Ditapuluka dia muonji wa Achille, ditapuluka dia muonji wa patellar, ne dipanda dia dikasa dikole¶

Mutoyi wa tshimpitshimpi, wa dikuma anyi wa dibutuka mu nyima kua dikasa dia kuinshi anyi kumpala kua dikasa padibu benda lubilu, batuluka anyi balenduka ntshimanyinu tshia kale tshia dinyanguka dia muonji wa Achilles anyi ditapuluka dia muonji wa tshitupa tshia mubidi (patellar anyi quadriceps). Bia muomumue, dipanga dia tshimpitshimpi dia kubandisha tshitupa tshia kumpala tshia dikasa ne minu panshi (dikuluka dia dikasa dia lukasa, dienza bua minu ya makasa ikoka anyi ikuma panshi padi muntu wenda) ntshilumbu tshia lukasa tshia dikonkonona tshidi mua kufumina ku disama dia lumbar disque acute anyi cauda equina compression, anterior tibial compartment, syndrome wa perone, diondapangana dia nerve ditapuluka dia muonji wa kumpala wa tibialis, anyi tshipupu tshia mu buongo tshia munkatshi. Wewe anyi muntu mukuabu udi pabuipi nebe udi upeta disama dia mukolo, disama dia tshiadi, anyi dikasa didi kadiyi dikuma, udi mua kubikila nimero wa lupitadi lua muaba unudi diakamue ku diambuluisha dia nomba ya tshimpitshimpi. Tangila malu a tshimpitshimpi adi atangila mifuba ne mifuba mu mifuba mityumuke ne mifuba, disama dia cauda equina ne dikuma dia muonji wa mukolo, ne disama dia tshiadi ne disama dia tshitupa tshia mubidi.

Enza nunku mpindieu¶

1. Umbusha bujitu buonso pa dikasa didi ditapa diakamue ne kutetshi bua "kuenda." Kutungunuka ne kuambula bujitu pa muonji wa Achilles, muonji wa patellar, anyi muonji wa quadriceps udi mutshibuke bikole udi ukoka nsongo ya muonji udi mutapike santimetre ya bungi, udi utshibula mashi adi afumina mu paratenon, ne udi mua kuikala ne disama dia tshiadi tshidi mua kuikala tshinyanguke mu mutshima tshiamu tshia mudimu tshidi tshienza mudimu mu dilongolola dikole dia dipanda.
2. Tangila diakamue bua "Malu asatu adi mua kufikisha ku dikuluka dia makasa ne ku mukolo" (Bikila 911 / 112 / 999 mpindieu pikalaku):
3. Cauda Equina anyi Acute L4/L5 Radiculopathy Red Flags: Dikuluka dia makasa didi dilondangana ne disama dikole dia muinshi mua tshiadi, disama dia sciatica panshi ku dikasa dimue anyi onso abidi, disama dia mu tshiadi anyi mu tshiadi ("saddle anesthesia"), anyi lutatu lua kutuadija kuela mashi anyi kulama mala (tangila disama dia cauda equina).
4. Acute Anterior Compartment Syndrome anyi Popliteal Artery Occlusion (Knee Dislocation): Dipueka dia makasa didi dilondangana ne disama dikole, didi kadiyi dijika, dikole bu dibue ne disama dikole kumpala kua tshiadi didi dienda dikola padi minu ya makasa miolola panshi, anyi dikasa ditoke, mashika didi kadiyi ne mupuya wa makasa (* pedis*) kunyima kua disama dia tshiadi anyi dia makasa (tangila tshiadi tshia ischémie tshikole).
5. Acute Central Brain Stroke (ACA / Motor Cortex): Dikuluka dia makasa dia tshimpitshimpi kadiyi ne kanyinganyinga dilondangana ne butekete mu tshitupa tshimue tshia tshiadi, tshiadi, diboko, anyi mpala, ngakuilu mubi, anyi dipanga dia lungenyi.
6. Teka ne utapa tshikasa anyi dikasa didi ditapike mu mushindu udi ulengeja mishipa paudi ulongolola mushindu wa kuendesha:
7. Bua ditshibuka dia muonji wa Achille (muinshi mua tshiadi/tshianza): Leja dikasa ditangile kakese MUINSHI (mu 20 too ne ku 30 degrés ya plantarflexion / "tiptoe" position) ku diambuluisha dia tshiamu tshia mitaku anyi tshia kulala. KUENZEJI tshikasa tshia Achille tshidi tshitapuluke ku bukole too ne ku angle wa 90 degrés, bualu kukoka dikasa mulu kudi kutapulula nsongo ya Achille mitshibuke ku santimetre 3 too ne ku 5.
8. Bua ditshibuka dia tshiadi tshia patellar anyi tshia quadriceps (kumpala kua dikasa): Ela dikasa dishindame bimpe (0 degrés ya diunzulula dijima) pa tshilamba tshile, pa tshilamba tshia kulala, anyi pa tshintu tshidi tshipangisha dikasa bua kuenda. Kuinama dikasa nansha dimo, bualu dikoka didi dikoka tshitupa tshia dikasa ne nsongo ya mishipa idi mipanduluke.
9. Wenza tshikebelu tshia Thompson Calf-Squeeze Teste pikala wela meji ne: Achilles udi ne disama dia tshiadi. Leja muntu udi mutapike alale mpala panshi pa bulalu anyi pa ditanda ne makasa onso abidi malenga ku muelelu (anyi afukame pa nkuasa ne makasa malenga). Fina bitekete bitekete difu dia pankatshi dia munyinyi wa muana wa ngombe pa dikasa dimpe kumpala (dikasa nedileje nkayadi panshi), pashishe ufina tshitupa tshia muana wa ngombe tshia dikasa didi ditapa. Shi dikasa kadiyi dienda panshi padibu bafina muana wa ngombe (Diteta dia Thompson dimpe), muonji wa Achille udi utshibuka tshishiki.
10. Sula anyi utapulula tshintu tshionso tshikole tshia fibre de verre, tshilamba tshia ski tshikole, anyi tshiamu tshia ku tshianza diakamue pikala disama dia nsukadi anyi dikuluka dia dikasa dikola. Nerve peroneal (fibulaire) udi unyunguluka buludiludi pa tshitupa tshia mifuba tshidi ku luseke lua pambelu lua dikasa anu kuinshi kua dikasa (nshingu wa fibulaire); tshilamba tshikole, tshilamba tshia ku tshiadi, anyi dikasa dia mutantshi mule didi difina tshitupa etshi ku mufuba, tshienza neurapraxia udi mua kupingana udi ulua wa kashidi padibu kabayi bapuekesha dikuma mu mêba makese.
11. Bandisha dikasa, wela tshilamba tshia mashika mu minite 15 to ne 20 musangu umua (kuyi nansha kakese pa mutu pa dikasa dia pambelu didi ne mifuba muinshi mua dikasa), ne ulongolole tshibambalu tshia malu a mpukapuka anyi tshikebelu tshia lukasa tshia mifuba tshia dituku dimue. Mikenji ya lelu idi kayiyi ya dipanda ne ya dipanda idi ilomba bua kuteka dikasa dia tshiamu tshia mifuba (anquinus anyi ) boot mu meba 24 too ne ku 72 a pop bua se hematoma mupiamupia ikale ulamakaja nsongo ya tendon mu dipetangana dia buludiludi.

Mutshi wa dipangadika: Disungula dia dishilangana dia tshiadi tshia muana wa ngombe, ditshibuka dia tshitupa tshia dikasa, ne dikuluka dia dikasa¶

flowchart TD
    Start["Dipanga dia tshimpitshimpi dia kubandisha/kuleja dikasa"] --> DirectionCheck{"Ntshinyi tshidi tshijimina anyi tshidi tshisama?"}

    DirectionCheck -->|"KAKUENA MUA KULEJA DIKASA PANSHI / Kupuekesha panshi ('Pop' udi umvuika kunyima kua tshiadi tshia ngombe/tshianza)"| AchillesBranch["KUELA MU MUTU WA ACHILLES: 1. Enza tshikebelu tshia Thompson Calf-Squeeze (Dikasa didi dipanga kuenza plantarflex = Positive). 2. Umvua tshitupa tshia 2-6 cm pa mutu pa mufuba wa tshikasa. 3. Tshiamu tshia ku tshiadi tshidi tshitangila panshi (20-30 deg equinus); ZERO bujitu bua kuambula; Dilama dia lukasa/dia mifuba mu 24-48h."]

    DirectionCheck -->|"KAKUENA MUA KULONGOLOLA DIKASA Ku bukole budi bukokela bintu panshi to (Pop kumpala kua dikasa panyima pa dituta/diteketa)"| KneeExtensorBranch{"Tshilema tshidi tshimueneka tshidi penyi ne mmushindu kayi uvua tshitupa tshia dikasa (Patella) tshishintuluke?"}

    KneeExtensorBranch -->|"Ditapuluka dia kuinshi kua dikasa + dikasa dikoka muulu muulu (Patella Alta), Bidimu bia pa tshibidilu < 40"| PatellarTear["PATELLAR TENDON RUPTURE: 1. Immobilize knee 100% STRAIGHT (0 deg extension). 2. Dipanda dia lukasa dia mifuba didi dikengedibua mu matuku makese bua kupingaja muonji ku tubercle tibial."]

    KneeExtensorBranch -->|"Tshitupa tshia pa mutu pa dikasa + dikasa dipueka panshi (Patella Baja), Bidimu bia pa tshibidilu > 40"| QuadTear["DIPATUKA DIA TENDON WA MU MUTU: 1. Kulekela dikasa dienda 100% LULOME (0 deg extension). 2. Dilongolola dia lukasa dia mifuba didi dikengedibua lukasa bua kuepuka dipanga dia kashidi dia extensor."]

    DirectionCheck -->|"KAKUENA MUA KUBANGISHA DIKASA / MINUA MU MUTU WA MUTU (Dikuluka dia makasa dia lukasa / Dienda dia dibeji)"| FootDropRedFlags{"Tangila malu a tshimpitshimpi a mu mitu ne a mu mishipa kumpala: Disama dia mukolo/dia makasa, disama dia tshibandilu, lutatu lua mu tshisuku, NANSHA disama dia mu tshiadi didi dikole bu dibue / dikasa didi kadiyi dikuma?"}

    FootDropRedFlags -->|"EYOWA: Disama dia mukolo, Sciatica, anyi Bimanyinu bia mu tshiadi/tshiadi"| SpineEmergency["ACUTE L5 RADICULOPATHY OR CAUDA EQUINA SYNDROME: Bikila 911 / 112 / 999 bua Stat Lumbar Spine MRI & Emergency Neurosurgical Decompression."]

    FootDropRedFlags -->|"EYOWA: Disama dikole dia mu tshiadi pa dikasa dia ku makasa didi kadiyi dienza mudimu anyi pa dikasa didi kadiyi ne mashika"| VascularCompartment["MUSHINDU WA KUMPALA ANYI DIFUKA DIA MUSHINDU WA KUMPALA: Bikila 911 / 112 / 999 bua dipanda dia lukasa dia mishipa / dipanda dia mishipa."]

    FootDropRedFlags -->|"KAKUENA mukolo anyi mu mishipa: diteta dia dikudimuna dia tshiadi (dikudimuna dia dikasa dia munda)"| InversionTest{"Mubedi udi mua kukudimuna tshitupa tshia dikasa munda mua dikasa anyi (dikuluka dia tshiadi = Tibialis Posterior, L5) anyi?"}

    InversionTest -->|"Dikokangana dia tshikasa didi ne bukole (kadiyi dinyanguke), Dikokangana didi ditekete, dipanga dia lungenyi pa mutu pa dikasa/1st Webspace"| PeronealOrTendon["COMME PERONEAL NERVE PALSIE (at Fibular Neck) OR TIBIALIS ANTERIOR TENDON RUPTURE: Umbusha bipese bia ku tshiadi; Tangila tshingoma tshidi mua kulenga kumpala kua tshikasa; Diyukidilangana dia lukasa dia Neurologie/Orthopédique."]

    InversionTest -->|"BIONSO BIONSO Dikudimuna dia tshikasa ne Dikudimuka bidi bitekete + Dikosa dia tshiadi didi ditekete"| L5RootOrSciatic["L5 NERVE ROOT LESION, SCIATIC NERVE PALSY, OR CENTRAL STROKE: Immediate Emergency Department Neurological & MRI Workup."]

Bualu 1: Ditapa dia muonji wa Achille¶

"Kukuma anyi kukuma bingoma kunyima kua tshikasa" Dileja¶

Mushipa wa Achilles (mushipa wa tshiadi) udi mushipa munene ne wa bukole mu mubidi wa muntu, muenza ku disangisha dia gastrocnemius ne soleus mishipa ya muana wa ngombe ne udi ubuela kunyima kua mufuba wa tshikasa (tuberosity calcaneal). Nansha mudibi mua kutantamena bujitu bua mubidi misangu 8 anyi 12 padibu benda banyema, muonji udi ne tshitupa tshibi tshia tshitupa tshia mashi tshidi katshiyi tshikumbane tshidi pa bule bua santimetre 2 too ne ku 6 (0,8 too ne ku 2,4 inches) pa mutu pa tshikasa tshiende.

Padi muena manaya anyi "muena mvita wa ku ndekelu kua lumingu" (utu ne bidimu 30 too ne ku 55 mu manaya a tennis, pickleball, basketball, soccer, badminton, anyi lubilu lukole) wela lubilu lukole ne dikasa dia kumpala padi dikasa dienda dikola, anyi ubuela mu tshina tshia mpukapuka: 1. Diumvua: Bantu bapite pa 70 pa lukama badi bakudimuka ne tshiji bua kumona nganyi uvua mubakuma ku tshikasa anyi mubakuate ne mupimbu wa tennis anyi ne mupimbu wa tennis, bualu muonji udi utshibuka udi umvua anu bu dikuma dikole dia buludiludi difumina kunyima. 2. The Audible Pop: Mutoyi udi bu wa bingoma anyi mutoyi mukole utu misangu ya bungi umvuika kudi bantu bimane mutantshi wa metre a bungi. 3. Dijimija dia tshimpitshimpi dia bukole: Muntu kena mua kuela minu yende anyi kuenza dikasa dimue dia kubandisha tshikasa ku luseke ludi lutapike, wenda ne dikasa ditekete. Disama ditu dijika mu minite 15, didi dishima bantu ba bungi bua kulekela luondapu.

Buanga ne malu adi mua kunyangakaja mishipa ya Achille ne ya Quadriceps¶

Tangila misangu yonso ni mubedi udi ne disama dia tshiadi anyi dia bukole bukese uvua mupete manga anyi malu adi anyanga collagène wa mushindu wa kumpala: - Fluoroquinolone Antibiotics (Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin): Ikala ne FDA ne EMA Boxed Warning bua acute tendinitis ne tendon rupture (udi unyanga muonji wa Achilles mu 90 pa lukama ya bilumbu, ne bilateral mu tshitupa tshimue tshia bisatu tshia bilumbu). Fluoroquinolones udi ubandisha matrix metalloproteinases (collagenase) udi ushipa mishipa ya mishipa. Latency: Dinyanguka didi mua kuenzeka mu meba 48 a tshiamu tshia kumpala tshia antibiotique NANSHA too ne ku ngondo 6 kunyima kua dijikija dia luondapu lua antibiotique, ne njiwu idi mua kuvula bikole kudi babedi bapite pa bidimu 60 anyi badi banua corticosteroïdes musangu umue. - Diela dia corticosteroïde dia mubidi anyi dia muaba: Ditua dia steroïde buludiludi mu anyi pabuipi ne muonji wa Achilles, wa patellar anyi wa quadriceps didi ditekesha dipetangana dia collagen ne difikisha ku ditshibuka. - Statins, Disama dia mfyo dia kashidi (Dialyse / Hyperparathyroidism), Gout, Diabete, ne Rheumatoid Arthritis / Lupus.

Bipimu 4 bia ku luseke lua bulalu bua kumanya disama dia tshiadi tshia Achilles¶

Mu tshibambalu tshia malu a tshimpitshimpi, dikonkonona dia masama ku diambuluisha dia Tshilongelu tshia bena Amerike tshia baminganga ba mifuba (AAOS) Quartet of Tests didi bushuwa dikole kupita MRI: 1. Diteta dia Thompson (Diteta dia Simmonds-Thompson Calf-Squeeze, 96% Sensitivity): Padi mubedi mulale panshi (mutangile panshi) pa mesa a tshikebelu ne makasa ende onso abidi malenga ku ndekelu kua mesa, muena tshikebelu udi ufinya difu dia munyinyi wa munkatshi mua tshiadi. Pa tshibidilu, kufina muana wa ngombe kudi kukoka muonji wa Achille mulu ne kuenza bua dikasa dikale plantarflex (dileja panshi). Mu ditapa dia Achille dijima, dikasa didi dishala dishindame pa kumona luseke ludi ne makanda a mubidi mimpe. 2. Diteta dia Matles (Diteta dia Angle wa dikisha dia binu, 88% wa diumvua): Padi mubedi mulale mpala panshi pa bulalu, umulombe bua kuinama binu biende bionso bibidi ku 90-degree angle bua bikono biende bitangile buludiludi ku plafond, eku balama bikono biende bimpe menemene. - Dikasa dia pa tshibidilu: Dikasa dia dikisha dia pa tshibidilu dia muonji wa Achille udi kayi munyanguke didi dilama dikasa ditangile kakese ku plafond (mu \(20\text{ to }30\text{ degrees}\) ya plantarflexion). - Dikasa dia Achilles ditshibuka: Bualu bukole budi bukoka dikasa didi kadiyi dikuatshisha panshi kakuyi tshilamba tshia Achille tshidi katshiyi tshinyanguke, dikasa didi ku luseke ludi lutshibuka didi dikuluka panshi mu muaba mupepele (neutral \(0\text{ degrees}\)) anyi dorsiflexed (Positive Matles Sign). 3. Dilenga dia tshitupa tshia muonji (tshilema): Kuenda ne minu ibidi bitekete bitekete pa muonji wa Achille 2 to ne ku 6 santimetre pa mutu pa mufuba wa tshikasa kudi kuleja muaba udi ne tshitupa tshia munda mutupu muaba udi muonji munyanguke (bimpe kumvua mu mêba 24 a kumpala kumpala kua disama dia hematoma kuwuja tshitupa atshi). 4. Dipuekesha dia mutoyi wa tshikasa tshia dikisha ne dipanga dia mushindu wa kubandisha tshikasa tshia dikasa dimue.

Bua tshinyi dipanda dia lukasa dia Equinus (Plantarflexion) mu mêba 48 a kumpala didi dishintulula malu onso¶

Mateta a mu lupitadi (bu mudi mateta a SMART ne UKSTAR) mmashintulule mushindu wa kuondopa disama dia Achille: dilongolola dia mudimu didi kadiyi dienza mudimu mu tshilamba tshia pa buadi didi difila bungi bukese bua dipanda dia mubidi (2 too ne ku 4 pa lukama) anu mudi dipanda dia patupu, anu mudi dikasa dikale dienda dikola (mu tshitupa tshia dikasa tshidi tshienza mudimu bimpe, \(20\text{ to }30\text{ degrees}\) toes-down) diakamue mu meba 24 too ne 72 a kumpala. - Padi dikasa ditangile kuinshi mu equinus diakamue kunyima kua disama, nsongo ibidi ya muonji wa Achille udi ulengangana munda mua tshilamba tshia paratenon tshidi katshiyi tshinyanguke, bienza bua mashi mapiamapia (adi ne plakete ne fibroblaste) apingaje muonji pamue mu bule buawu bua dikisha. - Shi mubedi wenda mu nsapatu ya 90-degree mu lumingu lumue kumpala kua kuya kumona munganga, Achilles udi ukola mule (mutambakana ku 2 to ne 3 centimètres), ushiya muntu ne butekete bua kashidi ne disama dia tshiadi dia kashidi didi dilomba dipanda dia mishipa mikole. - Didimuija dia njiwu mikole ya DVT: Bualu dipangisha dia makasa a kuinshi mu tshilamba tshia equinus anyi mu tshilamba tshia ku makasa panyima pa ditshibuka dia Achille didi diimanyika pompe wa mishipa ya mu tshiadi, Ditshibuka dia muonji wa Achille didi ne umue wa ku bungi bunene bua disama dia mashi a mu mishipa (DVT) ne disama dia tshiadi tshia mu mikolo mu malu a mifuba (too ne ku 5 too ne ku 30 pa lukama ku ultrason); Baminganga batu batamba kukonkonona bua kumanya ni badi ne manga a DVT (bu mudi: heparine wa bujitu bukese anyi manga adi apangisha mashi bua kuela mu mishiku) padibu kabayi mua kuenza mudimu.

Bualu 2: Ditapuluka dia muonji wa patellar ne ditapuluka dia muonji wa quadriceps (Mushindu wa dikola dia dikasa)¶

Mushindu wa dilengeja dia dikasa i tshijengu tshidi ne mushipa wa tshiadi -> tshiadi tshia tshiadi -> tshiadi tshia tshiadi -> tshiadi tshia tshiadi (tshiamu tshia tshiadi) -> tshiadi tshia tshiadi ku mutu kua mufuba wa tshiadi. Shi tshintu nansha tshimue tshia mu tshijengu etshi tshinyanguka tshishiki, muntu kena mua kululamija dikasa diende ku bukole budi bukokela bintu panshi to ne dikasa diende didi dinyanguka diakamue padiye ukeba kuimanapu.

Dishilangana dia muonji wa Quadriceps ne muonji wa Patellar Rupture¶

(Clinical Pitfall: Anu mudi mishipa ya diambuluisha mua kushima baminganga mu disama dia Achille, patellar retinaculum udi kayi munyanguke ku nseke ya dikasa udi mua kuambuluisha mubedi udi ne tshitupa tshia mu tshiadi tshia munkatshi bua kulama dikasa diende bululame padi munganga umubandisha, nansha mudiye ne 30-to-30-300 lag* padibu bateta bua kudibandisha nkayabu.

Nsombelu 3: Disungula dia dikuluka dia makasa (Mukolo vs. Nerve vs. Compartiment vs. Tendon)¶

Dikuluka dia dikasa ndipanga dia kubandisha kumpala kua dikasa ne minu muulu mutangile ku tshikasa (dijimija dia dikosa dia tshiadi). Bu mudi minu ya makasa ilenga panshi mu tshikondo tshia dienda, mubedi udi ne tshia kukoka minu yende panshi anyi kubandisha dikasa diende muulu bikole bu mudiye ubanda pa bibandilu ("steppage gait") ne kukuma dikasa diende panshi ne dîyi dikole pa tshibandilu tshionso.

Dikuluka dia makasa dia tshimpitshimpi didi lutatu lua bungi bualu malu atanu mashilangane mu buongo, mu mukolo, mu mishipa ya ku makasa, mu mijilu ya ku mpenga, ne mu mishipa ya ku makasa adi mua kudikebesha. Ingidija tshibambalu etshi tshia difuanyikija dia lupitadi ne tshikebelu tshia mubidi tshia ku luseke lua bulalu bua kumanya tshidi tshikebesha:

Difuanyikija dia malu 5 adi akebesha dikuluka dia makasa¶

Tshintu tshia 10-Second tshia ku luseke lua bulalu: Kuteta dishintuluka dia tshiadi bua kutapulula mukolo ne tshiadi¶

Padi mubedi ufika ne dikasa dikole, mmunyi mudi baminganga ba lupitadi lua lukasa mua kumanya diakamue ni lutatu elu ludi lua lukasa lua dipanda dia mitu mu mukolo wa kuinshi (muji wa muonji wa L5) anyi disama dia muonji wa ku dikasa dia pambelu (muji wa muonji wa pa tshibidilu)? - Badi bateta ANKLE INVERSION (balomba mubedi bua kukudimuna dikasa diende didi ditapike MUNDA mutangile ku dikasa dikuabu ku tshianza tshia muena mudimu) ne HIP ABDUCTION (kuela tshiadi pambelu): 1. Tibialis Anterior (udi ubandisha dikasa) ne Tibialis Posterior (udi ukudimuna tshitupa tshia dikasa munda) badi bapeta mionji yabu ya L5 spinal nerve root mu mukolo wa kuinshi. 2. Ino, muulu mu tshiadi, mionji ya L5 idi itapuluka mu mishindu ibidi mishilangane: mionji idi ibandisha dikasa idi ipueka mu Common Peroneal Nerve (udi unyunguluka nshingu wa pambelu wa fibular ku dikasa), kadi mionji idi ivuija dikasa munda (inversion) idi ipueka mu Nbial mukubibue muinshi mua dikasa muana wa ngombe. 3. Mukenji wa luondapu: - Shi mubedi udi ne Dikuluka dia makasa + Dikuluka dia tshiadi ditekete (kadiena mua kukudimuna dikasa dia munda) + Dibutuka dia tshikasa ditekete, tshilonda tshidi MU MUTU MU L5 Nerve Root mu Lumbar Spine (anyi Sciatic Nerve) -> Needs urgent lumbar spine MRI. - Shi mubedi udi ne Dikuluka dia makasa + Dikuluka dia tshikasa dikole (dikudimuna dikasa dia munda bikole) + Dikuluka dia tshikasa ditekete, tshilonda tshidi MUINSHI KUINSHI ku Nerve Peroneal Common ku Nshingu wa Fibular -> Tangila diakamue bua kumanya ni udi ne tshintu tshikole, tshiamu tshia ku tshianza tshia dikasa, ditshibuka dia mutu wa tshiadi, ditshibuka dia maulu dia Baker anyi tshia tshibidilu.

Mushindu kayi wa kujingulula dinyanguka dia muonji wa kumpala wa Tibialis (tshilejilu tshia dikuluka dia makasa)¶

Mu bantu bakole ba bidimu 50 too ne ku 75 (anyi kunyima kua dikosa dia kumpala dia tshikasa ku dikalashi anyi ku muelelu wa tshilamba tshia ski), tibialis anterior tendon udi mua kutshibuka anu muaba udiye usabuka kumpala kua tshikasa: - Tangila kumpala kua tshikasa paudi ubandisha minu: Pa tshibidilu, paudi ukoka dikasa diebe ne minu yebe kuulu mutangile ku diulu diebe bua kukandamena, muonji munene wa bunene bua crayon (the tibialis anterior tendon) udi upatuka bimpe pa tshitupa tshia kumpala tshia tshikasa tshiebe. - Mu Tibialis Anterior Tendon Rupture, muonji wa munda udi mujimine, mupingajibua kudi tshitupa tshia bunene bua walnut ("pseudotumor") tshia muonji mubuikila 3 too ne ku 5 centimètres ku mutu kua tshiadi, eku extensor hallucis longus (EHL) udi ubandisha mudimu mutantshi mule kuteta kua tshianana bua kukoka dikasa dijima mulu (kukoka dikasa/dibandisha dia dikasa dinene). Diumvua dia kikoba didi 100 pa lukama dia pa tshibidilu.

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

• Etats-Unis ne Canada: Ela 911 bua kupeta dikuluka dia makasa ne bimanyinu bikunze bia mukolo (cauda equina), bimanyinu bia stroke, anyi bimanyinu bia vascular/compartment syndrome. Londa American Academy of Orthopaedic Surgeons (AAOS) Mikenji ya mudimu wa luondapu bua dinyanguka dia muonji wa Achilles (dipangisha dia tshiamu tshia nzembu mu meba 48 ne dilongolola dia njiwu ya DVT).
• Royaume-Uni: Ela 999 (anyi 112) bua cauda equina, stroke, anyi limb ischémie. Bua dinyanguka dia muonji wa Achille, ndaku ku A&E anyi ku NHS Minor Injuries Unit / Virtual Fracture Clinic dituku dimue dimue bua tshikasa tshitekabu mu equinus boot/plaster cast ne bakonkonone bua kumanya ni udi ne thromboembolisme venous (VTE) bilondeshile NICE Guideline NG8BOST ne Orthodic Orthodic Mikenji ya tshisumbu tshia malu a kanyinganyinga) mikenji.
• Buobumue bua matunga a ku Mputu: Ela 112. Londa mikenji ya ESSKA (European Society of Sports Traumatology, Knee Surgery & Arthroscopy) pa bidi bitangila mputa ya Achilles ne ya tshitupa tshia dikasa.
• Australie ne Nouvelle-Zélande: Ela 000 mu Australie anyi 111 mu Nouvelle-Zélande. Londa mikenji ya Australian Orthopaedic Association (AOA) ne ANZCOR bua dipangisha dia mifuba ne dikonkonona dia mishipa.
• India ne Asia-Pacifique: Ela 112 mu Inde, 119 mu Japon ne mu Corée du Sud, anyi 995 mu Singapour. Mu bitupa mudi mputa ya squat-toilet miunzulula (mibuela mu tshilongo tshia mabue) misangu mivule ikosolola muonji wa Achille bu mputa miunzulula, ikala ulama mashi ne tshienzedi tshia sterile, ikala ne tshikasa tshikole, ne uya nayi diakamue bua kuondopa mu nzubu wa dipanda, dikuba dia disama dia tetanus, manga a antibiotique, ne dilongolola dia muonji wa kumpala.

Tangila nomba ya tshimpitshimpi bua nomba yonso ya dituma dia matunga makuabu.

Nkonko itubu bela misangu ya bungi¶

Mmunyi mudi muonji wanyi wa Achille mua kutshibuka tshishiki meme mua kuleja dikasa dianyi ne kunyungisha minu yanyi mu bulalu?¶

Mushipa wa Achilles (mifuba ya gastrocnemius ne soleus) udi ukupesha bukole bua 80 pa lukama bua kubandisha bujitu bua mubidi webe ku nsongo ya makasa ebe, kadi misunya mikese isatu idi munda mua tshiadi tshiebe (**flexor hallucis longus, flexor digitorum longus, ne tibialis posterior**) idi ipita panyima pa tshikasa tshiebe tshia munda tshitapuluke ne mufuba wa Achilles. Mifuba mikese isatu eyi idi anu ikuambuluisha bua kunyungisha minu yebe ne kuleja dikasa diebe mu lupepele paudi mulale panshi, ke bualu kayi baminganga batu beyemena **Thompson calf-squeeze test** ne dibandisha dia tshikasa tshia dikasa dimue pamutu pa kuleja dikasa diebe mu lupepele.

Ndi ne tshia kuenzabu dipanda bua muonji wa Achille udi munyanguke bikole anyi, anyi udi mua kuondopibua mu tshibombi?¶

Malongesha a matuku etu aa (bu mudi mateta a UKSTAR ne SMART) adi aleja ne: padibu bateka muonji wa Achilles mu tshitupa tshia pa buatshi tshia **equinus (minu idi mitangile kuinshi) anyi mu tshilamba tshia wedge mu mêba 24 too ne ku 72 a kumpala** a disama ne pashishe kulonda kudi dilongolola dia kumpala dia dilongolola dia mudimu wa bujitu, ** udi wenza mudimu wa muomumue tshipiminu tshikese tshia dipanda (2 too ne ku 4 pa lukama) bu dipanda** eku bepuka disama dia mputa ya dipanda ne mputa ya mu mijilu. Dipanda ditu ditamba kuenzeka anu bua bantu badi bafika panyima pa dîba (muaba udi tshitupa kampanda tshikale tshiunzuluke), bena manaya bapiluke badi batuluka ne bingoma, anyi bantu badi ne disama dia mufuba wa tshikasa.

Bua tshinyi munganga wa lupitadi lua lukasa uvua muele tshiamu tshianyi tshia ku tshiadi tshileja panshi bu muena manaya a ndundu pamutu pa kuikala tshitekete ku 90 degrés?¶

Padi muonji webe wa Achille utshibuka, mushipa webe wa tshiadi udi ukoka tshitupa tshia kuulu tshia muonji au mulu eku bukole budi bukoka dikasa diebe panshi. Muntu yeye muele tshianza tshiebe mu tshitupa tshia 90, nsongo ibidi ya muonji wa Achille idi mikoka mu bule bua santimetre 3 anyi 5 ne kayena mua kulengangana bua kuondopibua to. Kuleja dikasa panshi ku 20 to ne ku 30 degrés (**plantarflexion / equinus**) kudi kupingaja tshitupa tshia kuinshi tshia tshikasa bua kutua tshitupa tshia kuulu tshia dikasa bua mubidi wikale mua kubisangisha pamue ku bukole buakane.

Bua tshinyi dinua dia ciprofloxacin anyi levofloxacin bua disama dia mu tshiadi anyi dia mu mashi didi mua kuenza bua muonji wanyi wa Achille unyanguke ngondo ya bungi pashishe?¶

Biamu bia fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) bidi bibuela mu tshitupa tshia mishipa ne bienza bua **matrix metalloproteinase (MMP) enzymes** ikale wenza mudimu eku bipangisha dienza dia collagen wa fibroblaste, udi utekesha mu mushindu wa microscope mishipa ya collagen ya Achilles tendon. Bu mudi kolagene wa mu mishipa wenda unyunguluka bitekete bitekete, butekete ebu budi butungunuka munkatshi mua **ngondo 6 kunyima kua wewe mumane kumina tshiamu tshieba tshia ndekelu tshia antibiotique**; Shi udi umvua disama dia mu tshiadi anyi dia mu tshiadi paudi unua anyi panyima pa wewe mumane kujikija manga a fluoroquinolone, lekela kuenza manaya a mubidi diakamue ne yukila ne munganga webe.

Meme mujuke ne "dikasa difua" (dikuluka dia makasa) kunyima kua meme mumane kulala ne dikasa dianyi dibuikila anyi muvuale tshilamba tshikole tshia ku dikasa, netshipingane anyi?¶

Padi dikuluka dia makasa difumina ku dikuma dia pambelu dia **nerve peroneal** ku mufuba wa pambelu wa nshingu udi kuinshi kua dikasa (ku diambuluisha dia dikasa dia kusabuka, dikuma dikole, anyi dishindamena dia dikasa dia pambelu ku tshintu tshikole), nerf utu upeta lutatu lua tshitupa tshîpi lua tshitupa tshia myeline sheath (**neura praxia**) pamutu pa nerve severe. Shi udi umbusha tshinyangu diakamue, wepuka kusabuka mikolo yebe, ne wenze mudimu ne **Ankle-Foot Orthosis (AFO) brace** bua kuepuka dikuluka ne dikolesha dia Achilles, bantu batue ku 80 too ne ku 90 pa lukama badi ne disama dia peroneal palsies didi dikola bimpe mu **mbingu 2 too ne ku 12**.

Bua tshinyi dipanda dia muonji wa patellar ne wa quadriceps ditu misangu yonso dilomba dipanda eku binsonji bia Achille kabiyi bilomba?¶

Mu ditshibuka dia Achille, kuleja dikasa panshi munda mua tshilamba tshia ku makasa kudi kusaka nsongo ibidi ya mishipa idi mipanduluke pamue ne kuyikuba ku bukole budi bukokela bintu panshi. Mu **patellar tendon anyi quadriceps tendon tear** ku meso a dikasa, muscle wa quadriceps wa bukole udi mu tshiadi udi ukoka misangu yonso tshitupa tshia dikasa anyi tshitupa tshia tendon tshia kuulu kule ne muaba udi dipanda, ne dikoka dionso dikese dia dikasa didi dibakoka kule menemene; kakuyi dipanda dia lukasa mu mifuba mu matuku makese kunyima kua disama, tshitupa etshi tshidi tshiuwula ne mputa mitekete ne muntu udi ujimija bukole bua kululamija dikasa diende bua kashidi.

Malu adi apetangana¶

• Mifuba mityumuke, mifuba mityumuke, ne mifuba mityumuke
• Dikasa dinyanguke, tshitupa tshia dikasa, ne dipanga dia tshitupa tshia mubidi
• Disama dia Cauda equina ne dikuma dia muonji wa mukolo bidi bimueneka
• Disama dia mutshima ne disama dia tshitupa tshia mubidi

Miaba ne buludiki bua mbulamatadi¶

• Tshilongelu tshia bena Amerika tshia baminganga ba mifuba (AAOS, États-Unis): Mukenji wa mudimu wa luondapu udi utangila dimanya ne diondapa dia dinyanguka dia muonji wa Achilles (Thompson test, Matles test, early functional equinus rehabilitation vs. surgical repair, and VTE assessment).
• National Institute for Health and Care Excellence (NICE, United Kingdom) and British Orthopaedic Association (BOAST): Venous Thromboembolism in Over 16s: Reduction the Risk of Hospital-acquired Deep Vein Thrombosis or Pulmonary Embolism in Lower Limb Immobilisation (NGUK889) Trual Bracing and Furyal Bracing Mikenji.
• European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA): Mêyi a buobumue pa bidi bitangila dilama dia ditapa dia tshiadi tshia Achilles ne dia tshiamu tshia dikola dia tshiadi (Quadriceps ne Patellar Tendon).
• Tshibambalu tshia biakudia ne manga tshia mu États-Unis (FDA) ne tshibambalu tshia manga tshia ku Mputu (EMA): Malu adi atangila bukubi bua manga ne madimuija adi mu kazubu adi atangila disama dia tshiadi didi difumina ku fluoroquinolone ne ditshibuka dia tshiadi.
• Tshisumbu tshia bena Amerike tshia malu a mitu ne a diagnostic a nzembu (AANEM): Tshimanyinu tshia mudimu wa dikonkonona dia nzembu ya dikuluka dia makasa (Common Peroneal Neuropathy vs. L5 Radiculopathy).