Glenohumeral Çıkıklar
Özet
Glenohumeral eklem çıkıkları, vücutta en sık görülen büyük eklem dislokasyonları olup sıklıkla travma kaynaklı gelişmektedir ve anatomik olarak anterior, posterior ve inferior olmak üzere üç tipe ayrılmaktadır. Vakaların %95'ini oluşturan anterior çıkıklar genellikle kolun abdüksiyon ve dış rotasyonuyla oluşurken; tanıda fiziksel muayenedeki apolet bulgusu, nörolojik değerlendirmeler ile Hill-Sachs veya Bankart gibi ek yaralanmaların tespiti büyük önem taşımaktadır. Standart AP ve skapular Y grafileriyle tanı konulmasının ardından Hipokrat, Stimson, Milch veya Cunningham gibi çeşitli yöntemlerle acil redüksiyon uygulanmakta, sonrasında ise yaşa bağlı olarak 1-3 hafta boyunca omuz askısıyla immobilizasyon ve kademeli rehabilitasyon önerilmektedir. Nadir görülen posterior çıkıklar ise fleksiyon ve iç rotasyondaki aksiyel yüklenmeler, epileptik nöbetler veya elektrik çarpmaları sonucu oluşmakta, röntgenlerde gözden kaçabilmekle birlikte ampul bulgusu ve ters Hill-Sachs lezyonu ile kendini göstermektedir. En nadir görülen ve kolun 180 derece abdüksiyonda kilitlenmesiyle karakterize olan inferior çıkıklar (Luxatio erecta) ise rotator manşet yırtıkları ve nörolojik komplikasyonlarla seyretmekte, traksiyonla kolayca redükte edilebilmekle birlikte yumuşak doku sıkışmasında cerrahi müdahale gerektirmektedir.
Glenohumeral dislocations are the most common large joint dislocations in the body, mostly trauma-induced, and are anatomically divided into three types as anterior, posterior, and inferior. Anterior dislocations, comprising 95% of cases, typically occur with arm abduction and external rotation, while the epaulette sign in physical examination, neurological assessments, and detecting concomitant injuries like Hill-Sachs or Bankart lesions are highly important for diagnosis. Following diagnosis with standard AP and scapular Y radiographs, urgent reduction is performed using various methods such as Hippocratic, Stimson, Milch, or Cunningham techniques, which is followed by immobilization with a simple sling for 1-3 weeks depending on age and gradual rehabilitation. Rare posterior dislocations occur due to axial loading in flexion and internal rotation, epileptic seizures, or electric shocks, and though easily missed on radiographs, they manifest with the light bulb sign and reverse Hill-Sachs lesions. Inferior dislocations (Luxatio erecta), the rarest type characterized by the arm locked in 180-degree abduction, present with rotator cuff tears and neurological complications, and while easily reduced with traction, they require surgery in cases of soft tissue entrapment.
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