Pathologieën
Inhoudsopgave
Nek Graad III en IV .................................................................................................................................................. 4
Graad III: Cervicale radiculopathie...................................................................................................................... 4
Graad IV: Fracturen............................................................................................................................................. 5
Graad IV: Cervicale arteriële disfunctie .............................................................................................................. 5
Graad IV: Schade aan het ruggenmerg/ Cervicale myelopathie ......................................................................... 6
Graad IV: Infecties .............................................................................................................................................. 6
Graad IV: Maligne tumoren ................................................................................................................................ 6
Graad IV: Systemische ziekten ............................................................................................................................ 6
Schouderaandoeningen .......................................................................................................................................... 7
Subacromiaal pijnsyndroom (SAPS) .................................................................................................................... 8
Schouderimpingment ..................................................................................................................................... 8
Rotator cuff tendinopathie ............................................................................................................................. 9
Rotator cuff ruptuur ..................................................................................................................................... 10
Tendinitis calcarea ........................................................................................................................................ 11
Biceps (caput longum) pees ruptuur (+SLAP laesie) ..................................................................................... 12
Bursitis subacromialis ....................................................................................................................................... 13
Glenohumerale gewrichtsklachten ................................................................................................................... 14
Frozen shoulder ............................................................................................................................................ 14
Artrose .......................................................................................................................................................... 16
Overige schouderaandoeningen ....................................................................................................................... 17
Glenohumerale instabiliteit .......................................................................................................................... 17
Cervicale radiculopathie ............................................................................................................................... 18
Aandoening van de plexus brachialis – Thoracic Outlet Syndroom (TOS).................................................... 19
Schouderluxaties .............................................................................................................................................. 20
AC-Luxaties (+ indeling in Tossy)....................................................................................................................... 21
Elleboogaandoeningen.......................................................................................................................................... 23
Laterale epicondylalgie (LE) / epicondylus lateralis .......................................................................................... 23
Mediale epicondylalgie (ME) / epicondylus medialis ....................................................................................... 24
Elleboogluxatie ................................................................................................................................................. 25
Osteochondritis dissecans (OD) ........................................................................................................................ 26
Bursitis olecrani ................................................................................................................................................ 27
Cubitale tunnel syndroom ................................................................................................................................ 28
Polsaandoeningen ................................................................................................................................................. 29
Ziekte van de Quervain ..................................................................................................................................... 29
Roeierspols (intersection syndrome, oarsman’s wrist) .................................................................................... 30
Carpaletunnelsyndroom ................................................................................................................................... 31
Compressieneuropathie n. ulnaris .................................................................................................................... 32
1
,Pathologieën
Scaphoideum fractuur ...................................................................................................................................... 33
Scapuholunaire instabiliteit .............................................................................................................................. 34
Contractuur van Dupuytren .............................................................................................................................. 35
Triggerfinger ..................................................................................................................................................... 36
Ganglion ............................................................................................................................................................ 37
Artrose .............................................................................................................................................................. 38
Reumatoïde artritis ........................................................................................................................................... 38
Skiduim (gamekeeper’s thumb) ........................................................................................................................ 39
Malletvinger (hamervinger) .............................................................................................................................. 39
Heupaandoeningen ............................................................................................................................................... 40
Trochanter major pijnsyndroom ....................................................................................................................... 40
Liesklachten ...................................................................................................................................................... 41
Femoroacetabulair impingement ..................................................................................................................... 42
Coxartrose......................................................................................................................................................... 43
Heupfracturen .................................................................................................................................................. 44
Avasculaire kopnecrose femur ......................................................................................................................... 45
Heupaandoeningen bij kinderen ...................................................................................................................... 46
Bovenbeen en knieaandoeningen ......................................................................................................................... 47
Patellofemoraal pijnsyndroom c.q. young girls knee ................................................................................... 48
Hamstring(spier)ruptuur .............................................................................................................................. 50
Voorste kruisbandletsel................................................................................................................................ 51
Achterste kruisbandletsel ............................................................................................................................. 51
Meniscus laesie ............................................................................................................................................ 52
Meniscus bewegingen .................................................................................................................................. 53
Collaterale band ruptuur .............................................................................................................................. 54
Osgood Schlatter .......................................................................................................................................... 55
Iliotibiaal bandsyndroom c.q. Runner’s knee ............................................................................................... 56
Patellofemoraal instabiliteit ......................................................................................................................... 57
Tendinopathie patellapees c.q. Jumper’s knee ............................................................................................ 58
Bursitis .......................................................................................................................................................... 59
Bursitis infrapatellaris................................................................................................................................... 59
Baker’s cyste c.q. kniekuilcyste .................................................................................................................... 59
Onderbeen, Voet en Enkelaandoeningen ............................................................................................................. 60
Acute pathologieën .......................................................................................................................................... 60
Achillespeesruptuur ..................................................................................................................................... 61
Spierletsel Gastrocnemius – Zweepslag c.q. Coup de fouet......................................................................... 63
Inversietrauma = supinatietrauma .............................................................................................................. 64
Syndesmose letsel ........................................................................................................................................ 66
2
,Pathologieën
Chronische structurele pathologieën enkel, voet en tenen ............................................................................. 67
Enkelartrose ................................................................................................................................................. 67
Deformiteiten van de voet ........................................................................................................................... 68
Deformiteit van de tenen ............................................................................................................................. 68
Chronische pathologieën; Belasting -Belastbaarheid ....................................................................................... 69
Functionele instabiliteit ................................................................................................................................ 70
Fasciosis plantaris c.q. fasciitis ..................................................................................................................... 71
Mediaal Tibiaal Stresssyndroom (MTSS) c.q. shin splint .............................................................................. 72
Achillespeestendinopathie c.q. achillodynie ................................................................................................ 74
Tarsale tunnelsyndroom............................................................................................................................... 75
Claudicatio Intermittens: c.q. perifeer arterieel vaatlijden c.q. etalagebenen ........................................... 77
Mortons Neuroom........................................................................................................................................ 79
Specifieke lage rugpijn .......................................................................................................................................... 80
Spondylolyse (wervelfractuur) .......................................................................................................................... 81
Spondylolisthesis (wervelverschuiving) ............................................................................................................ 81
Osteoporose ..................................................................................................................................................... 82
Kanaalstenose ................................................................................................................................................... 82
Bechterew ......................................................................................................................................................... 83
Aspecifieke lage rugpijn – 90% ......................................................................................................................... 84
EXTRA .................................................................................................................................................................... 85
Motor Control Impairment ............................................................................................................................... 85
Scapula dyskinesie ............................................................................................................................................ 87
Schouderinstabiliteit en indelingen .................................................................................................................. 88
T.U.B.S. = traumatische anterieure instabiliteit ........................................................................................... 88
A.I.O.S = overbelastingsinstabiliteit .............................................................................................................. 89
G.I.R.D. = Glenohumeral Internal Rotational Deficit .................................................................................... 89
A.M.B.R.I = multidirectionele instabiliteit .................................................................................................... 90
Indeling instabiliteit volgens Stanmore classification .................................................................................. 91
De pees en peesaandoeningen ......................................................................................................................... 92
De pees ......................................................................................................................................................... 92
Pees-bot overgang........................................................................................................................................ 93
Spier-pees overgang ..................................................................................................................................... 93
Tendinitis ...................................................................................................................................................... 94
Tendinose = peesdegeneratie ...................................................................................................................... 95
Overige peesaandoeningen (valt onder tendinose) ..................................................................................... 96
Bindweefsel .................................................................................................................................................. 97
3
, Pathologieën
Nek Graad III en IV
normaal beloop: <6 wkn (pijn afname, activiteit e/o participatie toename)
afwijkend beloop: >6 wkn (pijn, recidiverend)
Wereldwijd op drie na grootste categorie musculoskeletale klachten
Neck Pain Task Force
- Graad I: functiestoornissen zonder invloed op ADL
- Graad II: activiteitsbeperkingen
- Graad III: zonder tekenen of symptomen die kunnen wijzen op grote structurele pathologie,
waarbij wel neurologische symptomen aanwezig zijn, zoals verminderde peesreflexen,
spierzwakte of sensibiliteitsstoornissen (hypo- of hyperesthesie) in de bovenste extremiteit.
- Graad IV: met tekenen of symptomen die kunnen wijzen op ernstige structurele pathologie:
o Fracturen
o Cervicale arteriële disfunctie
o Schade aan het ruggenmerg/ Cervicale myelopathie
o Infecties
o Maligne tumoren
o Systemische ziekten, waaronder gewrichtsontstekingen
Fysiotherapie – Diagnostisch proces
Allereerst dient Graad IV uitgesloten te worden, middels screening rode vlaggen + rode vlaggen nek.
Indien uit screening/anamnese Graad III (cerv. radiculopathie) duidelijk blijkt, dan insluiten (SpPin):
- Spurling’s test >>provocatie van symptomen positief insluiten
- Tractie/distractie test>>afname symptomen positief insluiten
Indien uit screening/anamnese twijfel is voor een Graad III (cerv. radi), dan uitsluiten (SnNout):
- ULTT (upper limb tension) test>>geen symptomen negatief uitsluiten
Graad III: Cervicale radiculopathie
Kenmerken :
- ‘elektrische’ schietende pijn binnen de aangedane dermatomen,
vooral bij activiteiten die drukverhoging binnen de dura
veroorzaken (niezen, persen ed)
- Nekpijn
- Radiculaire pijn
- Pijn in arm of hand (evt rondom scapula)
- Paresthesieën, hypesthesie, anesthesie
- Krachtsverlies van arm- en handspieren
- Hyporeflexie
- Monosegmentaal en unilateraal
Oorzaken: (of combi van deze twee)
- Zachte nekhernia
- Harde nekhernia (facet-, unc- en discusartrose)
4
Inhoudsopgave
Nek Graad III en IV .................................................................................................................................................. 4
Graad III: Cervicale radiculopathie...................................................................................................................... 4
Graad IV: Fracturen............................................................................................................................................. 5
Graad IV: Cervicale arteriële disfunctie .............................................................................................................. 5
Graad IV: Schade aan het ruggenmerg/ Cervicale myelopathie ......................................................................... 6
Graad IV: Infecties .............................................................................................................................................. 6
Graad IV: Maligne tumoren ................................................................................................................................ 6
Graad IV: Systemische ziekten ............................................................................................................................ 6
Schouderaandoeningen .......................................................................................................................................... 7
Subacromiaal pijnsyndroom (SAPS) .................................................................................................................... 8
Schouderimpingment ..................................................................................................................................... 8
Rotator cuff tendinopathie ............................................................................................................................. 9
Rotator cuff ruptuur ..................................................................................................................................... 10
Tendinitis calcarea ........................................................................................................................................ 11
Biceps (caput longum) pees ruptuur (+SLAP laesie) ..................................................................................... 12
Bursitis subacromialis ....................................................................................................................................... 13
Glenohumerale gewrichtsklachten ................................................................................................................... 14
Frozen shoulder ............................................................................................................................................ 14
Artrose .......................................................................................................................................................... 16
Overige schouderaandoeningen ....................................................................................................................... 17
Glenohumerale instabiliteit .......................................................................................................................... 17
Cervicale radiculopathie ............................................................................................................................... 18
Aandoening van de plexus brachialis – Thoracic Outlet Syndroom (TOS).................................................... 19
Schouderluxaties .............................................................................................................................................. 20
AC-Luxaties (+ indeling in Tossy)....................................................................................................................... 21
Elleboogaandoeningen.......................................................................................................................................... 23
Laterale epicondylalgie (LE) / epicondylus lateralis .......................................................................................... 23
Mediale epicondylalgie (ME) / epicondylus medialis ....................................................................................... 24
Elleboogluxatie ................................................................................................................................................. 25
Osteochondritis dissecans (OD) ........................................................................................................................ 26
Bursitis olecrani ................................................................................................................................................ 27
Cubitale tunnel syndroom ................................................................................................................................ 28
Polsaandoeningen ................................................................................................................................................. 29
Ziekte van de Quervain ..................................................................................................................................... 29
Roeierspols (intersection syndrome, oarsman’s wrist) .................................................................................... 30
Carpaletunnelsyndroom ................................................................................................................................... 31
Compressieneuropathie n. ulnaris .................................................................................................................... 32
1
,Pathologieën
Scaphoideum fractuur ...................................................................................................................................... 33
Scapuholunaire instabiliteit .............................................................................................................................. 34
Contractuur van Dupuytren .............................................................................................................................. 35
Triggerfinger ..................................................................................................................................................... 36
Ganglion ............................................................................................................................................................ 37
Artrose .............................................................................................................................................................. 38
Reumatoïde artritis ........................................................................................................................................... 38
Skiduim (gamekeeper’s thumb) ........................................................................................................................ 39
Malletvinger (hamervinger) .............................................................................................................................. 39
Heupaandoeningen ............................................................................................................................................... 40
Trochanter major pijnsyndroom ....................................................................................................................... 40
Liesklachten ...................................................................................................................................................... 41
Femoroacetabulair impingement ..................................................................................................................... 42
Coxartrose......................................................................................................................................................... 43
Heupfracturen .................................................................................................................................................. 44
Avasculaire kopnecrose femur ......................................................................................................................... 45
Heupaandoeningen bij kinderen ...................................................................................................................... 46
Bovenbeen en knieaandoeningen ......................................................................................................................... 47
Patellofemoraal pijnsyndroom c.q. young girls knee ................................................................................... 48
Hamstring(spier)ruptuur .............................................................................................................................. 50
Voorste kruisbandletsel................................................................................................................................ 51
Achterste kruisbandletsel ............................................................................................................................. 51
Meniscus laesie ............................................................................................................................................ 52
Meniscus bewegingen .................................................................................................................................. 53
Collaterale band ruptuur .............................................................................................................................. 54
Osgood Schlatter .......................................................................................................................................... 55
Iliotibiaal bandsyndroom c.q. Runner’s knee ............................................................................................... 56
Patellofemoraal instabiliteit ......................................................................................................................... 57
Tendinopathie patellapees c.q. Jumper’s knee ............................................................................................ 58
Bursitis .......................................................................................................................................................... 59
Bursitis infrapatellaris................................................................................................................................... 59
Baker’s cyste c.q. kniekuilcyste .................................................................................................................... 59
Onderbeen, Voet en Enkelaandoeningen ............................................................................................................. 60
Acute pathologieën .......................................................................................................................................... 60
Achillespeesruptuur ..................................................................................................................................... 61
Spierletsel Gastrocnemius – Zweepslag c.q. Coup de fouet......................................................................... 63
Inversietrauma = supinatietrauma .............................................................................................................. 64
Syndesmose letsel ........................................................................................................................................ 66
2
,Pathologieën
Chronische structurele pathologieën enkel, voet en tenen ............................................................................. 67
Enkelartrose ................................................................................................................................................. 67
Deformiteiten van de voet ........................................................................................................................... 68
Deformiteit van de tenen ............................................................................................................................. 68
Chronische pathologieën; Belasting -Belastbaarheid ....................................................................................... 69
Functionele instabiliteit ................................................................................................................................ 70
Fasciosis plantaris c.q. fasciitis ..................................................................................................................... 71
Mediaal Tibiaal Stresssyndroom (MTSS) c.q. shin splint .............................................................................. 72
Achillespeestendinopathie c.q. achillodynie ................................................................................................ 74
Tarsale tunnelsyndroom............................................................................................................................... 75
Claudicatio Intermittens: c.q. perifeer arterieel vaatlijden c.q. etalagebenen ........................................... 77
Mortons Neuroom........................................................................................................................................ 79
Specifieke lage rugpijn .......................................................................................................................................... 80
Spondylolyse (wervelfractuur) .......................................................................................................................... 81
Spondylolisthesis (wervelverschuiving) ............................................................................................................ 81
Osteoporose ..................................................................................................................................................... 82
Kanaalstenose ................................................................................................................................................... 82
Bechterew ......................................................................................................................................................... 83
Aspecifieke lage rugpijn – 90% ......................................................................................................................... 84
EXTRA .................................................................................................................................................................... 85
Motor Control Impairment ............................................................................................................................... 85
Scapula dyskinesie ............................................................................................................................................ 87
Schouderinstabiliteit en indelingen .................................................................................................................. 88
T.U.B.S. = traumatische anterieure instabiliteit ........................................................................................... 88
A.I.O.S = overbelastingsinstabiliteit .............................................................................................................. 89
G.I.R.D. = Glenohumeral Internal Rotational Deficit .................................................................................... 89
A.M.B.R.I = multidirectionele instabiliteit .................................................................................................... 90
Indeling instabiliteit volgens Stanmore classification .................................................................................. 91
De pees en peesaandoeningen ......................................................................................................................... 92
De pees ......................................................................................................................................................... 92
Pees-bot overgang........................................................................................................................................ 93
Spier-pees overgang ..................................................................................................................................... 93
Tendinitis ...................................................................................................................................................... 94
Tendinose = peesdegeneratie ...................................................................................................................... 95
Overige peesaandoeningen (valt onder tendinose) ..................................................................................... 96
Bindweefsel .................................................................................................................................................. 97
3
, Pathologieën
Nek Graad III en IV
normaal beloop: <6 wkn (pijn afname, activiteit e/o participatie toename)
afwijkend beloop: >6 wkn (pijn, recidiverend)
Wereldwijd op drie na grootste categorie musculoskeletale klachten
Neck Pain Task Force
- Graad I: functiestoornissen zonder invloed op ADL
- Graad II: activiteitsbeperkingen
- Graad III: zonder tekenen of symptomen die kunnen wijzen op grote structurele pathologie,
waarbij wel neurologische symptomen aanwezig zijn, zoals verminderde peesreflexen,
spierzwakte of sensibiliteitsstoornissen (hypo- of hyperesthesie) in de bovenste extremiteit.
- Graad IV: met tekenen of symptomen die kunnen wijzen op ernstige structurele pathologie:
o Fracturen
o Cervicale arteriële disfunctie
o Schade aan het ruggenmerg/ Cervicale myelopathie
o Infecties
o Maligne tumoren
o Systemische ziekten, waaronder gewrichtsontstekingen
Fysiotherapie – Diagnostisch proces
Allereerst dient Graad IV uitgesloten te worden, middels screening rode vlaggen + rode vlaggen nek.
Indien uit screening/anamnese Graad III (cerv. radiculopathie) duidelijk blijkt, dan insluiten (SpPin):
- Spurling’s test >>provocatie van symptomen positief insluiten
- Tractie/distractie test>>afname symptomen positief insluiten
Indien uit screening/anamnese twijfel is voor een Graad III (cerv. radi), dan uitsluiten (SnNout):
- ULTT (upper limb tension) test>>geen symptomen negatief uitsluiten
Graad III: Cervicale radiculopathie
Kenmerken :
- ‘elektrische’ schietende pijn binnen de aangedane dermatomen,
vooral bij activiteiten die drukverhoging binnen de dura
veroorzaken (niezen, persen ed)
- Nekpijn
- Radiculaire pijn
- Pijn in arm of hand (evt rondom scapula)
- Paresthesieën, hypesthesie, anesthesie
- Krachtsverlies van arm- en handspieren
- Hyporeflexie
- Monosegmentaal en unilateraal
Oorzaken: (of combi van deze twee)
- Zachte nekhernia
- Harde nekhernia (facet-, unc- en discusartrose)
4
