Ruptured Baker's Cyst vs Calf DVT vs 'Kafar Tennis' Hawaye na Muscle: Mummunan Kumburin Maraƙi¶

Lokacin da maraƙi ɗaya ba zato ba tsammani ya zama zafi, kumbura, matsewa, da zafi don tafiya a kan, ƙananan gaggawa na gaggawa guda uku sun kai ga ganewar asali: ** zurfafa thrombosis (DVT) **, wani ** ruptured popliteal Baker's cyst (pseudothrombophlebitis) *, da kuma ** m hawaye na tsaka-tsakin shugaban tsoka ( strotenemius) Domin ruwan synovial ya fashe daga wani ruptured Baker's cyst bayan gwiwa yana waƙa a ƙasa tsakanin jiragen sama na maraƙi kuma yana haifar da mummunan kumburin kumburi, yana haifar da maraƙi mai ja, mai zafi, kumbura wanda yake wanda ba a iya rarrabewa a asibiti a gefen gado daga Zurfin Jijiyoyin Thrombosis * ba tare da venous Duplex Dor. Mafi muni, ** 5 zuwa 10 bisa dari na marasa lafiya suna da nau'in Baker's cyst da DVT na gaskiya a lokaci guda **, yayin da suke bda magungunan jini (anticoagulants) ga majiyyaci wanda maraƙin da ya kumbura ya haifar da tsokar gastrocnemius mai tsage ("kafar wasan tennis") ko ƙwayar Baker na jini na iya haifar da catastromatin hemorrhage. m sashe ciwo**. Idan mai haƙuri ya kamu da ƙarancin numfashi, ciwon ƙirji na pleuritic, tari sama da jini, dizziness, ko bugun zuciya tare da maraƙi mai kumbura, kira lambar gaggawa ta gida nan da nan (911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a Burtaniya) ko duba kundin adireshi na mu lambobin gaggawa. Don abubuwan gaggawa masu alaƙa da jijiyoyin jini da tsoka, karanta jagororin mu akan huhu embolism da zurfin jijiya thrombosis (DVT) triage, ruptured Achilles tendon, patellar tendon yagayen, da matsananciyar faduwa kafa, kuma Kwatsam sanyi mara motsin hannu da matsananciyar rufewar jijiya.

Yi wannan yanzu¶

1. ** Allon nan da nan don ciwon kumburin huhu (PE) da Ciwon Ciwon Ciwon Cutar Cutar Cutar Cutar Jajaye:** Idan maraƙi mai kumbura, mai raɗaɗi yana tare da ** gajeriyar numfashi, ciwon ƙirji na pleuritic, saurin bugun zuciya (fiye da bugun 100 a cikin minti daya), haske, ko tari na jini**, kira 911/999 don gaggawar gaggawa. huhu embolism. Idan maraƙi ya ji ** itace mai wuya *, zafi yana daɗaɗawa lokacin da yake miƙar da ƙafafu zuwa sama, ko yatsanka ya ji ** baƙar fata, sanyi, ko kodadde, kai tsaye zuwa sashin gaggawa mafi kusa don abin da ake zargi. kashi ciwo.
2. A daina tafiya akan kafa, huta nan da nan, kuma KADA KA tausa, yin kumfa, ko cuɗa sabon maraƙi mai kumbura: Ko dalilin ya zama gudan jini mai zurfi, fashewar synovial cyst, ko tsagewar tsokar maraƙi, tausa ɗan maraƙi yana da haɗari. A cikin bugun jini mai zurfi (DVT)**, zurfin tausa na iya yayyage ɗigon jini daga bangon jijiya na popliteal ko femoral, yana ƙaddamar da embolus na huhu a cikin huhu. A cikin gastrocnemius hawaye, tausa yakan buɗe sabon ruɓaɓɓen capillaries na intramuscular kuma yana haifar da zub da jini mai tsanani na ciki.
3. Kada a fara raguwar magungunan kashe kwayoyin jini (apixaban, rivaroxaban, warfarin) ko aspirin/NSAIDs masu yawan gaske kafin a gwada duban dan tayi: Kada a dauki maganin jijiyoyi na wani ko kuma a dora aspirin, ibuprofen, ko naproxen yayin jiran tantancewa. Idan ɗan maraƙi mai kumbura shine ainihin ** medial gastrocnemius hawaye ("kafar wasan tennis")** ko kuma haɗaɗɗen Baker's cyst rupture, maganin rigakafin da bai kai ba yana jujjuya jini mai laushi mai laushi ya zama hematoma mai fa'ida, mai barazana ga gaɓoɓi a cikin ɗakin bayan gida.
4. Je zuwa sashen gaggawa ko cibiyar kulawa da gaggawa sanye take da Venous Duplex Compression Ultrasound na rana guda: Hanyoyin gwajin jiki (kamar alamar Homans) ba za su iya bambance DVT cikin aminci da tsagewar Baker's cyst ko tsagewar tsoka ba. Kowane ɗan maraƙi mai zafi da kumbura wanda ba a bayyana shi ba yana buƙatar ** duban dan tayi ** duka don tabbatar da cewa zurfin popliteal da veins na mata suna matsawa akai-akai kuma don ganin kowane tarin ruwa a cikin bursa ko cikin tsoka.
5. Duba ƙasusuwan idon sawu na ciki da na waje (malleoli) don raunin "Alamar Crescent": Cire safa biyu sannan a duba fata a ƙasan ƙashin idon sawu na ciki da na waje da saman ƙafar. Wani lankwasa, shuɗi-shuɗi mai raɗaɗi yana bayyana a ƙarƙashin malleoli 24 zuwa 72 hours bayan kumburin maraƙi kwatsam (** alamar jinjirin watan **) yana nuna ruwa da jini a ƙasa ta hanyar jiragen sama daga ** ruptured Baker's cyst *** ko ** gastrocnemius hawaye *** (alhali DVT mara nauyi baya haifar da ƙwanƙwasa).
6. Ɗaga ƙafar ƙasa a hankali akan matashin kai sannan a shafa fakitin sanyi mai lulluɓe (kawai idan ƙafar ta yi dumi tare da bugun jini na yau da kullun): Huta tare da maraƙi yana goyan bayan matakin zuciya ko dan kadan sama da matakin zuciya don rage venous hydrostatic pressure da kuma bin diddigin ruwan synovial. Aiwatar da fakitin sanyi zuwa bayan gwiwa ko maraƙi na sama na tsawon mintuna 15 zuwa 20, kuma kiyaye nauyi daga ƙafar ta amfani da ƙugiya idan sauka yana haifar da zafi mai zafi.

Bishiyar yanke shawara: m kumbura ko raɗaɗin ɗan maraƙi¶

flowchart TD
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    CheckPE -->|"EH: Wanda ake zargi da kumburin huhu"| Call911PE["PROTOCOL MAI BARAZANAR RAYUWA: 1. Kira 911/112/999 Nan da nan 2. Zauna Daidai Ka Tsaya Kafafun Biyu Gabaɗaya 3. Kada Ka Taɓa Zuwa Mota ko Ka Tausasa Maraƙi"]

    CheckPE -->|"A'a: Keɓaɓɓen Alamomin Ƙafafun Ƙafafun"| CheckSixPs{"2. Shin Kafar Kankara- Sanyi, Farin Alli, Marasa Jiki, Ko Yatsun Yatsu/Shayayye Da Maraƙin Dutse?"}

    CheckSixPs -->|"Ee: Ƙunƙarar Jiji ko Ciwon Ciki"| Call911Limb["GAGGAWAR GAGGAWA NA HOUR 6-HOUR: 1. Kira 911/112/999 ko Ku tafi Kai tsaye Asibiti ED 2. Tsaya Leken Kafa (Kada Ka Ƙimar Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarfafawa)"]

    CheckSixPs -->|"A'a: Ƙafa yana da Dumi tare da Ji na al'ada"| CheckOnset{"3. Ta Yaya Ciwon Maraƙi Ya Fara?"}

    CheckOnset -->|"Nan take 'Snap/Pop' yayin turawa ko huhu"| TennisLeg["WANDA AKE ZATON 'KAFIN TENNIS' (Medial Gastrocnemius Tear) KO RAGEWAR ACHILLES: 1. Dakatar da Nauyi Nan da nan; Kar A Taba Massage 2. Yi Simmonds-Thompson Calf Squeeze Test Don Duba Cigaban Achilles 3. KAR KU SHA MAGANAR Blood ko Aspirin (Risk of Massive Hematoma)"]

    CheckOnset -->|"Tarihin Knee Arthritis / Kumburi wanda Nan da nan ya 'Ba da Hanya' Bayan Knee a cikin Maraƙi"| BakerCyst["WANDA AKE TSOKACI RUPTURED BAKER'S CYST (Pseudothrombophlebitis): 1. Huta da Ƙara Ƙafa; KADA KADA KA TSARA 2. Duba Ƙashin Ƙaƙwalwar Ƙaƙwalwar Ƙaƙwalwar Ƙwararren Ƙwararren Ƙwararren Ƙwararriyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru na Rana guda na Tilas don Kashe Gaskiyar DVT (Yana tare a cikin kashi 5 zuwa 10)"]

    CheckOnset -->|"Ciwon Hankali a Hankali, Tsantseni, Dumi, ko Ciwon Ciwon Jiki Sama da Sa'o'i zuwa Kwanaki"| SuspectDVT["LABARI DA DUMI-DUMINSA DEEP VEIN THROMBOSIS (DVT): 1. Kididdige Makin Wells DVT (Tiyata, Rashin Motsawa, Jirgin Sama, Ciwon daji, Tarihin Ciwon Jiki) 2. Ƙafafun Huta Ya Daukaka; Kar a Taba Massage ko Sanya Tsantsan Makada marasa dacewa 3. Sashen Gaggawa na Gaggawa / Ziyarar Asibiti don D-Dimer da Ciwon Jini na Ultrasound"]

Pathophysiology na uku mai girma maraƙi mimics¶

Don fahimtar dalilin da yasa waɗannan yanayi guda uku suka yi kama da juna daga waje duk da haka suna buƙatar jiyya daban-daban a cikin asibiti, bincika jikin jikin gwiwa na baya (popliteal fossa) da kuma sashin baya na ƙasan kafa.

1. Ruptured Popliteal (Baker's) Cyst da "Pseudothrombophlebitis"¶

• Yadda Baker's cyst ya zama: Wanda ake kira bayan likitan fiɗa na Burtaniya William Morrant Baker, wani ** Baker's cyst (popliteal synovial cyst)** a cikin manya kusan koyaushe yana sakandare zuwa ** intra-articular pathology pathology** kamar ** osteoarthritis**, ** rheumatoid arthritis *, wani ** tsage medial meniscusut / p raunin ligament (ACL). Lokacin da haɗin gwiwa mai kumburi ya haifar da ruwa mai yawa na synovial a ƙarƙashin matsin lamba, wannan ruwan yana matse baya ta wurin rauni mai rauni a cikin kwandon gwiwa na baya zuwa cikin gastrocnemius-semimembranosus bursa a gefen ciki na bayan gwiwa.
• Hanyar Bawul Mai Hanya Daya: kunkuntar nama mai ninki tsakanin haɗin gwiwa gwiwa da bursa yana aiki kamar ** bawul-bawul mai hanya ɗaya**. A duk lokacin da gwiwa ta jujjuya kuma ta tsawaita yayin tafiya, ana zubar da ruwan haɗin gwiwa a cikin cyst na baya, yayin da bawul ɗin ke hana ruwa komawa ga haɗin gwiwa. A cikin makonni, cyst ɗin yana shiga cikin jin daɗi a bayan gwiwa.
• Abin da ke faruwa a lokacin da cyst ɗin ya fashe (Pseudothrombophlebitis): Yayin zurfafa zurfafawa, durƙusa, ko hawan matakalai, matsa lamba na ruwa a cikin cyst ɗin Baker ɗin ya zarce ƙarfin juzu'i na bakin ciki na busar bursal. Katangar cyst ta fashe a kasan sandarsa. Matsi, mai arzikin enzyme, pro-inflammatory synovial fluid (sau da yawa gauraye da jini daga tsagewar bursal capillaries) jets zuwa ƙasa tare da fasinja jirgin tsakanin ** matsakaici shugaban gastrocnemius tsoka ** da kuma tushen ** soleus tsoka **.
• Me yasa yake kwaikwayi DVT da gamsarwa: Ruwan Synovial a waje da capsule na haɗin gwiwa yana fusatar da ƙananan ƙwayoyin cuta da ƙwayoyin cuta. A cikin mintuna 30 zuwa ƴan sa'o'i kaɗan na fashewa, kullin da aka sani a baya a bayan gwiwa yakan yi laushi ko ɓacewa ("kullun gwiwar da ke ɓacewa"), yayin da maraƙi na tsakiya da na ƙasa da sauri ya zama ** kumbura, jin zafi, zafi zuwa tabawa, erythematous (ja), da kuma dadi mai dadi **. Likitoci suna kiran wannan ciwo pseudothrombophlebitis saboda yana maimaita kowace alama ta jiki na thrombosis mai zurfi mai zurfi.

2. Zurfin jijiya Thrombosis (DVT) na maraƙi da kuma Popliteal Veins¶

• Yadda jijiyar jini ke samuwa (Virchow's Triad): Cutar sankara mai zurfi tana faruwa ne lokacin da gudan jini (thrombus) ya taso a cikin zurfafan jijiyar kafar kafa, wanda Virchow's triad* ke tafiyar da shi: (1) ** stasis venous** (tashin tafiya mai tsayi ko mota ya hau sama da awanni 4), ko ta kwana 2, kwanciyar hankali, kwanciyar hankali, hutawa. rauni ** (kwanan nan kothopedic gwiwa / hip tiyata, rauni na ƙafa, ko kafin DVT), da (3) ** hypercoagulability *** (ciwon daji mai aiki, ciki / yanayin haihuwa, maganin estrogen, shan taba, kiba, ko cututtukan da aka gada kamar Factor V Leiden).
• ** Distal (Maraƙi) vs Proximal (Popliteal/Femoral) DVT:** Yawancin DVTs na ƙanana suna farawa a cikin jijiyoyin maraƙi mai zurfi (** tibial na baya, peroneal, soleal, ko gastrocnemius veins**). Saboda arteries suna ci gaba da zubar da jini mai dumi a cikin ƙafa yayin da bututun da ke fita daga venous ke toshewa, matsa lamba na hydrostatic yana dawowa a cikin gadaje na capillary. Ruwa yana zubowa cikin nama mai tsaka-tsaki (** pitting edema**), jijiyoyi na sama a kan shinfida sun zama batattu, kuma maraƙi yana kumbura da santimita 2 zuwa 5 (0.8 zuwa 2 inci) a kewaye tare da raɗaɗi, ciwon kai wanda ke tsananta lokacin tsayawa.
• Me yasa DVTs maraƙi marasa magani ya zama mai mutuwa: Idan an yi watsi da DVT na ɗan maraƙi mai nisa, ** kashi 15 zuwa 25 cikin ɗari suna yaduwa zuwa sama zuwa cikin jijiyoyin popliteal da femoral ** a baya da sama da gwiwa a cikin makonni 1 zuwa 2. Da zarar gudan jini ya shiga manyan jijiyoyi masu kusanci, akwai hadarin ** 40 zuwa 50 bisa dari ** cewa guntu zai wargaje ya toshe jijiyoyin huhu (** embolism pulmonary embolism), wanda zai iya haifar da kamawar zuciya cikin mintuna.

3. Medial Gastrocnemius Muscle Tear ("Kafar Tennis")¶

• Haɗin raunin jiki a mahaɗar musculotendinous:* Rukunin tsokar maraƙi (** triceps surae**) ya ƙunshi zurfin haɗin gwiwa guda ɗaya ** tsokar tafin hannu ** da na sama mai haɗin gwiwa guda biyu ** tsokar gastrocnemius ** (wanda ke haye duka gwiwa da haɗin gwiwa kafin haɗuwa a cikin Achilles). Saboda gastrocnemius ya ketare gidajen abinci guda biyu kuma ya ƙunshi babban adadin filaye masu saurin-twitch (Nau'in II), yana fuskantar matsananciyar ɗaukar nauyi a duk lokacin da mutum ** ya miƙe gwiwa a tsaye yayin da suke murƙushe ƙafar sawun su lokaci guda* (turawa da baya ƙafa a wasan tennis ko ƙwallon ƙwallon ƙafa, sprinting, ko tashi daga kangi).
• ** Dalilin da ya sa kai tsaye yana hawaye: *** A cikin kashi 85 zuwa 90 na lokuta, hawaye yana faruwa a ** musculotendinous junction (MTJ) na tsakiya (ciki) shugaban gastrocnemius ** a cikin manya masu shekaru 35 zuwa 60. A lokacin turawa, mai haƙuri yana jin kwatsam ** "snap," "kamar tsalle-tsalle," kamar yadda yake juyawa. shawo kan wani ya jefa kwallo ko dutse a kafa.
• ** Jinkirtawar hematomas da tarin ruwa:** A cikin sa'o'i, zubar jini daga tsagewar filayen tsoka da rushewar aponeurosis tsakanin gastrocnemius na tsakiya da tafin hannu yana haifar da hematoma mai ruwa tare da maraƙi na ciki. A cikin sa'o'i 24 zuwa 48, maraƙi ya kumbura, yana daɗaɗawa cikin ƙumburi (hana diddige daga taɓa ƙasa ba tare da ciwo mai tsanani ba), kuma yana tasowa mai zurfi mai zurfi wanda ke tafiya zuwa idon sawu.

Kwatanta gefe-gefe: DVT vs Ruptured Baker's Cyst vs "Tennis Leg" vs Achilles Rupture vs Cellulitis¶

Yadda za a lissafta yiwuwar asibiti na DVT: ma'auni na Wells Score¶

Kafin yin odar gwaje-gwajen jini ko hoton duban dan tayi, likitocin gaggawa suna amfani da Wells Clinical Prediction Rule for Deep Vein Thrombosis:

1. Cancer mai aiki (maganin da ke gudana, a cikin watanni 6, ko mai kashewa): +1 aya
2. **Inna, paresis, ko na baya-bayan nan na plaster immobilization na ƙananan sassan: +1 aya
3. ** Kwanaki 3 ko fiye da haka a kwance, ko kuma Babban tiyata a cikin makonni 12*: +1 point
4. ** Ƙaunar wuri ** tare da zurfin tsarin venous (bayan maraƙi ko fossa popliteal): +1 aya
5. Dukkan kafa ya kumbura (daga cinya zuwa idon sawu): +1 aya
6. ** kumburin maraƙi aƙalla santimita 3 (inci 1.2) ya fi girma** fiye da ƙafar asymptomatic (wanda aka auna ** 10 centimeters [inci 4] ƙasa da tuberosity na tibial **): +1 aya
7. Pitting edema an keɓe ga ƙafar alamar alama: +1 aya
8. ** Jijiyoyin da ba na varicose ba: +1 aya
9. **DVT da aka rubuta a baya: +1 aya

10. **Madaidaicin ganewar asali yana da aƙalla kamar DVT *** (kamar "pop" na al'ada yayin wasan tennis ko sanannen cyst na Baker): **-2 maki ***

11. Yadda asibitoci ke fassara makin: Maki na 2 ko sama da haka ("Mai yiwuwa DVT") yana ba da umarnin gaggawar bugun jini na duban dan tayi . Ko da maki shine ** 1 ko ƙasa ("DVT wanda ba zai yiwu ba") saboda ruptured Baker's cyst ko tsoka hawaye ya rage maki 2, gwajin jini na **D-dimer ** yawanci zai dawo yana ɗaukaka a cikin yanayi biyu saboda fibrin ya rushe a cikin fashewar cyst da kuma cikin tsokar tsoka. Saboda haka, kusan kowane majiyyaci mai kumburin maraƙi yana buƙatar duban dan tayi.

Me yasa "Alamar Crescent" a idon ƙafar idon sawu ce ta yau da kullun don bin diddigin ruwa ko jini¶

Lokacin yin la'akari da mara lafiya wanda maraƙi ya kumbura sama da sa'o'i 24 zuwa 72 da suka wuce, duba fata a kusa da haɗin gwiwa a ƙarƙashin ƙwayar ƙwayar maraƙi:

1. Hanya ta jiki ta alamar jinjirin watan¶

A cikin duka ** ruptured Baker's cyst ** da ** medial gastrocnemius hawaye , ruwa mai kyauta (ruwa mai jini na jini daga gwiwa bursa ko jini daga tsagewar tsoka aponeurosis) yana tserewa tsakanin faci na baya da tsokar maraƙi. Ƙwaƙwalwar nauyi, wannan ruwa yana tafiya ƙasa tsakanin gastrocnemius da tsokoki na tafin hannu har zuwa idon sawun ** retinaculum , inda pigments na haemoglobin ke shiga cikin fata a ƙasan ** medial malleolus (ƙashin idon sawun ciki), ** malleolus na gefe (ƙashin idon sawun na waje), ko ** dorsum na ƙafafu (blue bluc) alamar jinjirin wata)**.

2. Dalilin da yasa Alamar jinji ta shafi al'amura a sashen gaggawa¶

• Cutar DVT maras rikitarwa baya haifar da kumburin ƙafar ƙafar sawu ba tare da bata lokaci ba kafin a fara maganin kashe jini, saboda gudan jini yana kamawa a cikin jijiya mai zurfi.
• Don haka, gano alamar wata alama mai launin shuɗi ** a idon sawu a cikin mara lafiya maras lafiya yana faɗakar da likitan gaggawa zuwa ** ruptured Baker's cyst ** ko ** gastrocnemius/plantaris hawaye **, yana gargadin likitan ** ba *** don allurar heparin mara nauyi mai nauyi kafin fara aiwatar da duban dan tayi.

Abin da ke faruwa a lokacin duban dan tayi na asibiti da kuma yadda ake kula da kowane yanayi¶

Lokacin da kuka isa sashin gaggawa ko asibitin jijiyoyin jini, mai daukar hoto yana yin wani abu mara zafi ** Doppler ƙananan-ƙarfi da duban dan tayi na musculoskeletal **:

1. Tabbatarwa ko ban da Zurfin Jijiya Thrombosis (Matsi Ultrasonography)¶

• ** Gwajin Gwaninta na Zinariya:** Likitan yana sanya binciken duban dan tayi mai tsayi mai tsayi a bayan gwiwa (popliteal fossa), a cikin makwancinta (jijiya na mata na yau da kullun), da ƙasa veins maraƙi, yana amfani da matsa lamba ƙasa kowane santimita 1 zuwa 2. Jijiyoyin da ba su da gudan jini na al'ada ** ta ruguje gaba daya ** karkashin matsin bincike mai haske. Idan jijiya ** ya ƙi damfara lebur **, ɗigon jini (DVT) ya cika lumen.
• Maganin idan an tabbatar da DVT:
• ** DVT na kusa (popliteal, femoral, ko iliac vein) ko Babban Haɗarin Distal Calf DVT:** Mai haƙuri yana farawa ** maganin rigakafin cutar kansa ** nan da nan, yawanci maganin ƙoshin lafiya na baka kai tsaye (** DOAC** kamar su apixaban ko rivaroxaban, ko ƙananan ƙwayoyin cuta / gadawar heparino) mafi ƙarancin watanni 3 ***.
• *** Idan an killace karamin gudan jini a cikin jijiyoyin maraƙi mai zurfi a ƙasan gwiwa kuma mara lafiya ba shi da ciwon daji mai aiki ko alamun bayyanar cututtuka, ** KIJIRA ** jagororin ba da izinin maganin ƙoshin lafiya nan da nan don watanni 3 KO serial sake duba duban dan tayi a cikin mako 1 da makonni 2** don tabbatar da cewa jini bai girma ba.

2. Binciken duban dan tayi da kuma magani don Ruptured Baker's Cyst¶

• Abin da duban dan tayi ya nuna: Mai sonographer ya hango siffar wuyan "mai siffa mai waƙafi" na cyst ɗin Baker da ke fitowa tsakanin ** matsakaicin shugaban gastrocnemius da semimembranosus tendon a bayan gwiwa. Lokacin da ya fashe, gefensa na kasa yana bayyana mai nuni ko rashin daidaituwa, tare da fili mai ruwa yana rarraba ƙasa tare da saman gastrocnemius zuwa idon sawun.
• Tsarin jiyya don Ruptured Baker's Cyst:
• ** Gudanar da maraƙi mai ra'ayin mazan jiya:** Ruwan synovial kyauta a cikin kyallen maraƙi ana sake dawo da shi ta hanyar tsarin lymphatic sama da makonni 2 zuwa 4**. Kaɗa ƙafar ƙafa lokacin da kake zaune, shafa fakitin kankara na minti 15 zuwa 20 sau uku a kowace rana, saka safa mai laushi mai laushi (da zarar an cire DVT), kuma amfani da crutches na kwanaki 2 zuwa 5 idan tafiya ya yi zafi.
• Dakatar da tushen a cikin haɗin gwiwa na gwiwa (Intra-articular corticosteroid injection): Domin mai Baker's cyst yana ciyar da kumburin haɗin gwiwa ta gwiwa ta hanyar bawul mai hanya ɗaya, zubar da cyst kadai yana da yawan sake dawowa. Sau ɗaya septic arthritis ba a cire shi ba, ƙwararren likitan kasusuwa ko rheumatologist akai-akai yana yin ** buri na Ultrasound da allura corticosteroid intra-articular a cikin gwiwa gwiwa **, yana rufe synovitis don haka cyst yana raguwa kuma ya rufe cikin kwanaki.

3. Binciken duban dan tayi da gyarawa don "Kafar Tennis" (Medial Gastrocnemius Tear)¶

• Abin da duban dan tayi ya nuna: Ultrasound yana hango katsewar fiber inda ** matsakaicin shugaban gastrocnemius** ke sakawa a cikin zurfin aponeurosis, tare da hematoma mai ruwa wanda aka shimfiɗa tsakanin gastrocnemius na tsakiya da tsokoki na tafin kafa.
• Tsarin jiyya na "Kafar Tennis":
• Mataki mai zafi (kwanaki na 1 zuwa 7): Kada ku taɓa miƙewa sabon hawayen maraƙi ta hanyar ɗaga yatsun kafa zuwa sama ko rataya diddigin ku daga mataki, yayin da wannan yakan wargaza zaruruwa kuma yana haɓaka hematoma.
• Daga diddige da Sarrafa Ƙwallon ƙafar ƙafar ƙafar ƙafa (CAM): Saboda barin diddigin faɗuwar ƙasa yana shimfiɗa gastrocnemius da ya yage, likitoci sun rubuta ko dai ** tayal ɗin tafiya a cikin ɗan ƙaramin tsire-tsire** ko ** 1 zuwa 1.5 centimeters (0.4 zuwa 0.6 inch) madaidaicin ƙafar ƙafar ƙafar ƙafar ƙafa zuwa makonni 4. har sai tafiya ba ta da zafi.
• Ultrasound-shiryar da hematoma evacuation (idan babba): Idan duban dan tayi ya bayyana wani ruwa tarin jini a kan 2 zuwa 3 santimita lokacin farin ciki raba gastrocnemius da tafin kafa, wasanni magani likitoci wani lokacin aspirate ruwa hematoma a karkashin bakararre duban dan tayi shiriya a lokacin na farko 1 zuwa 2 makonni don hanzarta tsoka reattachment da kuma hana ssifi calcyos.

Rare amma m mimics: Plantaris rupture, Popliteal Artery Aneurysm, da Ciwon Ciki¶

Lokacin da ake kimanta ɗan maraƙi mai raɗaɗi, likitocin kuma suna bincika yanayin jijiyoyin jini da tsarin abubuwa uku:

1. Maƙarƙashiya ko Ruptured Popliteal Artery Aneurysm:
2. Kullun da ke jujjuyawa a bayan gwiwa shine ba* cyst din Baker; yana da popliteal artery aneurysm (yana shafar mazan maza, kashi 50 cikin 100 daga cikinsu suna da ciwon bugun jini mai cin karo da juna da kashi 30 zuwa 40 cikin 100 daga cikinsu suna da ciwon bugun jini na ciki**).
3. Yawanci yana nunawa ta hanyar ** rufewa ko harbi thromboembolism a cikin arteries na tibial **, yana haifar da m gabobin jiki ischemia (ƙafar sanyi, fari, mara bugun jini), ko lokaci-lokaci yana fashewa cikin bugun jini, hematoma mai ƙarfi a bayan gwiwa yana buƙatar tiyatar gaggawa ta jijiyoyin jini.
4. ** Rupwar Tendon Plantaris:**
5. plantaris wata 'yar karamar tsoka ce wacce ta samo asali a bayan gwiwa ta gefe wacce jijiyar siraran ta ke gudana tsakanin gastrocnemius da tsokoki na tafin hannu. Yayin da fiye da kashi 90 cikin 100 na "kafafun wasan tennis" sune hawaye na gastrocnemius na tsakiya, fashewar tsire-tsire na tsire-tsire yana haifar da tsakiyar maraƙi tare da kumburi mai laushi da farfadowa a cikin makonni 1 zuwa 3.
6. Ciwon Ciwon Ciwon Ciki Na Baya Daga Cutar Hawayen Maraƙi Mai Magance Magani:
7. Idan majiyyaci da ke shan magungunan jini na yau da kullun yana fama da gastrocnemius hawaye ko ruptured Baker's cyst, ko kuma idan an yi kuskuren ba da hawaye maraƙi na jini ba tare da duban dan tayi ba, zubar da jini a cikin sassan baya na iya tayar da matsa lamba na ciki bayan 30 mmHg.
8. Jan Tutoci na Gaggawa: Kula da ** zafi daidai gwargwado ga jarrabawa **, * maraƙi mai wuyar allo , ** zafi mai zafi akan tafin ƙafar ƙafar ƙafa, da ** raɗaɗi akan tafin ƙafar (matsin jijiya na tibial), buƙatar gaggawa ta gaggawa ** fasciotomy ***.

Lambobin gaggawa na yanki da ka'idojin hukumar¶

• Amurka da Kanada: Ku kira 911 nan take idan maraƙi ya kumbura yana tare da gajeriyar numfashi, ciwon ƙirji, suma, ko ƙafar sanyi/ mara ƙarfi. Don keɓantaccen kumburin maraƙin maraƙi ba tare da damuwa na numfashi ba, je zuwa ** Sashen Gaggawa *** ko kuma wanda aka amince da shi ** Kulawa da gaggawa tare da wurin Venous Duplex Ultrasound ** (kira gaba don tabbatar da samuwar duban dan tayi, kamar yadda yawancin asibitocin tafiya ba su da mai daukar hoto na jijiyoyin bugun jini a kan aiki bayan 17:00 ko a karshen mako).
• United Kingdom: Kira 999 don alamun kumburin huhu ko ischemia mai tsanani. Don matsananciyar zafi, kumbura maraƙi ba tare da alamun ƙirji ba, kira ** NHS 111 ** ko kuma ku halarci ** Kula da Gaggawar Gaggawa na Rana ɗaya (SDEC) / Ambulatory DVT Clinic ** ko asibiti ** A&E Sashen , inda ** NICE Guideline NG158 ya ba da umarnin ƙimar ƙimar Wells na wakili da rana guda (ko a cikin sa'o'i 24 na ƙwayar tsoka) duban dan tayi na jijiyar kafafu na kusa.
• Ƙungiyar Tarayyar Turai: Kira 112 a duk ƙasashe membobin EU don abin da ake zargi da cutar kumburin huhu ko gaggawar jijiyoyin jini.
• ** Ostiraliya da New Zealand:** Kira ** 000** a Ostiraliya ko 111 a New Zealand don jigilar motar daukar marasa lafiya ta gaggawa, ko kira Healthdirect (1800 022 222 a Ostiraliya) / Layin lafiya (0800 611 116 a New Zealand) don nemo sashin gaggawa na gaggawa tare da 24 gnostic.
• Indiya da Asiya-Pacific: Kira 112* ko108* a Indiya,995* a Singapore,119* a Japan da Koriya ta Kudu, ko 999 a Hong Kong da Malaysia.

Tambayoyin da ake yawan yi¶

Me yasa likita ba zai iya bambanta tsakanin cyst ɗin Baker da ya fashe da DVT ba kawai ta hanyar bincika ƙafata?¶

Lokacin da cyst ɗin Baker ya fashe a bayan gwiwa, matsa lamba ruwan haɗin gwiwa yana gudana zuwa ƙasa tsakanin tsokoki na maraƙi kuma yana haifar da kumburi mai tsanani. Wannan yana haifar da ainihin alamun jiki iri ɗaya da ake gani a cikin jijiyar jijiyoyi mai zurfi: kumburin maraƙi ɗaya wanda ya fi santimita 3, zafi, ja, da taushin maraƙi mai zurfi. Ko da gwajin jini na clots (D-dimer) ya zama mai kyau a cikin ruptured cyst. Na'urar duban dan tayi na duplex ne kawai zai iya tabbatar da gani ko jijiyoyi suna matsawa akai-akai ko sun ƙunshi gudan jini.

Me zai faru idan wani mai tsagewar tsokar maraƙi ("ƙafa ta wasan tennis") ko ruptured Baker's cyst an yi kuskuren ba da magungunan jini don DVT da ake zargi da shi?¶

Idan an ba da magungunan maganin warkewa (kamar enoxaparin, apixaban, ko rivaroxaban) ga mara lafiya wanda maraƙin da ya kumbura shine ainihin ƙwayar gastrocnemius na tsakiya ko kuma ƙwayar Baker na jini, maganin yana hana tsagewar tasoshin intramuscular daga clotting. Wannan yana haifar da saurin faɗaɗa babban hematoma maraƙi na intramuscular, naƙasa mai tsayi, da yuwuwar cutar gaɓoɓin gaɓoɓi na baya wanda ke buƙatar fasciotomy na gaggawa na gaggawa.

Za ku iya samun cyst ɗin Baker da ainihin Zurfin Jijiya Thrombosis a lokaci guda?¶

Ee. Nazarin duban dan tayi na jini ya nuna cewa kashi 5 zuwa 10 na marasa lafiya da ke da alamun bayyanar cututtuka ko ruptured cysts na Baker suma suna da ciwon ƙwayar cuta mai zurfi na gaskiya a lokaci ɗaya. Ciwon huhu a bayan gwiwa a zahiri yana danne jijiyar popliteal da ke kusa, yana rage jinkirin dawowa (stasis) da haifar da samuwar jini. Shi ya sa dole ne mawallafin sonographer ya bincika dukan bishiyar jijiyoyi mai zurfi ko da bayan ya gano cysts na Baker.

Menene “alamar jinji” a idon sawun, kuma menene ma’anarta?¶

Alamar jinjirin wata mai lankwasa, shuɗi-blue bruise (ecchymosis) yana bayyana a ƙarƙashin ƙashin idon sawu na ciki ko na waje 1 zuwa 3 days bayan an fara ciwon maraƙi mai tsanani. Yana faruwa a lokacin da jini da ruwan synovial daga ruptured Baker's cyst ko gastrocnemius hawaye suna gangarowa ƙasa da nauyi tare da kumfa na fashe har sai sun haɗu a idon idon sawu. Saboda DVT mara rikitarwa baya haifar da rauni a idon sawun, ganin alamar jinjirin wata yana nuna ƙarfi ga fashewar cyst ko tsagewar tsoka.

Me yasa kullin bayan gwiwa na ya ɓace a daidai lokacin da maraƙi na ƙasa ya kumbura da zafi?¶

A cikin marasa lafiya waɗanda ke da matsewa a bayan gwiwa daga ƙumburi na Baker na yau da kullun, bacewar kwatsam ko tausasa wannan kullin lokaci guda tare da zafi mai tsagewa da saurin kumburin maraƙi shine babban sa hannu na tsattsauran ƙwayar ƙwayar cuta. Lokacin da bangon bursal ya ba da hanya, ruwa yana zubar da ƙasa zuwa cikin ɗakin maraƙi, yana kawar da matsa lamba a bayan gwiwa yayin da yake kafa pseudothrombophlebitis a cikin ƙananan ƙafa.

Yaya tsawon lokacin da mai Baker's cyst ya rushe ko "kafar wasan tennis" yaga tsoka don warkar da zarar an cire DVT?¶

Da zarar duban dan tayi ya fitar da DVT, ruwan sinavial na kyauta daga ruptured Baker's cyst yana sake dawowa ta hanyar lymphatics na maraƙi sama da makonni 2 zuwa 4 tare da haɓakawa, ƙanƙara, matsawa mai laushi, kuma sau da yawa wani allurar steroid mai jagorancin duban dan tayi a cikin haɗin gwiwa. Tsawon gastrocnemius na tsakiya yana buƙatar makonni 2 zuwa 3 na kariya ta tafiya tare da hawan diddige ko tafiya kafin tafiya ba tare da jin zafi ya dawo ba, da kuma makonni 6 zuwa 8 na farfadowa na jiki kafin komawa wasanni na kotu.

Jagora masu alaƙa¶

• Ƙunƙarar ƙwayar huhu da ƙwayar ƙwayar cuta mai zurfi (DVT).
• Rupted achilles tendon, patellar tendon yagayen, da kuma matsanancin faɗuwar ƙafa
• Murkushe rauni da ciwon sashe taimakon farko
• Kwatsam sanyi mara motsin hannu da matsananciyar rufewar jijiya

Tushen da jagorar hukuma¶

• ** Cibiyar Kula da Lafiya da Ƙwararrun Kulawa ta Ƙasa (NICE, United Kingdom): ** * Cututtukan Thromboembolic Venous Thromboembolic: Diagnosis, Management and Thrombophilia Testing (NG158), Mataki na biyu Wells DVT Score da Proximal Leg Vein Ultrasound Pathways*.
• Kwalejin Likitocin Kirji na Amurka (KIRJI, Amurka): Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report (Management of Distal Distal DVT vs Proximal DVT).
• American College of Radiology (ACR, United States): ACR Appropriateness Criteria: Suspected Lower-Extremity Deep Vein Thrombosis and Ultrasound Evaluation of Popliteal Masses / Pseudothrombophlebitis.
• ** Cibiyar Nazarin Magungunan Orthopedic ta Amurka (AAOS, Amurka):** Jagorar asibiti akan Popliteal (Baker's) Cyst Rupture, Medial Head of Gastrocnemius Tear ("Kafar Tennis"), da Ciwon Ciwon Ciki na Baya.
• ** Ƙungiyar Biritaniya don Hematology (BSH) da Ƙungiyar Turai don Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru.