Omuz Bölgesinin Sinir Yaralanmaları
Özet
Omuz bölgesi sinir yaralanmaları; penetran travmalar, kompresyon, traksiyon ve cerrahi işlemler gibi çeşitli etkenler sonucunda glenohumeral eklem çevresindeki yapılarda meydana gelen nörolojik hasarları kapsamaktadır. Şiddetli akson yaralanmalarında distal segmentte Wallerian dejenerasyonu gelişirken, proksimal hasar ilk Ranvier düğümüne kadar ilerler ve fonksiyonel geri kazanım için reinnervasyonun 12-18 ay içinde tamamlanması gerekir. Klinik değerlendirmelerde hasarın şiddetini belirlemek amacıyla Seddon ve histopatolojik temelli Sunderland sınıflandırma sistemleri kullanılmakta; en hafif evre olan nörapraksiden, destek dokularının ve sinir bütünlüğünün tamamen kaybolduğu nörotmezise kadar geniş bir yelpaze tanımlanmaktadır. Tanı süreçlerinde klinik ve nörolojik muayenenin yanı sıra elektronöromiyografi (ENMG), ultrasonografi ve manyetik rezonans görüntüleme (MRG) yöntemlerinden faydalanılmaktadır. Tedavi yaklaşımlarında, düşük dereceli sinir yaralanmaları (Sunderland I-III) için fizik tedavi ve egzersiz gibi konservatif metotlar öncelik kazanırken; ileri derece yaralanmalarda (Sunderland IV-V) veya tıbbi tedaviye dirençli vakalarda nörolizis, greftleme ve sinir transferi gibi cerrahi müdahaleler uygulanmaktadır. Ayrıca, omuz dislokasyonları ve rotator manşet onarımları gibi açık veya artroskopik operasyonlar sırasında aksiller, supraskapuler ve muskulokütanöz sinirler yüksek iyatrojenik hasar riski taşımaktadır.
Nerve injuries of the shoulder region encompass neurological damages occurring in the structures around the glenohumeral joint due to various factors such as penetrating trauma, compression, traction, and surgical procedures. In severe axonal injuries, Wallerian degeneration develops in the distal segment, while proximal damage progresses up to the first node of Ranvier, and reinnervation must occur within 12-18 months for functional recovery. In clinical evaluations, Seddon and histopathological-based Sunderland classification systems are utilized to determine the severity of injury, defining a wide spectrum from neurapraxia, the mildest stage, to neurotmesis, where supporting tissues and nerve integrity are completely lost. In diagnosis processes, electronuromyography (ENMG), ultrasonography, and magnetic resonance imaging (MRI) methods are utilized alongside clinical and neurological examinations. Regarding treatment approaches, conservative methods such as physical therapy and exercise gain priority for low-grade nerve injuries (Sunderland I-III), whereas surgical interventions like neurolysis, grafting, and nerve transfer are required for advanced injuries (Sunderland IV-V) or cases resistant to medical treatment. Furthermore, during open or arthroscopic operations such as shoulder dislocations and rotator cuff repairs, the axillary, suprascapular, and musculocutaneous nerves carry a high risk of iatrogenic damage.
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