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Samenvatting Locomotorische pathologie

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In deze samenvatting van locomotorische pathologie vind je alle onderwerpen terug die worden besproken. Door de duidelijke opbouw en de inhoudstabel vooraan de samenvatting, is alles gemakkelijk terug te vinden.

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  • January 22, 2023
  • 32
  • 2022/2023
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LOCOMOTORISCHE PATHOLOGIE
Inhoud
1. Reumatologie........................................................................................................................................................5
1.1 Omschrijving....................................................................................................................................................5
1.2 Artrose.............................................................................................................................................................6
1.2.1 Epidemiologie...........................................................................................................................................6
1.2.2 Pathofysiologie.........................................................................................................................................6
1.2.3 Etiologie....................................................................................................................................................7
1.2.4 Symptomen..............................................................................................................................................8
1.2.5 Diagnose...................................................................................................................................................8
1.2.6 Behandeling..............................................................................................................................................8
1.3 Reumatoïde artritis.........................................................................................................................................8
1.3.1 Definitie....................................................................................................................................................8
1.3.2 Epidemiologie...........................................................................................................................................9
1.3.3 Etiologie....................................................................................................................................................9
1.3.4 Symptomen..............................................................................................................................................9
1.3.5 Diagnose...................................................................................................................................................9
1.3.6 Verloop...................................................................................................................................................10
1.3.7 Behandeling............................................................................................................................................10
1.4 Ziekte van Bechterew....................................................................................................................................10
1.4.1 Definitie..................................................................................................................................................10
1.4.2 Epidemiologie.........................................................................................................................................10
1.4.2 Etiologie..................................................................................................................................................11
1.4.3 Symptomen............................................................................................................................................11
1.4.4 Behandeling............................................................................................................................................11
1.5 Jicht................................................................................................................................................................11
1.5.1 Definitie..................................................................................................................................................11
1.5.2 Fysiopathologie......................................................................................................................................12
1.5.3 Epidemiologie.........................................................................................................................................12
1.5.4 Symptomen............................................................................................................................................12
1.5.5 Behandeling............................................................................................................................................12
1.6 Osteoporose..................................................................................................................................................13
1.6.1 Definitie..................................................................................................................................................13
1.6.2 Epidemiologie.........................................................................................................................................13
1.6.3 Symptomen............................................................................................................................................13

1

, 1.6.4 Diagnose.................................................................................................................................................13
1.6.5 Preventie................................................................................................................................................13
2. Traumatologie.....................................................................................................................................................14
2.1 Fracturen.......................................................................................................................................................14
2.1.1 Indeling...................................................................................................................................................14
2.1.2 Gevolgen.................................................................................................................................................15
2.1.3 Genzeingsproces....................................................................................................................................15
2.2 Peesletsels.....................................................................................................................................................16
2.2.1 Etiologie..................................................................................................................................................16
2.3 Luxatie en subluxatie.....................................................................................................................................16
2.3.1 Oorzaak..................................................................................................................................................17
2.3.2 Complicaties...........................................................................................................................................17
2.3.3 Behandeling............................................................................................................................................17
2.4 Spierletsels....................................................................................................................................................17
2.4.1 Cassificatie..............................................................................................................................................17
2.4.2 Behandeling............................................................................................................................................18
2.5 Distorsie.........................................................................................................................................................18
2.5.1 Definitie..................................................................................................................................................18
2.5.2 Classificatie naar ernst...........................................................................................................................18
2.5.3 Behandeling............................................................................................................................................19
2.6 Claviculafractuur...........................................................................................................................................19
2.6.1 Plaats......................................................................................................................................................19
2.6.2 Ontstaan.................................................................................................................................................19
2.6.3 Symptomen............................................................................................................................................19
2.6.4 Behandeling............................................................................................................................................20
2.7 Scapulafractuur.............................................................................................................................................20
2.7.1 Onstaan..................................................................................................................................................20
2.7.2 Symptomen............................................................................................................................................20
2.7.3 Behandeling............................................................................................................................................20
2.8 Humerusfractuur...........................................................................................................................................21
2.8.1 Humeruskopfracturen en subcapitae humerusfracturen......................................................................21
2.8.2 Diafysaire humerusfracturen.................................................................................................................23
2.9 Schouderluxatie.............................................................................................................................................23
2.9.1 Etiologie..................................................................................................................................................24
2.9.2 Syptomen...............................................................................................................................................24
2.9.3 Behandeling............................................................................................................................................24
2.9.4 Complicaties...........................................................................................................................................24

2

,2.10 Ellebogfractuur............................................................................................................................................24
2.10.1 Indeling.................................................................................................................................................24
2.10.2 Behandeling..........................................................................................................................................25
2.10.3 Complicaties.........................................................................................................................................25
2.10.4 Tenniselleboog.....................................................................................................................................25
2.11 Voorarmfractuur.........................................................................................................................................25
2.11.1 Pouteau-Colles fractuur.......................................................................................................................25
2.12 Scaphoid fractuur........................................................................................................................................26
2.12.1 Oorzaak................................................................................................................................................26
2.12.2 Symptomen..........................................................................................................................................27
2.12.3 Diagnose...............................................................................................................................................27
2.12.4 Behandeling..........................................................................................................................................27
2.12.5 Duimluxatie..........................................................................................................................................27
2.13 Femurhalsfractuur.......................................................................................................................................28
2.13.1 Symptomen..........................................................................................................................................28
2.13.2 Diagnose...............................................................................................................................................28
2.13.3 Prognose...............................................................................................................................................28
2.13.4 Behandeling..........................................................................................................................................28
2.14 Diafysaire femurfractuur.............................................................................................................................28
2.14.1 Behandeling..........................................................................................................................................29
2.15 Kniefractuur.................................................................................................................................................29
2.16 Meniscusletsel.............................................................................................................................................29
2.16.1 Ontstaan...............................................................................................................................................29
2.16.2 Symptomen..........................................................................................................................................30
2.16.3 Diagnose...............................................................................................................................................30
2.16.4 Behandeling..........................................................................................................................................30
2.17 Kruisbandletsel............................................................................................................................................30
2.17.1 Functie kruisbanden.............................................................................................................................30
2.17.2 Ontstaan...............................................................................................................................................30
2.17.3 Klinisch..................................................................................................................................................30
2.17.4 Diagnose...............................................................................................................................................31
2.17.5 Behandeling..........................................................................................................................................31
2.18 Onderbeenfractuur.....................................................................................................................................31
2.18.1 Ontstaan...............................................................................................................................................31
2.19 Enkeldistortio..............................................................................................................................................31
2.19.1 Symptomen..........................................................................................................................................32
2.19.2 Behandeling..........................................................................................................................................32

3

,4

,1. REUMATOLOGIE

1.1 OMSCHRIJVING

 Alle chronische aandoeningen van het locomotorisch stelsel
 Niet aangeboren
 Niet veroorzaakt door een trauma
 Pijn is het meest voorkomende symptoom

 Term “reuma” dekt meer dan 200 verschillende ziekten
o Slijtagereuma (“artrose”)
o Inflammatoire reuma (“artritis”):
 Reumatoïde artritis (RA)
 Spondylarthropathieën vb. ziekte van Bechterew
o Bindweefselziekten
 Lupus erythematosus
o Weke delen reuma
 Fibromyalgie
o Reuma van het skelet
 Osteoporose



2 grote pijntypes

 Mechanische pijn
o Degeneratieve pijn
o Neemt toe ’s avonds en bij beweging, inspanning of vermoeidheid
o Is beter in rust
o Er is geen nachtelijke pijn
o Startpijn

 Inflammatoire pijn
o Erger in rust, beter tijdens en na inspanning
o Nachtelijke pijn met wakker worden van de pijn
o Constante pijn
o Ochtendstijfheid




5

,1.2 ARTROSE

 Arthrosis deformans (AD)
 Slijtagereuma
 Meest voorkomende gewrichtsafwijking




1.2.1 EPIDEMIOLOGIE
 Meest voorkomende gewrichtsafwijking
 Life-time risk: 25%
 Toenemend met leeftijd
 Grote oorzaak van invaliditeit bij ouderen
 Mannen > vrouwen
 Meest aangedane gewrichten: handen, knieën, tenen, heup, WK




1.2.2 PATHOFYSIOLOGIE

6

,  Fissuren en erosies in gewrichtskraakbeen, vooral in gewichtsdragende gewrichten
als gevolg van excessieve mechanische druk
 Oppervlak van kraakbeen wordt ruw, en interfereert met vlotte gewrichtsbeweging
 Progressief verlies van kraakbeen
 Aantasting van subchondrale botweefsel
 Verhoogde druk op botweefsel
 Vorming van osteofyten rond de beenuiteinden
 Vorming van cysten
 Delen van osteofyten en kraakbeen breken af in gewrichtsholte, en veroorzaken nog
meer irritatie
 Gewrichtsspleet wordt nauwer
 Mogelijks secundaire inflammatie van omliggend weefsel




1.2.3 ETIOLOGIE
 Primaire vorm
o Defect in stofwisseling van kraakbeencellen
 Secundaire vorm
o Trauma
o Overbelasting
o Verkeerd gebruik
o Onstabiel gewricht
 Rol van erfelijke factoren



7

,1.2.4 SYMPTOMEN
 Pijn toenemend bij belasting, afnemend bij rust
 Ochtendstijfheid
 Spieratrofie
 Verminderde beweeglijkheid van gewricht
o Cave: vicieuze cirkel
 Geen systemische symptomen, geen serummerkers
 Niet altijd correlatie tussen graad van slijtage en symptomen




1.2.5 DIAGNOSE
Radiologie




1.2.6 BEHANDELING
 Symptomatisch
o Behoud mobiliteit
o Voldoende rust, overbelasting vermijden
o Pijnbestrijding
o Hyaluronzuurinjecties
o Glucosamines
o Heelkunde
 Artroplastiek prothesen



1.3 REUMATOÏDE ARTRITIS


1.3.1 DEFINITIE
 Meest frequente inflammatoire reumatische aandoening
 Ontstekingsproces: auto-immuun
 Chronische ontsteking van het synoviale membraan (=synovium)




8

,1.3.2 EPIDEMIOLOGIE
 Prevalentie: 1% van de Belgen
 3 keer meer vrouwen dan mannen
 komt het vaakst voor in de leeftijdscategorie van 30 tot 55 jaar
 10% van alle RA patiënten  ernstige invaliditeit




1.3.3 ETIOLOGIE
 Idiopathisch
 Genetische factor




1.3.4 SYMPTOMEN
 (Mono-), oligo- of polyarticulair
o Typisch
 Eerste kleine hand- en teengewrichten (PIP, MCP en pols)
 Later: ellebogen, schouders, knieën
o Opstoten van gewrichtspijn, -stijfheid, -zwelling, -roodheid
o Vaak symmetrische symptomen
o Nachtelijke pijn, ochtendstijfheid
o Contracturen, spierspasme, spieratrofie, gewrichtsmisvorming
 Systemisch
o Moeheid, depressie, malaise, anorexie, koorts




1.3.5 DIAGNOSE
 RX-straling (pas nuttig in verder gevorderd stadium)
 Biochemische labo-waarden door bloedanalyse
o Inflammatie-parameters (CRP, BSE)
o Auto-immuunmerkers (antilichamen: reumafactor)
 Niet te gebruiken als screening want niet specifiek (5% van de gezonde
populatie heeft deze reumafactor)




9

, 1.3.6 VERLOOP
 In remissies en exacerbaties
 Onvoorspelbaar
 Effect van therapie op te volgen door labo-waarden en RX




1.3.7 BEHANDELING
 Doel:
o Stoppen van ontsteking, gewrichtsbeschadiging voorkomen, tegengaan
progressie aantasting en vervormingen
 Multidisciplinair
o Ergotherapie  balans tussen rust en milde activiteit
 (Medicamenteus)
o NSAID’s
o Corticosteroïden
o TNF-antagonisten
 Chirurgie: contracturen verminderen, beschadigde pezen vernieuwen, …



1.4 ZIEKTE VAN BECHTEREW

= Spondylitis ankylosans




1.4.1 DEFINITIE
 Chronische ontsteking van de gewrichten van de wervelkolom (meestal ook sacro-
iliacale gewrichten), die verloopt in remissies en exacerbaties
 Gevolg: verstijving ten gevolge van verkalking van de ligamenten en fibrosering van
de gewrichtskapsels




1.4.2 EPIDEMIOLOGIE
 1 op 1000 Belgen
 Begint gemiddeld tussen 20 – 30 jaar (gemiddeld: 23 jaar), bijna altijd voor 40 jaar
 3 keer meer bij mannen
 Grote interindividuele verschillen in ernst




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