa kweLunate kunceda kwakhona ukuchonga uphawu lwe �pie� d/t Lunate olugqithe iCapitate
• I-Rx: ukunciphisa uxinzelelo kunye nokulungiswa komsebenzi wegigaments eziqhekekileyo

Ukulimala kweMetacarpal kunye nePhalangeal

• Bennett Fx: intra-articular kodwa noncomminuted impembelelo-uhlobo lwe-Fx yesiseko se-1st MC ithambo lesithupha. I-X-radiography yanele.
• I-Rad Dx: isiqwenga sesigxina sesithambo kwisimo se-1st MCbase, ngokuqhelekileyo nge-subluxation ye-radial aspect of the 1st MC
• Iingxaki: DJD, non-union, njl.
• I-Rx: ithambekele ekuzinzileyo / engekho imibutho efuna ukunakekelwa kwabasebenzi
• Rolando Fx: aka wamisa uBennett kunye no-Y okanye uT-configuration. Ukulimala okungakumbi. Kuyinto engaqinisekanga idinga ukunakekelwa kokusebenza

• Umlindi wesigcina: ngokwesiko ichazwa njengokukrazuka okungapheliyo kwe-ulnar (medial) collateral ligament kwi-1stMCP ngesiNgesi Abagcini beMidlalo 'abenza ukujija intamo/ukubulala inyamazana encinci. Ukwenzakala okumanyumnyezi kusenokubizwa ngokuba ngubhontsi kaSkier. Le nzakala ingaba yi-ligamentous w / oa fracture kunye nokulimala kwe-avulsion kwi-1st proximal phalanx base.
• Ingxaki: Isilonda esinezintlu okanye ukufuduka kwe-ligament ephukile kwi-Adductor i-pollicis muscle engakwazi ukuphilisa w / o ukulungiswa kocwangco. I-MRI Dx iyadingeka.
• Gwema iimbono zoxinzelelo lwezontathu ezingabangela iStenerlesion
• Ukucinga: i-x-radiography elandelwa yi-MRI ukuya kwi-Dx Stenerlesion. I-MSK US ingasetyenziswa ukuba i-MRI ayifumaneki.
• I-Stener lesion kwi-MRI & MSUS: i-ulnar collateral stump ingaphezulu kakhulu kwi-Adductor pollicis aponeurosis kwaye ibonakala njengophawu oluphantsi lwe-mass-like stump eyenza into ebizwa ngokuba yi-"yo-yo kwisignali yentambo" ibike zombini kwi-MRI kunye ne-MSK US.
• I-Rx: ihlala isebenza

• Boxer Fx: m/c MC Fx. I-extra-articular ngokuqhelekileyo i-non-comminuted okanye i-minimal comminuted Fx nge-m / c ye-5 kwaye ngamanye amaxesha i-4th MCneck-head junction (ngamanye amaxesha ngokusebenzisa i-shaft) ebangela ukuba i-volar head angulation. Inkqubo: impembelelo ethe ngqo njengakwinqindi elibhinqiweyo elibetha umhlaba oqinileyo (umzekelo, amathambo obuso/ukubetha eludongeni) kungoko i-95% kumadoda aselula.
• iMifanekiso: Uchungechunge lwesandla lwe-x-rayography lwanele
• Rad Dx: Umgca weFx ojikelezayo okanye oblique nge-MCneck nge-volar heading angulation. Ukuphonononga umlinganiselo wokufuduka, ukugxeka ukubika.
• Rx: ngokuqhelekileyo ayisebenzi kwaye ihonjiswe ngomjelo wengalo omfutshane kunye namasuntswana ajijekileyo. (www.aafp.org/afp/2009/0101/p16.html)
• QAPHELA Ukuba kwa lo matshini wophula i-2ndand 3d MC kwindawo efanayo ye-anatomic, unokufuna ukhathalelo lomsebenzi.

• Isandla sePhalangeal Fx: m / c skeleton Fx (10% yazo zonke iiFx). Ukulimala kwezemidlalo kunye nezoshishino kubusa
• iMifanekiso: x-radiographie nge-series series okanye ukubukwa kwe-PA / lateral finger kuyanele
• Rad Dx: ukuba i-prox phalanx Fx, iqhekeza le-distal lijikijelwe nge-angle nge-prox fragment dorsally. I-Distal phalanx inokujongwa ngasemva. Uqwalaselo oluphambili: ukwenzakala kwebhedi yeenzipho, ethathela ingqalelo iFx evulekileyo enobungozi bosulelo.
• Rx: ukuba <10-degree angulation-buddy-taping nge motion rehab. I-CRPP vs. ORIF inokuqwalaselwa kwiimeko ezinzima-Ukudluliselwa kwe-Orthopedic hand surgeon
• Ingxaki: ukulahlekelwa kwesindululo, i-necrosis, isifo
• Ngokulimala okongeziweyo okuqhelekileyo: I-PIP yi-m / c edibeneyo edibeneyo. Umnwe weMullet (i-baseball), umnwe weJersey kunye nolunye ukonzakala lubhekisa ku:
• www.aafp.org/afp/2012/0415/p805.html

 

 

• Felon: usulelo lweseptic lwentlama yencam yomnwe ngokuqhelekileyo ngeStaph.Aureus. Izizathu: ukuhlatywa kwenaliti (isifo seswekile), i-paronychia, i-nail splinters, njl njl. m / c kwisalathisi kunye nesithupha, ebonisa intlungu, ukudumba, njl.
• I-D / t ethile ye-pulp anatomy theinfection> ukudumba kukhokelela kwintlama yegazi lesifo-uxinzelelo kunye necrosis.
• I-Rx: esebenzayo kunye ne-incision distal kwi-DIP, ukunkcenkceshela / ukuxiliswa

Ukulimala kwenkosi

• Fx engapheliyo: IGreenstick Fx, iTorus (iBuckle) iFx, ukugoba (iPlastiki) ukukhubazeka / iFx. D / t FOSHe umz. yawa kwinqanaba lenkawu. m / c ichaphazela <iminyaka eli-10 ubudala.
• Ukujonga ukujonga ukujonga: iqondo lokuthungula / ukufuduka, ukulimala kwepiphyseal plate plate (udidi lweSalter-Harris)
• I-Rx: ngokuqhelekileyo engekho ukusebenza (ukunciphisa nokuvalwa).

• I-Radioulnar Joint Distribution (DRUJ) Ukuzimela-ukwenzakala okuqhelekileyo okulandela umonzakalo njengakwiFOOSHngokwandiswa okukhulu kwesihlahla kunye nokujikeleza kunye nokuphazamiseka kweeligaments zeDRUJ kunye ne-TFCcomplex. Ukuvuswa kwe-ulnar styloid kunye ne-dorsal okanye i-volar displacement ye-distal ulnar kufuneka iqatshelwe.
• Amanqanaba okucinga: ii-ray-ray ekuqaleni, i-MRI inokuthi ichonge i-ligaments kunye nomonakalo we-TFC, i-MSKUScan inokunceda ngemigqabhagqabha.
• Qaphela: i-DRUJ volar engasese (umfanekiso ophezulu) kunye nokugqithisa (umfanekiso ophantsi) ukutshintshwa.

Isandla kunye neArthritis yesandla

• I-Wrist DJD-ngokuqhelekileyo iyisibini kwi-trauma, i-scapholunate dissociation, i-SLAC, i-SNAC wrist, i-CPPD, i-Keinboch okanye i-Preiser Disease kunye nabanye.
• Ingakhokelela ekulahlekeni okusebenzayo
• Ukucinga: ngokuqhelekileyo kubonisa njenge-radiocarpal JSL, i-subchondral sclerosis, i-osteophytosis, i-cysts subcortical, kunye nezidumbu ezivulekileyo. Ukongezwa ngokuqhelekileyo kunciphisa ukuchithwa kwe-intercarpal kwaye ngokukodwa i-Tri-scaphe idibene.
• I-MRI ingaba luncedo ekuqaliseni kwangaphambili ukuxhatshazwa kwe-scapholunate, i-AVN ye-Lunate / Navicular.
• I-Rx: i-conservative vs. operative.

• DJD Isandla: Kuqheleke kakhulu. Eyona nyani iphambili i-OA. I-MCP-ayikaze ichaphazele w / o IDIP kunye nePIP
• Ukuba iyodwa i-MCP OA iqaphele i-CPPD kunye neHemochromatosis (ii-osteophytes ezinjenge-Hook)
• Klinikhi:
• Phakathi kwamabhinqa
• Iintlungu ezingaqhelekanga ngaphandle kwe-1st CMC OA
• I-DIPs-i-Heberden nodes, iipipi ze-PIPs-Bouchard
• I-Erosive OA (ngamanye amaxesha ibizwa ngokuba yi-"inflammatory OA�)
• ISpectrum ye-OA kodwa ivelisa ukhukuliseko olusembindini olusondeleyo kwii-DIPs kunye nee-PIPs ezikhokelela ngenkangeleko �ikhokoni. Akukho ukudumba kwenkqubo (akukho CRP, RF, Anti-CCP Ab) ngokuqhelekileyo kubantu abaneminyaka ephakathi / abadala, njenge-OA yesandla, ihlala ibonwa kwiintsapho

Irheumatoid arthritis

• I-Rheumatoid Arthritis (RA) -Isifo esingapheliyo sokuvuvukala kwenkqubo ye-etiology engaziwayo, ekujoliswe kuyo kwi-synovial joints, i-tendon kunye nokubandakanyeka kwenkqubo eninzi (imiphunga, i-CVS, i-Ocular, i-Skin, njl.) I-Pathology: Tcell> Macrophage / APC>inkqubo ye-mediatedautoimmune ebangela ukubunjwa kwe-pannus kunye nokutshatyalaliswa ngokuthe ngcembe kwe-ST , intlala, ithambo,� nezinye izihlunu. 3% AbasetyhiniVS.1% Amadoda. Izinto ezibangela imekobume: usulelo, umonzakalo, ukutshaya, kunye nezinye kumntu osesichengeni sofuzo. I-20-30% inokukhubazeka emva kweminyaka eyi-10.
• I-Dx: iiklinikhi, iilebhu, imaging.Symmetrical Polyarthritis esp. kwi-MCP, izihlahla (2 & 3RD MCP)