מציאת מקור הבעיה

מציאת מקור הבעיה

אחד הקשיים הגדולים בתחום האורתופדי הוא למצוא את מקור הבעיה. כאב בברך למשל, יכול לנבוע מהירך או בכלל מהגב התחתון. תסמונת התעלה הקארפלית (חולשה וזרמים בכף היד) יכולה לנבוע מהצוואר, ומרפק טניס יכול להגיע מהגב העליון.

אז מה הבעיה, פשוט נעשה צילום…

זה לא כל כך פשוט.

אם לא מדובר בחבלה טראומטית, כגון נפילה מגובה, תאונת דרכים וכדומה –  הסיכוי שצילום יעזור לנו לגלות את מקור הבעיה שואף לאפס. (כמובן, אני מוציא מהכלל הזה מצבים שאינם אורתופדיים במהותם כדון גידול ממאיר וכדומה).

מעל גיל 30-40 כמעט תמיד יהיו ממצאים בצילום, והם אף פעם לא יהיו ההסבר העיקרי לכאבים או למגבלת התנועה. הדברים נכונים לגבי כל בדיקות ההדמיה, כולל CT, MRI, הולכה עצבית, ואולטראסאונד.

כדי להמחיש את הבעיה, אתן דוגמא.

נניח שלאדם בן 60 כואבת מאוד הברך הימנית כבר תקופה ארוכה. בצילום רנטגן רואים שיש לו שחיקת סחוס וב MRI של הגב התחתון רואים פריצת דיסק ב L3-L4.

איך ניתן להתקדם מכאן? הכאב הוא בגלל שחיקת הסחוס או שמא בגלל פריצת הדיסק?

הדרך היחידה להגיע לאבחנה היא על ידי תשאול ובדיקה מקיפה.

אם האדם מספר שהכאב בברך מופיע דווקא בנהיגה, או בישיבה במשרד, ופחות בהליכה ובמדרגות, יש יותר לחשוב לכיוון הגב התחתון, ולהיפך.

אם הכאב הוא בצורת שריפה, ולעתים נודד מהברך כלפי מעלה או מטה, סביר יותר שמדובר בגב התחתון.

אם אין כאבים במנוחה, אלא רק בפעילות כגון עליה במדרגות, כריעה וכדומה, נחשוב יותר על הברך עצמה.

בבדיקה עצמה נבדוק היכן הממצאים הקליניים יותר מתאימים לתלונת המטופל. בגב או בברך? ולפי זה נחליט כיצד להתקדם.

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