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Samenvatting HOC's MOB IIIB
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Notities en lesslides gecombineerd van het hoorcollege gedeelte van MOB IIIB.
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SAMENVATTING MOB IIIB HOC:CERVICALE EN THORACALE WERVELZUIL
EXAMENS JUNI 2021-2022
INHOUDSOPGAVE
CWK & TWK: Inleiding – Prof. Dr. L. Leysen ...................................................................................................... 4
Uitgangspunt....................................................................................................................................................... 4
Cervicale wervelkolom ........................................................................................................................................ 4
Functionele anatomie en beweeglijkheid ....................................................................................................... 4
Thoracale wervelkolom ..................................................................................................................................... 14
Functionele anatomie ................................................................................................................................... 14
Klinische diagnostiek ..................................................................................................................................... 15
Neurale structuren en nekaandoeningen – Prof. Dr. L. Leysen ....................................................................... 26
Relevantie? ........................................................................................................................................................ 26
Anatomie en fysiologie van het zenuwstelsel.................................................................................................... 26
Terminologie ................................................................................................................................................. 27
Perifere zenuwen .......................................................................................................................................... 27
Design features of the nervous system ............................................................................................................. 29
Zenuwbewegingen ........................................................................................................................................ 29
Pathofysiologische mechanismen van neuropathieën bij nekaandoeningen .................................................... 33
Zenuw ‘entrapment’ en compressie ............................................................................................................. 33
Traumatische zenuwleasie ............................................................................................................................ 40
Klinische manifestatie van neuropathieën bij nekaandoeningen ...................................................................... 40
De ongewone karakteristieken van neuropathieën .......................................................................................... 41
6 klinische observaties .................................................................................................................................. 41
Het neuro-immuun systeem ......................................................................................................................... 43
Neurodynamics ................................................................................................................................................. 45
Neurodynamische testing ............................................................................................................................. 45
Evaluatie en behandeling van slaap bij patiënten met musculoskeletale pijn: een ver-van-mijn-bed-show? –
Prof. Dr. J. Nijs ................................................................................................................................................ 48
Oplossingen quiz ............................................................................................................................................... 48
Traumatische en niet-traumatische nekpijn – Prof. Dr. L De Baets ................................................................. 49
, Inleiding en onderliggende mechanismen van traumatische en niet-traumatische NP .................................... 49
Cervicale wervelzuil....................................................................................................................................... 49
Het biopsychosociaal model ......................................................................................................................... 49
Nekpijn: prognose en beloop ........................................................................................................................ 50
Indelingen van nekpijn .................................................................................................................................. 50
Chronische idiopathische nekpijn versus chronische whiplash geassocieerde aandoeningen .......................... 58
CINP en CWAD............................................................................................................................................... 58
CINP vs CWAD ............................................................................................................................................... 58
Centrale sensitisatie bij CINP en CWAD? ...................................................................................................... 62
De hersenen spelen een belangrijke rol bij (chronische) pijn ....................................................................... 64
Prognostische en herstelbelemmerende factoren geassocieerd met NP .......................................................... 66
Predictoren voor slechte uitkomst na whiplashtrauma ................................................................................ 66
Overzicht van prognostische factoren voor vertraagd herstel bij NP ........................................................... 71
Take home messages ........................................................................................................................................ 72
Onderzoek en behandeling nekpijn inclusief klinische praktijkrichtlijnen – Prof. Dr. L De Baets .................... 73
Onderzoek en behandeling nekpijn ................................................................................................................... 73
Klinisch denkkader ........................................................................................................................................ 73
Nekpijn – EBP ................................................................................................................................................ 73
Onderzoek NP ............................................................................................................................................... 74
KNGF-richtlijn nekpijn ................................................................................................................................... 74
Behandelprofielen NP ................................................................................................................................... 78
Behandeling traumatische en niet-traumatische NP .................................................................................... 83
Te kennen .......................................................................................................................................................... 88
Ziektepercepties en aspecifieke nekpijn: implicaties voor de fysiotherapeutische praktijk – Prof. Dr. Lennard
Voogt ............................................................................................................................................................. 89
Doelstellingen .................................................................................................................................................... 89
Achtergrond ...................................................................................................................................................... 89
Richtlijn ‘Aspecifieke nekpijn’ (Bier et al. 2017)................................................................................................. 89
Internal Classification of Human Functioning ................................................................................................... 89
Praktische implicatie: keuze maken tussen profiel B en C ................................................................................. 89
Stoornissen in anatomische eigenschappen en lichamelijke functies (voorbeelden) ........................................ 89
Beperkingen in activiteiten (voorbeelden) ........................................................................................................ 90
Verlies sociale participatie ................................................................................................................................ 90
Determinanten van het bewegend functioneren van mensen met aspecifieke nekpijn ................................... 90
Aspecifieke nekpijn als vorm van complexe pijn ............................................................................................... 91
Handelingsverlegenheid en psychosociale determinanten ............................................................................... 91
Psychosociale factoren zijn een prognostische factor ....................................................................................... 91
Resumé .............................................................................................................................................................. 91
Ziektepercepties: het common sense model van Leventhal .............................................................................. 92
,Ziektepercepties en musculoskeletale pijn ........................................................................................................ 92
Vijf dimensies van Leventhal’s CSM-model ....................................................................................................... 92
Ziekterepresentatie ........................................................................................................................................... 93
Implicaties voor diagnostiek en therapie .......................................................................................................... 93
Illness perceptions in people with chronic disabling non-specific neck pain: a qualitative study (Kragting et al,
submitted) ......................................................................................................................................................... 93
Achtergrond .................................................................................................................................................. 93
Ziektepercepties van mensen met traumagerelateerde nekpijn .................................................................. 93
Methode van onderzoek ............................................................................................................................... 94
Resultaten (8 thema’s) .................................................................................................................................. 94
Bronnen van ziektepercepties....................................................................................................................... 96
Implicaties voor fysiotherapeutisch handelen .............................................................................................. 97
Discussie ........................................................................................................................................................ 98
, CWK & TWK: INLEIDING – PROF. DR. L. LEYSEN
UITGANGSPUNT
(1) Nekpijn = wijdverspreide gewaarwording met overgevoeligheid van de huid, ligamenten en spieren in
de nekregio
→ langer dan 6 maanden: chronisch
CERVICALE WERVELKOLOM
FUNCTIONELE ANATOMIE EN BEWEEGLIJKHEID
FUNCTIONELE ANATOMIE
• Morfologisch en functioneel wordt de CWK onderverdeeld in 3 verschillende delen:
o Hoogcervicale WK (C0-C2): zeer specifieke en uitgebreide bewegingsmogelijkheden
o Mid- en laagcervicale WK (C3-C7): typische cervicale bewegingen
o De cervicothoracale overgang (CTO) (functioneel tot T3)
→ Osteoligamentaire en musculaire structuren zorgen voor bescherming ruggenmerg en A. vertebralis
→ Hoogcervicaal = atlas en axis + os occipitalis (ontbreken disci intervertrebralis)
→ CTO = C7 tot T3
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