Bovenste Extremiteit
Gabriëlle Van Eekert
UNIVERSITEIT ANTWERPEN
,Inhoudsopgave
Rotator Cuff Related Shoulder Pain (RCRSP) .................................................................................................... 4
Evolution... .......................................................................................................................................................... 4
Diagnostische schoudertest ................................................................................................................................ 5
Imaging?............................................................................................................................................................. 6
So, what is RCRSP? ............................................................................................................................................. 6
Increasing evidence of intrinsic role (Cook et al. 2016) ...................................................................................... 6
Scapular dyskinesis => shoulder pain?................................................................................................................ 8
What is the evidence of... ................................................................................................................................. 10
What should the exercise look like? ................................................................................................................. 11
Artrose ........................................................................................................................................................... 12
Omvang van het probleem ............................................................................................................................... 12
Indicaties voor protheses (anno 2021) ............................................................................................................. 12
Patiënten selectie: bemerkingen ...................................................................................................................... 12
Patho-anatomische problemen om te overwegen ........................................................................................... 12
Spectrum van de pathologie: Primaire OA ....................................................................................................... 12
Glenoid wear .................................................................................................................................................... 13
Spectrum of Pathology: Posttraumatic OA ....................................................................................................... 13
Spectrum of Pathology: Cuff Tear Arthropathy ................................................................................................ 13
Anatomical Shoulder Arthroplasty Hemi and Total .......................................................................................... 13
TSA versus RSA ?? ............................................................................................................................................. 14
Instabiliteit ..................................................................................................................................................... 16
Clinical Classification ........................................................................................................................................ 16
Clinical examination (voorbeelden zie PPT) ...................................................................................................... 17
Acute dislocatie ................................................................................................................................................ 17
Nerve Injury ...................................................................................................................................................... 18
More Technical Investigations ? ....................................................................................................................... 18
MR - arthogram ................................................................................................................................................ 18
CT-arthrogram .................................................................................................................................................. 18
First-time dislocation ........................................................................................................................................ 19
Wrist pain in athletes ..................................................................................................................................... 20
Introductie ........................................................................................................................................................ 20
Scaphoid fractur ............................................................................................................................................... 20
SL-injury (scapho-lunate) .................................................................................................................................. 21
TFCC letsels ....................................................................................................................................................... 22
ECU Tenosynovitis – (sub)luxation .................................................................................................................... 24
Ulnair styloid impingement .............................................................................................................................. 24
, Triquetrum-lunatum gewrichtsband scheur ..................................................................................................... 24
Hamatum stress fractur (hamulus ossis hamatum) ......................................................................................... 24
Ski-duim ............................................................................................................................................................ 25
Flexor pees avulsie ............................................................................................................................................ 25
Pulley letsels ..................................................................................................................................................... 26
PIP-dislocatie .................................................................................................................................................... 26
Extra notities .................................................................................................................................................... 26
Shoulder arthroplasty rehab .......................................................................................................................... 27
Operatie via deltopectorale groeve: ................................................................................................................. 27
Rehab: .............................................................................................................................................................. 27
Info: .................................................................................................................................................................. 27
Indicaties voor schouderartroplastiek .............................................................................................................. 28
Prognosis .......................................................................................................................................................... 28
Verschil RTSA en ATSA rehab ............................................................................................................................ 29
Frozen shoulder ............................................................................................................................................. 29
Epidemiologie - Prevalentie .............................................................................................................................. 29
Risicofactoren ................................................................................................................................................... 30
Stages of Frozen Shoulder ................................................................................................................................ 30
Hypothese ......................................................................................................................................................... 30
Pathophysiology in summary (Millar et al. 2022)............................................................................................. 31
Assessment ....................................................................................................................................................... 32
Definition of a frozen shoulder (Kelley et al. 2013) .......................................................................................... 32
FS with HIGH, MODERATE & LOW level of irritability ....................................................................................... 33
Management of FS ........................................................................................................................................... 33
Bemerkingen .................................................................................................................................................... 34
Future advances ............................................................................................................................................... 35
Anatomie van de elleboog ............................................................................................................................. 36
Humerus ........................................................................................................................................................... 36
Kapsel ............................................................................................................................................................... 36
Ulna .................................................................................................................................................................. 37
Radius ............................................................................................................................................................... 37
Gewrichten ....................................................................................................................................................... 37
Ligamenten ....................................................................................................................................................... 38
Geen enkel ligament dat vastzit aan de radius ................................................................................................ 38
Lig anulare: ulna-ulna....................................................................................................................................... 38
Neurovasculair.................................................................................................................................................. 38
Nervus ulnaris .................................................................................................................................................. 38
, - Houdingsgebonden; veel voorkomend (15% voelt al luxeren bij passieve flexie, 140° tricepspees) ....... 38
Nervus medianus ............................................................................................................................................. 39
- Verloop: antero-mediaal ......................................................................................................................... 39
- Motorisch ................................................................................................................................................ 39
o Flexor, pronator ...................................................................................................................................... 39
o AIN: FPM en ½ FDP ................................................................................................................................. 39
- Sensibel: kapsel ....................................................................................................................................... 39
Nervus radialis ................................................................................................................................................. 39
Nervus interosseus posterior: diepe aftakking van N. Radialis: motorische tak ............................................... 39
o Extensie (BR, ECRB, ECRL, EDM) .............................................................................................................. 39
o PIN (ECU, sup, EDC, APL, EPL, EPB, EI)..................................................................................................... 39
o N. cutaneus brachii lateralis inferior ....................................................................................................... 39
o N. cutaneus brachii posterior .................................................................................................................. 39
o N. cutaneus antebrachia posterior ......................................................................................................... 39
Bloedvaten........................................................................................................................................................ 40
Bursae ............................................................................................................................................................... 40
Spieren .............................................................................................................................................................. 40
Biomechanica van de elleboog ....................................................................................................................... 41
Mobiliteit .......................................................................................................................................................... 41
Load Transfer .................................................................................................................................................... 41
Stabiliteit .......................................................................................................................................................... 42
Cornoid en radiuskop ........................................................................................................................................ 43
Olecranon ......................................................................................................................................................... 43
Rotatoire instabiliteit........................................................................................................................................ 43
Instabiliteit van de elleboog ........................................................................................................................... 45
Acuut ................................................................................................................................................................ 45
Complex (= met fractuur) ................................................................................................................................. 46
Simpel (= zonder fractuur) ................................................................................................................................ 46
Severe chronic PLRI ........................................................................................................................................... 47
Chronic medial instability ................................................................................................................................. 47
VEOS: Valgus Extension Overload Syndrome ................................................................................................... 47
Stijve elleboog................................................................................................................................................ 48
Anatomical Classification ................................................................................................................................. 48
Clinical evaluation ............................................................................................................................................ 49
Treatment ......................................................................................................................................................... 49
Benaderingen van de elleboog ....................................................................................................................... 51
Mediale chirurgische benaderingen ................................................................................................................. 51
Gabriëlle Van Eekert
UNIVERSITEIT ANTWERPEN
,Inhoudsopgave
Rotator Cuff Related Shoulder Pain (RCRSP) .................................................................................................... 4
Evolution... .......................................................................................................................................................... 4
Diagnostische schoudertest ................................................................................................................................ 5
Imaging?............................................................................................................................................................. 6
So, what is RCRSP? ............................................................................................................................................. 6
Increasing evidence of intrinsic role (Cook et al. 2016) ...................................................................................... 6
Scapular dyskinesis => shoulder pain?................................................................................................................ 8
What is the evidence of... ................................................................................................................................. 10
What should the exercise look like? ................................................................................................................. 11
Artrose ........................................................................................................................................................... 12
Omvang van het probleem ............................................................................................................................... 12
Indicaties voor protheses (anno 2021) ............................................................................................................. 12
Patiënten selectie: bemerkingen ...................................................................................................................... 12
Patho-anatomische problemen om te overwegen ........................................................................................... 12
Spectrum van de pathologie: Primaire OA ....................................................................................................... 12
Glenoid wear .................................................................................................................................................... 13
Spectrum of Pathology: Posttraumatic OA ....................................................................................................... 13
Spectrum of Pathology: Cuff Tear Arthropathy ................................................................................................ 13
Anatomical Shoulder Arthroplasty Hemi and Total .......................................................................................... 13
TSA versus RSA ?? ............................................................................................................................................. 14
Instabiliteit ..................................................................................................................................................... 16
Clinical Classification ........................................................................................................................................ 16
Clinical examination (voorbeelden zie PPT) ...................................................................................................... 17
Acute dislocatie ................................................................................................................................................ 17
Nerve Injury ...................................................................................................................................................... 18
More Technical Investigations ? ....................................................................................................................... 18
MR - arthogram ................................................................................................................................................ 18
CT-arthrogram .................................................................................................................................................. 18
First-time dislocation ........................................................................................................................................ 19
Wrist pain in athletes ..................................................................................................................................... 20
Introductie ........................................................................................................................................................ 20
Scaphoid fractur ............................................................................................................................................... 20
SL-injury (scapho-lunate) .................................................................................................................................. 21
TFCC letsels ....................................................................................................................................................... 22
ECU Tenosynovitis – (sub)luxation .................................................................................................................... 24
Ulnair styloid impingement .............................................................................................................................. 24
, Triquetrum-lunatum gewrichtsband scheur ..................................................................................................... 24
Hamatum stress fractur (hamulus ossis hamatum) ......................................................................................... 24
Ski-duim ............................................................................................................................................................ 25
Flexor pees avulsie ............................................................................................................................................ 25
Pulley letsels ..................................................................................................................................................... 26
PIP-dislocatie .................................................................................................................................................... 26
Extra notities .................................................................................................................................................... 26
Shoulder arthroplasty rehab .......................................................................................................................... 27
Operatie via deltopectorale groeve: ................................................................................................................. 27
Rehab: .............................................................................................................................................................. 27
Info: .................................................................................................................................................................. 27
Indicaties voor schouderartroplastiek .............................................................................................................. 28
Prognosis .......................................................................................................................................................... 28
Verschil RTSA en ATSA rehab ............................................................................................................................ 29
Frozen shoulder ............................................................................................................................................. 29
Epidemiologie - Prevalentie .............................................................................................................................. 29
Risicofactoren ................................................................................................................................................... 30
Stages of Frozen Shoulder ................................................................................................................................ 30
Hypothese ......................................................................................................................................................... 30
Pathophysiology in summary (Millar et al. 2022)............................................................................................. 31
Assessment ....................................................................................................................................................... 32
Definition of a frozen shoulder (Kelley et al. 2013) .......................................................................................... 32
FS with HIGH, MODERATE & LOW level of irritability ....................................................................................... 33
Management of FS ........................................................................................................................................... 33
Bemerkingen .................................................................................................................................................... 34
Future advances ............................................................................................................................................... 35
Anatomie van de elleboog ............................................................................................................................. 36
Humerus ........................................................................................................................................................... 36
Kapsel ............................................................................................................................................................... 36
Ulna .................................................................................................................................................................. 37
Radius ............................................................................................................................................................... 37
Gewrichten ....................................................................................................................................................... 37
Ligamenten ....................................................................................................................................................... 38
Geen enkel ligament dat vastzit aan de radius ................................................................................................ 38
Lig anulare: ulna-ulna....................................................................................................................................... 38
Neurovasculair.................................................................................................................................................. 38
Nervus ulnaris .................................................................................................................................................. 38
, - Houdingsgebonden; veel voorkomend (15% voelt al luxeren bij passieve flexie, 140° tricepspees) ....... 38
Nervus medianus ............................................................................................................................................. 39
- Verloop: antero-mediaal ......................................................................................................................... 39
- Motorisch ................................................................................................................................................ 39
o Flexor, pronator ...................................................................................................................................... 39
o AIN: FPM en ½ FDP ................................................................................................................................. 39
- Sensibel: kapsel ....................................................................................................................................... 39
Nervus radialis ................................................................................................................................................. 39
Nervus interosseus posterior: diepe aftakking van N. Radialis: motorische tak ............................................... 39
o Extensie (BR, ECRB, ECRL, EDM) .............................................................................................................. 39
o PIN (ECU, sup, EDC, APL, EPL, EPB, EI)..................................................................................................... 39
o N. cutaneus brachii lateralis inferior ....................................................................................................... 39
o N. cutaneus brachii posterior .................................................................................................................. 39
o N. cutaneus antebrachia posterior ......................................................................................................... 39
Bloedvaten........................................................................................................................................................ 40
Bursae ............................................................................................................................................................... 40
Spieren .............................................................................................................................................................. 40
Biomechanica van de elleboog ....................................................................................................................... 41
Mobiliteit .......................................................................................................................................................... 41
Load Transfer .................................................................................................................................................... 41
Stabiliteit .......................................................................................................................................................... 42
Cornoid en radiuskop ........................................................................................................................................ 43
Olecranon ......................................................................................................................................................... 43
Rotatoire instabiliteit........................................................................................................................................ 43
Instabiliteit van de elleboog ........................................................................................................................... 45
Acuut ................................................................................................................................................................ 45
Complex (= met fractuur) ................................................................................................................................. 46
Simpel (= zonder fractuur) ................................................................................................................................ 46
Severe chronic PLRI ........................................................................................................................................... 47
Chronic medial instability ................................................................................................................................. 47
VEOS: Valgus Extension Overload Syndrome ................................................................................................... 47
Stijve elleboog................................................................................................................................................ 48
Anatomical Classification ................................................................................................................................. 48
Clinical evaluation ............................................................................................................................................ 49
Treatment ......................................................................................................................................................... 49
Benaderingen van de elleboog ....................................................................................................................... 51
Mediale chirurgische benaderingen ................................................................................................................. 51
