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Samenvatting Pathologie van het bewegingsapparaat
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Samenvatting van alle hoorcolleges van Maartje. Informatie uit de slides en eigen notities erbij getypt. Inclusief foto's & voorbeeldexamenvragen!
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PATHOLOGIE VAN HET BEWEGINGSAPPARAAT : SAMENVATTINGINHOUDSTAFEL
Pathologie van het bewegingsapparaat: samenvatting .................................................................................. 1
Inhoudstafel ....................................................................................................................................................... 1
Hoorcollege 1: orthopedie ............................................................................................................................. 21
Begrip orthopedie ........................................................................................................................................... 21
Etiologie = het voorkomen van een bepaald letsel, hierbij horen alle risicofactoren ............................ 21
Diagnose van orthopedisch letsel ................................................................................................................ 22
Anamnese.................................................................................................................................................... 22
Inspectie/observatie ................................................................................................................................... 22
Klinisch onderzoek ..................................................................................................................................... 23
Functioneel onderzoek .............................................................................................................................. 23
Neurologisch onderzoek ............................................................................................................................ 23
Medische beeldvorming/radiologie .......................................................................................................... 24
RX (röntgenonderzoek) ......................................................................................................................... 24
CT-scan (Computer Tomografie) ......................................................................................................... 24
NMR (Nucleaire Magnetische Resonantie) of MRI (Magnetic Resonance Imaging) ................... 25
Echografie................................................................................................................................................ 25
Skeletscintigrafie..................................................................................................................................... 25
Elektrofysiologisch onderzoek .............................................................................................................. 26
Artroscopie .............................................................................................................................................. 26
Medische overcomsumptie ................................................................................................................... 26
Behandeling van orthopedische letsels....................................................................................................... 26
Preventief ..................................................................................................................................................... 26
Conservatief ................................................................................................................................................ 27
Medicamenteus....................................................................................................................................... 27
Immobilisatie ........................................................................................................................................... 28
Kinesitherapie & ergotherapie .............................................................................................................. 28
Operatief ...................................................................................................................................................... 28
Operatie bot ............................................................................................................................................. 28
Operatie gewricht ................................................................................................................................... 28
Operatie pees .......................................................................................................................................... 29
Operatie ligament ................................................................................................................................... 29
Operatie zenuw ....................................................................................................................................... 30
Amputatie ................................................................................................................................................. 30
Post-operatieve behandeling ........................................................................................................................ 31
Pagina 1 van 213
, Medicamenteus ( zie eerder) + antitrombotica....................................................................................... 31
Multi-disciplinaire benadering ................................................................................................................... 31
Hoorcollege 2: traumatologie........................................................................................................................ 31
Begrip traumatologie ...................................................................................................................................... 31
ATLS (Advanced Trauma Life Support) → melding ongeval: inschatting ernst .................................... 31
Soorten traumatologische letsels ................................................................................................................. 32
Spier- en peesletsels: algemeen .............................................................................................................. 32
Spier- en peesletsels: specifiek ................................................................................................................ 33
Ligamentaire letsels ................................................................................................................................... 34
Fracturen ..................................................................................................................................................... 36
Classificaties ........................................................................................................................................... 36
Symptomen ............................................................................................................................................. 37
Genezing.................................................................................................................................................. 38
Abnormale genezing .............................................................................................................................. 39
Acute opvang & initiële behandeling ................................................................................................... 42
Definitieve genezing ............................................................................................................................... 42
Hoorcollege 3: traumatologie........................................................................................................................ 43
Begrip ............................................................................................................................................................... 43
Wat is een synoviaal gewricht? .................................................................................................................... 43
2 belangrijke eenheden ............................................................................................................................. 43
Overzicht bot – kraakbeen – synovium ................................................................................................... 44
Kraakbeen: soorten en eigenschappen ...................................................................................................... 44
Hyalien kraakbeen ...................................................................................................................................... 44
Eigenschappen matrix ........................................................................................................................... 45
Werking matrix ........................................................................................................................................ 45
4 zones ..................................................................................................................................................... 45
Factoren die zorgen voor minimale wrijving van het gewricht ......................................................... 46
Frictie hyalien kraakbeen ...................................................................................................................... 46
Artrose .............................................................................................................................................................. 46
Indeling......................................................................................................................................................... 46
Prevalentie en incidentie ........................................................................................................................... 46
Meest voorkomende locaties ................................................................................................................ 46
Prevalentie ............................................................................................................................................... 47
Risicofactoren ............................................................................................................................................. 47
Pathogenese ............................................................................................................................................... 47
Gradaties ..................................................................................................................................................... 47
Symptomen ................................................................................................................................................. 48
Pagina 2 van 213
, Diagnose ...................................................................................................................................................... 49
Anamnese en lichamelijk onderzoek ................................................................................................... 49
Labo-onderzoek ...................................................................................................................................... 49
Radiologie/medische beeldvorming (vooral RX) ................................................................................ 49
Behandeling ................................................................................................................................................ 49
Medicamenteus....................................................................................................................................... 49
Conservatief ............................................................................................................................................ 49
Operatief .................................................................................................................................................. 49
Reumatoïde artitis (RA) ................................................................................................................................. 50
Epidemiologie.............................................................................................................................................. 50
Risicofactoren ............................................................................................................................................. 50
Pathogenese ............................................................................................................................................... 50
Symptomen ................................................................................................................................................. 51
Symptomen hand ................................................................................................................................... 51
Diagnose ...................................................................................................................................................... 51
Anamnese en lichamelijk onderzoek ................................................................................................... 51
Labo-onderzoek ...................................................................................................................................... 52
Radiologie ................................................................................................................................................ 52
Criteria diagnose (meer dan 6 → RA) ................................................................................................. 52
behandeling ................................................................................................................................................. 52
Medicamenteus....................................................................................................................................... 52
Conservatief ............................................................................................................................................ 53
Operatief .................................................................................................................................................. 53
Septische/infectieuze artritis ......................................................................................................................... 53
Pathogenese ............................................................................................................................................... 53
Epidemiologie en risicofactoren ............................................................................................................... 53
Symptomen ................................................................................................................................................. 54
Behandeling ................................................................................................................................................ 54
Spondyloartritis/Seronegatieve spondyloartropathie ................................................................................ 54
Verschil tussen reumatoïde artritis en spondyloartritis ......................................................................... 55
Psoriasis artritis .......................................................................................................................................... 55
Pathogenese ........................................................................................................................................... 55
Risicofactoren ......................................................................................................................................... 55
Symptomen ............................................................................................................................................. 55
Behandeling ............................................................................................................................................ 55
Reactieve artritis ......................................................................................................................................... 56
Pathogenese ........................................................................................................................................... 56
Pagina 3 van 213
, Risicofactoren ......................................................................................................................................... 56
Symptomen ............................................................................................................................................. 56
Kristalartropathie: jicht ................................................................................................................................... 56
Pathogenese ............................................................................................................................................... 56
Epidemiologie en risicofactoren ............................................................................................................... 56
Risicofactoren ......................................................................................................................................... 56
Symptomen ................................................................................................................................................. 57
Acuut ........................................................................................................................................................ 57
Chronisch ................................................................................................................................................. 57
Behandeling ................................................................................................................................................ 57
Fibromyalgie (= “fibro”) .................................................................................................................................. 57
Metabolische botziektes ................................................................................................................................ 57
Hoorcollege 4: Pathologie van bekken en heup ...................................................................................... 58
Anatomie van het bekken .............................................................................................................................. 58
Anterieur ...................................................................................................................................................... 58
Posterieur .................................................................................................................................................... 58
Lateraal (acetabulum) ................................................................................................................................ 58
Functies bekken.......................................................................................................................................... 59
Form & force closure bij de sacroiliacale gewrichten ........................................................................ 59
Bekkenbodemspieren ............................................................................................................................ 59
Bekkenfracturen.............................................................................................................................................. 60
Krachtinwerking .......................................................................................................................................... 60
Classificatie ................................................................................................................................................. 60
Behandeling ................................................................................................................................................ 61
Conservatief ............................................................................................................................................ 61
Operatief .................................................................................................................................................. 61
Complicaties ................................................................................................................................................ 61
Vroege complicaties (treden onmiddellijk op) .................................................................................... 61
Late complicaties .................................................................................................................................... 61
Acetabulumfracturen ...................................................................................................................................... 62
Behandeling ................................................................................................................................................ 62
Conservatief ............................................................................................................................................ 62
Operatief .................................................................................................................................................. 62
Complicaties ................................................................................................................................................ 62
Anatomie van de heup ................................................................................................................................... 62
Interne ligamenten ...................................................................................................................................... 62
Externe ligamenten .................................................................................................................................... 63
Pagina 4 van 213
,Congenitale heupletsels: heupdysplasie ..................................................................................................... 63
Etiologie en risicofactoren ......................................................................................................................... 64
Onderzoek baby’s ...................................................................................................................................... 64
Abductietest ............................................................................................................................................. 65
Asymmetrie huidplooien ........................................................................................................................ 65
Beenlengteverschil (Galeazzi test) ...................................................................................................... 65
Instabiliteitstesten: Barlow en Ortolani ................................................................................................ 65
Behandeling ................................................................................................................................................ 65
Belang vroege opsporing .......................................................................................................................... 66
Congenitale heupletsels: Legg-Calvé-Perthes ........................................................................................... 66
Epidemiologie.............................................................................................................................................. 66
Pathogenese ............................................................................................................................................... 66
Symptomen ................................................................................................................................................. 67
Behandeling ................................................................................................................................................ 67
Verworven luxaties + luxatiefracturen ......................................................................................................... 67
Verworven heupfracturen .............................................................................................................................. 68
Collum femoris fractuur ............................................................................................................................. 68
Complicaties ............................................................................................................................................ 68
Behandeling ............................................................................................................................................ 68
Pertrochantaire/intertrochantaire fractuur ............................................................................................... 69
Behandeling ............................................................................................................................................ 69
Subtrochantaire fractuur ............................................................................................................................ 70
Behandeling ............................................................................................................................................ 70
Femurschacht fractuur ............................................................................................................................... 70
Behandeling ............................................................................................................................................ 70
Post-operatieve benadering .................................................................................................................. 71
Verworven heupletsels: vergevorderde heupartrose ................................................................................ 71
Totale heupprothese .................................................................................................................................. 71
Posterieure approach ............................................................................................................................. 71
Direct laterale approach ........................................................................................................................ 71
Direct anterieure approach.................................................................................................................... 72
Materialen heupprothesen .................................................................................................................... 72
Heupprothese Post-operatief: advies .................................................................................................. 72
Heupprothese post-operatief: juiste verwachtingen creëren ........................................................... 73
Heupprothese post-operatief: multidisciplinaire revalidatie (kine & ergo) ...................................... 73
Combinatie congenitaal & verworven heupletsel: femoroacetabulair impingement (FAI) ................... 73
Symptomen ................................................................................................................................................. 73
Pagina 5 van 213
, Behandeling ................................................................................................................................................ 74
Hoorcollege 5: pathologie van de knie ....................................................................................................... 74
Anatomie knie ................................................................................................................................................. 74
Tibiofemoraal .............................................................................................................................................. 75
Patellofemoraal ........................................................................................................................................... 76
Artrokinematica knie....................................................................................................................................... 76
Tibiofemoraal .............................................................................................................................................. 76
Patellofemoraal ........................................................................................................................................... 77
Stabiliteit kniegewricht ................................................................................................................................... 77
Passieve stabiliteit ...................................................................................................................................... 77
Actieve stabiliteit ......................................................................................................................................... 78
Samenwerking spieren .............................................................................................................................. 79
Standafwijkingen ter hoogte van de knie .................................................................................................... 80
Gene valgum/varum ................................................................................................................................... 80
Gene valgum ........................................................................................................................................... 80
Gene varum ............................................................................................................................................. 80
Wanneer doorverwijzen? ....................................................................................................................... 80
Behandeling ............................................................................................................................................ 80
Gene valgum correctie bij kinderen ..................................................................................................... 80
Gene valgum correctie bij volwassenen ............................................................................................. 81
Dynamic knee valgus ................................................................................................................................. 81
Toing in ........................................................................................................................................................ 82
Toing out ...................................................................................................................................................... 82
Verworven letsels ter hoogte van de knie: weke delen letsels ................................................................ 82
Meniscusletsels .......................................................................................................................................... 82
Soorten scheuren ................................................................................................................................... 82
Oorzaken ................................................................................................................................................. 83
Symptomen ............................................................................................................................................. 83
Onderzoek ............................................................................................................................................... 83
Diagnose .................................................................................................................................................. 84
Behandeling ............................................................................................................................................ 84
Voorste kruisband letsel ............................................................................................................................ 85
Oorzaak.................................................................................................................................................... 85
Symptomen ............................................................................................................................................. 85
Onderzoek ............................................................................................................................................... 85
Diagnose .................................................................................................................................................. 85
Behandeling ............................................................................................................................................ 85
Pagina 6 van 213
, Achterste kruisband letsel ......................................................................................................................... 86
Oorzaak.................................................................................................................................................... 86
Symptomen ............................................................................................................................................. 86
Onderzoek ............................................................................................................................................... 86
behandeling ............................................................................................................................................. 86
Letsel collateraal ligament ......................................................................................................................... 87
Oorzaak.................................................................................................................................................... 87
Symptomen ............................................................................................................................................. 87
Behandeling ............................................................................................................................................ 87
Unhappy triad .............................................................................................................................................. 87
Spier-pees ruptuur ter hoogte van de knie ............................................................................................. 87
Verworven letsels ter hoogte van de knie: luxaties ................................................................................... 88
Femoro-tibiale luxatie................................................................................................................................. 88
Oorzaak.................................................................................................................................................... 88
Patellaluxatie ............................................................................................................................................... 88
Oorzaak.................................................................................................................................................... 88
Risicofactoren ......................................................................................................................................... 88
Behandeling ............................................................................................................................................ 89
Verworven letsels ter hoogte van de knie: fracturen ................................................................................. 89
Supracondylair en intercondylair .............................................................................................................. 89
Oorzaken ................................................................................................................................................. 89
Classificatie volgens Orthopedic Trauma Association (OTA) system ............................................ 90
Behandeling ............................................................................................................................................ 90
Patellafractuur ............................................................................................................................................. 90
Oorzaak.................................................................................................................................................... 90
Classificatie ............................................................................................................................................. 90
Behandeling ............................................................................................................................................ 90
Tibiaplateu fractuur..................................................................................................................................... 91
Oorzaak.................................................................................................................................................... 91
Classificatie volgens Schatzker ............................................................................................................ 91
Behandeling ............................................................................................................................................ 92
Verworven letsels ter hoogte van de knie: gonartrose .............................................................................. 92
Oorzaken ..................................................................................................................................................... 92
Symptomen ................................................................................................................................................. 92
Diagnose ...................................................................................................................................................... 92
Behandeling ................................................................................................................................................ 93
Post-operatief .............................................................................................................................................. 94
Pagina 7 van 213
, Advies ....................................................................................................................................................... 94
Juiste verwachtingen creëren ............................................................................................................... 95
Multidisciplinaire revalidatie .................................................................................................................. 95
Hoorcollege 6: pathologie van onderbeen, enkel en voet ..................................................................... 96
Anatomie onderbeen ...................................................................................................................................... 96
Articulatio tibiofibularis proximalis ............................................................................................................ 96
Articulatio tibiofemoralis distalis ............................................................................................................... 97
Arthrokinematica ......................................................................................................................................... 97
Membrana interossea ................................................................................................................................ 98
Spieren ......................................................................................................................................................... 98
Loges ............................................................................................................................................................ 99
Letsels van het onderbeen: fracturen .......................................................................................................... 99
Fracturen van tibiaplateau ......................................................................................................................... 99
Open fracturen ............................................................................................................................................ 99
Crurisfracturen (van tibia en fibula) ........................................................................................................ 100
Oorzaken ............................................................................................................................................... 100
Behandeling .......................................................................................................................................... 100
Geïsoleerde tibia- en fibulafracturen ..................................................................................................... 100
Geïsoleerde tibia-fractuur .................................................................................................................... 100
Geïsoleerde fibula fractuur .................................................................................................................. 101
Distale tibiafracturen (meer naar de enkel toe) .................................................................................... 101
Behandeling .......................................................................................................................................... 101
Complicaties onderbeenfracturen .......................................................................................................... 101
Letsels van het onderbeen: luxaties proximaal tibiofibulair gewricht .................................................... 102
Anterolaterale dislocatie .......................................................................................................................... 102
Posteromediale dislocatie ....................................................................................................................... 102
Superieure dislocatie ............................................................................................................................... 103
Anatomie enkel ............................................................................................................................................. 103
Laterale ligamenten .................................................................................................................................. 103
Mediale ligamenten (ligamentum deltoideum) ..................................................................................... 104
Arthrokinematica ....................................................................................................................................... 104
Spieren ....................................................................................................................................................... 105
Anterieure spieren ................................................................................................................................ 105
Laterale spieren .................................................................................................................................... 105
Posterieure spieren .............................................................................................................................. 106
Letsels van de enkel: standafwijkingen ..................................................................................................... 106
Spitsvoet .................................................................................................................................................... 106
Pagina 8 van 213
, Oorzaken ............................................................................................................................................... 106
Behandeling .......................................................................................................................................... 106
Klompvoet .................................................................................................................................................. 107
Etiologie ................................................................................................................................................. 107
Behandeling .......................................................................................................................................... 107
Letsels van de enkel: achillespeesruptuur ................................................................................................ 108
Oorzaken ................................................................................................................................................... 108
Gradaties ................................................................................................................................................... 108
Volledige ruptuur ...................................................................................................................................... 108
Behandeling .............................................................................................................................................. 109
Letsels van de enkel: acute enkelbandletsels .......................................................................................... 109
Inversietrauma .......................................................................................................................................... 109
Eversietrauma ........................................................................................................................................... 110
Syndesmose.............................................................................................................................................. 110
Symptomen ............................................................................................................................................... 110
Onderzoek ................................................................................................................................................. 110
Behandeling .............................................................................................................................................. 111
Letsels van de enkel: enkelfracturen ......................................................................................................... 111
Weber en Lauge-Hansen ........................................................................................................................ 111
Ottowa ankle rules .................................................................................................................................... 112
Behandeling .............................................................................................................................................. 112
Letsels van de enkel: enkelartrose ............................................................................................................ 112
Kenmerken op medische beeldvorming ................................................................................................ 112
Oorzaken ................................................................................................................................................... 112
Symptomen ............................................................................................................................................... 113
Behandeling .............................................................................................................................................. 113
Letsels van de enkel: tarsale tunnelsyndroom ......................................................................................... 113
Behandeling .............................................................................................................................................. 114
Anatomie voet ............................................................................................................................................... 114
Voetbogen ................................................................................................................................................. 115
Mediale longitudinale voetboog .......................................................................................................... 115
Laterale longitudinale voetboog ......................................................................................................... 115
Dwarse/transversale voetboog ........................................................................................................... 116
Letsels van de voet: standafwijkingen ....................................................................................................... 116
Pes planus = platvoet .............................................................................................................................. 116
Pes cavus = holvoet ................................................................................................................................. 116
Pes plano valgus/varus = knikplatvoet .................................................................................................. 116
Pagina 9 van 213
, Pes plano transversus = spreidplatvoet ................................................................................................ 116
Hallux valgus ............................................................................................................................................. 116
Etiologie ................................................................................................................................................. 116
Behandeling .......................................................................................................................................... 116
Hamertenen ............................................................................................................................................... 117
Klauwtenen ................................................................................................................................................ 117
Oorzaken hamertenen en klauwtenen .............................................................................................. 117
Gevolgen hamertenen en klauwtenen ............................................................................................... 117
Behandeling hamertenen en klauwtenen ......................................................................................... 117
Klompvoet .................................................................................................................................................. 117
Letsels van de voet: talusfracturen ............................................................................................................ 117
Fracturen talus .......................................................................................................................................... 117
Behandeling .............................................................................................................................................. 118
Complicaties .............................................................................................................................................. 118
Letsels van de voet: calcaneusfracturen ................................................................................................... 118
Letsels van de voet: fracturen van middenvoet, voorvoet en tenen ..................................................... 118
Fracturen middenvoet (tarsus) ............................................................................................................... 118
Fracturen metatarsalen ........................................................................................................................... 118
Fracturen tenen ........................................................................................................................................ 118
Letsels van de voet: metatarsalgie ............................................................................................................ 118
Oorzaken ................................................................................................................................................... 119
Behandeling .............................................................................................................................................. 119
Letsels van de voet: mortonse neuralgie .................................................................................................. 119
Symptomen ............................................................................................................................................... 119
Oorzaken ................................................................................................................................................... 119
Behandeling .............................................................................................................................................. 119
Letsels van de voet: fascitis plantaris ........................................................................................................ 119
Risicofactoren ........................................................................................................................................... 119
Behandeling .............................................................................................................................................. 120
Letsels van de voet: diabetesvoet .............................................................................................................. 120
Pathogenese ............................................................................................................................................. 120
Neuropathie (aantasting zenuwen) .................................................................................................... 120
Angiopathie (aantasting bloedvaten) ................................................................................................. 120
Verminderde gewrichtsbeweeglijkheid .............................................................................................. 121
Gevolgen ................................................................................................................................................... 121
Letsels van de voet: Charcot-voet ............................................................................................................. 121
Risicofactoren ........................................................................................................................................... 121
Pagina 10 van 213
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