Samenvatting per college:
Diagnostiek en behandeling van
- Liesklachten
- Meniscusletsel
- Enkelletsel
- Schouderluxatie
- Ruptuur hamstring
- Motor control impairment LWK
- Motor control impairment CWK
c-FH1 Diagnostiek liesklachten
Leerdoelen
1. De FIO heeft kennis van de symptomen die bij liesklachten
voorkomen.
2. De FIO heeft kennis van de epidemiologie van liesklachten.
3. De FIO heeft kennis van de diagnostiek bij liesklachten.
4. De FIO heeft inzicht in de invloed van het bekken op liesklachten.
Liespijn - diagnostiek en behandeling
Inhoud
• Definitie
• Pathomechanica
• Epidemiologie
• Symptomen
• Paramedische routing
• Differentiaal diagnostiek
• Bekkendysfunctie; relatie bekken en liesklachten
• Therapie
Definitie
• Een verzamelnaam voor aandoeningen van verschillende
anatomische structuren met als gemeenschappelijk kenmerk pijn in
de regio inguinalis (liesregio)
• Nadruk is dat het verschillende anatomische structuren zijn
• H. Inklaar 2000
-Common problem in sports that involve kicking/ twisting mvts while
running
- these movemets place strain on fascial and MSK structures that
are fixed to a number of bony anatomical structures.
- Tissue damage and/or entrapment of these structures may cause
pain.
-Ranks behind only fracture and ACL repair in terms of time out of
training/ play
Adductor related problems (enthesopathy)
Inguinal related problems (Gilmores groin/ sportsman’s hernia/ athletic
pubalgia)
Psoas related problems (tendinopathy, bursitis)
Don’t forget: Hip joint (FAI) and SIJ (arthrogenic)
, • Diagnose; “They are difficult to diagnose and
treat correctly because they involve a
complex regional anatomy that produces
diffuse, insidious symptoms and
uncharacteristic presentations”
• -> Lastig omdat anatomie nogal met elkaar
verbonden is
• Rectus abdominis en adductor longus bijv.
• Vezels en pezen hebben connectie met elkaar
anatomisch gezien; duidelijk verband
• Renstrom 1999
• And quite often the anatomy itself is complex/ inter-related (AL/
RA + symphysis pubis continuous attachment), therefore difficult
to differentiate.
• Most groin pain problems involve more than one structure (multi-
pathology)
Pathomechanica
• Cochrane (1971): surmenage adductoren; lokaal; overbelasting;
kleine overbelasting; ruste en rekken
• Harris (1974): microtraumata/instabiliteit SI; kleine scherutjes
zichtbaar; instabiliteit SI gewricht (bekken)
• Bowerman (1977): trek en schuifkrachten op symfyse; niet allen SI
aan achterkant maar symfyse betrokken (trek en schuikrachten)
• Hanson (1978): spondylarthropathie; spondylen
• Williams (1978): endorotatie heup; beperkt; gewricht kan meespelen
• Lloyd-Smith (1985): excessieve symfyse beweging; te veel beweging
in symfyse
• Snijders (1993): self bracing model/functionele eenheid; SI
gewricht; bekkenring zien als één functionele eenheid; stabiliteit
belangrijk!
• Pathomechanics: changes in the normal biomechanical function of
a joint/ structure
• 2 joints in this region: hip (compressive forces through IR,
labrum, FAI) and symphysis pubis
• Other joints that can refer: SIJ dysfunction, Lumbar spine (L1/2
radicular, L1/2/3, S1-2 somatic referral)
• Snijders self-bracing model talks about the pelvis as a functional
unit – and that we have 2 different stability mechanisms:-
, • Form and Force closure
Overzicht pathomechanica
Sacturm; driehoekvorm en ligamenten eromheen
- Selfbracingmodel;
- Vormsluiting; rol van de vorm; zie afbeelding hieronder
- Krachtsluiting; banden (ligamenten), pezen en spieren geven SI-
gewricht meer stabiliteit; steun en minder bewegingsmogelijkheid
-> Beide sluitingen zorgen voor stabiliteit
Primary function of the pelvis = to transfer loads generated by body
weight, during standing, walking, sitting and other functional tasks.
We often use the word “stability” to describe effective load transfer
Panjabi talks about stability in 3 systems “passive” (form closure),
“active” (force closure) and “control” (motor control – sequencing and
timing of activation)
Collectively these systems produce approximation of the joint surfaces
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