Musculoskeletale kinesitherapie 2 (praktijk)
H1: Klinisch onderzoek van heup............................................................................................................3
2.1. Algemene inspecte.....................................................................................................................3
2.2. Anamnese....................................................................................................................................3
2.3. Specifeke inspecte.....................................................................................................................4
2.4. Functeonderzoek........................................................................................................................4
3.1. Functeeeses.................................................................................................................................6
A. SQUAT TEST........................................................................................................................................7
B. ACTIEVE HEUPFLEXIE..........................................................................................................................8
C. SCOUR TEST........................................................................................................................................8
D. ACTIEVE HEUPEXTENSIE.....................................................................................................................8
E. PASSIEVE ENDOROTATIE.....................................................................................................................8
A. FABERTEST = PATRICKTEST (Flexie – Abducte – Exoroeatee..............................................................8
B. TEST VOLGENS OBER..........................................................................................................................8
C. THOMAS TEST.....................................................................................................................................9
D. FADDIR TEST = LABRUMTEST.............................................................................................................9
E. FAI TEST = LABRUMTEST.....................................................................................................................9
F. SNAPPING HIP TEST............................................................................................................................9
G. SIGN OF BUTTOCK............................................................................................................................10
H. |P| STRAIGHT LEG RAISE..................................................................................................................10
I. TEST VAN BRAGARD..........................................................................................................................10
J. TEST VAN NERI..................................................................................................................................10
K. OMGEKEERDE TEST VAN LASEGUE...................................................................................................10
3.2. Palpate......................................................................................................................................10
H2: Klinisch onderzoek knie..................................................................................................................12
2.1. Anamnese..................................................................................................................................12
2.2. Inspecte....................................................................................................................................13
2.3. Palpate......................................................................................................................................13
2.4. Functeonderzoek......................................................................................................................14
3.1. Functeeeses...............................................................................................................................16
A. FRONTALE KNIE INSTABILITEIT.........................................................................................................17
F. SAGITTALE KNIE INSTABILITEIT.........................................................................................................18
G. MENISCUSTESTS...............................................................................................................................19
H. PATELLOFEMORAAL GEWRICHT.......................................................................................................20
I. ANDERE TESTS...................................................................................................................................22
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, 3.2. Palpate......................................................................................................................................23
H3: Klinisch onderzoek enkel en voee...................................................................................................25
3.3. Anamnese..................................................................................................................................25
3.4. Inspecte....................................................................................................................................26
3.5. Palpate......................................................................................................................................26
3.6. Functeonderzoek......................................................................................................................26
A. ALGEMEEN.......................................................................................................................................27
J. ART. TALOCRURALIS..........................................................................................................................27
K. ART. SUBTALARIS..............................................................................................................................27
L. CHOPART GEWRICHTSLIJN – ART. TARSI TRANSVERSA.....................................................................27
M. GEWRICHTSLIJN VAN LISFRANC – ART. TARSOMETATARSALES I-V.................................................28
N. TENEN..............................................................................................................................................28
O. INTERPRETATIE PASSIEF ONDERZOEK..............................................................................................28
4.1. Functeeeses...............................................................................................................................29
A. ART. TIBIOFIBULARE.........................................................................................................................29
B. ART. TALOCRURALIS.........................................................................................................................30
C. ART. MIDTARSALE.............................................................................................................................30
A. STAR EXCURSION TEST.....................................................................................................................31
B. ANTERIEURE SCHUIFLADE VAN TALUS.............................................................................................31
C. TESTEN SYNDESMOSES TIBIOFIBULARIS...........................................................................................31
D. ACHILLESPEESRUPTUUR...................................................................................................................32
4.2. Palpate......................................................................................................................................32
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,H1: Klinisch onderzoek van heup
1. INLEIDING
Aandoeningen heupgewricht: geven meeseal liespijn en/of pijn in L2 of L3 dermaeoom
o + |w| eese heup: duiden vaak op aandoening ineree seruceuur (vb. bursae i.p.v.
coneractele seruceuur
Diagnose t.h.v. heup: moeilijk omdae pijn in bil/lies dikwijls afomstg is uie lumbale
wervelkolom, sacro-iliacaal gewriche of symphysis pubis
o Omgekeerd: age rugpijn kan ook oneseaan door heupaandoening
2. BASISONDERZOEK
2.1. Algemene inspecte
- Hoe kome de patine binnen?
- Gelaaesuiedrukking?
- Gebruik hulpmiddelen?
- …
2.2. Anamnese
Leeftijd
o Sommige aandoeningen heupgewriche komen alleen op bepaalde leefijden voor
Zeer jonge kinderen: coxits fugax + morbus perehes
Tieners: epifysiolysis capits femoris
Adolesceneen: oseeochondrosis dissecans
Volwassenen: coxarerose
Beroep
o Zware laseen tllen verge veel van heupgewriche
o Zitend beroep: kraakbeenvoeding verminderd + verkortng heuplexoren + burstts
ischiadica
Hobby/sport
o Voeebal is spore waarbij veel pubalgie voorkome
Wat zijn klachten?
o Pijn? Waar? Wanneer?
o Koores?
o Paresehesiein? veroorzaake door compressieneuropaehiein
o Looppaeroon? zelden enige klache
Hoe zijn klachten begonnen?
o Trauma-analyse
o Belastng – belasebaarheidsanalyse
Wat is aard van klachten?
o Zeurende pijn eypisch coxarerose
o Seekende pijn tjdens actvieeie eypisch eendinits
o Koredurende seeken + doorzakken corpora libera
Hoelang bestaan klachten al?
o Peesproblemen kunnen maanden duren
Andere pijnlijke regio’s?
o Indien er klacheen zijn in andere regio’s diene men mee syseeemziekee rekening ee
houden
3
, Operatieve ingrepen?
Medicatie gebruik?
o Antcoagulanta: bepaalde behandelvormen geconeranndiceerd
Vb. diepe dwarse frictes
o Pijnstllers: minder pijn tjdens sporeer, kans op overbelastng
o Morfne: bennvloede anamnese
o Cortcoseeronden: op koree eermijn positef effece, lange eermijn herval
Andere behandeling?
2.3. Specifeke inspecte
Voor-/achteraanzicht + zijaanzicht L & R
o Seand voeeen, kniein, benen, bekken
o Beenlengee, aerofe, kleurveranderingen,…
Vooraan
o SIAS: hoogeeverschil beenlengeeverschil / bekkenroeate
o Trochaneor major beenlengeeverschil
o Toeing oue/in voeeen vergroote aneeversiehoek
Zijaanzicht
o Plaevoeeen / holvoeeen
o Bekken anee/reeroversie
Reeroversie = verkoree buikspieren
Aneeversie = verkoree heuplexoren
2.4. Functeonderzoek
ae Actef functeonderzoek
Functioneel onderzoek
o Hurken
o Trappen doen
o Spreidseand – uievalspas
o Ganganalyse
o Tese volgens Trendelenburg: M. glueeus medius
P: niee ee eeseen been 30° heuplexie, knie gebogen, voee dorsilexie
T: dorsaal van P, observeere crisea iliaca en SIPS
Kijk of hoogee al gelijk is bij seare oefening (bekkenverwringinge
Bekken niee ee eeseen been zo hoog mogelijk heffen
Houding 30 seconden aanhouden
!!! Ook al is uie functoneel deel duidelijk dae er sprake is van heupaandoening, in seand altjd mee
basisonderzoek van LWK beginnen !!!
Basisonderzoek LWZ
o Exeensie
o Flexie
o Laeerolexie L en R
Artrokinematica
o Oriineate aceeabulum: veneraal – laeeraal – caudaal
o Capue femoris = convex
o Aceeabulum = concaaf
Bewegende gewrichesparener = convex : rol glij
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