Mihai Nicolescu SEMIOLOGIE ORTOPEDICA Editura Universitara ,Carol Davila” Bucuresti 2003,ISBN: 973-7918-61-4 AUTORI COLABORATORI: br. Radu Radulescu, sof de rin Civica de Onopedte 9) Traumaniog® ‘Sota Unwesiar Bees br. Florina Ojoge, mod sponaist, aston universtar UME ,Cao! Dav’ ‘inca de Recuperre il Insti Natena! de Reeupeare, Medina Fics Sainocimatsioge Buco? br. Lins Ojoga, mode spect assent de cecstare, Civica de ‘rnopade pTaumatioge, Soe Unvertar de Ugerta Buco? br. Catilin Crstoln, assent unvorsan, Crea de Onopede, Splatt “Unrate br. Codrin Huston medi rede. Cina de Onopedie, Spt Unverstar ‘cues Dr. Indre hata, med primar, Cc de Rolo, Spa Cotes Dr. rita sae. mod roodort. Spal! Cinc de Ugert de. Chup Pasta, Ropartore 9 Asa br. Mina! Berteanu, eonoveniar unvertar, Clea oe Recuporae ‘medica, Spa Eras Format 116 in 704100. Bun de tipar: Decembrie 2003. Apart 203 Tipit Elta Universitars Carol Davila copyright ©2003 Toate dropturite sunt rezervateEaturil Universtare carl Davila” Bucuresti CUPRINS ne ws _— = Scorut sini, laser, valor normale.PREFATA tn tinpurile coder manic de a inviga” semioogin de un macs pein Indra I pt ola sain copslaisanbulatoie fre dese asta cid agemerteastuenjlor ct 9 programa operator Incireat al asistnir,inpicies desiguatea unui ate de nvm tives sau pstniverstar In acest context *Semisogia Ortop 4 Conf Dr Mia Niolesc vie st cope aces ips, Et este aml ect un manual” xte un nda fore prefos pew tet ce se fomeaza ss perfeconeza in tap ‘Din acles condone crn enna cirri enoped mdr ea exageraimporan apse in pone diagonal raced de ‘ipa din vedere mele de chnce ce se dosed wleror abot es In pera dap “reuie sublines cinie deere pe replant sao sunt ati coe ance cae sa dove in ip alr ct 9 cele de ulti (rd, ede care nu poate Healt cnet fetiune onapee ‘Somiologia oropodia” este io primal lad ut indeplar pera efectuaen una examen clic complet, a mai ales capabi $2 pn un “gone prumpi n acest en de erp: ila ariel esr In ‘dala cu toate gree de mgcre pase st atve pare neces ast uma in examene medico-eate: pena punerea wnt dagosti tn pratica ‘te neces mma evientrs mc mis amps pra oniolterals snunan: ace Israel din ce Ava, det ate mente seniologce sat remain i exten ant evideci # ‘Shit in pct de vedere alr lor pet seen dingo xarcnal cic exe bla de tate dite actual poracinice 93 imate cuinteretre acess, prin fasta ea sugestva. Dn {cet unghi al esamenshn ci sunt pezentate asl principale ‘fej sindeame, pe. baze anatomic, ce sc vided prin Sinpromatlogia descr ‘iter sels afeiunilor nopeice esa aba sunt cle le freveneh 9h grip crtent ivoete 1 absolut peesare ott din ‘acticeambultore i sptaicas ‘toa ese un chris dest in a pin! sale maura it tora un cada date de mare talents yout cre sie "ce" 5 urbe pret cea ding pen af bine sh.os cum a realzat at pin capo Semiologin onopedics este 0 pledeanie frees datelor de smi nomics pela la miloae modeme ost Tore costae, Sheesh roped es is deci in ca ab rezenul mana ps Eh inerpeteze coeds EXAMENUL GENERAL AL PACIENTULUL ORTOPEDIC M. Nicolesew pore Cee ary eo ery roy Poaney Anamneza ei ese important deoatece nu acorn rent spe in diagowc de probabil. Trcbue Se comple si adap afecputor ontop Vartan fae La now asc malformatit congenital ~ snaie 4 bridle “amnaice” amputaie congsiale hala come abso unui as mat malo segments) emimelile longkudinlefabseta nes ave cepernire 3h metatsene. defrmatitae feuremiagfor picor var equi, burs! in Sementare sau dierenjiere —sinsize, sind Uaviclelor disso cledoaniand, Traumstanete omelet sol frst lai, bums Fema, a para obstctrialapen il Cpiara ee mat deat rats spolintele yh epfintle,poliomisita hina ‘Singer de gol erat gen alsa, pie plat. Solera ese inna sav pen mlfat Traumatnmcle provessh fstr “in lemn son ar dsl elie fade a spt eck O50) ‘su sia cpus al (rota doer)La putertte pte i mai eve Bi ines ea ostonisia aolescntla, tv sasaiclar,otecondle Bola Perth pots tal, eaeanoana (Sever) Sbral (fo Sheeran) da 5 ba ‘ara (lount) su scliortolscertl,Anamite tumors benign sunt Scopes a aces vir ~ exostoce onogeic,cncomul Osco ‘hist ous esi sau maligne weoaroamee sacomul Eving “tn nde pred face #1 hate pi accident mun, de ecules spre: apt de enon (Ac) Ernie gamer nro menace, xia aban aa, ‘ia. ea de die ands ac ep pr eile desserts de til aorlor (old gun. rope de oa ori + maul, tumor wsese pimive (conrosreoamel) sau mesa. Baan ora eters pontmenopara si sei sued. oven froth, salle, tse ohana, col femur sau Tact Prtloic er ame) ‘Sena ete uh incon orenarea elie anumite fet: fata congenital ene i feet la ee 9 wolioaadlescet, nai fectivanta rote, La ile fora yi de tbuan endocrine Suk atporo genta = se tne sat es cilia capa emul a ial Pees 9 Sehewremans a vemel postpartum, ard mir endorine ee determin © hiperianate2sis pve scosiashr apr due onostism { proleme de daprste rea ht: set ot [recta condi pein anumite toi ates scoed 3 nies muculra verbal lev 5 rato carpe muscular serra, tenoninvia, ili Pn, eerie spcondiienlr ote tesimanul), Ractr Je ‘Shwcls ~ siptor!pmonsle done. greta (ubius). bale ‘lrg bie, prone, miranda ctasen). orl pla sa, vancle rostace sunt even chr tela iar necrozee oases nla hesonienton- ass foc ax post Sterna apr ah fever wor fecn? Tai congea de ol enema eset fn anomte Fun, ra uncle mafonma engeniale(onsangvintatea; nosed pire ulti Gin cadre epanoitorl rat des nn Ta rasa ABS Imeiranen, Ge var lesne de mein exe aa abe Anecedntte famine Se vor srvn pai it ms are, dcarece ‘xi un mare numa de aecjuni cu tansmitee rear. Anomalile mofologie cu carter sess (sa ete una sa ma multe generat ma Frecvent inte sun hai cogent de old, pcr pla hypertoe Ingrsae a tabeculelr esos 5! myoraen echo ranspart pi Ta ‘span, in ean severe, zon act, ist de sca raion [van aypest dos de iy au de arma tendo, cre reper Tormare de os in exces pe fs ners compacts ‘Peristoa (eatiaperostal)presupune formarea deo icon paologice la nivel pevostul Is functe de eto pt spare aspecte fadlosce dete Tn stom, peiostra se manifests sub form nei opuit in, Inia, are dbl sompoca rnin spars de aceasta no Hine sraspaent In cus ell ol, lima oc se ingroasd se sueaza Tacempact Inrtcuo-sarcoml Ewing apare imagines iit peiostoza in “bulb de ceapa lance osiase mull, conentice). Ae pur de. uo Imig sunt soe deo ete eros su forma spc os, Pepeniculr pe os, cae ceva pines de “isi de soe ‘Osicrieheterotpe repens formar de et oe i rn in ‘are el nu exis in com norm partum ost ‘final se depun srr faf-clie dono sue de vcd Un exorp tne de cuir belerotops sant oxtail, care ness se repul process snlamatore, spring cate formant apace trang Ta locl de serie capsule sau ligament, prelangnd infara segmental sos afta, Osietrile de la svelllgumentcor “rsh se nes indewmofite Distrofia ene o medicare caactezad de alleen profinds a strc owas, cu proven simula de zone de emieralate, oto Modified ale formel si dimensiunilor osoase Wiperostorn iscamns ingrogaeh ocala sa generalzat @ unl os ins de modiic de scr aleaceatia ele conseciola ute penntoze import sa devo anor proce tumoral Exotara reprint 9 frmatane cesar asemanaoae CU 62 ‘sui normal, tga un segment os eeu mode forma ‘Ocdostorapresupune cee dametrul transversal una os hue Aion dervotntute tuned Beane sav a un chs 0s in nero Seementu respect ein apt de “oe sl", Compact rast ‘min resent meetup da Se uz ep, pe ms en roe edervolts o and de extol. Scallstoa ete © modiare a asst longitudinal al easel tans dduorita seer tezstene) mecanice (ex rahi. estomaace) a aller asimetice a carlju de eet "Aplzia lagemela sunt flora de devotes aslo. Ageezia presupne absent congenital anti a mat llr Sepmente esse. In Tip ce in cael apa, segmentl ows interes nu jung in dervoared Stl aspectl ost noon dar amle se mans raloge pen lips ‘ke sinuzae soll eset Wipoplaria'shiperplaria sua carceizat= de nite dimensun seca rept eres hon aires carei pez is forma ‘hmensante nite normale Disparile pesipuno desfsure anormal a proccslor de eiiare nconda sau pest eset de mca osu care determin ‘oc deforma i damestune soi de aera ale ston esse Dispecile dutrateculburnlor de eresewe encom, sunt caractete de ose lang lngime srt in somparape cu roca (died cific pevoslt se desflgsrh norma, cu epfize plait duc in tn Ta sublnai5)aroze,s ase scurte igroyate cain condoplic Tn plzile periosale, cascle au Iungime normals (lac mu ste Moca seyret snoondai), dru five nat 9 sab minerliate care se solder ou scolstve gi flat de oboscald (ox mala Displaile prin alors processor de moles ubulitie respun un dete al fant de rere aostenlssor conde fa nog Zelor matatrareoaslor lan ists de stensclero nen la nl de arm sa seteqpetors” desea de Aber Schone) anal nel igus sau absent (2 bls Camarat Engels) TUMORILE OSOASE, ‘Tumorite benigne Osteomul osteold fost deses prima dats de alle ia 1935 9h rsprenints 1s din oul tumor benign. Este de du rt ifn Tar ect a feme ir incdeta maine stu in decode a dua 5 tris de it Toi in pct de vere sini, ese oscoid se caracteizeat prin der ners, de ntensat mae, predominant tn. cle {Ee aninamatoarlenesterione sseminitr mace oaoasenecleifete (causal) 0 cond perfec de ‘stonceora react, Seal bist este compact easlor lungs, cel mat event find Ieclizat nivel mataizetor peosimale femurale ub dar poste sta rice os, inca mk de ree Rolo. oscomul exc const in akksu aor st ‘cn, inoonjrt de os Slee pac. Inca in eae reacta slr ‘ste fare tens, mus exe masat pe raiograi clase, lsd pout ‘Seca pin examen CT. Freevent se tsciazt sian prot de Tamale (pt.Oxteoblastomal fost dss cw ote osteoid de ma mens Sone deonbire de act, afeara cu preictic easel sure (in speci Pecli vertcbral i proces spss), pein o celular as Dost “Osteo et ours sh oaslor membrane, feliz el ma Aiseoperte levent la aut sub forma nor leu be cums, non ad-apoce ede de bie Ser amet ‘Condromal epsenta cits 159 di taal ufo enine soa Terme de encondomn ese sb conroamelor care au a pune de plecarecavtatn mela oul Afetearl in propor cgale ambele {EAe an isgostcte la pte cu vst cups In ite ort {1030 an. Pot aire in once os, drs loclzeza In special in Zone ncaa, cel mal fecvet a ell metacapencr fags Exsth si fame ou local muliple cu afore plusegmeniars 3 Tenis de dnb hominis ex “encondmatoza Oe) apa facture oe ptoogi li cet vel Radiologe sot repezentate de Zone radio-tansparente rotund sa alae, In aprpictes pillar putind eterna toa poi ndowsle compact! adacem: utero, pe msura ce tunaren ae Seveole, compacta se subnets onl capil aspecul de "on ua pice must fete devi op nchieres carl de restr. sper ner x rap ie i pledcazs penn diagnostic riot neds gpropire a compact, In majontatca cucu feted Ietafizelepoxial al mers, fears falangelr Co ene slic excenie, caracterle radiologic sunt seminars cu el ale ncondroamsor Fg),Condroblastoml ts 0 tumoare catastoas rar care fete

pret Kren ferret W, with: determin agin timer de has linus) 9 central ferestel(C, dtermind obictle Stor salar de stmuae va epee la vel medial seri de gs). emerson hperdense saw hipodense compara eu densi cinowots» tcl normale, Examenal CT ‘alma selon in plan via sont is pole reconstruct Br au tadmensional rctactele pot generate de obiccle metaice (pote dente. rote tapi, cpu vascular), seuctunle osoase foarte dense psd patent, cal ale examen CT in ortopedic traumatloge: Achinhia pila 91 reconsineile bis $i dimensions pemit ssemenca 0 ana Pictel de facta comple sau comsnive ae aeloe ang (g.02‘cin Hs ne it Ls Oa en os inumplare; uma lor crespunde uni magntizsitole nue. Phasing Iesuul respects intra camp magnetic ines uniform. mometele Iugnetice indadile ale prtniorse vor rope lectoria# 2 cont ‘Cigeae de pecs”) in jar asl empl magnetic (pi prael respect pi aiparlelis MagnetzartllM” repreinth suma_momentelor_magnstie ingividuae ee defn in 2 plains magnetcarelngtoals ML” imagntzaretrnseral MT” Penna detects cmponentle MT ML" ale sna fet fear au valor exter de mit rapist ‘gril, ace tee sco dn sre nde coi ora co 82 poate face sh schunes une unde elecromgntice, de radlrcvenl (RP) Transfeal de energie del und ado acct de Hn se produce det pens anu revene al unde ai, eal cu deena ce cele dou Sir energcice ale H™~ Acsta este fenomenul de rezonanta. Unda BF Furia o eatate de ene proton ecind de pe nivel energetic Selva ao sidcat Refazaju potollr este al doles means pin ate conc (simula unda ra Exist det oul ipa dete de magnetizare tsar eu mecanism en de producer ~ component longudials magrtizini ML~ spare prin tania proton ine nivel energcice dente dup famaparnures ener onfent de uns RF espa eT (amp de relate nga) componena taasveral a magnetar MT pate pi tl 5 kj proton: exe eta dT (np de east tans ‘up incurs solic exteme,sistemulfevine la echiibea ateror prin acoure exponential, pind eneriatnmagazinat,Fenono ‘Scere prin constante de tiny mp de reasare longitudinal (TI) transversal (2), rim irate IRM, Fenomentl IME dese observable prin “elaarea” rotor. Relaxarea TI (longitudinal) spare print tranziie energ lnvers pint aniparatel spre paral, een ces instete de» emis ide emerge prin schimb trmic cu mediel moleclar inconjerator. Recuperares magnetizrt longitudinale se" face dupa curbs “exponentials cresetoar, unde constant de imp TT (eprint in) ‘te caractersia unut fest dat en corespunde une "reeuperit™ 3 Imagnetirirt de. Magnctiarea longitadinala'a wnat eset este Feeuperatt ca atit mai repede ew cit TY al sult respetiv este mal curt TH varira cu stratura molecular, et st cu starea sla Sau Tiida (ste mal lng entra ichide i raport cu sail) este seurt In fesutal grass, Acote craters sunt Spculte de seetileponeat= 71. Pentru realizarea unui anuait tp de seevenph TH sau T2 sunt ttt de ctr operator protocale de examen dere, cu parameti ‘ent spect, Relarare 12 (transveral) spare prin fnomonl de defi al spor la incetrea undet RF" dere mpi a componentlor transverse mentor in dfs dire; exe Sart iterarun spinor ine Arse fae dup o cura exponen desrescitoure unde T2 coespune Smpul (expimat in ms) in care se puede 63% dia magnetarea ‘wanes, Cu cit T2 este ma lng. cast magetzarea vansveral ‘erst si mul 2 varias cu sctire molecular, procam si cu sae Soli sau ihida @ mate: ste ma ung in che fa de. sole Caractere acest sunt speeulate de sev enjee ponderate 12 Revenid la stare fe de eh, proton Wyo ete det u senna magnetic ae af eapat de reo amen, att informatics conser in Iimpie: tmagines ene constrain fen de 4 parameti principal Senstaten proton, timp de relavare longitudinal ransverst testturilor respective 9 respect, Fenomencle de Mr roca elapuls magne gal ander ral. Ty plas meta permite "chin depo cele 3 planet onogonale se sail xl, oral, ‘Stal fea sehimba pozapaient Deravaniae examen neces mabiliarea complet ¢ bonavuki ttament: insta de pros sie cap raiisos sal rae > ~ eczeca raia ropes in pain paca sounds > arse srw anus pranl narra (orto) fue rae asin atc Sindroml de canal cubital iotpssienlorst de malate TRE 0 sp Facerl Eerie tumanm CCPL! COLE un 1 gpd mL, fac spe Brno defrare i cubis val, cas ‘ura, nae deco! ‘aogen ‘tamstism rani corral os eterotopice) ener vlna vel roe cu cee revimite de bola 0 Clini - erm Tint Sev diez -dre ane eene te P eprcencbifuleer medlial mk olny leer At Atpelag ke ewe ap Paraclinieslectromiograie- Sect Cee. ar clit eonrol iced TR nto, sechee pot actrh comet reas cu cou exe 70 ‘sania Bf, annfsmston neeroiione chica lberare ner lar liberrs > Campochié anew subeutanat Complcai- sompresi rere Artroza cotului _Biitogle— ein gait de sex masclin, $060 ani Scundar-postamatics uote cuserdeterreereme (oLCxCLLiM old ¢ See feropire spsei de Mendis ema s clr Renin Trvtmest = debidaeanracopis 1 CdvagUATO’ ~~ aroplstie opryvaleragne , OUI Oka +l q qeofic wick pun Bid WF cule tev ial, alr ovina {har ttle An! SOME ae ioe congenial Watament iced pani osoase inespere de fiscin tt iia capo ‘al Pesiraunatic (cru osose su ale parlor moi fBiogent (un sigur abord chirrgal pers tee os) “ratament|— fxoterpi, ifosfnati,_an ha Aro bens aya caleefeae fe Weare any ireaga Abe JG WY robin oct ub hep — oA, OY Ou lujod TEE AA Liyebrnant POM, C4 ont dard. TE ina dapAD Boyd. — Sunil treatment ofthe elbow In sbeum Bact C.-Semologie cin ‘Choung W. Heinrich SD, — Acute annular ligament inter the radocepitlla out tn chile (oursemanfs elbow). Jour Pade Orhopdic, (4854-61995 1l- Avg 1S Brody, RD Leffert, RJ Sith. Technical pons with wae frve tansposton atthe low Findings and reals of teperaton. J Mand Seng # 19TH 45-89 IW Seradge tal Cubial tun lease with medial epcondyectomy facts iflcneng the oucone J. Hand Sarg. Vol 23" A. No. May pats Labelle Het al. Lack of scsoife evidence for teatment of later tqconigis ofthe elbow. Amster ta analysis JIS Vol 4-8 Gi 109, pose 651 Me Rae ® Beamer linge on Orthop: Moone 2002 NST Genet al. Synovectomy of he elbow an radial ead excision inRA. Praictvefstr and Toms tm eucome J. Val 79 B. No. Price ot ah hematology. Vol 30,p 39-44. 1991 oS: Stabl and T, Kasfinan.— The eficocy ofan inet Tralalepeondyh. A pnpecne stay of 6 elbows. J8US. Vol 19 NOI Now 997 p fad cxtment of tennis lbow ish J Local injection Tides compared. : pee Kor Ha Poter peer cloak Abe POMEL hte PUMNUL Radu Rady Procese Panes Cn) clinic Framenut Anatomic Soleo Arica pumnulus (aruba rao pans gital mai) este © Sarr condiand cre ‘impr biel spre medal de eo, seman ical slong ur coed dl foreat din apez apron far, call cu clip, Prime eh ease capone dn il froin (ecsfo semua, penal) foe un condi eapian cas ance cu ras “impladinea miscartor uv ese dat in prin de cul radocepan, dar in mo scandens e "ulin meiocspan care enn ne prime des Find de oaseearpione, Aces dod aia imped fc Posh mgaren de creomdache Pe fla amerarh Srvclaer paral we tendoaele flexor tune oie deine Resor. e as poster fi ltl article! tee tndounce mugen extensor ‘nent in poi enact extensor Procese patologice Arica pummel poste sedal patologie tumatie su dopeneratve stv 8 Toe