Diz Ağrısı Nedenleri
Özet
Diz ağrısı, klinik ortamda sırt ağrısından sonra en sık karşılaşılan ikinci kas-iskelet sistemi şikayetidir. Tanısal yaklaşımda klinisyenlerin sırasıyla akut-kronik ayrımı (6 haftalık eşik), travmatik-nontravmatik ayrımı, eklem efüzyonu varlığı ve ağrının anatomik lokalizasyonunu (anterior, medial, lateral, posterior) değerlendirmesi gerekir. Travmatik akut durumlarda ön çapraz bağ, arka çapraz bağ ve menisküs yırtıkları ile intraartiküler fraktürler ve osteokondral defektler ön plana çıkmaktadır. Non-travmatik durumlarda ise ağrının aktiviteyle ilişkisi ve efüzyon varlığı belirleyicidir. Aktiviteyle kötüleşen ve efüzyon barındıran durumlarda osteoartrit ve osteokondral yaralanmalar düşünülürken; aktiviteden bağımsız durumlarda kristal artropati, enfeksiyöz (septik) artrit, yaygın gonokok enfeksiyonu ve sistemik romatizmal hastalıklar acil veya kapsamlı inceleme gerektirir. Efüzyon bulunmayan fokal veya diffüz non-travmatik ağrılarda ise Osgood-Schlatter hastalığı, bursit, tendinopatiler, patellofemoral ağrı sendromu, safen sinir sıkışması, pes anserin bursiti ve iliotibial bant sendromu gibi bölgesel yumuşak doku veya mekanik sorunlar ayırıcı tanıda yer alır. Ayrıca primer veya metastatik kemik tümörleri, kalça veya sırttan yansıyan ağrılar ile sistemik hastalıklar ve bazı ilaçların (glukokortikoidler, kinolonlar) yan etkileri de nadir fakat önemli diz ağrısı nedenleri arasındadır.
Knee pain is the second most common musculoskeletal complaint in clinical settings after back pain. The initial diagnostic approach requires clinicians to systematically evaluate the acute-chronic differentiation (using a six-week threshold), traumatic versus non-traumatic origin, the presence of joint effusion, and the exact anatomical localization of the pain (anterior, medial, lateral, or posterior). Traumatic acute knee pain is commonly associated with anterior cruciate ligament (ACL) tears, posterior cruciate ligament (PCL) tears, meniscus lesions, intra-articular fractures, and osteochondral defects. In non-traumatic presentations, the relationship between pain and physical activity, along with the presence of effusion, guides the differential diagnosis. Conditions that worsen with activity and present with effusion often indicate osteoarthritis or osteochondral injuries. Conversely, non-traumatic pain independent of activity coupled with effusion necessitates urgent investigation for crystal arthropathy, infectious (septic) arthritis, disseminated gonococcal infection, or systemic rheumatic diseases. When effusion is absent, non-traumatic fokal or diffuse pain points toward regional soft-tissue or mechanical issues such as Osgood-Schlatter disease, bursitis, tendinopathies, patellofemoral pain syndrome, saphenous nerve entrapment, and iliotibial band syndrome. Rare but critical etiologies include bone tumors, referred pain from the hip or spine, systemic conditions, and medication-induced side effects.
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