Dit is 1 van de 6 delen van het grote vak 'Wervelkolom' in Kinesitherapie. Deze samenvatting is gebaseerd op alle slides van de theorie over de cervicale wervelkolom. De slides van dit vak waren chaotisch en een groot aantal. Ik heb deze wat beknopter en gestructureerd samengevat, maar het komt no...
Cervicale wervelkolom: theorie en klinisch
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Examen casus
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Intro CWK
Musculoskeletal disorders (MSDs) of cervical spine (Cx)
→ Refers to clinical conditions that involve nerves, tendons, muscles, joints and supporting structures of Cx
- Examples of MSD Cx
o Cervical hypomobility (or cervical articular dysfunction)
o Cervico-brachialgia (uitstraling van nek naar arm)
o Cervical radicular pain (schietende pijn van zenuwwortel naar arm)
o Cervical radiculopathy (verminderde geleiding → voosheid, tintelingen, doof gevoel,
krachtsverlies, afwezige reflexen)
o Postural syndrome (houding heeft invloed op klachten)
o Cx myofascial pain (trapezius syndrome)
o Cervicogenic headache
o Tension type headache
o Acute pain following Motor Vehicle Accident (MVA)
o Chronic pain following MVA (WAD)
o Cervical instability (bv door fractur of hypermobiliteit)
Cervical spine-related MSDs
- Can give rise to neck pain and/or radiating pain and/or associated symptoms
,Facts and figures
Blijft toenemen
Hoge kost
Common MSD
- NP (neck pain) reported to be 2nd most common reason leading to disability and injury claims
Economic burden of NP
- 2nd only to LBP in workers’ compensation claims in USA
→ Nekpijn & lage rugpijn = grote kost in maatschappij
Point prevalence NP
- 10% at any one time
- 13,8% of population aged > 18j
- Point prevalence: 5,9 – 22,2% for adult population (15-74j)
Year prevalence
- 45-54% each year
- More percentage in workers
- NP with associated disability: 1,7 – 11,5% in general population
Life prevalence
- 50-75% of individuals have neck or shoulder pain at least once in their life
Common in outpatient physiotherapy practice
- Cx-related MSDs account for approximately 25% of patients seen in outpatient physiotherapy
Gender differences
- Chronic NP is more common in women (22%) than in men (16%)
Temporal definition – based on timeline
- Hyperacute: first week
- Acute neck pain: 0-3 weeks’ duration of pain and/or disability
- Sub-acute neck pain: 4-12 weeks’ duration of pain and/or disability
- Chronic/persistent neck pain: more than 12 weeks’ duration of pain and/or disability
- Recurrent neck pain: patients seeking help after at least 1 month of not seeking care or being on
sick leave after at least 1 month of working
Persistent neck pain
- Rarely associated with
, o Serious tissue damage (abnormal anatomical structure)
o Identifiable underlying disease
- Classified as ‘non-specific’ neck pain (NS-NP)
Many and diverse treatment approaches for (NS)-NP
- Most patients receive conservative treatment from a general practitioner or a physiotherapist
- Traditional biomedical model: diagnosis aims to identify an anatomical structure or pathology
responsible for disorder
- Most patients with NS-NP: definitive pathology cannot be identified → this biomedical model fails
to direct treatment
- What are indicators to direct the intervention?
- What causes neck pain when there is no tissue damage?
Natural course of NP
- Remains unclear
- Normally self-limiting within a few weeks of onset
- Sometimes persistent
o Severely limiting daily functioning
o Resulting in prolonged sick leave and disability
o Inducing substantial medical consumption
- Places a heavy burden on individuals, employers and health care services
Acute pijn
- Veel pijn, weefselschade mogelijk
- Herstel: schade herstelt samen met reductie van pijn (normaal binnen 6 weken)
Persisterende pijn: tijdens herstelperiode toch nog pijn
Bergtop: acute pijn Heuvels: persisterende pijn
, Psychosociale factoren die lichaam gevoelig kunnen maken
- Stress, slaaptekort, bewegingsangst, aandacht voor pijn, drinken en roken, slechte voeding,
maladaptieve cognities, emoties
→ Centrale sensitisatie: pijnsysteem overactief
Persistent neck pain
Cx related MSDs & heterogeneity
Elke patiënt individueel bekijken
- Per patiënt oorzaak van klachten vinden (analogie met boomstam/ijsberg)
NS-NP is
MULTIDIMENSIONAL
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