Omuz Eklem Patolojilerinde Tanı Ve Görüntüleme
Özet
Omuz eklem patolojileri, bel ve diz sorunlarından sonra en sık karşılaşılan kas-iskelet sistemi klinik problemleridir ve sıklıkla kadınlarda ve 45-64 yaş aralığında ağrı, hareket kısıtlılığı ve güç kaybı gibi semptomlarla ortaya çıkar. Doğru etiyolojik tanı ve tedavi planlaması için ayrıntılı bir hasta öyküsü, fizik muayene ve radyolojik görüntüleme yöntemlerinin bütünsel olarak kullanılması kritik önem taşır. Klinik değerlendirmede konvansiyonel radyografi, kırıklar, dislokasyonlar ve dejeneratif süreçlerin tespiti için ilk tercih edilen yöntemdir. Yumuşak doku, kas, tendon ve ligament patolojilerinin yanı sıra okült kırıkların ve rotator manşet yırtıklarının detaylı incelenmesinde en değerli görüntüleme yöntemi manyetik rezonans görüntülemedir (MRG). Dinamik değerlendirme imkanı sunan ultrasonografi (USG) özellikle rotator manşet rüptürleri ve enjeksiyon kılavuzluğunda düşük maliyetli bir alternatif olarak öne çıkarken, bilgisayarlı tomografi (BT) ise kemik rezervinin ve karmaşık kırıkların preoperatif planlamasında tercih edilir. Kapsülolabral patolojilerde ve instabilite durumlarında MR veya BT artrografi duyarlılığı artırırken; supraskapuler sinir nöropatileri gibi durumlarda elektrofizyolojik çalışmalar tanı sürecini destekler. Sonuç olarak, omuz patolojilerinin etkin tedavisi, kapsamlı bir anamnez ile hastaya özgü doğru radyolojik yöntemlerin kombinasyonuna dayanmaktadır.
Shoulder joint pathologies are the third most common musculoskeletal clinical problems after back and knee disorders, frequently presenting with symptoms like pain, motion limitation, and power loss, particularly in women and the 45-64 age range. For accurate etiological diagnosis and treatment planning, the holistic utilization of a detailed patient history, physical examination, and radiological imaging methods is of critical importance. In clinical evaluation, conventional radiography is the initial method of choice for detecting fractures, dislocations, and degenerative processes. Magnetic resonance imaging (MRI) is considered the most valuable imaging modality for detailed evaluation of soft tissue, muscle, tendon, and ligament pathologies, as well as occult fractures and rotator cuff tears. While ultrasonography (USG), offering dynamic evaluation capability, stands out as a low-cost alternative for rotator cuff ruptures and injection guidance, computed tomography (CT) is preferred for preoperative planning of complex fractures and bone reserve assessment. In capsulolabral pathologies and instability conditions, MR or CT arthrography increases diagnostic sensitivity, whereas electrophysiological studies support the diagnosis in conditions like suprascapular nerve neuropathies. Consequently, effective treatment of shoulder pathologies relies on the combination of a comprehensive anamnesis and the appropriate radiological imaging methods.
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