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Samenvatting Cursus wervelkolom CWK en TWK
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CURSUS WERVELKOLOM 2 –THORACALE EN CERVICALE
WERVELKOLOM
Module onderzoek en behandeling 3B
ANKE DOBBELAERE
2019-2020
Matthias Eggermont, Maarten Cnudde, Lynn Leemans
Revalidatiewetenschappen en kinesitherapie
,Deel 1 .................................................................................................................................................8
1. Theoretische achtergrond van de thoracale wervelkolom........................................................8
1.1. Inleiding: algemeen: thoracale wervelkolom ....................................................................8
1.2. Morfologie..................................................................................................................... 12
1.3. Totale ROM: TWK + LWK ................................................................................................ 14
1.4. TLO: Overgangsgebieden ............................................................................................... 14
1.5. Artrokinematica............................................................................................................. 15
1.6. Enkele voorbeelden van mogelijke verwijsdiagnosen ..................................................... 15
1.7. Te kennen technieken van vorig semester ..................................................................... 15
2. Aanvullend lichamelijk onderzoek: inspectie ......................................................................... 16
2.1. Inspectie ventraal .......................................................................................................... 17
2.1.1. Kenpunten loodlijn................................................................................................. 17
2.1.2. Aandachtspunten ................................................................................................... 17
2.1.3. Voorbeelden cursus inspectie 1BARE ..................................................................... 17
2.2. Inspectie lateraal ........................................................................................................... 18
2.2.1. Kenpunten loodlijn................................................................................................. 18
2.2.2. Aandachtspunten ................................................................................................... 18
2.2.3. Voorbeelden uit de cursus inspectie 1BARE ............................................................ 18
2.3. Inspectie dorsaal............................................................................................................ 19
2.3.1. Kenpunten loodlijn................................................................................................. 19
2.3.2. Aandachtspunten ................................................................................................... 19
2.4. Palpatie dorsaal ............................................................................................................. 20
2.5. Inspectie en palpatie ribben: welke bewegingen te verwachten? ................................... 21
2.6. Doelstelling aanvullend lichamelijk onderzoek ............................................................... 21
3. Actief functie onderzoek ....................................................................................................... 22
3.1. Bewegingsdiagram (herhaling) ....................................................................................... 22
3.2. Flexie ............................................................................................................................. 23
3.3. Extensie ......................................................................................................................... 24
3.4. Lateroflexie.................................................................................................................... 24
3.5. 3D Flexie homolateraal .................................................................................................. 25
3.6. 3D Flexie heterolateraal ................................................................................................. 25
3.7. 3D Extensie homolateraal .............................................................................................. 25
3.8. 3D Extensie heterolateraal ............................................................................................. 25
3.9. Specifieke screening ...................................................................................................... 26
4. Regionaal provocatief onderzoek .......................................................................................... 26
4.1. Veringstest .................................................................................................................... 26
1
, 4.2. Segmentale veringstest.................................................................................................. 27
4.3. Compressietest .............................................................................................................. 27
4.4. Tractietest ..................................................................................................................... 28
5. Extra: ribbreuk/indeukingsfractuur........................................................................................ 28
5.1. Breuken constateren van de wervel of het ribrooster .................................................... 28
5.2. Ribbreuk constateren .................................................................................................... 28
5.3. Indeukingsfractuur......................................................................................................... 29
6. Regionaal passief basis onderzoek ......................................................................................... 29
6.1. Flexie T1-T12 ................................................................................................................. 29
6.2. Extensie ......................................................................................................................... 30
6.3. Lateroflexie.................................................................................................................... 30
6.4. 3D Flexie homolateraal .................................................................................................. 31
6.5. 3D Flexie heterolateraal ................................................................................................. 31
6.6. 3D Extensie homolateraal .............................................................................................. 32
6.7. 3D Extensie heterolateraal ............................................................................................. 32
7. Kinesitherapeutische diagnose/analyse ................................................................................. 32
7.1. Interpretatie onderzoek ................................................................................................. 32
7.2. Invullen gezondheidsprofiel ........................................................................................... 32
8. Kinesitherapeutisch zorgplan................................................................................................. 32
8.1. Therapieplanning ........................................................................................................... 32
9. Hands-on behandeling .......................................................................................................... 33
9.1. Dwarse rek (buiklig) ....................................................................................................... 33
9.2. Dwarse rek (zijlig) .......................................................................................................... 34
9.3. Stretching M. Pectoralis Minor (ruglig)........................................................................... 34
9.4. Stretching M. Pectoralis Minor (zijlig)............................................................................. 35
9.5. Stretching M. Pectoralis Major ....................................................................................... 35
9.6. Tractie ........................................................................................................................... 36
9.7. Oscillaties (buiklig) ......................................................................................................... 36
9.8. Harmonics (buiklig) ........................................................................................................ 37
9.9. Mobilisaties: ribrooster (algemeen) ............................................................................... 37
9.10. Mobilisatie: TWK (regionaal) ...................................................................................... 38
10. Cervico-thoracale overgang (CTO) ..................................................................................... 39
10.1. Inleiding CTO gebied .................................................................................................. 39
10.2. Aanvullend lichamelijk onderzoek: opmerking ........................................................... 39
10.3. Screening CWK-CTO-GH: een moeilijke zaak............................................................... 39
10.4. Screening CTO volgens Stenvers................................................................................. 40
2
, 10.4.1. Sneltest-CTO .......................................................................................................... 40
10.4.2. Okselhaarlijn .......................................................................................................... 40
10.4.3. Horizontale adductie .............................................................................................. 41
10.4.4. Claviculaire rol ....................................................................................................... 41
10.4.5. Tipping out............................................................................................................. 41
10.5. Aanvullend lichamelijk CTO onderzoek ....................................................................... 42
10.5.1. Flexie CTO .............................................................................................................. 42
10.5.2. Extensie CTO .......................................................................................................... 42
10.5.3. 3D homolaterale/heterolaterale (?) flexie CTO ....................................................... 43
10.5.4. 3D homolaterale/heterolaterale (?) extensie CTO .................................................. 43
10.6. Therapie/aanpassing behandeling: behandeling/mobilisaties CTO ............................. 44
10.6.1. Articulaire mobilisatie (regionaal) .......................................................................... 44
10.6.2. Articulaire mobilisatie (segmentaal) ....................................................................... 44
DEEL 2 .............................................................................................................................................. 45
11. Inleiding CWK .................................................................................................................... 45
11.1. Nekpijn: definitie ....................................................................................................... 45
11.2. Morfologie cervicale wervelkolom ............................................................................. 45
11.2.1. Hoog cervicaal........................................................................................................ 45
11.2.2. Cervicaal vs Thoracaal ............................................................................................ 46
11.3. Range of motion ........................................................................................................ 46
11.3.1. Gekoppelde bewegingen........................................................................................ 47
11.4. KNGF 2016 ................................................................................................................. 47
11.4.1. Beloop ................................................................................................................... 47
11.4.2. Methodisch handelen: indicatie therapie? ............................................................. 48
11.4.3. Graad IV: pathologieën .......................................................................................... 48
11.4.4. Graad III ................................................................................................................. 48
11.4.5. Graad I en II ........................................................................................................... 49
11.4.5.1. Verder onderzoek ............................................................................................ 49
11.5. Aanvullend lichamelijk onderzoek: onderzoeksstrategie ............................................ 49
11.6. Neurologisch onderzoek: cervicaal radiculair syndroom ............................................. 50
11.7. Onderzoeksstrategie: scherp begrensd/vage uitstraling? ........................................... 50
11.8. Specialistisch onderzoek ............................................................................................ 50
11.8.1. Hoofdpijn ............................................................................................................... 50
11.8.2. Cervicogene hoofdpijn ........................................................................................... 51
11.8.3. AVBI ....................................................................................................................... 51
12. Screening: sneltests cervicaal ............................................................................................ 52
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