Donuk Omuz (Adheziv Kapsülit)
Özet
Donuk omuz (adheziv kapsülit); omuz ekleminde ağrı, sertlik ve hareket kısıtlılığı ile karakterize, polikliniklerde sık karşılaşılan ve uzun tedavi süreci gerektiren kronik bir omuz patolojisidir. Genel popülasyonda görülme sıklığı %3-4 iken, özellikle 40-65 yaş arası kadınlarda, dominant olmayan tarafta ve diyabet ya da tiroid hastalarında bu oran %40'a kadar çıkabilmektedir. Nedeni kesin bilinmemekle birlikte, travma veya sistemik bir hastalıkla ilişkisi bulunmayan idiyopatik (primer) ve internal-eksternal faktörlere bağlı gelişen sekonder tip olarak iki ana grupta sınıflandırılır. Hastalığın seyrinde omuz kapsülünde kontraksiyon, hacim küçülmesi ve sitokin artışına bağlı inflamasyon ile fibrozis gelişmektedir. Tanı sürecinde detaylı bir anamnez ve fiziki muayenenin yanı sıra MR, direkt grafi, tomografi ve laboratuvar testleriyle ayırıcı tanılar (enfeksiyon, tümör, kırıklar vb.) dışlanmalıdır. Tedavide ilk 3-6 ay boyunca egzersizler, fizyoterapi, oral NSAİİ, intraartiküler steroid enjeksiyonları ve hidrodilatasyon gibi konservatif yöntemler ön planda tutulur. Bu aşamalı tedavilere direnç gösteren ve başarısız olunan kronik vakalarda ise güncel tıp yaklaşımları doğrultusunda genel anestezi altında manipülasyon veya artroskopik kapsüler gevşetme gibi cerrahi yöntemler başarıyla uygulanarak multidisipliner bir yaklaşım sergilenir.
Frozen shoulder (adhesive capsulitis) is a chronic shoulder pathology frequently encountered in outpatient clinics, characterized by pain, stiffness, and limitation of motion in the shoulder joint, requiring a long treatment process. While its incidence in the general population is 3-4%, this rate can increase up to 40% especially in women between the ages of 40-65, on the non-dominant side, and in patients with diabetes or thyroid disease. Although its exact etiology is unknown, it is classified into two main groups as idiopathic (primary), which is not associated with trauma or systemic disease, and secondary, which develops due to internal-external factors. During the course of the disease, contraction and volume reduction in the shoulder capsule, as well as inflammation and fibrosis due to increased cytokine levels, develop. In the diagnosis process, in addition to a detailed medical history and physical examination, differential diagnoses (infection, tumor, fractures, etc.) must be ruled out using MRI, direct radiography, tomography, and laboratory tests. In the treatment, conservative methods such as exercises, physiotherapy, oral NSAIDs, intra-articular steroid injections, and hydrodilatation are prioritized for the first 3-6 months. In chronic cases that resist these gradual treatments and fail, a multidisciplinary approach is exhibited by successfully applying surgical methods such as manipulation under general anesthesia or arthroscopic capsular release in line with current medical literature.
Referanslar
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