KRONİK EL BİLEK AĞRISININ DEĞERLENDİRİLMESİ

Year 2022, , 417 - 427, 31.08.2022

Meriç Çırpar , Ozan Pehlivan

https://doi.org/10.24938/kutfd.1137183

Abstract

Kronik el bilek ağrısı sık karşılaşılan, yarattığı fonksiyonel kayıplarla ciddi iş gücü ve maddi kayıplara yol açan bir klinik problemdir. El bileği eklem kompleksinin anatomik olarak karmaşıklığı ve bu karmaşık yapının biyomekanik nitelikleri, doğru teşhis ve uygun tedavinin planlanması konusunda zorluklar ortaya çıkarmaktadır. Kronik el bilek ağrısına yol açabilen çok sayıda hastalık ve klinik tablo mevcuttur. Bunların el bileğinin anatomik özelliklerine ve ağrının lokalizasyonuna göre radial taraf, merkezi, ulnar taraf ve yaygın el bilek ağrısı başlıkları altında kategorize edilebilir. El bilek ağrısının ayırıcı tanının yapılabilmesi için, sistematik bir yaklaşım gereklidir. Eksiksiz bir anamnez, iyi yapılmış fizik muayene, tekniğe uygun çekilmiş radyografiler, bilgisayarlı tomografi, magnetik rezonans ve tanısal el bilek artroskopisi gibi görüntüleme yöntemleri sayesinde kronik el bilek ağrısı nedenleri daha objektif kriterlere dayandırılarak ortaya konabilmekte, spesifik ağrı nedenlerinin saptanması ve nedene yönelik tedavi ile daha başarılı klinik sonuçlar elde edilebilmektedir.

Keywords

el bilek ağrısı, ulnar taraf, radial taraf, el bilek instabilitesi, tendinopati

Evaluation of Chronic Wrist Pain

Abstract

Chronic wrist pain is a frequent clinical entity which causes serious workforce and financial loss due to functional impairment. The anatomic complex structure of the wrist and its biomechanical properties bring about difficulties in diagnosis and planning of appropriate treatment modalities. Many etiological factors play a role in development of chronic wrist pain. These factors can be categorized into radial side, central, ulnar side and generalized wrist pain according to anatomical properties of the wrist and the localization of the pain. For differential diagnosis of chronic wrist pain, a systematical clinical approach is mandatory. The etiology of the chronic wrist pain can be identified depending on more objective criteria by getting a full history of pain, a detailed physical examination, appropriate radiographs, computerized tomography, magnetic resonance imaging and diagnostic wrist arthroscopy. By combining these diagnostic tools, the specific etiological factor for pain can be identified and successful clinical treatment outcomes be achieved.

Keywords

Wrist pain, ulnar side, radial side, wrist instability, tendinopathy

References

• 1. Kox LS, Kuijer PPFM, Kerkhoffs GMMJ, Maas M, Frings-Dresen MHW. Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes: a systematic review Br J Sports Med. 2015;49(18):1189-96.
• 2. Jordan KP, Kadam UT, Hayward R, Porcheret M, Young C, Croft P. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskelet Disord. 2010;2(11):144.
• 3. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004;51(4):642-51.
• 4. Wolfe SW. Distal radius fractures. In Wolfe SW, Hotchkiss RN, Pedersen WC, Kozin SH, Cohen MS, eds. Green’s Operative Hand Surgery. 7th ed. Philadelphia. Elsevier Inc, 2017:516-87.
• 5. Mauck BM, Swigler CW. Evidence-based review of the distal radius fractures. Orthop Clin North Am. 2018;49(2):211-22.
• 6. Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br. 1996;78(4):588-92.
• 7. Mikić ZD. Age changes in the triangular fibrocartilage of the wrist joint. J Anat. 1978;126(2):367-84.
• 8. Tiegs-Heiden CA, Howe BM. Imaging of the hand and wrist. Clin Sports Med. 2020;39(2):223-45.
• 9. Amrami KK, Berger RA. Imaging of the wrist. In: William P. Cooney III (ed). The Wrist Diagnosis and Operative Treatment. 2nd ed. Philedelphia. Wolters Kluver Lippincott Williams & Wilkins, 2010:151-67.
• 10. Welling RD, Jacobson JA, Jamadar DA, Chang S, Caoili EM, Jebson PJL. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. Am J Roentgenol. 2008;190(1):10-6.
• 11. Langner I, Fischer S, Eisenschenk A, Langner S. Cine MRI: a new approach to the diagnosis of scapholunate dissociation. Skeletal Radiol. 2015;44(8):1103-10.
• 12. Hayter CL, Gold SL, Potter HG. Magnetic resonance imaging of the wrist: bone and cartilage injury. J Magn Reson Imaging. 2013;37(5):1005-19.
• 13. Michelotti BF, Chung KC. Diagnostic wrist arthroscopy. Hand Clin. 2017;33(4):571-83.
• 14. Liao J, Chong A, Tan D. Causes and assessment of subacute and chronic wrist pain. Singapore Med J. 2013;54(10):592-8.
• 15. Pickrell BB, Eberlin KR. Thumb basal joint arthritis. Clin Plast Surg. 2019;46(3):407-13.
• 16. Sauvé PS, Rhee PC, Shin AY, Lindau T. Examination of the wrist: Radial-sided wrist pain. J Hand Surg. 2014;39(10):2089-92.
• 17. Fowler JR, Hughes TB. Scaphoid Fractures. Clin Sports Med. 2015;34(1):37-50.
• 18. Pao VS, Chang J. Scaphoid nonunion: Diagnosis and treatment. Plast Reconstr Surg. 2003;112(6):1666-77.
• 19. Patrick NC, Hammert WC. Hand and Wrist Tendinopathies. Clin Sports Med. 2019;39(2):247-58.
• 20. Watson HK, Ashmead 4th D, Makhlouf MV. Examination of the scaphoid. J HanD Surg Am. 1988;13(5):657–60.
• 21. Salmon J, Stanley JK, Trail IA. Kienböck’s disease. Cocervative management verssu radial shortenning J Bone Joint Surg. 2000;82(6):820-3.
• 22. Wolfe SW, Garcia-Elias M, Kitay A. Carpal instability nondissociative. J Am Acad Orthop Surg. 2012;20(9):575-85.
• 23. DaSilva MF, Goodman AD, Gil JA, Akelman E. Evaluation of ulnar sided wrist pain. J Am Acad Orthop Surg. 2017;25: e150-e156.
• 24. Palmer AK, Bille B, Anderson A. Acute injuries of the distal radioulnar joint: Tears by the triangular fibrocartilage. In: William P. Cooney III (ed). The Wrist Diagnosis and Operative Treatment. 2nd ed. Philedelphia. Wolters Kluver Lippincott Williams & Wilkins, 2010:857-82.
• 25. Lester B, Halbrecht J, Levy IM, Gaudinez R. Press Test for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg. 1995;35(1):41-5.
• 26. Cirpar M. El ve El Bileği Muayenesi. In: Erişkilerde Ortopedik Muayene Yöntemleri. Kose O, Kalenderer O eds. Ankara. TOTBİD Yayınları, 2015:71–84.
• 27. Yıldıran G, Selimoğlu N. Ulnar taraflı el bileği ağrısında muayene ve tanı. TOTBID Dergisi. 2021;20(4):387-94.
• 28. Leibig N Lampert FM, Haerle M. Ulnocarpal impaction. Hand Clin. 2021;37(4):553-62.