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Samenvatting pathologie van het bewegingsapparaat
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genezing .................................................................................................................... 36INHOUDSOPGAVE 1.3.3.1 2 genezingswijzen: .................................................................................................. 36
1.3.3.2 Factoren die genezing beïnvloeden ................................................................... 38
HOOFDSTUK 1 ORTHOPEDIE ................................................................................................ 11 1.3.3.3 Duur .......................................................................................................................... 38
1.3.3.4 Beoordeling van de genezing o.b.v.: .................................................................. 38
1 ORTHOPEDISCH LETSEL.......................................................................................................... 11
abnormale genezing ................................................................................................ 38
Acute opvang & initiële behandeling.................................................................... 41
ETIOLOGIE ........................................................................................................................ 11
DIAGNOSE VAN ORTHOPEDISCH LETSEL ................................................................................ 13
Definitieve genezing ................................................................................................. 42
anamnese .................................................................................................................. 13
inspectie/ observatie ................................................................................................ 14 HOOFDSTUK 3 REUMATOLOGIE........................................................................................... 44
klinisch onderzoek ..................................................................................................... 14
functioneel onderzoek ............................................................................................. 15 1 BEGRIP, SOORTEN EN TERMINOLOGIE ..................................................................................... 44
neurologisch onderzoek ........................................................................................... 15 REUMATOLOGIE: MEEST VOORKOMENDE AANDOENINGEN..................................................... 44
medische beeldvorming (MBV)/radiologie ........................................................... 16 REUMATOLOGIE: VERSCHILLENDE TERMINOLOGIE .................................................................. 44
1.2.6.1 RX (röntgenonderzoek) ......................................................................................... 16 2 WAT IS EEN SYNOVIAAL GEWRICHT? ...................................................................................... 45
1.2.6.2 CT-scan .................................................................................................................... 17 BOT – KRAAKBEEN – SYNOVIUM ........................................................................................... 45
1.2.6.3 NMR of MRI .............................................................................................................. 18 3 KRAAKBEEN: SOORTEN EN EIGENSCHAPPEN ............................................................................ 46
1.2.6.4 Echografie ............................................................................................................... 18 SOORTEN .......................................................................................................................... 46
1.2.6.5 Skeletscintigrafie (botscan) ................................................................................... 19 hyalien kraakbeen .................................................................................................... 46
1.2.6.6 elektrofysiologisch onderzoek ............................................................................... 19 4 ARTTROSE ........................................................................................................................... 49
1.2.6.7 Artroscopie .............................................................................................................. 20 INDELING .......................................................................................................................... 49
1.2.6.8 medische overcomsumptie .................................................................................. 20 PREVALENTIE EN INCIDENTIE ................................................................................................ 49
labo............................................................................................................................. 21 RISICOFACTOREN .............................................................................................................. 49
BEHANDELING VAN ORTHOPEDISCH LETSEL ........................................................................... 22 PATHOGENESE................................................................................................................... 50
preventief ................................................................................................................... 22 GRADATIES ....................................................................................................................... 50
conservatief ............................................................................................................... 22 SYMPTOMEN ..................................................................................................................... 51
operatief .................................................................................................................... 23 DIAGNOSE ........................................................................................................................ 52
post-operatieve behandeling ................................................................................. 26 BEHANDELING ................................................................................................................... 52
5 REUMATOÏDE ARTRITIS .......................................................................................................... 52
HOOFDSTUK 2 TRAUMATOLOGIE ........................................................................................ 27 EPIDEMIOLOGIE ................................................................................................................. 52
RISICOFACTOREN .............................................................................................................. 53
PATHOGENESE................................................................................................................... 53
1 SOORTEN TRAUMATOLOGISCHE LETSELS .................................................................................. 28
SYMPTOMEN ..................................................................................................................... 54
SPIER- EN PEESLETSEL .......................................................................................................... 28
Symptomen algemeen ............................................................................................ 29 symptomen hand...................................................................................................... 54
DIAGNOSE ........................................................................................................................ 55
Risicofactoren algemeen ........................................................................................ 30
Behandeling .............................................................................................................. 30 criteria diagnose ....................................................................................................... 56
BEHANDELING ................................................................................................................... 56
LIGAMENTAIR LETSELS ......................................................................................................... 30
Etiologie ...................................................................................................................... 31 6 SEPTISCHE ARTRITIS .............................................................................................................. 57
PATHOGENESE................................................................................................................... 57
Risicofactoren ............................................................................................................ 31
EPIDEMIOLOGIE EN RISICOFACTOREN .................................................................................. 57
Symptomen ............................................................................................................... 31
SYMPTOMEN ..................................................................................................................... 57
Behandeling (idem spier en peesletsel (PEACE & LOVE)).................................... 32
BEHANDELING ................................................................................................................... 58
FRACTUREN ...................................................................................................................... 32
7 SPONDYLOARTRITIS .............................................................................................................. 58
Classificaties............................................................................................................... 32
PSORIARIS ARTRITIS ............................................................................................................. 59
symptomen ................................................................................................................ 36
Pagina 1 van 229 Pagina 2 van 229
, pathogenese ............................................................................................................. 59 ARTROKINEMATICA PATELLAFEMORAAL ............................................................................... 82
risicofactoren ............................................................................................................. 59 STABILITEIT KNIEGEWRICHT ................................................................................................... 82
symptomen ................................................................................................................ 60 Passieve stabiliteit:..................................................................................................... 82
behandeling .............................................................................................................. 60 Actieve stabiliteit: ...................................................................................................... 84
REACTIEVE ARTRITIS ............................................................................................................ 60 samenwerking spieren.............................................................................................. 85
pathogenese ............................................................................................................. 60 2 STANDAFWIJKINGEN T.H.V. DE KNIE ....................................................................................... 86
risicofactoren ............................................................................................................. 60 GENU VALGUM/VARUM..................................................................................................... 86
symptomen ................................................................................................................ 60 genu valgum correctie bij kinderen ....................................................................... 87
8 KRISTALARTROPATHIE: JICHT ................................................................................................. 61 genu valgum correctie bij volwassenen ................................................................ 87
PATHOGENESE................................................................................................................... 61 dynamic knee valgus ............................................................................................... 88
EPIDEMIOLOGIE & RISICOFACTOREN ................................................................................... 61 toing in ........................................................................................................................ 89
SYMPTOMEN ..................................................................................................................... 61 toing out ..................................................................................................................... 89
BEHANDELING ................................................................................................................... 61 3 VERWORVEN LETSELS T.H.V. DE KNIE ....................................................................................... 90
9 FIBROMYALGIE.................................................................................................................... 62 WEKE DELEN LETSELS ........................................................................................................... 90
10 METABOLISCHE BOTAANDOENINGEN (WERVELKOLOM)........................................................... 62 Meniscusletsels .......................................................................................................... 90
voorste kruisband letsel ............................................................................................ 92
HOOFDSTUK 4 PATHOLOGIE VAN HET BEKKEN EN DE HEUP .............................................. 63 achterste kruisband letsel ........................................................................................ 94
letsel collateraal ligament ....................................................................................... 95
1 BEKKEN .............................................................................................................................. 63
unhappy triad ............................................................................................................ 95
FUNCTIES BEKKEN: .............................................................................................................. 64 spier-pees ruptuur t.h.v. de knie .............................................................................. 96
LUXATIES ........................................................................................................................... 96
2 LETSELS VAN HET BEKKEN ...................................................................................................... 66
BEKKENFRACTUREN ............................................................................................................ 66
femoro-tibiale luxatie (zeldzaam) ........................................................................... 96
ACETABULUMFRACTUREN ................................................................................................... 67 patellaluxatie ............................................................................................................. 96
3 LETSELS VAN DE HEUP ........................................................................................................... 68
Oorzaak ................................................................................................................................. 96
FRACTUREN ....................................................................................................................... 97
ANATOMIE ........................................................................................................................ 68
Interne ligamenten: .................................................................................................. 68 supracondylair en intercondylair ............................................................................ 97
Externe ligamenten: .................................................................................................. 69 patella ........................................................................................................................ 97
LETSELS ............................................................................................................................. 69
tibiaplateau ............................................................................................................... 98
GONARTROSE ................................................................................................................... 99
congenitaal ............................................................................................................... 69
3.2.1.1 heupdysplasie ......................................................................................................... 69
3.2.1.2 Legg-Calvé-Perthes ............................................................................................... 71 HOOFDSTUK 6 PATHOLOGIE VAN ONDERBEEN, ENKEL EN VOET .................................... 106
verworven .................................................................................................................. 73
3.2.2.1 heupluxaties ............................................................................................................ 73 1 PATHOLOGIE VAN HET ONDERBEEN ...................................................................................... 106
3.2.2.2 heupfracturen......................................................................................................... 73 ANATOMIE ..................................................................................................................... 106
3.2.2.3 heupartrose: vergevorderd................................................................................... 76 articulatio tibiofibularis proximalis.......................................................................... 106
combinatie congenitaal & verworven ................................................................... 78 articulatio tibiofibularis distalis ............................................................................... 107
3.2.3.1 femoroacetabulair impingement (FAI) ............................................................... 78 arthtokinematica .................................................................................................... 107
membrana interossea ............................................................................................ 108
HOOFDSTUK 5 PATHOLOGIE VAN DE KNIE ......................................................................... 80 spieren ...................................................................................................................... 108
loges ......................................................................................................................... 108
LETSELS VAN HET ONDERBEEN ............................................................................................ 109
1 ANATOMIE KNIE.................................................................................................................. 80
TIBIOFEMORAAL ................................................................................................................ 80 Fracturen onderbeen ............................................................................................. 109
PATELLAFEMORAAL ........................................................................................................... 81 1.2.1.1 Fracturen van tibiaplateau (zie les 5 – knie) ..................................................... 109
ARTROKINEMATICA TIBIOFEMORAAL .................................................................................... 81 1.2.1.2 Open fracturen..................................................................................................... 109
Pagina 3 van 229 Pagina 4 van 229
,1.2.1.3 Crurisfracturen ...................................................................................................... 109 LABRUM GLENOIDALE ...................................................................................................... 135
1.2.1.4 Geïsoleerde tibia- en fibulafracturen ................................................................ 110 LIGAMENTEN ................................................................................................................... 136
1.2.1.5 Distale tibiafracturen............................................................................................ 110 PLEXUS BRACHIALIS .......................................................................................................... 137
1.2.1.6 Complicaties onderbeenfracturen: ................................................................... 111 ROTATOR CUFF ............................................................................................................... 138
Luxaties proximaal tibiofibulair gewricht .............................................................. 111 ANTERIEURE SPIEREN ........................................................................................................ 139
2 PATHOLOGIE VAN DE ENKEL ................................................................................................ 111 POSTERIEURE SPIEREN ....................................................................................................... 140
ANATOMIE ...................................................................................................................... 111 ARTHROKINEMATCA SCHOUDER........................................................................................ 141
Laterale ligamenten ............................................................................................... 112 2 LETSELS VAN DE SCHOUDERN EN BOVENARM ......................................................................... 141
Mediale ligamenten “Lig. Deltoideum” ............................................................... 112 PLEXUS BRACHIALIS LETSEL ................................................................................................. 141
Arthrokinematica .................................................................................................... 112 Ernst ........................................................................................................................... 142
Spieren ...................................................................................................................... 113 Symptomen ............................................................................................................. 143
2.1.4.1 Anterieure spieren ................................................................................................ 113 Ernst inschatten ....................................................................................................... 143
2.1.4.2 Laterale spieren .................................................................................................... 113 Behandeling en prognose ..................................................................................... 143
2.1.4.3 Posterieure spieren ............................................................................................... 114 Behandeling algemeen ......................................................................................... 144
LETSELS VAN DE ENKEL ...................................................................................................... 114 LUXATIES ......................................................................................................................... 144
Standafwijkingen ..................................................................................................... 114 Inleiding .................................................................................................................... 144
2.2.1.1 Spitsvoet ................................................................................................................ 114 2.2.1.1 SC luxatie ............................................................................................................... 144
2.2.1.2 Klompvoet: ............................................................................................................ 114 2.2.1.2 AC luxatie .............................................................................................................. 145
Achillespeesruptuur ................................................................................................ 116 2.2.1.3 GH luxatie: ............................................................................................................. 147
Acute enkelbandletsels.......................................................................................... 117 FRACTUREN ..................................................................................................................... 150
Enkelfracturen ......................................................................................................... 119 Clavicula .................................................................................................................. 150
2.2.4.1 Ottowa ankle rules ............................................................................................... 120 Scapula .................................................................................................................... 151
Enkelartrose.............................................................................................................. 121 Humerus.................................................................................................................... 153
Tarsale tunnelsyndroom ......................................................................................... 122 2.3.3.1 Humeruskop fractuur ........................................................................................... 153
3 PATHOLOGIE VAN DE VOET ................................................................................................. 123 2.3.3.2 Humerusschacht fractuur .................................................................................... 155
ANATOMIE ...................................................................................................................... 123 2.3.3.3 Supracondylaire fractuur .................................................................................... 157
VOETBOGEN ................................................................................................................... 123 SPIER-/PEESLETSELS ........................................................................................................... 159
Mediale longitudinale voetboog: ......................................................................... 124 GLENOHUMERALE ARTROSE .............................................................................................. 160
Laterale longitudinale voetboog .......................................................................... 124 IMPINGEMENT SYNDROOM ............................................................................................... 162
Transversale voetboog ........................................................................................... 125 FROZEN SHOULDER........................................................................................................... 163
LETSELS VAN DE VOET ....................................................................................................... 125 3 stadia ..................................................................................................................... 163
standafwijkingen ..................................................................................................... 125 Behandeling ............................................................................................................ 164
talusfracturen .......................................................................................................... 127 Prognose .................................................................................................................. 164
calcaneusfracturen ................................................................................................ 128
fracturen van middenboet, voorvoet en tenen ................................................. 128 HOOFDSTUK 8 PATHOLOGIE VAN ELLEBOOG, ONDERARM EN HAND ........................... 165
metatarsalgie .......................................................................................................... 128
mortonse neuralgie ................................................................................................. 129 1 ELLEBOOG & ONDERARM ................................................................................................... 165
fascitis plantaris ....................................................................................................... 129 ANATOMIE ...................................................................................................................... 165
diabetesvoet ........................................................................................................... 130 Statische stabilisatoren ........................................................................................... 166
charcot-voet ........................................................................................................... 131 Dynamische stabilisatoren ..................................................................................... 166
ARTHROKINEMATICA ........................................................................................................ 167
HOOFDSTUK 7 PATHOLOGIE VAN DE SCHOUDER EN BOVENARM ................................. 135 PATHOLOGIE ................................................................................................................... 168
Letsels elleboog en onderarm ............................................................................... 168
1 ANATOMIE ....................................................................................................................... 135 1.3.1.1 Luxaties .................................................................................................................. 168
Pagina 5 van 229 Pagina 6 van 229
, 1.3.1.2 Fracturen ............................................................................................................... 170 spinaalkanaalstenose ............................................................................................. 202
1.3.1.3 Intra-articulaire aandoeningen .......................................................................... 173 cauda equina syndroom (ces) ............................................................................. 204
1.3.1.4 Extra-articulaire aandoeningen ......................................................................... 176 overzicht hernia (posterolateraal) vs spinaalkanaalstenose ............................. 205
1.3.1.5 Spier- en peesletsels ............................................................................................. 180 degeneratieve spondylolisthesis ........................................................................... 205
2 POLS ............................................................................................................................... 180 osteoporotische indeukingsfractuur ..................................................................... 206
ANATOMIE ...................................................................................................................... 180 de novo scoliose: zie 2 scoliotische afwijkingen .................................................. 207
Triangulair fibrocartilagineus complex (TFCC) ..................................................... 180 SCOLIOTISCHE DEFORMITEITEN (VOORNAMELIJK FRONTAAL VLAK) ........................................ 207
ARTHROKINEMATICA ........................................................................................................ 181 idiopathische scoliose bij kinderen/adolescenten ............................................. 208
PATHOLOGIE (LETSELS VAN DE POLS) ................................................................................. 181 idiopathische scoliose bij volwassenen ................................................................ 210
fracturen................................................................................................................... 181 de novo scoliose ..................................................................................................... 210
2.3.1.1 Distale radiusfractur: ............................................................................................ 181 scoliose secundair aan neuromusculaire pathologie ........................................ 211
2.3.1.2 Fractuur carpalia: ................................................................................................. 183 DEFORMITEITEN IN HET SAGITTAAL VLAK .............................................................................. 211
pseudo-artrose os scaphoideum .......................................................................... 184 spondylolyse ............................................................................................................ 211
ligamentaire instabiliteit pols ................................................................................. 184 spondylolisthesis....................................................................................................... 213
tfcc letsels ................................................................................................................ 184 scheuermann-kyfose .............................................................................................. 213
carpaaltunnelsyndroom (CTS)............................................................................... 185 bechterew-kyfose ................................................................................................... 214
3 HAND .............................................................................................................................. 186 indeukingsfracturen ................................................................................................ 216
ANATOMIE ...................................................................................................................... 186 kyfose secundair aan neuromusculaire pathologie ........................................... 216
PATHOLOGIE ................................................................................................................... 187
luxaties phalanxen .................................................................................................. 187 HOOFDSTUK 10 PATHOLOGIE VAN DE WERVELKOLOM DEEL 2 ...................................... 217
fracturen................................................................................................................... 187
3.2.2.1 Metacarpalia ........................................................................................................ 187 1 LETSELS VAN DE WERVELKOLOM ........................................................................................... 217
3.2.2.2 CMC 1 .................................................................................................................... 188 CLASSIFICATIE VAN WERVELLETSELS .................................................................................... 217
3.2.2.3 Phalanx .................................................................................................................. 189 Inleiding .................................................................................................................... 217
artrose CMC 1 ......................................................................................................... 189 Morfologie van letsels ............................................................................................. 217
skiduim ...................................................................................................................... 190 neurologische status ............................................................................................... 219
de quervain tendinitis ............................................................................................. 191 klinische modifiers ................................................................................................... 220
triggerfinger ............................................................................................................. 192 LETSELS VAN DE GEHELE CERVICALE WK............................................................................. 220
standafwijkingen vingers ........................................................................................ 192 whiplash ................................................................................................................... 220
LETSELS VAN DE HOOG-CERVICALE WK ............................................................................. 221
HOOFDSTUK 9 PATHOLOGIE VAN DE WERVELKOLOM DEEL 1 ........................................ 193 anatomie ................................................................................................................. 221
letsels van de hoog-cervicale WK ........................................................................ 221
1 ANATOMIE ....................................................................................................................... 193 LETSELS VAN DE LAAG-CERVICALE WK............................................................................... 223
VERTEBRAE ...................................................................................................................... 193 LETSELS VAN DE THORACALE, THORACOLUMBALE EN LUMBALE WK ....................................... 224
NEUROANATOMIE ............................................................................................................ 194 NEUROLOGISCHE LETSELS T.G.V. LETSELS VAN DE WK ............................................................ 225
DISCUS ........................................................................................................................... 194 ruggenmerg ............................................................................................................. 225
SPIEREN .......................................................................................................................... 195 dwarslaesie .............................................................................................................. 225
2 ARTHROKINEMATICA.......................................................................................................... 196
3 FUNCTIES WERVELKOLOM ................................................................................................... 196 HOOFDSTUK 11 EXAMEN: STELLINGEN ............................................................................. 229
OVERZICHT...................................................................................................................... 198
4 LETSELS VAN DE WERVELKOLOM ........................................................................................... 198
DEGENERATIEVE AFWIJKINGEN .......................................................................................... 198
discopathie .............................................................................................................. 198
spondylose ............................................................................................................... 201
Pagina 7 van 229 Pagina 8 van 229
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