Deze samenvatting beval alle bullets ( EXAMENVRAGEN) dat de prof in de les aanhaalt. Er zijn 3 powerpoints van gastproffen die er niet instaan omdat zij geen bullets hebben aangehaald.
NIEUWE CURRICULUM
- acuut: < 1 month
- subacuut 1-3 months
- chronisch > 3M
o lage rugpijn: life time prevalence: 8/10 <-> nek: 48,5%
▪ lage rugpijn SI: 3-5%, leg pain: 40%
o lage rugpijn: 90% over binnen 3M <-> nek: geen complete resolution pain & disability
o lage rugpijn: reccurence 62%
o 1/5 rule of thumb: 1/5 populatie lage rugpijn → 1/5 GP → 1/5 specialist → 1/5 ZH →
1/5 operatie
WAT ZIJN RISICOFACTOEN VOOR ONTWIKKELEN, PERSITERENDE EN RECURERENDE PIJN
- verschillende domeinen:
Individual factors Morfologische fact General physosocial Occupational Occupational
physical psychological
Heavy physcial work Rapid work rate
- >50 jaar Disc generation Inappropriate pain
Repetitive motion Monotonous work
- Genetic behaviour
Disc herniation Twisting & bending Low social support
influence (disk Transition from acute
Spina bifida Frequent lifting Job stress
generation) to chronic pain
Whole body vibration
- Vrouw > man Scheuermann Low work satisfaction
(bv helicopter
- Obesitas disease Depression
bestuurder)
- Previous low Anxiety
Spondylolysis Static load
back pain Stress
Segmental vibration
- General health Spondylolisthesis =>ervaren pijn erger
Acceleration/
status en meer risico om
deceleration
- Roken pijn te ontwikkelen
movements
- Sedentaire
levensstijl
- Vlaggen systeem vr risicofact
o Red flag: serious spinal pathology
▪ Pijn snachts, gewichtsverlies, lage rugpijn < 15 jaar
o Yellow flag: individual emotional en behavioural risk (“geel individueel”)
o Blue flag: work related psycho-social risk factors(“ik ben toch zo sociaal en psyho moe)
o Black flag: occupational en societal factors
ANATOMIE
- Facet gewrichten C1: beide ant
- Facet gewricht C2: vanboven ant (processus articularis inf) + , eronder post (processus artc sup van
vertebra eronder)
- Luxatie C1-C2 => geen breathing => geen zuurstof => dood
- Geen medulla onder L1, enkel processus transversi in lumbar spine: atachement vr spieren
CERVICAL SPINE PATHOLOGY
- Torticollis → kids!!
o Wat? Head is tilted & rotated away to the side => fibrose SCM
o KO: geen pijn, assymetrische face, palpable mass
1
, o ET:
▪ congenitaal → vroeg herkennen! Al vanaf geboort aanwezig → Anders ogen in
gezicht veranderen →oorzaak: musculair, hemivertebra, klippel-feil
▪ acquired: discitis, atlantoaxial subluxatie (Griesel syndrome: jong kind met
virale BLW)
o R/ conservative (fysiotherapie: spier strekken) / surgery (3M rna brace dragen)
- Klippel – Feil syndrome → kids “feil”:”veel”
o Wat? Failure of segmentation of cervical somite (6-8W) => fusion min 2 vertebra (75%
in upper cervical segments)
▪ Association with other abnorml: scoliosis, renal , deafness, cognetital hart ziekte
o KO: triade!!!!!!!!! Short neck with webbing (gespannen zoals een tent) + low hariline +
limited neck mobility
▪ Latere sympt: pijn, loss of mobility, neurology
- Dengerative disorders
o Radiculopathy
o Whisplash
o Neck pain
o Myelopathy
- RA
o Wat? C0-C1-C2 complex
▪ Atlanto – axial subluxatie → pannos: inflam tissue voor en achter dens => eet
ligamenten weg => opening => stenose: geen verbinding tussen C1,C2 => paralyse
▪ Atlanto axial invaginatie → indringing in hersenen van dens
▪ Subaxial subluxatie → shift van vertebrae onder C2
o KO: headdache, axial neckpain, neurolgical symptoms
o Classificatie: I: no neurological deficit, II: subjective weakness, dysethesias, hyperreflexia,
III: objective signs of weakness & supper motor sings, IIIA: amublatory, IIIB: are not
ambulatory
o R/ operatie : door mond, want dan is C2 voor jou = gevaarlijke operatie dr bact mond bij
immuungecompromiteerde ptµ
- Brachialgia = plotste extreme pijn in arm NIET door spine (<-> bradiculopathy wel dr spine)
o Parsonage turner
▪ = gradueel maar heel ernstige zwakte
▪ Epidem: zeldzaam, man, 40, unilat, any nerve brachial plexus can be involved
(meestal n. thoracicus longus), et: unclear (autoimmuun/ bimechanical:
disruption of blood-nerve barrier)
▪ Ko:
• Fase I: suden onset of sever shoulder pain, radiationg to neck, lasts d-
weeks => slapen ni meer
• Fase II: painless flaccid paralyse, involves upper brachial plexus (> 1 N),
patchy paresis
• Phase III: slow recovery (6-18M), pijn nt beinvleod dr palpatie/
beweging, atrophy spieren rond schouder, secere weakness (abductie &
external rotation shouder), paresthesia, autonomic disregulatie
(↑zweten, alterned hair, nail growth)
▪ D: Klinische suspicion, EMG: denervatie & reinnervatie
▪ R/ conservative: observation & pijn controle (nsaid, narcotic), physical therpy,
oral corticosteroids
▪ Prognose: good but slow
- Man pijn R arm, lat aspect R schouder ; verstoord slaap snachts, fysiotharpie, cervical traction,
acupuncture ni extra pijn
- Welke structuren compressen zenuwwortels? (radicluaire pijn = pijn tgv inflam/ compressie
zenuwwortel)
o Disc herniation
o Osteophytes of uncovertebral joint
o Facet hypertrophy
o Other (tumor) → kan nachtelijke pijn
HOE LOPEN NERVE ROOTS
- Cervical nerve roots lopen BOVEN het vertebrae
o Bv nerve root C6 loopt boven C6; tussen C5 en c6
- Lumbar nerve roots lopen ONDER vertebrae (onder pedikel zelfde nummer)
3
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