sx manguitos rotadores
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ortopediaTRANSCRIPT
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Sx mango de los rotadores Talpa Fabiola Cosio Rios
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Definición
• La alteracion de la funcion del manguito rotador ocasionara un ascenso de la cabeza humeral con el choque secundario del manguito contra el arco coracoacromial, pudiendo llegar al atrapamiento o colision subacromial
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Intrinseco • Degenerativas • Traumaticas • Reactivas
Extrinseco • Atrapamiento • Primario • Secundario
Origen :
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Asociación
Sx del manguito rotador
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Síntomas
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Síntomas
• Dolor exacerbado si se mueven los brazos por encima de la cabeza .
• Incomodidad nocturna • Dolor en la region deltoidea• Debilidad muscular
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ABDUCCION 1°) DELTOPIDES (PORCION MEDIA) SUPRAESPINOSO 2°) DELTOIDES (ANT- MED) SERRATO MAYOR
ROTACION EXTERNA 1°) INFRAESPINOSO REDONDO MENOR 2°) DELTOIDES ( PORCION POSTERIOR)
ROTACION INTERNA
1°) SUBESCAPULAR, PECTORAL MAYOR DORSAL ANCHO REDONDO MAYOR 2°) DELTOIDES ( PORCION ANTERIOR)
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Estudios de gabinete
• Rx simple de hombro (AP)• Rx simple del hombro con rotacion (AP)• Rx proyeccion oblicuoa a 30° en direccion caudal • Resonancia magnetica • Neumo- artrografia• Artrografia –resonancia • Ultrasonido
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Estándar de oro
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Estándar de oro
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Diagnostico diferencial
• Lesion acromioclavicular• Angina de pecho • Tendinitis del bicipital • Rediculopatia cervical • Subluxacion de hombro
• Problemas neurologicos • Infarto al miocardio• Inestabilidad del hombro • Capsulitis adhesiva• Artritis gleno-humeral
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Clasificación de Neer
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Tratamiento
Tx c onservador• AINES• Corticosteroides • Rehabilitacion
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• La infiltracion intraarticular se prepara :
• 2 ml de cortico-esteroide• 2 ml de lidocaina al 2% sin epinefrina
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Rehabilitacion consiste en : • Ejercicios fisiatricos • Calor local • Diatermia • Ultrasonido terapeutico
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Qx Existen 5 tecnicas qx para reparar el manguito rotador
• Desbridamiento del manguito • Un solo rollo de anclaje de
sutura • Anclas de sutura dobles • Anclas de suturas triples • Tecnica de sutura trans- osea
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Contraindicaciones de Qx• Hombro congelado • onfiltRACION GRASA DEL
SUBESCAPULAR E INFRAESPINOSO
• ARTRODESIS • ARTROSIS SEVERA• + 65 ALOS
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BIBLIOGRAFIA • http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoM
aestro/IMSS_617_13_SXDEMANGUITOROTADOR/617GER.pdf
• MILLER PAG 281