Locomotor system 2
,Spondyloarthritis.........................................................................................................................6
Overview..................................................................................................................................6
1.Introduction..........................................................................................................................6
2.Pathogenesis.......................................................................................................................8
3.Axialspondyloarthritis..........................................................................................................8
4.Psoriaticarthritis................................................................................................................13
5.IBD-relatedspondyloarthritis.............................................................................................15
6.Reactivearthritis................................................................................................................15
7.Treatment...........................................................................................................................17
Post-infectiousarthritis..........................................................................................................19
Casediscussions...................................................................................................................21
Casus1..................................................................................................................................21
Casus2..................................................................................................................................23
Casus3..................................................................................................................................23
Casus4..................................................................................................................................24
Generalisedpainsyndromes...................................................................................................26
Fibromyalgiadiagnosis..........................................................................................................26
Chronicfatiguesyndrome......................................................................................................28
Systemicdiseases.....................................................................................................................29
A.ANA-associatedsystemicdiseases..................................................................................29
B.Vasculitis...........................................................................................................................43
C.Sarcoidosis........................................................................................................................49
Summary...............................................................................................................................52
Cervicalspine............................................................................................................................53
Epidemiologyandriskfactorsofspinaldisorders(JefMichielsen).......................................53
Cervicalspinepathology(Stassijns)......................................................................................57
Casestudy.............................................................................................................................61
Degenerativedisordersofthecervicalspine.........................................................................68
Radiculopathyversusperipheralpainsyndromes................................................................77
Whytalkingaboutdifferentialdiagnosis?..............................................................................77
Degenerativedisordersofthelumbarspine(Jef)..................................................................81
Lumbarspineanatomy..........................................................................................................81
1.Lumbago:Casestudy‘acutebackpain’(notinbook).......................................................83
2.Discherniation...................................................................................................................89
3.Caudaequinasyndrome....................................................................................................98
4.SpinalCanalStenosis......................................................................................................102
TraumatologieUpperLimb.....................................................................................................108
Essentialfacts......................................................................................................................108
1.Fracturesoftheclavicleandshouldergirdle...................................................................110
2.Proximalhumeralfractures..............................................................................................114
3.Humeralshaftfractures....................................................................................................116
2
, .Fracturesaroundtheelbow.............................................................................................117
4
5.Fracturesoftheforearm..................................................................................................121
6.Fracturesatthewristandhand.......................................................................................123
7.Tendonandnerveinjuries................................................................................................126
SpinalCordInjury....................................................................................................................127
Hypovolemicshock/Neurogenicshock(belangrijk)...........................................................129
ImagingofSpondyloarthritis..................................................................................................131
Spondyloarthritis..................................................................................................................131
ImagingofInfection.................................................................................................................141
Osteomyelitis.......................................................................................................................141
ImagingofBoneTumors.........................................................................................................153
Verschillendebottumoren(benign&malignant)..................................................................162
Spondylolysisandspondylolisthesis...................................................................................176
Terminology.........................................................................................................................176
Classification........................................................................................................................176
Spondylolysis/Isthmicspondylolisthesis..............................................................................177
Treatment.............................................................................................................................182
Clinicalcase.........................................................................................................................185
Spinalinfections......................................................................................................................186
Spinalinfections:overview..................................................................................................186
Pathofysiologyofspinalinfections.......................................................................................186
Clinicalpresentation............................................................................................................188
Radiographicevaluation......................................................................................................190
Treatment.............................................................................................................................192
Conclusions:spinalinfection...............................................................................................194
Fragility(pathological)fracturesofthespine.......................................................................195
Pathologicalfracture............................................................................................................195
Causes.................................................................................................................................195
VCF......................................................................................................................................196
Metastaticspinedisease(MSD)(EXAMEN!!).....................................................................199
Casefragilityfracture...........................................................................................................201
Spinaltumors...........................................................................................................................202
Spinalcolumntumors(SCT)................................................................................................202
Diagnosisandtreatment......................................................................................................205
Neurologyandthespinalcanal.............................................................................................206
Cervicaal..............................................................................................................................206
Lumbaal...............................................................................................................................209
Sacropelvicpathology............................................................................................................213
Inleiding...............................................................................................................................213
Anatomy...............................................................................................................................213
Sacroiliacjointdysfunction..................................................................................................215
3
, occygodynia......................................................................................................................224
C
Stressfracturesofthesacrum.............................................................................................225
Chapter5:Traumatologyofthelowerlimb...........................................................................227
Introduction..........................................................................................................................227
Mechanismofinjury-EXAMEN..........................................................................................227
1.Hipdislocation:anteriorvsposterior................................................................................233
2.Pelvicfractures................................................................................................................235
3.Proximalfemoralfractures...............................................................................................236
Specials...............................................................................................................................247
Chapter3:Pathologyofankleandfoot.................................................................................254
Anatomy...............................................................................................................................254
Semiology............................................................................................................................257
Pesplanus...........................................................................................................................260
Pescavus(holvoet).............................................................................................................262
Adulthalluxvalgus...............................................................................................................263
Lessertoedeformity............................................................................................................265
Anklesprain.........................................................................................................................268
Peritendinitis/Tendinitis/Tendinose.......................................................................................274
Chapter4:Children’sorthopaedics.......................................................................................277
Reality:normalversusabnormal.........................................................................................277
Overview:Part1..................................................................................................................277
Overviewpart2:Paediatrichippathology...........................................................................288
Infectionofthelocomotorsystem.........................................................................................294
Overview..............................................................................................................................294
Hip.............................................................................................................................................302
Thehip:anatomy.................................................................................................................302
Articularpathology(adult)....................................................................................................304
Hip:Softtissuepathology....................................................................................................314
QUIZ....................................................................................................................................319
Chapter2:Knee.......................................................................................................................320
Anatomie..............................................................................................................................320
Anamnesis...........................................................................................................................321
Physicalexamination...........................................................................................................321
Articularpathology(adult)....................................................................................................322
Meniscus..............................................................................................................................329
Plicasyndrome....................................................................................................................330
OsteochondritisDissecans..................................................................................................331
Articularcartilagedefectsoftheknee..................................................................................331
Instability..............................................................................................................................332
Cavekneeluxation!..............................................................................................................338
Patello-femoralpathology....................................................................................................338
4
, est......................................................................................................................................341
T
Tendinopathy...........................................................................................................................343
What’sinaname?Tendinopathy.........................................................................................343
Clinicalpresentationoftendinopathy...................................................................................347
Therapyintendinopathy......................................................................................................348
SpecificTendinopathies.......................................................................................................352
Othercommontendinopathiesofthelowerlimb.................................................................357
Sudeck-PhysicalMedicineandRehabilitation...................................................................358
Case....................................................................................................................................358
Upperlimb................................................................................................................................362
Casestudy1:Rotatorcuffimpingement..............................................................................362
Casestudy2:Tenniselbow.................................................................................................368
Casestudy3:Carpaltunnelsyndrome................................................................................370
Casestudy4:Dupuytren'sdisease.....................................................................................371
Casestudy5:DeQuervain’sdisease(belangrijk)...............................................................373
Boneandsofttissuetumors..................................................................................................375
Introduction..........................................................................................................................375
Bonytumors&wekedelentumoren....................................................................................376
SpecificLesions(terinfo)....................................................................................................385
5
,Spondyloarthritis.........................................................................................................................6
Overview..................................................................................................................................6
1.Introduction..........................................................................................................................6
2.Pathogenesis.......................................................................................................................8
3.Axialspondyloarthritis..........................................................................................................8
4.Psoriaticarthritis................................................................................................................13
5.IBD-relatedspondyloarthritis.............................................................................................15
6.Reactivearthritis................................................................................................................15
7.Treatment...........................................................................................................................17
Post-infectiousarthritis..........................................................................................................19
Casediscussions...................................................................................................................21
Casus1..................................................................................................................................21
Casus2..................................................................................................................................23
Casus3..................................................................................................................................23
Casus4..................................................................................................................................24
Generalisedpainsyndromes...................................................................................................26
Fibromyalgiadiagnosis..........................................................................................................26
Chronicfatiguesyndrome......................................................................................................28
Systemicdiseases.....................................................................................................................29
A.ANA-associatedsystemicdiseases..................................................................................29
B.Vasculitis...........................................................................................................................43
C.Sarcoidosis........................................................................................................................49
Summary...............................................................................................................................52
Cervicalspine............................................................................................................................53
Epidemiologyandriskfactorsofspinaldisorders(JefMichielsen).......................................53
Cervicalspinepathology(Stassijns)......................................................................................57
Casestudy.............................................................................................................................61
Degenerativedisordersofthecervicalspine.........................................................................68
Radiculopathyversusperipheralpainsyndromes................................................................77
Whytalkingaboutdifferentialdiagnosis?..............................................................................77
Degenerativedisordersofthelumbarspine(Jef)..................................................................81
Lumbarspineanatomy..........................................................................................................81
1.Lumbago:Casestudy‘acutebackpain’(notinbook).......................................................83
2.Discherniation...................................................................................................................89
3.Caudaequinasyndrome....................................................................................................98
4.SpinalCanalStenosis......................................................................................................102
TraumatologieUpperLimb.....................................................................................................108
Essentialfacts......................................................................................................................108
1.Fracturesoftheclavicleandshouldergirdle...................................................................110
2.Proximalhumeralfractures..............................................................................................114
3.Humeralshaftfractures....................................................................................................116
2
, .Fracturesaroundtheelbow.............................................................................................117
4
5.Fracturesoftheforearm..................................................................................................121
6.Fracturesatthewristandhand.......................................................................................123
7.Tendonandnerveinjuries................................................................................................126
SpinalCordInjury....................................................................................................................127
Hypovolemicshock/Neurogenicshock(belangrijk)...........................................................129
ImagingofSpondyloarthritis..................................................................................................131
Spondyloarthritis..................................................................................................................131
ImagingofInfection.................................................................................................................141
Osteomyelitis.......................................................................................................................141
ImagingofBoneTumors.........................................................................................................153
Verschillendebottumoren(benign&malignant)..................................................................162
Spondylolysisandspondylolisthesis...................................................................................176
Terminology.........................................................................................................................176
Classification........................................................................................................................176
Spondylolysis/Isthmicspondylolisthesis..............................................................................177
Treatment.............................................................................................................................182
Clinicalcase.........................................................................................................................185
Spinalinfections......................................................................................................................186
Spinalinfections:overview..................................................................................................186
Pathofysiologyofspinalinfections.......................................................................................186
Clinicalpresentation............................................................................................................188
Radiographicevaluation......................................................................................................190
Treatment.............................................................................................................................192
Conclusions:spinalinfection...............................................................................................194
Fragility(pathological)fracturesofthespine.......................................................................195
Pathologicalfracture............................................................................................................195
Causes.................................................................................................................................195
VCF......................................................................................................................................196
Metastaticspinedisease(MSD)(EXAMEN!!).....................................................................199
Casefragilityfracture...........................................................................................................201
Spinaltumors...........................................................................................................................202
Spinalcolumntumors(SCT)................................................................................................202
Diagnosisandtreatment......................................................................................................205
Neurologyandthespinalcanal.............................................................................................206
Cervicaal..............................................................................................................................206
Lumbaal...............................................................................................................................209
Sacropelvicpathology............................................................................................................213
Inleiding...............................................................................................................................213
Anatomy...............................................................................................................................213
Sacroiliacjointdysfunction..................................................................................................215
3
, occygodynia......................................................................................................................224
C
Stressfracturesofthesacrum.............................................................................................225
Chapter5:Traumatologyofthelowerlimb...........................................................................227
Introduction..........................................................................................................................227
Mechanismofinjury-EXAMEN..........................................................................................227
1.Hipdislocation:anteriorvsposterior................................................................................233
2.Pelvicfractures................................................................................................................235
3.Proximalfemoralfractures...............................................................................................236
Specials...............................................................................................................................247
Chapter3:Pathologyofankleandfoot.................................................................................254
Anatomy...............................................................................................................................254
Semiology............................................................................................................................257
Pesplanus...........................................................................................................................260
Pescavus(holvoet).............................................................................................................262
Adulthalluxvalgus...............................................................................................................263
Lessertoedeformity............................................................................................................265
Anklesprain.........................................................................................................................268
Peritendinitis/Tendinitis/Tendinose.......................................................................................274
Chapter4:Children’sorthopaedics.......................................................................................277
Reality:normalversusabnormal.........................................................................................277
Overview:Part1..................................................................................................................277
Overviewpart2:Paediatrichippathology...........................................................................288
Infectionofthelocomotorsystem.........................................................................................294
Overview..............................................................................................................................294
Hip.............................................................................................................................................302
Thehip:anatomy.................................................................................................................302
Articularpathology(adult)....................................................................................................304
Hip:Softtissuepathology....................................................................................................314
QUIZ....................................................................................................................................319
Chapter2:Knee.......................................................................................................................320
Anatomie..............................................................................................................................320
Anamnesis...........................................................................................................................321
Physicalexamination...........................................................................................................321
Articularpathology(adult)....................................................................................................322
Meniscus..............................................................................................................................329
Plicasyndrome....................................................................................................................330
OsteochondritisDissecans..................................................................................................331
Articularcartilagedefectsoftheknee..................................................................................331
Instability..............................................................................................................................332
Cavekneeluxation!..............................................................................................................338
Patello-femoralpathology....................................................................................................338
4
, est......................................................................................................................................341
T
Tendinopathy...........................................................................................................................343
What’sinaname?Tendinopathy.........................................................................................343
Clinicalpresentationoftendinopathy...................................................................................347
Therapyintendinopathy......................................................................................................348
SpecificTendinopathies.......................................................................................................352
Othercommontendinopathiesofthelowerlimb.................................................................357
Sudeck-PhysicalMedicineandRehabilitation...................................................................358
Case....................................................................................................................................358
Upperlimb................................................................................................................................362
Casestudy1:Rotatorcuffimpingement..............................................................................362
Casestudy2:Tenniselbow.................................................................................................368
Casestudy3:Carpaltunnelsyndrome................................................................................370
Casestudy4:Dupuytren'sdisease.....................................................................................371
Casestudy5:DeQuervain’sdisease(belangrijk)...............................................................373
Boneandsofttissuetumors..................................................................................................375
Introduction..........................................................................................................................375
Bonytumors&wekedelentumoren....................................................................................376
SpecificLesions(terinfo)....................................................................................................385
5
