Name: El Paso Back Clinic | Spine Specialists - El Paso, TX
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Ukujonga kunye nokuchonga

IQela lokuBamba iKlinikhi eNgemva kunye neQela lokuxilonga. UDkt Alex Jimenez usebenza kunye neengcali zokuxilonga eziphezulu kunye neengcali zokucinga. Kubudlelwane bethu, iingcali zokujonga umfanekiso zibonelela ngokukhawuleza, ngembeko, kunye neziphumo ezikumgangatho ophezulu. Ngentsebenziswano nee-ofisi zethu, sibonelela ngomgangatho wenkonzo ngokwegunya lezigulana zethu nezilufaneleyo. I-Diagnostic Outpatient Imaging (i-DOI) liziko le-Radiology ye-state-of-art e-El Paso, TX. Yeyona ndawo yodwa yohlobo lwayo e-El Paso, ephethwe kwaye iqhutywa yiRadiologist.

Oku kuthetha ukuba xa ufika kwi-DOI kuvavanyo lwe-radiologic, zonke iinkcukacha, ukusuka kuyilo lwamagumbi, ukhetho lwezixhobo, itekhnoloji ekhethwe ngesandla, kunye nesoftware eqhuba iofisi, ikhethwe ngononophelo okanye iyilwe yiRadiologist. kwaye hayi ngomgcini-mali. I-niche yethu yemarike yindawo enye yokugqwesa. Imilinganiselo yethu enxulumene nokhathalelo lwezigulane zezi: Sikholelwa ekuphatheni izigulana ngendlela esiya kuphatha ngayo intsapho yethu kwaye siya kwenza konke okusemandleni ethu ukuqinisekisa ukuba unamava amnandi kwikliniki yethu.

Kutheni i-Chiropractors isebenzisa i-X-Rays njengeSixhobo sokuxilonga soNyango

by UGqr Alex Jimenez | Ukujonga kunye nokuchonga, Ukunyamekela

Uninzi lwababoneleli bonyango basebenzisa x-ray njengethuluzi lokuxilonga ukunyanga iintlobo zezikhalazo zezigulane, kubandakanywa nezigulane. Baya kunceda oogqirha baqaphele umthombo wengxaki okanye ukuba kukho into eqhubekayo. I-ray-ray inokukunceda abancedisi be-chiropractors ukuba banqume indlela efanelekileyo yokunyango. Ukuze siqonde ngakumbi, makhe sijonge ngokubhekisele ukuba zeziphi kunye nendlela esetyenziswa ngayo kwiiofisi ezininzi ze-chiropractic.

Ziziphi ii-ray?

I-x-reyi luhlobo olunamandla kakhulu lwemitha ye-electromagnetic efana namaza erediyo, imitha ye-ultraviolet, ii-microwaves, okanye ukukhanya okubonakalayo okusetyenziselwa ukujonga ukubunjwa kwangaphakathi komntu okanye into. Umqadi ugxile kwindawo ethile yomzimba womntu, njengasemva, uvelisa umfanekiso wedijithali skeletal isakhiwo.

Umqadi udlula ngokulula eluswini nakwezinye izihlunu ezithambileyo�kodwa awukwazi ukudlula emathanjeni nasemazinyweni. Izihlunu ezithambileyo ezixineneyo, ezifana namalungu, iiligaments, kunye nezihlunu, ziya kubonakala; kodwa ziya kubanjwa zibe ngwevu. Iindawo ezifana nezibilini okanye imiphunga zibonakala kwifilimu zimnyama.

Ukusetyenziswa kwe-chiropractic x-ray

I-X-ray ye-Chiropractic inikezela ngolwazi olubalulekileyo olunokuchaphazela indlela i-chiropractor ikhetha ukunyanga ngayo isigulane. Kwezinye iimeko, ukunakekelwa kwe-chiropractic okanye ukunyanzeliswa komgogodla kungabi yinkqubo efanelekileyo yesenzo ngelo xesha, kwaye isigulane sinokuqalwa ngonyango oluhlukileyo, oluncinci.

Ngamanye amaxesha, inokubonisa i-chiropractor indlela yokuqhubeka nokunyanga isigulana. Ngamafutshane, izigulana zinokufumana ukhathalelo olungcono, olulungelelanisiweyo olunokuthi luququzelele ngcono ukuphilisa kunye nokulawulwa kweentlungu.

Ezinye zeenzuzo ze i-chiropractic x-ray ziquka:

Chonga imeko okanye uphawu, olufana nethumba lomqolo okanye isilonda-eya kubonelela ngesizathu sonyango sokuba inkambo ethile yokhathalelo mayingenziwa.
Fumana ulwazi olubalulekileyo lwe-biomechanical olungancedisa ekukholeni unyango.
Ukuhlala unolwazi kunye nokugcina irekhodi yenkqubo yokuwohloka kwesigulana.
Uncedo ekufumaneni iziphulo zomgudu kunye namalungu angachaphazela unyango.
Ivumela izigulana ukuba ziqonde imeko yazo kunye nocwangciso lwezocwangco olungcono, zibavumela ukuba bathathe ubunini beenkqubo kwaye babandakanyeke ngakumbi kunyango lwabo nokuphilisa.

x-ray njengethuluzi lokuxilonga el paso tx.

Yintoni eyenziwa yi-chiropractor kwifilimu ye-x-ray?

Xa chiropractor ithatha i-x-reyi yesigulana, bafuna izinto kwiindawo ezininzi ezithile. Into yokuqala abayijongileyo kukuqinisekisa ukuba akukho ziqhushumbisi, ukwaphuka, umhlaza, usulelo, amathumba, okanye ezinye iimeko ezinokuba yingozi.

Bese bekhangela ukuphakama kwedisk kunye nezinye iimpawu zokuguqulwa kwediski, ukuxinwa kwethambo, ukuxhamla kwethambo, izithuba ezidibeneyo kunye nokulungelelaniswa. Oku kuvumela ukuba bafumane iinkalo ezifana ne-scoliosis kunye nezinye iimeko ezingadinga iindlela ezithile zonyango.

Abaninzi be-chiropractors bakhetha ukuba isigulane sisesimweni sobunzima xa sithatha x-ray. Oku kwahluke kuninzi lwezonyango ezibonela isiguli.

I-advanteji ye-x-reyi ethwala ubunzima njengesixhobo sokuxilonga� kukuba ivumela ukulinganisa, oko kukuthi, ukunqongophala kobude bomlenze, i-scoliosis, kunye nokucutha kwendawo edibeneyo. Ingabonisa kwakhona ukuba amathambo athile, afana ne-tibia kunye ne-fibula, ayahlula into enokuthi ibe ngumqondiso we-tendon eqhekekileyo okanye ingxaki ngokudibeneyo. I-x-reyi engenabunzima ayinakubonelela ngembono efanayo, kwaye imikhondo ebalulekileyo kwimeko yesigulana inokuphoswa.

Uphulo lweentlungu

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

by UGqr Alex Jimenez | Ukujonga kunye nokuchonga

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

Isandla somfanekiso wesandla somlenze wesifo somnxeba.

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)

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

by UGqr Alex Jimenez | Ukujonga kunye nokuchonga

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

Indlela yokuCinga ukuThatyathwa kweNgcaciso | El Paso, TX.

by UGqr Alex Jimenez | Ukujonga kunye nokuchonga

Ubume obuninzi be-Anatomy

I-Traumatic Acute

Ukuxhamla kweFx i-akhawunti ye-4-6% yazo zonke iiFxs. I-Osteoporotic (OSP) Fx kwi> 60 yo kunye ne-traum e-F: M 2: umlinganiselo we-1. Kwizigulane ezincinci, ukugonywa kwamandla aphezulu kwamandla.
Iingxaki: Intloko ye-AVN, i-Axillary N yokukhubazeka.
Ulwahlulo lweNeer: ithathela ingqalelo ukwaphuka kwemigca ye-4-anatomical kunye okanye w / o ukufuduka> 1-cm kunye ne-45-degree degree
Inxalenye enye yeNeer Fx- akukho bhabha okanye ubuncinci kakhulu <1-cm / 45-degree. Inokuchaphazela imigca e-1-4 kunye neM / C kwisifo sephepha esikhulu. I-80% ye-humeral humx Fx eyinxalenye enye yeNeer.
Iingxenye ezimbini zeFx: Icandelo le-1 lifuduka> 1-cm / 45-degrees. m / c ibandakanya intamo yokugada
Ingxenye e-Fx: I-2-izingxenye ziyafuduswa> 1-cm / 45-degrees.
Inxenye ye-Fx: Onke amalungu e-4 anokufuduswa. Okungaqhelekanga <1%
iMifanekiso: 1st isinyathelo-radiography, i-CT ingasetyenziswa kwiimeko ezinzima. Ukugqithiswa kwama-orthopedic
Ulawulo: Inxalenye enye inxalenye yeFx iphathwa ngeSling Immobilisation kunye ne-rehab yokuqhubekayo
Ubuninzi beFx kubantu asebekhulile baphathwa ngokungasebenzi
Izigulane ezincinci (40-65) zingahle zifune i-hemiarthroplasty ukuba i-3 okanye i-4-nxalenye ye-Neer Fx ikhona. Umngcipheko omkhulu we-AVN

I-Humerus Proracimal Fractures

Qaphela: Umfanekiso wasekhohlo: Fx ebandakanya i-anatomical neck kunye ne-tuberosity enkulu ngokufuduka okuncinci <1-cm / 45-degree yiyo ke iDx njengenxalenye yeFx. Imifanekiso yasekunene: Ukugxothwa okuncinci kweFx yesifo esikhulu sesifo kunye nokufuduka okubalulekileyo (> iidigri ezingama-45 kunye ne-1-cm) yiyo loo nto iDx njengenxalenye ezimbini zeFx

Qaphela: iinxalenye ezintathu zeNeer Fx (ngasekhohlo) kunye nenxalenye ezine zeNeer Fx (ngasekunene)> Ulawulo: ukusebenza kwiimeko ezininzi kwizigulana ezincinci (40-65)

Ukuxhatshazwa kwamagxathu aka Glenohumeral Joint dislocation (GHJD)

Ubhekiselele ukugqiba ukwahlukana kwe-humerus kwi-scapula glenoid. Kwi-20-40s M: F 9: Umlinganiselo we-1, kwi -60-80S M: F 3: 1
Anatomy: Ngamahlombe ukuzinza kubingelelwa ukuhamba, kwaye iyonke i-GHJD yi-m/c phakathi kwamalungu amakhulu emzimbeni
Ukuwa okukhuselayo (umz., FOOSH) kunye ne-MVA zizizathu ze-m/c. I-GHJ isengozini kakhulu ekuthinjweni, ukwandiswa kunye nokujikeleza kwangaphandle. Izinto ze-anatomical: i-glenoid engekho nzulu, i-capsule ye-ant-inferior capsule kunye ne-GH ligaments. I-GHJD iya kubangela ukukrazuka okukhulu kwezithintelo ezinkulu ze-GHJ. Ukulimala okunxulumene ne-osseous kunye ne-labral kuqhelekileyo kwaye kunokukhokelela ekungazinzini okungapheliyo, i-DJD, kunye noshintsho olusebenzayo.
Iifom ze-3: I-GHJD yangaphakathi (95%)
I-Posterior GHJD (i-4%) ngokukhethekileyo inxulumene nokuthathwa kwe-stroke, i-electrocution kwaye iyakwenzeka b / l
Ixabiso eliphantsi le-GHJD aka Laxatio Erecta (<1%) enxulunyaniswa noxinzelelo olukhulu
Klinikhi: I-AGHJD ibonisa intlungu ebuhlungu, ingalo ijikeleze ngaphandle kwaye iyancitshiswa, iyanqanda kakhulu ukuhamba. I-GHJD inokuqhubeka ikhutshwe ngokungapheliyo.
Ulawulo: ukunciphisa ngokukhawuleza kwe-ED phantsi kwe-anesthesia okanye i-sedation enzima kunye ne-Kocher technique top image (engasetyenziswanga), indlela yokujikeleza yangaphandle (ephakathi) okanye ubuchule be-Milch (bunokusetyenziswa nge-anesthesia) kunye nezinye iindlela ezimbalwa. Ukulibaziseka ekunciphiseni kuhambelana nomngcipheko omkhulu weengxaki zangoko kunye nezexesha elide

Indlela yokuTyekisa yokuThengisa

Uthotho lwamagxa x-radiography yanele. I-Imaging eyongezelelweyo kunye ne-CT scanning kunye ne-MRI ingaba luncedo kwi-Dx osseous, i-cartilage, i-labral / ligaments pathology
Interior GHJD (95%). Isikhundla se-subcoracoid (phezulu kwesokudla) se-humerus yi-m / c
I-Anterior GHJD ingenzeka kwakhona njenge-subglenoid (ngaphantsi kwesobunxele) kwaye ngokungapheliyo njenge-subclavicular
Isitshixo kukhangelo lweradiographic kukuvavanya ukulimala kweBankart kunye ne-Hill-Sachs

Bankart Lesion

Yenzeka ngexesha langaphambili le-GHJD d/t impembelelo yentloko kwi-glenoid yangaphambili-ephantsi. Iiyantlukwano zikhona (jonga isilayidi esilandelayo). I-BonyBankart inokubonwa kwi-x-reyi. Into ebizwa ngokuba yi-soft tissue Bankart ifuna i-MRI. Intlala (ethambileyo)Bankart yim/c.
I-Hill-Sachs aka Hatchet deformity (i-postreduction ye-arrow) kwenzeka ngexesha elifanayo ne-Bankart, okt, ukunyanzeliswa kunye nefuthe le-posterolateral yentloko ngokuchasene ne-glenoid evelisa i-wedge-shape Fx. I-Hill-Sachs isilonda sinokubeka phambili kwi-GHJD eqhubekayo / engapheliyo.
I-Bankart lesion inokuphilisa, kodwa i-anchor suture esebenzayo iyafuneka ngamanye amaxesha
I-CT arthrogram kunye ne-MRI inokuba luncedo

Iintlobo zeBhanart Lesion

Qaphela iintlobo ezahlukeneyo zesilonda seBankart. I-Bankart kuphela inokubonwa ngeradiographically. Izicubu ezithambileyo I-Bankart ifuna i-MRI kunye nangaphandle kwe-intra-articular gadolinium (arthrogram).

Ukususwa Kwangemva

Qaphela: i-GHJD yangemva kweempawu kunye nezibonakaliso zayo:
Uphawu lomkhombe aka reverse Hill-Sachs. Kwenzeka d/t impembelelo yentloko ye-anterolateral Fx
Uphawu lweRim: lwenzeka kuphela kwi-PGHJD d/t kwindawo yangasemva yentloko kunye ne-anterior glenoid-to-humeral head distance 6-mm okanye ngaphezulu.
Uphawu lwe-bulb lokukhanya: d / t ukujikeleza kwangaphakathi kwe-humerus (intloko)

GHJD ephantsi

I-GHJD ephantsi yeLaxatio Erecta
Ukuxhatshaza kakhulu kunye nokufuduka kwezantsi kwe-humerus. Amathuba amakhulu kakhulu okulimala ngokwegazi kunye ne-acromial Fx
Ingalo ekhutshiweyo ixhwilwe kakhulu kwaye ilungiswe ingqiniba ijike nengalo ingaphezulu kwentloko.

I-ACJ Ukuchithwa (ACJD)

ACJD: ukulimala okuqhelekileyo, i-9% yokulimala kombhinqo wamagxa esp. kwiimbaleki zamadoda ngokubethwa ngokuthe ngqo
Ukwahlula kwe-Rockwood (ngasekhohlo) kuhlola ukutshatyalaliswa kwe-AC kunye ne-CC ligaments kunye nezidumbu zengingqi
Uhlobo1, 2, 3 phakathi kwe-m/c
Uhlobo lwe-1: i-ACrain ye-ACL yokukrazula
Uhlobo lwe-2: iinyembezi ze-ACL kunye ne-CCL
Uhlobo 3: ukukrazula kwe-AC & CCL. I-clavicle iphakanyisiwe ngaphezu kwe-acromion. Ukuba <2-cm iziphumo ezilungileyo nge-Conservative Rx.
iMifanekiso: x-radiografi nge b / l iimbono ze-ACJ kunye ne-w / o ubunzima ukuthelekisa zombini ii-ACJ. Kwiimeko ezinzima I-CT scanning esp. ukuba iFx ithathwa
Ulawulo: Chwetheza 3 (> 2-cm) kunye neentlobo 4-6Operative

Uhlobo lwe-3 ACJ Ukwahlula

Uhlobo lwe-3 I-ACJ yokwahlula (phezulu ngakwesobunxele)
I-ACJD ebalulekileyo (imifanekiso engezantsi) kunye nomqondiso weklinikhi we-acromion phantsi kwesikhumba kunye ne-ORIF ephumela

I-Rotator Cuff Muscles (RCM) Pathology

I-tendinopathy yeRCM: i-collagenous degeneration ye-RCM ngokukodwa i-Supraspinatus M. tendon (SSMT) d/t overuse/degeneration-micro breaking with collagenous replacement. I-Impingement syndrome yimbangela ye-2 yangaphandle. Inikezelwe ngeklinikhi njengentlungu kunye neROM elinganiselweyo
Ukujonga iDx: I-MSK US ingaba nechanekileyo njenge-MRI kwaye ibhetele kwezinye iimeko d / t ukuvandlakanya okuvakalayo
Isitshixo se-MRI esiyintloko siqinisiwe kwi-SSMT engafaniyo kunye nomqondiso owandileyo kuko konke ukulandelelana kwe-pulse d / t ukonakala kwamafutha kunye nokudumba (imifanekiso yasekhohlo: T1 & T2 FS)
Iziphumo ze-MSKUS: ukujiya kwe-SSMTsubstance kunye notshintsho �kwi-echogenicity yesiqhelo.MSKUS ilungile kwi-DDx ngeenyembezi ze-SSMT. Izibonelelo zase-US kukuba ivumela uvandlakanyo oluguquguqukayo lwezakhiwo ezibuhlungu

Iintlungu ze-SSMT: ngokuyinxenye (okungaphelelanga) ukukrazuka kweSSMT kunokwenzeka kumphezulu we-bursal kunye ne-articular okanye ngaphakathi, okt, intra-substance/noncommunicating. I-Etiology: i-sub-acromial impingement, i-acute strain, kunye ne-microtrauma tendinosis engapheliyo.
Klinikhi: intlungu kwi-abd kunye ne-painting, iimvavanyo zokufaka impingement, iimvavanyo ze-Hawkins-Kennedy, njl njl. Iiparele: Iinyembezi ezincinci zinokuba buhlungu ngaphezu kweenyembezi ezipheleleyo
Ukujonga iDx: I-MSKUS ifanelekile njenge-MRI (NBIzifundo ezithile zibonisa ukuba i-MSKUS iphezulu kuneMRI). Iziphumo ze-MRI eziphambili: ikhefu / iingazi ezingaphelelanga ze-SSMT ezizaliswe ngamanqamu ahlangeneyo +/- granulation tissue
I-MSKUS: iyanciphisa i-echogenicity ye-SSMT, ukunqunyulwa nokukhahlaza ngokukhawuleza okuzaliswe ngamanzi athile (i-anechoic iintolo). Ukugqithiswa kwe-tendon bursal okanye i-articular interface.

Ubunzima obupheleleyo I-SSMT (i-coff rot) ikhembe: ukutshatyalaliswa / ukutshatyalaliswa kokubola. I-2nd ukuya kutshintshwe nge-acromion ekhonjiweyo, ukusetyenziswa ngokugqithiseleyo okanye ukuxhatshazwa. I-7-25% yeentlungu zentlungu ebantwini bonke. Klinikhi: intlungu kwiimvavanyo zokupasa.
Ukujonga iDx: I-MSKUS ifana ne-MRI.Ukulinganiselwa: i-Dx embi ye-labral pathology. I-USDx engundoqo: ukuphazamiseka kwe-tendon ekugxilwe kuyo, i-gap ye-anechoic (i-fluid egcweleyo), i-hypoechoic tendon, i-tendon retraction, uphawu lwe-cartilage olungabonakaliyo (ezantsi ngasekhohlo, A: US B: MRI)
MRI: i-Dx eyintloko: Iinyembezi ezifakiweyo ezidlulela kuyo yonke icrescent ye-SSMT, ukuhlehla ngokuwohloka kwamafutha e-SSMT kunye nezihlunu. Ukuba ukurhoxa ngentsimbi ye-12 okanye ngaphezulu (imifanekiso ephezulu), isenokungamiswa ngokusebenzayo.

I-Rotator Cuff (RTC) I-Calcific Tendinitis: ngokuqhelekileyo d/t calcium HADD iikristale. Abasetyhini abakubudala obuphakathi bachaphazeleka kakhulu. Uluhlu ukusuka ekufumaneni umfanekiso ongabonakaliyo ukuya kwi-arthropathy eyonakalisayo okanye igxalaba laseMilwaukee (ngokungaqhelekanga)
I-HADD inezigaba ze-3-pathological: ukubunjwa kokuphumla-resorption.Intlungu ephakathi ukuya kwimodareyitha esp. kwisigaba sokuphumla.
iMifanekiso: i-x-radiography: i-homogenous ovoid mineralization ngaphakathi kwe-RTCMT, m/c kwi-SSMT. I-MRI: i-ovoid / globular iyancipha isignali kuzo zonke iiseyile ze-pulse rhoqo kunye ne-edema ejikelezileyo (ezantsi ngasekhohlo)
Rx: ukuziphendulela kwenzeka. Iimeko eziphambili: iinjongo zokusebenza njl.

I-Labrum Ephezulu Kwangaphambili kwi-Posterior (SLAP) Izilonda / Iinyembezi

Iindleko ze SLAP: I-FOOSH kunye nokuphosa imidlalo okanye ukungazinzi kwegxalaba okungapheliyo aka Ukungazinzi kwegxalaba le-Multidirectional (kwi-20%). Uhlobo 1-9 lukhona kodwa iM/C ziType 1-4
Kuzo zonke ii-4-iindidi eziphezulu eziphezulu zithinteka okanye i-w / oLHBMT i-anchor isilizi (bona imifanekiso). Klinikhi: intlungu, ukunciphisa i-AROM kunye neemvavanyo zokunyamezela, ngokuqhelekileyo iziphumo ezingafaniyo ezifana ne-RTCpathology
Ukucinga kubalulekile: ngcamango e bhetele MRI i-arthrography. Iimpawu eziphambili: i-hyperintenselinear linear fluid signal ngaphakathi kwe-labrum ephezulu +/- eyandisa ecaleni kwe-LHBT kwi-fat-suppressed fluid imaging kunye ne-FS T1 arthrogram. Eyona nto ibonwe kakhulu kwizilayi ze-coronal.
Rx: iinyembezi ezincinci zingaphilisa, kodwa iinyembezi ezingazinzanga zifuna ukhathalelo lotyando.
I-DDx engundoqo: iinguqu ze-anatomiki ezifana neBuford complex kunye neSub-labral foramen

Ukukrazuka kwe-SLAP nge-cyst paralabral (ezantsi ekunene)
Umehluko oqhelekileyo we-DDx: i-sub labral foramen(ezantsi ekhohlo) qaphela: I-MR arthrography kunye nochasaniso olusikwa ngaphantsi kwe-labrum kodwa i-w/o idlulela ngasemva kwi-LHBT

I-Arthritis

GHJ DJD: ngokuqhelekileyo ihambelana nesizathu se-2: ukuxhwaleka, ukungazinzi, i-AVN, i-CPPD, njl. Ukunikezelwa ngentlungu, i-crepitus kunye nokunciphisa i-ROM / umsebenzi. Isifo se-RTC esinxulumeneyo sinokubakho. Imifanekiso; I-x-radiography yanele kwaye ibonelela ngokucwangcisa / ukunyamekela.Iziphumo eziphambili: ukucutha ngokubambisana, i-osteophytosis esp. kwintloko engaphantsi kwe-medial (utolo lwe-orange), i-subchondral sclerosis / i-cysts. Kusoloko kuqatshelwa ukufuduka kwentloko ephezulu d/t isifo se-RTC.
ACJ OA: ixhaphakile kwaye iqhelekile ngokuguga. Inika ilahleko ye-ACJ kunye ne-osteophytes. Ii-osteophytes ecaleni komphezulu we-ACJ �keel osteophytes�(utolo olubhlowu) zinokukhokelela ekukrazukeni kwezihlunu ze-RTC. I-regional bursitis lolunye uphawu lweklinikhi lwe-ACJ arthrosis.
Ulawulo: ngokuqhelekileyo lulondoloza ngokuxhomekeke kwiimpawu zekliniki / iimpawu

I-Rheumatoid Arthritis GHJ: I-RA yi-multisystem inflammatory disease echaphazela amajoyina amaninzi afakwe yi-synovium. I-GHJ RA iqhelekile (m / c amajoyina amakhulu kwi-RA ngamadolo / amagxa). Klinikhi: intlungu, i-ROM encinci kunye nokungazinzi, ubuthathaka bemisipha / ukuchithwa. Izandla, iinyawo, kunye nezihlahla ziyachaphazeleka m/c. Ukucinga: I-x-radiography ibonisa ukhukuliseko lwe-periarticular, ukulahleka kwendawo yokudibanisa okufanayo, i-juxta-articular osteoporosis, i-subluxation, kunye nokudumba kwezicubu ezithambileyo. I-MRI inokunceda ukufumanisa okuxhaphakileyo ukukrazula kunye nokungazinzi kwe-RTC. Utshintsho lwangoko lunokubonwa nguMSKUS esp. ngokusebenzisa amandla Doppler ebonisa hyperemia / ukudumba.
Qaphela: I-x-ray yehlombe ebonisa ukutshatyalaliswa kwe-cartilage kunye nokulahleka kwe-symmetrical joint, ukukhukuliseka okuphindaphindiweyo, kunye nokulahlekelwa kwenkxaso ye-RTCM kunye nokufuduka kwentloko ephezulu, i-ST effusion ikhona.
Qaphela: I-PDFS i-coronal kunye ne-axial MRI izilayi ze-GHJ RA ezibonisa ukuvuvukala kwamalungu, ukukhukuliseka kwamathambo / i-edema, ukwakheka kwe-synovial pannus kunye nokukrazuka kwe-RTC m. Ulawulo: Ukudluliselwa kweRheumatological kunye ne-pharmacotherapy kunye ne-DMARD. Ukhathalelo olusebenzayo njengeRTCM ukulungiswa. I-10% yezigulane zikhubazekile d/t RA

I-Neuropathic Osteoarthropathy aka igxalaba likaCharcot: d / t neurovascular and neural periarticular umonakalo. Izizathu ezininzi zikhona. / c ikhula kubantu abanesifo seswekile kwi-midfoot. I-Charcot Charcot yi-m / c kwi-Syringomyelia (i-25%), ukukhubazeka, i-MS, njl njl. Dx: iklinikhi (50% ubuhlungu / ukukhukhuma 50% intshabalalo engenakubuhlungu). Ukucinga kubalulekile. I-X-radiografi yanele kwiimeko ezisekwe kakuhle, kodwa ekuqaleni kweDx inzima. I-MRI inokukunceda nge-Dx yokuqala kwaye ibalekele iingxaki. Rad Dx: I-Charc Charcot i-m / c iboniswe njengoluhlobo lwe-atrophic disthroptive arthropathy kunye nekhanda eliqhawulayo elibonakala ngathi unqunywe ngokugqithisileyo kunye ne-intra-articular debris, ukuxininisa, ukuphazamiseka, ukuchithwa, kunye nezinye izinto eziphambili

I-Septic Shoulder: igxalaba yi 3rd m/c followingknee>hips. Izigulane ezisemngciphekweni: i-diabetics, i-RA pts, i-immunocompromised, abasebenzisi beziyobisi ze-IV, i-catheters yokuhlala, njl. Imizila: i-hematogenous (m / c), inoculation ngqo (iatrogenic, trauma etc.) ukusasazeka okukufutshane (umz. OM). Staph. I-Aureus (>50%) m/c.
Klinikhi: iintlungu kunye nokudibanisa. I-ROM, ifiva 60% kuphela, toxemia, inc. I-ESR / CRP. I-Dx: ukucinga kunye nokudibana / inkcubeko. I-RadDx: ii-x-ray zakuqala zihlala zingamangalisi ngaphandle kokuchithwa kwe-ST / amanqwanqwa amanqatha, ukudibanisa ngokudibeneyo. Emva kweentsuku ezi-7 ukuya kwezi-12, i-osteopenia ebambekayo, ukutya kwenundu / ukugcwala kwamathambo, ukutshatyalaliswa kwe-articular, ukudityaniswa kwamalungu. Ngamana inkqubela phambili ekutshatyalalisweni ngokudibeneyo kunye nee-ankyloses. Ii-antibiotics zakwangoko ze-Dx & IV zibaluleke nangaphambi kwenkcubeko. Ukunkcenkceshela okusebenzayo kunye nokudityaniswa ngokudibeneyo kwezinye iimeko. Iingxaki zinokwenzeka esp. ukuba i-Rx iyalibaziseka. I-MSKUS nge-aspiration aspiration inokunceda. Qaphela: (umfanekiso ophezulu) ukungadibani ngokudibeneyo ngokudibeneyo kwentloko ye-inferolateral d / t septic A dx: nge-aspiration aspiration Staph. Izifo.

I-Ischemic Osteonecrosis

I-Ischemic Osteonecrosis yintloko yentloko kungenzeka d/t trauma (Neer four-part Fx), iSteroids, Lupus, Sickle cell, Alcoholism, Diabetes, �kunye nezinye iimeko ezininzi. Ukucinga kubalulekile: I-MRI ifumanisa utshintsho lwakwangoko njenge-edema ye-intraosseous. Iimpawu ze-X-reyi zishiywe kade, ziboniswa njengokuwa kwethambo le-subchondral eline-sclerosis �snow cap� uphawu, ukuqhekeka, kunye ne-DJD eqhubekayo.
Ulawulo: ukuthunyelwa kwamathambo, ukuchithwa kwengundoqo kwiimeko zokuqala, i-hemiarthroplasty kwi-moderation ethythroplasty.

Iintlobo zeengxowa

Kubantu abadala> i-40, ithambo i-Mets d / t lung, isifuba, iseli yezintso, i-thyroid CA kunye ne-prostate yim / c ebangela. Ngokonyango: inokulinganisa intlungu efana ne-RTC / utshintsho oludibeneyo. Kufuneka ivavanywe ngononophelo. Isitshixo se-Dx: I-Hx, i-PE kunye ne-Imaging esp.in pts kunye neprayimari eyaziwayo
Ukucinga: I-1st step x-rays, i-MRI inokunceda, i-Tc99bone scintigraphy inceda ukufumanisa isifo sommandla kunye nokude. Iimpawu ze-X-reyi: utshintsho olutshabalalisayo lwe-lytic ngokuqhelekileyo kwi-prox humerus (umongo obomvu) kunye okanye w / o indlela Fx. DDx: Mets, MM, lymphoma
Ngoklinikhi: iintlungu zasebusuku, intlungu ekuphumleni, njl. Iimvavanyo zaseLebhu: azinamvuzo, kwiimeko ezinzima, i-hypercalcemia inokuqatshelwa.

Iiprayimant bone eziphambene namathambo (umxhasi) Abantu abadala: M. Myeloma okanye i-Solitary plasmacytoma, i-Chondrosarcoma inokutshintsha ukusuka kwi-enchondroma kunye nabanye. Ebantwaneni/abafikisayo: OSA vs. Ewing�s
I-bone primary bone neoplasms (egazini). Abantu abadala: i-Enchondroma (izigulane kwi-20-30s yazo) i-GCT. Kubantwana: I-cyst yangasese elula (i-Unicameral Bone cyst), i-Osteochondroma, i-Aneurysmal I-Bone Cyst, ICondroblastoma (ezingaqhelekanga)
Ukufanekisa: 1st isinyathelo x-i-radiography
I-MRI ibalulekile kwiDx. Ngokukodwa kwiziganeko eziphambili zeengxaki zokuziphazamisa Ukujonga ubungakanani, ukuhlaselwa kwezicubu ezithambileyo, ukucwangcisa kwangaphambili, isiteji, njl.

Uxilongo noLawulo lwe-Arthritis yeRheumatoid

by UGqr Alex Jimenez | Arthritis, I-Arthropathies, Chiropractic, Uvavanyo lweChiropractic, Ubuhlungu obungapheliyo, Iimeko eziPhathwayo, impilo, Ukujonga kunye nokuchonga, Izifundo zoPhando, Uvavanyo lweSkrini, Unyango, Ukuphila

Mayelana nabantu abayi-1.5 abantu base-United States bane-arthritis ye-rheumatoid. Irheumatoid arthritis, okanye i-RA, isifo esingasigxina, esizimeleyo esichazwe intlungu kunye nokuvuvukala kwamalungu. Nge-RA, isimiso somzimba sokuzivikela, esikhusela impilo yethu ngokuhlasela izinto zangaphandle njengebhaktheriya kunye neentsholongwane, ukuhlaselwa ngamacandelo ngamacandelo. I-rheumatoid arthritis ixhaphaza kakhulu izihlanganisi zezandla, iinyawo, izibonda, izibonda, amadolo kunye namaqaqa. Uninzi lwezonyango zonyango lucebisa ukuxilongwa kwangaphambili kunye nokwelashwa kwe-RA.

Abstract

Isifo samathambo sesona sifo sixhaphakileyo esihlasela isifo. Abasetyhini, abatshayayo, kunye nabo banembali yosapho yesi sifo bahlala bechaphazeleka. Iikhrayitheriya zokuchonga isifo zibandakanya ukuba lilungu elinye okungenani kunye nokudumba okungacaciswanga sesinye isifo. Amathuba okuchongwa kwesifo samathambo anyuka ngenani lamalungu amancinci abandakanyekayo. Kwisigulana esinesifo samathambo esidumbisayo, ubukho bento ebangela irheumatoid okanye iprotein antibody ye-anti-citrullinated, okanye inqanaba eliphezulu le-C-esebenzayo leprotein okanye inqanaba le-sedryation ye-erythrocyte iphakamisa ukufumanisa isifo samathambo. Uvavanyo lokuqala lwelebhu kufuneka lubandakanye ukubala okupheleleyo kwegazi ngokungafaniyo kunye nokuvavanywa kokusebenza kwezintso kunye ne-hepatic function. Izigulana ezithatha iiarhente zebhayiloji kufuneka zivavanyelwe i-hepatitis B, hepatitis C, kunye nesifo sephepha. Ukuchongwa kwangoko kwe-rheumatoid arthritis kuvumela unyango lwangaphambili ngezifo ezinokuguqula isifo. Ukudityaniswa kwamayeza kuhlala kusetyenziswa ukulawula isifo. I-Methotrexate ngesiqhelo sisiyobisi kumqolo wokuqala kwisifo samathambo. Iiarhente zebhayoloji, ezinjenge-tumor necrosis factor inhibitors, zihlala zithathwa njengeearhente zodidi lwesibini okanye zinokongezwa kunyango olubini. Iinjongo zonyango zibandakanya ukunciphisa iintlungu ezidibeneyo kunye nokudumba, ukuthintela ukonakaliswa kwemitha kunye nokukhubazeka okubonakalayo, kunye nokuqhubeka komsebenzi kunye nemisebenzi yobuqu. Ukutshintshwa okuhlangeneyo kubonisiwe kwizigulana ezinomonakalo omkhulu ngokudibeneyo onempawu ezilawulwa gwenxa ngabaphathi bezonyango. (NdinguGqirha weNdawo. 2011; 84 (11): 1245-1252. Ilungelo lokushicilela 2011 American Academy of Family Physicians.) I-rheumatoid arthritis (RA) yiyona nto ixhaphakileyo isifo se-arthritis, esinexesha lokuphila elide ukuya kuma-1 ekhulwini emhlabeni wonke. I-1 Inset ingafumaneka nanini na ubudala, kodwa iphakama phakathi kwe-30 kunye ne-50 yeminyaka. Ukukhubazeka kwe-2 kuqhelekile kwaye kubalulekile. Kwiqela elikhulu lase-United States, i-35 ipesenti yezigulane ezine-RA zazikhubazekile emsebenzini emva kweminyaka eyi-10.3

Etiology kunye nePathophysiology

Njengezifo ezininzi ezizimeleyo, i-etiology ye-RA i-multifactorial. Ukuchaphazeleka kwemfuza kuyabonakala ekuhlanganiseni usapho kunye ne-monozygotic yamawele, kunye neepesenti ezingama-50 zomngcipheko we-RA obangelwa zizinto zofuzo. Izifundo zomanyano ngokubanzi ziye zachonga utyikityo lwemfuzo olongezelelekileyo olonyusa umngcipheko we-RA kunye nezinye izifo ezizimele, kubandakanya i-STAT4 gene kunye ne-CD45 locus. 1 Ukutshaya yeyona nto ibangela imeko ye-RA, ngakumbi kwabo banofuzo. Inokuthi ichaze impendulo yokuzimela, akukho nto ibonakalisiweyo ibangela ukuba i-RA.6,7 RA ibonakaliswe ngeendlela ezivuthayo ezikhokelela ekwandeni kweeseli ze-synovial kumalungu. Ukuqulunqwa kwepannus emva koko kunokukhokelela ekutshatyalalisweni kwe-cartilage kunye ne-bony erosions. Ukuveliswa ngaphezulu kwee-cytokines zepro-inflammatory, kubandakanya i-tumor necrosis factor (TNF) kunye ne-interleukin-4, eqhuba inkqubo etshabalalisayo.40

Izinto zobungozi

Ubudala obudala, imbali yentsapho yesifo, kunye nesondo sesifazana zidibaniswa nomngcipheko wokwanda kwe-RA, nangona ukuhlukana kwesondo kungabonakali kakhulu kwizigulane ezidala. = 1, ukuya kuthi ga kwi-1.4 kwiminyaka engaphezu kwe-2.2 ye-pack-pack-years) .40 Ukukhulelwa kudla ngokubangela ukuxolelwa kwe-RA, mhlawumbi ngenxa yokunyamezela kwe-immunologic.11 I-Parity ingaba nefuthe elide elide; I-RA ayinakwenzeka ukuba ifunyanwe kubasetyhini be-parous kunabasetyhini abangenayo (RR = 12) .0.61 Ukuncancisa kunciphisa umngcipheko we-RA (RR = 13,14 kubasetyhini abancancisayo ubuncinane kwiinyanga ezingama-0.5), kanti ukuqala kokuya esikhathini�(RR = 24 kwabo bahamba kwi-mearche kwiminyaka eyi-1.3 ubudala okanye encinci) kunye nexesha elingaqhelekanga kakhulu lokuya esikhathini (RR = 10) kwandisa umngcipheko.1.5 Ukusetyenziswa kweepilisi zokukhulelwa komlomo okanye i-vitamin E ayichaphazeli umngcipheko we-RA.14

Ukuqondwa

Ukunikezelwa Kwendlela

Izigulane ezine-RA zikhona ngokubuhlungu kunye nokuqina kumalungu amaninzi. Izibonda, amanxeba aphakathi kwe-interphalangeal joints, kunye nama-metacarpophalangeal joints athile abandakanyekayo. Ukuqina koMasa okuhlala ngaphezu kweyure enye kubonisa i-etiology evuthayo. Ukuthumba kwe-Boggy ngenxa ye-synovitis inokubonakala (Umfanekiso we-1), okanye ukunyaniseka kwe-synovial kungabonakaliswa kwiimviwo ezidibeneyo. Izigulana zingabonisa nge-indulent arthralgias ngaphezulu kokuqala kokuvuvukala komzimba ngokubonakalayo. Iimpawu eziqhelekileyo zokukhathala, ukulahleka kwesisindo, kunye ne-fever-grade-fever iyakwenzeka ngezifo ezisebenzayo.

Iimpawu zokuxilonga

Ngo-2010, i-American College of Rheumatology kunye ne-European League Against Rheumatism zasebenzisana ukuyila iikhrayitheriya ezintsha zokwahlulahlula i-RA (1 Table) .16 Iikhrayitheriya ezintsha ziinzame zokuchonga i-RA ngaphambili kwizigulana ezingenakho ukuhlangabezana nohlelo lwe-1987 lweKholeji yaseMelika yeRheumatology iikhrayitheriya. Iikhrayitheriya zika-2010 azibandakanyi ubukho bamaqhuqhuva e-rheumatoid okanye utshintsho lwe-radiographic erosive, zombini ezo zinqabileyo kwi-RA yokuqala. Ububanzi be-symmetric abufuneki kwiikhrayitheriya zika-2010, ukuvumela ukuboniswa kwangoko kokulinganisa. Ukongeza, abaphandi baseDatshi baphuhlisile kwaye baqinisekisa umthetho wokuxelwa kwangaphambili kweklinikhi yeRA (Itheyibhile 2) .17,18 Injongo yalo mthetho kukunceda ekuchongeni izigulana ezinesifo samathambo esingachazwanga ekunokwenzeka ukuba siqhubele phambili ukuya kwiRA, kunye nokukhokela ukulandela- phezulu kunye nokuthunyelwa.

Uvavanyo lweNgcaciso

Izifo ezizimelayo ezifana ne-RA zihlala zibonakaliswa bubukho be-autoanti- body. I-Rheumatoid factor ayingqalanga kwi-RA kwaye inokubakho kwizigulana ezinezinye izifo, ezifana ne-hepatitis C, nakubantu abadala abasempilweni. I-anti-citrullinated protein antibody ibaluleke ngakumbi kwi-RA kwaye inokudlala indima kwi-pathogenesis yesifo.6 Malunga nama-50 ukuya kuma-80 ekhulwini abantu abaneRA bane-rheumatoid factor, anti-citrullinated protein antibody, okanye zombini.10 Izigulane ezineRA zisenokuba nazo. iziphumo zovavanyo lwe-antinuclear antibody, kwaye uvavanyo lubalulekile kwi-prognostic kwiindlela zolutsha zesi sifo. Imilinganiselo yokuhlelwa kwe-RA.19 Amanqanaba eprotheyini asebenzayo kunye ne-erythrocyte sedimentation rate ingasetyenziselwa ukulandela umsebenzi wesifo kunye nokuphendula kumayeza. Isiseko sobalo lwegazi olupheleleyo olunokwahluka kunye novavanyo lwezintso kunye nomsebenzi wesibindi luluncedo kuba iziphumo zinokuchaphazela iindlela zonyango (umzekelo, isigulana esinokusilela kwezintso okanye i-thrombocytopenia ebalulekileyo ekunokwenzeka ukuba ayinakumiselwa ichiza elichasene nokudumba [NSAID]). I-anemia encinci yesifo esingapheliyo yenzeka kwi-16 ukuya kwi-33 ipesenti yazo zonke izigulane ezine-RA, i-60 nangona ukulahleka kwegazi kwesisu kufuneka kuqwalaselwe kwizigulane ezithatha i-corticosteroids okanye i-NSAID. I-Methotrexate ichasene nezigulane ezine-hepatic disease, ezifana ne-hepatitis C, kunye nezigulane ezinokukhubazeka okukhulu kwezintso.20 Unyango lwe-Biologic, olufana ne-TNF inhibitor, ludinga uvavanyo olubi lwe-tuberculin okanye unyango lwe-tuberculosis efihliweyo. Ukuvuselelwa kwe-Hepatitis B kunokuphinda kwenzeke ngokusetyenziswa kwe-TNF inhibitor.21 I-Radiography yezandla kunye neenyawo kufuneka yenziwe ukuvavanya iimpawu ze-periarticular erosive change, �enokuthi ibonise i-RA encinci ye-RA.22

Ukuxilongwa ngokungafani

Iziphumo zolusu zibonisa ukuba i-systemic lupus erythematosus, i-systemic sclerosis, okanye i-psoriatic arthritis. I-Polymyalgia rheumatica kufuneka ithathelwe ingqalelo kwisigulane esikhulileyo kunye neempawu eziphambili egxalabeni nasesinqeni, kwaye isigulane kufuneka sibuzwe imibuzo enxulumene ne-arteritis yesikhashana. I-radiography yesifuba iluncedo ukuvavanya i-sarcoidosis njenge-etiology ye-arthritis. �Izigulane ezineempawu ezivuthayo zangasemva, imbali yesifo sesibindi esivuthayo, okanye isifo samehlo esivuthayo sinokuba ne-spondyloarthropathy. Abantu abangaphantsi kweeveki ezintandathu zeempawu banokuba nenkqubo yentsholongwane, njenge-parvovirus. Iziqendu eziphindaphindiweyo zokudumba ngokudibeneyo zicebisa i-crystal arthropathy, kwaye i-arthrocentesis kufuneka yenziwe ukuvavanya i-monosodium urate monohydrate okanye i-calcium pyrophosphate dihydrate crystals. Ubukho bamanqaku amaninzi e-myofascial trigger kunye neempawu ze-somatic zinokucebisa i-fibromyalgia, enokuthi ihlale kunye ne-RA. Ukunceda ukukhokela ukuxilongwa kunye nokumisela isicwangciso sonyango, izigulane ezine-arthritis ezivuthayo kufuneka zithunyelwe ngokukhawuleza kwi-rheumatology subspecialist.16,17

I-rheumatoid arthritis, okanye i-RA, uhlobo oluqhelekileyo lwe-arthritis. I-RA iyisifo esingenakuzimela, esibangelwa xa isistim somzimba, isistim somzimba wokhuselo lomzimba, sihlasela iiseli zayo kunye nezicubu, ngokukodwa amajoyina. I-rheumatoid arthritis idlalwa rhoqo ngeempawu zentlungu kunye nokuvuvukala, okuhlala kuthintela amaqela amancinci ezandla, izibonda kunye neenyawo. Ngokutsho kweengcali ezininzi zonyango, ukuxilongwa kwangaphambili kunye nokwelashwa kwe-RA kubalulekile ukukhusela umonakalo ohlangeneyo kunye nokunciphisa iimpawu ezibuhlungu. UDkt Alex Jimenez DC, i-CCST Insight

impatho

Emva kokuba i-RA ifunyenwe kwaye uhlolo lokuqala luyenziwe, unyango lufanele luqale. Izikhokelo zakutsha zijongene nolawulo lwe-RA, i-21,22 kodwa ukhetho lwesigulane ludlala indima ebalulekileyo. Kukho iingqwalasela ezikhethekileyo kubasetyhini bexesha lokubeletha ngenxa yokuba amaninzi amayeza aneempembelelo ezingekho phantsi kokukhulelwa. Iinjongo zonyango ziquka ukunciphisa intlungu kunye nokuvuvukala, ukuthintela ukubola (njengokuphambuka kwe-ulnar) kunye nomonakalo we-radiographic (njengemibhobhozo), ukugcina umgangatho wobomi (umntu kunye nomsebenzi), nokulawula imbonakalo eyongezelelweyo. Izidakamizwa zokuguqula izifo (anti-hyheumatic drugs) (i-DMARD) yiyona nto ephambili ye-RA.

DMARD

I-DMARD ingaba yi-biologic okanye i-nonbiologic (Itheyibhile 3) .23 i-Biologic agents ziquka i-antibodies ye-monoclonal kunye ne-recombinant receptors ukuvimba i-cytokines ekhuthaza i-cascade evuthayo ejongene neempawu ze-RA. I-Methotrexate inconywa njengonyango lokuqala kwizigulane ezine-RA esebenzayo, ngaphandle kokuba iphikisana okanye ayinyamezelwanga. I-Sulfasalazine (Azulfidine) okanye i-hydroxychloroquine (i-Plaquenil) i-pro-inflammatory njenge-monotherapy kwizigulana ezinezifo eziphantsi-umsebenzi okanye ezingenazo iimpawu zokubikezela (umzekelo, i-seronegative, i-RA engasebenziyo). ngaphezu kwe-monotherapy; nangona kunjalo, iziphumo ezibi nazo zingaba zikhulu.21 Ukuba i-RA ayilawulwa kakuhle nge-DMARD engeyona i-biologic, i-DMARD ye-biologic kufuneka iqalwe. Ukuba i-TNF inhibitors ayisebenzi, unyango olongezelelweyo lwebhayoloji lunokuqwalaselwa. Ukusetyenziswa ngaxeshanye ngaphezu konyango lwebhayoloji enye (umz., adalimumab [Humira] ene-abatacept [Orencia]) ayikhuthazwa ngenxa yezinga elingamkelekanga lemiphumo emibi.21,22

IiNSAID kunye neCorostosteroids

Ukusetyenziswa kweziyobisi kwi-RA kunokubandakanya ii-NSAID kunye ne-oral, intramuscular, okanye intraticular corticosteroids yokulawula intlungu kunye nokuvuvukala. Ngokufanelekileyo, i-NSAID kunye ne-corticosteroids zisetyenziselwa ukuphathwa kwexesha elifutshane. I-DMARD yonyango olukhethiweyo.21,22

Iinkqubo eziPheleleyo

Ukungenelela kokutya, kubandakanywa nokutya kwemifuno kunye neMeditera, kufundwe kunyango lwe-RA ngaphandle kobungqina obukholisayo benzuzo. kunye ne-RA.25,26 Ukongeza, i-thermotherapy kunye ne-ultrasound yonyango ye-RA ayizange ifundwe ngokwaneleyo.27,28 Ukuhlaziywa kwe-Cochrane yonyango lwe-herbal ye-RA yagqiba ukuba i-gamma-linolenic acid (ukusuka kwi-primrose ngokuhlwa okanye ioli ye-currant emnyama) kunye ne-Tripterygium. i-wilfordii (i-thunder god vine) ineenzuzo ezinokubakho.29,30 Kubalulekile ukwazisa izigulane ukuba iziphumo ezibi kakhulu ziye zaxelwa ngokusetyenziswa kwonyango lwe-herbal.31

Ukuzivocavoca kunye noTyhila

Iziphumo zezilingo ezilawulwa ngononophelo zixhasa ukuzivocavoca umzimba ukuze kuphuculwe umgangatho wobomi kunye namandla omzimba kwizigulane ezine-RA.32,33 Iiprogram zokuqeqesha uqeqesho azibonakalanga zineempembelelo ezingathandekiyo kwimisebenzi yesifo se-RA, amanqaku eentlungu okanye umonakalo odibeneyo we-radiographic.34 Tai i-chi iboniswe ukuphucula uluhlu lwezandla lwabantu abane-RA, nangona iilingo ezingenangqiqo zilinganiselwe. I-35 izilingo ezilawulwa ngokungaqhelekanga ze-Iyengar yoga kubantu abadala abase-RA bayaqhubeka.36

Ubude bonyango

Ukuxolelwa kuyafumaneka kwiipesenti ezili-10 ukuya kwezi-50 zezigulane ezine-RA, kuxhomekeke kwindlela ukuxolelwa okuchazwe ngayo kunye nokunyanzeliswa kwonyango. 10 Ukuxolelwa kunokwenzeka kakhulu kubantu besilisa, abangatshayiyo, abantu abangaphantsi kweminyaka engama-40, nakwabo abanezifo zokuqala emva kwexesha ( abaguli abadala kuneminyaka eyi-65), benesifo esifutshane, sinesifo esibukhali, ngaphandle kwesigulo se-acute, kwaye ngaphandle kwesifo se-rheumatoid okanye iiprotein anti-citrullinated protein antibody. kwelona xabiso liphantsi liyimfuneko. Izigulana ziya kufuna ukubekwa esweni rhoqo ukuqinisekisa ngeempawu ezizinzileyo, kwaye ukonyuka ngokukhawuleza kwamayeza kuyacetyiswa ngezifo ezothusayo.37

Ukutshintshwa okuhlangeneyo

Ukutshintshwa okuhlangeneyo kuboniswe xa kukho umonakalo omkhulu kunye nokulawulwa okungenakuqinisekiswa kweempawu kunye nolawulo lwezonyango. Iziphumo zexesha elide zixhasa, nge-4 kuphela kwipesenti ze-13 zengxowankulu ezinkulu ezifakelwayo ezifuna ukuhlaziywa phakathi kwe-10 iminyaka.38 I-hip kunye namadolo ngamalungu amaninzi afanelekileyo.

Ukujonga ilanga elide

Nangona i-RA ithathwa njengesifo samalungu, ikwasisifo senkqubo esikwaziyo ukubandakanya iinkqubo ezininzi zamalungu. Izibonakaliso ezongezelelweyo ze-RA zibandakanyiwe kwiThebhile 4.1,2,10 Izigulane ezine-RA zinengozi ephindwe kabini eyongeziweyo ye-lymphoma, ekucingelwa ukuba ibangelwa yinkqubo yokuvuvukala ephantsi, kwaye kungekhona umphumo wonyango.39 Izigulane ezine-lymphoma I-RA nayo isengozini enkulu ye-coronary artery disease, kwaye oogqirha kufuneka basebenze kunye nezigulane ukuguqula izinto ezinobungozi, ezifana nokutshaya, uxinzelelo lwegazi oluphezulu, kunye ne-cholesterol ephezulu. ukuchasana nokusebenzisa i-TNF inhibitors, enokuthi ibangele iziphumo ze-CHF zibe zibi nakakhulu. Ii-DMARD ze-Biologic, i-methotrexate, kunye ne-leflunomide akufanele ziqaliswe kwizigulane ezine-herpes zoster esebenzayo, ukusuleleka kwefungal ephawulekayo, okanye ukusuleleka kwebhaktheriya kufuna i-antibiotics.40,41 Iingxaki ze-RA kunye nonyango zidweliswe kwiThebhile 21

Prognosis

Iziguli ezine-RA zihlala ezintathu ukuya kwi-12 iminyaka engaphantsi kobonke abantu .40 Ukufa okuphezulu kwezi zi gulane kubangelwa kakhulu ngokukhawuleza kwezifo zengqondo, ngokukodwa kulabo abanesifo esiphakamileyo somzimba kunye nokuvuvukala okungapheliyo. Iindlela ezintsha zokwelapha ze-biologic ziyakunqanda ukuqhubela phambili kwe-atherosclerosis kunye nokwandisa ubomi kulabo abane-RA.41 Imithombo yolwazi: Uphando lwe-PubMed lugqityiwe kwiiNkcazo zeZliniki usebenzisa amagama asemqoka i-rheumatoid arthritis, imbonakalo eyongeziweyo, kunye ne-anti-thermatic agents. Ukukhangela kwakuquka ukuhlaziywa kweemitha, ukuhlolwa okungahleliwe, ukuvavanywa klinikhi kunye nokuhlolwa. Kwakhona kuphandwe yiArhente yeeNgxelo zoPhando lwezeMpilo kunye noBungqina bemiGangatho, ubungqina bezonyango, inkcazelo yaseCchrane, Ubungqina obuBalulekileyo kunye ne-UpToDate. Umhla wosesho: Septemba 20, 2010. Ukubhaliweyo kombhali: Akukho manyano lwemali olufanelekileyo olunokuchazwa. Ukuqukumbela, isifo samathambo sisifo esingapheliyo, isifo esizimelayo esibangela iimpawu ezibuhlungu, ezifana nentlungu kunye nokungahambi kakuhle, ukuvuvukala kunye nokuvuvukala kwamalungu, phakathi kwabanye. Umonakalo odibeneyo obonakaliswe njenge-RA ulingana, oku kuthetha ukuba uchaphazela macala omabini omzimba. Ukuxilongwa kwangoko kubalulekile kunyango lwe-RA. Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nemiba yempilo yomgogodla. Ukuxoxa ngalo mbandela, nceda uzive ukhululekile ukubuza uGqr. Jimenez okanye uqhagamshelane nathi apha915-850-0900�. Uphethwe nguDkt Alex Jimenez

Ingongoma eyongezelelweyo Ingxoxo: Ukuxoxisa ubuhlungu be-Knee Pain ngaphandle kokuPhenywa

Intlungu yedolo luphawu olwaziwayo olunokuthi lwenzeke ngenxa yeengozi zamadolo kunye / okanye iimeko, kubandakanya ukulimala kwezemidlalo. Amadolo ngenye yezona zinto ezinzima kakhulu emzimbeni womntu njengoko zenziwe yintlupheko yamathambo amane, iigamente ezine, iintlobo ezihlukahlukeneyo, i-menisci emibini, kunye ne-cartilage. Ngokwe-American Academy ye-Family Physicians, izizathu eziqhelekileyo zokubandezeleka kwamadolo zibandakanya i-patellar subluxation, i-patellar tendinitis okanye i-jumper, kunye ne-Osgood-Schlatter. Nangona ubuhlungu beentolo buya kwenzeka kubantu abantu abangaphezu kwe-60 ubudala, ubuhlungu beendolo buya kwenzeka kubantwana nakwishumi elivisayo. Iintlungu zesisu zingaphathwa ekhaya emva kweendlela ze-RICE, nangona kunjalo, ukulimala kwamadolo amakhulu kunokufuna ukunyangwa kwangoko kunyango, kubandakanya ukunakekelwa kwe-chiropractic.

I-EXTRA EXTRA | INGXELO EBALULEKILEYO: El Paso, TX I-Chiropractor Kunconywe

***

Ngenanto

Ucaphulo

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31. UCameron M, uGagnier JJ, uCrubasik S. Ulwaphulo lwe-Herbal ekuphatheni i-rheumatoid arthritis. I-Cochrane Database Syst Rev. 2011; (2): CD002948.
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37. Katchamart W, Johnson S, Lin HJ, et al. Iziqulatho zokuqwalaselwa kwezigulane ze-rheumatoid arthritis: uhlolo oluhlelekile. I-Arthritis Care Res (i-Hoboken). 2010; 62 (8): 1128-1143.
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Vala i-Accordion

I-Ankle kunye neenyawo Ukuxilongwa kwe-Arthritis & Trauma II | El Paso, TX.

by UGqr Alex Jimenez | Arthritis, Ukujonga kunye nokuchonga

I-Lisfranc Fracture-Dislocation

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.

M / C ukuchithwa kweenyawo kwintetho ye-tarsal-metatarsal (idibene yaseLisfranc). Impembelelo ngqo okanye ukuthutha kunye nokutshala okanye ukuguqula ukutshintsha kweenyawo. Lisfranc ligament ephethe isiseko se-2nd MT kunye ne-1st Cu ichithwe. Ibonisa okanye i-o / o ukuphulwa kwe-fracture-evulsion.
Ukucinga: inyathelo le-1: i-rayography yonyawo kwiimeko ezininzi ezaneleyo kwi-Dx. I-MSK yaseMelika inokunceda: bonisa ukuphazamiseka kweCu1-Cu2. I-Ligament kunye nendawo ebanzi> 2.5mm. I-MRI inokunceda kodwa ayibalulekanga. Izinto zokuncedisa ukujonga ubunzima Dx.
Iindidi ze-2: i-homolateral (i-1st MTP iqhagamshelana) kunye nokuhlukana (i-2-5 MT ihambelane ngokukhawuleza kunye ne-1st MT phakathi)
Ulawulo: Ukulungiswa komsebenzi kubalulekile
Ukuphazamiseka kwe-Atraumatic yaseLisfranc yintlupheko rhoqo yesifo sikashukela seCharcot

I-Osteochondral Injury yeTalus (OCD)

Eziqhelekileyo. Ukungahambi kabuhlungu okufumaneka kwidome ye-talar ephezulu. Ingxaki echaphazelekayo inokuchaphazela idome ephezulu.
Kwizonyango: intlungu / ukuxhamla / ukuvala. Ukucinga kubalulekile.
Isinyathelo se-1st: i-radiografi ingabonisa ukuxhaswa kwe-radiolucent / halo, isahluko.
MRI inceda esp. ukuba i-OCD iyigqirha kwaye ibonise i-edema ye-bone.
Ulawulo: ongasebenziyo: ukukhangela imilenze emfutshane / ukuxhatshazwa-4-6 wk. esebenzayo: ukususwa kwe-arthrocsopic.
Iingxaki: I-DJD yangaphambi kwe2nd

Ukulimala kweMatatarsal

Ukuqhaqhaqhaqhaqhaqeka kunye noxinzelelo kuqhelekile: m / c 5th MT & 2, 3rd MT.
Jones Fx: I-Fx eyongezelelekileyo ye-metaphysis ye-5th MT. Ikhokelwa kumanyano. Ngokuqhelekileyo ichanekile ngokusebenzayo.
I-Pseudo-Jones: I-intra-articular avulsion ye-5th MT istloid / isiseko ngokuqina kwe-Peroneus Brevis M. Ulawulwa ngokufanelekileyo: i-boot-cast immobilization. Zombini iJones kunye nePseudo-Jones Dx ngothotho lwe-radiography.
Uxinzelelo lweFx. ICalcaneus, yesi-2, yesi-3, yesi-5 yee-MT. Ukuphinda kulayishwe (kuyaqhutywa) okanye "Matshi unyawo" 2nd / 3rd MT. Klinikhi: iintlungu zomsebenzi, ezincitshiswe ngokuphumla. I-Dx: ii-x-ray zihlala zingabuyiseli ngaphambili. I-MRI okanye i-MSK US inokunceda. Ulawulo: Ngokulondolozwa. Iingxaki; inkqubela phambili kwiFx epheleleyo
Inyosi yeTurf: ukuxhaphaza okuqhelekileyo kwezemidlalo ze-1st MTP-sesamoid/ plantar isicatshulwa esiyinkcenkcesha. I-1st MTP ayiqinisekanga / ikhululekile. Lawulwa ngokusebenzayo.

Isifo samathambo seenyawo kunye neqatha

DJD ye-ankle: iqhelekileyo i-OA. Ngokuqhelekileyo ikhula njenge-2nd kwi-trauma / AVN, RA, CPPD, i-Hemophilic arthropathy, i-Juvenile Idiopathic Arthritis, njl njll ibonakalisa njenge-DJD: i-osteophytes, i-JSL, i-cycs subchondral yonke ebonwa kwi-ray-ray
Arthritis evuthayo: I-RA ingahlakulela kuyo maqatha okanye nayiphi na intlangano ye synovial. Ngokuqhelekileyo iza kubonisa iiHands / iinyawo ezilinganayo RA ekuqaleni (i-2nd, i-3rd MCP, ii-WP, i-MTPs ezinyaweni) ngokuqhelekileyo kunye nokukhukhula, i-JSL efanayo, i-osteopenia ye-jticta-articular, kunye nokulibaziseka.
I-HLA-B27 i-spondyloarthropathies: ixhaphaze ngokuqhelekileyo umgama osezantsi: isithende, i-ankle in Reactive (Reiter). Ukwanda kwamathambo okuvelisa i-Erosi ebaluleke kakhulu.
Gouty Arthritis: eziqhelekileyo kumgca ophantsi. I-Ankle, ezinyaweni ezinyaweni nge-1st MTPs. Ukuqala kokuqala: isifo se-arthritis esisisigxina nge-ST effusion kunye no-erosions / tophi. I-gout yokuphefumula engapheliyo: i-peri-articular, intra-osseous-out-out-out exosions with edges-hanging edges, akukho JSL / osteopenia, ST. I-Tophi ibonakala.
Uxinzelelo oluninzi: PVNS. Akuqhelekanga. Ichaphazela i-3-4th eminyaka yobomi. Isiphumo sokusasazeka kwe-synovial kunye ne-Macrophages kunye nee-cell nucleated Multi-cell ezinokuzaliswa kwe-hemosiderin kunye nobutyebi zingakhokelela ekubhubhiseni, umonakalo we-cartilage, umonakalo we-bone exerinsic. I-Dx: ii-ray-ray zizinzileyo, imodareythi yokuzikhethela. Synovial biopsy. Ulawulo: ukusebenza, kunokuba nzima.

Neuropathic Osteoarthropathy

(Ilungu likaCharcot) Ngokuqhelekileyo kunye nokunyuka kwed / ubhubhane ngohlobo lwe-2 DM. Unokuthi ungabonakalisa ngentlungu ekuqaleni (50% yamatyala) kunye nobuthakathaka obubi obungonakaliyo njengobonakaliso obusemva kwexesha. Ekuqaleni kweDx: ukulibaziseka. Ukucingwa kubalulekile: x-ray: ekuqalekeni ukungabonakali, ukukhwabanisa kwe-SF kubonakala. I-MRI inceda nge-Dx yokuqala kunye neyokuphela kokulayishwa. Ixesha elide Dx: ukuchithwa okungenakuguquka, ukuwa, ukukhubazeka. Qaphela: Ukutshintshwa kokungeniswa kwempahla kwi-Charcot ngokubambisana
I-M / C phakathi kweenyawo (i-TM joint) kwi-40% yamatyala, i-ankle 15%. Inkqubela: Iinyawo-ezantsi, isilonda, izifo, ukunyuka kwamanzi kunye nokufa.
Ukuqala kweDx: nge-MRI ibalulekile. Mxhomekeke kwizigulane ezine-type 2 DM ngokukodwa xa ubuhlungu bokuqala beinyawo / iintlungu ze-ankle zibikwe.

Ukujonga i-Ankle kunye neenyawo

Indlela iArthritis iyakwenza ngayo i-Knee

by UGqr Alex Jimenez | Arthritis, I-Arthropathies, Chiropractic, Uvavanyo lweChiropractic, Ubuhlungu obungapheliyo, Iimeko eziPhathwayo, impilo, Ukujonga kunye nokuchonga, Uvavanyo lweSkrini, Ukulimala kwezemidlalo, Unyango, Ukuphila

I-arthritis ibonakala njengokuvuvukala kwelungu elinye okanye amaninzi. Iimpawu eziqhelekileyo ze-arthritis ziquka intlungu kunye nokungahambi kakuhle, ukuvuvukala, ukuvuvukala, kunye nokuqina, phakathi kwabanye. I-arthritis inokuchaphazela nayiphi na idibeneyo emzimbeni womntu, nangona kunjalo, ihlala ikhula emadolweni. � Isifo samathambo edolo sinokwenza imisebenzi yomzimba yemihla ngemihla ibe nzima. Ezona ntlobo zixhaphakileyo ze-arthritis yi-osteoarthritis kunye ne-rheumatoid arthritis, nangona kukho ngaphezulu kwe-100 iintlobo ezahlukeneyo ze-arthritis, ezichaphazela abantwana kunye nabantu abadala ngokufanayo. Nangona kungekho unyango lwe-arthritis, iindlela ezininzi zonyango zinokunceda ukunyanga iimpawu ngamathambo emadolweni.

I-Anatomy ye-Knee

� Idolo lelona lungu likhulu nelinamandla emzimbeni womntu. Yenziwe ngencam engezantsi yethambo lethanga, okanye i-femur, isiphelo esiphezulu sethambo le-shin, okanye i-tibia, kunye ne-kneecap, okanye i-patella. Iziphelo zamathambo amathathu zigqunywe nge-articular cartilage, isakhiwo esigudileyo, esithambileyo esikhusela kwaye sikhusela amathambo xa egoba kwaye elungisa idolo.

� Iindawo ezimbini zecartilage ezimile okwe wedge, ezaziwa ngokuba yimeniscus, zisebenza njengezinto ezifunxa ukothuka phakathi kwamathambo edolo ukunceda ukuqinisa ilungu kunye nokubonelela uzinzo. Idolo elidibeneyo likwajikelezwe ngumgca omncinci owaziwa ngokuba yi-synovial membrane. Le inwebu ikhupha ulwelo oluthambisa intlala kwaye ikwanceda ekunciphiseni ukukhuhlana edolweni. Iindidi ezibalulekileyo ze-arthritis ezichaphazela idolo - ziquka i-osteoarthritis, i-rheumatoid arthritis, kunye nesifo samathambo sasemva kwe-traumatic.

Osteoarthritis

� IOsteoarthritis lolona hlobo luxhaphakileyo lwesifo samathambo esichaphazela idolo. Olu hlobo lwesifo samathambo ngumba wempilo owohlokayo, onxitywayo kunye nokukrazula okwenzeka kakhulu kubantu abaneminyaka engama-50 ubudala nangaphezulu, nangona kunjalo, inokuphuhla nakubantu abancinci.

� Kwi-osteoarthritis, intlala ekwijoyinti yedolo ngokuthe ngcembe iyaphela. Njengoko intlala iphela, umgama phakathi kwamathambo uyehla. Oku kunokukhokelela ekuhlikihleni amathambo kwaye kunokwenza i-spurs ebuhlungu yamathambo. I-osteoarthritis ikhula ngokucothayo kodwa iintlungu zinokuba mandundu ngokuhamba kwexesha.

Irheumatoid arthritis

� I-Rheumatoid arthritis ngumba wezempilo ongapheliyo ochaphazela amalungu amaninzi emzimbeni wonke, ngakumbi amadolo. I-RA iphinda ilingane, oku kuthetha ukuba ihlala ichaphazela ilungu elinye kwicala ngalinye lomzimba womntu.

� Kwi-rheumatoid arthritis, inwebu ye-synovial egquma idolo elihlangeneyo iyadumba kwaye idumbe, ibangele iintlungu zedolo, ukungakhululeki, kunye nokuqina. I-RA sisifo esizilawulayo, nto leyo ethetha ukuba inkqubo yomzimba yokuzikhusela ihlasela izicubu zayo ezithambileyo. Amajoni omzimba ahlasela izicubu ezisempilweni, eziquka imisipha, imithambo kunye nerhalaxa, kwakunye nokuthambisa ithambo.

I-Arthritis engapheliyo

� I-posttraumatic arthritis luhlobo lwesifo samathambo esikhula emva komonakalo okanye ukwenzakala edolweni. Ngokomzekelo, idolo elihlangeneyo linokulimala ngethambo eliphukileyo, okanye ukuphuka, kwaye kubangele emva kweminyaka ebuhlungu emva kokulimala kokuqala. Iinyembezi ze-meniscal kunye nokulimala kwe-ligament kunokubangela ukugqoka okongeziweyo kwi-joint joint, ekuhambeni kwexesha kunokukhokelela kwi-arthritis kunye nezinye iingxaki.

Iimpawu ze-Knee Arthritis

� Ezona mpawu zixhaphakileyo ze-knee arthritis ziquka iintlungu kunye nokungakhululeki, ukudumba, ukudumba, kunye nokuqina. Nangona ukuqalisa ngequbuliso kunokwenzeka, iimpawu ezibuhlungu zihlala zikhula ngokuthe ngcembe ekuhambeni kwexesha. Iimpawu ezongezelelweyo ze-knee arthritis zinokuqatshelwa ngolu hlobo lulandelayo:

Umdibaniso unokuba lukhuni kwaye uvuthe, okwenza kube nzima ukugoba nokuguqa ngamadolo.
Ukuvuvukala nokuvuvuka kunokuba kubi nakusasa, okanye xa uhleli okanye uphumla.
Umsebenzi onamandla unokubangela ukuba intlungu ivuke.
Iziqhekeza ezilahlekileyo ze-cartilage kunye nezinye izicubu ezithambileyo zingaphazamisa ukunyakaza okuhambelanayo kwamalungu, okubangela ukuba idolo livale okanye linamathele. Iyakwazi kwakhona ukukrafaza, nqakraza, yenza i-snap okanye wenze isandi esisikiweyo, esaziwa njenge-crepitus.
Ubuhlungu bunokubangela ingxaki yokukhathala okanye ukuguqa emadolweni.
Abantu abaninzi abane-arthritis bangaphinda bachaze intlungu edibeneyo yokwanda kunye nesimo sezulu nesimo sezulu.

Ukuxilongwa kwe-Knee Arthritis

� Ngexesha lokutyunjwa kwesigulana sokuxilongwa kwe-arthritis yamadolo, ingcali yezempilo iya kuthetha ngeempawu kunye nembali yonyango, kunye nokwenza uvavanyo lomzimba. Ugqirha unokuphinda aodole iimvavanyo zokuxilonga, ezifana ne-X-reyi, iMRI okanye iimvavanyo zegazi ukwenzela ukuxilongwa ngakumbi. Ngexesha lovavanyo lomzimba, ugqirha uya kukhangela:

Ukuvuvukala okuhlangeneyo, ukuvuvukala, ukufudumala, okanye ubomvu
Ukunyamezela ngeenxa zonke emadolweni
Ukuxhaswa kwempahla yokunyusa nokusebenza
Ukukhubazeka kwamadolo
I-Crepitus, i-grating sensation ngaphakathi kwendibano, ngokunyakaza
Ubuhlungu xa isisindo sifakwa emadolweni
Iingxaki ezinobungozi, okanye indlela yokuhamba
Nayiphi na imiqondiso yomonakalo okanye ukulimala kwiimisipha, iintambo, kunye nemigqa ejikeleze idolo
Ukubandakanywa kwamalungu angaphezulu (isalathisi se-rheumatoid arthritis)

Ukujonga iilingo zokuhlola

X-ray. Ezi mvavanyo zengqondo yokuxilonga zivelisa imifanekiso yezakhiwo ezihlanganisiweyo, ezifana namathambo. Banganceda ukuhlula phakathi kweendlela ezahlukeneyo zesifo samathambo. I-X-ray ye-knee arthritis ingabonisa inxalenye yomgama odibeneyo, utshintsho kwithambo kwakunye nokwakhiwa kweethambo zethambo, ezaziwa njenge-osteophytes.
Uvavanyo olongezelelweyo. Ngamanye amaxesha, i-imaging resonance magnetic, okanye i-MRI, i-scans, i-computed tomography, okanye i-CT, i-scans, okanye i-bone scans iyafuneka ukuze kuqinisekiswe imeko yethambo kunye nezicubu ezithambileyo zamadolo.

Uvavanyo lweGazi

� Ugqirha wakho unokucebisa ukuba kuhlolwe igazi ukuze kubonwe ukuba loluphi na uhlobo lwesifo samathambo onaso. Ngeentlobo ezithile ze-arthritis, ezifana ne-rheumatoid arthritis, iimvavanyo zegazi zinokunceda ngokuchongwa ngokufanelekileyo kwesi sifo.

Nangona idolo lihlangene linye lamanyathelo aqine kakhulu kwaye anamaqela amaninzi emzimbeni womntu, ngokuqhelekileyo ulungele ukulimala okanye ukulimala, okubangelwa kwiimeko ezahlukeneyo. Ukongeza, nangona kunjalo, ezinye izinto zempilo, ezinjenge-arthritis, zinokuchaphazela uxolo oluhlangeneyo. Kwi-intanethi yenkoliso ye-El Paso, TX, ukunakekelwa kwe-chiropractic kunokunceda ukuphucula iimpawu ezibuhlungu ezinxulumene ne-arthritis ye-knee, phakathi kwezinye izinto zempilo. UDkt Alex Jimenez DC, i-CCST Insight

Unyango lwe-Knee Arthritis

Unyango olunganyangekiyo

� Iindlela zonyango ezingasebenzisi utyando zihlala zicetyiswa phambi kokuba kuqwalaselwe unyango lotyando lwesifo samathambo. Abaqeqeshi bezempilo banokuncoma iindlela ezahlukeneyo zonyango, kubandakanywa ukunakekelwa kwe-chiropractic, unyango lomzimba, kunye nokuguqulwa kwendlela yokuphila, phakathi kwabanye.

Indlela yokuphila yokuguqula. Okunye ukuguqulwa kwendlela yokuphila kunokunceda ukukhusela idolo kunye nokuthintela inkqubela ye-arthritis. Ukunciphisa imisebenzi emzimbeni eyenza ukuba imeko ibe nzima, iya kubeka ingxaki emancinci emadolweni. Ukulahlekelwa isisindo kunokuncedisa ukunciphisa uxinzelelo kunye noxinzelelo emadolweni, kubangele iimpawu ezibuhlungu kunye nokunyuka komsebenzi.

Ukhathalelo lwe-Chiropractic kunye nonyango.Ukhathalelo lweChiropractic lusebenzisa uhlengahlengiso olupheleleyo lomzimba we-chiropractic ukubuyisela ngononophelo nakuphi na ukungahambi kakuhle komqolo, okanye ukuxutywa, okunokubangela iimpawu, kubandakanya isifo samathambo. Ugqirha unokucebisa unyango lomzimba ukwenza umthambo womntu ngamnye kunye nenkqubo yokuzivocavoca umzimba kwiimfuno zesigulane ngasinye.�Umthambo okhethekileyo uya kunceda ukwandisa uluhlu lwentshukumo kunye nokunyamezela, kunye nokunceda ukuqinisa imisipha kwiindawo ezisezantsi.

Izixhobo zokuncedisa. Ukusebenzisa izixhobo zokuncedisa, ezifana nenqanawa, izicathulo zokumangalisa okanye ukufaka izinto, okanye i-brace okanye umtya wamadolo, kunokunciphisa iimpawu ezibuhlungu. I-brace inceda ngomsebenzi nozinzo, kwaye inokuba luncedo ngakumbi xa i-arthritis isekelwe kwicala elinye lamadolo. Kukho iintlobo ezimbini zeebhonti eziqhelekileyo zisetyenziselwa ukuguqulwa kwamathambo: "Ukukhupha umthwalo" ukuguqula isisindo kwisigaba esichaphazelekayo sodolo, ngoxa i "bracket" brace inceda ukuxhasa yonke idolo.

Iziyobisi kunye / okanye amayeza. Zininzi iintlobo zamachiza zincedo ekuphatheni i-arthritis yamadolo. Ekubeni abantu baphendula ngokungafaniyo kumachiza, ugqirha uya kusebenza kunye nawe ukufumanisa amayeza kunye namayeza aphephile kwaye asebenzayo kuwe.

Utyando loPhando

� Igcisa lezempilo lingacebisa unyango lotyando ukuba isifo samathambo esibangela ukhubazeko olumandla kwaye kuphela ukuba ingxaki ayilungiswanga ngonyango olungaphangeliyo. Njengalo lonke utyando, kukho imingcipheko embalwa kunye neengxaki ngonyango lotyando lwe-arthritis yamadolo. Ugqirha uya kuxubusha iingxaki ezinokubakho nomguli.

Arthroscopy. Ngethuba le-arthroscopy, oogqirha basebenzisa izixhobo kunye neziphumo ezincinci zokuxilonga nokuphatha iingxaki zomdolo. Utyando lwe-Arthroscopic alisoloko lisetyenziselwa unyango lwe-arthritis yegama. Kwiimeko apho i-osteoarthritis ihamba kunye neendlebe ezidambisayo, utyando lwe-arthroscopic lungabulumko ukuphatha i-meniscus eqhekekileyo.

I-cartilage ukuxhoma. Iimpawu eziqhelekileyo zesikhumba zingathathwa kwibhanki yamathambo okanye kwiindawo ezihlukeneyo zamadolo ukuze zizalise umgodi kwi-cartilage ye-articular. Le nkqubo ibhekwe kuphela kwizigulane ezincinane.

Synovectomy. Ubuncwane obonakaliswe yimfuyo ye-rheumatoid isuswe ukunciphisa ukuvuvukala nentlungu.

Osteotomy. Kwi-knee osteotomy, mhlawumbi i-tibia (i-shinbone) okanye i-femur (ithambo lomlenze) liyasikwa emva koko libunjwe ngokutsha ukukhulula uxinzelelo kunye noxinzelelo kwi-joint joint. I-Knee osteotomy isetyenziswa xa i-osteoarthritis yesigaba sokuqala yonakele inxalenye enye yedolo. Ngokutshintsha ukusabalalisa ubunzima, oku kunokunciphisa kunye nokuphucula umsebenzi wamadolo.

Ukutshintshwa kwegama elipheleleyo okanye elincinane (i-arthroplasty).�Ugqirha uya kususa ithambo elonakeleyo kunye ne-cartilage, emva koko abeke iplastiki entsha okanye imigangatho yesinyithi ukubuyisela ukusebenza kwedolo kunye nezakhiwo ezijikelezileyo.

� Ukulandela naluphi na uhlobo lotyando lwedolo�yamathambo kuya kubandakanya ixesha lokuchacha. Ixesha lokubuyisela kunye nokuvuselelwa kuya kuxhomekeka kuhlobo lotyando olwenziweyo. Kubalulekile ukuthetha nengcali yakho yezempilo ukumisela olona khetho lonyango lwesifo samathambo edolo. Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nemiba yempilo yomgogodla. Ukuxoxa ngalo mbandela, nceda uzive ukhululekile ukubuza uGqr. Jimenez okanye uqhagamshelane nathi apha915-850-0900 .

Ibhalwe nguGqr. Alex Jimenez �

Ingongoma eyongezelelweyo Ingxoxo: Ukuxoxisa ubuhlungu be-Knee Pain ngaphandle kokuPhenywa

� Iintlungu zedolo luphawu olwaziwayo olunokuthi lwenzeke ngenxa yokulimala kwamadolo kunye / okanye iimeko, kubandakanya.ukulimala kwezemidlalo. Amadolo ngenye yezona zinto ezinzima kakhulu emzimbeni womntu njengoko zenziwe yintlupheko yamathambo amane, iigamente ezine, iintlobo ezihlukahlukeneyo, i-menisci emibini, kunye ne-cartilage. Ngokwe-American Academy ye-Family Physicians, izizathu eziqhelekileyo zokubandezeleka kwamadolo zibandakanya i-patellar subluxation, i-patellar tendinitis okanye i-jumper, kunye ne-Osgood-Schlatter. Nangona ubuhlungu beentolo buya kwenzeka kubantu abantu abangaphezu kwe-60 ubudala, ubuhlungu beendolo buya kwenzeka kubantwana nakwishumi elivisayo. Iintlungu zesisu zingaphathwa ekhaya emva kweendlela ze-RICE, nangona kunjalo, ukulimala kwamadolo amakhulu kunokufuna ukunyangwa kwangoko kunyango, kubandakanya ukunakekelwa kwe-chiropractic.

I-EXTRA EXTRA | INGXELO EBALULEKILEYO: El Paso, TX I-Chiropractor Kunconywe

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Ukubhukisha kwi-Intanethi kunye nokuTyunjwa 24/7 *

UGqirha oQinisekileyo oSebenzayo osebenzayo u-El Paso — Umboneleli woNyango oSebenzayo oqinisekisiweyo*
Bonke ababoneleli basebenza phantsi kolawulo olusemthethweni kwaye baseke umda wokuziqhelanisa wekliniki.*

IiNgcali zokuBuyiselwa kwiSimo sesiqhelo sokwenzakala kunye nokwenzakala

I-PUSHAsRx® Iziko lokuBuyiselwa kweNtshukumo

IiNgcali zeMpilo, iMpilo-mpilo kunye nezoSondlo

Ziziphi ii-ray?

Ukusetyenziswa kwe-chiropractic x-ray

Yintoni eyenziwa yi-chiropractor kwifilimu ye-x-ray?

Uphulo lweentlungu

I-Scapholunate Ligaments Dissociation

Ukulimala kweMetacarpal kunye nePhalangeal

Ukulimala kwenkosi

Isandla kunye neArthritis yesandla

Irheumatoid arthritis

Izikhalazo ze-Elbow kumdlali omncinci

Elbow Arthritis

Ezahlukeneyo pathologies

Izithambo ezithambileyo kunye neethambo le-Neoplasms malunga ne-Elbow

Ingqiniba

I-Traumatic Acute

I-Humerus Proracimal Fractures

Ukuxhatshazwa kwamagxathu aka Glenohumeral Joint dislocation (GHJD)

Indlela yokuTyekisa yokuThengisa

Bankart Lesion

Iintlobo zeBhanart Lesion

Ukususwa Kwangemva

GHJD ephantsi

I-ACJ Ukuchithwa (ACJD)

Uhlobo lwe-3 ACJ Ukwahlula

I-Rotator Cuff Muscles (RCM) Pathology

I-Labrum Ephezulu Kwangaphambili kwi-Posterior (SLAP) Izilonda / Iinyembezi

I-Arthritis

I-Ischemic Osteonecrosis

Iintlobo zeengxowa

Abstract

Etiology kunye nePathophysiology

Izinto zobungozi

Ukuqondwa

Ukunikezelwa Kwendlela

Iimpawu zokuxilonga

Uvavanyo lweNgcaciso

Ukuxilongwa ngokungafani

impatho

DMARD

IiNSAID kunye neCorostosteroids

Iinkqubo eziPheleleyo

Ukuzivocavoca kunye noTyhila

Ubude bonyango

Ukutshintshwa okuhlangeneyo

Ukujonga ilanga elide

Prognosis

Ingongoma eyongezelelweyo Ingxoxo: Ukuxoxisa ubuhlungu be-Knee Pain ngaphandle kokuPhenywa

Ngenanto

Ucaphulo

Vala i-Accordion

I-Osteochondral Injury yeTalus (OCD)

Ukulimala kweMatatarsal

Isifo samathambo seenyawo kunye neqatha

Neuropathic Osteoarthropathy

Ukujonga i-Ankle kunye neenyawo

I-Anatomy ye-Knee

Osteoarthritis

Irheumatoid arthritis

I-Arthritis engapheliyo

Iimpawu ze-Knee Arthritis

Ukuxilongwa kwe-Knee Arthritis

Ukujonga iilingo zokuhlola

Uvavanyo lweGazi

Unyango lwe-Knee Arthritis

Unyango olunganyangekiyo

Utyando loPhando

Ingongoma eyongezelelweyo Ingxoxo: Ukuxoxisa ubuhlungu be-Knee Pain ngaphandle kokuPhenywa

Ukubhukisha kwi-Intanethi kunye nokuTyunjwa 24/7 *

UKUZALISWA KWEBHAYIBHILE KWI-24/7 *

Iindawo zeklinikhi

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