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Samenvatting - extremiteiten
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Alles wat je nodig hebt aan kennis voor de module extremiteiten. Daarnaast handig als naslagwerk. 132 pagina's
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Table of ContentsEXTREMITEITEN .................................................................................................................................................................................................... 4
Enkel/voet........................................................................................................................................................................................................................... 4
Inversietrauma ...................................................................................................................................................................................................................................... 4
Cuboid dyspositie .................................................................................................................................................................................................................................. 6
Syndesmosis tibiofibiularis letsel............................................................................................................................................................................................................ 8
Anterieur impingement ........................................................................................................................................................................................................................10
Pes planus ............................................................................................................................................................................................................................................12
Hallux valgus/rigidus (incl. fasciitis plantaris).........................................................................................................................................................................................14
Hallux rigidus........................................................................................................................................................................................................................................16
Fascitis Plantaris ...................................................................................................................................................................................................................................18
Artrose BSG, OSG en hallux/MTP 1 .......................................................................................................................................................................................................20
Heup ................................................................................................................................................................................................................................. 21
Coxartrose............................................................................................................................................................................................................................................21
Femoraal Acetabulum Impingement Syndroom ....................................................................................................................................................................................23
Heupdysplasie (DDH) ............................................................................................................................................................................................................................25
Ziekte van Perthes ................................................................................................................................................................................................................................28
Epiphysiolysis capitis femoris ................................................................................................................................................................................................................31
Coxitis fugas .........................................................................................................................................................................................................................................34
Septische artritis...................................................................................................................................................................................................................................36
Fracturen .............................................................................................................................................................................................................................................38
Knie ................................................................................................................................................................................................................................... 41
Gonartrose ...........................................................................................................................................................................................................................................41
Anterieure kniepijn...............................................................................................................................................................................................................................45
Meniscus ..............................................................................................................................................................................................................................................47
Ligamentaire letsel ...............................................................................................................................................................................................................................53
,Schouder ........................................................................................................................................................................................................................... 58
(sub)luxatie ..........................................................................................................................................................................................................................................58
Schouder G-H instabiliteit .....................................................................................................................................................................................................................60
Labrum letsels ......................................................................................................................................................................................................................................65
Schouder Capsulitis Adhesiva................................................................................................................................................................................................................68
GH artrose............................................................................................................................................................................................................................................71
Schouder Sub-acromiaal Pijn syndroom ................................................................................................................................................................................................74
Schouder Scapulaire dyskinesie ............................................................................................................................................................................................................79
Schouder Fracturen ..............................................................................................................................................................................................................................81
Schouder AC luxatie..............................................................................................................................................................................................................................83
Schouder SC luxatie ..............................................................................................................................................................................................................................85
Schouder cuff rupturen ........................................................................................................................................................................................................................86
Schouder GIRD .....................................................................................................................................................................................................................................89
Elleboog ............................................................................................................................................................................................................................ 91
Epicondylitis lateralis & medialis ...........................................................................................................................................................................................................91
Fracturen elleboog ...............................................................................................................................................................................................................................96
Artrose elleboog met/zonder corpus liberum...................................................................................................................................................................................... 101
Instabiliteit / (sub) luxaties elleboog ................................................................................................................................................................................................... 103
Pols ................................................................................................................................................................................................................................. 107
Carpaal tunnel syndroom (CTS)........................................................................................................................................................................................................... 107
Tendinitiden: M. Quervain .................................................................................................................................................................................................................. 110
Tendinitiden: trigger finger en trigger thumb ...................................................................................................................................................................................... 112
Fracturen ........................................................................................................................................................................................................................................... 114
Artrose ............................................................................................................................................................................................................................................... 117
Instabiliteit (DISI en VISI) .................................................................................................................................................................................................................... 119
Luxaties .............................................................................................................................................................................................................................................. 122
Kienböck (lunatomalacie) ................................................................................................................................................................................................................... 125
TFCC letsel: Triangular fibrocartilage complex ..................................................................................................................................................................................... 127
Skiduim - ulnaire collaterale ligament (UCL) ....................................................................................................................................................................................... 130
SLAC & SNAC ...................................................................................................................................................................................................................................... 132
,
, EXTREMITEITEN
Enkel/voet
Inversietrauma
Definitie Een inversie trauma, oftewel enkel verzwikking, kan leiden tot een enkelbanddistorsie, een laterale enkelbandruptuur of een
enkelfractuur en wordt veroorzaakt door een combinatie van adductie, suppinatie en plantairflexie in het OSG (articulatio subtalaris en
articulatio talocalcaneonavicularis).
Incidentie Life time prevalentie 70%
prevalentie Incidentie tussen 15-24 jaar en binnen deze leeftijdscategorie bij mannen 17,8/1000 per jaar en bij vrouwen 14.2/1000 per jaar.
Pathologie Inzet van bovenaf: een verticaal belast been exoroteert om een verticale as à de tibia exoroteert ten opzichte van de nog stilstaande talus (talar-
delay) à syndesmose en lig. tibiofibulare worden aangespannen à door aangespannen tibiofibulare posterius wordt de fibula meegenomen in de
exorotatie à spanning op lig. talofibulare anterius à neemt talus mee in exorotatie ten opzichte van de calcaneus à calcaneus kantelt onder de
talus in gedwongen gekoppelde adductie onder invloed van scheve stand van gewrichtsvlakken tussen talus en calcaneus en ligamenten in de sinus
tarsi à art. talocalcaneonavicularis komt in zijn einstand à bij verdere geforceerde exorotatie in een verticaal belast onderbeen scheurt het lig.
talofibulare anterius à wordt de beweging nog verder doorgezet dan adduceert de talus in de vork en scheurt het lig. calcaneofibulare resulterend
in een talar tilt.
Inzet van onderaf: de voet land met het mediale deel op een oneffenheid en kantelt de calcaneus ten opzichte van de vloer à grote retractiekracht
op os metatarsale V à kanteling van de calcaneus gaat gepaard met een endorotatie ten opzichte van de talus (artrokinematisch gelijk aan
exorotatie van talus ten opzichte van de calcaneus zoals boven beschreven) à spanning op het lig. talofibulaire anterius welke de fibula meetrekt in
een endorotatie tot in de eindstand à bij nog verder doorzetten van de beweging scheurt het lig. talofibularis anterius, wederom in tweede
instantie gevolgd door het lig. calcaneofibulare.
Risicofactoren o Dorsaalflexie beperking
o Verstoorde propriocepsis
o Verminderde (pre-season) postural control/balance (positive single-leg balance test)
o Enkeldistorsie in de VG
o Vrouwen
o Basketbal, volleybal, veldsporten en klimmen
Klinische o Hevige pijn laterale zijde enkel direct na trauma
kenmerken o Hydrops / heamatros; waarschijnlijk gr 2/3 letsel
o Pijn bij wandelen
o Dorsaalflexie beperking
o Verstoorde propriocepsis
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