Or non-alcoholic liver disease GLI (What is NAYK)

NAYK, g our reputation, especially in western society, the most common causes of chronic liver diseases are among the. NAYK our country, the most common cause of chronic liver disease after viral hepatitis. NAYK simple steatosis, steatohepatitis, cirrhosis, and hepatocellular cancer, is a clinical broad spectrum.

I was variable depending on the methods used in diagnosis NAYK prevalence of society is seen in 24% of the 10-. With obesity levels are approximately 58-74% of this rate. Approximately 2.6% prevalence in children, 23-is 53% of obese children.

NAYK, part of the standard family practice, gastroenterology, endocrinology, cardiology, radiology, and gynecology as a metabolic disease in many areas of interest. NAYK, is clinically associated with many comorbidities. Of these morbidities of obesity, type 2 DM, HL best to be recognized. Studies, 30-to 100% in patients with NAYK obesity, type 2 diabetes by up to 75% 10-and 20-to 92% is defined as the frequency of HL.

G NAYK pathogenesis still remains unclear up to our reputation. The most widely accepted theory, multiple-beat (multi-hit), the hypothesis. The first beat, increased peripheral insulin resistance (IR) as a result of liver free fatty acids from adipose tissue as the latter depends on developing fatty liver disease has increased. The second beat as a result of the fat from the liver cells become susceptible to damage, oxidative stress, lipid peroxidation, and by the effect of inflammatory cytokines, inflammation (steatohepatitis). As the last beats, stellate cell activation by inflammatory mediators as a result of fibrosis developed. Some patients with simple steatosis, only some of them explained the reason for the development of steatohepatitis.

NAYK I usually asymptomatic patients. Some of the weakness, a feeling of fullness in the upper right quadrant of the abdominal symptoms may occur-such as pain. The presence of hepatomegaly, and one of the important findings on physical examination. NAYK asymptomatic patients, routine screening, the biochemical investigations and / or detected as incidental radiologic viewport.

Or Non-Alcoholic Liver Disease Diagnostic Laboratory GLI

NAYK heat clinical diagnosis, biochemical and histological evaluations are placed. Mild and moderate serum aminotransferase (alanine aminotransferase: ALT, aspartate aminotransferase: AST) elevation, and often one of the most common in patients with NAYK disorder in the laboratory. AST / ALT ratio is often less than 1, but this rate may vary in patients with advanced fibrosis. Serum gamma-glutamyl transferase (GGT) and alkaline fostafataz (ALP) levels may be higher in some patients. NAYK comorbid patients have a clinical presentation is related to these, for example, HL, laboratory abnormalities such as hyperglycemia, can also be detected. Hypoalbuminemia in patients with advanced fibrosis, thrombocytopenia, prothrombin time (PTZ) is prolonged. Patients with mild to moderate elevation of serum ferritin level is an important part of the determined and often interpreted as a marker for inflammation. NAYK serum autoantibody positivity can be seen. Approximately 33% of the low titer (<1:160) antinuclear antibody (ANA) positive, low titer (<1:40) antimitokondriyal antibody (AMA) positivity can be detected.

Lung damage in terms of biochemical liver tests (AST, ALT) elevation is an important finding in the diagnosis. However, these values ​​are normally detected in approximately 40% of patients. Chronic (6 months duration) elevation of liver damage in those tests, causing damage to other causes (viral causes: hepatitis B, C, otoimm reputation reasons, alcohol-induced elevation of the metabolic causes: such as hemochromatosis) to rule out an absolute, NAYK important in the diagnosis.

What is Liver Biopsy of lung

Liver and lung biopsy, the gold standard method in the diagnosis of NAYK today. Biopsy, liver damage, or other reasons, which plays a role in the differential diagnosis from introducing. Fat accumulation (steatosis), mixed inflammatory cell infiltration, hepatocyte ballooning, necrosis, glycogen accumulation, Mallory bodies and fibrosis NAYK'ın histological findings. NAYK defined in the spectrum of histological findings can be found alone or in combination. Portal inflammation that is often preserved. Kleiner and his colleagues recently by the scoring system has been modified NAYK histological diagnosis. Adiposity is associated with steatosis only in liver cells, hepatocyte lubricated with Steatozla graded from 0-3 depending on the amount of mononuclear and / or polymorphonuclear cell infiltration, hepatocyte ballooning and necrosis, defined as the presence of steatohepatitis. The presence of fibrosis in advanced stages, indicates that severe liver damage.

There are many factors that restrict NAYK biopsy in the diagnosis of liver and lung. Studies, liver biopsy specimens of patients with NAYK diagnostic differences and discrepancies can be highlighted in the evaluations by different pathologists (2,6,30). Differences in diagnostic liver biopsy specimens is more pronounced in cases where heterogeneous. Liver biopsy of the liver due to represent instances of 1/50.000 about giving all information about the liver is not sufficient. The liver biopsy in patients with biopsy NAYK entry angle in the diagnosis and grading of steatosis, the differences created by the differences shown in (6). In another study, the diagnosis of liver biopsy specimen NAYK length and the number of examples have been suggested to be related.

This is the definition of diarrhea associated with difficulty in minor and major complications include liver biopsy. Biopsy site pain, right shoulder pain, nausea associated with vasovagal reflex, hypotension, frequent complications. Bleeding, organ perforation, pneumothorax, infection, major complications, such as 1-in 3% of patients seen and require hospitalization. Biopsy in cases of death due to (1:10.000) have been reported. Therefore, as often seen in high society, a more practical diagnostic methods NAYK disease diagnosis and follow-up is needed.

Ultrasonography (U.S.)

Imaging Modalities Used in NAYK

U.S. Ultrasonography

NAYK, the most frequently used imaging modality for the diagnosis and follow-up US'dir. In U.S. fatty liver's ability to increase intracellular volume due to fat accumulation is seen as a diffuse increase in echogenicity. Comparative studies with liver biopsy, US'nin in demonstrating the sensitivity of 60-94%, specificity was found in the range 66-95%. U.S. examination of the posterior hepatic fibrosis without attenuation as a diffuse increase in echogenicity, it will always be made ​​the separation of hepatic steatosis. In addition, U.S. and minimal, moderate and severe steatosis, as a result of a classification can be made ​​and be given a quantitative measurement.

Another weak point is that the operator-dependent US. Three experienced operators conducted a retrospective U.S. study, the concordance rate between and within observers in the diagnosis of fatty liver and 72% and 76%, while intra-observer concordance rate the degree of adiposity was 55-68%. Fishbein and his colleagues, liver biopsy, MRI measurements and compared the findings of fatty liver US study, concluded that there is reliable in showing the amount of fat in the liver US.

Despite all this, easily available and cheap because of suspicion of fatty liver is still the preferred method US'dir first.

Magnetic Resonance Imaging (MRI)

MRI in determining the accumulation of fat in the liver and to characterize the most specific imaging modality used today. MRI in children and adults, the safe use of ionizing radiation-free because of, the reproducibility of the offers. MRI, T1 relaxation and chemical shift according to their oil from other molecules. Observations on conventional T1-weighted fat in the liver, is considered to be an increased intensity of conventional studies demonstrating the sensitivity of fatty liver disease is low. MRI and MRS chemical shift imaging to determine the amount of oil used in the methods. This is basically two methods, the triglyceride fatty acid chains of methylene groups (-CH2) protons in the water (OH) protons in the diversity of oscillation frequencies, ie the chemical shift due to these differences are based on separation of water and fat molecules.

What is Magnetic Resonance Spectroscopy (MRS)

MRS chemical shift difference between protons, using the information gained about their environment in a microscopic imaging technique protons. The negatively charged ions move around the protons on protons "shielding" (shading) information is available to replace partially the effect of magnet on the proton. Water and protons in different chemical relationships in the adipose tissue is in the oscillation frequency (chemical shift) will be different. This chemical shift can be defined and the amount of metabolites can be determined by the difference in tissue examined.

Single-voxel spectroscopy method is used in spectroscopy studies of the liver, and single-shot techniques review "Point Resolved

Spectroscopy "(PRESS), or" Stimulated Echo Acquisition Mode "(STEAM) and can be realized. STEAM'da 90 ° -90 ° -90 ° pulse sequence used, PRESS'te longer "time of the echo" (TE) and 90 ° -180 ° -180 ° pulse sequence is used. PRESS technique, a higher "signal-noise ratio," or (SNR) is a metabolite is more suitable for quantification. However, the determination of metabolites in fat and high SNR'ye Press, quantification is not needed because it is more sensitive to defects in STEAM spectroscopy of liver come forward. Voxel placed in the area to be examined does not contain the main arteries and abdominal fat tissue to avoid exposure, it is important that the abdominal wall 10 mm from the inner border

Chemical shift imaging

As mentioned earlier, chemical shift imaging, oil and water protons in the oscillation frequency are based on the difference. Methylene peak oil, peak water with this method, the relative chemical shift between the TE is determined according to phase in and out, and accordingly (IOP) is generated images. This relative chemical shift, 1.5T unit, the body temperature of -217 Hz. According to the oil molecules in water are 217 Hz slower than water and fat signals from the 1.5 T unit to be in the same direction every 4.6 msec, 2.3 sec in the opposite direction makes a. Accordingly, the total signal in-phase images obtained in water + fat, out-phase images can be obtained from water-fat signal. Out-of-phase images faz'a fat tissue contains relatively watched shows loss of signal.

In 1984, the two-point method described by Dixon for the first time the magnetic field (B0) to avoid the sensitivity of the technique in 1991, Glover 3 three-point method developed by adding an image. This method is reported on the many different studies and to reduce the effects of this method is not only B0 at the same time receive a combination of water and fat images that contain information for the quantitative measurement of oil has shown promise. Colleagues carried out by the first comprehensive noise analysis work, "Fast Spin Echo" (FSE), 3-point water-fat separation appropriate examination of water and oil phases-n / 6, n / 2, 7H / 6 phase has been shown to . However, the calculation of the appropriate amount of fat present in the liver, but all of the deviations from MR images can be corrected. These deviations and the correction methods are as follows:

1. Prediction of T1: T1-weighted viewport long T1 relaxation of the proton (water), the shorter one (oil) increases the signal. To eliminate this effect should reduce the weight of the T1 image and the flip angle (FA), achieved by 5 °.

2. T2 * (T2 relaxation time appears) impact: Oil-water separation methods such as T2 * effect leads to the use of different echo times. Especially this effect increases the accumulation of iron and may lead to incorrect measurements. For this reason, examination, T2 * is done by calculating correction.

3. Spectral complexity of the oil: NMR spectrum of the peak of the oil is at least 6 must be evaluated and appropriate for the calculation of the peaks of all the oil.

4. Noise prediction: Separate oil and water is calculated as the images of the errors that may occur when bringing together in order to calculate the percentage of fat. This phase also developed by Liu and colleagues, or magnetic separation techniques limited.

5. Vortex: Different from the complex in gradient echo times lead to a rapid opening and closing phase, it can distort the calculation of the percentage of fat. This effect was also developed by Yu and colleagues solved with hybrid-complex magnetic approach.

Developed with the chemical shift correction of the effects described by the effect of oil-water separation methods described in the last one-quant method IDEAL MR.

What is colchicine

Colchicine, which inhibits neutrophil recruitment to interfere with microtubule formation a plant. Cutaneous and articular involvement is effective for control. Usually 1-2 mg / day dose is well tolerated

The most common side effects, gastrointestinal side effects (nausea, vomiting, diarrhea, abdominal pain). May cause alopecia and bone marrow suppression.

Alkylating Agents

Alkylating agents, DNA replication and acts. Are detrimental to the functions of lymphocytes and proliferative. CNS involvement in the treatment of refractory eye disease and in combination with corticosteroids are used. However, due to dose-dependent side effects that are resistant to other treatments should be applied in cases

Short-term chlorambucil therapy is applied in cases of refractory in BiH, the cases of 2 / 3 ocular involvement and improved and shown to reduce the number of attacks. Side effects are bone marrow suppression, hepatotoxicity, secondary malignancies and infertility. In the presence of neurological or cardiovascular involvement today recommended the use of an agent.


Methotrexate, a folate analogue. Severe mucocutaneous involvement and helpful FAQ. Recommended the use of anterior uveitis cases.

Calcineurin Inhibitors

Calcineurin inhibitors, and the cycle affects the activation of T lymphocytes. A, although the most commonly used drugs in this group in particular is effective in refractory cases of eye disease. Are used in combination with corticosteroids, can be stabilized to lower the dose of corticosteroids. Neurotoxicity, hepatotoxicity, nephrotoxicity, hypertension, hirsutism, paresthesias, gastrointestinal manifestations, and there are side effects such as gingival hyperplasia.

And vascular involvement in Behcet's Disease


BH cases, retrobulbar hemodynamic parameters measured levels in the presence of ocular involvement, ocular involvement is different from non-GH patients and healthy controls.

Eye involvement in all retrobulbar arteries of patients with BH "end-diastolic velocity" (End-diastolic veloity-EDV) than in healthy controls and patients with GH levels without eye involvement, we have lower resistance index (RI) and index (PI) was measured as the higher levels . In addition, the other a study of cases of BiH, the ophthalmic artery and central retinal artery flow velocities were lower than healthy controls. Noble and colleagues (1998), the posterior ciliary artery and central retinal artery EDV ocular activation levels in BiH is determined independently of the lower levels of the controls. On the other hand, this study, active and inactive cases of BiH in the eyes there is no difference between retrobulbar blood flow velocities were observed. Posterior ciliary artery EDV GH levels in patients with ocular involvement, ocular involvement and healthy control cases were lower than the non-GH. In the same study, the posterior ciliary artery of ocular involvement in BiH has been shown to cause an increase in RI [95]. GH in patients with severe retinal involvement and retinal artery blood flow velocity, mild or moderate cases of vasculitis and healthy controls were found to be lower [96]. However, studies that failed to vary flow rate in BiH central retinal vein as in [8], severe vasculitis in patients with central retinal vein BiH there are studies showing a decrease in flow rate.


During the course of neurological involvement in BiH, the neural parenchymal involvement (primary) or may be secondary to major vascular involvement. Individuals with vascular BH, vascular problems in basic and clinical situations may arise depending on the observed lesions. Histopathological changes affect tissue perfusion and may cause tissue destruction. And pathological processes involved in the most common vasculitis in BiH is a state, although there is limited knowledge about pathological changes in the vascular system. In some cases, multiple segments, typically in the form of arthritis characterized by stenosis and appearance of an autopsy study evaluating patients with vascular BH layers of vascular inflammation and destruction of media and found that [101]. Lymphocyte infiltration of the extending, possibly resulting in the formation of thrombus. Partially activated endothelial cells and platelets are activated and the actual damage to the vascular characteristic superimposed. Major veins and arteries occlusions, often bleeding, infarction, or result in organ failure. Immunological mechanisms in BiH likely to result in the formation and distal embolization of vascular system. Large or medium-sized vessel involvement in BiH, transient ischemic attack, vascular thrombosis, cerebral artery occlusion, stroke, neurological abnormalities, such as resulting in death.

In cases of autoimmune disease, serum anti-endothelial cell antibodies were found. These autoantibodies, endothelial cells are activated and can trigger cytotoxicity or apoptotic processes. Increased cell surface expression of endothelial cells induced HSP60'ın. Anti-HSP60 antibody, the role of endothelial cell cytotoxicity, or apoptosis has received evidence. In addition, the anti-HSP60 antibody and complement-dependent activation of endothelial cells and cause endothelial cell lysis, in this context initiation, continuation and exacerbation of contributing.

What is Autoimmune Orchitis

Autoimmune orchitis, dog and spontaneously, may occur in rabbits after vasectomy. In humans, a variety of autoimmune orchitis similar idiopathic diseases are defined. The animals injected with homologous testicular antigen also develop autoimmune orchitis.

Experimental autoimmune orchitis (DOO) is shown to be involved in pro-inflammatory cytokines. Neutralizing antibodies, overcomes the effects of DOO. In addition, the T-lymphocyte clones derived from mice generated DOO normal mice was found to induce autoimmune orchitis. Transfer of CD4 + T-lymphocytes and the lymphocytes were carried out with sub-group of TNF-a, IL-2 and IFN-y cytokines secreted patient safety.

TNF-a positive DOO rats was observed that an increase in the number of testicular macrophages. In the same study, after being cultured testicular macrophages isolated from animals created the amount of TNF-alpha secreted by macrophages isolated from normal control animals were found to be higher than the amount. In addition, TNFR1-positive germ cells increase in number during DOO, DOO generated germ cell apoptosis in animals may indicate the possible role of TNF-a.To the pathologies observed in human testicular macrophages and testicular inflammation, macrophages, TNF increase in the number of TNF-a, may be an indication of the role of testicular inflammation.

Breast Cancer and Radiotherapy

Breast Cancer and Radiotherapy

Application of radiation to treat breast cancer was first performed in 1949. However, radiation, caused by the level of mortality due to cardiac side effects, reduces the appearance of survival after doubts emerged in RT. In 1997. Studies, after mastectomy or lymph node metastases in patients with tumors larger than 5 cm, and survival in the adjuvant radiotherapy reduces local recurrence, 9% increase in absolute value has caused the notice appeared in a re-RT treatment planning. The new meta-analysis also confirmed that this works.

Today, the early stage (Stage 1 and Stage 2) RT after breast conserving surgery in breast cancer treatment, is considered a component of the absolute. Adjuvant RT reduces the risk of local recurrence in patients with more advanced stages and is shown to increase survival in patients with axillary metastases. In locally advanced disease, neoadjuvant systemic therapy after modified radical mastectomy to achieve local control is needed in conjunction with the absolute RT. Local regional duplication in the utilized. Provide local control of distant metastasis outside the RT showed that the positive contributions. Purpose in the implementation of RT after mastectomy, post-operative chest wall, skin, breast tissue, and the rest of the tumor cells is the elimination of the regional lymphatics. For this reason, all patients underwent breast conserving surgery in the postoperative period the implementation of all breast RT has been a standard practice routine for today.

Radiotherapy Practice

a) The chest wall irradiation: the limits of this field is determined clinically. Mastectomy scar after mastectomy should be within target volume entirely. Area of the chest wall RT; middle line of the sternum medially, laterally extends from the mid-axillary line. The breast tissue was palpable breast intact 1 cm is sufficient to limit the lateral edge. The upper limit of the clavicle at the level of per-pass. Lower boundary of the breast against the ends of the region 1 - 2 cm conforms to the bottom. Lung volume 2 - 3 cm tangential to be included in the field.

b) The peripheral lymphatic irradiation: only the front area FNA-axillary area.

Sternum and the medial border of cricoid cartilage FNA passes at the level of mid-line neck braces (as it protects the spinal cord and esophagus). Crossing outside of the field as the head of the humerus (humeral head because of protection) axillae curve fits. The middle of the second rib axilla be treated all the cases the lower limit, only the first rib in the mid-axillary apex passes. In addition to this area by giving 12-15 ° angle to the trachea, esophagus and spinal cord protection is provided.

Rear axillary area, the dose may be added to complete. Rear-axilla medial clavicle superiorly, inferiorly jeans, superior lateral bracing of the humeral head

c) the dose of radiation therapy: clinical practice today of all breast tumor dose of 50 Gy, 25 fractions are given and the application is done once a day 5 times a week. Breast bed addition to the dose increase local control, especially in patients under 50 years of age. 16 Gy to the tumor bed following breast general approach is to give an additional dose. Additional doses of photon, electron or brachytherapy may be granted.

Stages of Breast Cancer Treatment

Stages of Breast Cancer Treatment

a) Stage 0: At the same time "in situ" is also known as. It remained in place and the surrounding tissue cancers. Clinical controls approximately 15% to 20% of cancers diagnosed with Stage 0 cancers. In addition to surgical treatment.

b) Stage 1: breast-conserving therapy: lumpectomy and radiation therapy which is done following the receipt of axillary lymph nodes. If necessary, is added to chemotherapy. Mastectomy and lymph node dissection can be made ​​if necessary.

c) Stage 2: Stage I is the same as for the treatments, but generally, if the tumor is larger than

Lymph nodes or chemotherapy, hormonal therapy and radiation is more common recommended as a complementary

d) Stage 3A: The standard treatment of mastectomy. After the operation in general and systematic treatment of radiation therapy, chemotherapy and hormone therapy as applied. If the tumor is too large, preoperative chemotherapy can be applied to reduction of the length of the tumor, chemotherapy applications of this type is called neoadjuvant chemotherapy. Hormone therapy can also be added before the operation with the purpose to help you.

e) Stage 3B: stage 3B breast cancer, standard treatment usually begins with neoadjuvant chemotherapy. The original length of the desired rate of tumor shrinkage after lumpectomy or mastectomy is done. After the operation, while the standard treatment, radiation therapy, chemotherapy and hormone therapy.

f) Stage 4: The main purpose of the treatment of stage 4 breast cancer survival and improve quality and eliminate the patient's complaints. The treatment usually affect the whole body, such as chemotherapy and hormone therapy are systemic treatments. With the aim of reducing the patient's symptoms in some cases also be recommended mastectomy.

Side Effects of Radiotherapy in Breast Cancer

Breast cancer radiotherapy side

The severity of injury may develop secondary to radiation, the radiation dose and duration of exposure to radiation in a manner proportional to the increase. Today, a daily dose of 2 Gy daily fractions with 50 Gy RT 25 days. These doses increased the frequency of adverse effects on the exits. Advanced RT techniques has decreased the introduction of radiation toxicity. Common side effects of breast cancer patients:

a) Lymphedema: Breast cancer is the most common complication after treatment. Accordingly, the functional damage may result in morbidity. Increased risk of axillary dissection and axillary RT is applied. Treatment of nonpharmacologic approaches such as massage and exercise.

b) the skin-breast complications: The most common are breast swelling. Motion of the muscle pain, incision pain, rib pain, erythema, and fibrosis may occur.

c) Brachial plexopathy: gy-dose RT and 50 during the one seen in the incidence of complications increases.

d) Pulmonary sequelae: In general, the implementation of more than 1 month after RT are observed. Irradiated lung volume in the development of risk associated with radiation pneumonitis.

e) The cardiac sequelae: Especially on the left hand is seen in patients irradiated. The treatment of ischemic heart disease may occur after 15-20 years. However, cardiac morbidity decreased with modern RT techniques. Sometimes a decrease in ejection fraction and cardiac wall motion changes after RT can be monitored.

f) Stroke: carotid artery stenosis in patients treated with RT FNA was thought to be acceleration in the development of the recent studies of other risk factors (hypertension, high LDL, etc.) RT is under control with no significant association was found between the stroke.

g) against radiotherapy and breast cancer: breast cancer risk for patients receiving RT In theory, despite the increase in radiation protection techniques, this risk is minimized today.

h) The development of secondary cancers: lung and esophagus cancer, leukemia and sarcoma can be seen.

i) breast angiosarcoma after RT: The first appearance of the skin is similar to an unexpected change in late radiation dermatitis is continued post RT in terms of angiosarcoma should be suspected. The actual tumor of about 2 years. RT average 3.5 years after treatment, are diagnosed.

Shoulder Anatomy

Shoulder Anatomy

Radiotherapy course because of proximity to the anatomy of the shoulder joint needs to be reviewed briefly.

Attending Bones Shoulder Joint Structure

a) The scapula: glenoid fossa with the head of the humerus; clavicle and shoulder joint by joint and creates.

b) Proximal humerus: the humeral head articular, the anatomic neck, the tendons of the rotator cuff and biceps muscle adheres large and small tubercles composed of long head tendon passes furrow.

c) Clavicle: the outside part of the scapula with acromio clavicular joint by axial and appendicular skeleton accretion connects.

Attending the shoulder joint and Ligaments Structure

a) SCJ: sternoclavicular joint located between the proximal part of the clavicle with Manibrium Sterne, shoulder strap connects the thorax and upper extremity.

b) Acromioclavicular joint: a small oval face medial facet and a facet joint between the clavicle on the same. Acromioclavicular joint stability during movement of the arm is supported by ligaments.

c) Glenohumeral joint: The humeral head and glenoid fossa between. Joint, flexion, extension, abduction, adduction, medial rotation, lateral rotation is doing the movements. Passive stability of the joint (glenohumeral ligaments, glenoid labrum, capsule, bone structures) and active mechanisms (the rotator cuff muscles, long head of biceps muscle and tendon) play a role.

d) the glenoid labrum: glenoid fossa, and vascularity of the edge of the adhesive, a little fibrous tissue is formed. Articular surface of the glenohumeral ligaments and next to expand and deepen the shoulder joint to increase stability for the long head biceps tendon adhesion creates a zone.

Attending Structure Shoulder Muscles

a) The rotator cuff muscles: subscapularis, and sticking a small tubercle in order from top to bottom with large tubercle-adhesive supraspinatus, infraspinatus and teres minor muscles occurs. Supraspinatus are involved in shoulder abduction. Infraspinatus and minor external rotation of the shoulder allows. At the same time contributing to the minor and infraspinatus function acts as a weak adductor. Powerful adductor and internal subscapularis.

b) Biceps muscle: biceps muscle function and stabilization of the joint contributes. Tuberculum majus and minus ligament lies between the synovial sheath of biceps long head and external boundaries. Centralization and stabilizes the glenohumeral joint.

Around the Shoulder Joint

Ranges formed by the merger facial. Normally surfaces to be slippery, especially among hard tissues, for example, the tendon-bone, skin, bone and tendons often are among the adhesion in muscle and bone. Connected or disconnected with the joint near the shoulder joint.

Coracoacromial ligament and subacromial extending below the shoulder joint is the most important neighbor. This grant is divided into the joint cavity with the rotator cuff. Rotator cuff and coracoacromial arch structure as a function of lubricant between the acts.

Subscapular bursa, joint capsule is an extension of the normal. Facilitates the movement of subscapular tendon.

They protrude out of the subscapular tendon separates, infraspinatus tendon, joint capsule and separating the infraspinatus and skin are separates

Shoulder Ultrasonography

Shoulder Ultrasonography

Shoulder US'i, using high-frequency linear probes noninvasive, real-time method for a radiographic examination. Between 7 and 12 MHz frequency can be changed according to the examined tissue. Soft tissue and vascular structures to determine changes in hyperemic CDUS and power Doppler is useful. Ultrasonography of the shoulder with the shoulder region of skin, subcutaneous tissues, subacromial bursa, rotator cuff tendons, glenohumeral joint, bone contours, deltoid and long head tendon bisepsin information available about. In the literature on the sensitivity and specificity of sonography in the various figures given as a general consensus on the use of shoulder pathologies in the first survey are available. Reliability and sensitivity are very high by experienced radiologists.

U.S. examination of the shoulder is seated on a stool returns to the patient. This position will sonographers person's shoulder to reach from all directions with ease. In order to sonography in shoulder, shoulder, very good knowledge of topographic anatomy is essential. Orientation of the probe is made ​​according to the orientation of the tendons.

Evaluation of the long head tendon of biceps muscle

The patient is placed in neutral position, the elbow angle is 90 ° and the hand propping up the string section of the dorsal and axial probe placed on the proximal humerus, long tendon of biceps groove bisipital between large and small tubercle-per-axial and sagittal planes is shown.

Long head of biceps muscle and tendon as bisipital oval hyperechoic sonographic appearance of the gutter and the schematic axial cross-section, cadaver, and Magnetic Resonance Imaging (MRI) shows the correlation between views

Turned 90 ° in the sagittal plane perpendicular to the axial plan Probe biceps tendon fibers are shown.

Evaluation of subscapular tendon

Brought to 90 ° flexion of the elbow and arm external rotation. The probe according to the localization of the biceps tendon sliding mild medial tubercle subscapular tendon adhesion to the small lot is shown along with the long axis

Evaluation of supraspinatus tendon

And internal rotation of the arm is brought. Large tubercle anterior to the sagittal plane shoulder tendon is taken as a cue point long axis. The long axis of the attachment point is in the style of the bird's beak

Examination of the long axis short axis is rotated 90 ° clockwise after the probe is considered

Tendon Pathologies detected by ultrasonography

An ultrasound torn tendons, tenosynovitis, bursitis and calcific tendinitis, subacromial-subdeltoid determined.

Torn: the deterioration of the integrity of the tendon. Full-thickness articular surface or articular face to face with is called limited if the partial tear.

Tendinosis: tendon degeneration without inflammation. But it is difficult to detect radiographically detectable with U.S.. Tendon thickening and heterogeneity are seen.

Tenosynovitis: Inflammation of the tendon sheath effusion was observed around the tendon. Especially seen around the biceps tendon.

Sub-deltoid subacromial bursitis: inflammation secondary collection of fluid.

Calcific tendonitis: tendon is seen as a result of the accumulation of calcium. Linear hyper-echoic in U.S. and posterior acoustic shadowing can be seen while the RDUS'de hyperemia.

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