Skausmas peties sąnario srityje: priežastys, klinikiniai simptomai, diagnostika ir gydymas

Rimvaldas BrogaVilniaus universiteto Ortopedijos,traumatologijos ir plastinės chirurgijos klinika,Vilniaus Greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-2043 VilniusEl paštas: [email protected] Peties skausmą yra pajutęs dažnas pacientas, kuriam jau per 40 metų. Dėl šio skausmo jis kreipiasi į įvairių specialybių gydytojus. Pečių juostos anatomija ir biomechanika labai sudėtinga ir visai nepanaši į kitų sąnarių. Pečių juostos judesių amplitudė įvairiose ašyse ir plokštumose labai plati dėl trijų tikrųjų sąnarių ir dviejų jungčių. Pečių juostos funkciją atlieka 26 raumenys ir jų dalys, tačiau biomechanikai svarbiausi yra mažieji sukamieji raumenys ir deltinis raumuo. Trinkant minėtų raumenų veiklai, ligonis pajunta skausmus, blogėja peties funkcija. Straipsnyje minimos peties sąnario degeneracijos priežastys, dėstomas ištyrimo planas. Kai kurie anamnezės ir apžiūros duomenys labai būdingi peties ligoms. Apžvelgiami patys populiariausi ištyrimo metodai: skausminiai, funkciniai ir jėgos pasipriešinimo. Rentgenologinis tyrimas palyginti nebrangus, tačiau labai informatyvus. Aptariami būdingiausi peties sąnario rentgenologiniai simptomai. Laiku diagnozuoto mažųjų sukamųjų raumenų degeneracinio ar trauminio pažeidimo operacinis gydymas labai veiksmingas. Jei liga užleista ir įsisenėjusi, t. y. minėti raumenys seniai nuplyšę, surandėję ir negali atlikti pagrindinės funkcijos (stabiliai ir kartu judriai fiksuoti žastikaulio galvą), operacinio gydymo rezultatai būna prastesni. Prasminiai žodžiai: peties sąnarys, klinikinis ištyrimas, mažieji sukamieji raumenys, degeneracija, ankštumo sindromas. Pain in the region of shoulder joint: causes, clinical symptoms,diagnostics and treatment Rimvaldas Broga At the age over 40 many patients experience shoulder pain. Due to this pain they are refered to doctors of different specialities. The anatomy of the shoulder joint as well as its biomechanics is very complicated and not similar to any other joint. The range of motion in the shoulder joint is very wide in all axes and planes. The wide motion is achieved by means of three true joints and two junctions. In the function of the shoulder joint 26 muscles and their parts take part, but most important in the biomechanics are the smallest rotation muscles and the deltoid muscle. The patient experiences pain and aches and the function of the shoulder is impaired in the case of dysfunction of the above mentioned muscles. In the paper, causes of shoulder joint degeneration are mentioned and a clinical examination scheme is presented. Some of the accents from the anamnesis and evaluation are very common to shoulder sicknesses. The most popular examination tests concerning pain, function and strength restriction are discussed. Roentgenological examination is rather cheap but very informative. The most informative and most common roentgenological features are discussed. In case of early diagnosis of the degenerative and traumatic impairment of small rotator muscles operative treatment is very effective. In cases of delayed and inveterate illnesses when the above mentioned muscles have been disrupted long ago, are shortened and cannot perform their basic function (stable and mobile fixation of the humeral head), the results of operative treatment are worse. Keywords: shoulder joint, clinical examination, small rotator muscles, degeneration, compartment syndrome.

Cervical radiculomyelopathy caused by deposition of calcium pyrophosphate dihydrate crystals in the ligamenta flava

✓ A case of cervical radiculomyelopathy caused by multiple calcified nodules in the ligamenta flava is presented. Roentgenological examination of the cervical spine showed radiopaque nodular lesions, 7 × 7 × 5 mm in size, located in the paramedian portion of the posterior spinal canal. The nodules were removed surgically and they were confirmed to be calcifications of ligamenta flava. Microscopic examination of the nodules with the polarized light revealed extensive deposition of crystals. By x-ray diffraction study, the crystal was determined as calcium pyrophosphate dihydrate (CPPD: Ca2P2O7 · 2H2O). Although CPPD deposition in the cartilage has been known as pseudo-gout syndrome, deposition in the ligament has been reported only in a few cases. This is the first case with radiopaque calcified nodules in the ligamenta flava causing spinal cord compression, the composition of which proved to be CPPD.

Mega-Antrum

Mega-antra may masquerade as destructive lesions of the antral portion of the temporal bone. Awareness of this entity and correlation with the physical and roentgenological examination could prevent surgical exploration of the temporal bone. New upper range size limits can be expected as mega-antra become more commonly identified.