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Samenvatting MOB3B WPO extremiteiten
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De cursus omvat alles wat je moet kennen voor het deel extremiteiten.
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MOB IIIBExtremiteiten
Phebe Goris
2020-2021
, SCHOUDER
INLEIDING
Fysiopathologie
Artritis Glenohumeraal (GH) of Acromioclaviculair (AC) gewricht
o Post-immobilisatie/-artroscopie
o Posttraumatisch/degeneratief OA
o Frozen Shoulder
Subacromiaal pijnsyndroom (SAPS)
= subacromiale “inklemming” van weke delen: bursa, supraspinatuspees, bicepspees
o Geeft dikwijls GH-bewegingsbeperking met soms scapulothoracale en/of CTO
functiestoornissen
Schouderpeesproblematiek
o Dikwijls tendinopathie soms met calcificatie en scheurvorming
o Soms traumatisch
o Dikwijls tgv SAPS
(Anterieure)instabiliteit GH gewricht
o Meestal post-operatief of post-immobilisatie
Functiestoornissen
o Verminderde mobiliteit
o Verminderde stabiliteit (ligamentair-musculair)
o Verminderde compressie-BBH
o Pijn & stijfheid (klinisch) tijdens houding en/of beweging
o Referred pain:
→ GH: uitstralende pijn in C5-T1 (meestal C5-C6)
→ ACG: vnl pijn in C4-C6 gebied
o Krachtverlies
1
,Kinematica
Caput humeri
o Staat iets naar posterieur en craniaal gepositioneerd
→ Belangrijk:
- Controle van caput humeri naar caudaal en posterieur tijdens bewegen (vnl bovenhands)
- Belangrijke interactie van GH-G met scapulothoracaal G (Upward Rotation; Posterior Tilt;
Exorotatie of Protractie)
Rotator cuff
o Verzorgt posterieure translatie van caput humeri tijdens opwaartse bewegingen door
supraspinatus & infraspinatus
o Verzorgt inferieure translatie van caput humeri door infraspinatus en subscapularis
Anteflexie-elevatie
GH-gewricht:
o Tot 90° abductie: anterieure translatie humerus
o Vanaf 90° abductie: posterieure & inferieure
translatie humerus
Scapulothoracaal-gewricht:
o Opwaartse rotatie: 0°-180°
o Posterieure tilt vanaf 120°
o Exorotatie vanaf 120°
o Exorotatie in 90° abductie: posterieure translatie humerus
o Max. exorotatie in 90° abductie: anterieure translatie humerus
o Max. endorotatie in 90° abductie: posterieure translatie humerus
Opwaartse rotatie stijgt tijdens anteflexie
Posterieure tilt stijgt tijdens anteflexie
Exorotatie stijgt tijdens anteflexie
2
, Klinimetrie scapulabewegingen & SAPS: EBP
Zijn scapulabewegingen gestoord bij patiënten met SAPS?
→ Cave: studies kinematica & EMG versus studies klinische veldtests!
Systematic review Struyf et al.(2014): EMG SAPS vs controle:
o Verminderde EMG-activiteit in Lower Trapezius en Serratus Anterior
Systematic review Kinsella et al.(2017) : EMG SAPS vs controle:
o Tendens tot verminderde EMG-activiteit Serratus Anterior (< amplitudo; te late reactie)
o Ratio Upper Trapezius tov Mid & Lower Trapezius-activiteit te groot
Verminderde activatie van infraspinatus, supraspinatus, subscapularis tijdens 1ste fase van scapulaire
abductie
Zijn scapulabewegingen gestoord bij patiënten met SAPS?
Systematic review Ratcliffe et al.(2014):
o Geen evidentie beschikbaar dat kinematica effectief gestoord is bij SAPS
o Geen valide klinische test beschikbaar om scapulaire dyskinesis vast te stellen
Systematic review Lange et al.(2017):
o Klinische tests voor scapulaire dyskinesis zijn onvoldoende betrouwbaar
Maar tegenspraak van andere studie:
o Moller et al. 2018: geeft aan dat er een goede interbeoordelaarsbetrouwbaarheid (Kappa
>.70) is voor de scapulaire controle tijdens anteflexie-elevatie en abductie-elevatie beweging
Moller et al. 2018:
The participants performed 5 repetitions of full shoulder flexion and abduction while holding either a
3 kg (for male) or 2 kg (for female) hand weight.
Scapular dyskinesis was defined as the presence of either winging or dysrhythmia as described by
McClure et al. (McClure et al., 2009)
Each shoulder was evaluated independently and classified as:
A. Normal scapular control (the scapula is stable with minimal motion during the initial 30°-60°
humerothoracic elevation, then smoothly and continuously rotates upward during elevation
and smoothly and continuously rotates downward during humeral lowering. No evidence of
winging is present (McClure et al., 2009)
B. Subtle scapular dyskinesis (mild or questionable evidence of either dysrhythmia or winging,
not consistently present (McClure et al., 2009)
C. Obvious dyskinesis (striking, clearly apparent abnormality like dysrhythmias or winging of 2.54
or greater displacement of scapular from thorax, evident on at least 3/5 trials) during shoulder
flexion and abduction movements (McClure et al., 2009)
The final evaluation of scapular control was based on combined flexion and abduction test
movements as described by McClure et al. (McClure et al., 2009). If both motions were rated as
normal or subtle, the final rating was normal. If both motions were rated as subtle dyskinesis, the final
rating was subtle dyskinesis, and if either motion was rated as obvious dyskinesis, the rating was
obvious dyskinesis.
3
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