Academiejaar
2022 - 2023
Onderste extremiteit: theorie
Gabriëlle Van Eekert
,Inhoudsopgave
.................................................................................................................1
Hoorcollege 17/02 – Liespijn - Lars Poppe...........................................................................................................................................7
Complexe regio ........................................................................................................................................................................................ 7
Incidentie ................................................................................................................................................................................................. 7
Eigenschappen ......................................................................................................................................................................................... 8
Onstaan ................................................................................................................................................................................................... 9
Terminologie .......................................................................................................................................................................................9
Doha classification of groin pain ............................................................................................................................................................. 9
Bruikbaarheid ................................................................................................................................................................................... 11
Liespijn in de praktijk .........................................................................................................................................................................11
Anamnese .............................................................................................................................................................................................. 11
Adductor gerelateerde liespijn ..........................................................................................................................................................12
Doha-classificatie................................................................................................................................................................................... 12
- Pijnlijke palpatie van adductoren ................................................................................................................................................. 12
- Pijn bij weerstandstest adductoren .............................................................................................................................................. 12
Onderzoek .............................................................................................................................................................................................. 12
- Palpatie ........................................................................................................................................................................................ 12
Beeldvorming ......................................................................................................................................................................................... 12
Pubis gerelateerde liespijn ................................................................................................................................................................12
Doha-classificatie................................................................................................................................................................................... 12
Onderzoek .............................................................................................................................................................................................. 12
Beeldvorming ......................................................................................................................................................................................... 12
Inguinaal gerelateerde liespijn ..........................................................................................................................................................12
Doha-classificatie................................................................................................................................................................................... 12
Onderzoek .............................................................................................................................................................................................. 12
Iliopsoas gerelateerde liespijn ...........................................................................................................................................................12
Doha-classificatie................................................................................................................................................................................... 12
Onderzoek .............................................................................................................................................................................................. 12
Beeldvorming ......................................................................................................................................................................................... 13
Heup gerelateerde liespijn.................................................................................................................................................................13
Doha-classificatie................................................................................................................................................................................... 13
Onderzoek .............................................................................................................................................................................................. 13
Casus S.D. ..........................................................................................................................................................................................14
Klachten ................................................................................................................................................................................................. 14
, Onderzoek .............................................................................................................................................................................................. 14
Liespijn bij adolescenten................................................................................................................................................................... 14
Casus G.B. ..........................................................................................................................................................................................16
Klachten ................................................................................................................................................................................................. 16
Onderzoek .............................................................................................................................................................................................. 16
Adductor gerelateerde liespijn............................................................................................................................................................... 16
Toegevoegd onderzoek: ......................................................................................................................................................................... 16
Behandeling: adductor .......................................................................................................................................................................... 17
Adductor preventief? ............................................................................................................................................................................. 22
Inguinaal gerelateerde liespijn .............................................................................................................................................................. 22
Behandeling: inguinaal .......................................................................................................................................................................... 22
Casus J.R. ...........................................................................................................................................................................................23
Onderzoek......................................................................................................................................................................................... 23
Iliopsoas gerelateerde pijn: ................................................................................................................................................................... 23
Behandeling Iliopsoas gerelateerd ................................................................................................................................................... 23
Pubisgerelateerde liespijn ...................................................................................................................................................................... 24
Behandeling: pubis-gerelateerd ....................................................................................................................................................... 24
Take home message ..........................................................................................................................................................................24
Addendum: scoring volgens Doha classificatie ..................................................................................................................................25
Hoorcollege 27/2 - De evaluatie en aanpak van een patiënt met complexe enkelklachten – Anthe Foubert .....................................27
Epidemiologie enkel artropathie ........................................................................................................................................................... 27
Enkel artropathie: klinische presentatie en klachten ....................................................................................................................... 27
Casus: patiënt met complexe enkelklachten ......................................................................................................................................... 28
Anamnese/Welke vragen ga je stellen aan patiënt? ........................................................................................................................ 28
Farmacokinetiek van FVIII & bloedingsrisico .................................................................................................................................... 29
Klinische presentatie......................................................................................................................................................................... 31
Klinische onderzoek .......................................................................................................................................................................... 31
Medische beeldvorming ................................................................................................................................................................... 32
Vragenlijsten: .................................................................................................................................................................................... 33
Achtergrond info hemofilie .................................................................................................................................................................... 33
Bloedingen ........................................................................................................................................................................................ 33
Ontwikkeling hemofilie arthropathie ............................................................................................................................................... 34
Enkel revalidatie .................................................................................................................................................................................... 34
Overzicht behandelopties enkel artropathie (hemofilie) ....................................................................................................................... 35
Kinesitherapie ................................................................................................................................................................................... 35
Sport? Ja! .......................................................................................................................................................................................... 35
Orthopedische chirurgie ................................................................................................................................................................... 36
Enkel arthrodese ............................................................................................................................................................................... 36
Totale enkel prothese ....................................................................................................................................................................... 36
Take home messages ............................................................................................................................................................................. 36
Hoorcollege 1/3: Kraakbeen en revalidatie – L. Poppe.......................................................................................................................37
Kraakbeen .............................................................................................................................................................................................. 37
Types kraakbeen ............................................................................................................................................................................... 37
Gewrichtsvocht ................................................................................................................................................................................. 39
Schade............................................................................................................................................................................................... 39
Classificatie ....................................................................................................................................................................................... 40
Kraakbeen letsels ................................................................................................................................................................................... 40
Knie ................................................................................................................................................................................................... 40
, Heup ................................................................................................................................................................................................. 40
Handen ............................................................................................................................................................................................. 40
Temporomandibulair gewricht ......................................................................................................................................................... 40
Schoudergordel................................................................................................................................................................................. 40
Voet .................................................................................................................................................................................................. 40
Wervelkolom .................................................................................................................................................................................... 40
Opmerkingen .................................................................................................................................................................................... 41
Risicofactoren ................................................................................................................................................................................... 42
Kraakbeenletsels in de praktijk .............................................................................................................................................................. 42
Mogelijke symptomen ...................................................................................................................................................................... 42
Onderzoek......................................................................................................................................................................................... 42
Behandeling ...................................................................................................................................................................................... 43
Kraakbeenletsels conservatief: PFP ....................................................................................................................................................... 44
Patellofemorale pijn (PFP) ................................................................................................................................................................ 44
Post operatief ........................................................................................................................................................................................ 47
Operatietechnieken .......................................................................................................................................................................... 47
Operatietechnieken – RTS ................................................................................................................................................................ 49
Operatietechnieken – postop ........................................................................................................................................................... 49
Fases van weefselherstel (post-op) .................................................................................................................................................. 49
Behandeling ........................................................................................................................................................................................... 51
Hoorcollege 3/3: Management of meniscus injuries: an overview – J. Verbrugghe ...........................................................................53
Meniscus anatomy................................................................................................................................................................................. 53
Functions of the menisci ........................................................................................................................................................................ 56
Mechanisms of injury............................................................................................................................................................................. 58
Prevalence of pathological meniscal injuries ......................................................................................................................................... 58
Prevalence of nonpathological meniscal injuries ................................................................................................................................... 58
Clinical presentation .............................................................................................................................................................................. 59
Meniscal tears ....................................................................................................................................................................................... 60
Other diagnoses related to menisci to keep in mind ............................................................................................................................. 60
Clinical examination and diagnostic testing .......................................................................................................................................... 61
Risk factors ............................................................................................................................................................................................ 62
Relationship with osteoarthritis ............................................................................................................................................................ 62
Relationship with ACL ............................................................................................................................................................................ 64
Surgical procedures ............................................................................................................................................................................... 64
Muscle repair innovations ..................................................................................................................................................................... 66
Rehabilitation algorithms ...................................................................................................................................................................... 68
Surgical procedures vs conservative treatment ..................................................................................................................................... 68
Active rehabilitation (without surgery) .................................................................................................................................................. 69
Active rehabilitation (after surgery) ...................................................................................................................................................... 69
Active rehabilitation (patient beliefs) .................................................................................................................................................... 71
Active rehabilitation (weight bearing) ................................................................................................................................................... 71
Active rehabilitation (aquatic vs land based) ........................................................................................................................................ 72
Active rehabilitation (blood flow restriction) ......................................................................................................................................... 73
Active rehabilitation (use of a knee brace) ............................................................................................................................................ 73
Return to play/sport .............................................................................................................................................................................. 74
Hoorcollege 13/3 - mHealth and Telerehabilitation current and future applications for musculoskeletal rehabilitation –
J.Verbrugghe .....................................................................................................................................................................................76
2022 - 2023
Onderste extremiteit: theorie
Gabriëlle Van Eekert
,Inhoudsopgave
.................................................................................................................1
Hoorcollege 17/02 – Liespijn - Lars Poppe...........................................................................................................................................7
Complexe regio ........................................................................................................................................................................................ 7
Incidentie ................................................................................................................................................................................................. 7
Eigenschappen ......................................................................................................................................................................................... 8
Onstaan ................................................................................................................................................................................................... 9
Terminologie .......................................................................................................................................................................................9
Doha classification of groin pain ............................................................................................................................................................. 9
Bruikbaarheid ................................................................................................................................................................................... 11
Liespijn in de praktijk .........................................................................................................................................................................11
Anamnese .............................................................................................................................................................................................. 11
Adductor gerelateerde liespijn ..........................................................................................................................................................12
Doha-classificatie................................................................................................................................................................................... 12
- Pijnlijke palpatie van adductoren ................................................................................................................................................. 12
- Pijn bij weerstandstest adductoren .............................................................................................................................................. 12
Onderzoek .............................................................................................................................................................................................. 12
- Palpatie ........................................................................................................................................................................................ 12
Beeldvorming ......................................................................................................................................................................................... 12
Pubis gerelateerde liespijn ................................................................................................................................................................12
Doha-classificatie................................................................................................................................................................................... 12
Onderzoek .............................................................................................................................................................................................. 12
Beeldvorming ......................................................................................................................................................................................... 12
Inguinaal gerelateerde liespijn ..........................................................................................................................................................12
Doha-classificatie................................................................................................................................................................................... 12
Onderzoek .............................................................................................................................................................................................. 12
Iliopsoas gerelateerde liespijn ...........................................................................................................................................................12
Doha-classificatie................................................................................................................................................................................... 12
Onderzoek .............................................................................................................................................................................................. 12
Beeldvorming ......................................................................................................................................................................................... 13
Heup gerelateerde liespijn.................................................................................................................................................................13
Doha-classificatie................................................................................................................................................................................... 13
Onderzoek .............................................................................................................................................................................................. 13
Casus S.D. ..........................................................................................................................................................................................14
Klachten ................................................................................................................................................................................................. 14
, Onderzoek .............................................................................................................................................................................................. 14
Liespijn bij adolescenten................................................................................................................................................................... 14
Casus G.B. ..........................................................................................................................................................................................16
Klachten ................................................................................................................................................................................................. 16
Onderzoek .............................................................................................................................................................................................. 16
Adductor gerelateerde liespijn............................................................................................................................................................... 16
Toegevoegd onderzoek: ......................................................................................................................................................................... 16
Behandeling: adductor .......................................................................................................................................................................... 17
Adductor preventief? ............................................................................................................................................................................. 22
Inguinaal gerelateerde liespijn .............................................................................................................................................................. 22
Behandeling: inguinaal .......................................................................................................................................................................... 22
Casus J.R. ...........................................................................................................................................................................................23
Onderzoek......................................................................................................................................................................................... 23
Iliopsoas gerelateerde pijn: ................................................................................................................................................................... 23
Behandeling Iliopsoas gerelateerd ................................................................................................................................................... 23
Pubisgerelateerde liespijn ...................................................................................................................................................................... 24
Behandeling: pubis-gerelateerd ....................................................................................................................................................... 24
Take home message ..........................................................................................................................................................................24
Addendum: scoring volgens Doha classificatie ..................................................................................................................................25
Hoorcollege 27/2 - De evaluatie en aanpak van een patiënt met complexe enkelklachten – Anthe Foubert .....................................27
Epidemiologie enkel artropathie ........................................................................................................................................................... 27
Enkel artropathie: klinische presentatie en klachten ....................................................................................................................... 27
Casus: patiënt met complexe enkelklachten ......................................................................................................................................... 28
Anamnese/Welke vragen ga je stellen aan patiënt? ........................................................................................................................ 28
Farmacokinetiek van FVIII & bloedingsrisico .................................................................................................................................... 29
Klinische presentatie......................................................................................................................................................................... 31
Klinische onderzoek .......................................................................................................................................................................... 31
Medische beeldvorming ................................................................................................................................................................... 32
Vragenlijsten: .................................................................................................................................................................................... 33
Achtergrond info hemofilie .................................................................................................................................................................... 33
Bloedingen ........................................................................................................................................................................................ 33
Ontwikkeling hemofilie arthropathie ............................................................................................................................................... 34
Enkel revalidatie .................................................................................................................................................................................... 34
Overzicht behandelopties enkel artropathie (hemofilie) ....................................................................................................................... 35
Kinesitherapie ................................................................................................................................................................................... 35
Sport? Ja! .......................................................................................................................................................................................... 35
Orthopedische chirurgie ................................................................................................................................................................... 36
Enkel arthrodese ............................................................................................................................................................................... 36
Totale enkel prothese ....................................................................................................................................................................... 36
Take home messages ............................................................................................................................................................................. 36
Hoorcollege 1/3: Kraakbeen en revalidatie – L. Poppe.......................................................................................................................37
Kraakbeen .............................................................................................................................................................................................. 37
Types kraakbeen ............................................................................................................................................................................... 37
Gewrichtsvocht ................................................................................................................................................................................. 39
Schade............................................................................................................................................................................................... 39
Classificatie ....................................................................................................................................................................................... 40
Kraakbeen letsels ................................................................................................................................................................................... 40
Knie ................................................................................................................................................................................................... 40
, Heup ................................................................................................................................................................................................. 40
Handen ............................................................................................................................................................................................. 40
Temporomandibulair gewricht ......................................................................................................................................................... 40
Schoudergordel................................................................................................................................................................................. 40
Voet .................................................................................................................................................................................................. 40
Wervelkolom .................................................................................................................................................................................... 40
Opmerkingen .................................................................................................................................................................................... 41
Risicofactoren ................................................................................................................................................................................... 42
Kraakbeenletsels in de praktijk .............................................................................................................................................................. 42
Mogelijke symptomen ...................................................................................................................................................................... 42
Onderzoek......................................................................................................................................................................................... 42
Behandeling ...................................................................................................................................................................................... 43
Kraakbeenletsels conservatief: PFP ....................................................................................................................................................... 44
Patellofemorale pijn (PFP) ................................................................................................................................................................ 44
Post operatief ........................................................................................................................................................................................ 47
Operatietechnieken .......................................................................................................................................................................... 47
Operatietechnieken – RTS ................................................................................................................................................................ 49
Operatietechnieken – postop ........................................................................................................................................................... 49
Fases van weefselherstel (post-op) .................................................................................................................................................. 49
Behandeling ........................................................................................................................................................................................... 51
Hoorcollege 3/3: Management of meniscus injuries: an overview – J. Verbrugghe ...........................................................................53
Meniscus anatomy................................................................................................................................................................................. 53
Functions of the menisci ........................................................................................................................................................................ 56
Mechanisms of injury............................................................................................................................................................................. 58
Prevalence of pathological meniscal injuries ......................................................................................................................................... 58
Prevalence of nonpathological meniscal injuries ................................................................................................................................... 58
Clinical presentation .............................................................................................................................................................................. 59
Meniscal tears ....................................................................................................................................................................................... 60
Other diagnoses related to menisci to keep in mind ............................................................................................................................. 60
Clinical examination and diagnostic testing .......................................................................................................................................... 61
Risk factors ............................................................................................................................................................................................ 62
Relationship with osteoarthritis ............................................................................................................................................................ 62
Relationship with ACL ............................................................................................................................................................................ 64
Surgical procedures ............................................................................................................................................................................... 64
Muscle repair innovations ..................................................................................................................................................................... 66
Rehabilitation algorithms ...................................................................................................................................................................... 68
Surgical procedures vs conservative treatment ..................................................................................................................................... 68
Active rehabilitation (without surgery) .................................................................................................................................................. 69
Active rehabilitation (after surgery) ...................................................................................................................................................... 69
Active rehabilitation (patient beliefs) .................................................................................................................................................... 71
Active rehabilitation (weight bearing) ................................................................................................................................................... 71
Active rehabilitation (aquatic vs land based) ........................................................................................................................................ 72
Active rehabilitation (blood flow restriction) ......................................................................................................................................... 73
Active rehabilitation (use of a knee brace) ............................................................................................................................................ 73
Return to play/sport .............................................................................................................................................................................. 74
Hoorcollege 13/3 - mHealth and Telerehabilitation current and future applications for musculoskeletal rehabilitation –
J.Verbrugghe .....................................................................................................................................................................................76
