Fa'afoma'i Falema'i Ata & Su'esu'ega Vaega. Dr. Alex Jimenez e galulue faʻatasi ma tagata suʻesuʻe faʻapitoa ma faʻataʻitaʻiga faʻapitoa. I la matou mafutaga, e maua ai e tagata poto faʻataʻitaʻi ata vave, faʻaaloalo, ma sili ona lelei taunuuga. I le galulue fa'atasi ai ma a matou ofisa, matou te tu'uina atu le tulaga lelei o le tautua o lo'o mana'omia ma e tatau ai. Diagnostic Outpatient Imaging (DOI) ose nofoaga fa'afoma'i fa'aonaponei i El Paso, TX. E na o le pau lea o le nofoaga tutotonu o lona ituaiga i El Paso, e umia ma faʻatautaia e le Radiologist.
O lona uiga pe a e sau i le DOI mo se su'ega radiologic, o auiliiliga uma, mai le mamanu o potu, filifiliga o meafaigaluega, tekinolosi filifilia lima, ma le masini komepiuta e faʻatautaia le ofisa, e filifilia ma le faʻaeteete e le Radiologist. ae le o se tausitusi. O le matou maketi maketi o se tasi o nofoaga autu o le lelei. O a matou fa'atauga e feso'ota'i ma le tausiga o ma'i: Matou te talitonu i le togafitia o gasegase i le auala matou te faia ai o matou aiga ma o le a matou faia le mea sili matou te mafaia e fa'amautinoa ai e te maua se poto masani lelei i le matou falema'i.
I tulaga uma, e manaʻomia le togafitiga o togafitiga Orthopedic
Kolisi fx: m / cd / t FOOSH + pronation. m / c inOSP / tamaitai matutua. E laʻititi i alii ma pe a manaʻomia le DEXA e aloese ai mai le lafu Fx ma isi mea faapena. Young pts: malosi tele-malosi. E masani lava ona faaopoopo-articular.50% -cases faʻaalia Ulna styloid (US) Fx.
Faʻalavelave faʻalavelave: faʻamaʻaloga o le taumafataga o le afiafi, CRPS, DJD, faʻamaʻi o le tino.
Ata: x-rad ua lava, CT i complex Fx, MRI fesoasoani i loimata ma le TFC.
Rx: pe afai e faʻaopoopo-articular ma <5-mm distal radius faʻapuʻupuʻuina ma <5-tikeri dorsal angulation tapunia faʻaititia + lafoina ua lava. ORIF i mataupu lavelave.
MFaʻamatalaga Dx: distal rad impaction / faʻapuʻupuʻu, dorsal angulation o distal fasi, vaʻai totoʻa pe afai intra-articular faʻaopoopoina, 50% US Fx
Smith Fx: Goyrand i tusitusiga Farani. Faʻapea ua fesuiaʻi Colles, a leai e toeititi lava tutusa, Ie, 85% faʻaopoopo-faʻapitoa, 50% US Fx, OSP / matutua fafine, talavou pts-maualuga-malosi faʻalavelave. Eseesega: masiniFOOSFaʻatasi ai ma le tapulima faʻapipiʻi faʻapea m. Laititi atu
Laasaga o ata: (silasila Colles Fx) C
Faʻalavelave faʻalavelave: tutusa i le Colles Fx
Rad Dx: 85% faʻaopoopoga faʻapitoa i le volar (pito i luma) o le vaega vaʻavaʻa, faʻasalaga faʻasalalau. Iloilo ma le faaeteete le solia o le tulafono ma le masalosalo i le faalauteleina o le igoa lea e mafai ona faaigoa o le Smith type 2 poʻo le toe liliu Barton Fx (isi)
Rx: faʻapena tutusa e pei o Colles.
Barton fx: FOOSH, le aʻafiaga o le faʻalavelave faʻalavelave e tutusa ma le Kolisi ae o le laina Fx e faʻalautele mai le itu i luga o le tino i le faʻasalaga o le radiocarpal e mafua mai i le faʻaaogaina o le taavale.
Ata: 1st sept x-radiography e masani ona suʻesuʻeina e le CTto faʻaopoopoga faʻaopoopoga Fx ma le fuafuaina o galuega
Rad Dx: faʻasolosolo faʻamalosi Fx faʻasalalau mai le taʻaloga i totonu o le faʻaogaina o le leitiola ma se fesuiaiga o le suiga, o le vavalalata vavalalata o le kapeta
Afai o le laina Fx e alu ese mai le itu i totonu o le tapulima tapunia e igoa ia Reversed Barton Smith kiliki 2 (pito i luga lalo)
Faʻafitauli: tutusa ma soo se mea fx fete
Rx: faʻatasi ma le ORIF
Chauffeur's / backfire Fx aka Hutchinson Fx: FX o le Radial styloid. O le igoa e mafua mai i le taimi e amata ai le taavale i le a lima uila e mafai ona toe faʻafoʻi ai le faʻaogaina o le tapulima ma le faʻavaveina o le tapulima.
Ata: x-radiography ua lava. E mafai ona aoga le CT pe a fai e le faigofie ona faʻaalia e le x-ray.
Rx: faʻamalositino faʻatasi ai ma faʻataʻitaʻiga uma mataupu d / t i totonu o faʻamatalaga
Die-Punch Fx: gaioiga Fx e le Lunate ponaivi i distal articularLosai fossa o le Radius. IntraarticularFx. Maua lona igoa mai se metotia e faʻafuaseʻi (faʻafiafiaina) se pu i masini gaosi "oti-punch." FOOSH manuʻa.
Ata: 1st laasaga x-ray, atonu o le equivocal d / t o le atuatuvale o le Fossa Lunate ona o le CT numera sili ona malamalama.
Rad Dx: faʻaleagaina o le fossa region with extension-articular Fx extension. E mafai ona tuʻuina atu o se Fxarticular Fx o le Distal Radius.
Rx: faagaoioia d / t intra-articular Fx
Fausia arcs o Gilula i le iloiloina o manua. O se laasaga tāua e manaʻomia e aloese ai mai le faʻaaogaina o suiga laiti i le faʻaogaina o taavale ma le faʻasolosolo faʻaoga
Paʻu Scaphoid Fx: m / c Fx bone bones. O le tapuni lima o le / / TFOOSH na vaeluaina. O le nofoaga o le Fx e sili ona taua i le faʻataʻitaʻiga: Taʻitaʻi-m / c nofoaga (70%). Tau maua 70-100% avanoa o le AVN. Polokalame Fx: 20-30% faʻatasi ai ma se tulaga lamatia tele o le le o faʻatasi. O le faʻamalosi-10% o loʻo faʻaalia ai le lelei sili atu. O le distal pole Fx o le m / c i tamaiti. Faailoga o le inisiua autu; tiga i le snuffbox.
Ata: 1st step-x-radiography ae o le 15-20% misia d / t faʻataulaitu Fx. Manatu faʻapitoa manaʻomia. Ma o le MRI e sili ona maaleale ma faʻapitoa mo vave gafa Fx. Bone scintigraphy has98 / 100% faʻapitoa & maaleale esp. 2-3 aso pe a maeʻa le amataga. Key rad. Dx: Fx laina pe a faʻamaonia, fesuiaʻiga ma le pupuni o scaphoid (navicular) gaʻo pad, iloiloina mo scapholucky faʻateʻaina. Afai o le latalata ivi foliga mai sclerotic-AVN tupu. MRI: maualalo ile T1 & maualuga ile T2 / STIR / FSPD d / t ivi edema, e mafai ona matauina se laina maualalo signalFx.
Rx: O le Spica cast e tatau ona faʻaaoga pe afai e masalomia masalosalo e oo lava i w / o x-ray findings. Mo le puʻupuʻese-cast mo le 3-mo mo le faʻasologa o 5-mo le faʻamalosia. ORIF poʻo le faʻasolosolo faʻasolosolo faʻatasi ma se faʻataʻitaʻiga a Herbert.
Scapholunate Ligaments Faʻafitauli
SNAC tapulima: scaphoid non-union advanced collaps. E masani d / t le tuʻufaʻatasia ma faʻateʻaina o scapholucky ligament (SLL) ma le alualu i luma radiocarpal ma intercarpalDJD. O le Proximal scaphoid fragment e faʻapipiʻi i le Lunate ma le faʻamamaina o le mama ma le faʻasologa o igoa mama i luga o x-ray.
O le tapuni o le SNAC e masani ona oʻo i le DISI
Rx: DJD agai i luma e mafai ona oʻo atu i le fath-corner arthrodesis
Scapholunate agavaʻa faʻafuaseʻi (lima faʻaoga SLAC): SLLdissociation ma alualu i luma intercarpal ma radiocarpal DJD ma volar poʻo dorsal carpal suiga (DISI & VISI). Mafuaaga: afaina, CPPD, DJD, Kienboch faamaʻi (AVN o Lunate), Preiserdisease (AVN o Scaphoid).
SLL dissociation o le a taitai atu ai i le Dorsal poo VolarIntercarlate aka Intercarpal Segmental Instability (DISIER VISI).
Rad Dx: Dx mafuaʻaga autu. O faʻataʻitaʻiga X e faʻaalia ai le faʻamalosi poʻo le leo o le Lunat i le faʻateleina poʻo le faʻaitiitia o le scapholunate angle i luga o le vaaiga lautele. I luga o le vaaiga i luma: Terry Thomas po o le faalauteleina o le mamao o le scapholunate 3-4-mm o le pito i luga o le masani.
RIMRI mafai ona fesoasoani ile ligament iloiloina ma muai taotoga fuafuaina
Rx: masani ona faʻatautaia ma le DJD. Faʻatonuga fa-fa
Triquetrum Fx: 2nd m / c carpal ponaivi Fx. M / C dorsal itu e faʻamalosia e le malosi Dorsal radiocarpal ligament. Mafuaaga: ALOFA.
Ata: x-radiography tapulima tapulaʻa ua lava. Sili faʻaalia luga o le faʻaaliga lautele o se aveʻesea ponaivi ponaivi latalata i le dorsum o le Triquetrum. E ono fesoasoani le CT pe a faʻatonuina leitio.
Rx: tausiga tausi
Faʻamaumauga: seasea, e ono aʻafia pea le tiga i luga o le pito o le tapulima
mātau o le Hamate Fx: m / c tupu i taʻaloga palate (kirikiti, pesipolo, hockey, aʻafiaga e le kalapu tapolo, ma isi) 2% o carpusFx.
Ata: x-radiography ono le mafai ona iloa se Fx seʻi vagana o le "carpal tunnel view" e faʻaaogaina. E ono fesoasoani le CT pe a fai o x-ray e le faʻamalieina.
Togafitiga: tiga, tofotofoga toso lelei, vaivai, tiga uu. Loloto ulnar n. E mafai ona afaina le paranesi i totonu o le alalaupapa o Guyon.
Rx: masani e le o faʻamalositino, ae o le taimi le tumau e le o se faʻapotopotoga e ono manaʻomia ai le faʻasalaga.
DDx: bipartite hamate
Fiafia vs. Faʻaletonu dislocation: O le sui o le m / c e vaʻaia le ponaivi gaʻo. O le aotelega o le manua o le gaʻo. Ae peitai, e masani ona misia!
E tupu i le FOOSH ma le tapulima ua faʻalauteleina ma ua le toe faʻaaoga. Ata: 1st laasaga x-ray. Faʻafesoʻotaʻi pe manaʻomia se faʻamaʻi faʻalavelave manua fuafuaina CT numera.
Key Rad DDx: DDx Lunate mai faʻalavelave faʻafuaseʻi. Faʻateʻa Lunate: ua leai se fesoʻotaʻiga a le lunate ma le radius radius 'ua masaʻa teacup i luga o le itu. Faʻaletonu le mautonu: Lunate tausia lona fesoʻotaʻiga ma distal faataamilosaga e ui lava i le Capitatedorsally dislocated. Lunate dislocation o loʻo fesoasoani tele e faʻailoa ai le pie sign d / t Lunate overlapping the Capitate
Rx: faʻaititia faʻafuaseʻi ma le faʻaleleia o le faʻaaogaina o ligaments
Metacarpal & Phalangeal Manua
Bennett Fx: intra-articular but noncomminuted impact-type Fx o le faʻavae o le 1st MC ponaivi o le limamatua. X-radiography ua lava.
Rad Dx: vaevaega tafatolu o le ponaivi i luga o le vaega o le 1st MCbase, e masani lava i le susulu radial o le vaega o totoe o le 1st MC
Faʻafitauli: DJD, non-union, etc.
Rx: faʻapitoa i le le faʻamalosia / le faʻapipiʻi e manaʻomia ai se tausiga
Rolando Fx: fesoasoani le Bennett faʻatasi ma le Y poʻo le T-faatulagaga. Faʻasalaga sili ona faigata. E le maluelue e manaʻomia le tausiga
Taʻu lima taʻavale lima lima: masani faʻamatalaina o se masani loimata o le `` lignar (medial) kolisi ligamenti i le 1stMCP i le Igilisi Gamekeepers 'na faia le ua mimilo / fasiotia o tamaʻi taʻaloga. O se manuʻa tuga e mafai foi ona faaigoaina o le limamatua o Skier. O lenei manua e mafai ona ligamentous w / oa gau ma se avulsion manuʻa i le 1st proximal phalanx base.
Faʻalavelave: Faʻasalaga o le lino poʻo le faʻaaogaina o le ligament liʻa i luga o le musika o le Adductor muscle e le mafai ona faʻamaloloina ai / o le gaosiga o taʻavale. E manaʻomia le MRI Dx.
Aloese mai mafaufauga mamafa o le mafaufau lea e mafai ona faatosinaina ai se Stenerlesion
Ata: x-radiography mulimuli ai MRI i Dx Stenerlesion. MSK US mafai ona faʻaaogaina pe a le maua MRI.
LesStener lesion on MRI & MSUS: ulnar collateral stump e sili atu ona papaʻu ia Adductor pollicis aponeurosis ma foliga mai o se maualalo o le faʻailoga tele-e pei o le tupuʻaga na taʻua o le "yo-yo i luga o le string sign" lipotia uma i MRI ma MSK US.
Rx: masani ona galue
Pusa Fx: m / c MC Fx. O le faʻaopoopo-faʻapitoa masani masani leai-comminuted poʻo laiti comminuted Fx ala m / c le 5th ma o nisi taimi le 4th MCneck-ulu fauga (taimi uma e ala i le pou) mafua ai volar ulu angulation. Faʻatulagaina: faʻatonutonu aʻafiaga pei o le uʻuina o lima o le tuʻiina o luga luga (faʻataʻitaʻi, ponaivi o ponaivi / pa puipui) o lea 95% i tama talavou.
Ata: x-radiography lima faasologa ua lava
Rad Dx: Fx laina e felafolafoaʻi pe faʻafefeteina e MCneck faʻatasi ai ma le faʻaogaina ole ulu. Iloilo le maualuga o le faʻaaogaina, taua le lipoti.
NB Afai o le tutusa metotia motusia le 2ndand 3d MC i le tutusa anatomic eria, e ono manaʻomia taotoga faʻaaoga.
Phalangeal lima Fx: m / c skeleton Fx (10% o Fx uma). Taʻaloga taʻaloga ma fale gaosi oloa
Ata: x-radiography ma faasologa o lima poo PA / tala i luga ole tamatamai lima o le a lava
Rad Dx: pe a fai o le prox phalanx Fx, o le distal fragment e faʻasolitulafono faʻatasi ma le prox fragment dorsally. Distal phalanx atonu e faʻasolosolo tulimanu. Matauga taua: manua moega fao, lea na manatu o le tatala Fx ma le aitalafu o siama.
Rx: peʻa <10-tikeri angulation-buddy-taping ma le minoi faʻasolosolo. CRPP vs. ORIF mafai ona mafaufauina i ni faʻalavelave laʻititi-Orthopedic hand surgeon referral
Faʻalavelave: leai se lafo, necrosis, siama.E mafua mai i le toesea
Mo faʻaopoopo manua masani: PIP o m / c dislocated soʻoga. Mullet (Baseball) tamatamailima, Jersey tamatamai lima ma isi manuʻa vaʻai i:
Felon: sapalai siama o le tamatamai lima pulupulu masani ma Staph.Aureus. Mafuaʻaga: tui nila (suka), paronychia, fao sikuea, ma isi m / c i le faʻasino igoa ma lima matua, faʻaalia ma le tiga, fulafula, ma isi
D / t faapitoa pulup anatomy theinfection> fulafula e oʻo atu i pulp compartment syndrome-mamafa ma nekrosis.
Rx: faʻamalositino ma faʻalavelave faʻalavelave i le DIP, faʻavaivai / faʻapipiʻi
Faigaluega a le tamaʻi maʻi
Faʻataunuʻu Fx: Greenstick Fx, Torus (Buckle) Fx, Punou (Palasitika) faʻaletonu / Fx. D / t FOSHe.g. paʻu ese mai le pa manuki. m / c aafia ai <10-tausaga le matua.
Faʻamatalaga Faʻamatalaga Ata: tikeri o le faʻafefe / faʻafefe, epiphyseal tuputupu aʻe o manu (Salter-Harris faʻavasegaga)
Rx: masani e le o faʻaogaina (tapunia ma tapuni)
Distal Radioulnar Soʻotaga (DRUJ) Faʻaletonu-masani manua mulimuli ane afaina pei o FOOSFaʻatasi ma tapulima hyperextension ma feauauaʻii ma faʻalavelaveina o DRUJ ligament ma TFCcomplex. Avulsion o ulnar styloid ma le 'eseʻese poʻo le faʻamatuʻu eseʻesega o distal ulnar e tatau ona maitauina.
Laasaga o ata: x-ray muamua, MRI e mafai ona iloa ligaments ma le TFC leaga, e mafai e MSKUScan ona fesoasoani i le vevesi o liga.
Faʻaaliga: vaʻaia le DRUJ volar (luga o le ata) ma le taʻe (image pito i lalo) le faʻavae.
Tapulima & Lima galu
Wrist DJD-masani lava lona lua ile faʻaletonu, scapholucky faʻamavaeina, SLAC, SNAC tapulima, CPPD, Keinboch poʻo Preiser Faamaʻi ma isi
E mafai ona oʻo atu i le tele o mea e leiloa
Faʻataʻitaʻiga: e masani ona maua mai le JSL radiocarpal, sclerosis subchondral, osteophytosis, cyclicical cysts, ma tino vavalalata. E masani lava ona faʻaosoosoina le faʻaleagaina o le vaʻaia ma le faʻapitoa faʻatasi.
MRI e mafai ona aoga i le vave iloa o le faʻafeeseeseaiga o le leʻofaʻi, Lunate / Navicular AVN.
Rx: conservative vs. faagaioiga.
DJD lima: Matua taatele. Moni muamua OA. MCP-e le afaina lava w / o DIP & PIP
A faʻamamaina MCP OA faʻapea mafaufauinaCPPD & Hemochromatosis (Hook-pei osteophytes)
Falemaʻi:
Tauleʻa tausaga
E masani ona leai se faʻaletonu sei vagana ai le 1 CM CMC OA
DIPs-Heberden fodes, PIPs-Bouchard
Erosive OA (o nisi taimi e faʻaigoaina o le `` faʻamamaina o le OA '')
O le Spectrum o le OA ae o loʻo faʻatupuina erosions vavalalata faʻatatau i DIPs ma PIPsemesinaʻi ma uiga masani - gullwing foliga. Leai se pupuga faʻapipiʻi (leai CRP, RF, Aneti-CCP Ab) masani i fafine feololo / matutua fafine, pei o Lima OA, e masani ona vaaia i aiga
gugu Rheumatoid
Ratuumatoid Arthritis (RA) -faʻamaʻi pipisi faʻamaʻi faʻamaʻi o le le iloa etiology, taulaʻi synovial soʻoga, tendons ma tele systemic aafia ai (mama, CVS, Ocular, Paʻu, ma isi) Pathology: Tcell> Macrophage / APC> faʻalauteleautoimmune gaioiga mafua ai pannus faʻatulagaina ma faifai malie faʻaleagaina o ST , cartilage, ponaivi, ma isi aano. 3% FafineVS.1% Tane. Siʻosiʻomaga faʻaosofia: faʻamaʻi, afaina, ulaula, ma isi i se tagata gafatia gofie. 20-30% ono le atoatoa pe a maeʻa le 10-tausaga.
I tagata matutua: Ulu Radial Fx o le m / c (33%) ma faʻamaumauga mo 1.5-4% o faʻalavelave uma. Etiology: FOOSH faʻatasi ai ma le faʻataʻitaʻiga. Manua faʻatasi: o loimata o le faʻamaufaʻailoga o tulivae e tagi. EssexLoprestiFx faʻatasi ai ma le faʻatautaia o le membrane i le vevelaina ma le faʻasalaga o le Distal Radio-Ulnar Joint (DRUJ)
Talofa mataʻutia: o le ulu Radial Fx, tosoina o le tulivae ma le faagasologa o le Coronid Fx (e masani lava ona osofaia e le Brachialis M)
Ata: 1st laasaga o le x-radiography ma le tulilima, o le numera CT e mafai ona fesoasoani i mataupu faigata, MRIif faʻaleaga manuʻa.
I tamaiti: Supracondylar Fx o le distal humerus numera mo le 90% o matuitui tiga. E masani lava d / t lavea faʻafuaseʻi ma FOOSH ma tulilima faʻalauteleina, seasea <5% ma tulilima tulilima. TeleSupracondylar Fx tupu i tamaiti <10 yo Males> Fafine. Faʻalavelave: faʻamaʻi i le cubitus varus aka Gunstock faʻaletonu, afaina o le tino ma le ogaoga o le toto ischemic compart syndrome ma le Volkmann contracture
Ata: 1st laasaga x-radiography e mafai ona lava. CT faʻaaoga i nisi taimi i mataupu faigata.
Ulu Radial (RH) Fx: O le tuʻufaʻatasia Mason e fesoasoani e fuafua le tikeri o le faigata ma le faiga o togafitiga
Tusa 1- e le o iai le m / c ma le meaʻai e aofia ai ligaments. I luga o leitiola e mafai ona matua iloga ma iloiloga o paʻu o le faga o le totilima le taua ma e na o le pau lava le faʻamatalaga o le faʻamaonia
Ituaiga 2- aveʻese e 2-mm po o> ma rotational poloka
Ituaiga 3- amataina> 2-3 fasi ma
Type4 o loʻo tuʻuina atu i le RH fx, le vavaega o le tulivae ma o nisi taimi o faʻasologa masani o le Coronid often f / t Brachialis M siitia
Rx: Tausaga 1 faʻatautaia le le faʻaaogaina e le immobilization ma le toe faʻaleleia o mea. Taʻu 2-ORIF pe a fai o poloka poloka. Pusa 3 ma le 4, ORIF ma le HR poʻo le RH arthroplasty
Faʻailoa le masani ai ona aveʻesea nofoa pito i luma gaʻo (moli lanumoli) ma le tulaʻi mai o le posterior fat pad (lanumeamata uʻamea) e masani ona loloto i le olecranon fossa ma e le vaʻaia seʻi vagana hemarthrosis matuitui poʻo isi aoga tulivae Fx
Mason type 1 RH Fx mafai ona v. maaleale ma misia. E tatau ona iai se faʻataʻitaʻiga ole faʻataʻitaʻiga ole faʻamaoniga ole gaʻo lelei ole gaʻo. Faʻaaliga luma gaʻo pad gaʻoga o Sail saini ma le i ai o le pou gaʻo pad d / t matuitui toto
Monteggia vavaeʻeseʻesega: vii 1 / 3ulnar o le Fx. faʻatasi ai ma le faʻalavelave faʻaleagaina o le PRUJ (ulu susulu). Faʻaleagaina FOOSH. Tamaiti4-12 yo E le masani i tagata matutua.
X-ray faigofie ona faʻaalia ulnar Fx, ae o le radial head dislocation atonu e faʻaoleole ma e iai taimi e misia ai. O se manuʻa tuga lea e oʻo atu ai i le tulilima le atoatoa pe a fai e tuai tolopo le 2-3 vaiaso pe a le faia togafitiga. X-ray e masani ona lava: Rx: lafo vs. faʻagaioiga.
Supracondylar Fx: o le M / C kuli Fx i tamaiti.
Aemaise lava, o le 1 (pito i luga taumatau) e leʻo faʻaaogaina e faigata ile Dx. O le le atoatoa o "fat fat" ma le pito i luma o le moemoega ma le radiocapitella line disturbance e masani ona sili ona faatuatuaina
Ituaiga 3 o loʻo tauʻavea se maualuga maualuga lamatiaga mo Volkmann koneteina (vascular ischemic-nekrosis o le pito i luma alava maso potu
Faʻasalaga o le kuli i se tagata taaalo
Epicondyle Fx: taatele o manuaga o tamaiti, e tusa ma le 10% .E faʻamaonia le osofia Fx ma le loimata MUCL. Medial epicondyle o le m / c Fx. FOOSH o le m / c mechanism.> F. Afai e fai si paʻu pe leai foi e mafai ona togafitia i le lafoina o esp. i totonu o le lima e le o se pule. Afai e vavae ese e pei ona i ai i lenei tulaga, manaʻomia le ORIF.
Medial epicondyle avulsive Fx i totonu o se tamaʻi pesipolo pesipolo na faiaina se 'ligilima liki' i le 60sand i le taimi nei e tatau ona aloese mai le le mautonu
OCD o le Capitellum o se masani afeleti manuʻaga faʻamalosia e ala i le faʻateleina compression / flexion. OCD tatau ona DDx mai Panner's faʻamaʻi poʻo osteochondritis masani faʻaalia i talavou gasegase
Faigata i le faʻamaoniga ono mafua mai-- mai le teleapophysis e uiga i le tulilima (vaʻai CRITOE)
Ata: 1st sitepu: x-ave mulimuli ai MRI ma MRarthrogramme pe a faʻailoa.
E ono fesoasoani le CT i le iloiloina o manuʻa faigata. MRI ma MSKUS ono fesoasoani i se '' manua manuʻa.
Elbow Arthritis
DJD o le tulilima e le masani ma e masani lava 2nd i le faʻalavelave, galuega, CPPD, OCD o le Capitellum poʻo isi togafitiga. Falemaʻi: tiga, faʻaititia le ROM. i le pule malosi, faʻaitiitia o le ADL. Faʻasolosolo o le fesuiaiga ma le faʻaopoopoga. 50% faʻalauteleina le neuropathy o le Ulnarcompressive. Rx: faʻamalositino, aveeseina o le debridement arthroscopic / osteophytes, faʻasalaga faʻapipiʻi. I tagata matutua matutua ma e le o gasegase o le tino Elbow Arthroplasty (TEA) e mafai ona faʻaaogaina
Ata: x-radiography ua lava, CT fesoasoani i le fuafuaina muamua
Inflammatory Arthritis: RA o le tulilima e masani (20-50%) ma faʻaleagaina d / t synovitis, pannus, ponaivi / cartilage, ma ligamentous faʻafanoga / laxity. Togafitiga: amata i le maeʻa ai o le amataga o lima faʻailoga ma, symmetrical fulafula, tiga, faʻaititia ROM, fetuʻunaʻiga contracture. O le iai o nodules rheumatoid e mafai ona maitauina ile olecranon ma tua i lalo. Rx: DMARD, faʻagaioiga tendons toe faʻaleleia.
Ata: x-radiography ma vave le faʻapitoa effusion (gaʻo pads), mulimuli ane: erosions, symmetric JSL, osteopenia. MSK US fesoasoani vave Dx. MRI faʻaalia synovitis; ponaivi edema faʻatasi ma muamua-erosive x-ray sailiiliga, synovial faʻaleleia atili i le FS T1 + C.
Gasegase o le oona: ono aʻafia ai le tulilima ae laʻititi ifo i le pito pito i lalo. Olecranon bursitis mafua ai le oso aʻe o le la luga o x-ave ma poʻo le i ai o ponaivi o le tafia. Aspiration ma polarized microscopy faʻaalia faʻaaogaina nila-foliga leaga birefringent monosodium urate tioata. Rx: colchisin, isi vailaʻau.
Septic Arthritis: mafaufau i tagata e maua i le maʻisuka, IV tagata faʻaogaina fualaʻau, tutusa RA, tagata mamaʻi e maua i le TB, gonococcal i talavou matutua. Togafitiga o loʻo avea ma monoarthritis ma poʻo w / o faʻavae faʻailoga. X-ray: le lelei mauaina i le amataga o laʻasaga. US mafai ona faʻaalia effusion ma maualuga Doppler.MRI: effusion, osseous edema. E mafai foi ona fesoasoani le sconeigraphy ivi. Labs: CBC, ESR, CRP. Diagnostic arthrocentesis ma le susunuina o le kalama ma le aganuu e taua tele. Rx: Faamalosi IV vailaʻau
Juvenile Idiopathic Arthritis (JIA) mafaufauina M / C faʻamaʻi tumau o le tamaititi ma muamua IBD le masani ai. O le Dx e faʻataʻitaʻi ma faʻataʻitaʻi: Faʻataʻitaʻiga: tiga soʻoga ma le fulafula o se tamaititi 0-16-tausaga mo le 6-vaiaso pe sili atu foʻi. Tele fomu o iai--M / C pauciarticular (oligoarticular) 40%, F> M, e fesoʻotaʻi ma ocular aafia ai (iridocyclitis) ma ono tauaso. Polyarticular ma faiga Faʻavae.
E masani ona aʻafia le tulilima faʻatasi ai ma tulivae, tapulima, ma lima, aemaise i le polyarticular dz.
Labs: ESR / CRP RF-VE i le tele o mataupu
Ata: vave foliga o le ray-ray e le o ni mea patino. Mulimuli ane: faʻaleagaina o le eleele, faʻaumatiaga o le gaosiga o le cartilage, faʻasolosolo o tala faʻapitoa, vave tapunia o le tino. Taimi e tolopoina: 2nd DJD, faʻatasi ankyloses.DDx: o le limophilic arthropathy. O le televise e taua tele.
Rx: DMARD, tausiga tausi
Eseesega faʻaleaga
Supracondylar faagasologa: 2% o le faitau aofaʻi. Na faamatalaina e Sir JohnStruthers i le 1854. Paʻu faʻamalosi (Ligament o Struthers) e mafai ona oʻo atu ai i le faʻamalosi o le Median N. DDx maiOsteochondroma lea e masani ona vaʻai ese mai le sooga
Chondrometaplasia synovial muamua(Reichel Syndrome): abnormalmetaplasia o sela sinovial sasaa cartilage i soʻoga ono mafua ai DJD, extrinsic ponaivi eria, synovitis, neura taofiofi ma isi Aveesea. Faʻataʻitaʻiga: tele osseocartilaginous tatalaina tino o tutusa tutusa tele i le soʻoga cavityDDx ma DJD ma 2ndosteochondromatosis. MRI-maualalo faʻailo onT1 ma T2 ma ono faʻatasi galulue. Ina fufusi soʻoga faʻatasi e pei o le tulilima ono i ai ma le tele soʻoga faʻasoesa. '
Panner's Disease: osteochondrosis o le Capitellum masani i le 5-10 yo talavou afeleti DDX mai le OCD o Capitellum (talanoaina) e tupu i talavou. Faʻataʻitaʻi: tiga i gaioiga. O le toe faʻaleleia e tupu i le tele o tulaga e ala i le faʻamaloloina e aunoa ma se taimi. Ata: x-ave faʻaalia sclerosis ma sina vaega o leCapitellum w / o faʻaletonu tino. MRI: maualalo T1 ma maualuga T2 faʻailoga i le atoaCapitellum.
Myositis Ossificance:
Tisu malulu & Bone Neoplasms e uiga i le tulilima
Lipoma: intramuscular, subcutaneous. O le tele o mea masani e vaivai le neoplasms. O le gaʻo o le gaʻo ae tele le numera e mafai ona maua ai le gaʻo-calcification-fibrosis. E tumau lava le pala. O nisi taimi e faigata ai ile DDx mai le liposarcoma vaʻaia lelei. Ata: x leitio: laina eletise ua uma ona faʻasalalau ma le w / o fuafuaina. US ma MRI e taua. I luga o MRIT1high, T2 low SI.
Hemangioma: lesi vavae lelei, masani ona aofia ai le tele o auala vascular. Capillary vs. ana. Sili atu taʻatele i tamaiti, ae maua i soʻo se tausaga. Atonu e masani ona fausia ai phleboliths (faʻafomaʻiina). Ata: x-ave faʻaalia o mea vaivai o loʻo i ai meaola i totonu. MRI: T1-maualuga pe fesuiaʻi faʻailo. T2-maualuga faʻailo i vaega o lemu tafe. 'Ato o anufe' saini. Sili ona 'aloʻese mai le paiopopo. Rx: faigata: faʻalotoifale excision vs. embolization vs. maitauina. Maualuga tupu.
Potoifale Tuma o le gaosiga o le gaʻo (PNST): faʻaleagaina ma faʻamalosi. Faʻalavelave tele i le NF1 ma le maualuga atu o le lamatiaga o le maʻi PNST. Benign PNST: Schwannoma vs.Neurofibroma. Spinal vs. gasegase lautele. Faʻasolopito: Schwann sela e pipii i le fibroblast ma ipu. Faʻamatalaga: pts i 20s ma 30s, faʻasalalauga faʻasalalau ma poʻo le w / o le aʻafiaga i le lotoifale. Ata: MRI: T1: faailoga vavae-gaʻo, T2: faʻailoga faʻamaonia. T1 + C faaleleia
Suga Suʻa Sarcomas: MFH, Synovial sarcoma, (talanoaina), Liposarcoma (sili atu i le retroperitoneum) Dx: MRI. Clinical: O le Dx e tuai le tuai o le tele o le tele o mea e le amanaiaina. Ole maualuga o le siakiina o le tino e talafeagai ma le MRI, e mafai ona fesoasoani le US. O le vailaʻau o loʻo faʻamaonia le Dx.
Ovi ponaivi Neoplasms: Tamaiti: OSA, Ewing's sarcoma (talanoaina) Matutua: Mets, Myeloma (talanoaina)
Faʻataʻotoga ole FX Fx tala mo le 4-6% o FX uma. Osteoporotic (OSP) Fx i> 60 yo e fesoʻotaʻi ma sina faʻafitauli faʻapitoa i le F: M 2: ratio 1. I le gasegase talavou, o le maualuga o le malosi o le gasegase malosi e sili ona taua.
Faʻalavelave faʻafuaseʻi: ulutala o le AVN, Axillary N paralysis.
Neer Faavasegaina: mafaufauina vae i le laina 4-anatomical ma poʻo le o ese atu> 1-cm & 45-tikeri angulation
E tasi le vaega Neer Fx- leai se sifi poʻo le laʻititi lava <1-cm / 45-tikeri. Mafai ona aʻafia 1-4 laina ma M / C i sili tuberosity. 80% o le vavalalata faʻamalulu Fx o se tasi-vaega Neer.
Vaega lua Fx: 1-vaega ua faʻanoanoa> 1-cm / 45-degrees. m / c aofia ai le taotoga
Vaega tolu Fx: 2-vaega ua faimalaga> 1-cm / 45-tikeri.
Vaega fa Fx: uma 4-vaega mafai ona aveʻesea. Le masani ai <1%
Ata: 1st laasaga-radiography, CT e mafai ona faʻaaoga i mataupu sili ona faigata. Orthopedic referral
Pulega: O le tasi itu vaega Fx e togafitia ma le Sling Immobilisation ma le alualu i luma alualu i luma
O le toatele o le Fx i le au matutua o loʻo togafitia e le o galulue
Tamaiti laiti (40-65) atonu e manaʻomia i nisi taimi le hemiarthroplasty pe a maua le 3 poʻo le 4-part Neer Fx. Tele le lamatiaga o le AVN
Faʻasologa o Vaʻavaʻa
Faʻaaliga: Ata tauagavale: Fx aofia ai le anatomical ua ma le tele tuberosity ma laʻititi femalagaaiga <1-cm / 45-tikeri o lea Dx o se tasi-vaega Fx. Ata taumatau: Laʻititi avulsion Fx o le sili tuberosity ma taua suiga (> 45-tikeri & 1-cm) faʻapea Dx o lua-vaega Fx
Faʻaliga: tolu-vaega Neer Fx (agavale) ma le fa vaega Neer Fx (taumatau)> Pulega: faʻagaioiga i le tele o mataupu i laiti (40-65) tagata mamaʻi
Faʻasalaga o le faʻaaogaina o le lima ae Glenohumeral Joint dislocation (GHJD)
Manaʻo e faʻavae le vavae ese o le humerus mai le sulu sikola. I 20-40s M: F 9: ratio 1, in60-80S M: F 3: 1
Anatomia: tauʻau stability is sacrificed for mobility, and overall GHJD is the m/c among large joints in the body
Protective falls (e.g., FOOSH) and MVA are m/c causes. GHJ is most vulnerable in abduction, extension and external rotation. Anatomical factors: shallow glenoid, laxed ant-inferior capsule and GH ligaments. GHJD will induce severe tearing of major GHJ restraints. Associated osseous and labral injuries are common and may lead to chronic instability, DJD,�and functional changes
3-ituaiga: Anterior GHJD (95%)
GHJD Faʻapitoa (4%) aemaise lava e fesoʻotaʻi ma faʻataʻi faʻamaʻi, electrocution ma mafai ona tupu b / l
Maualalo GHJD aka Laxatio Erecta (<1%) e fesoʻotaʻi ma manuʻa tuga
Falemaʻi: O le AGHJD o loʻo i ai se tiga matuia, o le lima o loʻo faʻasalaga i fafo ma faʻasolosolo, o le faʻaitiitia tele o le gaioiga. E mafai e le GHJD ona faʻaauau pea le faʻaleagaina.
Pulega: prompt reduction in ED under anesthesia or heavy sedation with Kocher technique top image (not used), External rotation method (middle) or Milch technique (can be used w/o anesthesia) and a few other methods. Delay in reduction correlates with greater risk of immediate and long-term�complications
Faʻamatalaga Faʻasalaga Ata
Shoulder series x-radiography is sufficient. Additional Imaging with CT scanning and MRI may be helpful to Dx osseous, cartilage, labral/ligaments pathology
Anterior GHJD (95%). O le vaega pito i lalo (pito i luga) o le humerus o le m / c
Vaʻaia GHJD e mafai foi ona tupu e avea o le eletise (lalo tauagavale) ma e le o se taimi mulimuli ane i lalo ifo
Key to radiographic search is to evaluate associated Bankart and Hill-Sachs injuries
Bankart Lesion
Occurs during anterior GHJD d/t impaction of the head into anterior-inferior glenoid. Variations exist (see next slide). BonyBankart can be seen on x-rays. So-called soft tissue Bankart requires MRI. Cartilage (soft)Bankart is the m/c.
Hill-Sachs aka Hatchet deformity (arrow postreduction)occurs during the same mechanism as Bankart, i.e., compression and impaction of posterolateral aspect of the head against the glenoid producing wedge-shape Fx. Hill-Sachs lesion may predispose to recurrent/chronic GHJD.
Bankart lesion may heal, but operative suture anchors are needed sometimes
CT arthrogram and MRI may be helpful
Ituaiga o Bankart Lesion
Note different types of Bankart lesion. Onlyosseous Bankart can be seen radiographically. Soft tissue Bankart requires MRI with and without intra-articular gadolinium(arthrogram).
Faʻafitauli Faʻapitoa
Faʻamatalaga: o le GHJD mulimuli ane ma ona faʻailoga iloga:
Trough sign aka reverse Hill-Sachs. Occurs d/t anterolateral head impaction Fx
Rim sign: only occurs in the PGHJD d/t posterior position of the head and anterior glenoid-to humeral head distance 6-mm or greater
Faailoga o le moli: d / t suiga loloto i totonu o le humerus (ulu)
GHJD maualalo
GHJD fesoasoani Laxatio Erecta
O le faʻamalosi faʻamalosi ma le leai o se mea e sili atu ona leaga nai lo le maʻiti. Faʻalavelave sili atu ona afaina ai le manua o le neurovascular ma le fax Fx
The dislocated arm is hyperabducted and fixed with the elbow flexed and the arm above the head
ACJ Dislocation (ACJD)
ACJD: common injury, 9% of shoulder girdle injuries esp. in male athletes by a direct blow
Rockwood faʻavaeina (agavale) iloilo le faʻailoaina o le AC ma le CC ligaments ma musika o loʻo i lalo
Type1, 2, 3 among the m/c
Tusia 1: faʻamalosi o le ACL ma / o le faʻanoanoa
Tusia 2: loimata o le ACL ma le faʻamalosi o CCL
Type 3: tear of AC & CCL. The clavicle is elevated above the acromion. If <2-cm good results with conservative Rx.
Ata: x-radiography ma le b / l ACJ ma faatasi ma w / o mamafa e faatusatusa uma ai le ACJ. I mataupu ogaoga CT scanning esp. pe afai o le Fx ua manatu
Pulega: Ituaiga 3 (> 2-cm) & Ituaiga 4-6Operative
Faʻasologa 3 ACJ Vavaega
Faʻasologa 3 ACJ vavaega (pito i luga tauagavale)
E sili atu le taua o le ACJD (ata pito i lalo) ma le faailoilo o le acromion i lalo o le paʻu ma maua ai le ORIF
Rotator Cuff Muscles (RCM) Pathology
RCM tendinopathy: collagenous degeneration of RCM particularly Supraspinatus M. tendon(SSMT) d/t overuse/degeneration-micro tearing with collagenous replacement. Impingement syndrome is a 2nd extrinsic cause. Presented clinically as pain and limited ROM
Ata ata Dx: MSK US e mafai ona faʻamaonia e pei o le MRI ma sili atu i nisi o itu v / v iloiloga malosi v. Tau aoga
Key MRI clue is thickened inhomogeneous SSM Faatasi ai ma le faʻateleina o faʻailo luga uma o poloka faasologa d / t gaʻoa faʻaleagaina ma pupuga (agavale ata: T1 & T2 FS)
MSKUS findings: thickening of the SSMTsubstance with a change�in normal echogenicity.MSKUS is good to DDx with SSMT tears. US advantages are that it allows dynamic evaluation of painful structures
Lisi leotele o le SSMT: partial (incomplete) tear ofSSMT may occur at the bursal and articular surface or interstitial, i.e., intra-substance/noncommunicating. Etiology: sub-acromial impingement, acute strain, and chronic microtrauma tendinosis
Falemaʻi: tiga i le abd ma le fesuisuiai, suega o le tui, suega a Hawkins-Kennedy, ma isi Pelas: o loimata maligi e sili atu ona tiga nai lo loimata uma
Ata ata Dx: E lelei tele le MSKUS e pei o le MRI (suʻesuʻega NBsome o loʻo faailoa mai ai le MSKUS sili atu nai lo le MRI). Faʻaiʻuga I le MRI: afaina / le atoatoa le loimata o le SSMT ua tumu i le vaeluaga o le suavai +/- teuga o le tino
MSKUS: faʻaitiitia le faʻalogoina o le SSMT, faʻamalosolo ma le vaeluaina ua faatumuina i le vai (vaega o tala i lalo). Faʻasalaga leiloloa o le tendon bursal poʻo le faʻaoga faʻapitoa.
Loto Tonu SSMT (rot cuff) loimata: fesuiaiga / vevesi o le rot cuff. 2nd i le aʻafia e ala i le avega o le Acoked, le faʻaaogaina o le tino poʻo le faʻalavelave tigaina. 7-25% o le tiga o le tauau i le lautele o tagata. Falemaʻi: tiga i suega o tui.
Ata ata Dx: MSKUS is as good as MRI.Limitations: poor Dx of labral pathology. Key USDx: focal tendon interruption, an anechoic gap (fluid filled), hypoechoic tendon, tendon retraction, uncovered cartilage sign (bottom left, A: US B: MRI)
MRI: key Dx: insertional tear extending through entire SSMT crescent, retraction with fatty degeneration of SSMT and the muscle. If retraction is at 12 o�clock or greater (top images), it may not be anchored operatively
Rotator Cuff (RTC) Tendinitis Faʻapitoa: usually d/t calcium HADD crystals. Middle-aged women are most affected. Ranges from asymptomatic imaging finding to severe destructive arthropathy or Milwaukee shoulder(infrequent)
HADD has 3-pathological phases: formation resting-resorption.Mild-to-moderate pain esp. in resting phase.
Ata: x-radiography: homogenous ovoid mineralization within RTCMT, m/c in SSMT. MRI: ovoid/globular decreased signal on all pulse sequences often with surrounding edema (bottom left)
Rx: fofo o le tagata lava ia. Tulaga faʻapitoa: faʻataʻitaʻiga galue, ma isi.
Lautele Laumei Apamemea i le Lagolago (SLAP) Liona / Loimata
SLAP loimata: FOOSH and throwing sports or chronic shoulder instability aka Multidirectional shoulder instability (in 20%). Type 1-9 exist but the M/C areType 1-4
I le 4-types sili atu lebrum e aafia i le w / oLHBMT fao anchor (vaai ata). Falemaʻi: tiga, tapulaʻa o le AROM ma suʻega faʻaosoosoga malosi, e masani lava e le o ni faʻamatalaga maʻoti e faʻamaonia ai le RTCpathology
E taua tele le faʻataʻitaʻiga: ata sili ona lelei MRI arthrography. Key signs: hyperintense linear fluid signal within superior labrum +/- extending along the LHBT on fat-suppressed fluid sensitive imaging and FS T1 arthrogram. Best observed on coronal slices.
Rx: small tears may heal, but unstable tears require operative care.
Key DDx: fesuiaiga faʻaanatura e pei ole foford complex maSub-labral foramen
SLAP tear with a paralabral cyst (bottom right)
Normal variant DDx: sub labral foramen(bottom left) note: MR arthrography with contrast undercutting the labrum but w/o extending posteriorly to the LHBT
Laʻu Uʻamea
GHJ DJD: usually associated with a 2nd cause: trauma, instability, AVN, CPPD, etc. Presented with pain, crepitus and decreased ROM/function. Associated RTC disease may be present. Imaging; x-radiography is sufficient and provides grading/care planning.Major findings: joint narrowing, osteophytosis esp. at the inferior-medial head (orange arrow), subchondral sclerosis/cysts. Often noted superior head migration d/t RTC disease.
ACJ OA: common and typically primary with aging. Presents with ACJ loss and osteophytes. Osteophytes along the undersurface of the ACJ �keel osteophytes�(blue arrow) may lead to RTC muscle tear. Regional bursitis is other clinical feature of ACJ arthrosis.
Management: usually conservative depending on clinical signs/symptoms
Ratuumatoid Arthritis GHJ: RA is a multisystem inflammatory disease affecting multiple joints lined by the synovium. GHJ RA is common (m/c large joints in RA knees/shoulders). Clinically: pain, limited ROM and instability, muscle weakness/wasting. Hands, feet,�and wrists are m/c affected. Imaging: x-radiography reveals periarticular erosions, uniform joint space loss, juxta-articular osteoporosis, subluxations,�and soft tissue swelling. MRI can help detect�commonly associated RTC tearing and instability. Early changes can be detected by MSKUS esp. with power Doppler use indicating hyperemia/inflammation.
Note: L shoulder x-ray revealing cartilage destruction and symmetrical joint loss, multiple erosions, and likely loss of RTCM support with superior head migration, ST effusion present.
Note: PDFS coronal and axial MRI slices of GHJ RA indicating marked inflammatory joint effusion, bone erosion/edema, synovial pannus formation and likely tear in RTC m. Management: Rheumatological referral and pharmacotherapy with DMARD. Operative care asRTCM repair. 10% of patients are disabled d/t RA
Neuropathic Osteoarthropathy aka Charcot’s shoulder: d / t neurovascular ma le neural periarticular damage. Mafuaʻaga tele e i ai. / / E faʻaleleia le maʻisuka i le ogatotonu. Shoulder Charcot is m / c i Syringomyelia (25%), faʻamaʻi pipisi, MS, ma isi. Dx: falemaʻi (50% tiga / fulapula 50% faʻaleagaina le tiga). E taua tele ata. X-radiography e lava i mataupu ua faʻatulaga lelei, ae o le taimi muamua o le luʻitau o le Dx e luʻitauina. MRI e mafai ona fesoasoani i le vave o le Dx ma le tuai o faʻafitauli. Rad Dx: O le Shoulder Charcot o le m / c ua faailoa mai e pei o se ituaiga o mea e faaleagaina ai le ulu ma le ulu o le ulu e foliga mai o le gasegase ua gasegase faatasi ai ma otaota o le tino, o le eletise, taofiofi, o le vavae ese, ma isi mea autu
Septic Shoulder: shoulder is the 3rd m/c followingknee>hips. Patients at risk: diabetics, RA pts, immunocompromised, I.V. drug users, indwelling catheters, etc. Routes: hematogenous (m/c), direct inoculation (iatrogenic, trauma etc.) adjacent spread(e.g. OM). Staph. Aureus (>50%) m/c.
Falemaʻi: tiga soʻoga ma dec. ROM, fiva 60% naʻo, toxemia, inc. ESR / CRP. Dx: ata faʻataʻitaʻi ma tuʻufaʻatasi manaʻoga / aganuu. RadDx: vave x-ave e masani ona le mafaamatalaina seʻi vagana ST aoga / gaʻoa vaʻalele pupuni, soʻoga faʻalauteleina. I se taimi mulimuli ane7-12 aso patchy osteopenia, mogamoga 'aina / permeating ponaivi resorption, articular faʻatamaia, soʻoga vaiti Me alualu i luma i le ogaoga faʻatasi faʻaleagaina ma ankyloses. Early Dx & IV vailaʻau faʻafomaʻi e taua e oʻo lava i luma o le aganuʻu. Faʻasusuina faʻagaioiga ma alavai faʻatasi alavai i nisi tulaga. Faʻafitauli e mafai esp. pe a fai e tuai le Rx. MSKUS ma le faʻanaunauga ole nila e mafai ona fesoasoani. Faʻaaliga: (ata pito i luga) e le o ni faʻalavelave faʻafuaseʻi o loʻo faʻalauteleina le ulu ma le maualalo o le ulu o loʻo faʻaletonu d / t septic A dx: e ala i le faʻanaunauga o le nila Staph. Aures.
Ischemic Osteonecrosis
Ischemic Osteonecrosis o le ulu o le taumene may occur d/t trauma (Neer four-part Fx), Steroids, Lupus, Sickle cell, Alcoholism, Diabetes,�and many other conditions. Imaging is crucial: MRI detects earliest changes as intraosseous edema. X-ray features are late, presented as a collapse of subchondral bone with sclerosis �snow cap� sign, fragmentation, and progressive severe DJD
Faʻataʻitaʻiga: faʻataʻitaʻiga faʻasolosolo, faʻasolosolo i taimi muamua, hemiarthroplasty i le faʻasolosolo ma le maualuga o le gasegase i mataupu ogaoga.
Shoulder Neoplasms
In adults >40, bone Mets d/t lung, breast, renal cell, thyroid CA & prostate are the m/c causes. Clinically: may mimic pain resemblingRTC/joint changes. Should be evaluated carefully. Key to Dx: Hx, PE and Imaging esp.in pts with known primary
Ata: 1st step x-rays, MRI can help, Tc99bone scintigraphy helps to detect regional and distant disease. X-ray features: destructive lytic changes typically in prox humerus(red marrow) with or w/o path Fx. DDx: Mets, MM, lymphoma
Clinically: night pain, pain at rest, etc. Lab tests: unrewarding, in severe cases hypercalcemia may be noted.
Peraimeri O le ponaivi afaina o le neoplasms (tauau) Adults: M. Myeloma or Solitary plasmacytoma, Chondrosarcoma may transform from an enchondroma and some others. In children/teenagers: OSA vs. Ewing�s
Peraimeri le ponaivi ponaivi (nefalms) (tauau). Tagata matutua: Enchondoma (faʻamaʻi io latou 20-30s) GCT. I tamaiti: O le ponaivi ole ponaivi (Unicameral Bone cyst), Osteochondroma, Aneurysmal Bone Cyst, Chondroblastoma (seasea)
Ata: 1st step x-radiography
MRI e taua ile Dx. Ae maise lava i mataupu o neoplasms leaga matuia Iloilo le maualuga, osofaʻiga o le tino vaivai, fuafua tatau, faatulaga, ma isi.
E tusa ma le 1.5 miliona tagata i le Iunaite Setete o loʻo i ai le faʻamaʻi faʻamaʻi. gugu Rheumatoid, poʻo le RA, o se faʻamaʻi masani, faʻaleagaina autoimmune e mafua mai i le tiga ma le mumu o sooga. Faatasi ai ma le RA, o le puipuiga, lea e puipuia ai lo tatou manuia e ala i le osofaia o mea mai fafo e pei o siama ma siama, sese osofaia osofaʻi. O le gasegase o le toto e masani ona afaina ai sooga o lima, vae, tapulima, alofilima, tulivae ma tapuvae. O le tele o tagata soifua maloloina e fautuaina togafitiga vave ma togafitiga o le RA.
lē faʻatino
O le gasegase o le Rheumatoid o le galu masani lea e maua i le faʻamaʻi o le gugu. O fafine, ulaula, ma i latou e iai talafaʻasolopito o aiga ole faʻamaʻi e masani ona aʻafia. Taʻiala mo faʻamaoniga e aofia ai le i ai o le tasi le soʻoga faʻatasi ma le mautinoa fulafula e le faʻamatalaina e se isi faʻamaʻi. O le ono maua mai se faʻamaʻi gugu rheumatoid faʻateleina ma le numera o laiti soʻoga aofia ai. I le tagata maʻi ma le gugu o le gugu, o le i ai o le vaega o le rheumatoid poʻo le anti-citrullined protein antibody, poʻo le maualuga o le C-reactive protein poʻo le erythrocyte sedimentation rate o loʻo fautua mai ai o se faʻamaoniga o le rheumatoid gugu. Ole suʻesuʻega muamua ile fale suʻesuʻe e tatau ona aofia ai ma le toto atoa ma le taua ma le suʻesuʻeina ole fatugaʻi ma le faʻaleagaina o le tino. Tagata mamaʻi ave biologic sooupu tatau ona tofotofoina mo le hepatitis B, hepatitis C, ma le fatafata. O le faʻamaoniga muamua o le gugu o le rheumatoid e faʻatagaina ai le vave faia o togafitiga ma faʻamaʻi o le antirheumatic agents. O le tuʻufaʻatasia o vailaʻau e masani ona faʻaogaina e faʻatonutonu ai le faʻamaʻi. Methotrexate e masani lava o le muamua-laina vailaʻau mo rheumatoid gugu. Biologic agents, e pei o le tumo nerosis factor inhibitors, e masani ona manatu i le laina lona lua sooupu pe mafai foi ona faʻaopopo mo lua togafitiga. O manulauti o togafitiga e aofia ai le faʻaitiitia o tiga soʻoga ma le fulafula, puipuia o leitio faʻaleagaina ma vaʻaia tino faʻaletonu, ma le faʻaauauina o galuega ma oe lava gaioiga. O loʻo vaʻaia le sui soʻosoʻoga mo tagata mamaʻi ma leaga o latou soʻoga o latou faʻailoga e leʻo pulea lelei e pulega faʻafomaʻi. (Am Fam Physician. 2011; 84 (11): 1245-1252. Pule Tau Fatuga 2011 American Academy of Family Physicians.)
O le gasegase o le Rheumatoid (RA) o le sili ona taatele o le gasegase o le tino, ma o le ola atoa e oo atu i le 1 pasene i le lalolagi atoa.1 Onset e mafai ona tupu i soo se tausaga, ae o le va o 30 ma 50 years.2 Disability e taatele ma taua. I le toʻatele o le US, o le 35 pasene o tagata gasegase ma le RA na i ai le le atoatoa o le tino pe a uma 10 tausaga.3
Etiology ma le Pathophysiology
E pei o le tele o faʻamaʻi autoimmune, o le etiology o le RA e faʻateleina. Genetic susceptibility o loʻo aliali mai i aiga potopoto ma monozygotic masaga suʻesuʻega, faatasi ai ma le 50 pasene o le RA aʻafiaga e mafua mai i genesisi mafuaʻaga.4 Genetic asosi mo RA aofia ai tagata leukocyte antigen-DR45 ma -DRB1, ma le tele o alleles taʻua o le tufatufaina epitope.6,7, O suʻesuʻega a le asosi i le lautele o genome ua maitauina le faʻaopopoina o saini o gafa e faʻatele ai le ono maua o le RA ma isi faʻamaʻi o le autoimmune, e aofia ai ma le STAT4 gene ma le CD40 locus.5 O le ulaula o le mea sili lea na faʻaosofia ai le siosiomaga mo le RA, aemaise ia i latou o loʻo iai le tuinanau. ono tatala le tali a le autoimmune, leai se faʻapitoa pathogen ua faʻamaonia e mafua ai RA.8 RA o loʻo faʻailoa mai e ala faʻavevesi e mafua ai le faʻateleina o sela sela i soʻoga. Faʻavaeina mulimuli ane pannus faʻavae ono taitaiina atu i lalo mafuaʻaga faʻafanoga cartilage ma ponaivi erosions. O le soona faʻatuputeleina o cytokines pro-inflammatory, e aofia ai le tumo tumoʻu kulimi (TNF) ma le interleukin-9, e faʻatosina ai le leaga.
Faʻamatalaga Faʻatau
Matua tausaga, se talaʻaga aiga o le faʻamaʻi, ma feusuaʻiga fafine e fesoʻotaʻi ma le faateleina o le aʻafiaga o le RA, e ui lava o le itupa eseesega e le lauiloa i tagata matutua tagata mamaʻi.1 O loʻo iai nei ma muamua sikaleti ulaula faʻateleina le tulaga lamatia o le RA (faʻatatau lamatiaga [RR] = 1.4, oʻo atu i le 2.2 mo le sili atu i le 40-pack-year ulaula) .11 O le maʻitaga e mafua ai le faʻamagaloina o le RA, e mafua mai ona o le faʻamalosi o le puipuia o le puipuia o le tino.12 Parity atonu e umi se aafiaga; O le RA e tau le maua i faʻamaʻi fafine nai lo fafine le aoga (RR = 0.61) .13,14 O le faʻasusu e faʻaititia ai le aʻafia o le RA (RR = 0.5 i fafine e faʻasusu i le itiiti ifo ma le 24 masina), ae o le vave lava o le menarche. (RR = 1.3 mo i latou e maua i le menarche ile 10 tausaga le matutua pe laititi ifo) ma le le faʻasolosolo o masina faʻafuaseʻi (RR = 1.5) faʻateleina tulaga lamatia.14 Faʻaaogaina o fofoga fualaʻau fualaʻau poʻo vaitamini E e le aʻafia ai le faʻamaʻi ole RA.15
faʻautaga maʻi
Faʻailoga masani
O tagata maʻi faʻatasi ma le RA e masani lava ona iai ma le tiga ma le faʻamalosi i le tele o sooga. O tapulima, mea vavalalata vavalalata vavalalata, ma sooga faʻasolosolo e masani ona aofia ai. O le faʻamalosi o le taeao i le silia ma le tasi le itula o loʻo taʻu mai ai se aʻoaʻoga faʻapitoa. E mafai ona iloa le pipiʻi Boggy ona o le synovitis (Ata 1), poʻo le faʻaaogaina o synovial maaleale e mafai ona paʻu i luga ole suʻega faʻatasi. E mafai foi e tagata maʻi ona maua mai faʻasolosolo faʻasalaga ao le i amataina le faʻafesoʻotaʻi o le sologa lelei ole tino. O faʻamalologa masani o le vaivai, gau o le mamafa, ma le fiva maualalo maualalo e mafai ona tupu ma faʻamaʻi malosi.
Faʻamaumauga Faʻamaonia
I le 2010, le American College of Rheumatology ma European League Against Rheumatism na galulue faʻatasi e fausia ni faʻavasegaga fou tuʻufaʻatasia mo RA (Laulau 1) .16 O fou taʻiala o se taumafaiga e faʻailoaina RA muamua i tagata mamaʻi oe ono le ausia le 1987 American College of Rheumatology faʻavasegaina taʻiala O faʻataʻitaʻiga a le 2010 e le aofia ai le iai o rheumatoid nodules poʻo leitio suiga suiga, o mea uma e lua e laititi mai i le amataga o le RA. E le manaʻomia foi le symmetric arthri i le taʻiala o le 2010, e faataga ai le vave faia o le asymmetric. I se faʻaopopoga, Dutch tagata suʻesuʻe na atiaʻe ma faʻamaonia se falemaʻi vavalo tulafono mo RA (Laulau 2) .17,18 O le mafuaʻaga o lenei tulafono o le fesoasoani faʻailoaina tagata mamaʻi ma le le faʻamaʻi gugu lea e foliga mai e alualu i luma i le RA, ma faʻatonutonu mulimuli ai- luga ma faʻasino.
Suʻega Faʻamatalaga
O faʻamaʻi o le autoimmune pei o le RA e masani ona iloga mai i le i ai o autoanti- tino. Rheumatoid vaega e le faʻapitoa mo le RA ma ono i ai i tagata mamaʻi ma isi faʻamaʻi, pei o le hepatitis C, ma i tagata matutua soifua maloloina. Aneti-citrullinated porotini vailaʻau e sili atu faʻapitoa mo RA ma ono faia se sao i faʻamaʻi pathogenesis.6 Pe tusa o le 50 i le 80 pasene o tagata ma RA o loʻo i ai le rheumatoid factor, anti-citrullined protein antibody, poʻo uma ia.10 Tagata mamaʻi ma le RA e ono maua o le lelei antinuclear antibody faʻaiuga faʻaiuga, ma o le suʻega o le prognostic taua i ituaiga talavou o lenei maʻi.19 C-toe faʻamalosia o le maualuga o le protein ma le erryrocyte sedimentation fua faatatau e masani ona faʻateleina ma galue malosi RA, ma o nei ogaoga vaega reactants o vaega o le fou RA faʻavasega tulaga faʻatulagaina.16 C-toe faʻamalosia porotini tulaga ma erythrocyte sedimentation fua faatatau mafai foi ona faʻaaogaina e mulimuli ai faʻamaʻi gaioiga ma tali atu i vailaʻau. E aoga tele le faʻavaeina ole toto ile faʻavasegaina ma le suʻesuʻeina ole fatugao ma le hepatic function ona e ono aʻafia ai filifiliga ile faʻaiuga (eg, o le tagata maʻi e le lava le fatugaʻo poʻo le taua o le thrombositopenia e ono le faatonuina se vailaʻau e le faʻaaogaina le vailaʻau e puipuia ai [NSAID]). O le vaivai o le toto o le maʻi masani e tupu i le 33 i le 60 pasene o tagata mamaʻi uma e maua i le RA, 20 e ui lava o le toto e tau leai se toto e tatau foi ona iloiloina i tagata mamaʻi o loʻo faia ni vailaʻau oona poʻo ni NSAID. O le Methotrexate o loʻo faʻataʻitaʻia i tagata mamaʻi e maua i gasegase o le hepatic, e pei o le hepatitis C, ma i tagata mamaʻi e tele le faaletonu o le toto. 21 O le togafitiga o le biologic, e pei o le TNF, e manaʻomia ai se suʻega o le tuberculin leaga poʻo togafitiga mo latent tuberculosis Hepatitis B reactivation mafai foi ona tupu ma TNF taofiofia le faʻaaogaina.22 Radiography o lima ma vae e tatau ona faia e iloilo ai mo uiga periarticular suiga erosive, na e ono faʻailoa mai o se sili atu osofaʻiga RA subtype.10
Eseesega Faʻamatalaga
O mea na maua i le paʻu e taʻu mai ai systemic lupus erythematosus, systemic sclerosis, poʻo le psoriatic arthritis. Polymyalgia rheumatica tatau ona mafaufauina i se tagata matua matua ma faʻailoga faʻapitoa i le tauʻau ma suilapalapa, ma le onosaʻi e tatau ona fesiligia ni fesili e fesoʻotaʻi ma fesoʻotaʻiga le tumau arteritis. E aoga tele le leitio ole fatafata e iloilo ai le sarcoidosis e fai ma aʻoaʻoga o le gugu. O tagata mamaʻi e iai faʻamaʻi i tua, o talaʻaga o faʻamaʻi o le manava o le manava, poʻo faʻamaʻi mata ole mata e iai le spondyloarthropathy. Tagata e i lalo ifo o le ono vaiaso o faʻailoga e ono maua i le virusi, pei o le parvovirus. Faʻatino taimi faʻatapulaʻaina o vaega ogaoga soʻoga soʻoga faʻapitoa fautua mai ai le tioata arthropathy, ma e tatau ona faia arthrocentesis e iloilo ai mo monosodium urate monohidate poʻo kalisiu pyrophosphate dihydrate tioata. O le iai o le tele o myofascial faʻaoso manatu ma somatic auga e ono fautua mai fibromyalgia, lea e mafai ona nonofo faʻatasi ma RA. Ina ia fesoasoani faʻatonutonu faʻamaoniga ma faʻataʻitaʻia togafitiga togafitiga, tagata mamaʻi ma le gugu gugu tatau ona vave faʻatatau atu i se rheumatology subspecialist.16,17
O le gasegase o le Rheumatoid, poʻo le RA, o le ituaiga masani lea o le gasegase. RA o se maʻi mimiti, mafua mai pe a osofaia e le tino puipuia, le tino o le tino o le tino, osofaʻiga o ana lava ma masini, aemaise o sooga. O le gasegase o le ruthumatoid e masani lava ona iloa e ala i faailo o le tiga ma le mumu, e masani ona aafia ai sooga laiti o lima, tapulima ma vae. E tusa ai ma le tele o polofesa, o le vave togafitiga ma le togafitiga o le RA e taua tele ina ia puipuia ai le faʻaleagaina atili o faʻatasi ma faʻaitiitia ai faʻamaʻi tiga. Dr. Alex Jimenez DC, CCST Insight
faiga
A maeʻa ona maua le RA ma faʻaalia se uluai iloiloga, e tatau ona amata togafitiga. O taiala talu ai nei na faʻatautaia ai le puleaina o le RA, 21,22 ae o le gasegase o maʻi e taʻalo foi i se vaega taua. E i ai ni manatu faʻapitoa mo tamaitai o le faʻasaga o le matua ona o le tele o vailaʻau e iai ni aafiaga leaga i le maʻitaga. O sini o le togafitiga e aofia ai le faaitiitia o tiga ma le fulafula, puipuia o le le atoatoa (e pei o le faasoesa o le auala) ma le faaleagaina o le leitio (e pei o le faaleagaina), tausia o le lelei o le olaga (o le tagata lava ia ma le galue), ma le pulea o isi mea faaalia. O faʻamaʻi-faʻafouina o virheumatic drugs (DMARDs) o le autu o le togafitiga RA.
DMARDs
DMARDs mafai ona avea ma biologic poʻo nonbiologic (Laulau 3) .23 Biologic agents aofia ai monoclonal antibodies ma recombinant recepinant e poloka ai cytokines e faʻalauiloaina le faʻateʻa cascade nafa mo le RA faʻailoga. Methotrexate e fautuaina e avea ma togafitiga muamua i tagata mamaʻi ma gaioi le RA, seʻi vagana ua faʻapipiʻiina pe le taliaina. 21 Leflunomide (Arava) e mafai ona faʻaaogaina o se fesuiaʻiga i le methotrexate, e ui lava o le gastrointestinal afaina ai aʻafiaga e sili ona taatele. Sulfasalazine (Azulfidine) poʻo le hydroxychloroquine (Plaquenil) faʻatamaʻi e pei o le monotherapy i tagata mamaʻi ma le maualalo o faʻamaʻi poʻo le leai o ni faʻamatalaga leaga (pei o le seronegative, non-erosive RA) .21,22 O le tuʻufaʻatasia o faʻatasi ma le lua pe sili atu DMARD e sili atu le aoga nai lo monotherapy; peitaʻi, o faʻaletonu e mafai foi ona sili atu.24 Afai e leʻo faʻatonutonuina le RA ma le DMbi e le faʻataʻitaʻia, e tatau ona amataina se DMARD biologic. Afai o le TNF taofiofia e le aoga, e mafai ona iloiloina faʻaopopo togafitiga biologic. Faʻaoga faʻatasi le sili atu ma le tasi le biologic therapy (eg, adalimumab [Humira] ma le abatacept [Orencia]) e le fautuaina talu ai le le taliaina o fua faatatau o aʻafiaga. 21,22
NSAID ma Corticosteroids
O togafitiga o fualaau mo le RA e mafai ona aofia ai NSAID ma oral, intramuscular, poʻo corticosteroids intra-articular mo le puleaina o tiga ma le mumū. I le tulaga lelei, o NSAID ma corticosteroids e faʻaaogaina mo na o le faʻafoega puupuu. DMARDs o le togafitiga sili ona lelei.21,22
Tomai Faʻapitoa
Meaʻai faʻapitoa, e aofia ai meaʻai o meaʻai ma meaʻai o le Mediterranean, na aʻoaʻoina i le togafitia o le RA e aunoa ma se faʻamaoniga mautinoa o penefiti.25,26 E ui lava i ni taunuuga lelei, e i ai le le lava o faʻamaoniga mo le aoga o le faʻasolosolo i nofoaga faʻatautaia o faʻatautaia o gasegase. ma le RA.27,28 I se faʻaopopoga, thermotherapy ma therapeutic ultrasound mo RA e leʻi suʻesuʻeina lelei.29,30 O le iloiloga a Cochrane o togafitiga o fualaʻau mo le RA faʻaiʻuina o le gamma-linolenic acid (mai le afiafi primrose poʻo le uliuli fualaʻau gaʻo fualaʻau) ma Tripterygium wilfordii (thunder god vine) e ono iai ni penefiti.31 E taua le faʻailoa atu i tagata mamaʻi o lipoti ogaoga le leaga na lipotia mai ile faʻaogaina ole vailaʻau.
Faamalositino ma togafitiga faafomaʻi
E maua mai iʻuga o faʻataʻitaʻiga faʻapipiʻiina le faʻamalositino faaletino e faʻaleleia ai le lelei o le ola ma le malosi o le muscle i tagata mamaʻi i le RA.32,33 Polokalame faʻaleaʻoaʻoga faʻaleaogaina e leʻi i ai ni aʻafiaga leaga i luga o le faʻamaʻi o le RA, numera o le tiga, poʻo le fesoʻotaʻiga o le radiographic damage.34 Tai O le atua ua faʻaalia e faʻaleleia ai le vavaega o le vavaega o tagata i le RA, e ui lava o faʻalavelave faʻafuaseʻi e faʻatapulaʻa .35 Faʻatautaia faʻafoeina o Iyengar yoga i tupulaga matutua ma RA o loʻo i lalo .36
Umi o le Tausiga
E mafai ona maua le faʻamagaloga i le 10 i le 50 pasene o tagata mamaʻi ma le RA, faʻalagolago i le faʻamalamalamaina o le faʻamagaloga ma le malosi o togafitiga.10 Faʻamagaloga e tele lava i aliʻi, tagata le ulaula, tagata e laititi ifo i le 40 tausaga, ma i latou e maua i le tuai o faʻamaʻi ( tagata mamaʻi e matua atu nai lo le 65 tausaga), ma le puʻupuʻu o le faʻamaʻi, ma le gaioi o faʻamaʻi gaioiga, aunoa ma le maualuga ogaoga vaega o mea e faʻaola ai, ma aunoa ma se mea lelei rheumatoid factor poʻo le anti-citrullined protein antibody sailiga. i le aofaʻi laʻititi talafeagai. Tagata gasegase e manaʻomia le mataʻituina soo ina ia mautinoa mausali faʻailoga, ma vave le faʻatuputeleina o vailaʻau e fautuaina ma faʻamaʻi mumu-luga.37
Suiga Fafo
O le sui sui e faʻaalia pe a iai le faʻaleagaina faʻatasi ma le le lelei o le puleaina o faʻamaoniga i le pulega faafomaʻi. O taunuʻuga uumi o le lagolago, faatasi ai ma le 4 i le 13 pasene o fesuiaiga faʻatasi soofaatasi e manaʻomia ai le toe iloiloga i totonu ole 10 tausaga.38 O le alofilima ma tulivae e masani ona suia sui.
Tausiga umi
E ui o le RA o se faʻamaʻi o soʻoga, o se faʻamaʻi foʻi e mafai ona aofia ai le tele o totoga. O faʻaaliga faʻaopoopo o le RA o loʻo aofia i le Laulau 4.1,2,10 Tagata mamaʻi ma le RA e faʻalua ona faʻateleina le ono maua o le lymphoma, lea e manatu e mafua mai ile faʻafitauli o loʻo tupu ae, ae leʻo se faʻaiʻuga o togafitiga faʻafomaʻi. 39 Tagata mamaʻi. O le RA o loʻo i ai foi i se tulaga sili atu lamatiaga o le coronary artery faamaʻi, ma fomai tatau ona galulue ma tagata gasegase e fesuiaʻi tulaga lamatia, pei o le ulaula, toto maualuga, ma maualuga kolisi. 40,41 Vasega III po o IV congestive fatu toilalo (CHF) o se faʻafitauli mo le faʻaaogaina o mea taofiofi TNF, e mafai ona faʻatamaia ai taunuʻuga o le CHF. Biologic DMARDs, methotrexate, ma leflunomide e le tatau ona amataina i tagata mamaʻi o loʻo maua i le herpes zoster, faʻamaʻi pipisi, poʻo siama siama e manaʻomia ai vailaʻau. 21 O faʻafitauli o le RA ma ana togafitiga o loʻo lisiina atu i le Laulau 21
Suʻega
O tagata maʻi ma le RA e ola i le tolu i le 12 tausaga e itiiti ifo nai lo le faitau aofaʻi lautele .40 Faateleina le soifuaga faaletino i nei tagata gasegase e mafua ona o le faʻalauteleina o le maʻi cardiovascular, aemaise lava i latou o loʻo i ai faʻamaʻi maualuga faʻamaʻi ma le mumū tumau. O togafitiga faʻapitoa o le biologic e mafai ona faʻaaogaina ai le alualu i luma o le atherosclerosis ma faʻateleina ai le ola i totonu oi latou e iai le RA.41
Punaoa o Punaoa: Na maeʻa le suʻesuʻega a PubMed i fesili faʻapitoa i le faʻaaogaina o upu autu o le gasegase o le toto, faʻamatalaga faʻapitoa, ma faʻamaʻi vailaau faʻamaʻi. O le suʻesuʻega na aofia ai faʻataʻitaʻiga, iloiloga faʻapitoa, faʻataʻitaʻiga, ma iloiloga. Na suʻesuʻeina foi le Ofisa mo Suesuega Faʻalesoifua maloloina ma le Auʻaunaga o faʻamaumauga molimau, faʻamatalaga faʻamalositino, le database o Cochrane, Essential Evidence, ma UpToDate. Suʻesuʻe aso: Setema 20, 2010.
Tusitala tusitusi: Leai se fesoʻotaʻiga fesoʻotaʻiga fesoʻotaʻi faʻaalia. I le faaiuga, rheumatoid gugu o se faaumiumi, autoimmune faamaʻi e mafua ai tiga tiga, pei o tiga ma le le lelei, pupuga ma fulafula o sooga, ma isi. O le soʻoga faʻaleagaina faʻailoaina o RA o symmetrical, o lona uiga e masani ona aʻafia uma itu o le tino. E taua le vave faʻailoaina mo le togafitia o le RA. O le lautele o a matou faʻamatalaga e faʻatapulaʻaina i le faʻafitauli o le soifua maloloina o le mafaufau ma le tuasivi. Ina ia talanoaina le mataupu, faʻamolemole lagona le saoloto e fesili ia Dr. Jimenez pe faʻafesoʻotaʻi mai matou i le915-850-0900 . Faʻatautaia e Dr. Alex Jimenez
Autu Maualuga Talanoaga: Faʻasalaina o Paʻu Tino e aunoa ma se Taʻaloga
Tiga tulivae o se lauiloa auga e mafai ona tupu ona o le eseese o tulivae manuʻa ma / poʻo tulaga, e aofia ai--afaina taʻaloga. O le tulivae o se tasi o sooga sili ona faigata i totonu o le tino o le tagata e pei ona faia i luga o le vaeluaina o ponaivi e fa, fagaga e fa, ituaiga o manoa, lua manisci, ma le cartilage. E tusa ai ma le American Academy of Family Physicians, o mafuaaga sili ona taatele o le tiga o le tulivae e aofia ai le patellar subluxation, patellar tendinitis poʻo le tulivae o le matua, ma le maʻi o Osgood-Schlatter. E ui lava e ono tupu le tiga o tulivae i tagata i luga o le 60 tausaga, e mafai foi ona tupu tiga le tulivae i tamaiti ma tamaiti. E mafai ona togafitia le tiga o le uila i le fale e mulimuli i metotia a le RICE, peitaʻi, o ni manua ogaoga o le tulivae atonu e manaʻomia vave togafitiga faafomaʻi, e aofia ai togafitiga faʻafefesa.
1. Etiology ma pathogenesis o gugu rheumatoid. I totonu: Firestein GS, Kelley WN, eds. Kelley'ss Tusitusiga o Rhematmology. 8th ed. Filatelefia, Pa .: Saunders / Elsevier; 2009: 1035-1086. 2. Bathon J, Tehlirian C. Rheumatoid falemaʻi ma faʻataʻitaʻiga falesuesue. I: Klippel JH, Stone JH, Crofford LJ, et al., Eds. Faʻalautele i luga o Rheumatic Disets. 13th ed. Niu Ioka, NY: Springer; 2008: 114-121. 3. Allaire S, Wolfe F, Niu J, et al. O aʻafiaga o loʻo iai i le taimi nei mo le le atoatoa o le malosi o le tino e fesootaʻi ma le faʻamaʻi vai. Loto o le Arthritis. 2009; 61 (3): 321-328. 4. MacGregor AJ, Snieder H, Rigby AS, et al. Faʻailoaina le saofaga faʻapitoa i le vailaʻau oona e faʻaaoga ai faʻamatalaga mai masaga. Loto o le Arthritis. 2000; 43 (1): 30-37. 5. Orozco G, Barton A. Faʻamatalaga i aʻafiaga o le gasegase mo gasegase oona. Expert Rev Clin Immunol. 2010; 6 (1): 61-75. 6. Balsa A, Cabezo? N A, Orozco G, et al. Aafiaga o le HLA DRB1 aleles i le aʻafia o le rheumatoid galu ma le faʻatonutonuina o vailaʻau e teteʻe atu i polotini citrullined ma rheumatoid vaega. Vailautusi Res Ther. 2010; 12 (2): R62. 7. McClure A, Lunt M, Eyre S, et al. Suʻesuʻeina le faʻaauau o le suʻesuʻeina o vailaʻau / faʻataʻitaʻiga mo le aʻafiaga o le RA e faʻaaoga ai faʻapotopotoga o le lima faʻafitauli lamatia lamatia. Rheuma- tology (Oxford). 2009; 48 (11): 1369-1374. 8. Bang SY, Lee KH, Cho SK, et al. O le ulaula tapaa e faateleina ai le gasegase o le gasegase i tagata taitoatasi o loo tauaveina le HLA-DRB1, e tusa lava po o le a le mafuaaga o le rumatiid po o le anti-cyclic citrullinated peptide antibody staop. Loto o le Arthritis. 2010; 62 (2): 369-377. 9. Wilder RL, Crofford LJ. E faia e tagata faʻamaʻi pipisi ni maʻi faʻapitoa? Clin Orthop Relat Res. 1991; (265): 36-41. 10. Scott DL, Wolfe F, Huizinga TW. Laʻau o le Rateumatoid. Lancet. 2010; 376 (9746): 1094-1108. 11. Costenbader KH, Feskanich D, Mandl LA, et al. Le malosi o le ulaula tapaa, umi, ma le mutaaga, ma le lamatiaga o le gasegase o le tino i fafine. Am J Med. 2006; 119 (6): 503.e1-e9. 12. Kaaja RJ, Greer IA. Faʻaalia o faʻamaʻi masani i le taimi o maitaga. JAMA. 2005; 294 (21): 2751-2757. 13. Guthrie KA, Dugowson TA, Voigt LF, et al. Faʻafefea le faʻamalosi e tuʻuina atu puipuiga puipui-e pei o le rheuma- toth arthritis? Loto o le Arthritis. 2010; 62 (7): 1842-1848. 14. Karlson EW, Mandl LA, Hankinson SE, et al. O faʻasusu-susu ma isi mea e gaosia ai e ono afaina ai le lumanaʻi o le gugu i le galu? Iʻuga mai Suʻesuʻega Soifua Maloloina. Gugu i le gugu. 2004; 50 (11): 3458-3467. 15. Karlson EW, Shadick NA, Cook NR, et al. Vitamini E i le muamua puipuia o rheumatoid gugu: le Suesuega a le Soifua Maloloina a Tamaʻitaʻi. Gugu i le gugu. 2008; 59 (11): 1589-1595. 16. Aletaha D, Neogi T, Silman AJ, et al. 2010 fuamato Faʻamaumauga o le tuʻufaʻatasiga o le gasegase: o le American College of Rheumatology / League of European League against the Rheumatism collaborative initiatives [faʻataʻitaʻiga faʻasalalau faʻaalia ile Ann Rheum Dis. 2010; 69 (10): 1892]. Ann Rheum Dis. 2010; 69 (9): 1580-1588. 17. van der Helm-van Mil AH, le Cessie S, van Dongen H, et al. O se taʻiala mo le faʻamaʻiina o faʻamaʻi i tagata gasegase talu ai nei-e amataina le faʻaleagaina o le gasegase. Loto o le Arthritis. 2007; 56 (2): 433-440. 18. Mochan E, Ebell MH. Faʻailoaina le lamatiaga o le gasegase o le maʻisuka i tagata matutua ei ai le gasegase e le faʻaleagaina. Am Fam Physiyan. 2008; 77 (10): 1451-1453. 19. Ravelli A, Felici E, Magni-Manzoni S, et al. O faʻamaʻi pipisi e faʻamalosia ai le faʻasaina o le faʻasalaga e faʻamalosia e faʻamalosia ai le faʻamalosia o le faʻamalosia o le tino. Loto o le Arthritis. 2005; 52 (3): 826-832. 20. Wilson A, Yu HT, Goodnough LT, et al. Vaʻaia ma taunuʻuga o le anemia i le oona o le vai. Am J Med. 2004; 116 (faʻapipiʻi 7A): 50S-57S. 21. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 fautuaga mo le faʻaaogaina o vailaʻau faʻamaʻi faʻamalosi e leai ni suʻesuʻega ma faʻasolosolo faʻamalosi i vailaʻau oona. Loto o le Arthritis. 2008; 59 (6): 762-784. 22. Deighton C, O--Mahony R, Tosh J, et al. Vaega o Atinaʻe o Taʻiala. Pulega o rheumatoid gugu: otootoga o le NICE taʻiala. BMJ. 2009; 338: b702. 23. AHRQ. Filifilia vailaʻau mo le gugu rumatika. Aperila 9, 2008. www.effectivehealthcare.ahrq.gov/ ehc / oloa / 14/85 / RheumArthritisClinicianGuide.pdf. Avanoa Iuni 23, 2011. 24. Choy EH, Smith C, Dore? CJ, ma isi. O se meta-auiliiliga o le aoga ma le oona o le tuʻufaʻatasia o faʻamaʻi-fesuiaʻiina anti-rheumatic vailaʻau i rheumatoid galu faavae faʻavae i onosaʻi tuʻumuliina. Rheumatology (Oxford). 2005; 4 4 (11): 1414 -1421. 25. Smedslund G, Byfuglien MG, Olsen SU, et al. Lelei ma le saogalemu o meaʻai mo meaʻai mo le gasegase oona. J Am Diet Assoc. 2010; 110 (5): 727-735. 26. Hagen KB, Byfuglien MG, Falzon L, et al. Faiga masani mo taumafa oona. Cochrane Database Syst Rev. 2009; 21 (1): CD006400. 27. Wang C, o Pablo P, Chen X, et al. Acupuncture mo le toomaga tiga i tagata gasegase i le gasegase oona: o se iloiloga faʻaleleia. Loto o le Arthritis. 2008; 59 (9): 1249-1256. 28. Kelly RB. Acupuncture mo tiga. Fomai Fomai. 2009; 80 (5): 481-484. 29. Robinson V, Brosseau L, Casimiro L, et al. Lafo mo le togafitia o le gasegase o le vai. Cochrane Data-base System 2002; 2 (2): CD002826. 30. Casimiro L, Brosseau L, Robinson V, et al. Fomaʻi togafitiga mo togafitiga o le gasegase o le vai. Cochrane Database Syst Rev. 2002; 3 (3): CD003787. 31. Cameron M, Gagnier JJ, Chrubasik S. Herbal o togafitiga mo le togafitia o le gasegase o le maʻisuka. Cochrane Database Syst Rev. 2011; (2): CD002948. 32. Brodin N, Eurenius E, Jensen I, et al. Faʻailogaina o tagata mamaʻi i le amataga o le gasegase o le gasegase i le gaioiga maloloina faaletino. Loto o le Arthritis. 2008; 59 (3): 325-331. 33. Baillet A, Payraud E, Niderprim VA, et al. O se faʻamalositino malosi polokalame e faʻaleleia atili ai tagata mamaʻi i le atoatoa i rheumatoid gugu: o se ono fuafuaina faʻasolitulafono faʻatautaia faʻataʻitaʻiga. Rheumatology (Oxford). 2009; 48 (4): 410-415. 34. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, et al. Polokalame faʻaosolosi o le faʻaaogaina (malosi faʻamalosi ma / poʻo le faʻamalosia le aʻoaʻoga malosi) i tagata gasegase e maua ai le gasegase oona. Cochrane Database Syst Rev. 2009; (4): CD006853. 35. Han A, Robinson V, Judd M, et al. Tai chi mo le togafitia o le gasegase o le vai. Cochrane Database Syst Rev. 2004; (3): CD004849. 36. Evans S, Cousins L, Tsao JC, et al. O se suega faʻatautaia e suʻesuʻe IYengar yoga mo le autalavou matutua ma faʻamaʻi faʻamaʻi. Tofotofoga. 2011; 12: 19. 37. Katchamart W, Johnson S, Lin HJ, et al. Predictors mo le togafitiga i tagata mamai o le gasegase oona: o se iloiloga faʻaleleia. Faʻasologa o Tausiga o le Arthritis (Hoboken). 2010; 62 (8): 1128-1143. 38. Wolfe F, Zwillich SH. O taunuʻuga umi o le gasegase o le tino: o se 23-tausaga o loʻo faʻamoemoe, suʻesuʻega umi o le tuufaatasiga faʻatasi uma ma ona sui i 1,600 faʻamaʻi faʻamaʻi faʻamaʻi. Loto o le Arthritis. 1998; 41 (6): 1072-1082. 39. Baecklund E, Iliadou A, Askling J, et al. Faʻalapotopotoga o faʻamafanafanaga masani, e le o togafitiga, faʻateleina le lamatiaga o le lymphoma i le gasegase oona. Loto o le Arthritis. 2006; 54 (3): 692-701. 40. Friedewald VE, Ganz P, Kremer JM, et al. AJC faatonu '' maliliega: rheumatoid gugu ma atherosclerotic fatu fatu faʻamaʻi. Am J Cardiol. 2010; 106 (3): 442-447. 41. Atzeni F, Turiel M, Caporali R, et al. Le aʻafiaga o togafitiga faʻafefelosolo i luga o le fatu cardiovascular o tagata mamaʻi ma faʻamaʻi pipisi. Faʻaaliga 2010 9; 12 (835): 839-XNUMX.
M / C faʻavaeina le vae i le faʻasalalauga-metatarsal (Lisfranc joint). Faʻatonu le aʻafiaga poʻo le faʻaleleia ma le totoina poʻo le faʻasolosolo e feliuaʻi le vae. Lisfranc ligament o loʻo umia 2nd MT base ma 1st Cu ua vaʻaia. Faʻaalia ma poʻo le f / o le faʻatauvaʻa-faʻamalosi.
Ata: 1st sitepu: vae radiography i le tele o mataupu lava ia Dx. E ono fesoasoani le MSK US: faʻaali le faʻalavelave ile Cu1-Cu2. Ligament ma lautele avanoa> 2.5mm. MRI ono fesoasoani ae le taua. Fesoasoani vaʻai mamafa mamafa Dx.
2-ituaiga: homolateral (1st MTP soʻotaga i le faʻafesoʻotaʻiga) ma eseesega (2-5 MT faʻasolosolo mulimuli ane ma 1st MT medally)
Faʻatautaia: faʻapitoa le faʻaaogaina o galuega
NB Atraumatic Lisfranc dislocation o se faʻalavelave faifaipea o le vae o le maʻisuka Charcot
Osteochondral Puapuaga a le Talus (OCD)
Taatele. E le o se faʻafitauli na maua i le sili-medial talar dome. E mafai ona aʻafia ai le gasegase o le gasegase.
Falemaʻi: tiga / faʻamataʻu / tapuni. E taua tele ata.
1st laasaga: e mafai e le radiography ona faʻaalia le le mautonu o le eletise / halo, vaega.
MRI fesoasoani esp. pe afai o le OCD o le cartilaginous ma e faʻaalia le ponaivi.
Pulega: e le o faagaoioia: short-leg cast / immonbilization-4-6 wk. faʻamalosi: aveeseina arthrocsopic.
Faʻamaumauga: faʻamuamua 2nd DJD
Metatarsal Manua
Masani ma Faʻamamaʻa gau e taatele: m / c 5th MT & 2nd, 3rd MT.
Jones Fx: extra-articular Fx o faʻataʻitaʻiga metaphysis o le 5th MT. Maua e le lotogatasi. E masani ona faʻagaioia faʻagaoioia.
Pese-Jones: intra-articular avulsion o le 5th MT styloid / base eccentric contraction o Peroneus Brevis M. Pulea faʻataʻitaʻi: boot-cast immobilization. Uma Jones & Pseudo-Jones Dx i vae faasologa radiography.
Manatua Fx. Calcaneus, 2nd, 3rd, 5th MTs. Utaina faʻateleina (tamoʻe) poʻo le "Mati vae" 2nd / 3 MT. Togafitiga: tiga i gaioiga, faaititia e malologa. Dx: x-ave masani unrewarding muamua. MRI poʻo le MSK US ono fesoasoani. Pulea: Faʻapitoa. Faʻafitauli; alualu i luma i le atoatoa Fx
Turf toe: taʻaloga taʻalo masani a le 1st MTP-sesamoid/ plantar ua masae le ipu lauti. 1st MTP le mautonu / tatala. Pulea faʻagaoioia.
Gugu o le vae ma tapuvae
DJD o le tapuvae: le masani ai o le muamua OA. Masani atiina ae pei o le 2 i faʻaletonu / AVN, RA, CPPD, Hemophilic arthropathy, Juvenile Idiopathic Arthritis, ma isi faʻaaliga pei DJD: osteophytes, JSL, subchondral cIST uma vaʻaia i luga o x-ray
Inflammatory Arthritis: E ono tupu le RA ile tapuvae poʻo se soʻoga soʻofaʻatasi. E masani lava ona iai ma symmetrical Lima / vae RA muamua (2nd, 3rd MCP, tapulima, MTP i vae) masani ma eleele tafia, JSL toniga, juxta-articular osteopenia, ma tuai tuai subluxations.
HLA-B27 spondyloarthropathies: e masani ona aʻafia ai vaega pito i lalo: mulivae, tapuvae vae i le Toʻaga (Reiter). Erosive-aoga ponaivi faʻateleina o se taua Dx.
Gasegase o le oona: taatele i le pito maualalo. Ankle, ogatotonu vae vae 1st MTPs. Amataga amata: matuitui gouty gugu ma ST aoga ma leai erosions / tophi. Gout tophaceous faaumiumi: peri-articular, intra-osseous taia-i fafo erosions ma ova-tautau pito, leai amataga JSL / osteopenia, ST. Tophi ono vaʻaia.
Eseesega faʻasoesa: PVNS. Le masani ai. Aafia 3-4th tausaga o le olaga. O le iʻuga o le faʻateleina o le synovial ma Macrophages ma le tele o vaega o Giant Cells ua faʻatumuina i le hemosiderin ma le faʻaputuputuina o gaʻo e ono taitai atu ai i le fulafula, faʻaleagaina o le cartilage, maʻa o ponaivi. Dx: x-ray o le le lava, MRI masani o filifiliga. Biopsy a le Synovial. Pulega: faʻagaioiga, mafai ona faigata.
Neuropathic Osteoarthropathy
(Soʻoga o Charcot) Masani ma le faʻatupulaia d / t faʻamaʻi i le ituaiga 2 DM. E ono iai muamua ma le tiga (50% o mataupu) ma le faʻamaʻi faʻaleagaina ole mafaufau male faʻamaoni ole faʻaaliga. Early Dx: tuai. E taua tele ata: x-ray: muamua le faʻasolosolo, o nisi SF faʻaalia e vaaia. MRI fesoasoani i le vave Dx ma le tele o ese ese-utaina. Late Dx: faʻasoesa le toe suia, pa'ū, le atoatoa. Faʻaaliga: Lisfrance dislocation i Charcot soʻoga
M / C ogatotonu vae (TM soʻoga) i le 40% o mataupu, tapuvae 15%. Alualu i luma: Rocker-lalo vae, papala, papala, faʻatupulaia le papala, ma le olaga nei.
Early Dx: e ala i le MRI e tāua tele. Faʻafesoʻotaʻi i tagata mamai i le 2 DM aemaise lava pe a amata ona lipotia muamua le tiga o le vae / tapuvae.
O le gugu e faʻaalia o le fula o le tasi poʻo le tele soʻoga. O faʻailoga masani a le gugu e aofia ai le tiga ma le le faʻamafanafana, fula, mumu, ma le maʻaʻa, faʻatasi ai ma isi. E mafai ona aʻafia le gugu i soʻoga ole tino ole tagata, peitaʻi, e masani lava ona tupu ile tulivae. Kn O tuli gugu e mafai ai ona faigata gaioiga i aso uma. O ituaiga o gugu ua sili ona taatele o le osteoarthritis ma le rheumatoid gugu, e ui e sili atu ma le 100 ituaiga eseese o gugu, e aafia ai tamaiti ma tagata matutua. E ui e leai se fofo mo gugu, tele togafitiga auala mafai ona fesoasoani togafitia auga o tulivae tulivae.
Anatomy o le Knee
O le tulivae o le soʻoga tele ma sili ona malosi i le tino o le tagata. E faia i le pito i lalo o le ponaivi ponaivi, poʻo le femur, o le pito i luga o le ponaivi ponaivi, po o le tibia, ma le tulivae, po o patella. O pito o ponaivi e tolu o loʻo ufiufi i le cartilage faʻapitoa, o se lamolemole, ma se mea maseesee e puipuia ma faʻamalulu ivi peʻa punou ma faʻasaʻo le tulivae.
Lua vaega faʻapipiʻi o cartilage, e taʻua o le meniscus, e avea o se mea e faʻateʻia ai le va o ponaivi o tulivae e fesoasoani ai i le soʻoga faʻatasi ma maua ai le mautu. O le tulivae soʻoga o loʻo faʻataʻamilomiloina foi e se ie manifinifi e taʻua o le synovial membrane. O lenei membrane faʻasaʻolotoina se suavai lea lubricates le cartilage ma fesoasoani foi e faʻaititia le feteʻenaʻi i le tulivae. O ituaiga taua o gugu e aafia ai le tulivae aofia ai ma le osteoarthritis, rheumatoid gugu, ma le gugu o tua.
Osteoarthritis
Osteoarthritis o le masani masani o gugu lea e afaina ai tulivae soʻoga. Lenei ituaiga o gugu o se faʻaletonu, laei-ma-loimata soifua maloloina mataupu e tupu sili ona masani ai i tagata 50 tausaga le matutua ma sili atu, peitaʻi, e mafai foi ona tupu aʻe i tagata laiti.
I le osteoarthritis, o le cartilage i le tulivae soʻosoʻo e mou malie ese atu. A o alu le cartilage ua leai, o le mamao i le va o ponaivi faʻaitiitia. Lenei mafai ona iʻuga i ponaivi olo ma mafai ai - gaosia tiga tiga ponaivi. Osteoarthritis masani lava ona tupu lemu ae o le tiga e ono faʻatupulaia i le taimi.
gugu Rheumatoid
R O le Rheumatoid arthritis o se faʻaletonu o le soifua maloloina e afaina ai le soʻoga o soʻoga i le tino, aemaise lava tulivae. O le RA e faʻasolosolo foi, o lona uiga e masani ona aʻafia ai le soʻoga e tasi i itu taʻitasi o le tino o le tagata.
I le rheumatoid gugu, o le sinovial membrane e ufiufi ai le sooga tulivae ua mu ma fulafula, mafua ai tulivae tiga, le mautonu, ma maaʻa. RA o le autoimmune faʻamaʻi, o lona uiga o le immune system osofaʻia ona lava vaivai sela. O le immune system e osofai ai le soifua maloloina, ―e aofia ai uaua o le tino, ligament ma ponaivi, faʻapea foi ma le faʻamaluluina o le ponaivi.
Faʻafaʻalele i le Post-Traumatic
Post Posttraumatic gugu o se ituaiga o gugu e tupu pe a maeʻa afaina pe manuʻa i le tulivae. I se faʻataʻitaʻiga, e mafai ona afaina le sooga o le tulivae i se ponaivi gagau, poʻo le gaui, ma mafua ai le post-traumatic arthritis tausaga ina ua maeʻa le manuʻa muamua. Meniscal loimata ma ligament manuʻaga mafai mafua ai faʻaopopoina-ma-loimata i luga o le tulivae soʻoga, lea i le aluga o taimi e mafai ona tau atu ai i le gugu ma isi faʻafitauli.
Faailoga o le Knee Arthritis
'O faʻailoga masani o tulivae o le tulivae aofia ai le tiga ma le le faʻamafanafanaina, fulafula, fula, ma le maʻaʻa. E ui lava o le faʻafuaseʻi o le amataga e ono tupu, o faʻailoga tiga e masani lava --e faifai malie i le aluga o taimi. Faʻaopopo faʻaopopo o tulivae gugu mafai ona amanaʻia faʻapea:
O le sooga faʻatasi e ono vaivai ma fulafula, e faigata ai ona punou ma faʻamaʻo le tulivae.
O le vevela ma le mumu atonu o le a sili atu ona leaga i le taeao, pe o le taimi e nofo ai pe malolo.
O se gaoioiga mataga atonu e ono afaina ai le tiga.
Lafoaʻi vaega o le cartilage ma isi mea vaivai e mafai ona faʻalavelave ai le gasolosolo solosolo o sooga, e mafua ai ona loka le tulivae pe pipii i le gaioiga. E mafai foi ona fatufatu, kiliki, puʻeina pe fai se leo leo, ua lauiloa o le timaʻi.
O le tiga e mafai ona mafua ai le lagona o le le lava po o le tui mai le tulivae.
O le toʻatele o tagata e maua i le gasegase e mafai foʻi ona faʻamatalaina le faʻateleina o paʻu faʻatasi ma timuga ma timuga.
Faʻamatalaga mo le Knee Arthritis
I taimi o tofiga o le tagata maʻi mo le faʻamaonia o le tulivae o le tulivae, o le fomaʻi fomaʻi o le a talanoa e uiga i faʻailoga ma talaʻaga faʻafomaʻi, faʻapea foi ma le faʻatautaia o se tino suʻega. E mafai foʻi ona poloa e le fomaʻi faʻataʻitaʻiga faʻataʻitaʻiga faʻataʻitaʻiga, e pei ole X-ray, MRI poʻo suʻega toto mo nisi faʻamaoniga. I le taimi o suʻega faʻaletino, o le a suʻe e le fomaʻi:
Paʻu faʻatasi, fulafula, mafanafana, poʻo le mumu
Tigā alofa i autafa o tulivae
Faiga faʻavae o le sologa lelei ma le gaioiga
Faʻapitoa o le sooga vae
Crepitus, le lagona fetaui i totonu o le sooga, faatasi ma le lafo
Paʻu pe a tuʻu le mamafa i luga o tulivae
Faʻafitauli i le gaioiga, poʻo le auala o le savali
Soʻo se faailoga o le faʻaleagaina poʻo le manua i muso, tendon, ma liga e siomia ai le tulivae
Faʻaaogāina o sooga faaopoopo (o se faʻamatalaga o le oona o le rūmatoid)
Faʻamatalaga Faʻamatalaga Faʻamatalaga
X-ave. O nei faʻataʻitaʻiga suʻesuʻega faʻataʻitaʻiga e maua ai ata o fausaga faʻapitoa, e pei o ponaivi. E mafai ona latou fesoasoani e iloa le eseesega o ituaiga eseese o le oona. X-ray mo le tulivae o le tulivae e mafai ona faʻaalia ai se vaega o le vavao faʻatasi, suiga i le ponaivi faapea foi ma le faia o ponaivi ponaivi, o loʻo taʻua o le osteophytes.
Suesuega faaopoopo. O isi taimi, faʻataʻitaʻiga o le resonance imaging, poʻo le MRI, faʻataʻitaʻi, faʻatulagaina o ata poʻo le CT, 'scans, poʻo le ponaivi e manaʻomia e faʻamautinoa ai le tulaga o ponaivi ma mea vaivai o le tulivae.
Totoga o le toto
E ono fautuaina foʻi e lau fomaʻi le suʻesuʻeina o le toto e iloa ai le ituaiga o gugu ua e maua. Faatasi ai ma nisi ituaiga o gugu, pei o le rheumatoid gugu, tofotofoga toto mafai ona fesoasoani i le faʻailoga saʻo o le faʻamaʻi.
E ui lava o le sooga tulivae o se tasi o sooga sili ona malosi ma sili ona tele i le tino o le tagata, e masani lava ona afaina i le faaleagaina o manuʻa poʻo manua, e mafua ai le tele o tulaga. E le gata i lea, o nisi mataupu faʻalesoifua maloloina, e pei o le gasegase, e mafai ona aʻafia ai le sooga vae. I le upega tafaʻilagi mo le tele o asiasiga o El Paso, TX, o le togafitiga o le chiropractic e mafai ona fesoasoani e faʻamaonia ai faʻamaʻi tiga e fesootaʻi ma le gaʻo o le tulivae, faatasi ai ma isi mataupu tau soifua maloloina. Dr. Alex Jimenez DC, CCST Insight
Togafitiga mo le Othine Arthritis
Togafitiga e le o se Togafitiga
Ole auala ole togafitiga e le masani ona fautuaina ae e leʻi fuafuaina se taotoga mo le gugu o le tulivae. E fautuaina e tagata polofesa mo le soifua maloloina le tele o ituaiga togafitiga, e aofia ai le togafitiga o le mafaufau, togafitiga o le tino, ma suiga o le olaga, ma isi.
Faʻaleleia o le soifua maloloina. O nisi ituaiga olaga faʻalelei mafai ona fesoasoani puipuia le tulivae soʻoga ma faʻalavelaveina le alualu i luma o le gugu. Faʻaititia gaioiga faʻamalosi tino e faʻatupuina ai le tulaga, o le a tuʻu ai i lalo tulivae. O le leiloa o le mamafa e mafai foi ona fesoasoani e faʻaititia ai le popole ma le mamafa i luga o tulivae, ma mafua ai le faʻaititia tiga tiga ma faʻateleina gaioiga.
Totogi togafiti ma togafitiga faʻapitoa. Chiropractic care faʻaaoga tino tino fesuiaʻiga fesuiaʻiga e toe faʻaleleia ma le faʻaeteete soʻo se tuʻufaʻatasiga o le tuasivi, poʻo subluxations, lea e ono mafua ai auga, e aofia ai gugu. E mafai foi e le fomaʻi ona fautuaina le faʻamalositino e fausia ai ni faʻamalositino taʻitasi ma se polokalame o faʻamalositino mo manaʻoga o tagata maʻi.
Fesoasoani fesoasoani. O le faʻaaogaina o masini fesoasoani, e pei o se tootoo, seevae e faʻafefe ma faʻafefe, poʻo se fusi poʻo le lima o le tulivae, e mafai ona faʻaitiitia ai faʻamaʻi tiga. O se fusi fesoasoani e fesoasoani i le galue ma le mausali, ma atonu e sili ona aoga pe afai o le maʻi o le maʻi e faʻavae i le tasi itu o le tulivae. E lua ituaiga o fusi e masani ona faʻaaogaina mo le tulivae o le tulivae: O le "faʻapipiʻiina" o le fusi e suia ai le mamafa mai le vaega o loʻo aʻafia o le tulivae, ao fesoasoani le "lagolago" e lagolago ai le tulivae atoa.
Fualaau ma / poʻo vailaʻau. E tele ituaiga vailaʻau e aoga i le togafitia o le gaʻo o le tulivae. Talu ai e eseese tali a tagata taʻitoʻatasi i vailaʻau, o lau fomaʻi o le a vavalalata vavalalata faʻatasi ma oe e fuafua ai vailaau ma vailaau e saogalemu ma aoga mo oe.
Tausiga o Tomai
E mafai e le polofesa tau soifua maloloina ona fautuaina se taotoga pe a fai o le tulivae o le tagata maʻi e mafua ai le le atoatoa o le malosi ma na o pe a fai e le faʻamamaina le faʻafitauli i le le faia o se taotoga Pei o taotoga uma, e i ai ni nai aʻafiaga ma faʻafitauli ma taotoga togafitiga mo tulivae gugu. O le a talanoaina e le fomaʻi faʻafitauli ono ma le tagata maʻi.
Arthroscopy. I le taimi o le faʻailoga, e faʻaaogaina e fomaʻi meafaifaʻaili ma mea laiti e faʻamaonia ai ma togafitia ai faʻavae tuʻuvae. O le taotoga Arthroscopic e le masani ona faʻaaogaina i le togafitiga o le gaʻo o le tulivae. I mataupu e tuʻuina atu ai le osteoarthritia ma le gasegase o le gasegase masisini, o le taotoga o le arthroscopic e mafai ona poto e togafitia le maniscus ua afaina.
Totoina o tilotila. E mafai ona aveesea ni mea faʻapitoa o le tileti mai se faletupe poʻo se vaega ese o le tulivae e faʻatumu ai se pu i le faletiula. O lenei gaioiga e masani lava ona mafaufauina mo na o tamaiti matutua.
Synovectomy. O le faʻalanu ua faʻamaʻi e le oona o le vai ua faʻaitiitia e faʻaitiitia ai le fulafula ma le tiga.
O le tino. I le tulivae osteotomy, a le o le tibia (shinbone) poʻo le femur (ogavae) e tipi ona toe faʻafouina e faʻamalolo ai le popole ma le mamafa i luga o tuli soʻoga. O le tulivae e faʻaaoga e faʻaaoga ai le osteoarthritis pe a amata le tulaga o le osteoarthritis i le itu e tasi o le sooga vae. I le suia o le mamafa tufatufaina, lenei mafai faʻamalieina ma faʻalauteleina le gaioiga o le tulivae.
Faʻaopopo poʻo le vaega ole sui ole tuli (arthroplasty). The doctor o le a aveʻesea le ponaivi ua faaleagaina ma le atigipusa, ona tuʻu ai lea o ni palasitika poʻo ni uʻamea luga e toe faʻaleleia ai le gaioiga o le tulivae ma ona faʻatulagaina fausaga.
'A maeʻa soʻo se ituaiga o taʻotoga mo tulivae, e aofia ai i le gasegase se vaitaimi o le toe malosi. O le taimi e toe faʻaleleia ai ma le toe faʻaleleia e faʻamoemoe i le ituaiga taotoga na faia. E taua le talanoa ma lau fomaʻi faʻapitoa e filifili le filifiliga sili ona lelei mo le faʻamaʻi o lou gugu. O le lautele o a matou faʻamatalaga e faʻatapulaʻaina i le faʻafitauli o le soifua maloloina o le mafaufau ma le tuasivi. Ina ia talanoaina le mataupu, faʻamolemole lagona le saoloto e fesili ia Dr. Jimenez pe faʻafesoʻotaʻi mai matou i le915-850-0900 .
Cur Faʻataʻitaʻia e Dr. Alex Jimenez
Autu Maualuga Talanoaga: Faʻasalaina o Paʻu Tino e aunoa ma se Taʻaloga
Pain O tuli tiga o se lauiloa auga e mafai ona tupu ona o le eseese o tulivae manuʻa ma / poʻo tulaga, e aofia ai--afaina taʻaloga. O le tulivae o se tasi o sooga sili ona faigata i totonu o le tino o le tagata e pei ona faia i luga o le vaeluaina o ponaivi e fa, fagaga e fa, ituaiga o manoa, lua manisci, ma le cartilage. E tusa ai ma le American Academy of Family Physicians, o mafuaaga sili ona taatele o le tiga o le tulivae e aofia ai le patellar subluxation, patellar tendinitis poʻo le tulivae o le matua, ma le maʻi o Osgood-Schlatter. E ui lava e ono tupu le tiga o tulivae i tagata i luga o le 60 tausaga, e mafai foi ona tupu tiga le tulivae i tamaiti ma tamaiti. E mafai ona togafitia le tiga o le uila i le fale e mulimuli i metotia a le RICE, peitaʻi, o ni manua ogaoga o le tulivae atonu e manaʻomia vave togafitiga faafomaʻi, e aofia ai togafitiga faʻafefesa.
le tulivae o se tasi o sooga sili ona faigata i le tino o le tagata, e aofia ai le ponaivi o le suilapalapa, poʻo le femur, le ponaivi o le ponaivi, poʻo le tibia, ma le tulivae, poʻo le patella, faatasi ai ma isi masini mumu. Toni e faʻafesoʻotaʻi ponaivi i maso ao fesoʻotaʻi faʻatasi ia ponaivi o le tulivae. E lua ituaiga foliga o le cartilage, e lauiloa o le meniscus, e maua ai le mautu i le sooga vae. O le faʻamoemoega o le tusiga o loʻo i lalo o le faʻaalia lea e pei o le talanoaina o le anotomy o le sooga vae ma ona laumei susu vaivai.
lē faʻatino
Anotusi: Faʻamatalaga e uiga i le faʻavae, tuʻufaʻatasiga, ma le gaioiga o le tulivae menisci ua salalau solo i le tele o punaoa ma fanua. Lenei iloiloga aofia ai se puʻupuʻu, auiliili faʻamatalaga o le tulivae menisci-- aofia ai anatomy, etymology, filogeni, ultrastructure ma biokimia, vascular anatomy ma neuroanatomy, biomekanisisi galuega, matua ma matua, ma ata faʻataʻitaʻiga.
Faamatalaga faʻamaonia: O le suʻesuʻeina o tusitusiga na faia e se toe iloiloga o lomiga a PubMed ma OVID na lolomiina mai le 1858 i le 2011.
Tali: O lenei suʻesuʻega ua faʻamaonia ai le faʻatulagaga, tuufaatasiga, ma uiga faʻatinoga o le masisini, lea atonu e talafeagai i faʻataʻitaʻiga, faʻataʻitaʻiga, ma toe teuteuina o taʻavale.
Faaiuga: O se malamalamaaga i le masani masani ma meaola o le masisini o se mea e manaʻomia muamua e malamalama ai i le faʻaleagaina o maʻi e aofia ai tulivae.
uputatala:tulivae, meniscus, anatomy, galuega
faʻatomuaga
O le taimi na faʻamatalaina ai o se toega embryonic leai se aoga, 162 le menisci ua lauiloa nei e taua tele mo le masani gaioiga ma umi-taimi soifua maloloina o le tulivae soʻofaʻatasi. ma meaʻai i le sooga tulivae.4,91,152,153
O aʻafiaga i le mitiia ua lauiloa o se mafuaʻaga o le faʻaleagaina o le musculoskeletal. O le tulaga tulaga ese ma le faigata o le manisci e togafitia ai ma faaleleia ai le luʻitau mo le tagata maʻi, fomai tipitipi, ma le fomaʻi maʻi. E le gata i lea, o le faaleagaina o taimi uumi e mafai ona oʻo atu ai i suiga faʻaleagaina o suiga faʻapitoa e pei o le osteophyte, faʻasolosolo o le faʻaitiitia o le cartilage, vaeluaga o le avanoa vaʻaia, ma le faailoga o le osteoarthritis.36,45,92 Faʻasaoina o le masini e faalagolago i le faatumauina o latou foliga ma le faʻatulagaina.
Anatomy o le Menisci
Meniscal Etymology
O le upu meniscus e sau mai le upu Eleni m? Niskos, o lona uiga crescent, diminutive of m? N ?, o lona uiga moon.
Meniscal Phylogeny ma le Anatomy Faatusatusaga
O nei ituaiga o meaola e foliga mai e atagia ai le gafa o le gafa lea e mafai ona toe maua mai nai lo le 40,66 miliona tausaga.300. O nei ituaiga o meaola, e aofia ai le faʻaaogaina o le mea e tasi.
I le gafa o le peraimeri e tau atu i tagata, hominids na tupu i le pipii tulaga i le tusa o le 3 i le 4 miliona tausaga talu ai, ma i le 1.3 miliona tausaga talu ai, o le onapo nei patellofemoral soofaatasi na faavaeina (faatasi ai ma se sili atu i le itu pito i tua patellar facet ma tutusa felavasaʻi femoral trochlea) .164 Tardieu suʻesuʻe le fesuiaiga mai i nisi taimi bipedalism i tumau bipedalism ma matauina o primates aofia ai le medial ma lateral fibrocartilaginous meniscus, ma le medial meniscus e morphologically tutusa i uma primates (crescent foliga mai ma 2 tibial insertions) .163 I se eseesega, o le lateral meniscus na matauina ia ia sili ona fesuisuiaʻi i foliga. Tulaga ese i Homo sapiens o le i ai o 2 tibial insertions`1 muamua ma le 1 tua 'o loʻo faʻamatalaina ai se masani masani o le faʻalauteleina o gaioiga faʻaopoopo o le tulivae soʻosoʻo i le taimi o le tu ma le fesuiaʻiga o vae o le savali lua .20,134,142,163,168
Faʻaleleia ma le Atinaʻe
O le foliga masani o le laasaga ma le medial menisci e maua i le va o le 8th ma le 10th vaiaso o le gestation.53,60 O loʻo tulaʻi mai i se faʻasalaga o le vaega faʻavave o tisinchymal tissue e faʻapipiʻi ai mea faʻapipiʻi i le faʻatalatalanoaga faʻasalalau lata ane.31,87,110 O le atinaʻeina o le masisisite e sili ona telefoni feaveai ma vascular, faatasi ai ma le toto mai le gataifale ma faalautele atu i le lautele o le menisci.31 Aʻo faʻaauau pea ona atinaʻe le fomaʻi, o loʻo i ai se faʻaitiitia maliega i le telefoni feaveaʻi o le manisci ma le faʻateleina o le faʻalauteleina o le mea faʻapena i totonu o se tulaga faatulagaga.30,31 Malosiaga felagolagomai ma le popolega i le postnatal o le mamafa o le mamafa o mea taua ia i le fuafuaina o le faʻatulagaina o filatini. I le matua, na o le lautele 10% i le 30% o loʻo maua ai le toto.12,31
E ui lava i nei suiga o le talafaasolopito, o le tele o le elebia platema o loʻo ufitia e le meniscus e fesoʻotaʻi, e faʻaauau pea i le gaosiga o le fetal, faatasi ai ma le masio ma le itu i le itu e pei o le 60% ma le 80% o le laufanua, respectively.31
Faʻatauga Anatomy
O le suʻesuʻega sili o le manisci tulivae o loʻo faʻaalia ai se mea lamolemole, faʻalanu (Figure 1). O i latou o ni mea e tutusa lelei le fibrocartilage o loʻo i luga o le pito i luga ma le itu i tua o le auvae tulivae (Ata 2A). O le lautele, vascular border (lea foi e lauiloa o le sone mumu) o maniscus taitasi e mafiafia, felafolafoaʻi, ma faapipii i le paʻu soofaatasi. O le pito i totonu (faʻapitoa foi o le paʻepaʻe paʻepaʻe) e pipii atu i se mea e leai se totogi. O maualuga pito i luga o le masisis o loʻo faʻamalosi, faʻamalosia faʻamalamalamaga lelei ma a latou feʻau faʻataʻitaʻi feʻaveaʻi. O pito maualalo e faʻapitoa e faʻaogaina ai le alalaupapa tipi (Ata 1) .28,175
Maniscus Medial. O le semicircular medial meniscus e tusa ma le 35 mm le lautele (luma i tua) ma e sili atu lona lautele i tua atu nai lo le pito i luma. E i ai le eseesega tele i le fesoʻotaʻiga nofoaga o le mua luma nifo o le medial meniscus. O le pu i tua e pipii i le posterior intercondylar fossa o le tibia i le va o le lateral meniscus ma le ligament cruciate ligament (PCL; Figures 175 ma and1B) .2B). Johnson et al toe suʻesuʻe ia nofoaga o loʻo i totonu o le menisci ma latou fesoʻotaʻiga i luga atu o laufanua o le tulivae. O le vaega o le pito i totonu na faʻaofiina i ai le meniscus o le pito sili ona tele na fuaina i le 2 mm82, ae o le nifo mulimuli o le meniscus pito i tua o le pito sili ona laʻititi, i le 61.4 mm2
O le vaega o le totoga o le mea e faʻapipiʻi ai o le ligamenti o le tino. I lona ogatotonu, o le medial meniscus e sili atu ona pipii mau i le femur e ala i se condencies i le soʻoga capsule lauiloa o le loloto medial kolisi ligament.175 O le transverse, poʻo 'intermeniscal,' ligament o se fibrous fusi o mea e fesoʻotaʻi ai le pito i luma ole medial meniscus ile nifo luma ole meniscus pito i tua (Ata 1 ma le2A2A).
Maniscus vave. O le maniscus pito i luga e toetoe lava o le poro, ma e tutusa le lautele o le lautele mai le pito i luma i le pito i tua (ata 1 ma leXXUMXA) .2A). O loʻo aofia ai se vaega tele (~ 2%) o le faʻavae faʻapitoa nai lo le medial meniscus (~ 80%) ma e sili atu le telefoni feaveaʻi.60 E lua puʻu o le meniscus pito i luga ua tuʻuina i le tibia. O le faʻapipiʻiina o le gaʻo muamua o le maniscus pito i tua o loʻo i tua ile pito i tua o le vaeluagalemu o le ACL (Figure 10,31,165B) .2 O le pu mulimuli mai o le maniscus inserts posterior to the lateral tibial spine and just anterior to o le faʻaofiina o le siʻosiʻo mulimuli o le maniscus medial (Ata 9,83B) .2 O le meniscus pito i tua e pipii mau i le ligamenti; ae ui i lea, o nei laupepa e le o fesootai atu i le ligamenti mo le puipuiga lautele. O le sipuni mulimuli o le meniscus pito i tua o loʻo pipii atu i le pito i totonu o le medial femoral condyle e ala i le pito i luma ma le isi malegafecoral ligaments o Humphrey ma Wrisberg, e mafua mai i le amataga o le PCL (Figures 83 ma leXXUMX) .1
Mengiafemoral ligaments. O loʻo lipotia mai e tusitusiga le tele o feteʻenaʻiga i le iai ma le tele o meniscofemoral ligament o le maleiscus meniscus. Atonu e leai se tasi, 1, 2, poʻo le 4.? A i ai, o nei mea faʻaaoga fesoasoani e fesuiaʻi mai le nifo i tua o le lateral meniscus i le itu pito i tua o le medial femoral condyle. Latou te faʻaofiina faʻafesoʻotaʻi lata ane i le fesoʻotaʻiga femoral o le PCL (Ata 1 ma le22).
I se faasologa o suʻesuʻega, na fuaina ai e Harner et al le vaega o le ligaments ma iloa ai le maualuga o le ligamenti maleiscoferal i le 20% o le tele o le PCL (range, 7% -35%). 69,70 Peitaʻi, o le tele o le vaega faʻapipiʻi na o ia e aunoa ma se malamalamaaga o le faʻapipiʻi poʻo le faʻaogaina o le paʻu e le o faʻaalia ai lo latou malosi .115 O le galuega a nei ligaga e le o iloa pea; e mafai ona latou tosoina le fusi mulimuli o le meniscus i fafo i se pito i luma ina ia faateleina ai le faʻaleagaina o le fiscas maleiscotibial ma le faʻasolosolo o femoral condyle.75
Aseta ma le Biochemistry
Extracellular Matrix
O le meniscus o se mafiafia extracellular matrix (ECM) aofia muamua lava o le vai (72%) ma collagen (22%), interposed ma sela. Cells Meniscal sela e gaosia ma faʻamalosia le ECM, e fuafua ai mea totino o le tino.
O sel o le manisci e taua o le fibrochondrocytes ona e foliga mai o se paluga o fibroblasts ma chondrocytes.111,177 O sel i le pito sili ona maualuga o le manisci ua fusifusia pe o le fulafulaina (sili atu le fibroblastic), ae o sene e sili atu ona loloto i le Meniscus o le ovoid poʻo le polygonal (tele chondrocytic) .55,56,178 Cell morphology e le eseese i le va o potu ma nofoaga tutotonu i le menisci.56
O ituaiga uma o le masini e aofia ai le tele o retipulum endoplasmic ma le Golgi complex. O Mitochondria e na o se vaaiga i nisi taimi, e fautua mai ai o le auala autu mo le gaosiga o le fibrochondrocytes i lo latou alalafaga e mafai atonu o le gelacolysis.112 anaerobic
vai
I le masani ai, o le manisini maloloina, o le tino o le tino e faatusa i le 65% i le 70% o le mamafa atoa. O le tele o le suavai o loʻo taofia i totonu o le tino o loʻo i totonu o le solvent domains o proteoglycans. O le vai o loʻo i ai masini maniscal e sili atu ona maualuga nai loʻo i totonu o atigipusa nai lo nofoaga tutotonu poʻo tuaʻoi; o meaola mai mea mai luga ma le loloto e iai mea tutusa .135
O le tele o le malosi o le eletise e manaʻomia e foia ai le toso o le feteenaiga o le faʻamalosia o le faʻafefe o le vai e ala i le maniscal tissue. O le mea lea, o fegalegaleaiga i le va o le vai ma le matrix macromolecular framework e matua aʻafia ai le viscoelastic mea o le tino.
Collagens
Collagens o le matafaioi muamua lea o le malosi o le faʻamalosi o le faʻaaogaina o masini; latou te saofaʻi atu i le 75% o le mamafa o le ECM.77 O le ECM e aofia ai muamua le collagen type I (90% mamafa le mamafa) faatasi ai ma le numera variable II, III, V, ma le VI.43,44,80,112,181 O le autu o le ituaiga I collagen e faʻamaonia le fibrocartilage o le menisci mai le faʻalaʻau (hyaline) cartilage. O collagens e maualuga le fesoʻotaʻiina e hydroxylpyridinium aldehydes.44
O le fetuunaʻiga o le fibre collagen e fetaui lelei mo le faʻamatuʻuina atu o se avega faʻasolosolo i totonu o faʻataʻamilosaga hohoop (Faʻata 3). O nei alava e tuʻufaʻatasia fesoʻotaʻiga ligamentous o nifo meniscal i le pito i luga o le tibial articular (Ata 57) .3 I le pito sili ona papaʻe o le menisci, o le ituaiga I alava e faʻatulagaina i se faʻatonuga e sili atu ona faʻaaoga. E i ai foʻi fibre e faʻatulagaina i le loloto o le sone ma e felavasaʻi pe lalagaina i le va o fusi e faʻataʻamilomilo ai le faʻamaumauga (Ata 10,27,49,156). # O loʻo i ai lipid lipid ma tino faʻapitoa i le ECM o tagata menisci.3 O tino faʻapitoa o loʻo iai ni tioata umi, paee o phosphorous, calcium, ma le magnesium i luga ole electron-probe roentgenographic analysis.54 O le faʻatinoga o nei tioata e leʻo malamalama lelei iai, ae e talitonu e ono iai se latou sao i le soʻoga soʻoga o le soʻoga male faʻamaʻi mata.
E leai ni meaola faʻapitoa o matrix, e pei o le fibronectin, e fesoasoani ai i le 8% i le 13% o le mamafa mamafa o le mamafa. O le fibronectin e aofia i le tele o telefoni feaveaʻi, e aofia ai le gaioiga o le tino, embryogenesis, faʻamaʻi toto, ma le meli / faʻafeiloaʻiga. O le Elastin e maualalo ifo i le 0.6% o le mamafa masisis; o lona faʻasalalauga faʻasalalau e leʻo manino. E ono faʻafesoʻotaʻi tuusaʻo ma le faʻapalapala e tuʻuina atu ai le faʻaleleia o le tino. **
Proteoglycans
O loʻo i totonu o se galuega lelei o fibrils collagen, proteoglycans e tele, ua le lelei le molia o molelaʻau eletise, e maua ai le 1% i le 2% o le mamafa o le mamafa.58 O loʻo faia i se fatutini autu faatasi ai ma le 1 poʻo sili atu faʻaopoopo faʻatasi glycosaminoglycan (Figure 4) .122 O le telē o nei fualaʻau e faʻapupulaina e ala i fegalegaleaiga patino ma le hyaluronic acid.67,72 O le aofaiga o proteoglycans i le meniscus o le tasi-valu o le cartilage faʻapitoa, 2,3 ma atonu e tele le fesuiaiga e fuafua i luga o le nofoaga o le faʻataʻitaʻiga ma le tausaga o le maʻi .49
E tusa ai ma le latou auivi faʻapitoa, maualuga faʻatulagaina-mamafa density, ma moliaga-faʻatosina malosiʻaga, proteoglycans i le ECM e nafa ma hydration ma maua ai le aano ma le maualuga gafatia e teteʻe compressive avega. meniscus aofia ai chondroitin-6-sulfate (40%), chondroitin-4-sulfate (10% i le 20%), dermatan sulfate (20% i le 30%), ma keratin sulfate (15%; Ata 4) .65,77,99,159 , 58,77 Ole maualuga glycosaminoglycan concentrations o loʻo maua i le meniscal pu ma le afa i totonu o le menisci i vaega muamua mamafa mamafa.XNUMX
O le tagata totoa o le sili lea o le puipuiga o le tagata na maua i le masiofo faaletagata ma o le tele lava o le matafaioi mo a latou viscoelastic compressive properties (Ata 5). E sili atu nai lo le mea e maua mai ai, e pei o decorin, biglycan, ma fibromodulin, e pei o decorin, biglycan, ma fibromodulin.124,151 Hexosamine e fesoasoani i le 1% i le mamafa o le ECM.57,74 O galuega patino o nei tamai proteoglycans i le masisiscus e le o toe faʻatuputeleina.
Matrix Glycoproteins
Meniscal cartilage o loʻo iai le tele o matrix glycoproteins, o faʻailoga ma galuega e leʻi fuafuaina. Electrophoresis ma mulimuli ane pisipisia o gaioiga polyacrylamide faʻaalia fusi ma mamafa molimoli eseese mai i nai kilodaltons e ova atu i le 200 kDa.112 O nei matrix molelave aofia ai fesoʻotaʻiga polotini e faʻamautuina proteoglycan hyaluronic acid faʻaputuputuga ma le 116-kDa polotini o le iloa galuega.46 O lenei polotini o loʻo nofo i totonu o le matrix i le tulaga o le disulfide-fusia faʻafitauli o le maualuga molemala mamafa.46 Immunolocalization suʻesuʻega faʻapea e sili ona tu i tafatafa o collagen bundles i le interterritorial matrix.47
O le glycoproteins o loʻo fusifusia ai se kulupu o le matrix glycoproteins. O nei macromolecules o loʻo i ai se vaega o le matafaioi mo le fusifusia ma isi matūlaʻau matū ma / poʻo ni sela. O ia ituaiga o molelaʻau o le adhesion molelaʻau o ni mea taua ia i le supramolecular organization o molekone extracellular o le meniscus.150 E tolu lala mole ua iloa i totonu o le meniscus: ituaiga o VI, colbrogen, thrombospondin.112,118,181
Anetomy vascular
O le meniscus o se tulaga faʻapitoa faʻapitoa ma se toto tuʻufaʻatasia. O le medial, lateral, ma le ogatotonu e faʻamaonia ai le gaogao (o le lala mai luga o le popupal uluga) e maua ai le vascularisation tele i tulaga maualalo ma sili atu o meniscus taitasi (Ata 5) .9,12,33-35,148 O le vaeluaga o le fatuga o se paranesi laʻititi lea e faʻaaogaina le faʻafeusuai le liuga o le popliteal i le pito i luga o le pito i luga o le mafutaga o le tibiofemoral. O se fesoʻotaʻiga muamua i luga o le laʻau mai luga o paranesi o nei tupua e mafua mai i totonu o le synovial ma le pito i lalo o le tulivae i le pito i tua o le manisci. O le 10% lautele i le 30% o le tuaoi medis meniscus ma le 10% i le 25% o le meniscus pito i luga ua vascularized, o loʻo i ai ni mea taua mo le maniscus faʻamaʻi (Figure 6) .12,33,68 Endoligamentous vessels from the anterior and posterior horns travel a Vaʻavaʻai mamao i le vailaau o le masini ma faʻapipiʻi faʻamaumau, tuʻuina atu se ala tuusaʻo mo le fafagaina .33 O le vaega totoe o maniscus taʻitasi (65% i 75%) e maua ai le fafagaina mai le vaivave faʻafouina e ala i le faʻasalalau poʻo le faʻaaogaina o masini (ie, motuga faʻatasi) .116,120
Bird ma Sweet na suʻeina le faʻaogaina o manu ma tagata e ala i le numera eletise ma le malamalama microscopy.23,24 Na latou matauina faʻavae e pei o sela e amata loloto i luga o le manisci. O nei alavai e mafai ona i ai se sao i le felauaiga o le suavai i totonu o le meniscus ma e mafai ona ave ai meaʻai mai le synovial fluid and blood vessels i vaega o vaalele o le meniscus.23,24 Ae peitai, o nisi suʻesuʻega e manaʻomia e faʻamalosia ai le faiga tonu lea e mafai ai e le masini fesoasoani meaai paleni i le vaega ole vavaega o le masini.
Neuroanatomy
O le sooga tulivae o loʻo nofoia e le pito i luma o le lala o le neura o le gaʻo mulimuli ma le lala o le pa puipui ma le nega o le feusuaʻiga. O le pito i tua o le capsule o loʻo nofoia e le lala o le perone faifaipea o le namu masani o le peroneal. O nei fiva namu e ulu i totonu o le kaputa ma mulimuli i le masini totofatu i le vaega o le masisis ma le pito i luma ma le pito i tua, ma o le tele o le uaua e taulaʻi .52,90 O le pito i fafo o le tino o le masisiscus e sili atu ona le tumau nai lo le ogatotonu pito tolu.183,184 I taimi uma o le fesuiaiga ma le faʻaopoopoga o le tulivae, o loʻo faʻateteleina maso masisinika, ma o le mea e sili ona fiafia i ai e sili atu ona maualuga i nei tulaga maualuluga.183,184
O le masini faiaʻoga i totonu o le menisci galue o transducers, liua le faʻamalosi tino o le feteʻenaʻi ma faʻapipiʻi i se faʻapitoa eletise faʻaosofia lagona. O suʻesuʻega o le menisci a tagata ua latou iloaina ai le 3 morphologically eseʻese masini gaosi: Ruffini iuga, Pacinian corpuslets, ma Golgi tendon totoga. `` Type I (Ruffini) mechanoreceptors e maualalo faitotoʻa ma lemu fetuunaʻi i suiga i soʻoga deformation ma omiga. Type II (Pacinian) mechanoreceptors e maualalo le amataga ma vave fetuunaʻi i fesuiaiga suiga. `` Type III (Golgi) o maualuga-faitotoʻa masini, o le a faʻailo pe a oʻo le tuli soʻoga latalata i le laina laina o gaioiga ma e fesoʻotaʻi ma neuromuscular taofi. O nei neural elemeni na maua i sili atu faʻapitoa faʻamamafaina i meniscal pu, aemaise lava le mulimuli posterior.
O le asymmetrical vaega o le tulivae galue i konaseti o se ituaiga o faʻaliliuina atu o meaola e taliaina, fesiitaʻi, ma faʻateʻa avega i luga o le femur, tibia, patella, ma femur.41 Ligament galue o se fetuʻunaʻiga fesoʻotaʻiga, ma menisci sui feaveaʻi bearings. E tele suʻesuʻega ua lipotia mai o vaega eseese o le intra-articular o le tulivae e maaleale, e mafai ona gaosia ni faailo o le neura e oʻo atu i le tuasivi, cerebellar, ma maualuga atu le ogatotonu o le tino. E talitonuina o nei faailo o neura e mafua ai le malamalama lelei ma e taua mo masani tulivae soʻoga gaioiga ma le tausiga o aano homeostasis.42
O le meniscus o le cartilage lea e maua ai le amio ma le amio saʻo i tulivae. O le manisci o ni mea se lua o le fibrocartilaginous tissue lea e faʻalauteleina ai feeseeseaiga i le sooga o le tulivae pe a feagai ma le le mautonu ma le vevesi i le va o le ponaivi ponasina, po o le tibia, ma le ponaivivaevae, po o le femur. O le malamalama i le tino ma le biomechanics o le sooga vae e taua i le malamalamaaga o manua o le tulivae ma / poʻo tuutuuga. Dr. Alex Jimenez DC, CCST Insight
Malosiaga Biomechanical
O le biomechanical function of the meniscus o se ata o le lapoʻa ma le ultrasonstrural anatomy ma lona fesoʻotaʻiga ma le intra-articular ma extra-articular fausaga. O le menisci tautua tele taua biomechanical gaioiga. Na latou fesoasoani i le aveina o uta, teʻi faʻaaogaina, 10,49,94,96,170 mautu, 51,100,101,109,155 taumafa, 23,24,84,141 soʻoga lubrication, 102-104,141 ma proprioception.5,15,81,88,115,147 Latou foi tautua e faʻaitiitia ai fesoʻotaʻiga faʻamamafa ma faʻateleina le faʻafesoʻotaʻiga o vaega ma le faʻasolosolo tulivae.91,172
Meniscal Kinematics
I se suʻesuʻega i le vaega o le ligamentous function, Brantigan ma Voshell na lipotia ai le medial meniscus e feosofai i le averesi 2 mm, ae o le pito i tua o le meniscus na sili atu ona feoaʻi ma le tusa ma le 10 mm o tuafale i tua i le taimi o femalagaiga. i lalo ole 25 mm ole pito i tua-tua, aʻo le meniscus pito i tua e alu i le 3 mm i le taimi o le femalagaiga.9 I se suʻesuʻega na faʻaaoga ai le 37 cadaveric tulivae, na lipotia mai e Thompson et al le uiga masani o le savali i le 5 mm (averesi o pu i luma ma tua) ma le o lona uiga o tafaoga lautele, 5.1 mm, i luga o le tibial articular luga (Ata 11.2) .7 O mea na maua mai i nei suʻesuʻega e faʻamaonia ai le tele o eseesega i vaega o gaioiga i le va o le medial ma lateral menisci. O le pito i luma ma le pito i tua o le maleiscus ratio o le meniscus e laiti ma o loʻo faʻailoa mai ai o le meniscus e faʻasolosolo ona avea o se iunite e tasi.165 A le o lea, o le medial meniscus (i lona atoaga) e laʻititi ifo nai lo le lateral meniscus, o loʻo faʻaalia ai le sili atu o luma i le posterior tandi eseʻesega faʻaaliga. Na maua e Thompson et al o le vaega o gaioi gofie o le meniscal o le pito i tua o le ogatotonu, lea o le meniscus e taofiofia e lona pipii atu i le laupepa o le tibial e le vaega o le meniscotibial o le ligament pito i tua, lea na lipotia mai e sili atu ona ono manuʻa. 165 O le faʻaititia o le gaioiga o le nifo i tua o le medial meniscus o se auala ono mafai mo loimata meniscal, faatasi ai ma le iʻuga 'o le fibrocartilage i le va o le femoral condyle ma le tibial plateau i le taimi atoa flexion. Ole tele eseʻesega ile va ole tafa o mua ma tua e mafai ona tuʻu ai le meniscus medial ile tele o lamatiaga o manuʻa.143,165
O le eseʻese o le pu i luma faʻasolosolo i luga o le faʻamalosi e mafai ai e le masisia ona faʻaalia se faʻaititia o le radius ma le feliuliʻu, lea e faʻamaonia ai le paʻu o le pavature o le fusi femoralles poster.165 O lenei suiga o le radius e mafai ai e le meniscus ona faʻafesoʻotaʻi le faʻafesoʻotaʻi o le o le femur ma le tibia i taimi uma.
Totogiina o le lafo
O le gaioiga o le masisini ua faʻamaonia i le tino e suiga fesuisuiai lea e faʻatasi ma lona aveese. Fairbank na faʻamatalaina le faateleina o le faʻaogaina ma suiga vavalalata o foliga o le tino i totonu o tulivae maniscectomized atoa .45 Talu mai lenei amataga o galuega, o le tele o suʻesuʻega ua faʻamaonia nei mea na maua ma ua toe faʻatuina ai le taua o le matafaioi a le meniscus e avea o se puipuiga, ma le fausiaina o le fausaga.
O le mamafa o le mamafa e maua mai ai malosiʻaga i le tulivae, ma oomi ai le menisci, ma mafua ai le faʻalavelave (liʻo) faʻamamafa. O fesoʻotaʻiga mautu e ala i le pito i luma ma le soʻoga o vaega o loʻo i lalo e puipuia ai le meniscus mai le sosolo ese i fafo atu o le taimi o le avega o le avega. menisci.170 O le menisci lafoina 8% o compressive avega e ala i le posterior pu i faʻalautelega, ma 94% auina atu i le 70` flexion.50 Radin et al faʻalia o nei uta e lelei tufatufaina pe a o le menisci e maopoopo.153 Peitai, aveʻesea o le medial meniscus e mafua ai le 50% i le 85% faʻaititia o femoral condyle contact area ma le 90% faʻaopopo i le contact stress.172 Aofaʻi maleiscectomy iuga e maua ai le 137% i le 50% faʻaititia o nofoaga faʻafesoʻotaʻi ma faʻateleina le faʻafitauli popole i o le itu laʻau i le 70% i le 100% o le masani ai.4,50,91 O lenei faʻateleina faʻateleina le avega i le iunite o vaega ma ono fesoasoani i le faʻatelevaveina faʻapitoa cartilage faʻaleagaina ma faʻaleagaina.40
Faʻasalaga Faʻasao
O le masiso e taua tele i le tosoina o galu na mafua ai ona oso i luga o le tulivae ma le malosi masani .94,96,153 Voloshin ma Wosk na faaalia ai o le tulivae masani o loʻo i ai le malosi e le mautonu e uiga i le 20% sili atu nai lo tulivae na faia i le meniscectomy.170 Ona o le le mafai o se suauʻu tuʻufaʻatasia e aʻafia ai le teʻi, ua aʻafia i le atinaʻeina o le osteoarthritis, o le meniscus o le a foliga mai e taua tele le sao i le faatumauina o le soifua maloloina o le sooga vaevaega .138
Soʻotaga tuʻufaʻatasia
O le fausaga o le masisini e maua ai se sao taua i le tausisia o le mausali ma le mautu. ## O le maualuga pito i luga o masini taitasi o le concave, e mafai ai ona faia se fesootaiga lelei i le va o le femoral condyles ma le laulau labial flat. A maeʻa le meniscus, o le tosoina o le tulivae o loʻo i ai le tele o galuega e faʻamautu ai, e faʻasaʻo ai le soona lafo i itu uma .9
O Markolf ma paʻaga na latou talanoaina le aʻafiaga o le meniscectomy i le pito i luma ma le faʻasolosolo tulivae tulivae. O le medial meniscectomy i le ACL-tuli tulivae e tau leai se aafiaga i luma-posterior lafo, ae i le ACL-le lava tulivae, e mafua ai le faateleina o le pito i luma-posterior tibial faaliliuga e oʻo i le 58% i le 90o o flexion.109 Shoemaker ma Markolf faʻaalia ai o le pu i tua o le medial meniscus o le mea sili ona taua e teteʻe atu ai i le pito i luma o le tibial i le ACL-deficit tulivae.155 Allen et al na faʻaalia o le malosiaga faʻamalosi i le medial meniscus o le ACL-deficit tulivae na siʻitia e le 52% i atoa faaopoopoga ma e 197% i le 60-- o flexion i lalo o le 134-N muamua tibial avega.7 O le tele suiga i kinematics ona o medial meniscectomy i le ACL-le lava tulivae faʻamaoniaina le taua matafaioi o le medial meniskus i tulivae faʻamautuina. Talu ai nei, Musahl et al na lipotia mai o le lateral meniscus e avea ma sao i le pito i luma tibial faaliliuga i le taimi o le pivot-shift maneuver.123
Faʻatasi o Meaʻai ma le Faʻasalalau
E mafai foi e le tamaʻitaʻi ona fai se sao i le meaʻai ma le faʻasusuina o le sooga vae. O le masini o lenei lubrication e tumau pea le le iloa; e mafai e le manisci ona faʻapipiʻi le vaivave o le synovial i totonu o le cartilage faʻapitoa, lea e faʻaitiitia ai malosiaga faʻavae i le taimi o le mamafa .13
O loʻo i ai se faʻaoga o microcanal i totonu o le masiscus e latalata i vaʻa toto, lea e fesoʻotai ma le vavave o le synovial; o nei mea e mafai ona tuʻuina atu ai le felaʻuaʻiga o le suavai mo meaʻai ma le tuʻuina faʻatasi .23,24
Faʻaleagaina
O le faʻamatalaga o le gaioiga tuʻufaʻatasia ma le tulaga (faʻasologa o le vaʻaia) e faʻatalanoaina e masini e faʻaaogaina ai le faʻaogaina o le masini eletise eletise eletise. O le vave faʻafetaui o masini, e pei o le Pacinian corpuscles, e manatu e faʻatautaia le lagona o le soosoo faʻatasi, ma faʻagesegese le fetuunaʻi o tagata e talia, e pei o Ruffini endings ma le Golgi tendon totoga o le sooga faʻatasi .140 O le faʻamaoniga o nei elemene (e masani lava i le ogatotonu ma le pito i fafo o le masisiscus) o loʻo faʻamaonia ai o le masisini e mafai ona iloa faʻamatalaga faʻamaonia i le sooga vaevaega, ma taalo ai taua tele le taua i le faiga faʻaalia o le faʻaalia o tulivae.61,88,90,158,169
Maturation and Growing of The Meniscus
O le microanatomy o le meniscus e faigata tele ma e faʻaalia ai suiga o senescent. I le agai i luma o le matua, o le masisiscus ua faasolosolo ina vaivai, ua le toe aoga, ma ua avea ma eleelea.78,95 Microscopically, ua i ai le leai o ni mea elemene ma avanoa avanoa ma le faateleina o mea fibrous pe a faatusatusa i mea e gaosia .74 O nei cystic e mafai ona amataina se loimata , ma faatasi ai ma le malosi o le malosi o le faamalosi o le femoral, o le palapala papalagi o le meniscus e mafai ona vele ese mai le loloto o le eleele i le atinaʻe o le suiga o le degenerative cystic, ma faia ai se loimata o le kiliva horizontal. O le vevesi i le va o nei palapala e mafua ai le tiga. O le maniscus ua afaina e mafai ona afaina ai le taʻavale pito sili ona taua .74,95
Na iloa e Ghosh ma Taylor o le faʻatuputeleina o le collagen na faʻateleina mai le fanau mai i le 30 tausaga ma tumau ai pea seʻia oʻo i le 80 tausaga le matua, ina ua maeʻa le paʻu o le tino. i neonates i le 58% 21.9% i le va o tausaga o le 1.0 i le 8.1 tausaga. 0.8 Ina ua mavae le 30 tausaga o le matua, o le noncollagenous matrix porotini maualuga siitia i le 70%% 80%. Peters ma Smillie na maitauina le faʻateleina o le hexosamine ma le uronic acid ma le matua.70
McNicol ma Roughley na suʻesuʻeina le fesuiaiga o le masisiccal proteoglycans i le aging113; o nai eseesega eseese i le gasolosolo ma le maualuga o le hydrodynamic na matauina. O le tele o le keratin sulfate e fesootaʻi i le chondroitin-6-sulfate na faʻatupulaia i le matua .146
Na suʻesuʻeina e Petersen ma Tillmann immunohistochemically menisci a tagata (amata mai i le 22 vaiaso o le maitaga e oʻo atu i le 80 tausaga), ma maitauina le eseesega o ala toto ma lymphatics i totonu o le 20 tagata. I le taimi o le fanau mai, toeititi atoa le meniscus na vascularized. I le lona lua tausaga o le olaga, o se avascular eria atiina ae i totonu totonu liʻo. I le lona lua sefulu tausaga, sa iai vai toto i le isi itu tolu. Ina ua maeʻa le 50 tausaga le matua, naʻo le kuata peripheral o le meniscal base na vaʻaia. O le pepa mafiafia o le faʻaofiina na vascularized ae le o le fibrocartilage o le faʻaofiina. O vaʻa toto na o faʻatasi ma lymphatics i itu uma. ''
Arnoczky na fautua mai o le mamafa o le tino ma le tulivae e mafai ona aveese ai toto toto i totonu ma le ogatotonu o le misa .9 Nutrition o le maniscal tissue e tupu e ala i le faʻamaʻi mai toto toto ma e ala mai i le faʻasesega mai le vai o synovial. O se manaʻoga mo mea taumafa e ala i le faʻasalalau o le faʻapipiʻiina ma le faʻasalaga i luga o luga o luga o mea faʻapitoa, faʻamalosia i le mamafa o le tino ma le muso.130 O le masini e faʻatusatusa i le meaʻai o le cartilage artics.22
Faʻaaliga Resonance Imaging o le Meniscus
O le faʻataʻitaʻiga o le resonance magnetic (MRI) o se vailaʻau faʻamalosi e le faʻaaogaina i le iloiloga, suʻesuʻega, ma le mataʻituina o le masini. MRI o loʻo talia lautele e avea o se faʻaoga lelei sili ona lelei ona o le sili atu o le vaʻaia o le tino.
I luga ole vaega ole MRI, o le maniscus masani e foliga mai o se laiga laʻititi (pogisa) tafatolu (Ata 9). O le loimata o le loimata e iloagofie e ala i le i ai o se faailoilo faʻalauiloa tele e oʻo atu i luga o lenei fausaga.
E tele suʻesuʻega ua suʻeina le aoga o le MRI mo le maligi mimiti. O le mea lautele, o le IRM e matua maaleale ma patino mo loimata o le meniscus. O le lagona o le MRI i le sailia o loimata masisina e mai i le 70% i le 98%, ma le faapitoa, mai le 74% i le 98% .48,62,105,107,117 The MRI o le 1014 maʻi aʻo leʻi faia se suʻega arthroscopic e saʻo le 89% mo pathology o le meniscus medial ma 88% mo le meniscus.48 A faʻataʻotoga faʻamalositino o tagata 2000 faʻamaʻi ma le MRI ma le suʻesuʻega arthroscopic ua maua 88% lagona ma 94% sao mo meniscal loimata.105,107
E i ai feeseeseaiga i le va o faʻataʻitaʻiga MRI ma faʻamaoniga na iloa i le taimi o le suʻesuʻega o le tino. "Na lipotia e le faʻamasinoga ma Quinn le feeseeseaʻi i le faʻamaoniga o le 66 o le 561 tagata mamaʻi (12%). 86 I le suʻesuʻega o le 92 tagata mamaʻi, o feeseeseaiga i le va o le MRI ma O le suesueina o le genroscopic diagnoses na matauina i le 22 o le 349 (6%) mataupu .106 Miller na faia se suesuega tauaso e tasi le tauaso i le faatusatusaga o suʻesuʻega o le falemaʻi ma le MRI i le 57 suʻega o tulivae.117 Na te leʻi mauaina se eseesega tele i le va o le suesueina o le falemaʻi ma le MRI (80.7 % ma le 73.7%, faʻatulagaina). Na iloiloina e Shepard et al le sao o le MRI i le sailia o faʻamaʻi taua o le nifo i luma o le meniscus i le 947 sosoo tulivae MRI154 ma maua ai le 74% sese-lelei fua. Ole faʻateleina ole faʻailoga ile nifo i luma e le faʻailoa mai ai se tulaga taua ile falemaʻi.154
faaiuga
O le vavave o le sooga o le tulivae o se mea e sili ona lelei i le fibrocartilage lea e maua ai le faʻatupulaia o le mausali i le faʻataʻitaʻiga, fefaasoaaʻi le avega mamafa, faʻavevesi le teʻi, ma tuʻuina le lubrication i le sooga vae. O aʻafiaga i le mitiia ua lauiloa o se mafuaʻaga o le faʻaleagaina o le musculoskeletal. O le faasaoina o le masisini e sili lona faalagolago i le faatumauina o lona tulaga ma le faatulagaga.
I le faaiuga, o le tulivae o le sili ona tele ma sili ona faigata`` soʻotaga i le tino o le tagata. Peitai, talu ai e mafai ona faʻaleagaina le tulivae ona o se manuʻa ma / poʻo se tulaga, e taua ai le malamalama i le anatomy o le tulivae soʻoga ina ia mafai ai e tagata gasegase ona maua togafitiga talafeagai. faʻafitauli tau soifua maloloina i le tuasivi. Ina ia talanoaina le mataupu, faʻamolemole lagona le saoloto e fesili ia Dr. Jimenez pe faʻafesoʻotaʻi mai matou i le915-850-0900 .
Faʻailoina e Dr. Alex Jimenez
Autu Maualuga Talanoaga: Faʻasalaina o Paʻu Tino e aunoa ma se Taʻaloga
Tiga tulivae o se lauiloa auga e mafai ona tupu ona o le eseese o tulivae manuʻa ma / poʻo tulaga, e aofia ai--afaina taʻaloga. O le tulivae o se tasi o sooga sili ona faigata i totonu o le tino o le tagata e pei ona faia i luga o le vaeluaina o ponaivi e fa, fagaga e fa, ituaiga o manoa, lua manisci, ma le cartilage. E tusa ai ma le American Academy of Family Physicians, o mafuaaga sili ona taatele o le tiga o le tulivae e aofia ai le patellar subluxation, patellar tendinitis poʻo le tulivae o le matua, ma le maʻi o Osgood-Schlatter. E ui lava e ono tupu le tiga o tulivae i tagata i luga o le 60 tausaga, e mafai foi ona tupu tiga le tulivae i tamaiti ma tamaiti. E mafai ona togafitia le tiga o le uila i le fale e mulimuli i metotia a le RICE, peitaʻi, o ni manua ogaoga o le tulivae atonu e manaʻomia vave togafitiga faafomaʻi, e aofia ai togafitiga faʻafefesa.
1. Adams ME, Hukins DWL. O le extracellular matrix o le meniskus. I le: Mow VC, Arnoczky SP, Jackson DW, faʻatonu. eds Tulivae Meniscus: Faavae faʻavae ma Faʻavae Faʻavae. Niu Ioka, NY: Raven Press; 1992: 15-282016
2. Adams ME, McDevitt CA, Ho A, Muir H. Tuʻua ma faʻailogaina o le maualuga-faʻamalosia-density proteoglycans mai semilunar menisci. J Bone Joint Surg Am. 1986;68: 55-64 [PubMed]
3. Adams ME, Muir H. Le glycosaminoglycans o canine menisci. Biochem J. 1981;197: 385-389 [PMC free article][PubMed]
4. Ahmed AM, Burke DL. Fuaina i totonu o le vitro o le tufatufaina o le mamafa o le mamafa i sooga o le synovial: vaega I. Tibial luga o le tulivae. J Biomech Eng. 1983;185: 290-294 [PubMed]
5. Akgun U, Kogaoglu B, Orhan EK, Baslo MB, Karahan M. Auala e mafai ona toe suia i le va o le medial meniscus ma le semi-membrane maso: o se suʻesuʻega faʻataʻitaʻi i lapiti. Tootuli Taʻaloga Taʻaloga Traumatol Arthrosc. 2008;16(9): 809-814 [PubMed]
6. Alberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P. Molecular Biology o le sela. 4th ed. Bethesda, MD: National Center mo Biotechnology Faʻamatalaga; 2002
7. Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL. Taua o le medial meniscus i le pito i luma cruciate ligament-le lava tulivae. J Orthop Res. 2000;18(1): 109-115 [PubMed]
8. Arnoczky SP. Fausiaina o se meniskus: iloiloga o meaola. Clin Orthop Relat Res. 1999;367: 244-253[PubMed]
9. Arnoczky SP. Gross ma vascular anatomy o le meniscus ma lana matafaioi i le faʻamaloloina o meniscal, toefaʻafouina ma toefaʻaleleia. I le: Mow VC, Arnoczky SP, Jackson DW, faʻatonu. , eds. Tulivae Meniscus: Faavae faʻavae ma Faʻavae Faʻavae. Niu Ioka, NY: Raven Press; 1992: 1-14
10. Arnoczky SP, Adams ME, DeHaven KE, Eyre DR, Mow VC. O le meniskus. I: Woo SL-Y, Buckwalter J, faʻatonu. , eds. Manuaga ma le toe faʻaleleia o Musculoskeletal Soft Tissues. Park Ridge, IL: American Academy of Orthopedic Surgeons; 1987: 487-537
11. Arnoczky SP, Warren RF. Anatomy o le liua cruciate. I: Feagin JA, faatonu. , ed. Le Faʻamanuiaga Taua. New York, NY: Churchill Livingstone; 1988: 179-195
12. Arnoczky SP, Warren RF. Microvasculature o le tagata meniskus. Am J Taʻaloga Med. 1982;10: 90-95[PubMed]
13. Arnoczky SP, Warren RF, Spivak JM. Meniscal lipea faʻaaogaina exogenous fibrin clot: o se faʻataʻitaʻiga suʻesuʻega i maile. J Bone Joint Surg Am. 1988;70: 1209-1217 [PubMed]
14. Aspden RM, Yarker YE, Hukins DWL. Kolisi faʻamasani i le meniskus ole soʻoga soʻoga. J Anat. 1985;140: 371. [PMC free article][PubMed]
15. Assimakopoulos AP, Katonis PG, Agapitos MV, Exarchou EI. O totonu o le tagata meniscus. Clin Orthop Relat Res. 1992;275: 232-236 [PubMed]
16. Atencia LJ, McDevitt CA, Naila WB, Sokoloff L. Cartilage anotusi o se maile matua. Fesoʻotaʻi Tissue Res. 1989;18: 235-242 [PubMed]
17. Athanasiou KA, Sanchez-Adams J. Inisinia o le Knee Meniscus. San Rafael, CA: Morgan & Claypool Publishers; 2009
18. Baratz ME, Fu FH, Mengato R. Meniscal loimata: o le aʻafiaga o le meniscectomy ma le toe faʻaleleia o vaega o fesoʻotaʻiga i totonu ma le mafatiaga i le tulivae o le tagata. O se uluaʻi lipoti. Am J Taʻaloga Med. 1986;14: 270-275 [PubMed]
19. Faleoloa RL, Skinner HB, Buckley SL. Proprioception i le pito i luma cruciate le lava tulivae. Am J Taʻaloga Med. 1989;17: 1-6 [PubMed]
20. Beaufils P, Verdonk R, faatonu. , eds. O le Meniskus. Heidelberg, Siamani: Springer-Verlag; 2010
21. Beaupre A, Choukroun R, Guidouin R, Carneau R, Gerardin H. Tulivae menisci: faʻafesoʻotaʻiga i le va o microstructure ma biomekanika. Clin Orthop Relat Res. 1986;208: 72-75 [PubMed]
22. Benninghoff A. Faʻavae und Bau der Gelenkknorpel in ihren Beziehungen zur Funktion. Erste Mitteilung: Maliu modellierenden und datinghaltenden Faktoren des Knorpelreliefs. Z Anat Entwickl Gesch. 1925;76: 4263
23. Bird MDT, MBE suamalie. Alavai o le semilunar meniskus: lipoti puʻupuʻu. J Bone soʻoga o taotoga Br. 1988;70: 839. [PubMed]
24. Bird MDT, MBE suamalie. O se faiga o alavai i semilunar menisci. Ann Rheum Dis. 1987;46: 670-673 [PMC free article][PubMed]
25. Brantigan OC, Voshell AF. Ole masini ole ligament ma le menisci ole tulivae. J Bone Joint Surg Am. 1941;23: 44-66
26. Brindle T, Nyland J, Johnson DL. O le meniskus: toe iloiloina o faʻavae masani ma le faʻaaogaina i taotoga ma le toe faʻaleleia. J Athl Toleni. 2001;32(2): 160-169 [PMC free article][PubMed]
27. Bullough PG, Munuera L, Murphy J, et al. Le malosi ole menisci ole tulivae aʻo fesoʻotaʻi ia latou lelei faʻusaga. J Bone soʻoga o taotoga Br. 1979;52: 564-570 [PubMed]
28. Bullough PG, Vosburgh F, Arnoczky SP, et al. O le menisci o le tulivae. I totonu: Insall JN, faatonu , ed. Taotoga o le Tootuli. New York, NY: Churchill Livingstone; 1984: 135-149
29. Burr DB, Radin EL. Meniscal function ma le taua o meniscal regeneration i le puipuia o le tuai medial compartment osteoarthrosis. Clin Orthop Relat Res. 1982;171: 121-126 [PubMed]
30. Carney SL, Muir H. Le fausaga ma le faʻagaioiga o cartilage proteoglycans. Physiol Rev. 1988;68: 858-910 [PubMed]
31. Clark CR, Ogden JA. Atinaʻeina o le menisci o le sooga tulivae o le tagata. J Bone Joint Surg Am. 1983;65: 530 [PubMed]
32. Clark FJ, Horsh KW, Bach SM, Larson GF. Saofaga o cutaneous ma soʻoga mauaina i static tulivae tulaga tulaga i le tagata. J Neurophysiol. 1979;42: 877-888 [PubMed]
33. Danzig L, Resnik D, Gonsalves M, Akeson WH. Ole sapalai ole toto ile meniskus masani male le masani ai ole tulivae ole tagata. Clin Orthop Relat Res. 1983;172: 271-276 [PubMed]
34. Davies D, Edwards D. Le sapalai o neura ma le neura o le meniskus a tagata. Am R Coll Surg Engl. 1948;2: 142-156
35. Aso B, Mackenzie WG, Shim SS, Leung G. Le sapalai o neura ma le neura o le meniskus a tagata. Arthroscopy. 1985;1: 58-62 [PubMed]
36. DeHaven KE. Meniscectomy versus faʻafouina: falemaʻi poto masani. I le: Mow VC, Arnoczky SP, Jackson DW, faʻatonu. , eds. Tulivae Meniscus: Faavae faʻavae ma Faʻavae Faʻavae. Niu Ioka, NY: Raven Press; 1992: 131-139
37. DePalma AF. Faamai o le tuli. Filatelefia, PA: JB Lippincott Co; 1954
38. De Smet AA, Graf BK. Meniscal loimata misia luga MR ata: sootaga i meniscal loimata mamanu ma luma cruciate ligament loimata. AJR Am J Roentgenol. 1994;162: 905-911 [PubMed]
39. De Smet AA, Norris MA, Yandow DR, et al. MR faʻamaoniga o meniscal loimata o le tulivae: taua o le maualuga faʻailoga i le meniscus e oʻo atu i luga. AJR Am J Roentgenol. 1993;161: 101-107[PubMed]
40. Vale SF. Faʻaaoga morphologic faʻaaogaina o le tulivae o le tagata: o se evolusione vaʻaiga. Clin Orthop Relat Res. 2003;410: 19-24 [PubMed]
41. Vale SF. O le tulivae e avea o se biologic transmission ma se teutusi o gaioiga: o se teori. Clin Orthop Relat Res. 1996;325: 10-18 [PubMed]
42. Vau SF, Vaupel GL, Vali CC. Malamalama lelei neurosensory faafanua o le i totonu fausaga o le tagata tulivae aunoa ma intraarticular vai faagase. Am J Taʻaloga Med. 1998;26(6): 773-777 [PubMed]
43. Eyre DR, Koob TJ, Chun LE. Biochemistry o le meniscus: tulaga ese faʻamatalaga o collagen ituaiga ma 'upega tafaʻilagi eseesega i fatuga. Orthop Trans. 1983;8: 56
44. Eyre DR, Wu JJ. Collagen o fibrocartilage: o se iloga molimoli phenotype i bovine meniscus. FEBS Lett. 1983;158: 265. [PubMed]
45. Fairbank TJ. Suiga soʻoga tuli pe a maeʻa le meniscectomy. J Bone soʻoga o taotoga Br. 1948;30: 664-670[PubMed]
46. Fife RS. Faʻailoaina o fesoʻotaʻiga polotini ma le 116,000-dalton matrix porotini i canine meniscus. Arch Biochem Biophys. 1985;240: 682. [PubMed]
47. Fife RS, Hook GL, Brandt KD. Topographic localization o le 116,000 dalton porotini i cartilage. J Histochem Cytochem. 1985;33: 127. [PubMed]
48. Fischer SP, Fox JM, Del Pizzo W, ma isi. Tonu o faʻamaoniga mai maneta resonance faʻataʻitaʻiga o le tulivae: o le tele-ogatotonu auiliiliga o le tasi le afe sefulufa tagata mamaʻi.. J Bone Joint Surg Am. 1991;73: 2-10[PubMed]
49. Fithian DC, Kelly MA, Mow VC. Meatotino meatotino ma fausaga-aoga sootaga i le menisci. Clin Orthop Relat Res. 1990;252: 19-31 [PubMed]
50. Fukubayashi T, Kurosawa H. O le vaega faʻafesoʻotaʻi ma le tufatufaina o le tulivae o le tulivae: o se suʻesuʻega o masani ma osteoarthritic tulivae soʻoga. Acta Orthop Scand. 1980;51: 871-879 [PubMed]
51. Fukubayashi T, Torzilli PA, Sherman MF, Warren RF. Suʻesuʻega o le biomechanical in vivo o le gaioiga i luma-tua o le tulivae, o le suiga o le tibial ma le torque. J Bone Joint Surg Am. 1982;64: 258-264 [PubMed]
52. Gardner E. O totonu o le sooga tulivae. Anat Rec. 1948;101: 109-130 [PubMed]
53. Gardner E, O'Rahilly R. O le vave atinaeina o le tulivae soofaatasi i staged tagata embryos. J Anat. 1968;102: 289-299 [PMC free article][PubMed]
55. GhadIAL FN, LaLonde JMA, Wedge JH. Ultrastructure o masani ma masaesae menisci o le sooga tulivae soʻoga. J Anat. 1983;136: 773-791 [PMC free article][PubMed]
56. GhadIAL FN, Thomas I, Yong N, LaLonde JMA. Ultrastructure o lapisi semilunar cartilage. J Anat. 1978;125: 499. [PMC free article][PubMed]
57. Ghosh P, Ingman AM, Taylor TK. Fesuiaʻiga i collagen, non-collagenous proteins, ma le hexosamine i le menisci na maua mai i le osteoarthritic ma le rheumatoid arthritic tulivae soʻoga. J Rheumatol. 1975;2: 100-107[PubMed]
58. Ghosh P, Taylor TKF. O le tulivae soʻoga o le tulimanu: o se fibrocartilage o se eseʻesega. Clin Orthop Relat Res. 1987;224: 52-63 [PubMed]
59. Ghosh P, Taylor TKF, Pettit GD, Horsburgh BA, Bellenger CR. Aʻafiaga o le postoperative immobilization luga o le toe faʻatupuina o tulivae soʻoga semilunar cartilage: o se faʻataʻitaʻiga suʻesuʻega. J Orthop Res. 1983;1: 153.[PubMed]
60. Grey DJ, Gardner E. Muaa-natal atinaeina o le tagata tulivae ma sili tibial fibula soʻoga. Am J Anat. 1950;86: 235-288 [PubMed]
61. Grey JC. Neural ma vascular anatomy o le menisci o le tagata tulivae. J Orthop Taʻaloga Phys Ther. 1999;29(1): 23-30 [PubMed]
62. Grey SD, Kaplan PA, Dus assault RG. Ata o le tulivae: tulaga o loʻo i ai nei. Orthop Clin North Am. 1997;28: 643-658 [PubMed]
63. Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal manua: I. Saienisi masani ma iloiloga. J Am Acad Orthop Surg. 2002;10: 168-176 [PubMed]
64. Gronblad M, Korkala O, Liesi P, Karaharju E. Totonu o le synovial membrane ma le meniscus. Acta Orthop Scand. 1985;56: 484-486 [PubMed]
65. Habuchi H, Yamagata T, Iwata H, Suzuki S. O le tupu mai o le tele o ituaiga o dermatan sulfate-chondroitin sulfate copolymers i fibrous cartilage. J Chem Biol. 1973;248: 6019-6028 [PubMed]
66. Haines RW. O le tetrapod sooga tulivae. J Anat. 1942;76: 270-301 [PMC free article][PubMed]
67. Hardingham TE, Muir H. O le fusifusia o oligosaccharides o le hyaluronic acid i proteoglycans. Biochem J. 1973;135 (4): 905-908 [PMC free article][PubMed]
68. Harner CD, Janaushek MA, Kanamori A, Yagi AKM, Vogrin TM, Woo SL. Suʻesuʻega faʻasolosolo o le faʻalua-fusifusi posterior cruciate ligament toefausia. Am J Taʻaloga Med. 2000;28: 144-151 [PubMed]
69. Harner CD, Kusayama T, Carlin G, et al. Fausiaina ma masini meatotino o le tagata posterior cruciate ligament ma meniscofemoral ligament. I: Galuega faʻatino a le Fonotaga Faʻaletausaga lona 40 a le Orthopedic Research Society; 1992
70. Harner CD, Livesgay GA, Choi NY, ma isi. Iloiloina o le tele ma foliga o le tagata pito i luma ma tua cruciate ligament: o se faʻatusatusaga suʻesuʻega. Trans Orthop Res Soc. 1992;17: 123
71. Hascall VC. Fegalegaleaiga o cartilage proteoglycans ma hyaluronic acid. J Supramol Faʻavae. 1977;7: 101-120 [PubMed]
72. Hascall VC, Heineg rd D. Faʻatasiga o cartilage proteoglycans: I. O le matafaioi a le hyaluronic acid. J Chem Biol. 1974;249(13): 4205-4256 [PubMed]
73. Heinegard D, Oldberg A. Faʻatulagaga ma le biology o cartilage ma ponaivi matrix noncollagenous macromolecules. FASEB J. 1989;3: 2042-2051 [PubMed]
74. Fesoasoani AJ. Osteoarthritis o le tulivae ma lona vave pueina. Faiaoga Vasega Lect. 1971;20: 219-230
75. Heller L, Langman J. Le fusi a le tagata tuli. J Bone Join Surg Br. 1964;46: 307-313 [PubMed]
76. Henning CE, Lynch MA, Clark JR. Vascularity mo le faʻamaloloina o meniscal lipea. Arthroscopy. 1987;3: 13-18 [PubMed]
77. Herwig J, Egner E, Budecke E. Suiga vailaʻau o le tagata tulivae soʻoga menisci i vaega eseese o le faʻaleagaina. Ann Rheum Dis. 1984;43: 635-640 [PMC free article][PubMed]
78. H pker WW, Angres G, Klingel K, Komitowksi D, Schuchardt E. Suiga o le elastin potu i le meniskus tagata. Virchows Arch O Pathol Anat Histopathol. 1986;408: 575-592 [PubMed]
79. Humphry GM. O se Talafaʻasolopito i luga o le Tagata Auivi aofia ai ma le soʻoga. Cambridge, Peretania: Macmillan; 1858: 545-546
80. Ingman AM, Ghosh P, Taylor TKF. Fesuiaʻiga o collagenous ma leai-collagenous porotini o tagata tulivae soʻoga menisci ma tausaga ma degeneration. Gerontology. 1974;20: 212-233 [PubMed]
81. Jerosch J, Prymka M, Castro WH. Faʻaaogaina o tulivae soʻoga ma se faʻamaʻi o le medial meniscus. Acta Orthop Belg. 1996;62(1): 41-45 [PubMed]
82. Johnson DL, Swenson TD, Harner CD. Toe fesuiaʻi o le mafaufau i le fegasoloaʻi i le mafaufau: anatomic ma le mafaufau loloto. Faʻaalia i le: Iva sefuluiva fonotaga faʻaletausaga a le American Orthopedic Society mo taʻaloga Faʻafomaʻi; Iulai 12-14, 1993; Sun Valley, ID
83. Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD. Faʻaofiina-nofoaga anatomy o le tagata menisci: tele, arthroscopic, ma topographic anatomy o se faʻavae mo meniscal totoina. Arthroscopy. 1995;11: 386-394 [PubMed]
84. Johnson RJ, Pope MH. Anotusi aoga o le meniskus. I: Symposium i le toefausiaina o le tulivae o le American Academy of Orthopedic Surgeons. St Louis, MO: Mosby; 1978: 3
85. Jones RE, Smith EC, Reisch JS. Aʻafiaga o medial meniscectomy i tagata mamaʻi e matutua atu i le fasefulu tausaga. J Bone Joint Surg Am. 1978;60: 783-786 [PubMed]
86. Faamasino WW, Quinn SF. Sese mamanu i le MR imaging iloiloga o le menisci o le tulivae. Radiology. 1995;196: 617-621 [PubMed]
87. Kaplan EB. O le embryology o le menisci o le tulivae soʻoga. Bull Hosp Joint Dis. 1955;6: 111-124[PubMed]
88. Karahan M, Kocaoglu B, Cabukoglu C, Akgun U, Nuran R. Aʻafiaga o vaega faʻapitoa meniscectomy i luga o le proprioceptive galuega a le tulivae. Arch Orthop Trauma Surg. 2010;130: 427-431 [PubMed]
89. Kempson GE, Tuke MA, Dingle JT, Barrett AJ, Horsfield PH. O le aafiaga o proteolytic enzymes i luga o le masini meatotino o le tagata matua poto faapitoa cartilage. Biochim Biophys Acta. 1976;428(3): 741-760[PubMed]
90. Kennedy JC, Alexander IJ, Hayes KC. Neura sapalai o le tagata tulivae ma lona aoga galuega. Am J Taʻaloga Med. 1982;10: 329-335 [PubMed]
91. Kettelkamp DB, Jacobs AW. Tibiofemoral contact area: naunautaiga ma aʻafiaga. J Bone Joint Surg Am. 1972;54: 349-356 [PubMed]
92. King D. O le gaioiga o le cartilages semilunar. J Bone soʻoga o taotoga Br. 1936;18: 1069-1076
93. Kohn D, Moreno B. Meniscus faʻaofiina anatomy o se faʻavae mo meniskus sui: o se morphological cadaveric suʻesuʻega. Arthroscopy. 1995;11: 96-103 [PubMed]
94. Krause WR, Pope MH, Johnson RJ, Wilder DG. Suiga faʻapitoa i le tulivae pe a maeʻa le meniscectomy. J Bone Joint Surg Am. 1976;58: 599-604 [PubMed]
95. Kulkarni VV, Chand K. Faʻavae tino o le matua meniscus. Acta Orthop Scand. 1975;46: 135-140 [PubMed]
96. Kurosawa H, Fukubayashi T, Nakajima H. Avega o le sooga i le tulivae: amioga faʻaletino o tulivae soʻofaʻatasi ma pe leai menisci. Clin Orthop Relat Res. 1980;149: 283-290 [PubMed]
97. LaPrade RF, Burnett QM, II, Veenstra MA, et al. Le faʻateleina o le masani ai maneta resonance imaging faʻamatalaga i tulimanu asymptomat: ma le faʻamaopoopoina o maneta resonance faʻataʻitaʻiga i le mauaina o le genroscopic i faʻailoga tulivae. Am J Taʻaloga Med. 1994;22: 739-745 [PubMed]
98. RJ mulimuli. Nisi anatomical auiliiliga o le tulivae soʻoga. J Bone soʻoga o taotoga Br. 1948;30: 368-688 [PubMed]
99. Lehtonen A, Viljanto J, K rkk in J. O le mucopolysaccharides o herniated tagata intervertebral discs ma semilunar cartilages. Acta Chir Scand. 1967;133(4): 303-306 [PubMed]
100. Levy IM, Torzilli PA, Warren RF. Le aʻafiaga ole maleiscectomy ile itu o tulivae. J Bone Joint Surg Am. 1989;71: 401-406 [PubMed]
101. Levy IM, Torzilli PA, Warren RF. Le aʻafiaga ole medial meniscectomy ile gaioiga ole mua-posterior ole tulivae. J Bone Joint Surg Am. 1982;64: 883-888 [PubMed]
102. MacConaill MA. O le gaioiga o intra-articular fibrocartilages ma faʻapitoa faʻapitoa i le tulivae ma maualalo leitio-ulnar soʻoga. J Anat. 1932;6: 210-227 [PMC free article][PubMed]
103. MacConaill MA. O gaioiga o ponaivi ma sooga: III. O le suavai synovial ma ona fesoasoani. J Bone soʻoga o taotoga Br. 1950;32: 244. [PubMed]
104. MacConaill MA. Suesuega i le inisinia o soʻoga sinovial: II. Faʻamatalaga i luga o laufanua faʻapitoa ma le taua o soʻoga soʻoga. Ir J Med Sci. 1946;6: 223-235 [PubMed]
105. Mackenzie R, Dixon AK, Keene GS, et al. Maneta resonance ata o le tulivae: iloiloga o le aoga. Clin Radiol. 1996;41: 245-250 [PubMed]
106. Mackenzie R, Keene GS, Lomas DJ, Dixon AK. Sese i tulivae maneta resonance ata: moni pe sese?Br J Radiol. 1995;68: 1045-1051 [PubMed]
107. Mackenzie R, Palmer CR, Lomas DJ, ma isi. Maneta resonance faʻataʻitaʻiga o le tulivae: diagnostic performance Studies. Clin Radiol. 1996;51: 251-257 [PubMed]
108. Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC. O le matafaioi o soʻoga avega i tulivae le mautonu. J Bone Joint Surg Am. 1981;63: 570-585 [PubMed]
109. Markolf KL, Mensch JS, Amstutz HC. Maʻaʻa ma laxity o le tulivae: o le saofaga o le lagolago fausaga. J Bone Joint Surg Am. 1976;58: 583-597 [PubMed]
110. McDermott LJ. Atinaʻeina o le soʻoga tulivae o le tagata. Faʻaosooso. 1943;46: 705-719
111. McDevitt CA, Miller RR, Sprindler KP. O sela ma sela o fuataga o le masiso. I le: Mow VC, Arnoczky SP, Jackson DW, faʻatonu. , eds. Tulivae Meniscus: Faavae faʻavae ma Faʻavae Faʻavae. Niu Ioka, NY: Raven Press; 1992: 29-36
112. McDevitt CA, Webber RJ. Ultrastructure ma biochemistry o meniscal cartilage. Clin Orthop Relat Res. 1990;252: 8-18 [PubMed]
113. McNicol D, Roughley PJ. Aveesea ma faʻailogaina o proteoglycan mai meniskus tagata. Biochem J. 1980;185: 705. [PMC free article][PubMed]
114. Merkel KHH. O le pito i luga o le tagata menisci ma ana tuai suiga i tausaga: o le tuʻufaʻatasia o le suʻesuʻeina ma le tuʻuina atu o le eletise suʻesuʻega (SEM, TEM). Arch Orthop Trauma Surg. 1980;97: 185-191 [PubMed]
115. Messner K, Gao J. O le menisci o le tulivae soʻoga: anatomical ma aoga uiga, ma o se mafuaaga mo togafitiga togafitiga. J Anat. 1998;193: 161-178 [PMC free article][PubMed]
116. Meyers E, Zhu W, Mow V. Viscoelastic meatotino o articular cartilage ma meniscus. I: Nimni M, faatonu. , ed. Collagen: Chemistry, Biology ma Biotechnology. Boca Raton, FL: CRC; 1988
117. Miller GK. O se suʻesuʻega suʻesuʻe faʻatusatusa le saʻo o le faʻamaʻi falemaʻi o meniscal loimata ma maneta resonance ata ma lona aʻafiaga i togafitiga faʻaiuga. Arthroscopy. 1996;12: 406-413 [PubMed]
118. Miller GK, McDevitt CA. Le i ai o le thrombospondin i ligament, meniscus ma intervertebral disc. Glycoconjugate J. 1988;5: 312
119. Mossman DJ, Sargeant SA. O tulagavae o manu ua mamate. Sci Am. 1983;250: 78-79
120. Mow V, Fithian D, Kelly M. Faʻavae o articular cartilage ma meniscus biomekanika. I: Ewing JW, faatonu. , ed. Articular Cartilage ma tulivae Faʻatino Galuega, Autu Saienisi ma Arthroscopy. Niu Ioka, NY: Raven Press; 1989: 1-18
121. Mow VC, Holmes MH, Lai WM. Felaʻuaiga o suavai ma masini masini poʻo articular cartilage: o se toe iloiloga. J Biomech. 1984;17: 377. [PubMed]
122. Muir H. Le fausaga ma metabolism o mucopolysaccharides (glycosaminoglycans) ma le faʻafitauli o le mucopolysaccharidoses. Am J Med. 1969;47 (5): 673-690 [PubMed]
123. Musahl V, Citak M, O--Loughlin PF, Choi D, Bedi A, Pearle AD. O le aʻafiaga o le medial versus lateral meniscectomy i luga o le mautu o le pito i luma cruciate ligament-le lava tulivae. Am J Taʻaloga Med. 2010;38(8): 1591-1597 [PubMed]
124. Nakano T, Dodd CM, Scott PG. Glycosaminoglycans ma proteoglycans mai sone eseese o le porcine tulivae meniscus. J Orthop Res. 1997;15: 213-222 [PubMed]
125. Newton RA. Fesoasoani tuʻufaʻatasi soʻotaga i tali faʻaalia ma kinaesthetic. Phys Ther. 1982;62: 22-29 [PubMed]
126. Faʻatasi BL. Le faʻavasegaina faʻasolopito o le maile tulivae menisci ma faʻamatalaga i lona ono ono taua. Am J Anat. 1976;147: 407-417 [PubMed]
127. Faʻatasi BL, McConnaughey JS. Le fausaga ma totonu o le pusi tulivae menisci, ma le latou faʻafesoʻotaʻi i le "faʻataʻitaʻiga faʻapitoa" o le meniscal function. Am J Anat. 1978;153: 431-442 [PubMed]
128. Oretorp N, Gillquist J, Liljedahl SO. Taunuuga umi o taotoga mo le le-ogaoga anteromedial rotatory le mautonu o le tulivae. Acta Orthop Scand. 1979;50: 329-336 [PubMed]
129. Pagnani MJ, Warren RF, Arnoczky SP, Wickiewicz TL. Anatomy o le tulivae. I: Nicholas JA, Hershman EB, faʻatonu. , eds. Le Maualalo Maualuga ma Spine i Taaloga Faʻafomai. 2nd ed. St Louis, MO: Mosby; 1995: 581-614
130. Pauwels F. [Aafiaga atinae o le aoga fetuʻunaʻiga o ponaivi]. Anat Anz. 1976;139: 213-220[PubMed]
131. Peters TJ, Smillie IS. Suesuega i luga o vailaʻau vailaʻau o le menisci o le tulivae soʻofaʻatasi ma faʻapitoa faʻapitoa i le faʻapipiʻi cleavage lesion. Clin Orthop Relat Res. 1972;86: 245-252 [PubMed]
132. Petersen W, Tillmann B. Collagenous fibril texture o le tagata tulivae soʻoga menisci. Anat Embryol (Berl). 1998;197: 317-324 [PubMed]
133. Poynton AR, Javadpour SM, Finegan PJ, O brrien M. O tamaʻi tulivae o le tulivae. J Bone soʻoga o taotoga Br. 1997;79: 327-330 [PubMed]
134. Preuschoft H, Tardieu C. Mafuaʻaga mafuaʻaga mo eseesega morphology o le tulivae soʻoga ma le distal epiphyseal suʻi i hominoids. Folia Primatol (Basel). 1996;66: 82-92 [PubMed]
135. Faʻatonu CS, Schmidt MB, Whipple RR, Kelly MA, Mow VC. Mea totino o le masani medial bovine meniscus. J Orthop Res. 1989;7: 771-782 [PubMed]
136. Proske U, Schaible H, Schmidt RF. Faʻamatalaga tuʻu faʻatasi ma kinanesthesia. Exp Brain Res. 1988;72: 219-224 [PubMed]
137. Radin EL, de Lamotte F, Maquet P. Matafaioi o le menisci i le tufatufaina o le popole i le tulivae. Clin Orthop Relat Res. 1984;185: 290-294 [PubMed]
138. Radin EL, Rose RM. Mataalia o le subchondral ponaivi i le amataga ma le alualu i luma o cartilage faaleagaina. Clin Orthop Relat Res. 1986;213: 34-40 [PubMed]
139. Raszeja F. Untersuchungen Bber Entstehung und feinen Bau des Kniegelenkmeniskus. Bruns Beitr clin Chir. 1938;167: 371-387
140. Reider B, Arcand MA, Diehl LH, et al. Proprioception o le tulivae i luma ma le maeʻa muamua cruciate ligament toefausia. Arthroscopy. 2003;19(1): 2-12 [PubMed]
141. Renstrom P, Johnson RJ. Anatomy ma biomekanika o le menisci. Falemai Taʻaloga Med. 1990;9: 523-538 [PubMed]
142. Retterer E. De la forme et des connexions que presentment les fibro-cartilages du genou chez quelques singes dʻAfrique. Cr Soc Biol. 1907;63: 20-25
143. Ricklin P, Ruttimann A, Del Bouno MS. Suʻesuʻega, Eseesega Suʻesuʻega ma togafitiga. 2nd ed. Stuttgart, Siamani: Verlag Georg Thieme; 1983
144. Rodkey WG. Biology faʻavae o le meniskus ma tali atu i manuʻa. I le: Tau CT, faʻatonu. , ed. Lauga Faʻatonuga mo Aʻoaʻoga 2000. Rosemont, IL: American Academy of Orthopedic Surgeons; 2000: 189-193 [PubMed]
145. Rosenberg LC, Buckwalter JA, Coutts R, Hunziker E, Mow VC. Faʻaputuga o ata i lalo. I: Woo SLY, Buckwalter JA, faʻatonu. , eds. Manua ma le toe faʻaleleia o Musculoskeletal Soft Tissues. Park Ridge, IL: American Academy of Orthopedic Surgeon; 1988: 401
146. Roughley PJ. Suiga i le cartilage proteoglycan fausaga i le taimi o le matua: amataga ma aafiaga: o se toe iloiloga. Agents Galue. 1986;518: 19 [PubMed]
147. Saygi B, Yildirim Y, Berker N, Ofluoglu D, Karadag-Saygi E, Karahan M. Suʻesuʻega o le neurosensory function o le medial meniscus i tagata. Arthroscopy. 2005;21(12): 1468-1472 [PubMed]
148. Scapinelli R. Suesuega i luga ole vasculature o le sooga tulivae soʻoga. Acta Anat. 1968;70: 305-331[PubMed]
149. Schutte MJ, Dabezius EJ, Zimny ML, Happe LT. Neural anatomy o le tagata pito i luma cruciate ligament. J Bone Joint Surg Am. 1987;69: 243-247 [PubMed]
150. Scott JE. Supramolecular faʻalapotopotoga o extracellular matrix glycosaminoglycans, in vitro ma i totonu o aano.. FASEB J. 1992;6: 2639-2645 [PubMed]
151. Scott PG, Nakano T, Dodd CM. Tuʻua ma faʻailogaina o tamaʻi proteoglycans mai sone 'eseʻese o le porcine tulivae meniscus. Biochim Biophys Acta. 1997;1336: 254-262 [PubMed]
152. Seedhom BB. Loadbearing galuega a le menisci. Fomaʻi togafitiga. 1976;62(7): 223. [PubMed]
153. Seedhom BB, Hargreaves DJ. Aveina o le avega i le tulivae soʻoga ma faʻapitoa faʻapitoa i le matafaioi i le menisci: vaega II. Iʻuga faʻataʻitaʻi, talanoaga ma faʻaiuga. Eng Med. 1979;8: 220-228
154. Shepard MF, Hunter DM, Davies MR, Shapiro MS, Seeger LL. O le taua o le falemaʻi o loimata muamua gofie meniscal loimata faʻamaonia luga maneta resonance ata. Am J Taʻaloga Med. 2002;30(2): 189-192[PubMed]
155. Fai seevae SC, Markolf KL. O le matafaioi a le meniskus i le pito i luma-faʻamautuina o le avega pito i luma cruciate-le lava tulivae: aʻafiaga o vaega faʻatusatusa faʻatamaiaina excision. J Bone Joint Surg Am. 1986;68(1): 71-79 [PubMed]
156. Skaags DL, Mow VC. Galue o le radial fusi i le meniscus. Trans Orthop Res Soc. 1990;15: 248
157. Skinner HB, Falepuipui RL. Lagolago tulaga tulaga i le masani ma pathologic tulivae soʻoga. J Electromyogr Kinesiol. 1991;1(3): 180-190 [PubMed]
159. Solheim K. Glycosaminoglycans, hydroxyproline, kalisiu, ma le phosphore i faʻamalologa toto. Acta Univ Lund. 1965;28: 1-22
160. Spilker RL, Donzelli PS. O le biphasic finite elemeni faʻavae o le meniskus mo le faʻamamafaina-faʻatamaʻiina auiliiliga. I le: Mow VC, Arnoczky SP, Jackson DW, faʻatonu. , eds. Tulivae Meniscus: Faavae faʻavae ma Faʻavae Faʻavae. Niu Ioka, NY: Raven Press; 1992: 91-106
161. Spilker RL, Donzelli PS, Mow VC. O le transversely isotropic biphasic finite elemeni faʻavae o le meniscus. J Biomekanika. 1992;25: 1027-1045 [PubMed]
162. Sutton JB. Ligament: Latou Natura ma Morphology. 2nd ed. Lonetona: HK Lewis; 1897
163. Tardieu C. Ontogeny ma filogene o femoral-tibial tagata i tagata ma hominid fossil: aoga faatosinaga ma genetin determinism. Am J Phys Anthropol. 1999;110: 365-377 [PubMed]
164. Tardieu C, Dupont JY. Le amataga o femoral trochlear dysplasia: faʻatusatusaga anatomy, evolusione, ma le tuputupu aʻe o le patellofemoral soʻoga. Rev Chir Orthop Reparatrice Appar Mot. 2001;87: 373-383 [PubMed]
165. Thompson WO, Thaete FL, Fu FH, Dye SF. Tibial meniscal dynamics faʻaaogaina le tolu-dimensional toefausiaina o maneta resonance ata. Am J Taʻaloga Med. 1991;19: 210-216 [PubMed]
166. Tissakht M, Ahmed AM. Tensile faʻamamafa-faigata uiga o le tagata meniscal mea. J Biomech. 1995;28: 411-422 [PubMed]
167. Tobler T. Zur normalen und pathologischen Histologie des Kniegelenkmeniscus. Arch Klin Chir. 1933;177: 483-495
168. Vallois H. Etude anatomique de l articulation du genou chez les primates. Montpelier, Farani: L Abeille; 1914
169. Verdonk R, Aagaard H. Galue o le masani meniscus ma iʻuga o le meniscal resection. Scand J Med Sci Taʻaloga. 1999;9(3): 134-140 [PubMed]
170. Voloshin AS, Wosk J. Mitiia faʻaosoina o meniskectomized ma tiga tulivae: o se faʻatusatusaga i vivo suesuega. J Biomed Eng. 1983;5: 157-161 [PubMed]
171. Wagner HJ. Maliu kollagenfaserarchitecktur der menisken des menschlichen kniegelenkes. Z Mikrosk Anat Forsch. 1976;90: 302. [PubMed]
172. Walker PS, Erkman MJ. O le matafaioi a le meniskus i le faʻamalosi o le faʻamavaega i luga o le tulivae. Clin Orthop Relat Res. 1975;109: 184-192 [PubMed]
173. Wan ACT, Felle P. Le fusi a le menisco-femoral ligament. Clin Anat. 1995;8: 323-326 [PubMed]
174. Warren PJ, Olanlokun TK, Cobb AG, Bentley G. Faʻalauiloaina pe a maeʻa tulivae tulivae: o le aʻafiaga o faiga faʻafoliga. Clin Orthop Relat Res. 1993;297: 182-187 [PubMed]
175. Warren RF, Arnoczky SP, Wickiewiez TL. Anatomy o le tulivae. I: Nicholas JA, Hershman EB, faʻatonu. , eds. Le Maualalo Maualuga ma Spine i Taaloga Faʻafomai. St Louis: Mosby; 1986: 657-694
176. Watanabe AT, Carter BC, Teitelbaum GP, ma isi. Masani afu i le maneta resonance ata o le tulivae. J Bone Joint Surg Am. 1989;71: 857-862 [PubMed]
177. Webber RJ, Norby DP, Malemud CJ, Goldberg VM, Moskowitz RW. Faʻailogaina o faʻatoa fausiaina proteoglycans mai lapiti menisci i aganuu aganuu. Biochem J. 1984;221(3): 875-884 [PMC free article][PubMed]
178. Webber RJ, York JL, Vanderseen JL, Hough AJ. O se okeni aganuu faʻataʻitaʻiga mo le suʻeina o manuʻa toe faaleleia o le fibrocartilaginous tulivae soʻoga meniscus. Am J Taʻaloga Med. 1989;17: 393-400 [PubMed]
179. Wilson AS, Legg PG, McNeu JC. Suesuega i totonu o totonu o le medial meniscus i le soʻoga tulivae o le tagata. Anat Rec. 1969;165: 485-492 [PubMed]
180. Wirth CJ. O le meniskus: fausaga, faʻatulagaina ma gaioiga. tuli. 1996;3: 57-58
181. Wu JJ, Eyre DR, Slayter HS. Ituaiga VI collagen o le intervertebral disc: biochemical ma electron microscopic faʻailogaina o le tagatanuʻu porotini. Biochem J. 1987;248: 373. [PMC free article][PubMed]
182. Yasui K. Tolu dimensional fausaga o masani tagata menisci. J Jpn Ortho Assoc. 1978;52: 391
183. Zimny ML. Masini faafeiloaʻi i masini tino. Am J Anat. 1988;64: 883-888
184. Zimny ML, Albright DJ, Dabezies E. Faʻapitoa i le meniscus medial a tagata. Acta Anat. 1988;133: 35-40 [PubMed]
185. Zivanovic S. Menisco-meniscal ligament o le soʻoga tulivae o le tagata. Anat Anz. 1974;145: 35-42[PubMed]
IFM's Find A Practitioner mea faigaluega o le sili ona tele fesoʻotaʻiga fesoʻotaʻiga i Functional Faʻafomaʻi, fausia e fesoasoani tagata mamaʻi saili Functional Faʻafomaʻi fomaʻi soʻo se mea i le lalolagi. IFM Faʻamaonia Faʻataʻitaʻi e lisiina muamua i le sailiga iʻuga, maua a latou aʻoaʻoga tele i Functional Faʻafomaʻi
Tusi i luga ole laiga & Tofiga 24/7 *
Tu'uina Fa'afoma'i Fa'amaonia* E galulue uma Au'aunaga i totonu o pulega fa'aletulafono ma fa'amautu tulaga fa'ata'ita'i fa'ata'ita'i.*
