Ke manaʻo nei ʻoe i kekahi manawa i kahi ʻeha ʻē a i ʻole ka mae ʻana e pālahalaha ana mai kou ʻāʻī a me kou poʻohiwi i lalo o kou lima? Ke ʻano nei anei kēia ʻeha e ʻoi aku ka ʻino ke hāpai ʻoe i kou lima? Manaʻo ka poʻe he mea maʻamau kēia, a i ʻole he aʻa liʻiliʻi wale nō ia i loko o kou ʻāʻī e ʻomi ʻia ana, akā ʻoi aku ka paʻakikī o ke kumu ma mua o kou manaʻo. I kēia lā e kamaʻilio mākou e pili ana i kahi kūlana e hiki ai ke hana i nā hōʻailona like, akā ʻaʻole i lohe ka poʻe he nui. ʻO ia ka Thoracic Outlet Syndrome (TOS).
I ka ʻōlelo maʻalahi, he aha ka Thoracic Outlet Syndrome (TOS)?
He mea paʻakikī paha kēia inoa. Akā, e maʻalahi kākou. E noʻonoʻo he wahi liʻiliʻi e like me ke ana ma waena o ko kākou ʻāʻī a me ka umauma. ʻO ka pololei, ʻo ia ka wahi ma lalo o ka iwi ʻāʻī a ma luna o ka iwi ʻaoʻao mua. ʻO kēia ka mea a kākou e kapa nei ʻo ka 'thoracic outlet' i ka lāʻau lapaʻau.
He mea nui loa kēia tunnel no ka mea, ʻo kahi pūʻolo nui o nā aʻalolo e hāʻawi ana i ka ʻike a me ka neʻe ʻana i ko mākou lima (i kapa ʻia ʻo ka brachial plexus ), a me ke aʻa nui e hoʻolako i ke koko i ka lima ( ke aʻa subclavian ), a me kahi aʻa nui e lawe ana i ke koko mai ka lima a i ka puʻuwai ( ka aʻa subclavian ) e hele ana ma waena o kēia wahi liʻiliʻi.
ʻO ka maʻamau, hiki i kēia mau aʻalolo a me nā kīʻaha koko ke hele ma o kēia wahi me ke keʻakeʻa ʻole. Akā pehea inā e ālai ʻia kēia tunnel no kekahi kumu? ʻO ia hoʻi, he aha ka mea e hana ʻia inā e ʻomi ʻia kēia mau aʻalolo a i ʻole nā kīʻaha koko e nā ʻiʻo a puni, nā iwi, a me nā mea ʻē aʻe? ʻO ia ka mea a mākou e kapa nei he Thoracic Outlet Syndrome (TOS) . ʻO kēia ʻomi ke kumu o nā hōʻailona he nui e like me ka ʻeha, ka mae, a me ka pehu ʻana ma ka lima.
Aia kekahi mau ʻano nui o nā TOS?
ʻAe, ua māhele ʻia ʻo TOS i ʻekolu ʻano nui ma muli o ke kumu o kēia kaomi. He mea nui loa ka ʻike pololei ʻana i kēia no ka mālama ʻana.
| ʻAno TOS | He aha ke kaomi ʻana a me ka wehewehe ʻana |
|---|---|
| ʻO ka Neurogenic Thoracic Outlet Syndrome (ka hoʻopili ʻana o nā aʻalolo) | ʻO kēia ke ʻano maʻamau (ma kahi o 95% o nā maʻi TOS). Pili ia i ke kaomi ʻana o ka pūʻolo aʻalolo e holo ana mai ka lima a i ka poʻohiwi (brachial plexus). Loaʻa pinepine ia i nā mea pāʻani e hana ana i nā neʻe hana hou a i ʻole i ka poʻe i loaʻa koke i ka ʻāʻī (e like me ka whiplash mai kahi ulia kaʻa). |
| ʻO ka Venous Thoracic Outlet Syndrome (Venous Throat Syndrome) | ʻO kēia kahi e ālai ʻia ai ke aʻa koko nui e hoʻihoʻi ana i ke koko mai ka lima (ka aʻa koko subclavian). Hiki i kēia ke kumu o ka hōʻiliʻili ʻana o ke koko i loko o ka lima, e hoʻoulu ai i ka pehu koke a lilo i polū . ʻO kēia ka mea maʻamau i nā kāne ʻōpio, ʻoiai ma ka lima a lākou e hoʻohana nui ai (ka lima dominant). |
| ʻO ka maʻi ʻāʻī puʻu (ʻāʻī puʻu) | ʻO kēia ke ʻano kakaikahi loa (ma kahi o 1% o nā maʻi TOS). Maanei, ua emi ke aʻa nui e lawe ana i ke koko i ka lima (ke aʻa subclavian). Hiki i kēia ke hōʻemi i ke kahe koko i ka lima, e lilo ai i mea anuanu, mae, a ʻeha. I kekahi manawa, hiki ke hana ʻia nā ʻōpū koko i loko o kēia aʻa. Hoʻokumu pinepine ʻia kēia e kahi mea e like me ka iwi ʻaoʻao keu i hānau ʻia me ka iwi ʻaoʻao cervical. |
ʻO nā ʻano venous a me arterial ua kapa ʻia ʻo Vascular Thoracic Outlet Syndrome . Pono nā ʻano ʻelua i ke ʻoki kino. Eia nō naʻe, ʻo ke ʻano Neurogenic maʻamau e pane maikaʻi pinepine i ka hoʻōla kino.
He aha nā hōʻailona o ka TOS?
Aia nā hōʻailona i ka ʻomi ʻia ʻana o ke aʻalolo a i ʻole ke kīʻaha koko. ʻIke pinepine ʻia kēia mau hōʻailona ma kekahi ʻaoʻao (ʻāʻī, umauma luna, poʻohiwi, lima, a i ʻole lima).
Nā hōʻailona i ʻike pinepine ʻia:
- ʻEha: Hiki ke hoʻonui ʻia kēia ʻeha ke hāpai ʻoe i kou lima. Manaʻo paha kekahi poʻe he ʻeha iki ia.
- Numbness: He manaʻo "pine a me nā nila", e like me ka manaʻo ke mae kou lima.
- ʻAno ʻeha: Ka nalowale ʻana o ka ʻike ma kekahi mau wahi o ka lima.
- Nāwaliwali: Hoʻemi ʻia ka ikaika ma ka lima a i ʻole nā manamana lima, paʻakikī i ka paʻa ʻana i nā mea.
- Pehu a kaumaha paha: Pehu paha ka lima a kaumaha, ʻoiai ke ʻūlū ʻia ke aʻa koko.
- Nā loli o ke kala o ka ʻili: Hiki ke lilo ka lima i keʻokeʻo a polū paha.
- Nā lima anu: Ke emi ka paʻa ʻana o ke aʻa koko a emi iho ke kahe o ke koko, e anuanu paha ka lima ma mua o ka lima ʻē aʻe.
- Ka lohi o ka ho'ōla ʻana o nā ʻeha manamana lima: Ma muli paha kēia o ke kahe koko maikaʻi ʻole.
E noʻonoʻo i kēia ʻano: ua like nā aʻalolo me nā uea uila i loko o ko kākou kino. Ke paʻa lākou, ʻike ʻia nā hōʻailona e like me ka ʻeha a me ka mae ʻana. Ua like nā kīʻaha koko me nā paipu wai. Inā paʻa ka ʻōmole lawe koko (artery), anuanu ka lima a nele i ke koko. Inā paʻa ka ʻōmole hoʻihoʻi koko (vein), pehu ka lima a piha i ke koko. Ke noʻonoʻo ʻoe i kēia ʻano, maʻalahi ka hoʻomaopopo ʻana i nā hōʻailona.
Hiki paha i kēia ʻeha ke pili i ka hāʻule puʻuwai?
He nīnau koʻikoʻi loa kēia. No ka mea hiki i ka TOS ke hōʻeha i ka umauma o luna, makaʻu paha kekahi he hōʻeha puʻuwai a i ʻole angina kēia. Eia nō naʻe, aia nā ʻokoʻa maopopo ma waena o nā mea ʻelua.
- ʻEha TOS: ʻOi aku ka ʻino ke hāpai ʻoe i ka lima i hoʻopilikia ʻia . ʻAʻole e ʻoi aku ka ʻino o kēia ʻeha ke hele ʻoe a hoʻoikaika kino paha.
- ʻEha ʻAngina: ʻO kēia ka ʻeha i hoʻokumu ʻia e ka loaʻa ʻole o ke koko lawa i ka puʻuwai. Hoʻonui pinepine ia i ka wā o ka hoʻoikaika kino, e like me ka hele wāwae a i ʻole ke piʻi ʻana i nā alapiʻi . Hoʻomaikaʻi ia me ka hoʻomaha. Hiki ke hele pū me nā hōʻailona e like me ka pōkole o ka hanu a me ka hou.
Pēlā nō, hiki i ka nāwaliwali ma kekahi ʻaoʻao o ke kino ke lilo i hōʻailona o ka hahau ʻana. Eia nō naʻe, hiki i ka hahau ʻana ke hana i nā hōʻailona e like me ke kūlou ʻana o ka waha ma kekahi ʻaoʻao, ka paʻakikī i ka ʻōlelo ʻana, a me nā loli o ka ʻike.
He mea nui loa: Inā ʻike koke ʻoe i ka ʻeha o ka umauma, ka pōkole o ka hanu, ka hou ʻana, ka nāwaliwali ma kekahi ʻaoʻao o ke kino, a i ʻole ka paʻakikī o ka ʻōlelo ʻana, mai manaʻo he TOS ia a e hele koke i ka lumi pilikia o ka haukapila (ETU). He mau hōʻailona paha kēia o ka hōʻeha puʻuwai a i ʻole ka hahau ʻana, e pono ai ka mālama koke ʻia.
He aha ke kumu o ka TOS?
Ua hoʻokaʻawale nā kauka i nā kumu o TOS i ʻekolu mau māhele nui.
| Māhele kumu | Ka wehewehe a me nā laʻana |
|---|---|
| Hānau ʻia | He mau loli kūkulu kēia i hānau ʻia me ʻoe. No ka laʻana, loaʻa paha i kekahi poʻe kahi iwi ʻē aʻe ma ko lākou ʻāʻī (iwi ʻaoʻao cervical). Hiki i kēia iwi ʻē aʻe ke hoʻemi i ka hakahaka ma ka puka thoracic a hoʻoulu i ke kaomi ma luna o nā aʻalolo a i ʻole nā kīʻaha koko. |
| Ulia (Traumatic) | Hiki ke hana ʻia kēia kūlana e kahi ʻeha ma ka ʻāʻī a i ʻole ka umauma o luna. ʻO ka laʻana maʻamau ka whiplash , i hana ʻia e ka neʻe koke ʻana o ka ʻāʻī i kahi ulia kaʻa. Hiki nō hoʻi ke hana ʻia e kahi mea e like me ka iwi ʻāʻī haki. |
| Hana | Hana ʻia kēia ma muli o ka hana hou ʻana o nā neʻe like, ʻoiai hoʻi nā hana e pili ana i ka hāpai ʻana i nā lima.
|
I kekahi manawa, ʻoiai inā he pilikia hānau (e.g., he iwi ʻaoʻao keu), ʻaʻole paha e ʻike ʻia nā hōʻailona a hiki i kahi ulia a i ʻole ka hana kūpono ʻole no ka wā lōʻihi.
He maʻi koʻikoʻi anei kēia? He aha ka mea e hiki mai ana inā ʻaʻole mālama ʻia?
ʻAe, hiki i ka TOS ke hoʻoulu i nā pilikia koʻikoʻi inā waiho ʻole ʻia, ʻoiai ma ke ʻano o ka ʻūlū ʻana o nā kīʻaha koko.
- Thrombosis: Hiki ke hana ʻia nā ʻōpū koko ma ka lima ma muli o ka haiki ʻana o nā aʻa koko. Inā haki kēia ʻōpū koko a noho i loko o nā māmā, hiki iā ia ke hana i kahi maʻi koʻikoʻi a hoʻoweliweli i ke ola i kapa ʻia ʻo pulmonary embolism .
- Pehu mau a me ka ʻeha: Pehu mau a me ka ʻeha ma ka lima.
- Make ʻana o nā ʻiʻo (Gangrene): Inā paʻa kahi aʻa a ʻoki loa ʻia ke kahe o ke koko i ka lima, hiki i nā ʻiʻo ma nā manamana lima ke make.
- Nā ʻeha ʻaʻole e ho'ōla: ʻAʻole paha e ho'ōla nā ʻeha ma nā manamana lima ma muli o ke kahe koko maikaʻi ʻole.
- ʻO ka hōʻino mau loa ʻana o nā aʻalolo: ʻO ka hoʻopaʻa lōʻihi ʻana o nā aʻalolo hiki ke hana i ka hōʻino mau loa.
No laila, inā loaʻa iā ʻoe kēia mau hōʻailona, he mea nui loa ia e ʻike pono i kāu kauka a ʻimi i ka ʻōlelo aʻo, ma mua o ka manaʻo wale ʻana "e nalo wale aku kēia."
Pehea e ʻike ai ke kauka i ka TOS?
Hiki i kekahi manawa ke paʻakikī iki ka ʻike ʻana i ka TOS no ka mea hiki ke like nā hōʻailona me nā maʻi ʻē aʻe he nui. E nīnau mua kāu kauka iā ʻoe e pili ana i kāu mau hōʻailona a nānā iā ʻoe.
I loko o kēia hoʻokolokolo kino, e noi ke kauka iā ʻoe e hana i kekahi mau neʻe ʻana. Eia kekahi laʻana:
- E hāpai i kou mau lima i luna a noi iā lākou e kulou a hoʻolōʻihi i ko lākou mau poho lima (Elevated Arm Stress Test).
- Ke noi aku nei lākou iā ʻoe e hoʻohuli i kou ʻāʻī i nā ʻaoʻao like ʻole.
Hiki i ke kauka ke loaʻa kahi manaʻo o kēia ma ka nānā ʻana inā ʻike ʻoe i nā hōʻailona e like me ka ʻeha a i ʻole ka ʻūhā i ka wā e hana ai i kēia mau neʻe, a pehea lākou e hana ai.
Eia kekahi, hiki ke kauoha ʻia nā hoʻokolohua aʻe e hōʻoia i ka hōʻailona a kāpae i nā kūlana ʻē aʻe:
- X-ray o ka umauma: E nānā inā he iwi ʻaoʻao keu (iwi ʻaoʻao cervical).
- CT scan a i ʻole MRI scan: No ka ʻike pono ʻana i kahi i hoʻopaʻa ʻia ai nā ʻano o ka ʻāʻī a me ka umauma, a me nā aʻalolo a me nā kīʻaha koko.
- Electromyography (EMG) / Haʻawina Hoʻoili Aʻalolo: Nānā i ka hana a me ka hōʻino ʻana o nā aʻalolo.
- Angiography (MRA a i ʻole CT Angiography): No ka nānā ʻana i ke kahe o ke koko i loko o nā kīʻaha koko a inā he ālai a ʻūlū koko paha.
He aha nā lāʻau lapaʻau no ka TOS?
Hoʻopili ʻia ka lāʻau lapaʻau i ke ʻano o ka TOS āu e loaʻa ai, ke koʻikoʻi o kāu mau hōʻailona, a me ke kumu.
1. Hoʻōla Kino: ʻO kēia ka lāʻau lapaʻau mua a koʻikoʻi loa no ka Neurogenic TOS. E aʻo aku kahi mea hoʻōla kino iā ʻoe i nā hoʻomaʻamaʻa kikoʻī e hoʻoikaika i nā ʻiʻo ma kou ʻāʻī a me kou poʻohiwi, hoʻonui i ka maʻalahi, a kōkua iā ʻoe e mālama i ke kūlana kūpono. No nā poʻe he nui, hiki i kēia lāʻau lapaʻau ke hōʻemi nui i nā hōʻailona.
2. Nā lāʻau lapaʻau:
- Nā lāʻau hoʻopau ʻeha: Hiki i kāu kauka ke ʻōlelo i nā lāʻau hoʻopau ʻeha e like me NSAID e kāohi i ka ʻeha.
- Nā Anticoagulants: Inā ua hana ʻia nā ʻūpā koko i loko o nā kīʻaha koko a i ʻole ua pilikia paha ke kūkulu ʻia, hāʻawi ʻia nā lāʻau lapaʻau hoʻomāmā koko. I kekahi manawa, hiki ke hāʻawi ʻia nā inikini kūikawā (thrombolytic therapy) e hoʻoheheʻe i ke ʻūpā.
3. ʻOki kino:
- ʻO ka TOS arterial a me venous (nā ʻano o ka ʻūlū ʻana o ke kīʻaha koko) koi pinepine ʻia ke ʻoki ʻana ma muli o ke kiʻekiʻe o ka pilikia o nā pilikia koʻikoʻi.
- Hoʻomaopopo pū ʻia ke ʻoki kino no nā poʻe maʻi me Neurogenic TOS i pane ʻole i nā lāʻau lapaʻau kino.
- ʻO ke ʻoki kino e pili ana i ka wehe ʻana i ke kumu o ke kaomi ʻana o nā aʻalolo a i ʻole nā kīʻaha koko. Eia kekahi laʻana, ka wehe ʻana i kahi iwi ʻaoʻao keu a i ʻole ka ʻoki ʻana i kahi ʻiʻo paʻa (ʻoki decompression).
E wehewehe pono ana kāu kauka iā ʻoe inā pono ʻoe i ke ʻoki kino, nā mea e pili ana i ia mea, a me nā pilikia.
Leka Lawe-Home
- Inā loaʻa iā ʻoe ka ʻeha mau, ka mae ʻana, a i ʻole ka nāwaliwali ma kou ʻāʻī, poʻohiwi, a lima paha, mai hoʻowahāwahā iā ia.
- Hiki ke kumu ʻia kēia mau hōʻailona e ka Thoracic Outlet Syndrome (TOS), i hana ʻia e ke kaomi ʻana o nā aʻalolo a i ʻole nā kīʻaha koko ma ka hakahaka ma waena o ka ʻāʻī a me ka umauma.
- ʻO ka hoʻowahāwahā ʻana i nā hōʻailona, ʻoiai i nā hihia o TOS e pili ana i nā kīʻaha koko, hiki ke alakaʻi i nā pilikia koʻikoʻi e like me nā ʻūpā koko.
- E ʻike pono i ke kauka no ka hōʻoia kūpono a me ka mālama ʻana.
- Hiki i nā poʻe he nui ke hoʻokele i kā lākou mau hōʻailona me ka hoʻoikaika kino, a i kekahi mau hihia, pono paha ke ʻoki ʻana.
- Inā loaʻa iā ʻoe nā hōʻailona e like me ka ʻeha koke o ka umauma a i ʻole ka nāwaliwali ma kekahi ʻaoʻao o ke kino, e hele koke i kahi lumi pilikia (ETU).
💬 Comments (0)
ʻAʻohe manaʻo i kau ʻia. Hoʻohui i kāu manaʻo ma ʻaneʻi no ka manawa mua.
Hoʻohui i kāu manaʻo