Ziekteleer Onderste lidmaat
Inhoud
Hoofdstuk 1: Heup...................................................................................................................7
1. anatomie..........................................................................................................................7
1.1. Mobiliteit in heup........................................................................................................7
1.2. Spieren.......................................................................................................................7
1.3. Klinisch onderzoek.....................................................................................................8
2. Coxartrose........................................................................................................................8
2.1. Ontstaan....................................................................................................................8
2.2. Symptomen................................................................................................................8
2.3. Diagnose....................................................................................................................9
2.4. Behandeling...............................................................................................................9
3. Resurfacing heup............................................................................................................12
3.1. Resultaat na THP......................................................................................................12
3.2. Nabehandeling na THP..............................................................................................12
3.3. Complicaties na THP................................................................................................13
3.4. Avasculaire necrose heup.........................................................................................14
4. Femoro acetabulair impingement (FAI)............................................................................15
4.1. Symptomen..............................................................................................................15
4.2. KO............................................................................................................................15
4.3. Beeldvorming...........................................................................................................16
4.4. Behandeling.............................................................................................................16
5. Snapping hip...................................................................................................................16
5.1. Oorzaken..................................................................................................................16
5.2. Diagnose..................................................................................................................16
5.3. Behandeling.............................................................................................................16
6. Meralgia paresthetica......................................................................................................16
6.1. Oorzaken..................................................................................................................17
6.2. Behandeling.............................................................................................................17
7. Greater Trochanter Pain Syndrome (GTPS).......................................................................17
7.1. Trochanter bursitis....................................................................................................17
8. Gluteus medius – tendinose of scheur.............................................................................17
1
, 8.1. Behandeling.............................................................................................................18
9. Stressfractuur femurhals.................................................................................................18
9.1. Diagnose..................................................................................................................18
9.2. KO............................................................................................................................18
9.3. Beeldvorming...........................................................................................................18
9.4. Behandeling.............................................................................................................18
10. Pubalgie adductoren tendinopathie...............................................................................19
10.1. Risicofactoren........................................................................................................19
10.2. Symptomen............................................................................................................19
10.3. Diagnose................................................................................................................19
10.4. Behandeling...........................................................................................................19
10.5. Differentieeldiagnose..............................................................................................19
11. Piriformis syndroom......................................................................................................20
11.1. Symptomen uitlokken door…..................................................................................20
11.2. Behandeling...........................................................................................................20
12. Hamstrings letsels........................................................................................................20
12.1. Letsel vorm.............................................................................................................20
12.2. Predisponerende factoren.......................................................................................20
12.3. Behandeling...........................................................................................................21
13. Proximaal hamstring syndroom.....................................................................................21
13.1. Behandeling...........................................................................................................21
Hoofdstuk 2: de knie...............................................................................................................21
1. Anatomie........................................................................................................................21
1.1. Botstructuren...........................................................................................................21
1.2. Gewrichten...............................................................................................................22
1.3. Assen.......................................................................................................................22
1.4. Meniscus..................................................................................................................22
1.5. Ligamenten..............................................................................................................23
1.6. Spieren.....................................................................................................................23
2. onderzoek.......................................................................................................................24
2.1. Anamnese................................................................................................................24
2.2. Klinisch onderzoek...................................................................................................25
2.3. Beeldvorming...........................................................................................................27
3. meniscusscheur.............................................................................................................27
2
, 3.1. Klinisch onderzoek...................................................................................................28
3.2. Beeldvorming...........................................................................................................28
3.3. Soorten scheuren.....................................................................................................28
3.4. Behandeling.............................................................................................................28
3.5. Revalidatie na een hechting......................................................................................28
4. ligament letsels...............................................................................................................29
4.1. Terminologie.............................................................................................................29
4.2. Mediale bandletsel...................................................................................................29
5. voorste kruisband letstels...............................................................................................31
5.1. Anatomie..................................................................................................................31
5.2. Trauma mechanisme................................................................................................31
5.3. Anamnese................................................................................................................31
5.4. Klinisch onderzoek...................................................................................................31
5.5. Beeldvorming...........................................................................................................32
5.6. Acute behandeling....................................................................................................32
5.7. Verdere behandeling................................................................................................32
5.8. Operatieve behandeling............................................................................................32
5.9. Nabehandeling.........................................................................................................33
6. achterse kruisband.........................................................................................................33
6.1. Anatomie..................................................................................................................33
6.2. Trauma mechanisme................................................................................................33
6.3. Klinisch onderzoek...................................................................................................33
6.4. Behandeling.............................................................................................................33
7. knieluxatie......................................................................................................................34
7.1. Classificatie.............................................................................................................34
7.2. Diagnose..................................................................................................................34
7.3. Behandeling.............................................................................................................34
8. kraakbeen.......................................................................................................................34
8.1. Anatomie..................................................................................................................34
8.2. Kraakbeen defect.....................................................................................................34
8.3. Biologisch kraakbeen herstel....................................................................................35
8.4. Behandeling.............................................................................................................35
8.5. Revalidatie biologische kraakbeen behandeling.........................................................37
9. artrose............................................................................................................................37
3
, 9.1. Risicofactoren..........................................................................................................37
9.2. Eerste aanpak artrose...............................................................................................37
9.3. Osteotomie..............................................................................................................38
10. knie prothese................................................................................................................38
10.1. Doelstelling............................................................................................................38
10.2. Soorten..................................................................................................................38
11. patellofemorale klachten..............................................................................................39
11.1. Biomechanische factoren.......................................................................................39
11.2. Stabiliteit van patellofemoraal gewricht...................................................................39
11.3. Instabiliteit van patellofemoraal gewricht................................................................40
11.4. Klinisch beeld.........................................................................................................40
11.5. Behandeling...........................................................................................................41
12. patellofemorale artrose.................................................................................................41
13. patella tendinopathie – jumpers knee............................................................................41
13.1. Stadia.....................................................................................................................41
13.2. Klinisch beeld.........................................................................................................42
13.3. Behandeling...........................................................................................................42
14. iliotibiaalband frictiesyndroom – laterale lopersknie-.....................................................42
14.1. Diagnose................................................................................................................42
14.2. Behandeling...........................................................................................................42
15. plicasyndroom..............................................................................................................42
15.1. Klinisch onderzoek en beeld....................................................................................43
15.2. Behandeling...........................................................................................................43
16. prepatellaire bursitis.....................................................................................................43
16.1. Klinisch beeld.........................................................................................................43
16.2. Behandeling...........................................................................................................43
17. bakercyste....................................................................................................................43
18. osteonecrose................................................................................................................43
18.1. Fasen.....................................................................................................................44
18.2. Behandeling...........................................................................................................44
19. ziekte ven osgood-schlatter en singing johanson............................................................44
Hoofdstuk 3: Enkel.................................................................................................................44
1. enkel gewrichten.............................................................................................................44
1.1. Tibiofibuliar gewricht................................................................................................45
4
Inhoud
Hoofdstuk 1: Heup...................................................................................................................7
1. anatomie..........................................................................................................................7
1.1. Mobiliteit in heup........................................................................................................7
1.2. Spieren.......................................................................................................................7
1.3. Klinisch onderzoek.....................................................................................................8
2. Coxartrose........................................................................................................................8
2.1. Ontstaan....................................................................................................................8
2.2. Symptomen................................................................................................................8
2.3. Diagnose....................................................................................................................9
2.4. Behandeling...............................................................................................................9
3. Resurfacing heup............................................................................................................12
3.1. Resultaat na THP......................................................................................................12
3.2. Nabehandeling na THP..............................................................................................12
3.3. Complicaties na THP................................................................................................13
3.4. Avasculaire necrose heup.........................................................................................14
4. Femoro acetabulair impingement (FAI)............................................................................15
4.1. Symptomen..............................................................................................................15
4.2. KO............................................................................................................................15
4.3. Beeldvorming...........................................................................................................16
4.4. Behandeling.............................................................................................................16
5. Snapping hip...................................................................................................................16
5.1. Oorzaken..................................................................................................................16
5.2. Diagnose..................................................................................................................16
5.3. Behandeling.............................................................................................................16
6. Meralgia paresthetica......................................................................................................16
6.1. Oorzaken..................................................................................................................17
6.2. Behandeling.............................................................................................................17
7. Greater Trochanter Pain Syndrome (GTPS).......................................................................17
7.1. Trochanter bursitis....................................................................................................17
8. Gluteus medius – tendinose of scheur.............................................................................17
1
, 8.1. Behandeling.............................................................................................................18
9. Stressfractuur femurhals.................................................................................................18
9.1. Diagnose..................................................................................................................18
9.2. KO............................................................................................................................18
9.3. Beeldvorming...........................................................................................................18
9.4. Behandeling.............................................................................................................18
10. Pubalgie adductoren tendinopathie...............................................................................19
10.1. Risicofactoren........................................................................................................19
10.2. Symptomen............................................................................................................19
10.3. Diagnose................................................................................................................19
10.4. Behandeling...........................................................................................................19
10.5. Differentieeldiagnose..............................................................................................19
11. Piriformis syndroom......................................................................................................20
11.1. Symptomen uitlokken door…..................................................................................20
11.2. Behandeling...........................................................................................................20
12. Hamstrings letsels........................................................................................................20
12.1. Letsel vorm.............................................................................................................20
12.2. Predisponerende factoren.......................................................................................20
12.3. Behandeling...........................................................................................................21
13. Proximaal hamstring syndroom.....................................................................................21
13.1. Behandeling...........................................................................................................21
Hoofdstuk 2: de knie...............................................................................................................21
1. Anatomie........................................................................................................................21
1.1. Botstructuren...........................................................................................................21
1.2. Gewrichten...............................................................................................................22
1.3. Assen.......................................................................................................................22
1.4. Meniscus..................................................................................................................22
1.5. Ligamenten..............................................................................................................23
1.6. Spieren.....................................................................................................................23
2. onderzoek.......................................................................................................................24
2.1. Anamnese................................................................................................................24
2.2. Klinisch onderzoek...................................................................................................25
2.3. Beeldvorming...........................................................................................................27
3. meniscusscheur.............................................................................................................27
2
, 3.1. Klinisch onderzoek...................................................................................................28
3.2. Beeldvorming...........................................................................................................28
3.3. Soorten scheuren.....................................................................................................28
3.4. Behandeling.............................................................................................................28
3.5. Revalidatie na een hechting......................................................................................28
4. ligament letsels...............................................................................................................29
4.1. Terminologie.............................................................................................................29
4.2. Mediale bandletsel...................................................................................................29
5. voorste kruisband letstels...............................................................................................31
5.1. Anatomie..................................................................................................................31
5.2. Trauma mechanisme................................................................................................31
5.3. Anamnese................................................................................................................31
5.4. Klinisch onderzoek...................................................................................................31
5.5. Beeldvorming...........................................................................................................32
5.6. Acute behandeling....................................................................................................32
5.7. Verdere behandeling................................................................................................32
5.8. Operatieve behandeling............................................................................................32
5.9. Nabehandeling.........................................................................................................33
6. achterse kruisband.........................................................................................................33
6.1. Anatomie..................................................................................................................33
6.2. Trauma mechanisme................................................................................................33
6.3. Klinisch onderzoek...................................................................................................33
6.4. Behandeling.............................................................................................................33
7. knieluxatie......................................................................................................................34
7.1. Classificatie.............................................................................................................34
7.2. Diagnose..................................................................................................................34
7.3. Behandeling.............................................................................................................34
8. kraakbeen.......................................................................................................................34
8.1. Anatomie..................................................................................................................34
8.2. Kraakbeen defect.....................................................................................................34
8.3. Biologisch kraakbeen herstel....................................................................................35
8.4. Behandeling.............................................................................................................35
8.5. Revalidatie biologische kraakbeen behandeling.........................................................37
9. artrose............................................................................................................................37
3
, 9.1. Risicofactoren..........................................................................................................37
9.2. Eerste aanpak artrose...............................................................................................37
9.3. Osteotomie..............................................................................................................38
10. knie prothese................................................................................................................38
10.1. Doelstelling............................................................................................................38
10.2. Soorten..................................................................................................................38
11. patellofemorale klachten..............................................................................................39
11.1. Biomechanische factoren.......................................................................................39
11.2. Stabiliteit van patellofemoraal gewricht...................................................................39
11.3. Instabiliteit van patellofemoraal gewricht................................................................40
11.4. Klinisch beeld.........................................................................................................40
11.5. Behandeling...........................................................................................................41
12. patellofemorale artrose.................................................................................................41
13. patella tendinopathie – jumpers knee............................................................................41
13.1. Stadia.....................................................................................................................41
13.2. Klinisch beeld.........................................................................................................42
13.3. Behandeling...........................................................................................................42
14. iliotibiaalband frictiesyndroom – laterale lopersknie-.....................................................42
14.1. Diagnose................................................................................................................42
14.2. Behandeling...........................................................................................................42
15. plicasyndroom..............................................................................................................42
15.1. Klinisch onderzoek en beeld....................................................................................43
15.2. Behandeling...........................................................................................................43
16. prepatellaire bursitis.....................................................................................................43
16.1. Klinisch beeld.........................................................................................................43
16.2. Behandeling...........................................................................................................43
17. bakercyste....................................................................................................................43
18. osteonecrose................................................................................................................43
18.1. Fasen.....................................................................................................................44
18.2. Behandeling...........................................................................................................44
19. ziekte ven osgood-schlatter en singing johanson............................................................44
Hoofdstuk 3: Enkel.................................................................................................................44
1. enkel gewrichten.............................................................................................................44
1.1. Tibiofibuliar gewricht................................................................................................45
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