I-Elbow: Indlela yokuCinga ukuCinga El Paso, TX.

I-Elbow Trauma

• Kubantu abadala: Intloko yeFx yi-m / c (i-33%) kunye ne-akhawunti ye-1.5-4% yazo zonke izivuno. I-Etiology: i-FOOSH ene-forearm engamanga. Ukulimala okuhlangeneyo EssexLoprestiFx kunye nokukrazula kwe-membrane kunye nokuchithwa kwe-Distal Radio-Ulnar Joint (DRUJ)
• Iintlanga ezinzima: ye-Radial head Fx, i-elbow dislocation kunye nenkqubo yeCoronoid Fx (ngokuphindaphindiwe yi-Brachialis M)
• Ukucinga: I-1st inyathelo x-radiographie nge-elbow series, i-CT ukuskena inokunceda kwiimeko ezinzima, i-MRIif inxeba yokulimala.
• Kubantwana: Supracondylar Fx ye-distal humerus yenza i-90% ye-acute trauma. Ihlala i-d / t i-trauma yengozi kunye ne-FOOSH kunye ne-elbow eyandisiweyo, kunqabile <5% kunye ne-elbow eguquguqukayo. Uninzi lweSupracondylar Fx lwenzeka kubantwana <10 yo Madoda>Abasetyhini. Iingxaki: i-malunion kwi-cubitus varus aka Gunstock deformity, ukulimala kwe-vascular kunye ne-acute ischemic compartment syndrome kunye ne-Volkmann contracture.
• Ukufanekisa: I-1st inyathelo x-i-radiografi inokwanela. I-CT isetyenziswe ngezihlandlo ezinzima.

 

 

• Intloko yeRadial (RH) I-Fx: Udidi lweMason lunceda ukucacisa ubunzima bezinto eziyinkimbinkimbi kunye nendlela yokonyango
• Uhlobo lwe-1- undisplaced yi-m / c kunye nozinzo eziqulethwe yimigaments. Kwi-radiographs ingaba yimfihlelo kwaye ukuphononongwa kweengxaki ezingavumelekanga zokuhlawula amaninzi kubaluleke kakhulu kwaye ngokukhawuleza kukuphela kwenkcazo yokuxilonga
• Uhlobo lwe-2- lokufuduswa nge-2-mm okanye> ngebhlokhi ejikelezayo
• Chwetheza u-3- odlulisiweyo> iziqwenga ezi-2-3 kunye
• Uhlobo lweX4 luboniswa nge-RH fx, i-posterior elbow dislocation kunye namaxesha athile Inkqubo yeCoronoid iphuka ngokuphindaphindiweyo d / t i-Brachialis M ukuvuswa
• I-Rx: Udidi lwe-1 olulawulwa ngokungasebenziyo ngokunyanzeliswa kunye nokuvuselela ukunyakaza. Uhlobo 2- ORIF ukuba ibhloko ejikelezayo. Uhlobo lwe-3 kunye ne-4, i-ORIF kunye ne-RH resection okanye i-RH arthroplasty

 

• Qaphela ngokungaqhelekanga iphedi yamafutha yangaphambili (utolo oluorenji) kunye nokuvela kwephedi yamafutha angasemva (utolo oluluhlaza) edla ngokuba nzulu kwi-olecranon fossa kwaye ayibonwa ngaphandle kokuba i-acute hemarthrosis okanye enye i-effusiondevelopsIimpawu zephedi ezinamafutha zezona zizalathisi ezithembekileyo ze-intra-articular. ibhokhwe Fx

 

 

• Uhlobo lweMason 1 RH Fx ingaba v. ezifihlakeleyo kwaye ziphosakele. Uphando lweRadiographic kufuneka lubandakanye uvandlakanyo olusondeleyo lweempawu zephedi ezinamafutha. Qaphela i-fat pad displacement yangaphambili aka uphawu lwe-Sail kunye nobukho be-post fat pad d/t acute bleed

 

 

 

• I-Monteggia i-fracture-dislocation: I-prox 1 / 3ulnar shaft Fx. kunye nokuchithwa kwe-PRUJ (intloko ye-radial). Ukulimala kweFOOSH. Abantwana4-12 yo Abangaphantsi kwabantu abadala.
• I-X-rays ityhila ngokukhawuleza i-ulnar Fx, kodwa ukuchithwa kwentloko ye-radial kunokuba bubuqili kwaye ngamanye amaxesha kuphoswe. Oku kukwenzakala kakhulu okukhokelela ekukhubazekeni kwe-elbow ukuba i-Dx ilibazisekile iiveki ze-2-3 okanye ishiywe ingaphathwanga. Ii-X-reyi zikholisa ukwanela:Rx: ukuphosa vs.

 

 

 

• I-Supracondylar Fx: lo yi-M / C elbow Fx kubantwana.
• Ngokukodwa, ii-non-displaced types 1 (phezulu kunene) kunzima ukuDx. Ukungaqhelekanga "kweenqatha ezinamafutha" kunye nomgca we-hummeral line kunye ne-radiocapitella line-disturbance ngokuqhelekileyo inokuthenjwa
• Uhlobo lwe-3 lunomngcipheko ophezulu kakhulu we-Volkmann contracture (i-vascular ischemic-necrosis ye-armral forearm muscle compartment).

 

 

 

Izikhalazo ze-Elbow kumdlali omncinci

 

• Epicondyle Fx: ukulimala komntwana ngokuqhelekileyo, malunga ne - 10% .Ukuvuswa kweFx kunye ne-MUCL yezinyembezi. I-epicondyle ephakathi ngu m / c Fx. I-FOOSH yindlela m / c. Ukuba ukunyuswa kweminye imizi okanye ukungabikho emsebenzini kungaphathwa ngokukhangela i-esp. kwiengalo ezingabonakaliyo. Ukuba abafudukiweyo njengale ndawo, bafuna i-ORIF.
• I-Medium epicondyle avulsive Fx kwi-pitcher encinci ye-baseball yenziwa "ingqiniba yeligi encinci" kwi-60sand ngoku kufuneka iphetshwe ukunqanda ukudideka.
• OCD yeCapitellum yinto eqhelekileyo yokulimala kwezemidlalo eyenziwa ngokuphindaphindiweyo ukunyanzeliswa / ukuguqa. I-OCD kufuneka ibe yi-DDx kwisifo sikaPanner okanye i-osteochondritis edla ngokunikezelwa kwizigulana ezincinci.
• Ubunzima bokuxilongwa bunokuvela kwi-multipleapophysis malunga nengqiniba (jonga i-CRITOE)
• Ukucinga: Isinyathelo se-1: i-x-rays elandelwa yi-MRI kunye ne-MRarthrogramme ukuba ibonisiwe.
• I-CT inokunceda ngovavanyo olunzima lokulimala. I-MRI kunye ne-MSKUS inokunceda ngokwenzakala kwe-ligament.

Elbow Arthritis

 

• DJD ye-elbow akuqhelekanga kwaye ngokuqhelekileyo i-2nd ku-trauma, umsebenzi, i-CPPD, i-OCD yeCapitellum okanye enye imfuyo. Iikliniki: intlungu, ukunciphisa i-ROM esp. kwisandla esiphezulu, ukungonakaliswa kwe-ADL. Ukulahlekelwa kwebala lokugcina kunye nokwandiswa. I-50% yakha u-Ulnar compress neuropathy. I-Rx: i-conservative, i-arthroscopic disridement / osteophytes ukususwa, ukukhululwa kwe-capsular. Kwizigulane ezindala kunye nezigulane ezisebenzayo I-Total Elbow Arthroplasty (TEA) ingasetyenziswa
• Ukucingela: x-radiography iyanele, i-CT inceda ngokucwangcisa kwangaphambili

 

 

• Arthritis evuthayo: RA weelbow rhoqo (20-50%) kunye ne-syovitis etshabalalisayo, i-pannus, ithambo / i-cartilage, kunye nokutshatyalaliswa kwe-ligamentous / laxity. Klinikhi: iqala emva kokuqala kweempawu zezandla kunye, ukuvuvukala kwe-symmetrical, intlungu, ukunciphisa i-ROM, i-flexion contracture. Ubukho be-rheumatoid nodules bunokuqatshelwa ecaleni kwe-olecranon kunye ne-forearm yangasemva. I-Rx: I-DMARD, ukulungiswa kwee-tendon zokusebenza.
• Ukwenza umfanekiso: i-x-radiography ene-effusion yokuqala engangqale (i-fat pads), kamva: ukhukuliseko, i-symmetric JSL, i-osteopenia. I-MSK US inceda kwangoko iDx. I-MRI ibonisa i-synovitis; i-bone edema ihambelana nokufunyaniswa kwangaphambili kwe-x-reyi, ukuphuculwa kwe-synovial kwi-FS T1 + C.
• Gouty Arthritis: inokuthi ichaphazele ingqiniba kodwa ibe ngaphantsi kweyona ndawo isezantsi. I-Olecranon bursitis ebangela �uphawu lokuphuma kwelanga� kwi-x-reyi enokhukuliseko lwamathambo okanye olune-w/o. Ulangazelelo kunye ne-polarized microscopy eveza iikristale ezimile njengenaliti ngokungalunganga zemonosodium urate. Rx: colchicine, ezinye iiyeza.
• I-Septic Arthritis: qwalasela kubantu abanesifo seswekile, abasebenzisi beziyobisi be-IV, i-RA efanayo, izigulane ezine-TB esebenzayo, i-gonococcal kubantu abadala abancinci. Ngokweklinikhi ibonakalisa njenge-monoarthritis eneempawu okanye i-w/o yomgaqo-siseko. X-reyi: ukufunyaniswa kakubi kumanqanaba okuqala. I-US ingabonisa ukuchithwa kunye ne-Doppler.MRI ephezulu: i-effusion, i-osseous edema. I-Bone scintigraphy inokunceda ngokunjalo. IiLabs: CBC, ESR, CRP. Uxilongo lwe-arthrocentesis ene-gram staining kunye nenkcubeko ibalulekile. Rx: Amayeza akhawulezayo e-IV

 

 

• I-Juvenile Idiopathic Arthritis (JIA) kuqwalaselwa isifo esingapheliyo se-M / C ebuntwaneni kunye ne-IBD eyandulelayo. I-Dx yiklinikhi kunye nemifanekiso: Iikhrayitheriya: Intlungu edibeneyo kunye nokuvuvukala kumntwana 0-16-iminyaka kwii-6-iiveki okanye ngaphezulu. Iifom ezininzi zikhona�M/C pauciarticular(oligoarticular) 40%, F>M, ezinxulumene nokubandakanyeka kwe-ocular (iridocyclitis) kunye nobumfama obunokubakho. Iifom zePolyarticular kunye neNkqubo.
• Ingqiniba isoloko ichaphazeleka kunye nedolo, izihlahla, � nezandla, ngakumbi kwi polyarticular dz.
• Iilebhu: ESR / CRP RF-VE kwimeko ezininzi
• Ukucinga: iimpawu zangaphambili ze-x-ray aziyiyo. Kamva: ukuguguleka komzimba, ukutshatyalaliswa kwe-cartilage ehlangeneyo, ukugqithisa kwe-epiphyses ye-articular, ukuvalwa kwangaphambili kwe-physis. Iimpawu ezichithwe: I-DJD ye-2nd, i-ankyloses ehlangeneyo.DDx: i-hemophilic hythropathy. Iirejimografi zentsholongwane zibalulekile.
• I-Rx: i-DMARD, ukunakekelwa okugcinayo

Ezahlukeneyo pathologies

 

• Inkqubo ye Supracondylar: 2% yabemi. Kucaciswe nguSir JohnStruthers kwi-1854. Ibhendi yeFibs (iLigament yeStruthers) inokukhokelela ekunyanzelweni kweMedian N. DDx ukusukaOsteochondroma ngokuqhelekileyo ikhupha ngaphandle
• Isiseko se-synovial chondrometaplasia(Reichel Syndrome): i-abnormalmetaplasia yeeseli ze-synovial ezichitha i-cartilage kwi-joint enokubangela ukuba i-DJD, i-extrinsic bone erosion, i-synovitis, i-nerve compressions njl. Isuswe ngokusebenza. Ukucinga: imizimba emininzi ekhululekileyo ye-osseocartilaginous enobungakanani obulinganayo kwi-joint cavityDDx kunye ne-DJD kunye ne-2ndosteochondromatosis. I-MRI-low signal kwi-T1 kunye ne-T2 ene-joint effusion enokwenzeka. Ilungu elibambeneyo elifana nengqiniba lisenokubonisa ukudityaniswa okukhulu kwamalungu.�
• I-Panner's Disease: i-osteochondrosis yeCapitellum ngokuqhelekileyo kwi-5-10 yomdlali omncinci we-DDX ovela kwi-OCD yaseCapitellum (ixoxiwe) eyenzeka kulutsha. Ukuchacha kwenzeka kwiimeko ezininzi ngokuphiliswa okuzenzekelayo. Ukwenza umfanekiso: ii-x-reyi zityhila ukuqina kwemithambo kunye nokuqhekeka okuncinci kweCapitellum w/o umzimba okhululekileyo. I-MRI: i-T1 ephantsi kunye nesignali ye-T2 ephezulu kwiCapitellum yonke.
• I-Myositis I-Ossificance:

Izithambo ezithambileyo kunye neethambo le-Neoplasms malunga ne-Elbow

• Lipoma: intramuscular, subcutaneous. Iimpawu eziqhelekileyo eziqhelekileyo zezicubu zomzimba. Ukuhlanganiswa kweenqatha kodwa inani elininzi linokuthi lithinte i-necrosis-calcification-fibrosis. Ngokuqhelekileyo uhlala esenamandla. Ngamanye amaxesha kunzima ukuDDx kwi-liposarcoma ehlukileyo kakhulu. Ukufanekisa: x i-radiography: i-lesion radiolucent i-circumscribed okanye i-calculation. I-US ne-MRI ibalulekile. Kwi-MRIT1high, T2 low SI.
• Hemangioma: i-benign vascular lesion, ehlala iqulethwe ngamajelo amaninzi e-vascular. I-Capillary vs. cavernous. Ixhaphake ngakumbi kubantwana, kodwa ifunyenwe nakweyiphi na iminyaka. Ngamaxesha amaninzi ingenza i-phleboliths (calcification). Ukwenza umfanekiso: ii-x-reyi zityhila ubunzima bezicubu ezithambileyo ezine-phleboliths. I-MRI: T1-phezulu okanye isignali eguquguqukayo. I-T2-high signal kwiindawo zokuhamba kancinci. �ingxowa yeentshulube� uphawu. I-Biopsy iphephe kakhulu. I-Rx: inzima: ukukhutshwa kwendawo vs. embolization vs. uqwalaselo. Ukuphindaphinda okuphezulu.
• I-Peripheral Nerve sheath tumor tumor (PNST): ngokubambisana ngokumalunga. Isiganeko esikhulu kwi-NF1 enomngcipheko ophezulu we-PNST embi. Benign PNST: Schwannoma vs.Neurofibroma. Umlanjana ngokumelene neentsimbi zomhlaba. I-Histology: Iiseli zeSchwann zifakwe kwi-fibroblast kunye neenqwelo.Izicwangciso: ii-pts kwi-20 kunye ne-30s, ubunzima obunokubethwa okanye okanye uxinzelelo lwengingqi. Ukucinga: I-MRI: T1: uphawu lwesithambiso-mafutha, i-T2: uphawu lokujolisa. Uxolo lwe-T1 + C
• I-Soft Tissue Sarcomas: I-MFH, i-Synovial sarcoma, (kuxutyushwa), iLiposarcoma (rhoqo rhoqo kwi-retroperitoneum) Dx: iMRI. Iikliniki: I-Dx ibambezelekile d / t ubunzima obungabonakaliyo obuninzi bengazange bayihoxiswe. Ubunzima obunokugula obufanelekile bufanele uviwo lwe-MRI, i-US inokuba luncedo. I-Biopsy iqinisekisa iDx.
• Amathumba ahlambalazayo Amapopu: Abantwana: OSA, Ewing�s sarcoma (ixoxiwe) Abantu abadala: Mets, Myeloma (ixoxiwe)

Ingqiniba