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Samenvatting Locomotorische pathologie

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  • Course
  • Ergotherapie In De Fysieke Revalidatie
  • Institution
  • Hogeschool Gent (HoGent)

In deze samenvatting van locomotorische pathologie vind je alle onderwerpen terug die worden besproken. Door de duidelijke opbouw en de inhoudstabel vooraan de samenvatting, is alles gemakkelijk terug te vinden.

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Document information

  • January 22, 2023
  • 32
  • 2022/2023
  • Summary

Subjects

  • fracturen
  • letsels
  • elleboogfractuur
  • scapulafractuur
  • reumatologie
  • bechterew
  • jicht
  • osteoporose
  • traumatologie
  • luxatie
  • claviculafractuur

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  • Hogeschool Gent (HoGent)
  • Ergotherapie
  • Ergotherapie In De Fysieke Revalidatie
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LOCOMOTORISCHE PATHOLOGIE
Inhoud
1. Reumatologie........................................................................................................................................................5
1.1 Omschrijving....................................................................................................................................................5
1.2 Artrose.............................................................................................................................................................6
1.2.1 Epidemiologie...........................................................................................................................................6
1.2.2 Pathofysiologie.........................................................................................................................................6
1.2.3 Etiologie....................................................................................................................................................7
1.2.4 Symptomen..............................................................................................................................................8
1.2.5 Diagnose...................................................................................................................................................8
1.2.6 Behandeling..............................................................................................................................................8
1.3 Reumatoïde artritis.........................................................................................................................................8
1.3.1 Definitie....................................................................................................................................................8
1.3.2 Epidemiologie...........................................................................................................................................9
1.3.3 Etiologie....................................................................................................................................................9
1.3.4 Symptomen..............................................................................................................................................9
1.3.5 Diagnose...................................................................................................................................................9
1.3.6 Verloop...................................................................................................................................................10
1.3.7 Behandeling............................................................................................................................................10
1.4 Ziekte van Bechterew....................................................................................................................................10
1.4.1 Definitie..................................................................................................................................................10
1.4.2 Epidemiologie.........................................................................................................................................10
1.4.2 Etiologie..................................................................................................................................................11
1.4.3 Symptomen............................................................................................................................................11
1.4.4 Behandeling............................................................................................................................................11
1.5 Jicht................................................................................................................................................................11
1.5.1 Definitie..................................................................................................................................................11
1.5.2 Fysiopathologie......................................................................................................................................12
1.5.3 Epidemiologie.........................................................................................................................................12
1.5.4 Symptomen............................................................................................................................................12
1.5.5 Behandeling............................................................................................................................................12
1.6 Osteoporose..................................................................................................................................................13
1.6.1 Definitie..................................................................................................................................................13
1.6.2 Epidemiologie.........................................................................................................................................13
1.6.3 Symptomen............................................................................................................................................13

1

, 1.6.4 Diagnose.................................................................................................................................................13
1.6.5 Preventie................................................................................................................................................13
2. Traumatologie.....................................................................................................................................................14
2.1 Fracturen.......................................................................................................................................................14
2.1.1 Indeling...................................................................................................................................................14
2.1.2 Gevolgen.................................................................................................................................................15
2.1.3 Genzeingsproces....................................................................................................................................15
2.2 Peesletsels.....................................................................................................................................................16
2.2.1 Etiologie..................................................................................................................................................16
2.3 Luxatie en subluxatie.....................................................................................................................................16
2.3.1 Oorzaak..................................................................................................................................................17
2.3.2 Complicaties...........................................................................................................................................17
2.3.3 Behandeling............................................................................................................................................17
2.4 Spierletsels....................................................................................................................................................17
2.4.1 Cassificatie..............................................................................................................................................17
2.4.2 Behandeling............................................................................................................................................18
2.5 Distorsie.........................................................................................................................................................18
2.5.1 Definitie..................................................................................................................................................18
2.5.2 Classificatie naar ernst...........................................................................................................................18
2.5.3 Behandeling............................................................................................................................................19
2.6 Claviculafractuur...........................................................................................................................................19
2.6.1 Plaats......................................................................................................................................................19
2.6.2 Ontstaan.................................................................................................................................................19
2.6.3 Symptomen............................................................................................................................................19
2.6.4 Behandeling............................................................................................................................................20
2.7 Scapulafractuur.............................................................................................................................................20
2.7.1 Onstaan..................................................................................................................................................20
2.7.2 Symptomen............................................................................................................................................20
2.7.3 Behandeling............................................................................................................................................20
2.8 Humerusfractuur...........................................................................................................................................21
2.8.1 Humeruskopfracturen en subcapitae humerusfracturen......................................................................21
2.8.2 Diafysaire humerusfracturen.................................................................................................................23
2.9 Schouderluxatie.............................................................................................................................................23
2.9.1 Etiologie..................................................................................................................................................24
2.9.2 Syptomen...............................................................................................................................................24
2.9.3 Behandeling............................................................................................................................................24
2.9.4 Complicaties...........................................................................................................................................24

2

,2.10 Ellebogfractuur............................................................................................................................................24
2.10.1 Indeling.................................................................................................................................................24
2.10.2 Behandeling..........................................................................................................................................25
2.10.3 Complicaties.........................................................................................................................................25
2.10.4 Tenniselleboog.....................................................................................................................................25
2.11 Voorarmfractuur.........................................................................................................................................25
2.11.1 Pouteau-Colles fractuur.......................................................................................................................25
2.12 Scaphoid fractuur........................................................................................................................................26
2.12.1 Oorzaak................................................................................................................................................26
2.12.2 Symptomen..........................................................................................................................................27
2.12.3 Diagnose...............................................................................................................................................27
2.12.4 Behandeling..........................................................................................................................................27
2.12.5 Duimluxatie..........................................................................................................................................27
2.13 Femurhalsfractuur.......................................................................................................................................28
2.13.1 Symptomen..........................................................................................................................................28
2.13.2 Diagnose...............................................................................................................................................28
2.13.3 Prognose...............................................................................................................................................28
2.13.4 Behandeling..........................................................................................................................................28
2.14 Diafysaire femurfractuur.............................................................................................................................28
2.14.1 Behandeling..........................................................................................................................................29
2.15 Kniefractuur.................................................................................................................................................29
2.16 Meniscusletsel.............................................................................................................................................29
2.16.1 Ontstaan...............................................................................................................................................29
2.16.2 Symptomen..........................................................................................................................................30
2.16.3 Diagnose...............................................................................................................................................30
2.16.4 Behandeling..........................................................................................................................................30
2.17 Kruisbandletsel............................................................................................................................................30
2.17.1 Functie kruisbanden.............................................................................................................................30
2.17.2 Ontstaan...............................................................................................................................................30
2.17.3 Klinisch..................................................................................................................................................30
2.17.4 Diagnose...............................................................................................................................................31
2.17.5 Behandeling..........................................................................................................................................31
2.18 Onderbeenfractuur.....................................................................................................................................31
2.18.1 Ontstaan...............................................................................................................................................31
2.19 Enkeldistortio..............................................................................................................................................31
2.19.1 Symptomen..........................................................................................................................................32
2.19.2 Behandeling..........................................................................................................................................32

3

,4

,1. REUMATOLOGIE

1.1 OMSCHRIJVING

 Alle chronische aandoeningen van het locomotorisch stelsel
 Niet aangeboren
 Niet veroorzaakt door een trauma
 Pijn is het meest voorkomende symptoom

 Term “reuma” dekt meer dan 200 verschillende ziekten
o Slijtagereuma (“artrose”)
o Inflammatoire reuma (“artritis”):
 Reumatoïde artritis (RA)
 Spondylarthropathieën vb. ziekte van Bechterew
o Bindweefselziekten
 Lupus erythematosus
o Weke delen reuma
 Fibromyalgie
o Reuma van het skelet
 Osteoporose



2 grote pijntypes

 Mechanische pijn
o Degeneratieve pijn
o Neemt toe ’s avonds en bij beweging, inspanning of vermoeidheid
o Is beter in rust
o Er is geen nachtelijke pijn
o Startpijn

 Inflammatoire pijn
o Erger in rust, beter tijdens en na inspanning
o Nachtelijke pijn met wakker worden van de pijn
o Constante pijn
o Ochtendstijfheid




5

,1.2 ARTROSE

 Arthrosis deformans (AD)
 Slijtagereuma
 Meest voorkomende gewrichtsafwijking




1.2.1 EPIDEMIOLOGIE
 Meest voorkomende gewrichtsafwijking
 Life-time risk: 25%
 Toenemend met leeftijd
 Grote oorzaak van invaliditeit bij ouderen
 Mannen > vrouwen
 Meest aangedane gewrichten: handen, knieën, tenen, heup, WK




1.2.2 PATHOFYSIOLOGIE

6

,  Fissuren en erosies in gewrichtskraakbeen, vooral in gewichtsdragende gewrichten
als gevolg van excessieve mechanische druk
 Oppervlak van kraakbeen wordt ruw, en interfereert met vlotte gewrichtsbeweging
 Progressief verlies van kraakbeen
 Aantasting van subchondrale botweefsel
 Verhoogde druk op botweefsel
 Vorming van osteofyten rond de beenuiteinden
 Vorming van cysten
 Delen van osteofyten en kraakbeen breken af in gewrichtsholte, en veroorzaken nog
meer irritatie
 Gewrichtsspleet wordt nauwer
 Mogelijks secundaire inflammatie van omliggend weefsel




1.2.3 ETIOLOGIE
 Primaire vorm
o Defect in stofwisseling van kraakbeencellen
 Secundaire vorm
o Trauma
o Overbelasting
o Verkeerd gebruik
o Onstabiel gewricht
 Rol van erfelijke factoren



7

,1.2.4 SYMPTOMEN
 Pijn toenemend bij belasting, afnemend bij rust
 Ochtendstijfheid
 Spieratrofie
 Verminderde beweeglijkheid van gewricht
o Cave: vicieuze cirkel
 Geen systemische symptomen, geen serummerkers
 Niet altijd correlatie tussen graad van slijtage en symptomen




1.2.5 DIAGNOSE
Radiologie




1.2.6 BEHANDELING
 Symptomatisch
o Behoud mobiliteit
o Voldoende rust, overbelasting vermijden
o Pijnbestrijding
o Hyaluronzuurinjecties
o Glucosamines
o Heelkunde
 Artroplastiek prothesen



1.3 REUMATOÏDE ARTRITIS


1.3.1 DEFINITIE
 Meest frequente inflammatoire reumatische aandoening
 Ontstekingsproces: auto-immuun
 Chronische ontsteking van het synoviale membraan (=synovium)




8

,1.3.2 EPIDEMIOLOGIE
 Prevalentie: 1% van de Belgen
 3 keer meer vrouwen dan mannen
 komt het vaakst voor in de leeftijdscategorie van 30 tot 55 jaar
 10% van alle RA patiënten  ernstige invaliditeit




1.3.3 ETIOLOGIE
 Idiopathisch
 Genetische factor




1.3.4 SYMPTOMEN
 (Mono-), oligo- of polyarticulair
o Typisch
 Eerste kleine hand- en teengewrichten (PIP, MCP en pols)
 Later: ellebogen, schouders, knieën
o Opstoten van gewrichtspijn, -stijfheid, -zwelling, -roodheid
o Vaak symmetrische symptomen
o Nachtelijke pijn, ochtendstijfheid
o Contracturen, spierspasme, spieratrofie, gewrichtsmisvorming
 Systemisch
o Moeheid, depressie, malaise, anorexie, koorts




1.3.5 DIAGNOSE
 RX-straling (pas nuttig in verder gevorderd stadium)
 Biochemische labo-waarden door bloedanalyse
o Inflammatie-parameters (CRP, BSE)
o Auto-immuunmerkers (antilichamen: reumafactor)
 Niet te gebruiken als screening want niet specifiek (5% van de gezonde
populatie heeft deze reumafactor)




9

, 1.3.6 VERLOOP
 In remissies en exacerbaties
 Onvoorspelbaar
 Effect van therapie op te volgen door labo-waarden en RX




1.3.7 BEHANDELING
 Doel:
o Stoppen van ontsteking, gewrichtsbeschadiging voorkomen, tegengaan
progressie aantasting en vervormingen
 Multidisciplinair
o Ergotherapie  balans tussen rust en milde activiteit
 (Medicamenteus)
o NSAID’s
o Corticosteroïden
o TNF-antagonisten
 Chirurgie: contracturen verminderen, beschadigde pezen vernieuwen, …



1.4 ZIEKTE VAN BECHTEREW

= Spondylitis ankylosans




1.4.1 DEFINITIE
 Chronische ontsteking van de gewrichten van de wervelkolom (meestal ook sacro-
iliacale gewrichten), die verloopt in remissies en exacerbaties
 Gevolg: verstijving ten gevolge van verkalking van de ligamenten en fibrosering van
de gewrichtskapsels




1.4.2 EPIDEMIOLOGIE
 1 op 1000 Belgen
 Begint gemiddeld tussen 20 – 30 jaar (gemiddeld: 23 jaar), bijna altijd voor 40 jaar
 3 keer meer bij mannen
 Grote interindividuele verschillen in ernst




10

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