Fysiotherapie aandoeningen van het bovenste lidmaat ..........................................................................6
Hoofdstuk 1: De schouder ................................................................................................................6
1.1 Rotator cuffpathologie ............................................................................................................6
1.1.1 Supraspinatus .................................................................................................................7
1.1.2 Infraspinatus ................................................................................................................. 12
1.1.3 Subscapularis ................................................................................................................ 13
1.2 Biceps brachii pathologie ...................................................................................................... 14
1.2.1 Biceps brachii tendinopathie .......................................................................................... 15
1.2.2 (Sub)luxatie caput longum biceps ................................................................................... 16
1.2.3 Ruptuur caput longum biceps ......................................................................................... 16
1.3 GIRD .................................................................................................................................... 17
1.4 Glenohumerale instabiliteit ................................................................................................... 17
1.4.1 Stabiliteit schouder ........................................................................................................ 18
1.4.2 Anamnese ..................................................................................................................... 18
1.4.3 Structurele instabiliteit ................................................................................................... 18
1.4.4 Functionele instabiliteit .................................................................................................. 19
1.5 Glenohumerale laxiteit .......................................................................................................... 19
1.6 Bursitis................................................................................................................................. 20
1.6.1 Bursitis subacromiodeltoïdea ......................................................................................... 20
1.6.2 Bursitis calcarea ............................................................................................................ 21
1.7 Frozen shoulder .................................................................................................................... 21
1.8 AC lijden .............................................................................................................................. 23
1.9 Sternoclaviculair lijden.......................................................................................................... 23
1.10 Scapulothoracale dysfunctie ............................................................................................... 24
1.10.1 Scapula alata ............................................................................................................... 24
1.11 Gerefereerde schouderpijn .................................................................................................. 25
Hoofdstuk 2: De elleboog ............................................................................................................... 26
2.1 Tendinopathie ECR ............................................................................................................... 26
2.1.1 Oorsprongstendinopathie ECR........................................................................................ 26
2.1.2 ECR intratendineuze scheur ........................................................................................... 28
2.2 Tendinopathie flexor carpi ulnaris (+ radialis) .......................................................................... 28
2.3 Bursitis olecranii ................................................................................................................... 29
2.4 Distale bicepspeespathologie ............................................................................................... 30
2.4.1 Tendinopathie ................................................................................................................ 30
2.4.2 Distale bicepspeesruptuur ............................................................................................. 30
2.5 Tricepspees pathologie ......................................................................................................... 30
1
, 2.5.1 Tendinopathie ................................................................................................................ 30
2.5.2 Ruptuur ......................................................................................................................... 31
Hoofdstuk 3: De pols – hand – vingers ............................................................................................. 32
3.1 Algemeen + anatomie ........................................................................................................... 32
3.2 De Quervain ......................................................................................................................... 32
3.3 Intersectiesyndroom ............................................................................................................. 33
3.4 Tendinopathie EPL ................................................................................................................ 34
3.5 Tendinopathie ECR, EDC ....................................................................................................... 34
3.6 Tendinopathie ECU ............................................................................................................... 34
3.7 Tendinopathie flexor digitorum .............................................................................................. 35
3.8 Tendinopathie flexor carpi ulnaris en flexor carpi radialis ........................................................ 35
3.9 Tendinopathie flexor pollicis longus ....................................................................................... 35
3.10 Springvinger ........................................................................................................................ 35
Hoofdstuk 4 : Overkoepelend ......................................................................................................... 37
4.1 Anamnese ............................................................................................................................ 37
4.2 Klinisch onderzoek ................................................................................................................ 37
4.3 Therapie ............................................................................................................................... 37
Fysiotherapie aandoeningen van het onderste lidmaat ......................................................................... 38
Hoofdstuk 1: Doelstelling in de behandeling .................................................................................... 38
1.1 Pijnstilling ............................................................................................................................ 39
1.1.1 Thermotherapie: koude en warmte .................................................................................. 39
1.1.2 Elektrotherapie .............................................................................................................. 42
1.2 Verbeteren van de mobiliteit .................................................................................................. 43
1.2.1 Passieve bewegingen ..................................................................................................... 43
1.2.2 Actieve mobilisatie ......................................................................................................... 44
1.3 Spierversterking .................................................................................................................... 44
1.4 Verbetering algemene conditie .............................................................................................. 45
1.5 Massage............................................................................................................................... 45
1.6 Hydrotherapie ...................................................................................................................... 46
1.7 Andere technieken ................................................................................................................ 47
1.7.1 Proprioceptieve oefeningen ............................................................................................ 47
1.7.2 Trilplaat ......................................................................................................................... 47
1.7.3 Extracorporele shock wave therapie: indicaties ............................................................... 47
Hoofdstuk 2: Pubalgie, Femero-acetabulair impingement (FAI) ......................................................... 48
2.1 Casus .................................................................................................................................. 48
2.2 Pubalgie ............................................................................................................................... 49
2.3 FAI: femoroacetabulair impingement ..................................................................................... 49
2
, 2.3.1 CAM .............................................................................................................................. 50
2.3.2 PINCER ......................................................................................................................... 51
2.3.3 Kliniek: typische patiënt.................................................................................................. 52
2.3.4 Behandeling................................................................................................................... 54
2.4 Te onthouden ....................................................................................................................... 54
Hoofdstuk 3: Anterieure kniepijn ..................................................................................................... 55
3.1 Inleiding ............................................................................................................................... 55
3.2 Peripatellair .......................................................................................................................... 55
3.3 Biomechanica van de knie ..................................................................................................... 55
3.3.1 Sagittaal vlak ................................................................................................................. 55
3.3.2 Frontaal vlak .................................................................................................................. 56
3.3.3 Transversaal vlak ........................................................................................................... 56
3.3.4 Stabiliserende factoren van de patella ............................................................................. 56
3.4 Kliniek : Chondromalacia patellae ......................................................................................... 56
3.4.1 Uitlokkende factoren malalignatie ................................................................................... 57
3.4.2 Symptomen ................................................................................................................... 58
3.4.3 Diagnose ....................................................................................................................... 58
Hoofdstuk 4: Achillespees .............................................................................................................. 59
4.1 Anatomie ............................................................................................................................. 59
4.2 Achillespeesoverbelasting .................................................................................................... 59
4.3 Klinische vormen achillespeespathologie............................................................................... 60
4.3.1 Achillodynie – tendinopathie ........................................................................................... 60
4.3.2 Achillestendinose – tendinopathie .................................................................................. 60
4.3.3 Achillespees – epithenon – peritenon – peritendinitis........................................................ 61
4.3.4 Insertionele tendinopathie – entesopathie ....................................................................... 62
4.4 Diagnose .............................................................................................................................. 62
4.4.1 Samenvatting ................................................................................................................. 63
4.5 Behandeling ......................................................................................................................... 63
4.6 Differentiaaldiagnose ............................................................................................................ 63
4.6.1 DD deel 1 (bursaproblemen) ........................................................................................... 64
4.6.2 DD deel 2 ....................................................................................................................... 67
Fysiotherapie aandoeningen van de wervelzuil .................................................................................... 69
Hoofdstuk 1: Cervicale wervelzuil ................................................................................................... 69
1.1 Oorzaken nekpijn .................................................................................................................. 69
1.2 Meest voorkomende problemen ............................................................................................ 69
1.2.1 Cervicale (strain) spierpijn .............................................................................................. 69
1.2.2 Facetdysfunctie ............................................................................................................. 73
3
, 1.2.3 Cervicale spondylose ..................................................................................................... 74
1.2.4 Cervicale discopathie ..................................................................................................... 75
Hoofdstuk 2: Thoracale wervelzuil ................................................................................................... 78
2.1 Syndroom van Tietze ............................................................................................................. 78
2.2 Facettaire en costovertebrale disfunctie ................................................................................ 78
2.2.1 Facettaire disfunctie ...................................................................................................... 78
2.2.2 Costovertebrale disfunctie ............................................................................................. 78
2.3 Ziekte van SCheuermann ...................................................................................................... 78
2.4 Discogene aandoeningen ...................................................................................................... 79
2.5 Artrosis deformans ............................................................................................................... 79
2.6 Pseudoradiculair .................................................................................................................. 79
2.7 Musculaire pathologie ........................................................................................................... 80
2.8 DISH .................................................................................................................................... 80
Hoofdstuk 3: Lumbale wervelzuil .................................................................................................... 81
3.1 Inleiding ............................................................................................................................... 81
3.2 Aspecifieke rugpijnklachten .................................................................................................. 81
3.3 Oorzaken rugpijn .................................................................................................................. 81
3.4 Rode vlaggen ........................................................................................................................ 82
3.5 Gele vlaggen ......................................................................................................................... 82
3.6 Mechanische rugpijn ............................................................................................................. 83
3.6.1 Acute lumbago ............................................................................................................... 83
3.6.2 Musculaire letsels - acuut ............................................................................................... 84
3.6.3 Musculaire letsels - chronisch ........................................................................................ 84
3.6.4 Discuslijden ................................................................................................................... 84
3.6.5 Facettaire problematiek ................................................................................................. 87
3.6.6 Arthrosis deformans ....................................................................................................... 88
3.6.7 Spondylose - spondylolisthesis ....................................................................................... 90
3.6.8 Sacro-iliacale dysfunctie ................................................................................................ 91
3.6.9 Overgangsanomalie ....................................................................................................... 92
3.7 Diagnose bij wervelkolom pathologie ..................................................................................... 92
3.8 Aanpak lumbale klachten ...................................................................................................... 95
3.8.1 Probleem thv spieren ..................................................................................................... 95
3.8.2 Probleem thv facetgewrichten ........................................................................................ 96
3.8.3 Radix compressie ........................................................................................................... 97
3.8.4 Discus pathologie .......................................................................................................... 98
Zenuwletsels ..................................................................................................................................... 99
Hoofdstuk 1: Inleiding .................................................................................................................... 99
4
Hoofdstuk 1: De schouder ................................................................................................................6
1.1 Rotator cuffpathologie ............................................................................................................6
1.1.1 Supraspinatus .................................................................................................................7
1.1.2 Infraspinatus ................................................................................................................. 12
1.1.3 Subscapularis ................................................................................................................ 13
1.2 Biceps brachii pathologie ...................................................................................................... 14
1.2.1 Biceps brachii tendinopathie .......................................................................................... 15
1.2.2 (Sub)luxatie caput longum biceps ................................................................................... 16
1.2.3 Ruptuur caput longum biceps ......................................................................................... 16
1.3 GIRD .................................................................................................................................... 17
1.4 Glenohumerale instabiliteit ................................................................................................... 17
1.4.1 Stabiliteit schouder ........................................................................................................ 18
1.4.2 Anamnese ..................................................................................................................... 18
1.4.3 Structurele instabiliteit ................................................................................................... 18
1.4.4 Functionele instabiliteit .................................................................................................. 19
1.5 Glenohumerale laxiteit .......................................................................................................... 19
1.6 Bursitis................................................................................................................................. 20
1.6.1 Bursitis subacromiodeltoïdea ......................................................................................... 20
1.6.2 Bursitis calcarea ............................................................................................................ 21
1.7 Frozen shoulder .................................................................................................................... 21
1.8 AC lijden .............................................................................................................................. 23
1.9 Sternoclaviculair lijden.......................................................................................................... 23
1.10 Scapulothoracale dysfunctie ............................................................................................... 24
1.10.1 Scapula alata ............................................................................................................... 24
1.11 Gerefereerde schouderpijn .................................................................................................. 25
Hoofdstuk 2: De elleboog ............................................................................................................... 26
2.1 Tendinopathie ECR ............................................................................................................... 26
2.1.1 Oorsprongstendinopathie ECR........................................................................................ 26
2.1.2 ECR intratendineuze scheur ........................................................................................... 28
2.2 Tendinopathie flexor carpi ulnaris (+ radialis) .......................................................................... 28
2.3 Bursitis olecranii ................................................................................................................... 29
2.4 Distale bicepspeespathologie ............................................................................................... 30
2.4.1 Tendinopathie ................................................................................................................ 30
2.4.2 Distale bicepspeesruptuur ............................................................................................. 30
2.5 Tricepspees pathologie ......................................................................................................... 30
1
, 2.5.1 Tendinopathie ................................................................................................................ 30
2.5.2 Ruptuur ......................................................................................................................... 31
Hoofdstuk 3: De pols – hand – vingers ............................................................................................. 32
3.1 Algemeen + anatomie ........................................................................................................... 32
3.2 De Quervain ......................................................................................................................... 32
3.3 Intersectiesyndroom ............................................................................................................. 33
3.4 Tendinopathie EPL ................................................................................................................ 34
3.5 Tendinopathie ECR, EDC ....................................................................................................... 34
3.6 Tendinopathie ECU ............................................................................................................... 34
3.7 Tendinopathie flexor digitorum .............................................................................................. 35
3.8 Tendinopathie flexor carpi ulnaris en flexor carpi radialis ........................................................ 35
3.9 Tendinopathie flexor pollicis longus ....................................................................................... 35
3.10 Springvinger ........................................................................................................................ 35
Hoofdstuk 4 : Overkoepelend ......................................................................................................... 37
4.1 Anamnese ............................................................................................................................ 37
4.2 Klinisch onderzoek ................................................................................................................ 37
4.3 Therapie ............................................................................................................................... 37
Fysiotherapie aandoeningen van het onderste lidmaat ......................................................................... 38
Hoofdstuk 1: Doelstelling in de behandeling .................................................................................... 38
1.1 Pijnstilling ............................................................................................................................ 39
1.1.1 Thermotherapie: koude en warmte .................................................................................. 39
1.1.2 Elektrotherapie .............................................................................................................. 42
1.2 Verbeteren van de mobiliteit .................................................................................................. 43
1.2.1 Passieve bewegingen ..................................................................................................... 43
1.2.2 Actieve mobilisatie ......................................................................................................... 44
1.3 Spierversterking .................................................................................................................... 44
1.4 Verbetering algemene conditie .............................................................................................. 45
1.5 Massage............................................................................................................................... 45
1.6 Hydrotherapie ...................................................................................................................... 46
1.7 Andere technieken ................................................................................................................ 47
1.7.1 Proprioceptieve oefeningen ............................................................................................ 47
1.7.2 Trilplaat ......................................................................................................................... 47
1.7.3 Extracorporele shock wave therapie: indicaties ............................................................... 47
Hoofdstuk 2: Pubalgie, Femero-acetabulair impingement (FAI) ......................................................... 48
2.1 Casus .................................................................................................................................. 48
2.2 Pubalgie ............................................................................................................................... 49
2.3 FAI: femoroacetabulair impingement ..................................................................................... 49
2
, 2.3.1 CAM .............................................................................................................................. 50
2.3.2 PINCER ......................................................................................................................... 51
2.3.3 Kliniek: typische patiënt.................................................................................................. 52
2.3.4 Behandeling................................................................................................................... 54
2.4 Te onthouden ....................................................................................................................... 54
Hoofdstuk 3: Anterieure kniepijn ..................................................................................................... 55
3.1 Inleiding ............................................................................................................................... 55
3.2 Peripatellair .......................................................................................................................... 55
3.3 Biomechanica van de knie ..................................................................................................... 55
3.3.1 Sagittaal vlak ................................................................................................................. 55
3.3.2 Frontaal vlak .................................................................................................................. 56
3.3.3 Transversaal vlak ........................................................................................................... 56
3.3.4 Stabiliserende factoren van de patella ............................................................................. 56
3.4 Kliniek : Chondromalacia patellae ......................................................................................... 56
3.4.1 Uitlokkende factoren malalignatie ................................................................................... 57
3.4.2 Symptomen ................................................................................................................... 58
3.4.3 Diagnose ....................................................................................................................... 58
Hoofdstuk 4: Achillespees .............................................................................................................. 59
4.1 Anatomie ............................................................................................................................. 59
4.2 Achillespeesoverbelasting .................................................................................................... 59
4.3 Klinische vormen achillespeespathologie............................................................................... 60
4.3.1 Achillodynie – tendinopathie ........................................................................................... 60
4.3.2 Achillestendinose – tendinopathie .................................................................................. 60
4.3.3 Achillespees – epithenon – peritenon – peritendinitis........................................................ 61
4.3.4 Insertionele tendinopathie – entesopathie ....................................................................... 62
4.4 Diagnose .............................................................................................................................. 62
4.4.1 Samenvatting ................................................................................................................. 63
4.5 Behandeling ......................................................................................................................... 63
4.6 Differentiaaldiagnose ............................................................................................................ 63
4.6.1 DD deel 1 (bursaproblemen) ........................................................................................... 64
4.6.2 DD deel 2 ....................................................................................................................... 67
Fysiotherapie aandoeningen van de wervelzuil .................................................................................... 69
Hoofdstuk 1: Cervicale wervelzuil ................................................................................................... 69
1.1 Oorzaken nekpijn .................................................................................................................. 69
1.2 Meest voorkomende problemen ............................................................................................ 69
1.2.1 Cervicale (strain) spierpijn .............................................................................................. 69
1.2.2 Facetdysfunctie ............................................................................................................. 73
3
, 1.2.3 Cervicale spondylose ..................................................................................................... 74
1.2.4 Cervicale discopathie ..................................................................................................... 75
Hoofdstuk 2: Thoracale wervelzuil ................................................................................................... 78
2.1 Syndroom van Tietze ............................................................................................................. 78
2.2 Facettaire en costovertebrale disfunctie ................................................................................ 78
2.2.1 Facettaire disfunctie ...................................................................................................... 78
2.2.2 Costovertebrale disfunctie ............................................................................................. 78
2.3 Ziekte van SCheuermann ...................................................................................................... 78
2.4 Discogene aandoeningen ...................................................................................................... 79
2.5 Artrosis deformans ............................................................................................................... 79
2.6 Pseudoradiculair .................................................................................................................. 79
2.7 Musculaire pathologie ........................................................................................................... 80
2.8 DISH .................................................................................................................................... 80
Hoofdstuk 3: Lumbale wervelzuil .................................................................................................... 81
3.1 Inleiding ............................................................................................................................... 81
3.2 Aspecifieke rugpijnklachten .................................................................................................. 81
3.3 Oorzaken rugpijn .................................................................................................................. 81
3.4 Rode vlaggen ........................................................................................................................ 82
3.5 Gele vlaggen ......................................................................................................................... 82
3.6 Mechanische rugpijn ............................................................................................................. 83
3.6.1 Acute lumbago ............................................................................................................... 83
3.6.2 Musculaire letsels - acuut ............................................................................................... 84
3.6.3 Musculaire letsels - chronisch ........................................................................................ 84
3.6.4 Discuslijden ................................................................................................................... 84
3.6.5 Facettaire problematiek ................................................................................................. 87
3.6.6 Arthrosis deformans ....................................................................................................... 88
3.6.7 Spondylose - spondylolisthesis ....................................................................................... 90
3.6.8 Sacro-iliacale dysfunctie ................................................................................................ 91
3.6.9 Overgangsanomalie ....................................................................................................... 92
3.7 Diagnose bij wervelkolom pathologie ..................................................................................... 92
3.8 Aanpak lumbale klachten ...................................................................................................... 95
3.8.1 Probleem thv spieren ..................................................................................................... 95
3.8.2 Probleem thv facetgewrichten ........................................................................................ 96
3.8.3 Radix compressie ........................................................................................................... 97
3.8.4 Discus pathologie .......................................................................................................... 98
Zenuwletsels ..................................................................................................................................... 99
Hoofdstuk 1: Inleiding .................................................................................................................... 99
4
