I-Achilles Tendon Rupture, i-Patellar Tendon Tear, kunye ne-Acute Foot Drop Triage¶

Ngokukhawuleza, ukukhwaza okukhulu okanye ukukhupha isandi ngasemva komlenze ongezantsi okanye phambi kwedolo ngexesha le-sprint, ukugxuma, okanye ukukhubeka luphawu oluqhelekileyo lwe-**Achilles tendon rupture ** okanye ** i-extensor mechanism (patellar okanye i-quadriceps tendon) ukukrazula . Ngokufanayo, ukungakwazi ngokukhawuleza ukuphakamisa phambi konyawo kunye neenzwane phantsi komhlaba ( i-acute foot drop , ebangela ukuba iinzwane zidonse okanye zibethe phantsi xa zihamba) yindlela yokuxilonga ephuthumayo enokuthi ivele kwi- acute lumbar disc herniation okanye i-cauda equina compression , ** i-anterior tibi compartment, ** i-commonpial nerve syndrome * i-anterior tibial compartment ** i-syndrome. ukugqabhuka kwethenda yangaphambili **, okanye i-brain brain stroke. Ukuba wena okanye umntu okufutshane nawe ufumana unyawo oluqatha olukhatshwa ziintlungu zomqolo, ukuba ndindisholo kwi-groin, okanye unyawo olubandayo olungaphefumliyo, fowunela inombolo yakho kaxakeka ngokukhawuleza. amanani kaxakeka. Phonononga iimeko ezingxamisekileyo ezinxulumene ne-musculoskeletal kunye neurovascular in amathambo aphukileyo kunye ne-sprains, i-cauda equina syndrome kunye noxinzelelo lwentambo yomgogodla, kwaye ukutyumza ukulimala kunye ne-compartment syndrome.

Yenza oku ngoku¶

1. Susa BONKE ubunzima kumlenze owenzakeleyo ngoko nangoko kwaye ungazami "ukuwususa." Ukuqhubeka nokuthwala ubunzima kwithenda ye-Achilles egqabhuke ngokupheleleyo, i-patellar tendon, okanye i-quadriceps tendon itsala umthambo okrazukileyo uphela ngeesentimitha ukucanana, kukrazule unikezelo lwegazi olucekethekileyo lwe-paratenon sheath, kwaye inokuguqula umthambo we-achilles osebenza nzima, kwaye unokuguqula umthambo we-achilles osebenzayo. ukwakhiwa ngokutsha.
2. Isikrini ngoko nangoko malunga "neZinga eziNtathu- kunye neNgxaki eyoyikisayo yokuLahla unyawo lukaNgxamiseko" (Fowunela u-911 / 112 / 999 ngoku ukuba kukho nabani na):
3. Cauda Equina okanye iAcute L4/L5 Radiculopathy Red Flags: Ukuwa kweenyawo okukhatshwa ziintlungu eziqatha ezisezantsi, ukudubula i-sciatica phantsi komlenze omnye okanye yomibini, ukuba ndindisholo kwiimpundu okanye kwigroin ("isaddle anesthesia"), okanye ingxaki yokuqalisa ukuchama okanye ukubamba izibilini (bona i-cauda equina syndrome).
4. Acute Anterior Compartment Syndrome okanye Popliteal Artery Occlusion (Knee Dislocation): Ukuwa konyawo kukhatshwa kukudumba okuqatha, okungayekeleliyo, ukudumba okuqinileyo kwelitye kunye neentlungu ezinzulu phambi kwe-shin eziye zibe mandundu xa iinzwane zolulelwe ezantsi, okanye unyawo oluphatshileyo, olubandayo kunye nepulse engekhoyo phezu kwedolo* Ilungu le-ischemic elibukhali).
5. I-Acute Central Brain Stroke (ACA / Motor Cortex): Ukuwa konyawo olungenazintlungu ngesiquphe okukhatshwa bubuthathaka kwicala elinye lethanga, inyonga, ingalo, okanye ubuso, intetho engacacanga, okanye ukubhideka.
6. Ukuma kunye nokuqhawula i-ankle eyonzakeleyo okanye idolo kwi-tendon-relaxing posture ngelixa ulungiselela ukuthutha:
7. Ngee-Achilles ezirhanelwayo zokuQhutywa kweTendon (Umva Wethole/Iqakala): Khubaza unyawo lukhombe kancinane ** PHANTSI (kwi-20 ukuya kwi-30 degrees of plantarflexion / "tiptoe" position)** usebenzisa i-padded splint okanye i-pillows. UNGAZE unyanzele i-Achilles egqabhukileyo iqatha ukuya kwi-engile eyi-90-degree ecaba, kuba ukutsalela unyawo phezulu kwahlula i-Achilles ekrazukileyo iphela nge-3 ukuya kwi-5 yeesentimitha.
8. NgePatellar eNcinciweyo okanye i-Quadriceps Tendon Ukukrazuka (Ngaphambi Kwedolo): Khubaza idolo ngokupheleleyo OKUNGQO (0 idigri zolwandiso olupheleleyo) kwibhodi ende, umqamelo, okanye isithinteli samadolo. Ungaze ugobe idolo, njengoko ukugoba kutsala i-kneecap kunye ne-tendon ekrazukileyo iphela ngaphandle.
9. Yenza uVavanyo lwe-Thompson Calf-Squeeze oluthambileyo ukuba kukrokrelwa ukugqabhuka kwe-Achilles. Cela umntu owenzakeleyo alale ejonge phantsi ebhedini okanye esofeni iinyawo zombini zijinga zikhululekile emphethweni (okanye uguqe esitulweni iinyawo zijinga). Cinezela ngobunono isisu esisembindini esinenyama sesihlunu sethole kumlenze olungileyo kuqala (unyawo luya kuzikhomba ezantsi ngokuzenzekelayo), emva koko ucudise ithole lomlenze owenzakeleyo. Ukuba unyawo aluyi ** aluyi kuhamba phantsi xa ithole licinezelwe (**Positive Thompson Test **), i-tendon ye-Achilles igqabhuke ngokupheleleyo.
10. Khulula okanye ucande nayiphi na i-fiberglass cast cast, i-ski boot eqinile, okanye intsimbi yokubeka idolo ngokukhawuleza ukuba ngaba ndindisholo okanye ukuhla konyawo kuvela. I-common peroneal (fibular) nerve* isonga ngokuthe ngqo phezu kweqhuma lamathambo kwicala elingaphandle lomlenze kanye ngaphantsi kwedolo (intamo ye-fibular); umphetho oqinileyo, umtya wokubopha idolo, okanye ukunqumla umlenze ixesha elide kucinezela le mithambo-luvo ngokuchasene nethambo, ibangele i-neurapraxia ebuyiselekayo ehlala isigxina ukuba uxinzelelo alukhululekanga kwiiyure nje ezimbalwa.
11. Phakamisa umlenze, sebenzisa ipakethi yomkhenkce esongelwe ngelaphu kwi-15 ukuya kwimizuzu engama-20 ngexesha (ungaze ube ngaphezu kwentloko ye-fibular yangaphandle yethambo ngaphantsi kwedolo), kwaye ulungiselele iSebe lezoNgxamiseko losuku olunye okanye uvavanyo olungxamisekileyo lwamathambo. Iiprothokholi ze-Achilles zanamhlanje ezingasebenzisiyo kunye notyando zifuna ukubeka unyawo kwisixhobo se-Achilles okanye i-2 flex 2 iiyure. yepop ngoko ke iibhulorho hematoma fresh umthambo uphela ngokudibana ngqo.

Umthi wesigqibo: Uvavanyo olwahlukileyo lwenkonyana pop, ukukrazula kwamadolo, kunye nokuwa kweenyawo¶

flowchart TD
    Start["I-Acute Lower Extremity Mechanical Pop OKANYE Ukungakwazi ukuPhakamisa/Ukukhomba unyawo ngesiquphe"] --> DirectionCheck{"Yeyiphi iNtshukumo Elahlekileyo okanye Ebuhlungu?"}

    DirectionCheck -->|"AWUKWAZI UKUKHOMBA UNYAWO PHANTSI / Tyhala Ngaphandle Komhlaba (Evakalayo 'Ipophu' Ngasemva Kwethole/Iqakala)"| AchillesBranch["UMQEQESHO WE-ACHILLES TENDON RUPTURE: 1. Yenza uvavanyo lwe-Thompson Calf-Squeeze Test (Unyawo luhluleka kwi-plantarflex = Positive). 2. Ziva umsantsa obonakalayo 2-6 cm ngaphezu kwethambo lesithende. 3. I-ankle edibeneyo ekhombe PHANTSI (20-30 deg equinus); ZERO ukuthwala ubunzima; Ukhathalelo olungxamisekileyo / lwe-Orthopedic ngaphakathi kwe-24-48h."]

    DirectionCheck -->|"AWUKWAZI UKUQEQA AMADOLO ngokuchasene noMxhuzulane (Pop phambi kwedolo emva kokutsiba/Ukukhubeka)"| KneeExtensorBranch{"Siphi isiphene esiPableable & Yeyiphi indlela eyaShift iKneecap (Patella)?"}

    KneeExtensorBranch -->|"Isikhewu NGEZANSI kweQela"| PatellarTear["I-PATELLAR TENDON RUPTURE: 1. Immobilize idolo 100% TRAIGHT (0 deg extension). 2. Utyando olungxamisekileyo lwe-Orthopedic olufunekayo ngaphakathi kweentsuku ukuphinda unamathisele i-tendon kwi-tubercle ye-tibial."]

    KneeExtensorBranch -->|"Umsantsa PHEZULU kweQela"| QuadTear["I-QUADRICEPS TENDON UPTURE: 1. Immobilize idolo 100% STRAIGHT (0 deg extension). 2. Ulungiso olungxamisekileyo lwe-Orthopedic Utyando olufunekayo ngokukhawuleza ukuthintela i-extensor lag esisigxina."]

    DirectionCheck -->|"AWUKWAZI UKUPHAKAMISA UNYAWULO / INZWENWE PHEZULU iSingise kwiShin (Ukuwisa unyawo oluqatha / ukuHamba kwePhepha leNyathelo)"| FootDropRedFlags{"Jonga i-Neurosurgical & Emergency yeVascular Okokuqala: Intlungu yomqolo/yomlenze, ukuba ndindisholo kwesali, ingxaki yomchamo, OKANYE i-rock-hard shin / pulseless foot?"}

    FootDropRedFlags -->|"EWE: Intlungu Engasemva, i-Sciatica, okanye i-Bladder / Saddle Signs"| SpineEmergency["I-ACUTE L5 RADICULOPATHY OKANYE I-CAUDA EQUINA SYNDROME: Shayela i-911 / 112 / 999 ye-Stat Lumbar Spine MRI & Emergency Neurosurgical Decompression."]

    FootDropRedFlags -->|"EWE: Iintlungu eziMandundu zeShin kwiPassive Toe Flexion OKANYE iCold Pulseless Foot"| VascularCompartment["I-ANTERIOR COMPARTMENT SYNDROME OKANYE I-POPLITEAL ARTERY OCCLUSION: Fowunela i-911 / 112 / 999 ye-Emergency Fasciotomy / i-Vascular Surgery."]

    FootDropRedFlags -->|"AWUKHO uMnqonqo okanye iiFlegi eziBomvu zeVascular: UVavanyo lwe-Ankle Inversion (Ukuguqula iSole ngaphakathi)"| InversionTest{"Ngaba isigulane siyakwazi ukuguqula iNqanawa leNgxaki NGAPHAKATHI (i-Ankle Inversion = Tibialis Posterior, L5)?"}

    InversionTest -->|"I-Ankle Inversion yi-STRONG (I-Intact), i-Eversion ibuthathaka, i-numbness phezu kweenyawo / i-Webspace ye-1st"| PeronealOrTendon["I-COMMON PERONEAL NERVE PALSY (kwi-Fibular Neck) OKANYE I-TIBIALIS ANTERIOR TENDON RUPTURE: Susa i-tight cast / straps emadolweni; khangela intambo ephathekayo phambi kweqatha; ungxamiseko Neurology/Orthopedic consult."]

    InversionTest -->|"ZOBINI I-Ankle Inversion KUNYE ne-Eversion ibuthathaka + i-Hip Abduction ibuthathaka"| L5RootOrSciatic["I-L5 I-NERVE ROOT LESION, SCIATIC NERVE PALSY, OKANYE I-STROKE EPHAKATHI: Isebe eliNgxamisekileyo eliNgxamisekileyo I-Neurological & MRI Workup."]

Umqathango 1: Ukuqhekeka kwe-Achilles Tendon¶

"Ukukhatywa okanye ukudutyulwa ngasemva kwe-Ankle".¶

** I-tendon ye-Achilles (i-tendon ye-calcaneal) ** iyona nto inkulu kwaye inamandla kunawo wonke emzimbeni womntu, eyenziwa ngokudibanisa kwe-gastrocnemius ** kunye ne- soleus ** imisipha yethole kunye nokufaka emva kwethambo lesithende (* i-tuberosity ye-calcaneal **). Nangona ukunyamezela imithwalo ye-tensile ukuya kwi-8 ukuya ku-12 kumaxesha obunzima bomzimba ngexesha lokugijima, i-tendon ine-notorious ** indawo yamanzi yokunikezelwa kwegazi elibi elifumaneka kwi-2 ukuya kwi-6 centimeters (0.8 ukuya kwi-2.4 intshi) ngaphezu kokufakwa kwesithende **.

Xa imbaleki okanye "igorha langempela-veki" (elidla ngokuba neminyaka engama-30 ukuya kwengama-55 ngexesha lentenetya, ibhola yokukhetha ibhola yomnyazi, ibhola yomnyazi, ibhola ekhatywayo, i-badminton, okanye i-sprinting) ityhala ngamandla ngomphambili ngelixa idolo likhula, okanye amanyathelo ngokungalindelekanga emngxunyeni: 1. I-Sensation: Ngaphezulu kweepesenti ze-70 zezigulane zijika ngomsindo ukuze zibone ukuba ngubani ** owakhabe ngasemva kwe-ankle ** okanye ukubetha ngebhola ye-tennis okanye i-racket, kuba i-tendon ehluthayo ivakalelwa ngokufanayo kunye nokubetha ngokuthe ngqo ngasemva. 2. I-Audible Pop: Ukuqhekeka okufana nokudubula okanye i-snap evakalayo ihlala iviwa ngabantu abame kumgama oziimitha ezininzi. 3. Ukuphulukana nokuqhutywa ngesiquphe: Umntu akakwazi ukutyhala iinzwane zakhe okanye aphakamise isithende esinomlenze omnye kwicala elonzakeleyo, ehamba eqhwalela. Iintlungu zihlala ziphela kwintlungu ebuhlungu kwimizuzu eyi-15, ekhohlisa amaxhoba amaninzi ukuba alibazise unyango.

Amayeza kunye neNkqubo yeMingcipheko yeMingcipheko Eyenza buthathaka i-Achilles kunye ne-Quadriceps Tendons¶

Ngalo lonke ixesha ujonge ukuba isigulane esibonisa ukuphuka kwe-tendon ngokuzenzekelayo okanye okuphantsi kwamandla aphantsi kuye kwavezwa kumayeza okanye iimeko ezithobisa udidi lwe-collagen lwe-I: - I-Fluoroquinolone Antibiotics (i-Ciprofloxacin, i-Levofloxacin, i-Moxifloxacin, i-Ofloxacin): Thatha i- FDA kunye ne-EMA Boxed Warning nge-acute tendinitis kunye ne-tendon rupture (echaphazela i-tendon ye-Achilles kwi-90 yepesenti yeemeko, kunye ne-bilateral ukuya kwisinye kwisithathu). I-Fluoroquinolones iphakamisa i-metalloproteinase ye-matrix (i-collagenase) eyenza i-tendon fibrils. Latency: Ukwaphuka kungenzeka kwisithuba seeyure ezingama-48 zepilisi yokuqala yesithinteli-ntsholongwane OKANYE ukuya kwiinyanga ezi-6 emva kokugqiba ikhosi yesibulala-zintsholongwane, ingozi iphindaphindeke ngokumangalisayo kwizigulane ezineminyaka engaphezu kwama-60 okanye ezo zithatha ngaxeshanye i-corticosteroids. - Izitofu zeCorticosteroid zeSistim okanye zeNgingqi: Iinaliti ze-steroid ezithe ngqo ngaphakathi okanye ezijikeleze i-Achilles, patellar, okanye i-quadriceps tendon zenza buthathaka i-collagen edibanisa ukuwela kunye nokugqabhuka. - IiStatins, Izifo Ezingapheliyo Zezintso (iDialysis / Hyperparathyroidism), IGout, Isifo seswekile, kunye neRheumatoid Arthritis / Lupus.

Iimvavanyo ze-4 ze-Bedside Diagnostic ye-Achilles Tendon Rupture¶

KwiSebe leeNgxamiseko, ukuxilongwa kweklinikhi usebenzisa i- American Academy of Orthopedic Surgeons (AAOS) Quartet of Tests ngokwenene ** i-e-efeatures kune-MRI : 1. ** Uvavanyo lwe-Thompson (uVavanyo lwe-Simmonds-Thompson Calf-Squeeze, i-96% ye-Sensitivity): ** Ngesigulane elele ngokucokisekileyo (ubuso-ezantsi) kwitafile yeemviwo kwaye zombini iinyawo zijinga ngokukhululekile ekupheleni kwetafile, umhloli ucinezela isisu esinenyama esiphakathi kwethole. Ngokuqhelekileyo, ukukhama ithole kudonsa i-tendon ye-Achilles phezulu kwaye yenza unyawo lwe-plantarflex (ukhomba phantsi). Kwi-Achilles rupture epheleleyo, ** unyawo luhlala luhleli ngokupheleleyo ** xa kuthelekiswa necala eliphilileyo. 2. Uvavanyo lweMatles (I-Knee Flexion Resting Angle Test, 88% Sensitivity): Xa isigulane silele sijonge phantsi ebhedini, bacele ukuba bagobe omabini amadolo kwi--90-degree angle ukuze imilenze yabo ijonge ngqo phezulu ukuya kwisilingi, ngelixa igcina amaqatha abo ekhululekile ngokupheleleyo. - Umlenze oQhelekileyo: Uxinzelelo lwendalo lokuphumla lomthambo we-Achilles ongaguqukiyo ubambe unyawo olujongise kancinane ngasesilingini (nge-\(20\text{ ukuya }30\text{ degrees}\) yeplantarflexion). - Umlenze we-Achilles owaphukileyo: Ngenxa yokuba ubunzima butsala unyawo olungaxhaswanga phantsi ngaphandle kwe-Achilles tether, unyawo kwicala eliqhekekileyo ** iwela phantsi kwi-flat (engathathi hlangothi \(0\text{ degrees}\)) okanye indawo e-dorsiflexed* (Positive Matles Sign). 3. I-Palpation ye-Tendon Gap (Isiphene): Ukuqhuba iminwe emibini ngobunono ecaleni kwentambo ye-Achilles 2 ukuya kwi-6 yeesentimitha ngaphezu kwethambo lesithende kubonisa **i-divot ecacileyo engenanto okanye i-gap ** apho ithenda yahlutha (ivakale kakuhle kwiiyure zokuqala ze-24 ngaphambi kokuba ukuvuvukala kwe-hematoma kuzalise isithuba). 4. Ithoni ye-Ankle yokuPhumla ye-Plantarflexion kunye nokungakwazi ukwenza isithende esinomlenze omnye.

Kutheni i-Equinus ekhawulezayo (iPlantarflexion) Ukuqhekeka kwiiyure zokuqala ze-48 zitshintsha yonke into¶

Iimvavanyo zekliniki ezingahleliwe (ezifana ne-SMART kunye nolingo lwe-UKSTAR) ziye zaguqula ukhathalelo lwe-Achilles rupture: ukuvuselelwa okusebenzayo okungasebenziyo kwi-specialized wedge boot kufezekisa amaxabiso aphantsi okukrazuka kwakhona (2 ukuya kwi-4 ekhulwini) njengotyando oluvulekileyo, NGOKUBA unyawo alushukumi kwi-equinus epheleleyo, i-$ 20} idigri ye-plantarflex {0} iinzwane-phantsi) ngokukhawuleza kwiiyure zokuqala ezingama-24 ukuya kwezingama-72. - Xa unyawo lubhekiselele ezantsi kwi-equinus ngokukhawuleza emva kokulimala, iziphelo ezibini ezikrazukileyo ze-tendon ye-Achilles zithintana ngaphakathi kwi-sleeve ye-paratenon engaguqukiyo, evumela ukuba i-clot yegazi elitsha (ezizityebi kwiiplatelet kunye ne-fibroblasts) ukuba idibanise i-tendon kunye nobude bayo obuqhelekileyo bokuphumla. - Ukuba isigulane sihamba ngesicathulo esisicaba okanye sifakwe kwi-flat 90-degree ehamba nge-boot kwiveki ngaphambi kokubona ingcali, i-Achilles iphilisa ** i-longlonged (yolulwe nge-2 ukuya kwi-3 centimeters) **, ishiya umntu onobuthakathaka obungapheliyo kunye nesigxina sobomi esifuna utyando olunzima lokudlulisa i-tendon. - Isilumkiso soMngcipheko ophezulu we-DVT: Ngenxa yokuba ukunyanzeliswa komlenze ophantsi kwi-equinus cast okanye i-boot emva kokuphuka kwe-Achilles kumisa impompo yemisipha yethole, I-Achilles tendon rupture ithwala enye yezona mazinga aphezulu i-deep vein thrombosis (DVT) kunye ne-pulmonary embolism kwi-orthopedics (ukuya kwi-5 ukuya kwi-30 ekhulwini kwi-ultrasound); Iiklinikhi zihlala zivavanya i-pharmacologic DVT prophylaxis (efana ne-heparin ephantsi-molekyuli okanye i-anticoagulants yomlomo ngqo) ngexesha lokunganyakazi.

Umqathango 2: I-Patellar Tendon Tear kunye ne-Quadriceps Tendon Rapture (I-Knee Extensor Mechanism)¶

I ** i-extensor mechanism yamadolo ** yintambo eqhubekayo equkethe ** i-quadriceps muscle -> i-quadriceps tendon -> i-patella (i-kneecap) -> i-tendon ye-patellar (i-ligament) -> i-tubercle ye-tibial ** phezulu kwe-shinbone. Ukuba kukho naliphi na ikhonkco kweli khonkco liqhawuka ngokupheleleyo, umntu akakwazi ukuwolula idolo lakhe ngokuchasene nomxhuzulane kwaye amadolo abo abophe ngoko nangoko nanini na xa bezama ukuma kuwo.

Ukwahlula i-Quadriceps Tendon vs. I-Patellar Tendon Rupture¶

*(I-Clinical Pitfall: Kanye njengokuba izihlunu ze-accessory zinokukhohlisa oogqirha kwi-Achilles rupture, i-medial edibeneyo kunye ne-lateral *patellar retinaculum ** emacaleni amadolo inokuvumela isigulane esine-tendon ephakathi ukukrazula ukuba sibambe umlenze wabo ngokuthe tye kanye xa ugqirha ewuphakamisela kubo, nangona bane-20-degree-to * extens xa bezama ukuphakamisa i-20-to * 30-to-exten 30. Vavanya ulwandiso lwedolo olusebenzayo ukusuka kwi-45-degree egobileyo ngokuchasene nomxhuzulane).

Umqathango 3: I-Acute Foot Drop Triage (Umqolo vs. Nerve vs. Compartment vs. Tendon)¶

Ukwehla kweenyawo kukungakwazi ukuphakamisa umphambili wonyawo kunye neenzwane phezulu ukuya kwi-shin (ukulahleka kwe-ankle dorsiflexion ). Ngenxa yokuba iinzwane zijinga phantsi ngexesha lokujinga lokuhamba, isigulana kufuneka sirhuqe iinzwane zaso emhlabeni okanye siphakamise idolo laso phezulu ngendlela engaqhelekanga njengezitepsi zokunyuka ("steppage gait") kwaye sibethe unyawo lwaso ngokuvakalayo kwisinyathelo ngasinye.

Ukuhla kweenyawo okuqatha yiphazili yoxilongo oluphezulu kuba iimeko ezingxamisekileyo ezintlanu ezahluke ngokupheleleyo kwingqondo yonke, umqolo, imithambo yomlenze, imithambo-luvo yeperipheral, kunye ne-ankle tendons zinokubangela oko. Sebenzisa le theyibhile yothelekiso lweklinikhi kunye novavanyo lomzimba osecaleni kwebhedi ukuze uchaze eyona sizathu:

Ukuthelekiswa kweklinikhi enkulu yezizathu ezi-5 zokuhla kweenyawo ezibukhali¶

Isitshixo se-10-Sesibini esisecaleni kwebhedi: Ukuvavanya ukuguquguquka kwe-Ankle ukwahlula umqolo kwiNerve yedolo¶

Xa isigulane sifika nge-acute foot drop, ngaba oogqirha bexakeka ngokukhawuleza baxela njani ukuba ingxaki yimeko engxamisekileyo ye-neurosurgical kwi-*-back back (L5 nerve root) ** ngokubhekiselele kwi-pinign peripheral nerve pinch kwi ** idolo langaphandle (i-nerve peroneal nerve)? - Bavavanya i-ANKLE INVERSION (bacela isigulana ukuba sijike intsika yonyawo olwanzakeleyo NGAPHAKATHI ukuya kolunye unyawo ngokuchasene nesandla somhloli) kunye ne-HIP ABDUCTION (ukutyhala ithanga ngaphandle): 1. Bobabini ** i-Tibialis Anterior ** (ephakamisa unyawo phezulu) kunye ** i-Tibialis Posterior ** (ejika i-sole yenyawo ngaphakathi) ifumana imicu yabo ye-nerve kwi- ** L5 ingcambu ye-nerve ye-spinal ** kwi-back back. 2. Nangona kunjalo, phezulu ethangeni, loo micu ye-L5 ye-nerve yahlula kwiindlela ezimbini ezihlukeneyo: iifayili eziphakamisa unyawo zihamba zihamba phantsi ** I-Common Peroneal Nerve ** (ijikeleze intamo ye-fibular yangaphandlemadolweni), ngelixaintambo ezijika unyawo lwangaphakathi ( inversion **) zihamba phantsi kwekhuselwe ** I-Tibial Nerve emva kwe-calf. 3. Umthetho weKlinikhi: - Ukuba isigulane sinayo ** I-Foot Drop + WEAK I-Ankle Inversion (ayikwazi ukujika yedwa ngaphakathi) + I-WEAK Hip Abduction *, isilonda si-HIGH UP kwi-L5 Nerve Root kwi-Lumbar Spine (okanye i-Sciatic Nerve) ** -> Idinga i-MRI ye-lumbar spine ephuthumayo. - Ukuba isigulane sinayo ** I-Foot Drop + STRONG I-Ankle Inversion (ijika yodwa ngaphakathi ngamandla) + I-Eversion ye-Ankle ebuthakathaka , i-lesion yi- PHANTSI kwi-Common Peroneal Nerve kwi-Neck ye-Fibular ** -> Khangela ngokukhawuleza i-tight cast, i-knee brace, i-fracture ye-fibular head fracture, i-cyst Baker's crossing, okanye i-cyst ye-leg yesiqhelo.

Indlela yokuqaphela i-Tibialis Anterior Tendon Rupture (I-Mechanical Foot Drop Mimic)¶

Kubantu abadala abaneminyaka eyi-50 ukuya kwi-75 (okanye emva kokusikwa okubukhali phambi kwe-ankle ukusuka kwiglasi okanye kwi-ski boot edge), i-**tibialis anterior tendon ** inokugqabhuka kanye apho iwela khona umphambili we-ankle joint: - Jonga ngaphambili kwe-Ankle Ngelixa uphakamisa iinzwane: Ngokuqhelekileyo, xa utsala unyawo lwakho kunye neenzwane phezulu ukuya empumlweni yakho ngokuchasene nokuchasana, intambo ye-tendon engqindilili, elingana nepensile (**i-tibialis anterior tendon **) iphuma ngokucacileyo kwi-crease yangaphakathi-ngaphambili ye-ankle yakho. - Kwi- **Tibialis Anterior Tendon Rupture **, loo ntambo yangaphakathi evelele ** ilahlekile **, ithathelwe indawo yintlama enobungakanani be-walnut ("pseudotumor") ye-tendon ebuyisiweyo 3 ukuya kwi-5 yeesentimitha ukuphakama phezulu kwi-shin, ngelixa i-*extensor hallucis longus (EHLw) isebenza kwi-tendon enkulu ezama i-tendon (EHLw) ukutsala unyawo lonke phezulu (clawing/hyperextension of the big toe). Ukuvakalelwa kwesikhumba yi-100 ekhulwini eqhelekileyo.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

• I-United States neKhanada: Dial 911 ngenxa yokuhla kweenyawo ezibukhali kunye neeflegi ezibomvu zomgogodla (i-cauda equina), iimpawu ze-stroke, okanye iimpawu ze-vascular / compartment syndrome. Landela i-American Academy of Orthopedic Surgeons (AAOS) Izikhokelo zokuSebenza kweKlinikhi ye-Acute Achilles Tendon Rupture (i-equinus immobilization yangethuba kwiiyure ezingama-48 kunye ne-DVT yomngcipheko).
• United Kingdom: Cofa 999 (okanye 112) ye-cauda equina, i-stroke, okanye i-ischemia yelungu. Ukuphulwa kwe-tendon ye-Achilles eyodwa, ukuya kwi-A & E okanye kwi-NHS Minor Injuries Unit / Virtual Fracture Clinic* ngosuku olufanayo ukuze i-ankle ifakwe kwi-equinus boot/plaster cast kwaye ivavanywe kwi-venous thromboembolism (VTE) prophylaxis phantsi kwe-* NICE Guideline NG89 ye-British Orthodic Standards (iBritish Orthodic Standards) kunye ne-Trothodic Standards ye-Trauma
• I-European Union: Cofa 112. Landela ** i-ESSKA (i-European Society of Sports Traumatology, uTyando lwamadolo kunye ne-Arthroscopy)** izikhokelo zokuvumelana kwii-Achilles ezibukhali kunye nokulimala kwe-knee extensor mechanism.
• Ostreliya neNew Zealand: Cofa 000 e-Australia okanye 111 eNew Zealand. Landela iAustralian Orthopedic Association (AOA) kunye ANZCOR izikhokelo zokunyanzeliswa kwe-musculoskeletal immobilization kunye ne-neurovascular checks.
• ** I-Indiya kunye ne-Asia-Pacific: ** Ukudayela ** 112 ** e-Indiya, ** 119 ** eJapan naseMzantsi Korea, okanye ** 995 ** eSingapore. Kwiindawo apho i-squat-toilet lacerations evulekileyo (i-slipping kwi-pan ye-ceramic) ihlala inqumla i-tendon ye-Achilles njenge-** i-laceration evulekileyo **, ukulawula ukopha ngoxinzelelo oluyintsholongwane oluthe ngqo, gcina i-ankle plantarflexed, kunye nokuthutha ngokukhawuleza ukuchithwa kwegumbi lokusebenza, i-tetanus prophylaxis, i-IV antibiotics, kunye nokulungiswa kwe-tendon yokuqala.

'Yabona amanani kaxakeka kuzo zonke iinombolo zokuthumela kumazwe ngamazwe.

Imibuzo ebuzwa qho¶

Inokuthini i-Achilles tendon yam igqabhuke ngokupheleleyo ukuba ndisakwazi ukukhomba unyawo lwam kwaye ndishukumise iinzwane zam ebhedini?¶

I-tendon ye-Achilles (i-gastrocnemius kunye ne-soleus muscles) inikezela malunga neepesenti ze-80 zamandla akho ukutyhala ubunzima bomzimba wakho kwi-tiptoes yakho, kodwa izihlunu ezintathu ezincinci zesibini ezinzulu kwithole lakho (** flexor hallucis longus, flexor digitorum longus, kunye ne-tibialis posterior **) udlula emva kwethambo lakho langaphakathi le-ankle ngokwahlukileyo. Ezo zihlunu ezithathu ezincinci zisakuvumela ukuba ushukumise iinzwane zakho kwaye ujonge ngobuthathaka unyawo lwakho emoyeni ngelixa ulele phantsi, yingakho oogqirha bathembele kuvavanyo lwe-**Thompson ithole lokucudisa ithole ** kunye nesithende somlenze omnye uphakamise kunokuba unyawo olusebenzayo lubhekiselele emoyeni.

Ngaba kufuneka ndenze utyando kwi-tendon ye-Achilles eqhekekileyo, okanye ngaba inokuphilisa kwi-boot?¶

Izilingo zeklinikhi zanamhlanje (njenge-UKSTAR kunye nezilingo ze-SMART) zibonisa ukuba ukuba i-tendon ye-Achilles ephukile ifakwe kwi-specialized ** i-equinus (inzwane-ekhombe-phantsi) iphonswe okanye i-wedge boot ngaphakathi kwe-24 yokuqala kwiiyure ze-72 ** yokulimala kwaye ilandelwa yiprotocol yokuvuselela i-weight-bearing functional rehabilitation protocol, i-tendon iphinda iphilise isantya esifanayo kunye ne-4) ukuphepha ukosuleleka kwenxeba lotyando kunye nemithambo-luvo. Utyando lugcinelwe unikezelo olulibazisekileyo (apho umsantsa sele uvulekile), iimbaleki eziqhumayo eziqhumayo, okanye ukuhlazeka kwithambo lesithende.

Kutheni le nto ugqirha wokhathalelo olungxamisekileyo eqhawule iqatha lam elijonge ezantsi njenge-ballerina endaweni yeflethi kwi-90 degrees?¶

Xa i-tendon yakho ye-Achilles ihluma, isihlunu sakho sethole sitsala isiphelo esiphezulu se-tendon phezulu ngelixa umxhuzulane utsalela unyawo lwakho ezantsi. Ukuba umntu udibanisa i-ankle yakho kwi-angle ye-90-degree, iziphelo ezibini ezikrazukileyo ze-tendon ye-Achilles zitsalwa nge-3 ukuya kwi-5 centimeters ngaphandle kwaye azikwazi ukuchukumisa omnye nomnye ukuze ziphilise. Ukwalatha unyawo ezantsi kuma-20 ukuya kuma-30 degrees (**plantarflexion / equinus**) izisa isiphelo sesithende esisezantsi ngasekunene umva ukuya kuncamisa incam yethole elingasentla ukuze umzimba ukwazi ukudibaniselana ngokuxinezeleka okuqhelekileyo.

Kutheni ukuthatha i-ciprofloxacin okanye i-levofloxacin kwi-sinus okanye usulelo lokuchama kunokubangela umthambo wam we-Achilles ukuba uqubude kwiinyanga kamva?¶

I-Fluoroquinolone antibiotics (i-ciprofloxacin, i-levofloxacin, i-moxifloxacin) ingena kwizicubu ze-tendon kwaye isebenze **i-matrix metalloproteinase (MMP) i-enzymes ** ngelixa icinezela ukuveliswa kwe-fibroblast collagen, eyenza buthathaka kancinci i-collagen fibers ye-Achilles tendon. Ngenxa yokuba i-tendon collagen ijika ngokucothayo, obo buthathaka besakhiwo buqhubeka kangange-*ukuya kwiinyanga ezi-6 emva kokuba uginye ipilisi yakho yokugqibela ye-antibiotics **; ukuba uhlakulela nasiphi na isithende okanye ubuhlungu bethole ngelixa uthatha okanye emva kokugqiba i-fluoroquinolone, yeka ukusebenzisa ngokukhawuleza kwaye uqhagamshelane nodokotela wakho.

Ukuba ndivuka "nonyawo olufileyo" (ukuhla kwenyawo) emva kokulala ndinqumle umlenze wam okanye ndinxibe intambo yokubopha idolo, ingaba iya kubuya?¶

Xa unyawo lwehla lubangelwa ukunyanzeliswa kwangaphandle kwe-*-common peroneal nerve ** ngokubhekiselele kwithambo lentamo ye-fibular yangaphandle engaphantsi kwedolo (ukusuka emlenzeni wokuwela, ukuphosa okuqinileyo, okanye ukuxhoma idolo elingaphandle ngokubhekiselele kumda onzima), i-nerve idla ngokuba ne-conduction block yesikhashana ye-myelin sheath yayo (** neurapraxia **) kunokuba i-nerve inqunywe. Ngaphandle kokuba ususa uxinzelelo ngokukhawuleza, ugweme ukuwela imilenze yakho, kwaye usebenzise i-**Ankle-Foot Orthosis (AFO) brace ** ukuthintela ukukhubeka kunye nokuqina kwe-Achilles, ngaphezu kwe-80 ukuya kwi-90 yepesenti ye-compressive peroneal palsies iphinda ibuyele ngokupheleleyo kwi-*2 ukuya kwiiveki ze-12 **.

Kutheni le nto i-patellar tendon kunye ne-quadriceps tendon iinyembezi zisoloko zifuna utyando ngelixa i-Achilles iinyembezi zihlala zingenzi njalo?¶

Kwi-Achilles ukugqabhuka, ukukhomba unyawo ezantsi ngaphakathi kwebhuthi ngokungazenzisiyo kutyhala imisipha emibini ekrazukileyo iphele kunye kwaye iyikhusele kumxhuzulane. Ngokupheleleyo ** i-patellar tendon okanye i-quadriceps tendon tear ** ngaphambili kwedolo, isihlunu esinamandla se-quadriceps ethangeni sihlala sitsala i-kneecap okanye isiphunzi se-tendon engaphezulu kwiisentimitha ezininzi ukusuka kwindawo yokukrazula, kwaye zonke iidolo ezincinci zokugoba zibatsalela kude; ngaphandle kokuthunga utyando olungxamisekileyo ngamatonela ethambo phakathi kweentsuku zokwenzakala, umsantsa ugcwala izicubu ezibuthathaka kwaye umntu ulahlekelwa ngokusisigxina ukukwazi ukolula idolo.

Izikhokelo ezinxulumeneyo¶

• Amathambo aphukileyo, amathambo kunye nama-sprains
• Igxalaba elichithiweyo, i-kneecap, kunye ne-joint immobilization
• I-Cauda equina syndrome kunye neeflegi ezibomvu zoxinzelelo lwe-spinal cord
• Ukulimala kweCrush kunye ne-compartment syndrome

Imithombo kunye nezikhokelo ezisemthethweni¶

• ** I-American Academy of Orthopedic Surgeons (AAOS, eUnited States): ** *Isikhokelo sokuSebenza kweKlinikhi kwi-Diagnostic kunye noNyango lwe-Acute Achilles Tendon Rupture * (uvavanyo lwe-Thompson, uvavanyo lwe-Matles, ukuvuselelwa kwe-equinus kwangaphambili kunye nokulungiswa kokuhlinzwa, kunye novavanyo lwe-VTE).
• ** Iziko leSizwe lezeMpilo kunye noNonophelo oluPhezulu (i-NICE, i-United Kingdom) kunye ne-British Orthopedic Association (BOAST): ** * I-Thromboembolism ye-Venous kwi-Over 16s: Ukunciphisa uMngcipheko weSibhedlele-efunyenwe kwi-Deep Vein Thrombosis okanye i-Pulmonary Embolism kwi-Lower Limb Immobilisation (NG89) * kunye ne-*UKSTARto Functional Functional * UKSTARTricing Functional
• ** I-European Society of Sports Traumatology, i-Knee Surgery & Arthroscopy (ESSKA): ** * Iingxelo zeMvumelwano malunga noLawulo lwee-Acute Achilles Tendon Ruptures kunye ne-Knee Extensor Mechanism (i-Quadriceps kunye ne-Patellar Tendon) yokulimala *.
• I-United States yoLawulo lokuTya kunye neDrugs (i-FDA) kunye ne-Arhente yeMithi yaseYurophu (EMA): *UNxibelelwano loKhuseleko lweziyobisi kunye nezilumkiso zeBhokisi malunga ne-Fluoroquinolone-Associated Tendinopathy kunye ne-Tendon Rupture *.
• ** Umbutho waseMelika we-Neuromuscular & Electrodiagnostic Medicine (AANEM): ** *Ziqhelise iParameter ye-Electrodiagnostic Evaluation ye-Acute Foot Drop (i-Common Peroneal Neuropathy vs. L5 Radiculopathy) *.