Ke manaʻo nei ʻoe i kekahi manawa i ka ʻeha a i ʻole ka mae ʻana e hoʻomaka ana ma kou ʻāʻī a me kou mau poʻohiwi a iho i lalo i kou lima? Malia paha ʻoi aku ka ʻino o kēia ʻeha ke hāpai ʻoe i kou lima. Hiki ke hoʻonāukiuki loa ke hāpai ʻoe i kahi mea kaumaha a hana paha i nā hana o kēlā me kēia lā. ʻOiai he nui ka poʻe e manaʻo nei he ʻeha ʻāʻī maʻamau a i ʻole ka sprain, ma muli paha ia o kahi kūlana a mākou e kamaʻilio nui ʻole ai, akā hoʻopilikia i nā poʻe he nui. I kēia lā, e kamaʻilio kākou e pili ana i ka thoracic outlet syndrome , a i ʻole TOS e like me ka kapa ʻana o nā kauka.
I ka ʻōlelo maʻalahi, he aha ka Thoracic Outlet Syndrome (TOS)?
E noʻonoʻo, aia kahi hakahaka haiki loa ma waena o ko kākou ʻāʻī a me ka umauma o luna, ma lalo pono o ka iwi ʻāʻī a ma luna o ka iwi ʻaoʻao mua. ʻO kēia hakahaka ka mea a kākou e kapa nei ʻo 'Thoracic Outlet'. Ma o kēia hakahaka haiki, hele nā aʻalolo nui a me nā kīʻaha koko (nā kīʻaha koko a me nā aʻa koko) e hele ana i ko kākou mau lima. Ua like ia me nā kaʻa he nui e hele ana ma ke alanui haiki.
E noʻonoʻo, he aha ka mea e hana ʻia inā e lilo kēia wahi haiki i mea haiki a paʻa paha no kekahi kumu? Hoʻomaka nā aʻalolo a me nā kīʻaha koko e holo ana ma kēlā ala e ʻūmiʻi a ālai ʻia. ʻO ka hui pū ʻana o nā hōʻailona e like me ka ʻeha, ka pehu ʻana, a me ka mae ʻana i hana ʻia e kēlā ʻūmiʻi ʻana ʻo ia ka mea a mākou e kapa nei ʻo Thoracic Outlet Syndrome (TOS) .
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 ʻeha. He mea nui e ʻike i kēia, no ka mea, ʻokoʻa ka lāʻau lapaʻau ma muli o ke ʻano.
| ʻAno TOS | Wehewehena |
|---|---|
| Nā TOS Neurogenic | ʻO kēia ke ʻano maʻamau. Loaʻa i 95% o ka poʻe kēia ʻano. Maanei kahi e ʻomi ʻia ai nā aʻalolo e hele ana i ka lima. |
| Nā TOS Venous | Eia kahi aa koko e lawe ana i ke koko lepo mai ka lima a i ka puʻuwai. He mea kākaʻikahi kēia. |
| Nā TOS Arterial | ʻO kēia ke ʻano kakaikahi loa a koʻikoʻi loa. Pili ia i kahi paʻa ʻana i loko o kahi aʻa e lawe ana i ke koko maʻemaʻe mai ka puʻuwai a i ka lima. |
ʻOi aku ka maʻamau o kēia ʻano ma waena o nā wahine, a ʻoi aku ka nui o ka pilikia o nā mea pāʻani a me ka poʻe e hana ana i kekahi mau hana e pili ana i nā neʻe lima hou.
He aha nā hōʻailona o ka TOS?
ʻIke nui ʻia nā hōʻailona ma kou mau lima a me nā pulima lima. Hiki ke ʻokoʻa iki kekahi mau hōʻailona ma muli o ke ʻano.
- ʻEha ka ʻāʻī, poʻohiwi, a i ʻole ka lima : ʻO kēia ka hōʻailona nui. Hoʻonui ka ʻeha ke hāpai ʻoe i kou lima.
- ʻO ka ʻeha a me ke kani ʻana: Hiki paha iā ʻoe ke manaʻo i kēia ʻano kani ʻana, ʻoiai ma kou mau manamana lima a me nā poho lima.
- Nāwaliwali o ka lima: Paʻakikī i ka hāpai ʻana i nā mea kaumaha a i ʻole ka paʻa ʻana i kahi mea me ka paʻa.
- Ka pehu ʻana o ka lima : Hiki ke ʻike ʻia kēia ma ke ʻano venous.
- Nā loli o ke kala o ka lima: Hiki i ka lima ke polū, ʻulaʻula, a mae paha. Hōʻike kēia ua pilikia ke kahe ʻana o ke koko.
- Nā poho lima anu: ʻOi aku ke anu o ka poho lima o ka lima i hoʻopilikia ʻia ma mua o ka lima ʻē aʻe.
- He puʻupuʻu ʻeha kokoke i ka iwi ʻāʻī : Hiki paha iā ʻoe ke ʻike i kēia iā ʻoe iho.
- ʻAtrophy ʻiʻo: Inā hoʻomau ke kaomi no ka manawa lōʻihi, hiki i kekahi o nā ʻiʻo o ka lima, ʻoiai nā ʻiʻo ma ke kumu o ka manamana wāwae nui, ke emi a ʻike ʻia ua emi. Ua kapa ʻia kēia he "lima ʻo Gilliatt-Sumner".
- Ka pulse nāwaliwali ma ka lima: Ma ke ʻano arterial, hiki i ka pulse ma ka lima i hoʻopilikia ʻia ke nāwaliwali a ʻaʻohe paha i ka wā e palpated ai.
He aha nā kumu a me nā kumu pilikia no ka hoʻomohala ʻana i ka TOS?
Aia paha kekahi mau kumu no kēia.
- Nā ʻeha: ʻO nā ʻeha ʻāʻī e like me ka whiplash mai kahi ulia kaʻa, a i ʻole nā ʻeha e like me ka iwi ʻāʻī haʻihaʻi hiki ke hana i ka ʻiʻo ʻeha a me ka pehu e hoʻohaiki hou i ka hakahaka.
- Kūlana maikaʻi ʻole: He kumu koʻikoʻi loa kēia. Ke kūlou mau ʻoe i lalo a kūlou kou mau poʻohiwi i mua (ʻoi aku hoʻi i kou wā i mua o ke kamepiula a i ʻole ke nānā ʻana i kāu kelepona), hiki i kou iwi ʻāʻī ke hāʻule iki, e ʻūmiʻi ana i nā aʻalolo a me nā kīʻaha koko. ʻO nā ʻiʻo poʻohiwi nāwaliwali kekahi kumu o kēia.
- Nā neʻe hou ʻana (Repetitive stress):ʻOi aku ke kiʻekiʻe o kēia pilikia no ka poʻe e hana mau ana i nā neʻe e pili ana i ka hāpai ʻana i ko lākou mau lima. Eia kekahi laʻana, nā mea ʻauʻau, ka poʻe e pāʻani ana i nā haʻuki e like me ka baseball, nā mea pena kiʻi, a me ka poʻe e hana ana ma nā hale hana.
- Nā ʻano ʻē o ka hānau ʻana: Hānau ʻia kekahi poʻe me kahi iwi ʻaoʻao keu (iwi ʻaoʻao cervical) ma ka ʻāʻī. Hiki i kēia ke hoʻohaiki i ka hakahaka.
- Momona: I ka piʻi ʻana o ke kaumaha o ke kino, piʻi aʻe ke kaomi ma ka iwi ʻāʻī a me nā ʻiʻo a puni. He kumu nō hoʻi kēia o ka hāhā ʻana.
- Hāpai keiki: I ka wā hāpai keiki, lilo nā hono o ke kino i palupalu. Me kēia palupalu, hiki i ka iwi ʻāʻī ke neʻe a hana i ka ʻeha.
- Nā kumu ʻē aʻe: ʻO nā puʻupuʻu ma ka umauma o luna a i ʻole ka armpit, ke kaumaha nui, a me ke kaumaha hiki ke lilo i kumu.
Pehea e ʻike ai ke kauka i kēia?
Ke hele ʻoe e ʻike i ke kauka, e nīnau mua ʻo ia iā ʻoe i kahi nīnau kikoʻī e pili ana i kāu mau hōʻailona a laila e hana i kahi hoʻokolokolo kino.
He paʻakikī ke ʻike ʻana i ke ʻano neurogenic i kekahi manawa no ka mea hiki ke huikau ʻia kona mau hōʻailona me nā kūlana ʻē aʻe e hoʻoulu ai i ka numbness a me ka ʻeha ma ka lima, e like me ka carpal tunnel syndrome, ka arthritis ma ka ʻāʻī a me ke kua, a me nā ʻūlū nerve ʻē aʻe. No laila, pono ke kauka e noʻonoʻo i kēia mau mea āpau e ʻike ai i ke kumu pololei.
Eia nō naʻe, ua maopopo nā hōʻailona o nā ʻano venous a me arterial (pehu ʻana, hoʻololi ʻana o ke kala) a hiki ke ʻike koke ʻia.
Hiki ke hoʻohana ʻia nā hoʻokolohua aʻe e hōʻoia i ka hōʻoia:
- Nā hoʻokolohua kūlana: E hoʻoneʻe ke kauka i kou mau lima a me ke poʻo i nā kūlana like ʻole e ʻike ai inā e ʻoi aku ka ʻino a i ʻole ka ʻino o kāu mau hōʻailona.
- Pale ʻiʻo Scalene: He inikini anesthetic i loko o kahi ʻiʻo ma ka ʻāʻī. Hana ʻia kēia e ʻike inā e pau ka ʻeha. Inā e pau ka ʻeha, aia paha ka pilikia ma laila.
- Nā hoʻāʻo kiʻi: Hiki i kahi X-ray, CT scan, a i ʻole MRI ke nānā no nā kīnā hānau, e like me kahi iwi ʻaoʻao keu. Hiki i kahi ultrasound ke nānā no nā poloka o nā kīʻaha koko.
- Nā hoʻāʻo aʻalolo: Kōkua kēia i ka hoʻopau ʻana i nā kūlana neurological ʻē aʻe.
- Nā hoʻāʻo kahe koko: ʻO nā hoʻāʻo X-ray e hoʻohana ana i kahi dye kūikawā, e like me ka arteriogram a venogram paha, hiki ke ʻike pololei i nā ʻūpā koko a i ʻole ka hōʻino ʻana i nā kīʻaha koko.
He aha nā lāʻau lapaʻau no ka TOS?
Pili nā koho lapaʻau i ke ʻano o ka TOS āu.
No nā TOS Neurogenic:
ʻAʻole pono kēia ʻano maʻamau i ke ʻoki ʻana.
- Hoʻōla kino: ʻO kēia ka lāʻau lapaʻau koʻikoʻi loa.Maanei, e aʻo ʻia ʻoe i nā hoʻomaʻamaʻa e hoʻoikaika a hoʻolōʻihi i nā ʻiʻo o ka ʻāʻī a me nā poʻohiwi. E kōkua pū lākou iā ʻoe e hoʻoponopono i kou kūlana. He nui ka poʻe e ʻike he mea pono loa kēia.
- Lāʻau lapaʻau: Hiki ke hāʻawi ʻia nā lāʻau ʻeha e like me 'Ibuprofen' a i ʻole 'Naproxen' (kapa pū nā kauka i kēia mau mea ʻo 'NSAIDS') a me nā mea hoʻomaha ʻiʻo e hōʻemi i ka ʻeha a me ka pehu.
- Nā Inikini Botox: ʻO ke inikini Botox i loko o kahi ʻiʻo ma ke kumu o ka ʻāʻī hiki ke hoʻomaha i ka wahi a hōʻemi i ka ʻeha. Loaʻa nā hopena no kahi o 3 mau mahina.
No nā TOS Venous a me Arterial:
ʻO ka maʻamau, pono ke ʻoki ʻana i kēia mau ʻano ʻelua.
- ʻO ka mea mua, inā he ʻūpā koko, mālama ʻia.
- A laila, hana ʻia kahi hana ʻoki i kapa ʻia ʻo ka thoracic outlet decompression. Ma kēia kaʻina hana, wehe ke kauka ʻoki i kahi i hoʻopaʻa ʻia ai ke kaomi. Hiki paha i kēia ke wehe i nā iwi ʻaoʻao keu, nā ʻiʻo ʻē aʻe, a i ʻole kahi ʻāpana o ka ʻiʻo e hana ana i ke kaomi. Hiki iā lākou ke hoʻoponopono i nā kīʻaha koko i hōʻino ʻia.
Nā mea hiki iā ʻoe ke hana ma ka home
ʻO ka hana ʻana i kēia mau mea me ka lāʻau lapaʻau e hāʻawi iā ʻoe i ka hōʻoluʻolu hou aku.
- E mālama i ke kaumaha olakino.
- E makaʻala i kou kūlana. E hoʻomaʻamaʻa i ka mālama ʻana i kou kua i pololei ma ka hana a ma ka home.
- E pale i ka hāpai ʻana i nā ʻeke kaumaha ma luna o kou mau poʻohiwi.
- I ka wā e hana ana, e hoʻomaha iki, e ala aʻe, a e kīkoʻo mau.
- E kau i kahi pā hoʻomehana i nā ʻiʻo ʻeha. E lomilomi.
- E hana i nā hoʻomaʻamaʻa hoʻomaha e hōʻemi i ke kaumaha.
He aha ka mea e hana ai inā ʻaʻole mālama ʻia ka TOS?
He mea nui loa ka mālama ʻana i ka TOS i ka wā hikiwawe loa. A i ʻole, hiki ke loaʻa nā pilikia koʻikoʻi, e like me:
- ʻO ka ʻeha mau a me ka pehu ʻana ma ka lima
- Ka pōʻino mau loa o ke aʻalolo
- Nā kūlana e like me nā ʻeha ischemic a i ʻole gangrene i nā manamana lima ma muli o ke kahe koko i hoʻopilikia ʻia
- Nā ʻūpā koko. Inā haki kahi ʻūpā koko a ālai i kahi kīʻaha koko i loko o nā māmā, ua kapa ʻia ia he "pulmonary embolism ." He pilikia koʻikoʻi loa kēia a hoʻoweliweli i ke ola.
Leka Lawe-Home
- ʻAʻole wale ka Thoracic Outlet Syndrome (TOS) he ʻeha ʻāʻī maʻamau, he maʻi kūikawā ia.
- Inā loaʻa iā ʻoe ka ʻeha, ka mae ʻana, a i ʻole ka nāwaliwali ma kou ʻāʻī, poʻohiwi, a lima paha, mai hoʻowahāwahā iā ia.
- ʻO ke kūlana maikaʻi ʻole a me nā neʻe pinepine ʻana paha ke kumu nui o kēia. No laila e makaʻala i kou kūlana.
- He lāʻau lapaʻau maikaʻi loa ka hoʻoikaika kino no ka neurogenic TOS.
- Inā loaʻa iā ʻoe ka pehu koke, ke kala ʻana o ke kino, ka ʻeha nui, a i ʻole ka nalowale ʻana o ka pulse ma kou lima, he pilikia paha ia. E ʻike koke i ke kauka a i ʻole e hele i ka Emergency Department (ETU).
- I kēlā me kēia manawa, inā loaʻa iā ʻoe nā hōʻailona e like me kēia, mai kuhi hewa, akā e ʻike i kāu kauka no ka hōʻoia kūpono a me ka lāʻau lapaʻau.











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