{"id":2014,"date":"2018-04-29T00:00:00","date_gmt":"2018-04-28T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/01\/29\/rehberler-kas-iskelet-sistemi-ultrasonu-teknik-kilavuzu-omuz\/"},"modified":"2022-04-08T16:25:41","modified_gmt":"2022-04-08T13:25:41","slug":"rehberler-kas-iskelet-sistemi-ultrasonu-teknik-kilavuzu-omuz","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2018\/04\/29\/rehberler-kas-iskelet-sistemi-ultrasonu-teknik-kilavuzu-omuz\/","title":{"rendered":"Kas \u0130skelet Sistemi Ultrasonu Teknik K\u0131lavuzu – Omuz"},"content":{"rendered":"\r\n\r\n\r\n

European Society of MusculoSkeletal Radiology<\/strong><\/h2>\r\n\r\n\r\n\r\n

Kas \u0130skelet Sistemi Ultrasonu Teknik K\u0131lavuz<\/strong><\/h3>\r\n\r\n\r\n\r\n

Omuz<\/strong><\/h3>\r\n\r\n\r\n\r\n

Hastan\u0131n pozisyonu bir\u00e7ok uygulay\u0131c\u0131 i\u00e7in farkl\u0131l\u0131k g\u00f6sterse de \u00f6nerimiz d\u00f6ner tabure \u00fczerinde oturarak de\u011ferlendirme yap\u0131lmas\u0131d\u0131r. Bu pozisyon ile tabure \u00e7evrilerek omuzun anterior, lateral ve posterior y\u00fczleri kolayca de\u011ferlendirilebilir.<\/p>\r\n\r\n\r\n\r\n

1. Biceps Tendonunun Uzun Ba\u015f\u0131<\/strong><\/p>\r\n\r\n\r\n\r\n

Kol hafif internal rotasyonda (kontralateral dize do\u011fru uzanacak \u015fekilde), dirsek 90 derece fleksiyonda ve supinasyonda olacak \u015fekilde pozisyon verilir. Maj\u00f6r ve min\u00f6r t\u00fcberositaslar aras\u0131nda uzun biceps tendonunu bulmakla ba\u015flay\u0131n, bicepsi de\u011ferlendirmek i\u00e7in k\u0131sa ve uzun aks planlar\u0131n\u0131 kullan\u0131n.<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG1\"<\/figure>\r\n\r\n\r\n\r\n

Probu yukar\u0131 do\u011fru kayd\u0131rd\u0131\u011f\u0131n\u0131zda bicepsin intraartikular b\u00f6l\u00fcm\u00fc, a\u015fa\u011f\u0131 do\u011fru kayd\u0131rd\u0131\u011f\u0131n\u0131zda miyotendinoz bile\u015fke g\u00f6r\u00fclmektedir. (Pectoralis maj\u00f6r tendonu seviyesi)<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG2\"<\/figure>\r\n\r\n\r\n\r\n

SubS<\/em><\/strong>: Subscapularis Tendonu;\u00a0SupraS<\/strong>: Suprascapularis Tendonu;\u00a0Ok<\/strong>: Biceps Tendonun Uzun Ba\u015f\u0131;\u00a0LT<\/strong>: Min\u00f6r T\u00fcberositas;\u00a0GT<\/strong>: Maj\u00f6r T\u00fcberositas;\u00a0SH<\/strong>: Bicepsin K\u0131sa Ba\u015f\u0131;\u00a0LH<\/strong>: Bicepsin Uzun Ba\u015f\u0131;\u00a0H<\/strong>: Humerus \u015eaft\u0131;\u00a0Okba\u015flar\u0131<\/strong>: Pectoralis Maj\u00f6r Tendonu<\/em><\/p>\r\n\r\n\r\n\r\n

2. Subscapularis Tendonu<\/strong><\/p>\r\n\r\n\r\n\r\n

Dirse\u011fi iliak \u00e7\u0131k\u0131nt\u0131ya sabitleyerek kolu eksternal rotasyona getirdi\u011fimizde subscapular tendon ve t\u00fcberositas min\u00f6rdeki insersiosu g\u00f6r\u00fcl\u00fcr. (hafif supinasyon gerimi n\u00f6tralize etmeye yarar)<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG3\"<\/figure>\r\n\r\n\r\n\r\n

Bu tendon kolun as\u0131lmas\u0131 ile pasif eksternal ve internal rotasyon s\u0131ras\u0131nda uzun (transvers plan) ve k\u0131sa (sagittal plan) akslarda de\u011ferlendirilmelidir. Prob a\u015fa\u011f\u0131 ve yukar\u0131 kayd\u0131r\u0131larak subscapular tendon g\u00f6r\u00fcnt\u00fclenir.\u00a0<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

Ok<\/em><\/strong>: Bicepsin Uzun Ba\u015f\u0131;\u00a0\u00c7izgili Hat<\/strong>: Subscapuler Tendonun \u0130nsersiosu;\u00a0Co<\/strong>: Coracoid:\u00a0Del<\/strong>: Deltoid Kas;\u00a0Beyaz Ok Ba\u015flar\u0131:<\/strong>\u00a0Tendonlar\u0131n Arasndaki Kas Doku;\u00a0Bo\u015f Ok Ba\u015flar\u0131<\/strong>: Subscapularisin Tendon Fasik\u00fclleri<\/em><\/p>\r\n\r\n\r\n\r\n

3. Anteromedial Yap\u0131lar ve Coracoacromial Ligaman<\/strong><\/p>\r\n\r\n\r\n\r\n

Probu transvers planda mediale do\u011fru ilerletince coracoid proses, coracoacromial ligaman, biti\u015fik tendon ve subacromial subdeltoid bursan\u0131n anterior y\u00fcz\u00fc g\u00f6r\u00fcl\u00fcr. Sonras\u0131nda subscapuler \u00e7\u0131k\u0131nt\u0131 ve subcoracoid bursa ef\u00fczyon i\u00e7in de\u011ferlendirilir. External ve internal rotasyon, anteromedial impingment\u2019\u0131 g\u00f6stermek i\u00e7in kullan\u0131labilir. (internal rotasyonda \u00f6l\u00e7\u00fclen coracoid process ile t\u00fcberosistas min\u00f6r aras\u0131 mesafe )<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

Acr:<\/em><\/strong>\u00a0acromio;\u00a0Oklar<\/strong>: bicepsin k\u0131sa ba\u015f\u0131;\u00a0Ok ba\u015flar\u0131<\/strong>: coracoacromial ligamant;\u00a0Co<\/strong>: coracoid;\u00a0<\/em>CoBr<\/em><\/strong>: coraco-brachialis;\u00a0HH<\/strong>: humerus ba\u015f\u0131;\u00a0SubS<\/strong>: subscapularis tendon;\u00a0SupraS<\/strong>: supraspinatus<\/em><\/p>\r\n\r\n\r\n\r\n

4. Supraspinatus Tendon: Pozisyon verme (1)<\/strong><\/p>\r\n\r\n\r\n\r\n

Hastan\u0131n kolunu posteriora do\u011fru al\u0131n, elin palmar y\u00fcz\u00fc iliak kanad\u0131n superioruna getirilerek dirsek posteriorda iken fleksiyona getirin. Suprapinatus tendonu uzun ve k\u0131sa aksta de\u011ferlendirilmelidir.<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n

Supraspinatus Tendon<\/strong><\/p>\r\n\r\n\r\n\r\n

Supraspinatus g\u00f6r\u00fcnt\u00fclemesinde \u00f6ncelikle prob oryantasyonu i\u00e7in bicepsin intraartik\u00fcler k\u0131sm\u0131 landmark olarak kullan\u0131lmal\u0131d\u0131r. Asl\u0131nda bu tendonlar birbirine paralel uzanmas\u0131 ve bicepsin intraartik\u00fcler k\u0131sm\u0131n\u0131n fibriller yap\u0131s\u0131 sayesinde kolay tan\u0131nabilir. Prob, ultrason g\u00f6r\u00fcnt\u00fcs\u00fcnde biceps m\u00fcmk\u00fcn olduk\u00e7a uzun g\u00f6r\u00fclene kadar \u00e7evirilir. Daha sonra oryantasyon de\u011fi\u015fmeden supraspinatusun \u00fczerinden yukar\u0131 ve posteriora kayd\u0131r\u0131l\u0131r. Elde edilen g\u00f6r\u00fcnt\u00fc supraspinatus ile ayn\u0131 akstad\u0131r. Supraspinatus ve deltoid kaslar\u0131 aras\u0131nda, normal subacromial ve subdeltoid bursa ince bir hipoekoik bant olarak g\u00f6r\u00fcl\u00fcr.<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

Acr<\/em><\/strong>: Acromion;\u00a0Asterisk<\/strong>: Myotendin\u00f6z Bile\u015fke;\u00a0Del<\/strong>: Deltoid;\u00a0GT<\/strong>: B\u00fcy\u00fck T\u00fcberositas;\u00a0Bo\u015f Ok Ba\u015f\u0131<\/strong>: Eklem Kartilaj\u0131;\u00a0E\u011fri Ok<\/strong>: Anizotropiye Ba\u011fl\u0131 Hipoekoik Artefakt;\u00a0SupraS<\/strong>: Supraspinatus Tendon;\u00a0Beyaz Ok Ba\u015f\u0131<\/strong>: Subacromial Subdeltoid Bursa<\/em><\/p>\r\n\r\n\r\n\r\n

Anizotropiden ka\u00e7\u0131nmak i\u00e7in tendon insersiosunun \u00fczerindeki alanda probun a\u00e7\u0131s\u0131n\u0131 hafif\u00e7e de\u011fi\u015ftirin. T\u00fcberositas maj\u00f6r\u00fcn lateral taraf\u0131nda bulunan subacromial subdeltotid bursan\u0131n lateral po\u015funu g\u00f6r\u00fcnt\u00fclemeyi unutmay\u0131n. K\u0131sa aksta supraspinatus de\u011ferlendirilirken normal cuff biceps tendon landmark\u0131n\u0131n 2 cm gerisi ile ayn\u0131 kal\u0131nl\u0131kta olmal\u0131. Bu alanda tendonun gerisinde g\u00f6r\u00fclen yap\u0131 ise infraspinatustur.<\/p>\r\n\r\n\r\n\r\n

5. Supraspinatus tendon: Pozisyon verme (2)<\/strong><\/p>\r\n\r\n\r\n\r\n

El dorsumunu ters taraftaki skapulan\u0131n alt taraf\u0131na do\u011fru yerle\u015ftirin (internal rotasyon ile stress manevras\u0131 yap\u0131l\u0131r). Dirsek ile g\u00f6\u011f\u00fcs duvar\u0131 laterali aras\u0131nda bo\u015fluk kalmamal\u0131d\u0131r. Bu pozisyonu kullanmakla supraspinatus daha \u00f6ne do\u011fru yer de\u011fi\u015ftirir ve prob ayn\u0131 d\u00fczlemi g\u00f6sterebilmek i\u00e7in neredeyse vertikal olarak yerle\u015ftirilmelidir. Bir \u00f6nceki pozisyona g\u00f6re tendon fiberleri daha gergin olacakt\u0131r. Mevcut bir y\u0131rt\u0131k boyutunun oldu\u011fundan fazla olarak de\u011ferlendirilmesine neden olabilir.Belirgin internal rotasyon yap\u0131ld\u0131\u011f\u0131 i\u00e7in bicepsin uzun ba\u015f\u0131 bu pozisyonda g\u00f6r\u00fcnt\u00fclenemeyebilir.<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

6. Subacromial impingement testi<\/strong><\/p>\r\n\r\n\r\n\r\n

Subacromial impingementin dinamik de\u011ferlendirmesi probun medial k\u0131sm\u0131n\u0131n koronal planda akromionun lateral kesimine getirilmesi ile yap\u0131labilir. Hasta kolunu abduksiyona getirip internal rotasyon yapar. Bu manevra ile suprapinatus ve bursa, coracoacromial ark\u0131n alt\u0131na do\u011fru yer de\u011fi\u015ftirmesi sayesinde g\u00f6r\u00fclebilir.<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

Acr<\/em><\/strong>:Acromion;\u00a0GT<\/strong>: Maj\u00f6r T\u00fcberositas,\u00a0Oklar<\/strong>: Supraspinatus Tendonu<\/em><\/p>\r\n\r\n\r\n\r\n

7. \u0130nfraspinatus ve teres min\u00f6r tendonlar\u0131<\/strong><\/p>\r\n\r\n\r\n\r\n

Hastan\u0131n kolu hafif internal rotasyonda ve el kontralateral dize do\u011fru uzand\u0131\u011f\u0131 pozisyonda (madde2-biceps tendonu uzun ba\u015f\u0131 de\u011ferlendirmesi) iken probu glenohumeral eklem posterioruna yerle\u015ftirin ve ultrason g\u00f6r\u00fcnt\u00fcs\u00fcn\u00fcn g\u00f6r\u00fc\u015f alan\u0131nda bulunan posterior fossa yap\u0131lar\u0131n\u0131n de\u011ferlendirebilmek i\u00e7in derinli\u011fi artt\u0131r\u0131n. \u0130nfraspinatus fossadan (probu a\u015fa\u011f\u0131 kayd\u0131rarak) supraspinatus fossay\u0131 (probu yukar\u0131 kayd\u0131rarak) sagittal planda de\u011ferlendirmek i\u00e7in scapulan\u0131n spinini belirleyici nokta olarak kullan\u0131n.<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

a:<\/em><\/strong>\u00a0supraspinatus;\u00a0Ok<\/strong>: skapula;\u00a0b<\/strong>: infraspinatus;\u00a0c<\/strong>: teres minor; kesik \u00e7izgi: skapula;\u00a01<\/strong>: Supraspin\u00f6z fossa;\u00a02<\/strong>: \u0130nfraspin\u00f6z fossa;\u00a0Bo\u015f Ok Ba\u015flar\u0131<\/strong>: Deltoid;\u00a0Beyaz Ok Ba\u015flar\u0131<\/strong>: Trapezius<\/em><\/p>\r\n\r\n\r\n\r\n

Deltoid kas\u0131n derin k\u0131s\u0131mlar\u0131ndan infraspin\u00f6z fossay\u0131 dolduran yap\u0131lar olarak infraspinatus ve teres min\u00f6r kaslar\u0131 ayr\u0131 yap\u0131lar olarak g\u00f6r\u00fcl\u00fcr. Bu kaslar\u0131 tarad\u0131ktan sonra probu sagital planda b\u00fcy\u00fck t\u00fcberositasa do\u011fru ilerletin. Bu alanda kaslar\u0131n devam\u0131 olarak tendonlar da s\u0131ras\u0131yla g\u00f6r\u00fcnt\u00fclenecektir.<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

Asterisk<\/em><\/strong>: Scapula;\u00a0Del<\/strong>: Deltoid Kas;\u00a0GT<\/strong>: B\u00fcy\u00fck T\u00fcberositas;\u00a0InfraS<\/strong>: \u0130nfraspinatus Kas\u0131;\u00a0Tm:<\/strong>\u00a0Teres Minor Kas\u0131;\u00a0Bo\u015f Ok<\/strong>: Teres Minor Tendon;\u00a0Beyaz Oklar<\/strong>: \u0130nfraspinatus Tendon<\/em><\/p>\r\n\r\n\r\n\r\n

8. Posterior yap\u0131lar ve posterior glenohumeral eklem bo\u015flu\u011fu<\/strong><\/p>\r\n\r\n\r\n\r\n

Kol internal ve eksternal rotasyonda iken probu glenohumeral eklemin posterior y\u00fcz\u00fcnde kayd\u0131rarak bu tendonlar ayr\u0131 ayr\u0131 uzun akslar\u0131nda de\u011ferlendirilir.<\/p>\r\n\r\n\r\n\r\n

Posterior labrum-kaps\u00fcl kompleksine bakarak eklemin posterior bo\u015flu\u011funda ef\u00fczyon varl\u0131\u011f\u0131 de\u011ferlendirilir. Probu medailde labruma transvers planda hareket ettirince spinoglenid notch g\u00f6r\u00fcl\u00fcr. Paralabral kist bu alanda aranmal\u0131d\u0131r.<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n
\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

Asterisk<\/em><\/strong>: Spinoglenoid Notch;\u00a0E\u011fri Ok:\u00a0<\/strong>Glenoid Kemik;\u00a0HH<\/strong>: Humerus Ba\u015f\u0131;\u00a0Infras<\/strong>: \u0130nfraspinatus;\u00a0Bo\u015f Oklar<\/strong>: Teres Minor Tendon;\u00a0Beyaz Oklar<\/strong>: \u0130nfraspinatus Tendon;\u00a0Beyaz Ok Ba\u015flar\u0131<\/strong>: Posterior Labrum<\/em><\/p>\r\n\r\n\r\n\r\n

9. Acromioclaviculer Eklem<\/strong><\/p>\r\n\r\n\r\n\r\n

Akromioklavikuler eklemi de\u011ferlendirmek i\u00e7in probu koronal planda omuz \u00fcst\u00fcne yerle\u015ftirin. Os acromiale varl\u0131\u011f\u0131n\u0131 de\u011ferlendirmek i\u00e7in probu anterior ve posteriora kayd\u0131r\u0131n. Probu acromioklavik\u00fcler eklemin posterioruna do\u011fru kayd\u0131rmak supraspinatus kas\u0131n\u0131n yerine ula\u015fmay\u0131 m\u00fcmk\u00fcn k\u0131lar.<\/p>\r\n\r\n\r\n\r\n

\"OmuzUSG\"<\/figure>\r\n\r\n\r\n\r\n

Acr:<\/em><\/strong>\u00a0Acromion;\u00a0Ok Ba\u015flar\u0131:<\/strong>\u00a0superior acromioclavicular ligaman,\u00a0Asterisk:<\/strong>\u00a0acromioclavicular eklem aral\u0131\u011f\u0131,\u00a0Cl:<\/strong>\u00a0Klavikula<\/em><\/p>\r\n\r\n\r\n\r\n

Not: Yaz\u0131n\u0131n ve g\u00f6r\u00fcnt\u00fclerin orjinaline\u00a0<\/em>https:\/\/www.essr.org\/subcommittees\/ultrasound\/<\/a>\u00a0adresinden ula\u015fabilirsiniz.<\/em><\/p>\r\n","protected":false},"excerpt":{"rendered":"

European Society of MusculoSkeletal Radiology Kas \u0130skelet Sistemi Ultrasonu Teknik K\u0131lavuz Omuz Hastan\u0131n pozisyonu bir\u00e7ok uygulay\u0131c\u0131 i\u00e7in farkl\u0131l\u0131k g\u00f6sterse de \u00f6nerimiz d\u00f6ner…<\/p>\n","protected":false},"author":1599,"featured_media":2029,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[19,20,12],"tags":[65],"class_list":["post-2014","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-rehberler-surekli-yayinlar","category-surekli-yayinlar","tag-kas-iskelet-usg"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2014","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1599"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2014"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2014\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2029"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2014"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2014"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2014"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}