HOGESCHOOL LEIDEN (2014-2018)
Kennis OP7
Van richtlijn naar maatwerk
(A)specifieke rugklachten, (a)specifieke nekklachten, oudere
patiënt, knieaandoeningen
,Inhoud
HOGESCHOOL LEIDEN (2014-2018) ....................................................................................................... 1
(A)SPECIFIEKE LRP ..................................................................................................................................... 8
INCIDENTIE / PREVALENTIE LRP ......................................................................................................... 8
ARTIKELEN ............................................................................................................................................... 8
KLINISCHE PREDICTIE REGELS (HC) ................................................................................................... 9
ANATOMIE LAGE RUG / LUMBAAL / TLO / SPIEREN / A.V.N. .................................................... 11
PASSIEVE STRUCTUREN ...................................................................................................................... 11
ACTIEVE STRUCTUREN ........................................................................................................................ 15
ARTERIËN / VENEN / NERVEN ........................................................................................................... 17
ARTERIËN ........................................................................................................................................... 18
VENEN ................................................................................................................................................ 21
NERVEN .............................................................................................................................................. 21
BIOMECHANICA VAN DE LAGE RUG ................................................................................................ 23
ANAMNESE ............................................................................................................................................ 25
PROGNOSTISCH & RISICOFACTOREN .............................................................................................. 25
PREVENTIE ......................................................................................................................................... 25
PERSOON & PERSOONSFACTOREN .................................................................................................. 25
PIJNANALYSE ........................................................................................................................................ 25
ONDERZOEK (LUMBALE) WERVELKOLOM ...................................................................................... 25
KLINIMETRIE ..................................................................................................................................... 29
CLASSIFICATIES LRP ............................................................................................................................ 32
THERAPIE ............................................................................................................................................... 33
OEFENPROGRAMMA ........................................................................................................................... 41
VAN RICHTLIJN NAAR MAATWERK (HC) ......................................................................................... 44
NHG STANDAARD LRP ......................................................................................................................... 49
CBO-RICHTLIJN ASPECIFIEKE LAGE RUGPIJN ................................................................................. 50
KNGF RICHTLIJN LAGE RUGPIJN ....................................................................................................... 50
PRAKTIJKRICHTLIJN ............................................................................................................................. 50
DIAGNOSTISCH PROCES ................................................................................................................. 50
THERAPEUTISCH PROCES ............................................................................................................... 53
VERANTWOORDING & TOELICHTING .............................................................................................. 54
DIAGNOSTISCH PROCES ................................................................................................................. 55
THERAPEUTISCH PROCES ............................................................................................................... 56
KNGF RICHTLIJN ZWANGERSCHAPSGERELATEERDE BEKKENPIJN ............................................. 57
, PRAKTIJKRICHTLIJN ............................................................................................................................. 58
DIAGNOSTISCH PROCES ................................................................................................................. 60
THERAPEUTISCH PROCES ............................................................................................................... 61
NVAB-RICHTLIJN .................................................................................................................................. 63
AANDOENINGEN RUG ......................................................................................................................... 64
LUMBOSACRAAL RADICULAIR SYNDROOM (LSRS / LRS) ........................................................ 64
KANAALSTENOSE ............................................................................................................................. 66
RECESSUS LATERALIS ...................................................................................................................... 68
FACETGEWRICHTARTROSE/-IRRITATIE/SPONDYLARTROSE .................................................... 69
M. BECHTEREW ................................................................................................................................ 70
ARTRIDEN, DISCITIS ........................................................................................................................ 71
SCOLIOSE ........................................................................................................................................... 72
SPONDYLOSE ..................................................................................................................................... 73
SPONDYLOLISTHESIS ....................................................................................................................... 73
ISCHIALGIE/ISCHIAS ........................................................................................................................ 74
M. PIRIFORMISSYNDROOM ........................................................................................................... 76
LUMBALE INSTABILITEIT ................................................................................................................ 77
SI-KLACHTEN (ZWANGER) .............................................................................................................. 78
DISCOGENE KLACHTEN ................................................................................................................... 80
(A)SPECIFIEKE NEKKLACHTEN ............................................................................................................... 83
INCIDENTIE / PREVALENTIE ............................................................................................................... 83
ANATOMIE CERVICAAL + CTO ........................................................................................................... 83
SPIEREN ................................................................................................................................................. 84
ANATOMIE VAAT-ZENUWSTRENG HALSGEBIED ........................................................................... 84
BIOMECHANICA VAN DE NEK ............................................................................................................ 89
ANAMNESE ............................................................................................................................................ 89
PROGNOSTISCH EN RISICOFACTOREN ............................................................................................ 91
VLAGGEN ........................................................................................................................................... 92
PREVENTIE ......................................................................................................................................... 92
PERSOON EN PERSOONSFACTOREN ................................................................................................ 92
ONDERZOEK NEK .................................................................................................................................. 92
KLINIMETRIE ..................................................................................................................................... 93
THERAPIE ............................................................................................................................................... 98
OEFENPROGRAMMA ........................................................................................................................... 99
POSTOPERATIEF CERVICAAL RADICULAIR SYNDROOM ......................................................... 100
, RICHTLIJN KANS ................................................................................................................................. 100
RICHTLIJN WHIPLASH (WAD) .......................................................................................................... 104
PRAKTIJKRICHTLIJN ........................................................................................................................... 104
DIAGNOSTISCH PROCES ............................................................................................................... 106
THERAPEUTISCH PROCES ............................................................................................................. 108
VERANTWOORDING & TOELICHTING ............................................................................................ 109
AANDOENINGEN NEK ........................................................................................................................ 110
CERVICAAL RAIDCULAIR SYNDROOM ........................................................................................ 110
BRACHIALGIE (BRACHI = ARM) ................................................................................................... 111
RADICULOPATHIE .......................................................................................................................... 112
WHIPLASH ....................................................................................................................................... 113
VERDERE KLACHTEN NEK ............................................................................................................. 115
OSTEOPOROSE ........................................................................................................................................ 117
INCIDENTIE / PREVALENTIE ............................................................................................................. 117
PROGNOSE, BELOOP EN RISICOFACTOREN .................................................................................. 117
PATHOFYSIOLOGIE ............................................................................................................................ 118
VERANDERINGEN IN HET BOT ..................................................................................................... 120
VEROUDERING .................................................................................................................................... 123
ANAMNESE .......................................................................................................................................... 124
NAZORG EN PREVENTIE................................................................................................................ 125
FRACTUREN ......................................................................................................................................... 125
ONDERZOEK ........................................................................................................................................ 127
LICHAMELIJK ONDERZOEK ........................................................................................................... 127
KLINIMETRIE ................................................................................................................................... 129
THERAPIE ............................................................................................................................................. 131
OEFENPROGRAMMA ......................................................................................................................... 135
BEWEEGPROGRAMMA .................................................................................................................. 137
KNGF-RICHTLIJN & BEWEEGINTERVENTIE ................................................................................... 139
RICHTLIJN ............................................................................................................................................ 139
BEWEEGINTERVENTIE ....................................................................................................................... 141
AANDACHTSPUNTEN BIJ UITVOERING ...................................................................................... 142
VERSCHILLEN RICHTLIJN/BEWEEGINTERVENTIE ......................................................................... 143
NHG-STANDAARD .............................................................................................................................. 144
CBO-RICHTLIJN VALPREVENTIE BIJ OUDEREN ............................................................................. 145
ONCOLOGIE EN ANGST & VERDRIET ................................................................................................. 146
, INCIDENTIE / PREVALENTIE ............................................................................................................. 146
PATHOFYSIOLOGIE ............................................................................................................................ 146
RISICOFACTOREN & PROGNOSTISCH ............................................................................................ 152
MALIGNITEIT ....................................................................................................................................... 153
GROEIWIJZE, METASTASERING, CLASSIFICATIE, GRADERING ............................................. 153
ANAMNESE .......................................................................................................................................... 154
ONDERZOEK ........................................................................................................................................ 154
THERAPIE ............................................................................................................................................. 155
BEHANDEING EN OVERLEVING NA KANKER ................................................................................. 156
OEFENPROGRAMMA ......................................................................................................................... 160
RICHTLIJN ............................................................................................................................................ 160
BEWEEGINTERVENTIE ONCOLOGIE ............................................................................................... 160
ANGST & VERDRIET ........................................................................................................................... 160
PSYCOLOGISCHE ASPECTEN IRT KANKER ..................................................................................... 161
PIJN EN PIJNBESTRIJDING .................................................................................................................... 163
KOUDETHERAPIE ................................................................................................................................ 163
THERMOSENSOREN - FYSIOLOGIE ................................................................................................. 163
ALGEMEEN THERMOTHERAPIE ....................................................................................................... 164
KOUDETHERAPIE (CRYOTHERAPIE) ................................................................................................ 165
BEHANDELING ................................................................................................................................ 168
TENS ..................................................................................................................................................... 169
BEDIENING MED MODUL 6 .......................................................................................................... 170
TOEPASSEN TENS ........................................................................................................................... 171
WERKINGSMECHANISME ............................................................................................................. 175
KNIE .......................................................................................................................................................... 177
INCIDENTIE / PREVALENTIE ............................................................................................................. 177
PATHOFYSIOLOGIE ............................................................................................................................ 177
ANAMNESE .......................................................................................................................................... 178
SCREENING ...................................................................................................................................... 178
ONDERZOEK ........................................................................................................................................ 179
KLINIMETRIE ................................................................................................................................... 179
THERAPIE ............................................................................................................................................. 187
OEFENPROGRAMMA ......................................................................................................................... 188
KNGF ..................................................................................................................................................... 188
EVIDENCE STATEMENT – ACUUT KNIELETSEL ............................................................................. 188
, EVIDENCE STATEMENT – REVALIDATIE NA VKB-RECONSTRUCTIE ......................................... 188
RICHTIJN - MENISECTOMIE ............................................................................................................. 188
RICHTLIJNEN & PROTOCOLLEN ....................................................................................................... 188
AANDOENINGEN KNIE ...................................................................................................................... 188
KNIEDISTORSIE – ROTATIETRAUMA / UNHAPPY TRIAD ........................................................ 188
KNIELUXATIE ................................................................................................................................... 189
PATELLA LUXATIE........................................................................................................................... 190
PATELLA FRACTUUR ...................................................................................................................... 191
TIBIAPLATEAU FRACTUUR (& EMINENTIA FRACTUUR) ......................................................... 192
QUADRICEPSPEESRUPTUUR ........................................................................................................ 193
PATELLAPEES RUPTUUR ............................................................................................................... 194
VKB LETSEL ...................................................................................................................................... 195
MENISCUSLETSEL ........................................................................................................................... 196
DIFFENTIAALDIAGNOSTIEK .......................................................................................................... 198
COLLUM EN COLLUS # .......................................................................................................................... 199
INCIDENTIE / PREVALENTIE ............................................................................................................. 199
PATHOFYSIOLOGIE ............................................................................................................................ 199
OPERATIETECHNIEKEN ..................................................................................................................... 200
ONDERZOEK ........................................................................................................................................ 200
THERAPIE ............................................................................................................................................. 200
OEFENPROGRAMMA ......................................................................................................................... 200
GEDRAG EN PSYCHE .............................................................................................................................. 201
VERDERE INFO ........................................................................................................................................ 203
LICHAAM .............................................................................................................................................. 203
FRACTUURLEER .............................................................................................................................. 204
FYSIO IN DE ARBEIDSSECTOR .......................................................................................................... 204
ONDERZOEK ........................................................................................................................................ 204
RESTJES ................................................................................................................................................ 206
SPB’S ......................................................................................................................................................... 209
1.7 DIAGNOSTIEK PATIËNT MET LAGE RUGPIJN ......................................................................... 209
ANAMNESE .......................................................................................................................................... 209
ONDERZOEK ........................................................................................................................................ 210
2.7 POSTKLINISCH LUMBOSACRAAL RADICULAIR SYNDROOM ............................................... 212
STATUS PRAESENS ............................................................................................................................. 212
NEUROLOGISCH ONDERZOEK.......................................................................................................... 212
Kennis OP7
Van richtlijn naar maatwerk
(A)specifieke rugklachten, (a)specifieke nekklachten, oudere
patiënt, knieaandoeningen
,Inhoud
HOGESCHOOL LEIDEN (2014-2018) ....................................................................................................... 1
(A)SPECIFIEKE LRP ..................................................................................................................................... 8
INCIDENTIE / PREVALENTIE LRP ......................................................................................................... 8
ARTIKELEN ............................................................................................................................................... 8
KLINISCHE PREDICTIE REGELS (HC) ................................................................................................... 9
ANATOMIE LAGE RUG / LUMBAAL / TLO / SPIEREN / A.V.N. .................................................... 11
PASSIEVE STRUCTUREN ...................................................................................................................... 11
ACTIEVE STRUCTUREN ........................................................................................................................ 15
ARTERIËN / VENEN / NERVEN ........................................................................................................... 17
ARTERIËN ........................................................................................................................................... 18
VENEN ................................................................................................................................................ 21
NERVEN .............................................................................................................................................. 21
BIOMECHANICA VAN DE LAGE RUG ................................................................................................ 23
ANAMNESE ............................................................................................................................................ 25
PROGNOSTISCH & RISICOFACTOREN .............................................................................................. 25
PREVENTIE ......................................................................................................................................... 25
PERSOON & PERSOONSFACTOREN .................................................................................................. 25
PIJNANALYSE ........................................................................................................................................ 25
ONDERZOEK (LUMBALE) WERVELKOLOM ...................................................................................... 25
KLINIMETRIE ..................................................................................................................................... 29
CLASSIFICATIES LRP ............................................................................................................................ 32
THERAPIE ............................................................................................................................................... 33
OEFENPROGRAMMA ........................................................................................................................... 41
VAN RICHTLIJN NAAR MAATWERK (HC) ......................................................................................... 44
NHG STANDAARD LRP ......................................................................................................................... 49
CBO-RICHTLIJN ASPECIFIEKE LAGE RUGPIJN ................................................................................. 50
KNGF RICHTLIJN LAGE RUGPIJN ....................................................................................................... 50
PRAKTIJKRICHTLIJN ............................................................................................................................. 50
DIAGNOSTISCH PROCES ................................................................................................................. 50
THERAPEUTISCH PROCES ............................................................................................................... 53
VERANTWOORDING & TOELICHTING .............................................................................................. 54
DIAGNOSTISCH PROCES ................................................................................................................. 55
THERAPEUTISCH PROCES ............................................................................................................... 56
KNGF RICHTLIJN ZWANGERSCHAPSGERELATEERDE BEKKENPIJN ............................................. 57
, PRAKTIJKRICHTLIJN ............................................................................................................................. 58
DIAGNOSTISCH PROCES ................................................................................................................. 60
THERAPEUTISCH PROCES ............................................................................................................... 61
NVAB-RICHTLIJN .................................................................................................................................. 63
AANDOENINGEN RUG ......................................................................................................................... 64
LUMBOSACRAAL RADICULAIR SYNDROOM (LSRS / LRS) ........................................................ 64
KANAALSTENOSE ............................................................................................................................. 66
RECESSUS LATERALIS ...................................................................................................................... 68
FACETGEWRICHTARTROSE/-IRRITATIE/SPONDYLARTROSE .................................................... 69
M. BECHTEREW ................................................................................................................................ 70
ARTRIDEN, DISCITIS ........................................................................................................................ 71
SCOLIOSE ........................................................................................................................................... 72
SPONDYLOSE ..................................................................................................................................... 73
SPONDYLOLISTHESIS ....................................................................................................................... 73
ISCHIALGIE/ISCHIAS ........................................................................................................................ 74
M. PIRIFORMISSYNDROOM ........................................................................................................... 76
LUMBALE INSTABILITEIT ................................................................................................................ 77
SI-KLACHTEN (ZWANGER) .............................................................................................................. 78
DISCOGENE KLACHTEN ................................................................................................................... 80
(A)SPECIFIEKE NEKKLACHTEN ............................................................................................................... 83
INCIDENTIE / PREVALENTIE ............................................................................................................... 83
ANATOMIE CERVICAAL + CTO ........................................................................................................... 83
SPIEREN ................................................................................................................................................. 84
ANATOMIE VAAT-ZENUWSTRENG HALSGEBIED ........................................................................... 84
BIOMECHANICA VAN DE NEK ............................................................................................................ 89
ANAMNESE ............................................................................................................................................ 89
PROGNOSTISCH EN RISICOFACTOREN ............................................................................................ 91
VLAGGEN ........................................................................................................................................... 92
PREVENTIE ......................................................................................................................................... 92
PERSOON EN PERSOONSFACTOREN ................................................................................................ 92
ONDERZOEK NEK .................................................................................................................................. 92
KLINIMETRIE ..................................................................................................................................... 93
THERAPIE ............................................................................................................................................... 98
OEFENPROGRAMMA ........................................................................................................................... 99
POSTOPERATIEF CERVICAAL RADICULAIR SYNDROOM ......................................................... 100
, RICHTLIJN KANS ................................................................................................................................. 100
RICHTLIJN WHIPLASH (WAD) .......................................................................................................... 104
PRAKTIJKRICHTLIJN ........................................................................................................................... 104
DIAGNOSTISCH PROCES ............................................................................................................... 106
THERAPEUTISCH PROCES ............................................................................................................. 108
VERANTWOORDING & TOELICHTING ............................................................................................ 109
AANDOENINGEN NEK ........................................................................................................................ 110
CERVICAAL RAIDCULAIR SYNDROOM ........................................................................................ 110
BRACHIALGIE (BRACHI = ARM) ................................................................................................... 111
RADICULOPATHIE .......................................................................................................................... 112
WHIPLASH ....................................................................................................................................... 113
VERDERE KLACHTEN NEK ............................................................................................................. 115
OSTEOPOROSE ........................................................................................................................................ 117
INCIDENTIE / PREVALENTIE ............................................................................................................. 117
PROGNOSE, BELOOP EN RISICOFACTOREN .................................................................................. 117
PATHOFYSIOLOGIE ............................................................................................................................ 118
VERANDERINGEN IN HET BOT ..................................................................................................... 120
VEROUDERING .................................................................................................................................... 123
ANAMNESE .......................................................................................................................................... 124
NAZORG EN PREVENTIE................................................................................................................ 125
FRACTUREN ......................................................................................................................................... 125
ONDERZOEK ........................................................................................................................................ 127
LICHAMELIJK ONDERZOEK ........................................................................................................... 127
KLINIMETRIE ................................................................................................................................... 129
THERAPIE ............................................................................................................................................. 131
OEFENPROGRAMMA ......................................................................................................................... 135
BEWEEGPROGRAMMA .................................................................................................................. 137
KNGF-RICHTLIJN & BEWEEGINTERVENTIE ................................................................................... 139
RICHTLIJN ............................................................................................................................................ 139
BEWEEGINTERVENTIE ....................................................................................................................... 141
AANDACHTSPUNTEN BIJ UITVOERING ...................................................................................... 142
VERSCHILLEN RICHTLIJN/BEWEEGINTERVENTIE ......................................................................... 143
NHG-STANDAARD .............................................................................................................................. 144
CBO-RICHTLIJN VALPREVENTIE BIJ OUDEREN ............................................................................. 145
ONCOLOGIE EN ANGST & VERDRIET ................................................................................................. 146
, INCIDENTIE / PREVALENTIE ............................................................................................................. 146
PATHOFYSIOLOGIE ............................................................................................................................ 146
RISICOFACTOREN & PROGNOSTISCH ............................................................................................ 152
MALIGNITEIT ....................................................................................................................................... 153
GROEIWIJZE, METASTASERING, CLASSIFICATIE, GRADERING ............................................. 153
ANAMNESE .......................................................................................................................................... 154
ONDERZOEK ........................................................................................................................................ 154
THERAPIE ............................................................................................................................................. 155
BEHANDEING EN OVERLEVING NA KANKER ................................................................................. 156
OEFENPROGRAMMA ......................................................................................................................... 160
RICHTLIJN ............................................................................................................................................ 160
BEWEEGINTERVENTIE ONCOLOGIE ............................................................................................... 160
ANGST & VERDRIET ........................................................................................................................... 160
PSYCOLOGISCHE ASPECTEN IRT KANKER ..................................................................................... 161
PIJN EN PIJNBESTRIJDING .................................................................................................................... 163
KOUDETHERAPIE ................................................................................................................................ 163
THERMOSENSOREN - FYSIOLOGIE ................................................................................................. 163
ALGEMEEN THERMOTHERAPIE ....................................................................................................... 164
KOUDETHERAPIE (CRYOTHERAPIE) ................................................................................................ 165
BEHANDELING ................................................................................................................................ 168
TENS ..................................................................................................................................................... 169
BEDIENING MED MODUL 6 .......................................................................................................... 170
TOEPASSEN TENS ........................................................................................................................... 171
WERKINGSMECHANISME ............................................................................................................. 175
KNIE .......................................................................................................................................................... 177
INCIDENTIE / PREVALENTIE ............................................................................................................. 177
PATHOFYSIOLOGIE ............................................................................................................................ 177
ANAMNESE .......................................................................................................................................... 178
SCREENING ...................................................................................................................................... 178
ONDERZOEK ........................................................................................................................................ 179
KLINIMETRIE ................................................................................................................................... 179
THERAPIE ............................................................................................................................................. 187
OEFENPROGRAMMA ......................................................................................................................... 188
KNGF ..................................................................................................................................................... 188
EVIDENCE STATEMENT – ACUUT KNIELETSEL ............................................................................. 188
, EVIDENCE STATEMENT – REVALIDATIE NA VKB-RECONSTRUCTIE ......................................... 188
RICHTIJN - MENISECTOMIE ............................................................................................................. 188
RICHTLIJNEN & PROTOCOLLEN ....................................................................................................... 188
AANDOENINGEN KNIE ...................................................................................................................... 188
KNIEDISTORSIE – ROTATIETRAUMA / UNHAPPY TRIAD ........................................................ 188
KNIELUXATIE ................................................................................................................................... 189
PATELLA LUXATIE........................................................................................................................... 190
PATELLA FRACTUUR ...................................................................................................................... 191
TIBIAPLATEAU FRACTUUR (& EMINENTIA FRACTUUR) ......................................................... 192
QUADRICEPSPEESRUPTUUR ........................................................................................................ 193
PATELLAPEES RUPTUUR ............................................................................................................... 194
VKB LETSEL ...................................................................................................................................... 195
MENISCUSLETSEL ........................................................................................................................... 196
DIFFENTIAALDIAGNOSTIEK .......................................................................................................... 198
COLLUM EN COLLUS # .......................................................................................................................... 199
INCIDENTIE / PREVALENTIE ............................................................................................................. 199
PATHOFYSIOLOGIE ............................................................................................................................ 199
OPERATIETECHNIEKEN ..................................................................................................................... 200
ONDERZOEK ........................................................................................................................................ 200
THERAPIE ............................................................................................................................................. 200
OEFENPROGRAMMA ......................................................................................................................... 200
GEDRAG EN PSYCHE .............................................................................................................................. 201
VERDERE INFO ........................................................................................................................................ 203
LICHAAM .............................................................................................................................................. 203
FRACTUURLEER .............................................................................................................................. 204
FYSIO IN DE ARBEIDSSECTOR .......................................................................................................... 204
ONDERZOEK ........................................................................................................................................ 204
RESTJES ................................................................................................................................................ 206
SPB’S ......................................................................................................................................................... 209
1.7 DIAGNOSTIEK PATIËNT MET LAGE RUGPIJN ......................................................................... 209
ANAMNESE .......................................................................................................................................... 209
ONDERZOEK ........................................................................................................................................ 210
2.7 POSTKLINISCH LUMBOSACRAAL RADICULAIR SYNDROOM ............................................... 212
STATUS PRAESENS ............................................................................................................................. 212
NEUROLOGISCH ONDERZOEK.......................................................................................................... 212
