Ayakta g\u00f6rmeye al\u0131\u015f\u0131k oldu\u011fumuz nas\u0131rlar s\u0131rtta da olu\u015fabiliyor. Daha \u00e7ok kad\u0131nlar\u0131 tehdit eden s\u0131rt nas\u0131r\u0131 kol hareketi ile ortaya \u00e7\u0131kan t\u0131k\u0131rt\u0131 sesi, k\u00fcrek kemi\u011finin yukar\u0131 kalkmas\u0131 ve etraf\u0131nda \u015fi\u015flik, kolda kuvvetsizlik, kol ve s\u0131rt a\u011fr\u0131s\u0131 olarak kendini g\u00f6steriyor.<\/p>\n
S\u0131rt nas\u0131rlar\u0131n\u0131n olu\u015fum nedenlerini anlatan G\u00f6\u011f\u00fcs Cerrahisi Uzman\u0131 Do\u00e7. Dr. \u00d6zkan Demirhan, \u201dElastofibroma Dorsi nadir g\u00f6r\u00fclen iyi huylu ve yava\u015f b\u00fcy\u00fcyen g\u00f6\u011f\u00fcs duvar\u0131 t\u00fcm\u00f6r\u00fcd\u00fcr. K\u00fcrek kemi\u011fi (Skapula) ve g\u00f6\u011f\u00fcs duvar\u0131 aras\u0131nda mekanik s\u00fcrt\u00fcnme ve bas\u0131ya ba\u011fl\u0131 geli\u015fen, bu nedenle t\u00fcm\u00f6ral olmaktan \u00e7ok reaktif olarak kabul edilen fibroelastik yap\u0131da bir yalanc\u0131 t\u00fcm\u00f6rd\u00fcr (ps\u00f6dot\u00fcm\u00f6r). Genellikle orta ya\u015f grubunu etkilemektedir. 40 ya\u015f \u00fcst\u00fc daha \u00e7ok kad\u0131nlarda g\u00f6r\u00fcl\u00fcr (kad\u0131n erkek oran\u0131 6\/1), \u00e7o\u011funlukla tek tarafl\u0131 olmas\u0131na ra\u011fmen (tek ve \u00e7ift g\u00f6r\u00fclme oran\u0131) 3\/1\u2019dir. Tek tarafl\u0131 lezyonlar\u0131n \u00e7o\u011fu sa\u011f tarafta g\u00f6r\u00fclmektedir\u201d dedi.<\/p>\n
Omuz ve kolu s\u00fcrekli kullananlar ile a\u011f\u0131r i\u015fler yapanlarda daha s\u0131k g\u00f6r\u00fcl\u00fcr<\/p>\n
Kolu zorlayan hareketlerin s\u0131rt nas\u0131r\u0131n\u0131 tetikledi\u011fine de\u011finen Dr. Demirhan, \u201dElastofibroma Dorsi\u2019nin ger\u00e7ek bir t\u00fcm\u00f6r olup olmad\u0131\u011f\u0131 tart\u0131\u015fmal\u0131 olup, etiyolojisinin m\u00fcltifakt\u00f6riyel oldu\u011fu s\u00f6ylenebilir. Yap\u0131lan \u00e7al\u0131\u015fmalarda kas g\u00fcc\u00fc ile \u00e7al\u0131\u015fanlarda tekrarlay\u0131c\u0131 travmalarla g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131n\u0131n artabilece\u011fi bildirilmi\u015ftir. Omuz ve kolunu s\u00fcrekli kullanan ya da a\u011f\u0131r i\u015f yapan ki\u015filerde, s\u0131kl\u0131kla da sa\u011f k\u00fcrek kemi\u011fi etraf\u0131nda s\u0131rt nas\u0131r\u0131n\u0131n daha fazla g\u00f6r\u00fclmesi bu g\u00f6r\u00fc\u015f\u00fc desteklemi\u015ftir. Bununla birlikte Elastofibroma Dorsi, hayat\u0131 boyunca kolunu zorlamayan ki\u015filerde de g\u00f6zlenmektedir. K\u00fcrek kemi\u011fi d\u0131\u015f\u0131nda farkl\u0131 yerle\u015fimlerde de g\u00f6r\u00fclebilir\u201d \u015feklinde konu\u015ftu.<\/p>\n
Belirtilere dikkat<\/p>\n
S\u0131rt nas\u0131rlar\u0131n\u0131n 5 santimden b\u00fcy\u00fck olduklar\u0131 zaman belirti vermeye ba\u015flad\u0131klar\u0131n\u0131 ifade eden Demirhan, \u201dOlgular\u0131n y\u00fczde 50\u2019si genelde belirti vermez. Belirti veren durumlarda hastalar\u0131n \u00e7o\u011funda s\u0131rtta k\u00fcrek kemi\u011fi etraf\u0131nda \u015fi\u015flik, kolda kuvvetsizlik, s\u0131rt omuz a\u011fr\u0131s\u0131 g\u00f6r\u00fclmektedir. Di\u011fer belirtiler aras\u0131nda kol hareketiyle ortaya \u00e7\u0131kan k\u00fcrek kemi\u011finin kitleye tak\u0131lmas\u0131na ba\u011fl\u0131 t\u0131k\u0131rt\u0131 sesi (click), eklem sertli\u011fi, k\u00fcrek kemi\u011finin di\u011fer tarafa g\u00f6re y\u00fcksek olmas\u0131 gibi yak\u0131nmalar say\u0131labilir. Bu yak\u0131nmalarla ba\u015fvuran hastalar, fizik muayenede anormal bulgu yok ise de mutlaka radyolojik olarak de\u011ferlendirilmelidir. En basitinden komplekse do\u011fru Ultrasonografi (USG), Bilgisayarl\u0131 Tomografi (BT) ve MRG inceleme bu patoloji i\u00e7in olduk\u00e7a yararl\u0131 g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleridir. Radyolojide bazen toraks duvar\u0131 kaslar\u0131 ile net ay\u0131rt edilemeyen, malign kitle benzeri lezyon olarak tan\u0131mlan\u0131r. Asl\u0131nda Elastofibroma Dorsi a\u00e7\u0131s\u0131ndan lezyonun yeri ve klini\u011fi tipiktir radyolojik olarak da tipik bulgular elde edildi\u011fi i\u00e7in insizyonel biyopsiye gerek yoktur. Elastofibroma Dorsi tan\u0131s\u0131nda g\u00f6r\u00fcnt\u00fclemenin yeterli olmad\u0131\u011f\u0131nda ve agresif bir t\u00fcm\u00f6r gibi d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fc zaman nadir de olsa biyopsi yap\u0131lmas\u0131 gerekebilir. Fakat derin yerle\u015fimli yumu\u015fak doku ve ya\u011f dokusuna uzanan karakteristik lezyonlarda ba\u015fka testlere gerek olmayabilir. K\u00fc\u00e7\u00fck Elastofibroma Dorsi olgular\u0131nda BT ve MR yeterli olmayabilir. O zaman gadolinium kullan\u0131labilir. Bilgisayarl\u0131 tomografinin Elastofibroma Dorsi tan\u0131s\u0131ndaki duyarl\u0131l\u0131\u011f\u0131 MRG\u2019ye g\u00f6re daha d\u00fc\u015f\u00fckt\u00fcr. Ancak tipik lokalizasyonu ve iki tarafl\u0131 lezyon olmas\u0131 durumunda BT tan\u0131da yard\u0131mc\u0131 olabilir. MRG bulgular\u0131 varl\u0131\u011f\u0131nda elastofibroma dorsi tan\u0131s\u0131 kolayl\u0131kla d\u00fc\u015f\u00fcn\u00fclebilir. MRG\u2019de atipik bulgular\u0131n varl\u0131\u011f\u0131 durumunda ise lezyonun tipik lokalizasyonu, iki tarafl\u0131 (bilateral) olu\u015fu, hastan\u0131n ileri ya\u015fta ve kad\u0131n hasta olmas\u0131 elastofibroma dorsi tan\u0131s\u0131n\u0131 destekler. Lezyonun iki tarfal\u0131 olmas\u0131 ay\u0131r\u0131c\u0131 tan\u0131da d\u00fc\u015f\u00fcn\u00fclebilecek malign kitleleri b\u00fcy\u00fck oranda ekarte edebilir. Bu y\u00fczden elastofibroma dorsi tan\u0131s\u0131ndan klinik olarak \u015f\u00fcphe edildi\u011finde g\u00f6\u011f\u00fcs duvar\u0131 mutlaka iki tarafl\u0131 de\u011ferlendirilmelidir. Ay\u0131r\u0131c\u0131 tan\u0131da di\u011fer g\u00f6\u011f\u00fcs duvar\u0131 t\u00fcm\u00f6rleri de akla gelmelidir\u201d \u015feklinde bilgi verdi.<\/p>\n
Tedavisi cerrahi<\/p>\n
S\u0131rt nas\u0131rlar\u0131n\u0131n tedavi y\u00f6ntemlerine de\u011finen Demirhan, \u201dTedavide cerrahi ile \u00e7\u00f6z\u00fcm sa\u011flanabiliyor. Cerrahide radikal davran\u0131larak kanser cerrahisi gibi yakla\u015f\u0131l\u0131r en ufak bir kitle kal\u0131nt\u0131s\u0131 b\u0131rak\u0131lmamal\u0131d\u0131r. Ba\u015far\u0131s\u0131z cerrahide kitle yeniden ortaya \u00e7\u0131kabilir ikinci ameliyatta daha b\u00fcy\u00fck bir cerrahi gerekebilir. Bu nedenle tedavisi t\u00fcm\u00f6r\u00fcn tamamen temizlenmesi ile ger\u00e7ekle\u015fir. T\u00fcm\u00f6r kol ve omuz da fonksiyonel yetersizlik, bas\u0131 bulgular\u0131, a\u011fr\u0131 ve g\u00f6\u011f\u00fcs duvar\u0131nda \u015fi\u015fli\u011fe neden oluyorsa ve t\u00fcm\u00f6r\u00fcn \u00e7ap\u0131 5 santimi a\u015f\u0131yorsa kesinlikle \u00e7\u0131kar\u0131lmal\u0131d\u0131r. Daha k\u00fc\u00e7\u00fck ve \u015fikayete yol a\u00e7mayan lezyonlarda cerrahi tedavi uygulanmadan hasta izlenebilir. Elastofibroma Dorsinin ikiye katlanma zaman\u0131 dedi\u011fimiz \u201cDubling time\u201d suresi olduk\u00e7a uzun oldu\u011fu i\u00e7in hastal\u0131\u011f\u0131n kansere d\u00f6n\u00fc\u015ft\u00fc\u011f\u00fcne dair delil yoktur. Rezeke edilemeyen kitlelerde nadir de olsa radyoterapinin kullan\u0131lmaktad\u0131r\u201d dedi.<\/p>\n","protected":false},"excerpt":{"rendered":"
AYAKTA G\u00d6RMEYE ALI\u015eIK OLDU\u011eUMUZ NASIRLAR SIRTTA DA OLU\u015eAB\u0130L\u0130YOR. DAHA \u00c7OK KADINLARI TEHD\u0130T EDEN SIRT NASIRI KOL HAREKET\u0130 \u0130LE ORTAYA \u00c7IKAN TIKIRTI SES\u0130, K\u00dcREK KEM\u0130\u011e\u0130N\u0130N YUKARI KALKMASI VE ETRAFINDA \u015e\u0130\u015eL\u0130K, KOLDA KUVVETS\u0130ZL\u0130K, KOL VE SIRT A\u011eRISI OLARAK KEND\u0130N\u0130 G\u00d6STER\u0130YOR.<\/p>\n","protected":false},"author":1,"featured_media":208458,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[18796,5896,307,52626,192,52628,5897,7616,32602,52627],"class_list":["post-208457","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","tag-kol","tag-belirtisi","tag-gelen","tag-hareketleri","tag-ile","tag-nasiri","tag-olabilir","tag-sesi","tag-sirt","tag-tikirti"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/www.tvturk.com\/wp-content\/uploads\/2019\/09\/kol-hareketleri-ile-gelen-tikirti-sesi-sirt-nasiri-belirtisi-olabilir_3ccf70b.jpg?fit=1000%2C562","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/paKIfm-Sed","_links":{"self":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts\/208457","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/comments?post=208457"}],"version-history":[{"count":0,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts\/208457\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/media\/208458"}],"wp:attachment":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/media?parent=208457"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/categories?post=208457"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/tags?post=208457"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}