Rotator Manşet Yaralanmaları
Özet
Rotator manşet yaralanmaları, genellikle baskın ekstremitede görülen, yaş ilerledikçe sıklığı artan ve etiyolojisinde intrensek (tendon kanlanması, kollajen yapısı) ile ekstrensek (akromion basısı, internal sıkışma) faktörlerin yanı sıra genetik, sigara ve hiperkolesteroleminin rol oynadığı patolojilerdir. Tanı sürecinde detaylı anamnez ve bilateral sistematik fizik muayene kritik öneme sahip olup; ağrı, hareket kısıtlılığı ve atrofi gibi semptomlar ile Hawkins, impingement ve drop arm gibi özel omuz testleri değerlendirilir. Yırtıklar, derinliklerine ve ön-arka uzunluklarına göre parsiyel veya tam kat olarak sınıflandırılırken; radyolojik değerlendirmede direkt grafi, ultrasonografi ve eklem içi patolojilerde altın standart olan MRG'den yararlanılır. Tedavinin temel amacı ağrısız ve fonksiyonel bir omuz sağlamaktır; bu doğrultuda analjezikler, enjeksiyonlar ve egzersizleri içeren konservatif yöntemlerin yanı sıra debridman, açık, mini açık veya günümüzde en popüler olan artroskopik onarım gibi cerrahi seçenekler uygulanmaktadır.
Rotator cuff injuries, which are generally seen in the dominant extremity and increase in frequency with advancing age, are pathologies in which intrinsic (tendon blood supply, collagen structure) and extrinsic (acromion compression, internal impingement) factors, as well as genetics, smoking, and hypercholesterolemia, play a role in their etiology. Detailed history and bilateral systematic physical examination are of critical importance in the diagnosis process; symptoms such as pain, limitation of motion, and atrophy, along with special shoulder tests like Hawkins, impingement, and drop arm, are evaluated. Tears are classified as partial or full-thickness according to their depth and anteroposterior length, while direct radiography, ultrasonography, and MRI, which is the gold standard for intra-articular pathologies, are utilized in radiological evaluation. The main goal of treatment is to achieve a painless and functional shoulder; in line with this, conservative methods including analgesics, injections, and exercises are applied, as well as surgical options such as debridement, open, mini-open, or arthroscopic repair, which is the most popular method today.
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