תפיזיותרפיה

-

- Acronio-Clavicular- Sterno-Clavicular Joint , . .Saddle jt = Sterno-clavicular Joint Elevation- ,Depression (), - Glide . ,Retraction/Protraction (), . Acronio-Clavicular Joint Gliding . 6 Glenohumeral Joint . : Adduction + Flexion .scuption .Ball & Socket , . . ( Gliding , ). 1. : , , , , , , . , . . . . , . . . , , ( - ASIS, - Inguinal )Ligament . " . " , . , . , . ( ). . : , , . , (). , , (, , ...), . . (.)Alignment

1

-

: . . , . . -.Mid Position . , ( ). . . : ,Acromion Process Greater Tuberosity-.Deltoid . ,- ( ). ( , , ). Glenohumeral Joint . . - Glenohumeral Joint , . . ( )AC jt, SC jt . " . . - Humerus , - Lesser Tuberosity (- mid position ). - IR .ER - ,ER- Lesser Tuberosity , -.IR . SCM . , ( ). . - Side Flexion . , . Pectoralis Major . . ( ) ( ).

2

-

: . Acromion process . ( )CG ( ) . " , . - Protraction ( ) -.Retraction ( ) . . ( / / ). - Mid Position , 3/1 . " . , . : . . Depression- .Elevation -7 T- Spine -2( T ). , .Upward Rotation , .Protraction . Inferior Angle- Medial border . , , . - Medial Border 2 5 ", . ( Glenoid ), .Mid position Winging ( )Serratus Anterior-( False Winging Inferior Angle ). . Supraspinatus - Spine , . . Infraspinatus - Spine . ,Posterior Deltoid, ...

3

-

. , Iliac Crest - CG. . , , . . () . . - Lesser Tuberosity 2 . . . . ( ) . \ , . . , . 2. -.Glenohumeral 6 . , . , )EF( End Feel .)OP( Over-pressure : g ( ). , ( ). " . , ... , . : . ( ER ) , . ER = )HBN( Hand Behind Neck IR = )HBB( Hand Behind Back Horizontal Adduction " .OP : (, , ) " , , , ( ) . , , ( / ) .

4

-

, . ,overpressure , , .OP , " -.EF ( " ) . : . . " . . . . . ( )OP , , (.)GH , . -.GH . . .Winging OP ( ) , - OP -( .GH , ). Hand Behind Neck , - ( ) . , " . OP ( ), , ER" . Hand Behind Back . . : IR + Ext + Add OP . OP- IR , , . . Horizontal Adduction - . . . OP , . , . , " . , !!!

5

-

3. . , . , , End Feel , ,over pressure ,EF , . -.GH . -.GH , . . - web , - . Elevation . , . Depression , . Retraction . Protraction Rotation . -3 . -:Glenohumeral Joint Flexion . . ( "). . 90 ( -3/2 ). OP . , . . Abduction 120 - .GH . . ( ). ( ) , . - .GH External Rotation - 90 . . . . . Internal Rotation , . - ,45 , (), . " ( ) . . Horizontal Adduction . - 90. . .

6

-

4. , . . , , .ER ,IR , , . 1 - 2 3 , . . : . , , , . ; . , . , 01-5 . . . . , . 4 . ( Biceps" - )Long Head Biceps , , . Abduction , . . . . 5 . . . Adduction , , . . , . - 90 . - ER . . - IR ; .

7

-

: 1. , , . , . : . : - Sternoclavicular Joint . . . ( / / + ). - Acromioclavicular Joint . 4( C ) . Glenohumeral Joint . 5 ,C , . , . , . ( ). . . Impingement . Subacromial Impingement ", . Subcoracoid Impingement -( Coracoid ). Unstable Shoulder ", " -.GH , , . , . , . (, , ) , ': .

8

-

: , . = , , , (, ) . Subacromial Impingement Supraspinatus -.Subacromial Bursa , ,HBB ( IR ' ). Glenohumeral Joint Capsule ,HBB, , ER -.HBN ( ) , . , . , , . Glenohumeral Instability ( ) " . . , (, , ) . . . - AC Joint , Elevation . . -, ; -. : - ,GH , . . . Impingement - Greater Tuberosity . . 2. . ( Subacromial Impingement )Supraspinatus (" ,NSAID's ') . ' : , .Upward Rot - Supraspinatus RC ( , - RC ) .

9

-

: , " . . , , ( ) . . - Lesser Tuberosity . , . " - ,IR (" Pectoralis Major ) - . - 3/1 . . : - ,Subscapularis - ( .Infrapinatus ). " " " . , , . , . , AC ,SC ( ). (, ) . Elevation-.Depression Elevation ( Elevation - Levator Scapulae ). Depression " Pectoralis Minor ( ). / , - 5 " - ,Spine . (" / ). Pectoralis Minor . , - Glenoid , , .Upward Rotation Downward Rotation ( )AC ,SC Levator Scapula-( Pectoralis Minor ,)DR , , Serratus Anterior UR . True winging .Serratus Anterior False Winging Pectoralis Minor -Caracoid Process - Inferior Angle .

01

-

/ . . . . . . . ( ) . . . " . GH, , ,HBB ,HBN . , . . ,OP "" . ( OP ). OP . HBB ER. , . (, , ) OP . . , , . : * * . * . : * Scapulo-Humeral Rhythm 2:1 021 - GH (06 ). (-03 ) . 03 - .S/H Rhythm . * ,UR elevation , . * , . " ( ). . 6 -.GH " , -.EF OP .EF end feel . / - / -. - " . ( )

11

-

. : . . . : GH .ER>Abd>IR , . ': 90 = ER ; 120 = Abd ; 80 = IR. Normal 45 = ER Abnormal ; 90 = Abd ; 72 = IR. ; .10% = IR ; 25% = Abd 50% = ER - EF (). : , , " - .EF - Y ( )P ( .)R - X. 1 R . 1 P . . 2 R " . 2 P ( , ). ' P' / R . : . - EF . ,

. . (, '...). .

. .

" . . " .

21

-

. : * ROM . * " . * . ? * ( .)AC ,SC ,ST * " EF (.)STS * EF .Empty , ( ). SC AC . - GH - Infraspinatus ( A-P ). ? . - GH . . ER ( .)P-A ER P-A ( ). , . . . . , . . . , , .. , . , - Biceps-.Triceps . ': ER - Supraspinatus " ( ) . , . ': , . . : - Supraspinatus , ER . HBB . - RC -.Biceps

31

-

, " - Bursitis ( - .)Subacromial Bursa . 1. . 2. . 3. : ,RC, .Subscapularis ,Serratus Anterior . . . : ,Biceps ,Infraspinatus ,Pectoralis Minor .Pectoralis Major ,Levator Scapulae . . 2 -:Impingement Neer Impingement Test . IR . ( ). . Hawkins-Kennedy Impingement Test Neer . -09 , - 09 .IR . . .

41

-

3 : -, -, -. . " , (, ) . , , ,Tennis Elbow (5 )C . : , , , . " . , / . , (, ), , . ( / ) (, ) : = , , , . , , . ( 0), 5. ( Caring Angle ) . ,10-5 .10-15 . . = . . , . , , , (- Resting Position ). - EF . Cubitus Valgus , , . " . Cubitus Varus .

1

-

: , , , . . , , , .OP , . . . - EF . STA EF .Bone to Bone mid position . , . -.OP , . / - ,90 . . . OP . . , . : . / . . : , . . . 4 : , , , . 4 ": , , . : - 90 - .Mid Position 4 , . ( "), . : " ", , 5 . , . : , , , " . . . , " , . . , - Mid .Position , , . ( , ).

2

-

. , , , , , . ? - , , ( , ). ( , '..) , . : , ? ? , , , ... . Tennis Elbow .ECPB ,ECRL , , 4,3 ( 7.)C / , " ( / ) . " , ". ( )twinge . - GH 5 ,C 5.C . " , " .OP : 90" . . , + .OP

3

-

: .130 ( 30 30 )0 / 50-60, . End Feel - Bone to Bone ( ), " - EF Soft .)STA( Tissue Approximation Bone to Bone ( - EF Soft Tissue .)STS Stretch / .)STS( Soft Tissue Stretch end feel " . . . : ( ) (, ...). ( ) - Superior Radio-Ulnar Joint . = Closed Packed Position EF STS EF . . , (, ) . , " . . / . / : , , , ,Radio-Lunate-Scaphoid Joint, . . , , . . , . ECRB .

4

-

3 : 1 . 2 " . 3 3 ( ) , - EF Bone to Bone . ( ). , . . . : Biceps Pronator Teres FCU ,FCR ,ECRL

-Tennis Elbow ECRB- ECRL / . , , " - . , .Mill's test . . " . , ' " ( - ). ( ) .

5

-

: : ? ? ? : . ( ) ; . . . : " / / ( Thoracic Outlet ) . 2-1 , . . . :Quick Test . . : + over pressure . , : 7C 7.C : ; ; . : 5-4 , 8( C 7 C- 1 ,) T , (), ,Thoracic Outlet 7.C , . : " 6( C5-C 5 ) C + OP - GH " ( - .)quick test

1

-

, , . . , , . , , , - . : / / - /- . . , . ()alignment Resting Position Wrist , ( ) - PIP : ? ? , ? . . . . - RA -.MCP / , . , . Dinner Fork Deformity , " , Displacement . = Dupytren . Lunate - Capitate . : , , , . . . . . , .2

-

, , . . , : , - ,90 . : . . - Wrist " - . " , . . - . ( tip to tip ). : ? ? " ? ? : + OP + . .OP . , OP. - , . OP : - , . OP " - Lunate . OP -.wrist - EF STS ( ) ( )

3

-

. - . ( ) . .90 : - - .Mid Position . ( DF ) 4 . -.mid position DF ", PF : " ". - . ( ) ( ). PF .DF Ulnar & Radial Deviation . . . - MCP mid position ( PIP ,)flex- DIP- flex. . ( - .)wrist . . : Interosseus- MCP Lumbricals, PIP- DIP -.mid position - ,wrist . - . -2 . -. ( ). 5 -, - - .Opposition (" ) -.mid position . . ( ) . PIP .

4

-

Wrist = Flexion > Extension MCP & IP Abd > Extension Thumb CMC OA . . . . . . . . . . " . . Power Grip-Precision Grip Power Grip , . . , . . . . . Precision Grip . . ( , " 2). , , . : .Adductor Pollicis ,ED ,FDP ,FDS - Adductor Pollicis .

5

-

Sensation : (, ..) , ( ) . . ( ) . ? , , , ... ( ), , . 5 C . . , ( , ). ( ) . . : - Shaft - Radial Nerve . , . , . Carpal Tunnel Syndrome : \ \ . : Tinel's Sign FCR- Palmaris Longus Lunate ( ) . Phalens test " , .

6

-

De Quervainss Abductor Pollicis Longus-.Extensor Pollicis Brevis . : : . . . , " ( ) . Finklesteins test . . - mid position . 17 Colles (25\6 )F 71 Lt Colles 6 . , . . : , . . :Hx ? ? ? ? . - Close Pack Position . ( ) : ? ? . ? ? ? ? ?7

-

? ? ( ?) : , / / ? ? : , . O\E , ? , , . , ( + Tx+Cx )OP, , ( + .)OP . " + OP " . . " .AA

8

.WB )(Body Chart . , - SI Joint. - Patello-Femoral Joint . . . . , ? , , , . . . ( ) . : , , , , . . WB - Stance -( Swing , -.)WB . ()Quick Test . ,WB , , . WB . : + OP . .: Flat Foot .IR IR ( \ \ ).

1

? , , .... . , , , . " . 2 , ( ) ( \ ) , . Anterior , , 2. IR ER . , , ? . Posterior ) (Lx / / C-curve = List( List / S-curve side flexion ) . . . - Gluteus Maximus . Lateral - = Mid Position- ASIS-PSIS . - ASIS- Pubis -.Mid Position , -( APT . - APT- ASIS ) . ,ITB . - ITB . , . - Iliac Crests , , . -, , . , , .

2

. ,Iliac Crests ,Greater Trochanter ,PSIS ,ASIS . Iliac Crest - .Iliac Crest . ASIS- PSIS . ASIS - ASIS . PSIS ( ) - .Crest . GT . - ,Iliac Crest- GT . - GT ( ). . ( ). : : Mid Position , , IR-ER = Postural Fault . " - ,Mid Position" . : , -( ER ). Flexion Deformity - mid position . : Short Hip Flexors Tight Capsule & Ligaments " ( 1 )L5-S - APT . , . . , . 5 L-1.S - Sacro-iliac Joint . , , ... - APT .

3

External Rotation Deformity . - ER - IR -.mid position : ER . Adduction Deformity -.mid position : : . - Add , , "" . , , , . , . . -5 L . C-Curve ( ) . . - Iliac Crests . . . ' . .Iliac Crests . - Iliac Crest . . ( - ASIS), . ( ). . 2 : / Anatomical (true) Leg Length Difference Functional (apparent) Leg Length Difference ( ) / , .

4

- Iliac Crests ,GT , : - ,Tibial Shaft ,Femoral Shaft , '... / , ITB . . PSIS, ASIS ASIS's PSIS's = . , , -.SI jt - ASIS - PSIS . C-Curve . 5.0 , , ' ... ' . NWB . , Iliac Crests -2 . - ASIS's -09 . 2 . , . . . : - ASIS . : . , . . , ( ) . : , . , " . .

5

(:)Leg Circumference . . ( , ...). . : 3-2 . . . : " 2 . . . , , . , , , . : , . APT- PPT , / . Trendelenburg Test . - . ( ) . Squat / ... , -. Flexion . , . . Flexion .OP Abduction .ER . Abduction ( ) .OP .

6

Adduction . ( ) . Adduction , . + -09 . . . , . ( - IR , ). , , . - 90 . - ER . - IR . Extention . . - OP , , -.Ischial Tuberosity , OP . Extension ( ) . End Feel ( STS ). ER . IR - Close Pack Position , IR . - Close Pack . - EF , . - Resting Position . - Resting Position , ER . . . . : (03-52 ) . . . . -09 - Iliopsoas ( - 09 ).

7

: . . -03 . - Gluteus Maximus : . . - : -( Mid Position ) . ( ). , , , . , - Outer Range . () - Trochnteric Bursa . . " .US IR-ER: -09 -09 . 4 : " . " / , ( ) . " . " 1 ( ). () - 02 . . . - Piriformis ER - .mid position -09 .ER -09 ( ) -.Piriformis . .

8

1. 2. 3. , , 4. : WB : 50%( Iliopsoas , %05 ) . Gluteus Maximus Gluteus Minimus : Iliopsoas Rectus Femoris TFL\ITB Hamstrings Piriformis : Thomas test Modified Thomas test Rectus Femoris ,Iliopsoas-.TFL\ITB . Thomas Test . ( ) . . () . ( ) APT ( ) , - PPT . : () : "

9

Modified Thomas Test ( ) . 2 () . ( ) : Rectus Femoris ,Iliopsoas-.ITB -08 ( - + )mid position . ( ) " - . ( ). TFL\ITB - mid position , IR ( ) . -08 () . - mid position .TFL\ITB - Iliopsoas ( - Iliopsoas , .)ITB - Modified . Modified . - ITB: . - :Rectus Femoris , - mid position . = 011 ( APT ). TFL , . . , . . , . ( Hip Drop Test -)TFL . . ITB, . - Quadratus Lumborum -.ITB

01

: IR , - IR. - ,ER .

11

. " . . . . : ( ). . . , ( - Tibio-Femoral Joint , ). -Patello-Femoral Joint / . . . . = . " . . Medial & Lateral Collateral Ligaments " . . , . . . ( ). . .

1

. . ( ) . ( ). WB" . . Giving Way .WB . , , , . . : : , , , ( TFL- .)Pes Anserine , , . - ,MCL . : , . , " ( ). , . , . ': - GH Joint . , - GH - Serratus Anterior . Knee Locking : . . :

2

Quadriceps , , (, /, /, ). , ? /( ). ,Gluteus Maximus, . ()Flexion-Extension . , . - 0 ( ), . , , . . : . ITB Anteversion Coxa Vara ()Flat Foot Retroversion Coxa Valga - Eversion. - ( - Loose Pack , ). ()Internal Derangement - - - . .

3

Patellar Alignment . . ( , ). . " . . . IR ER ( "" ) . = ( Patella Alta ). . - . = Patella Baga . ( , DFM ). : , - 09 , . (, ). - mid position .ER , . + ER 03 . + OP IR- ER -09 . + .OP . . : . , , , , . , , " . , ... . ( ).

4

, ( - .)Suprapatellar Pouch . Fluctuation Test , . . - Suprapatellar Pouch . , ( ). - , (= ). Patellar Tap Test . . . , , . " . " -. - - . + OP OP . , . - EF STA - EF STS ,P-A ,A-P Tibio-Femoral Joint, . Patello-Femoral Joint ( ) , - -. Superior Tibio-Fibular Joint Patello-Femoral Joint . Compression . , . . . ", . , - .

5

Q Angle - Q , , . . - ASIS - .Tibial Tubercle -.Q Angle ( ) . 31/21-8 . " , . - .Patello-Femoral Joint - Q Angle : IR Anteversion ER Genu-Valgus ITB ,WB 2 , ( ). 2 - ASIS's . Apprehension Test - - .Patello-Femoral Joint . - 2 (52-02 ) . . . . . " . Tibio-Femoral Joint , . . , , . , , . , , EF . , . () 1 2 , , '... , 1 , . 2 . () ( 3) 2. .

6

- EF , . - EF . - EF " ( - ROM, , ). , . 1 2, , . ,US . 3, . , . : 1 , ,DFM '..., . 2 3 . , . Anterior Drawer Test . 09 . . = . - ACL . : 09 . , -.PCL - PCL = .Posterior Sag Sign - PCL , " . . . . - 09 . . Posterior Drawer Test , .

7

Valgus Stress . , " ( .)MCL 52-02 . ( ), " . , . . ( ). .ER : ( ) 1 2 . + 1 2, = . 3 ( ). - Close Pack , . 1 2, . 2 3 ( ). Varus Test . . Appley . -09 . . . . . , . - DF . -.Medial + Lateral Coronary Ligaments . ( ). . 09 .

8

/ , / : " . " " . , . ( ). . " , , . -EF " . : * . * " . * , , ... - MCL . ? .Giving way . , . . . : ,ACL , - ,MCL . - ACL . : " . ( = 3/2 ). " . " . .

9

ER-IR . ER - MCL -.Medial Coronary Ligament - MCL . MCL . (- 5.2 ") . - ER Medial Coronary Ligament, 09 . . Lateral Coronary Ligament . IR-09 . - LCL -.MCL -. ? . " " . Springy EF . McMurray Test " " . ( ). .Appley ER + - + ER. "". "" . . + + IR + IR . Extension Quadriceps . TFL Last 30 of ext Patello-Femoral Joint Flexion Hamstrings Pes Anserinus Gastrocnemius . TFL - 30 to full ext External Rotation Biceps Femoris TFL Internal Rotation Semimembranosus Semitendinosus Sartorius Gracilis

01

Flex-Ext . " , . , . : ER IR PF . : - Tibio-Femoral Joint , - Patello-Femoral Joint . Modified Thomas Test Rectus Femoris Prone Hamstrings Gastrocnemius

11

-3: Fore-Foot Mid-Foot, , . Hind-Foot DF ,PF - Abd ,Add / . - . Eversion ,Inversion . , . -)Open Chain( NWB ,Eversion -.DF - Subtalar joint 3-2 ( ) . ( ). -NWB ,Inversion -( PF ). -)Close Chain( WB -, . ;Eversion PF. Pronated Foot - Hind-foot , : -IR -IR . - PF - IR -.IR - Eversion . - PF (- PF ). .

1

(-) - HS , ( ) - Toe Off . : - Hind Foot ( ). = . , - .Toe Off . Pronated Foot " . Pronated Foot - 09 ( - 09 ). = .Pes Planus = Flat Foot - :Pronated Foot -: . , . , . . - DF , . .Tibialis Posterior : , . : Anteversion. . .TFL Gluteus Medius ( ). Pes Cavus Hind-foot " - = ( Rigid ).

2

Hallux Valgus - ( 1st MTP 2). , . . , . Hallux Valgus - Stance - Toe Off , . Hallux Valgus , , . " . Ligament Sprains - .ATFL . ( ). .Pronated Foot Quadriceps , , Toeing In / Out Forefoot / / - / / / Spasm / Wasting, , / / . . . " . ( ).

3

: . . , . - CG . - Iliac Crest . . . / Forefoot - / Hindfoot / ... , ? , ( ). Hallux Valgus , - Forefoot -.Hindfoot . . - ,Quad, . . WB . . , -, ( ), ( ). - Alignment . ' . Forefoot - Hindfoot - Forefoot -( Hindfoot -.)Pronated Foot 2 1 ( ). : . , - mid position . . - . ITB , - CG ( ). . : ,Gluteus Maximus, , . . -09 - 09 - Subtalar Joint -.mid position -09 . -mid position .

4

-WB , , , . : ER / IR IR .ER , . - 1st MTP - Toe Off . Eversion / Inversion, / - .Subtalar Joint , ... , , , , , . , . DF-:PF . ( ,)Talo-Crural Glide . , , - . ( ). DF , . PF . , . OP- DF , . , DF - WB .OP OP- PF ( ) - . () ( ) - OP .PF : . .OP : . .

5

PF- DF .OP - Subtalar Inversion- Eversion ( ). , . - Subtalar Joint - mid position inversion-.eversion - Inversion , - Eversion . - Mid-Tarsal Joint . , . -. .PF 1st MTP Joint . , , . -PIP Joints PF -DF - Inversion Subtalar Joint - Eversion - .Eversion - 1st MTP Joint Toe Off . - .ATFL - .Calcaneo-Fibular - DF -.DF :ATFL - ATFL , . PF ( ). . , . . ( ) . " . . / / . :Calcaneo-Fibular Ligament () ( , ). -.Inversion , . .PF / DF .

6

Anterior Drawer Test . - ATFL . -02 ( PF , ). 2 : 1) , 02 ,PF , . . . - ATFL, . 2) , , 02 ( PF ). ( ) . . . . Inversion .PF , .

7

ORTHOPEDICS & TRAUMATOLOGY : . . . : , , , ... , , '... = . = . = , , ...

: : . , . . (, ...). . . . : :X ray , . . ' : Simple -2 . Special Postures ( ). Plane Tomography , - C.T . , . Stress X-Rays" . Contrast Studies , . :Auxiliary Tools U.S , , , , , ... . Scintigraphy = Scann ( ). , : . ( ). .1

. (.)A-Vascular necrosis . CT , , ... " . . MRI .80-85% . - MRI . Arthroscopy -07. . . . E.U.A " . . Biopsy . .

- FRACTURES: = . , () . . " / .

: . , . - .

: Simple , . Compound , . Greenstick . . . Comminuted . Impacted .

2

: Greenstick . " . Salter Harris : .Epiphisiolysis . . ( .) 5 : 1) , . / . - stress . . 2) , . . . 3) . 4) 3+2 . 5) , , . 5 . , .

:Bone Healing . " = ( , ). : ! 1) - Hematoma . 2) Coagulate . 3) Callus - . 4) 5) . . .

3

: : . . : . , , . . . , ( 42 ), ( ), . . = / . , , - ( ). : Non Union . , PH, , ... = Pseudo-arthritis , 2 : 1) Hyperthrophic , . 2) Atrophic , . Delayed Union . . , . Mal Union . . : " " . - . Sling Splint . ( )Cast ( .). ( )Traction "" ( ). . - , , . = . = . . . . ". , . 2 : .External Fixation- Internal Fixation !

4

(:)Internal Fixation Kirshner Wire . . . . . . . (:)Replacement Hemiarthroplasty , . Total Joint Arthroplasty ( ). ( :)External Fixation . : : - : Arthrodesis - ( ). . : - Arthrotomy . - : Arthroplasty : Arthrolisis " . . : Arthroscopy : : Osteotomy , " . : Bone Graft . , . : Osteoclasis , . " : Osteosinthesis 2 " , '... : 2 , . . 2 . - + . , . . : , .

5

: . , . , . - Fibrocartilage , ( ). : Fibrocartilage . . , . : - . . , . .

6

Elbow Injuries Pulled Elbow . - . , - Annular Ligament . " 6, . , . , ( Capitellum ). , . . " -. , . ' . . Supracondylar Fracture , . ( %09 -). . : - Olecranon . " . . ( 01 ). . , . ( Percutaneous Pinning Fixation ), . " . : " . Brachial Artery . () . Compartment Syndrome ( ) . - :P , , , . , , . -.Median nerve : Mal-Union . - Cubitus Valgus / Varus . " - .1

Lateral Condyle Fracture " - ,Supracondylar . 5-3. - 081 , - ( ), , . . , - Epicondyle . ( 4-3 ). .Valgus

Tennis Elbow ( , ...). -.Extensor Carpi Radialis Brevis , . 7 C6-C - Posterior Interosseos Nerve . %59 . ' ( 81-21 ). . : .. . ( , ). - US , . , . %01-5 . . Supracondylar Fracture . . :Supracondylar Fracture 1) -. 2) - . 3) - -. : ( " ). . / " . , (-, -, ). , , ( ).

2

Olecranon Fracture " , - Triceps - Olecranon. , "" . - Olecranon . . 2 ( , ). , . : . . . , . , = .Capitalectomy , , ". , -.

Forearm Injuries 3 : Both Shafts Monteggia Galleazi Both Shafts - Shaft . . . " . ( Intramedullar Nail ) . " , . Monteggia . - Ulna - Shaft . , . , , . Galleazi . . + -. , . .

3

Wrist InjuriesColle's Fracture , -. . ( ). , . . -.Styloid Process , . : . . ( ). - Median Nerve ( ). : . , . " . ( ), . Close Reduction , . External Fixator 2 - 2nd Metacarpal-.Shaft Internal Fixator ( ). : -Median Nerve -Extensor Pollicis Longus Mal-Union . Frozen Shoulder . Sudeks Atrophy - . Reflex Sympathetic Dystrophy .Reflex Sympathetic Dystrophy , ( ). . , . . . , . ( ).

4

Carpal Injuries -Scaphoid . - Scaphoid , . , , - .A-Vascular Necrosis , -. . , . , , 01 . " . " , . ,Non-Union , . -, , . .

Carpal Lesions Carpal Tunnel Syndrome . ( ). , , ( / ). , , "". " . . . . , . " " .

5

Finger Injuries Subluxation - Ulnar Collateral Ligament- Phalangeal Metacarpal .Joint ' : Games Keeper Injury=Skier Thumb=Stenner Lesion , . , . , ( ). , .

Special Subluxation . . . - Dislocations ( ) . . () . . . . , , . ( ). -, . . ( ) = Bennet Fracture - . . . Mallet Finger " . . " , .

6

Shoulder PainFrozen Shoulder . . , . , . : , Frozen Shoulder . 06-04. - ( Frozen Shoulder ). ( ). Cervical Discopathy . :Frozen Shoulder 2 , . 1 .Irritative Capsulitis Type 2 .Adhesive Capsulitis Type , - ,Irritative Capsulitis - Adhesive Capsulitis , . Frozen Shoulder - Freezing 6 -9 . . . . . -. , . - Stiff 21-6 . . . . : - ( ). - Recovery 6 . " . , . .

1

Impingement Syndrome - Rotator Cuff " . - Supraspinatus . . . : = Coraco-Acromioclavicular Arch.Acromion+ Coracoid+ Acromioclavicular Ligament - Rotator Cuff Supraspinatus, Infraspinatus, Teres Minor, Subscapularis - ( ). : 3/1 (, ...) . 3/1 ( , , ...). . 3/1 . : . - 07 001 , . = - Supraspinatus . , . : , - acromion - . - .acromion : . , . 6 . ( ). , . -Sub-Acromio-Clavicular Decompression -Arthroscopy . , ( ), . , - Acromio-Clavicular ( ).

2

Rotator Cuff Syndrome -:Rotator Cuff ( ). + .Elevation . , , . Supraspinatus Bursa . . : . - .Frozen Shoulder , Painful Arch 021-06 . , ( ). Pseudo locking . . " ( ). . -:Rotator Cuff US . , . . CT Artrhogram . , . MRI ( - ,)CT . . , - Rotator Cuff ; - %06 . . : . . .. acromion . - . . . , .

3

Shoulder Injury

- 2 : (.)AP -( Gleno-humeral ).

. - 3/1 () . . . . -. : Malunion / Non Union . - , ( ). Spike of Bone . .: , . : ( . . : . . : Greater tuberosity -Supraspinatus . -:Surgical Neck " Neer 4 . - ( , ). 3,2 4 . . 3-2 " . 4 . CT ' . : " CRIF . Total Shoulder Arthroplasty . , .

4

: . . Malunion . AVN . Brachial Plexus injury . . Myositis Ossificans . Stiffness - ( Frozen Shoulder ). (-:)Shaft IMN " " . ( ), " . : . - Radial Nerve , . Nonunion Malunion Stiffness - .Frozen Shoulder

-DislocationsACJ dislocation . : " . . : Pain Piano Sign . : 1) - Sprain . 2) Partial Subluxation %05 . 3) - Dislocation ( ) ( ). : " . , . .

5

Shoulder dislocation - Glenoid-Humeral , . : . - = .Hills Sacs Lesion . " . . : .Bankart Lesion , - .Rotator Cuff *** ". Hills Sacs Lesion - .Glenoid . - . Bankart Lesion , . SLAP Lesion . . : Anterior Dislocation ; %09 . " + .External Rotation Posterior Dislocation . Erecta ( ). Fracture Dislocation . Multidirectional , . . : . Acute . Chronic : %69 . .(Habitual) Voluntary Anterior Dislocation . . . - . - AP-.Lateral : / - Rotator Cuff . 04 -%03 . 06 -%08 . . -.Axillary Nerve Irreducible . Frozen Shoulder . . , .

6

, , Frozen Shoulder . : . , . . . 6-3 . 3 " Frozen Shoulder. " 8-6 . , " . , " . , . .Hill Sacs Lesion Posterior Dislocation . . 2 , : . . " .

!!! Frozen Shoulder . -.Rotator Cuff - Rotator Cuff . .AVN - ,Gleno-Humeral Joint . , - Rotator Cuff-.Frozen Shoulder

7

Cervical Spine ( 1 )C2-C (3.)C7-C (" ). Cervical Pain - Cervical Spondylosis . 2 . , 2 ( ). . 04 %09 . ( ) . : . ( ) ( ). ( ). . .Cervical Pain Spondyloarthrosis . : . , , . . : . .Traction ,Taping , ( ). :- " , '... Fusion " ( ) " .Spacer

1

Protruded Disc - %09 . .Annulus Fibrosis .Nucleus ( ), . , . / : . - . , . , . : , . . " / . " 4 -4 C . -5 C6-C . . . . : , '... . NSAID's . . : ( %51-01 ). ( " ). Disectomy (-) , - (" )fusion 2 .spacer Acute Torticolis . . . , --, . . . 2

- Lower Back Pain %52 . %08 . . %09 3 . . : , , , . Acute Back Strain -. " . , . . . " . . 21-6 . . , . . , . , , " . %09 - 4( S1-L ) . : . . , - Spinous processes . ( ). Straight Leg Raising = SLR - .Sciatic Nerve , ( -07 ). () . , ( ). : . . CT . () . - MRI .

3

. : , . . . ( ). : . . . . - .Cauda Equina . ( ). . 3 : . . - - Sciatic -.Extensor Hallucis Longus !!! .

Spondylolisis . - .Pars Interarticularis . , . . / , . : ( Spondylolysthesis ) . : - ( ). . . 2 : " (" ). " .

4

Ankylosis Spondylitis . . . Bamboo Spine -.Anterior Longitudinal Ligament . 52-02. , . ( ). , -.Sacro-Iliac Joint : .Bamboo Spine . : " . . ( ) .

Scoliosis . " 2 : - . - Spinous process ( ). : () . - (' ) . : ( %08). . . - . , . : , , . 01. . ( ). " . : . ( ). . : .- .

5

: / - %59 ( ). Risser : . , . . , . : , ( ). . , Pedicle . : . " -02 . - 02 . , . : . ( )Braces Milwaukee . / . : - Brace . . . , .

- Juvenile Kyphosis - Scheurmman`s disease ( ). , . . . : Schmorl`s nodes ( ) = . . + . ( ). : - .- ().

6

- Spinal Injury Broken Neck . , . " . " - .broken neck . : Flexion . Extension . Vertical Compression . Rotation . : . " ( 3 C). - ,Spinous process - Nuchal Ligament . " . -.Spinous processes , . " . - " ( )Hallo Ring " . 8-6 " . - - Dislocation W/Fracture of body - . . Crush of Vertebral Body = " ( ). . : , . . - )Dens=( Odontoid Process 2 C . 3 , : (2 )Type . " (%05 ) . 3+1 Type . Hangman ( - )Pedicles 2 .C, , ( ). -%59 ( Hallo .)Traction + . , = , .Decompression7

,

:Vertical (axial) Compression Injuries . . 1 C1 C . . , , . : .Jefferson " Hallo Vest - Collar 6 . Whiplash Injury . . , , '... 21-6 . . -.Nuchal Ligament . ... , . . .

- !!!

-Thoracic Spine . . . - ( Paraplegia ). : (.)Compression . . . . " , . ( ). Seat Belt Injury . -. . . , . : . -.- .

8

Lumbar Spine Fractures . . - 3 : ( ) , . , - Posterior Longitudinal Ligament-%05 -%05 . , . %05, . . . . %07 . + , . 2 . " .- .

9

( ) - Leg Injuries : ( 41-31): : . 5 . " . 5 . " . . / Titanium Elastic Nail ) (TEN . : . ( ), 3 . . . Intramedullar Nail . - ,Intramedullar nail .External Fixator , , . 8-6 , Braces . , . : . Compartment Syndrome " . . , . . . 5 :5P Pain ( , ). Parlor. . )-( Pulse . Paresthesis. Palsy . . , , . :Compartment Syndrome " . .20mmHg1

: ( ) . 27 . . 5-4 ( )Observation ()Open Cast " - , ( ). : Delayed Union . Malunion . Non-Union , 5-4 , " . Joint Stiffness . ( )OA ! : : : " . , . ( %09-08 ). " / . AO . (-%09 ). (- %05 , -%05 ). (%08 ). . .Three / Two / One Malleular Fracture . : %51-01 . ( ...). . - . , " . , , %01 (-2 ") OA " . ; ( 6 ). . " Walking Brace . ...2

Ankle Sprain . Inversion -%59 . . ( ). / / . . . , . : . . . " . . . . . . 3 . ( ). , " , . Achilles Injury , 6-5 " . . .Plantar Flexion . ( 6 ), . Talus Injury . ( ) (= ). . , . , .A-vascular Necrosis Hawkins Types . 1 Type . %01-0. 2 Type . - %05-02 .A-vascular Necrosis 3 Type + -%001-02 . , . .

3

: . " .External Fixator " . Foot Injuries Calcaneus Fracture . . ( )Extra-articular (.)Intra-articular ", . . . " , . . 54 , - 52-02 . CT . Lisfranc - + Tarso-Metatarsal Joint . 2+1 2+1. , ,Stress . , . " ( ). - Foot deformities Flat Foot " - .Plantar Fascia 01-6 . -%02 ( ). 2 :Flat Foot Flexible Flat Foot , . %06 . Rigid Flat Foot . ( ). - .Flat Foot . Tarsal Coalition , . 2 "". ( ) " . -%2-1 . . " - , ( 51-41). - . .4

, . " , . Club Foot ( ). . = Equinovarus - .Plantar Flexion , . . : %03 " . , . -%09 . , " ( ) . -Ponseti's Method , . Equinovarus . -%01 " ( 9 ). Intoeing Gait %01 5-2 . 9. 3 -:Intoeing Gait Anteversion ( ). ( .)Internal Tibial Torsion ( ,)Forefoot , . . Hallux Valgus . ( Bunion). , . . , " Toe Split ( OA ), . , , . 3 . -%02 . " .

5

Diabetic Foot , , " . . , , . . " . . , . . ' 1 . , . . .

6

, , . : ()Direct ( )Indirect . ( )Overuse . 3 . . : , - Patello-Femoral -.)MFC( Medial condyle . . . : . . . , . . Overuse -, , Pseudolocking . . :Postural Problems , ( .)Mal-alignment / . , , . : ? ? ? , . . ( .)Vastus Medialis Oblique . ROM . . / . , ( ). .ACL . - Apley`s ,Mc Murray`s Bounce Home Test ( ) . . ( MCL)1

/ / / , , ( ) . 3 :ACL Lachman Test 03 . , . Anterior Drawer Sign 09 . , . (-) : Pivot Test , , / - .ACL-02 - ACL ( )internal rotation : .Ilio-Tibial Band - ACL, , - ilio-tibial band , .External Rotation - .Pivot Test . = Giving Away . ( - 02 ). Antero-Lateral-Rotator instability " . . ( ) . 03 . : , , . -2 : 04 ( , 04 ). . , , '... . Spect , . .CT .MRI CT . .- MRI , - %57.

2

: Arthroscopy , . , . , : .Locked Knee = Bucket Handle , , . , . . (-3/1 ) . , . , %01 . , ( )Flap Tear . . , , ( ). : - LCL + ACL . - MCL + PCL . ACL . , . / , . - .ACL ( - ACL ). ' : 3/1 - Patellar Tendon ( Achilles Tendon ,Gracilis ,Semitendinosus -.)Quadriceps . " . . . Bone-Patellar-Bone ( ). -3 : / . - notch . . . " . - 5 . , - 3 .

3

: . Chondromallacia = CMP , . ( , ). , '... " ,NSAID's ( ,ROM , ), ( , ). - %01 . . . , . - Medial-Patello-Femoral ( Ligament , - Adductor Tubercle ). . " . . 2 : . . , . (%06) .

4

- Osteomyelitis . ( !!!). ( ) Metaphysis (" ). " . (). %52 . 2 000,01 . (%09) .Staphylococcus Aureus .Streptococcus spp " Enterobacteriace " . : ., ( , ). - PH . . () . ( Sequestrum ). . : . : . . . : . . . -. . : . . ( " ).

1

. . . , 01 . : . , , ( ). : . , " . , , () .

Septic Arthritis . , (). . Staphylococci . : knee hip ankle elbow wrist shoulder pelvis . : ( ) : . . US , . , . MRI .

2

Degenerative Joint Disease )(DJD - )Osteoarthrosis (OA ( ) . . . ( ) . OA ( ). 06-05. . , . .OA . OA : . ( , ) . ( = Geno-Varus O ). . . . () , . . .OA - Clinical presentation . . X-Ray: . . () . ( )." ".

3

-OA , ( ). . . ( NSAID's ), ... Viscossuplementation , .OA ( ). : , . . . . Osteotomy , . Arthroplasties " .Total Hip Replacement (THR) Arthroplasties - .OA " . , . . - THR" . , . -:THR . ( ). . . THR ( 54), . - -:THR : ( , , ...). . . : 06, . . : , : " . DVT .

4

: . . . : . . ( ). )Total Knee Replacement (TKR THR . . . : Uni-Compartment . . , . Total Condyle . . -:TKR 06. . . - -:TKR : ( ). : 06. : . : . . . " .- " .

5

LIMPING CHILD . ' . , ... . . . Perthe's Disease . . . . . = Self limited disease . . . ; . . ( 51 ) . - . 21-4 ( 6-4). 0021:1. ( 4:1). 3S' Syndrome . 1 Early Stage () . 2 Chronic Stage Stiff Hip , ( 3-2 "); = .Shortening 3 Coxa Plana Late Stage ( )O.A : . . . ( ) -Internal rotation . , . . - . . . ( ). ; .

1

: . . - . ( ) . Catterall . Herring " . : . , . " . : Canes ; . Splints. Braces . Osteotomy : Pelvicosteotomy . , " . : (5-4) . 01 , . : 3 . " . Transient Synovitis Septic arthritis Slipped Femoral Capital Epiphysis Septic Synovitis , . . . " 0 3 . 3-2 . " . " ( ). " . : , , , . . .2

: . - . , ( ). , . Transient Synovitis or Irritable hip . 01-3 ( : 5). . . , ( ). . . - . ( )Scann ( ); - Transient Synovitis . MRI , . 5-4 . . ( ). Slipped Femoral Capital Epiphysis , . / . - Epiphysial Plate . 61-11. ( ). . ( ) ( ). ( .)ROM . - .Epiphysial plate - - AVN . " .

3

)Congenital hip dislocation (CDH / DDH . . (-) , (). 0001:1 . - . : 5 . " ( - 53:1). ( ). %07. , ... : . . . . " - ' ( ). . : , . 3 . 6-3 (). Galleazi . .Asymmetric skin folds 21 ( -). . , (" 3-2 "). , .-: " US . . ( / ). : 3 . 03 -. : . . . %59-58. ( AVN -%1 ) .4

3 " ; : , . 6-5 21-6 . . " = 2 . , . " . " (). " . . CDH ; . Club Foot or Talipes EquinoVarus . . . . . 0001:1 1:2 . -%05 -. . . . " . . 6 , . " . 6 " ( , ). " 8 .

5

Pelvic Injuries . Multiple Trauma . %6-3.0 . : : . %57 . , , " ( ,)Clamp ( ). . . -3 (, ). , . . " , , " . , . / / / . / / / , . = . " - Low Velocity . " - ,High Velocity " . - Iliac Crest . . -. , -. 3 : - . - , ( ). " , . . : . - (': ).1

! " C Clamp " ,External Fixator , . . ( CT ) . , - ,Sacro-iliac Joint ( ) " . . . + .

Acetabular Fractures , . : Anterior column Posterior column Transverse Complex . , OA . , . ( ), " 8-6 " . , . , (). : -Sciatic Nerve , . AVN . , OA'... .

2

Hip Dislocation 3 , . Central . : Isolated . , . " , . - .AVN . , , . CT , , . CT . , . , , . , .

3

57. " 08-07. . 5 , . " . " ( " ). " . . . -2 : .Intracapsular Extracapsular Intracapsular Fractures / / . / . . . AVN Non-Union . , , . . Garden . ! 1 Impacted = Type , . . 2 Valgus - Undisplaced = Type . 3 Displaced = Type . 4 Total displaced = Type . . ( 56) , " 21 , AVN . , " , , ( DHS , . ). 21 , . ( - ). 57-07 .Total Hip Replacement

4

Closed Reduction + Internal Fixation . Open Reduction + Internal Fixation , Close Reduction . Prosthesis . , 56; 56 . AVN-Non Union ( ). . Extracapsular Fractures . . , . : .Subtrochanteric / Intertrochanteric / Pertrochanteric " Internal Fixator . " . . .

5

- Shaft . ! 5 " . , , ( + + ) - 8 . , . 5 . External Fixator 8 . . - Intramedullar Nail . " ( ). Interlocking . " . . . %03 . ABC . ( Fat Emboli, " ) -. , " . , , . " , , " . Interlocking Intramedullar Nail - = Golden State . ( , - ,)Notch . A-P. External Fixator - . Mal-Union Delayed Union () Non Union ( )Stiffness .

6

Fractures of Distal Femur - Supracondylar . , . - -, . Extrarticular Fracture " - ,Gastrocnemius -.Condyle " Closed Reduction ( ). . , ( .)Intramedullar Nail Intrarticular Fracture - " . : Oblique One Condyle ( Y )T -.Notch . -.Condyles , . , ( ). : . .

Fractures Around the Knee ! . . : , . , . . . 2 , ( ). . . , . . - . .CPM , . , - %03 .7

Tibial Plateau -3/1 . , .Valgus , - MCL . . , . . " X-Ray .CT " Brace " . : ( ). External Fixator .- + Open Reduction .

8

-

= . . . " , ( ) . , . . , - ( ,)Pain, Touch ("). . ,MN (") . " - . MN -. MN : , " , . ( ), , . , - 2 : . , , ( " , - ) MN-.Nodes of Ranvier . " . , . , " . , .

1

-

Nociception & Pain , (': ). Traditional Pain Physiology 3 : ( Free End Endings ) ( .)1st order neuron , , ( .)2nd order neuron rd ( .)3 order neuron " Nociception" . ( )Pain . ( .)Post-Central Gyrus : .Anterior-Lateral Spino Thalamic Tract ( = , = ) . - . , " , . , MN (" ) . . . , " . ( ), () . , . . . Afferent Peripheral Receptors " . () : .Transduction : ' ( ). " = . . " Merkel , . " , . Ruffini ( ), . ) Free Nerve Endings (FNE = . FNE , . - FNE , . :

2

-

, . . . .FNE * , , , , .Ligamentum Flavum ; . : 34 ( ). -5 . . PH, ,ATP, Prostaglandins ,Bradykinine . : ( / / ...). Polymodal . " . Pain Perception , . . . . Transmission (") . Modulation ( / ) . . .

Pain Transmission " : C Fibers , (= ,)IV fiber = .0.5m/s ,III fiber = A Fibers , = .5m/s ( Bundle ) - X - Y : C A A A C .A A - C . First Pain - ,A , . Second Pain - ,C , . , .

3

-

( )NT' )Pain Factor( Substance P C- A ( C .)A 1 9 , 01 -.Central Canal 6/5-1 . 9-7 . 4-2 ' )SG( Substancia Gelatinosa . A 1 4, 5. C 1, 2. 1 -2 = .Nociceptive Specific 4 -5 = ) White Dynamic Range (WDR - A-( A). A () WDR . Nociception " ( III- )IV , . . - Pain Stimulus FNE" - FNE = ( transduction ) . - 1st order neuron - ,Dorsal root ganglia - ( ). 2nd order neuron : Anterior-Lateral Spino-Thalamic Tract - 3rd order neuron . , . "" . : .4th order neuron , , ': , ' , ... -.Cerebral Cortex

4

-

. . . . . , , " ACTH . , , " . Reticular Formation - ,Anterior-Lateral Spino-Thalamic Tract - Reticular Formation . ( ). : . , ...C.O . - Reticular Formation . )Periaqueductal Gray (PAG - Mid Brain . - ( Sylvius Aqueduct 3 -4). . Nucleus Raphe Magnus - PAG- ,Reticular Formation . . . Amygdala . , . (, , ...) : .General Drives of General Sensations . ( ). , , . : . . .

5

-

PET Scan , ( , , '...). Cerebrum = , . . . -Pain Experience ? . - Reticular Formation

- (" )Loser 1. . 2. . 3. " . 4. .

/ ).Visual Analog Scale (VAS VAS ( , - 1 01 ). .

6

-

3 () . , , , . , . , " ". High / Low Actuality Disorder - . . High Actuality Disorder . . , . ( .)ADL " , ( .)HAD . Low Actuality Disorder . . / . . . " ( ). .

7

-

Spinal Modulation , 5-1 ,2nd order neuron : , .Gait Control Theory ( ). . . , ,TENS , ' . , TENS . 5,4 ( ) .Wide Dynamic Range Neuron WDR 5 . - WDR 3,2 SG , - SG ( WDR ) . , input- ,SG" . -%05 . - SG 3,2 . - SG - SG - SG" . ,inputs input - .SG " - input . " .2nd order neuron 2,1 Nociceptive Specific Cells , , . ( ). , .

8

-

: . . TENS . . Transcutaneous Electrical Nerve Stimulus = TENS - ,TENS . , . = ( ). = . = . " . . TENS ( ), ( ).

Central Modulation , . ( .)Opiate () . : (). Cerebral Cortex PAG , ( ), " () . , , " ; , " . . 2 : Tolerance " . Addiction . :

9

-

: , " , . , " "" . .Pain Reception - ,PAG , - ,Nucleus Raphe Magnus- NT ( ) 2,1 " ( )Enkaphalin . : Descending Pain Control Modulation .Central Mechanism " , , . ( ) . - Anterior-Lateral Spino-Thalamic - PAG -.Nucleus Raphe : " . " - Central Mechanism . - TENS , . : Naloxone . , . Naloxone + TENS ( ) , . TENS , . -2 Excitation of A Fibers A " -.SG Excitation of C and A Fibers , " . :)HAD( High Actuality Disorder . . . .

01

-

:)LAD( Low Actuality Disorder . . , .

11

. " () . %07 . , . = : : (" ). ( ). . . . , . ' . : , . . , . - Low Intensity " . - High Intensity . " , . (1) Peak Intensity or Amplitude - ( .)mA , , - = . ( -.)-55mV ; , . (2) - ( .)sec : " . .

1

-001 - ; HAD " . . -( 200sec .)HAD -( 200sec .)LAD ( )Selective Currents . . ( )Non-Selective 002 -. (3) . - , . , . - , . - ( )AC , . . , - . (4) . . ( = )DC 01 - Galvanic current . -01 - - .DC

= . = . " .

2

Iontophoresis . " . ( ,NSAID, , '...) . " ( ). . ( DC ). - . , - - 01 - - 01 . AC AC . . Iontophoresis " ". (5) = . ( , , ). . , . : AC 40Hz 04 1000m sec = = 25msec = 04 1000m sec = .5msec AC 200Hz 002 = 002 - (" ). " HAD ( 100Hz ) " LAD .1Hz-50Hz LAD . ( 002 -) 1-50Hz , . . , .

3

HAD , . .100Hz " " . ( ). : . . . ( ). ( , ), ". ' " : / . (, , '...) ( ). ( )Neurogenic Inflammation , ' , " , - .Dorsal root ganglia : )SP( Substance P , .)Calcitonin Gene Related Protein( CGRP SP- CGRP ( ). SP- CGRP , . , CGRP- SP 2 . . . , . , . . Hyperalgesia CGRP ,SP ( .)SP ; , ( ) . = Hyperalgesia .Sensitization of Nociceptors

4

. . , , , SP- CGRP . - , SP-:CGRP

"" : .Arachnoid Acid " -. , , , . " : - " . . , . NSAID - . . NSAID . , - NSAID . , "" , " / , ( ) ? - . " . : 1 ( ) -, . -01 " -.HAD , , .

5

2 () -3 , . " . . 3 ( ) -3 ( ). , Over Load (' - ACL )A-P. , . )PHA( Primary Hyperalgesia - SP -.)DRG( Dorsal Root Ganglia " , - DRG SP - SP 02 " - ( ), Primary Hyperalgesia , . , . - . :Primary Hyperalgesia . ( ). ( ). ( ). = Lateral Epicondylitis -.Common Extensor Tendon - " PF -, . - PHA ( ). , . Medial Epicondylitis = Golfer's Elbow , DF - .Golfer's Elbow ( PF ), - %001 , .

6

. - , . , = : .Allodynia

)SHA( Secondary Hiperalgesia : ; ': . 22 ( SP ). SP .PHA SHA = = .Referred Pain , SP , , - PHA , - 2nd order ( neuron 5 2) 20% - SP , ( - SP . SP ). nd - SP - 2 order neurons. - SHA . , . . - SHA - Central Sensitization ( - PHA - ). :SHA . . . . ( .)PHA ': - PHA 5.C4,C - SP = .Segmental Hyperalgesia

7

: ( ). " . . . " / . ? 5C4-C , " . , . , . , ( ). / . 5 C4-C 5 C4-C 5C4-C 5 C4-C . . . , . . ' , -SP . - 6 C 1 .T- SP 5 C , . = - .Central Hypersensitization " . = () - ( ). 2 - .Descending Pain Inhibition " . -( PHA ), - ( SHA ) . PHA SHA .

8

2 : - :Monopolar 3. , , . - PHA - SHA . - Bipolar . - PHA -.SHA ( PHA -,ACL -). " ( - .)Sciatic Nerve ( ). ( ). , . - 2 " . ! , ... 5 , 5 . . 5 ,AC . , .

9

Dubner . , .SP . SP , ( )SP - (?) 6-3 , - SP - SG ( - )SG = . . SP - SG . , , - TENS . TENS . ( ). ( ). . - Carotid Sinus . - TENS .

01

-TENS

TENS = Transcutaneous Electrical Nerve Stimulation TENS ,TENS , . ( )AC . -002 -, .HAD = Asymmetric Biphasic Current , . : : 052-04 -. : 002-2 (): 001-05 - -81 -. , - ( HAD ). - . / "" ' 1 . = . ( , ) : Rapidly Adapting Receptor " . , -02 " . . Slowly Adapting Receptor . , . , . , . Small ( ) Merkel's Disk ()Touch Large ' ( ) Ruffini Endings () Adaptation1

Fast

Slowly

, .

-TENS

= Fast Modulation . ( )Pulse Rate . , -. " " .LAD HAD , . LAD . " . , " . Burst TENS Burst . ( , , ...). Burst- -. . - Burst - TENS . , " " . HAD ( ,)Burst - LAD Burst . = Current Modulation S. = Current Modulation M . Burst = Current Modulation B )IFC( Interferential Current - 04 . ( = 0). , ( ) . - IFC . - 4 : 2 . 2 - 09 . = .Interference . . , . ': 4000Hz 4100Hz , . 2 , , - .Bipolar Electrode Interferential = IFC - IFC 4000Hz / .

2

-TENS

2 : 1. = )AMF( Amplitude Modulated Frequency = = . 2. = Carrying Frequency , = { 2/)0014+0004( } - AMF . - IFC , AMF " . - AMF . HAD - AMF , .100Hz LAD , 50Hz. . : 1 1,000,000 )1=1000milli=1,000,000 (micro 250 sec 4000Hz 4000Hz 250sec HAD-( LAD -.)HAD = X ( ) , ( X ) 1 = f X 2fC = C - X , ; - IFC . 2/5 Current Trabert - . 2 - - 5 - . ,Very Low Actuality . = 1000/7=143Hz = 7 (5+2) - .LAD - 0 " 01 ( 01 ).

3

-TENS

Diadynamic Current 5/2 , . = 01 - = 000,01 - , . 01 - . = 1000/20=50Hz - . "" : ( MF -) 01 -; 01 -. ( DF -) . CP - - -.... CPid - -. , .

High Voltage Current - 2 - 2 . ( ) 001 - . , - ( HAD-.)LAD

4

-TENS

Galvanic Current (.)DC ( Iontophoresis ).

Russian Current , . 2500Hz = 004 -. . .

5

Muscle Stimulation

Electrical Motor Stimulation . ' " . - Motor Neuron . , - .Spinal Reflex , - MN - ,Flexion Withdrawal Reflex . : " . , () = . : .Crossed Extensor Reflex ( ), ( ). , , " , ( ). Muscle Spasm , - ,Spino-thalamic tract ( )Rectus Abdominis (= ) . -. , Flexion withdrawal reflex . , . , PH ; PH :Pain / Spasm Cycle

1

Muscle Stimulation

' " / ', " . . / Motor Neurons : .Slow & Fast Twitch - ST , ( .)Fatigue Resistance - 30( 30Hz" ). -2 03 . - FT ( ). .50Hz FT .ST ? , - .ST Motor Units - ST - FT . : / - ST " ( FT , ). 2 Motor Neuron ST Resting Potential -70mV - 15mV ". 1 Motor Neuron FT -90mV " - .35mV

, - (- )20mV - ST - .FT , - ST - FT - FT , , , - ST. ST :FT ST- FT - VMO ,FT , - FT- VMO ST = . - Patello-Femoral Syndrome - - VMO FT . VMO , ( .)Vastus Lateralis , - EMG - VM- VL VL . VMO .

2

Muscle Stimulation

: " . . .FT FT , .ST : ( ) .ST .FT . ( ST ST ). . , . . , , , ( 2/1 ). , 6-3 , (, , ...). . , ; . ; -.Z Lines = Biological Turnover / , ': 4-3 . 021 . Muscle Protein 3-2 . , . , , . , 4-3 ' " DFM . .Growth Hormone

3

Muscle Stimulation

?)EMS( Electrical Motor Stimulation 2 - Motor Neuron " - Motor End Plate . , " (" ). , - " ( ). -Muscle Stimulation - = ; = . . (': ECRB -. Radial N- .)Radial Groove - Motor Point, . " (" ). ' , . () . Musculocutaneous Nerve - ,Biceps , . - 2 . ( ). ; ( ). . " . - . - ( ). " ( / ) - EMS . - Intrafusal Fibers ( ). = Re-Education , "" ( ). - EMS . (" 01 - 03 3:1 ; 02 ).

4

Muscle Stimulation

: - .Drop Foot - . .Adductor Hallucis ( ). " - Deltoid- . . : . Kinesthetic Awareness . . . : -%04-03 . ( 3-0), 3 . / "- " ( Burke Soleus-.)Gastro 20-30Hz . 50-150Hz . . , , . , , (). , , . , , " (': " ).

5

Muscle Stimulation

- ( ). 0.1-1ms ( 05 ). ( 03-02 ). - - . )RT( Ramp Time . RT ( ). Speed Development - RT . RT (': - .)Soleus : )IFC( Interferential " , .AMF TENS - , ". High Voltage -. Russian Current . 0052 . 01 - - 01 - ... . "" -01 - " 50 = ( FT ST ). : " ( : " , !"). 01 " ( ). , 03 / . 3:1 (" , ). 02 . , Muscle fatigue . 1:1 , -01 . 3-2 ( .)MVIC Endurance Training 4-3 -. .

6

Muscle Stimulation

" , " '. , . DOMS . ( ). (.)Pumping Action . - . " Re-Education ( )Tendon Reconstruction . - . . " 8-6 . . 2 8 ( ). 8 + ( EMS ). . . - (= - ): ( )Reciprocal Inhibition . / .Inverse Myotatic Reflex = Myotatic Reflex ( ). = Inverse Myotatic Reflex- GTO ( ) , " - Motor Neuron = . GTO . ( 2 ) ( ) . .

7

Muscle Stimulation

Saturday Night Palsy = Radial Nerve Palsy ( .)Drop Wrist - Spiral Groove . " . Facial Palsy = Bell's Nerve Palsy - .Mastoid Process Carpal Tunnel Syndrome = CTS - Median Nerve -.Thenar Muscles Ulnar Nerve Palsy Drop Foot = Nerve Root Compression . = . , , ... . : . = . . ( - .)10ms ( .)10ms : , 3 3 , . ( ). Mild Reaction of Degeneration: . ()Axonotmesis ( ) . . Wallerian Degeneration = Nerve Degeneration = Denervation ( ). , , ,Wallerian Degeneration ( 3-2 ) " . - Node of Ranvier . 5.0 " . 3 . , .

8

Muscle Stimulation

: Severe Reaction of Degeneration

: = . ( )1ms ( )10ms , . 3 ( ).

()Neurotmesis . = Denervation . ( , ). , Severe Reaction of Degeneration , . . , . Complete Reaction of Degeneration . . . . : . , . . . , . Denervation Atrophy ( ' ). Nerve Sprouting and Reinnervation . , . , . . Type II (or FT) Denervation , .FT ST - FT . Ach Hypersensitivity Due to Up-Regulation of Ach Receptors , - - Motor End Plate , .up-regulation - . . -, - = ( ).

9

Muscle Stimulation

Strength-Duration Curve , , " . , ( ). = Rheobase . - Rheobase . = Rheobase x 2 = Chronaxie ( 0.7ms ).

- Chronaxie 0.7ms . - Rheobase , . 001 (.)70ms 10ms 001 -. . : / . . . : = Vermicular Contraction . ( 4-3 ). 09 ( - 07-001 ). -( 10ms = .)70ms . , - Kinesthetic Awareness .

01

285 ENDOMED -285 Endomed .HAD ( ) . (23+13) (81) 4 Interferential. (33+43) 1 -2. (02) 2 IFC 2 . (12) - ( ). (22) - . (32) Russian Current -.Muscle Stimulation (62) . (72) . Interferential (5) - ,IFC = .4000Hz (7) AMF , . -, . (8) , - AMF. ': AMF 002 , 02 002-081 . (9) - 002 -081 . : 03/1 = 03 . - HAD . 6/6 - HAD . 1/1 - LAD . (31) ( ). " , . - (6) - . (7) (8) (9) . (31)

1

Muscle Stimulation IFC 2 0004 . AMF ( ST - )50Hz ( FT ,)50Hz = .50Hz 0. (21) : 52/1/7/2 2 . 3:1 7 . 3 1 52 05/1/01/2 08/1/02/2 (03) , - Maximum tolerance .

285 ENDOMED

2

185 ENDOMED . .LAD . (61) DIA - ( - 0) 01 -. - DIA : = MF- 01 , 01 - = .50Hz = DF- 01 - = ( .100Hz ). = CP 1 MF-1 .DF = LP 1 1 ,MF DF . (9) 01 . (42) . , ( ). 5 01 . (52) 01 . -01 . Iontophoresis (71) - . ( ). 01 . (81) . (31) 5-2, 2 - - 5 - = - .143Hz - ,LAD -.DIA Dynamic LAD . . (41) - - ( ), - 001 - . ( Y - )X 05 - 02 - ... (51) - . " . 09 . - ( 41). " 07 - ( .)50-100ms ' (8) " 3 . (62).

3

185 ENDOMED

4

INTELECT - US. , , . (1). Contrast . (7). (5). , (51) = .Electrotherapy , Additional Wave Forms -, (' ). (31). " .)12( Home TENS / . Edit . CC/CV CC , CV . . , " -.CC " ( )CC . - .CV : Burst . 0. Burst -0 01 . . 0-250Hz . . " Cycle Time / " , 3:1. - Cycle Time- Continuous . " 1:1. Treatment Time " . . Polarity Reversal - ( DIA-) 5 .

5

: - )8( Start - Start , - Start . (01) Stop . (9) Pause . " . Home ( 1 -2). (11)

6

-Muscle Stimulation

-Muscle Stimulation 285 Endomed Drop Foot - - . -: ( - 3/1 ), - Shaft . . - .TENS / Russian Current / IFC -:IFC 052 -. %05 FT-%05 ST AMF 05 ( ST ;30Hz FT .)80-100Hz . 01 - 03 02 . " . 1-10Hz .Twitch 5Hz 5 twitches ( ). 15Hz ( ) - . -: () 3 (). - Motor Point .Tibialis Anterior . " - Fibularis - Motor Point . Adductor Hallucis Brevis -: . , - Over Flow . -: - Calcaneal Tuberosity ( ) . " . . ( , , ).

1

-Muscle Stimulation

-Quadriceps -: . - TENS / IFC / TENS / . 50Hz - WB . , . . )VMO( Vastus Medialis Oblique -: 3 L2-L" - Femoral Triangle - .VMO - ,VMO . , - Over Flow . - VMO -03 . FT .80Hz -: -. - 3/1 . . (" ) (" ). : 1) . 2) . 3) () 4) . 5) " 01-5 . 6) , . . : . " . . : , .

2

Sympathetic Neurvous System & Pain

( )P ( ). ( )S . ( )R . . 1 T-3,2.L (.)Fight & Flight Reaction , ', . " ( ). . - , . , . -. " , . . , Pre-Ganglionic Fiber ( )Post-Ganglionic Fiber .Ganglionic Chain . - 1 C -( Coccyx ). - Pre-Ganglionic Fiber 1 T-3,2.L , , (, ) . ( ) ( .)C.O (). . , , , . . , . . . - NT -, - NT (.)NE - , - NT -.

1

Sympathetic Neurvous System & Pain

- . " , -. : -4 T , . , ' , . - 4,T , - 4 T . " 4 T -. , . 01-5 . - 4 C 4 C - 4 ,C - 4 C -4 T ' - Pre-Ganglionic -4 T 4 C - Post-Ganglionic Fiber 4.C " -4 T 2 4 T -4 .C : ( Autochtonic Innervation ) 4.T . ( Alachtonic Innervation ) 4 .C . - 4 T 4 C . " (' ) . 9 T 1( T -2)T 01 T 3L 11 T 4L 21 T 5L 1 L 3,2,1S 2 L 5,4 S-Coccyx 1 T 1C 2 T 2C 3 T 3C 4 T 4C 5 T 5C 6 T