Fysische geneeskunde & revalidatie
Inhoudsopgave
Doelstelling behandeling....................................................................................................................................13
Pijnstilling.................................................................................................................................................... 14
1. Oppervlakkige warmte-applicatie..................................................................................................................14
Indicaties........................................................................................................................................................14
Contra-indicatie.............................................................................................................................................14
Opletten bij....................................................................................................................................................14
Voorbeelden..................................................................................................................................................14
2. Koude therapie/cryotherapie.........................................................................................................................14
Doel................................................................................................................................................................15
Indicaties........................................................................................................................................................15
Contra-indicaties............................................................................................................................................15
Werking pijninhibitie.....................................................................................................................................15
Voorbeelden..................................................................................................................................................15
3. Elektrotherapie...............................................................................................................................................15
Mobilisatie.................................................................................................................................................. 16
Passieve mobilisatie...........................................................................................................................................16
Actieve mobilisatie.............................................................................................................................................16
Spierversterkende oefeningen......................................................................................................................17
Isokinetische oefeningen...............................................................................................................................17
Massage...................................................................................................................................................... 17
Indicaties............................................................................................................................................................17
Contra-indicaties................................................................................................................................................17
Andere technieken..............................................................................................................................................17
Hydrotherapie............................................................................................................................................. 18
Indicaties............................................................................................................................................................18
Contra-indicaties................................................................................................................................................18
Coördinatieoefeningen................................................................................................................................ 18
Trilplaat....................................................................................................................................................... 18
Indicatie..............................................................................................................................................................18
Extracorporele Shock Wave Therapie (ESWT)............................................................................................... 18
Indicaties............................................................................................................................................................18
Praktisch.............................................................................................................................................................18
Acute cervicale (< strain) spierpijn................................................................................................................ 19
Etiologie........................................................................................................................................................19
Behandeling..................................................................................................................................................19
Acute torticollis ~ acute lumbago......................................................................................................................19
Ontstaan.......................................................................................................................................................19
Gevolgen.......................................................................................................................................................20
Hyperflexie trauma........................................................................................................................................20
1
,Fysische geneeskunde & revalidatie
Hyperextensie trauma...................................................................................................................................20
Onderzoeken......................................................................................................................................................20
Behandeling........................................................................................................................................................20
Chronische cervicale strain – nekpijn............................................................................................................ 21
M. trapeziussyndroom..................................................................................................................................21
Behandeling chronische spieroverbelasting.......................................................................................................22
Facetdysfunctie............................................................................................................................................ 22
Ontstaan.............................................................................................................................................................22
Kliniek.................................................................................................................................................................22
Diagnose.............................................................................................................................................................22
KO...................................................................................................................................................................22
Beeldvorming.................................................................................................................................................22
Behandeling........................................................................................................................................................22
Cercivale spondylose / artrose..................................................................................................................... 23
Pathofysiologie...................................................................................................................................................23
Kliniek.................................................................................................................................................................23
Diagnose.............................................................................................................................................................23
Behandeling........................................................................................................................................................23
Cervicale discopathie................................................................................................................................... 24
Kliniek.................................................................................................................................................................24
Behandeling........................................................................................................................................................24
Syndroom van Barré-Liéou........................................................................................................................... 24
Kliniek.................................................................................................................................................................25
Behandeling........................................................................................................................................................25
Syndroom van Tietze................................................................................................................................... 25
Behandeling........................................................................................................................................................25
Facettaire dysfunctie.................................................................................................................................... 25
Behandeling........................................................................................................................................................25
Costovertebrale dysfunctie.......................................................................................................................... 25
Behandeling........................................................................................................................................................25
Ziekte van Scheuermann.............................................................................................................................. 26
Behandeling........................................................................................................................................................26
Discogene aandoeningen............................................................................................................................. 26
Artrosis deformans...................................................................................................................................... 26
Pseudoradiculaire pijnen.............................................................................................................................. 26
2
,Fysische geneeskunde & revalidatie
Musculaire pathologie................................................................................................................................. 26
Slipping-ribsyndroom/ribtipsyndroom......................................................................................................... 27
Kliniek.................................................................................................................................................................27
Behandeling........................................................................................................................................................27
Costo-iliacaal compressiesyndroom............................................................................................................. 27
Behandeling........................................................................................................................................................27
Klachten..............................................................................................................................................................27
Rode vlaggen......................................................................................................................................................27
Gele vlaggen.......................................................................................................................................................28
Hoe screenen.................................................................................................................................................28
Oorzaken............................................................................................................................................................28
Acute lumbago............................................................................................................................................. 28
Kliniek.................................................................................................................................................................28
Oorzaken............................................................................................................................................................28
Advies.................................................................................................................................................................28
Musculaire letsels........................................................................................................................................ 29
Behandeling..................................................................................................................................................29
Behandeling..................................................................................................................................................29
Discuslijden................................................................................................................................................. 29
Acuut.................................................................................................................................................................29
Kliniek............................................................................................................................................................29
Uitlokkende factoren....................................................................................................................................29
Aanpak..........................................................................................................................................................30
Chronisch...........................................................................................................................................................30
Kliniek............................................................................................................................................................30
Aanpak..........................................................................................................................................................30
Heelkunde.....................................................................................................................................................30
Met radiculaire compressie...............................................................................................................................30
Klinisch onderzoek........................................................................................................................................31
Technisch onderzoek....................................................................................................................................31
Aanpak...........................................................................................................................................................31
Heelkunde.....................................................................................................................................................31
Facettair probleem....................................................................................................................................... 31
Kliniek.................................................................................................................................................................32
Beleid..................................................................................................................................................................32
Artrosis deformans...................................................................................................................................... 32
Kliniek.................................................................................................................................................................32
Complicaties.......................................................................................................................................................32
Diagnose.............................................................................................................................................................32
Aanpak...............................................................................................................................................................32
3
,Fysische geneeskunde & revalidatie
Spondylolyse – spondylothisthesis............................................................................................................... 33
Oorzaken...........................................................................................................................................................33
Kliniek................................................................................................................................................................33
Diagnose............................................................................................................................................................33
Aanpak..............................................................................................................................................................33
Kliniek................................................................................................................................................................33
Behandeling.......................................................................................................................................................33
Sacro-iliacale dysfunctie............................................................................................................................... 33
Kliniek............................................................................................................................................................34
Diagnose.......................................................................................................................................................34
Behandeling..................................................................................................................................................34
Overgangsanomalie..................................................................................................................................... 34
Andere oorzaken van lage rugpijn................................................................................................................ 34
Rotatorcuff pathologie................................................................................................................................. 34
M. supraspinatus................................................................................................................................................35
Oorzaak.........................................................................................................................................................35
Kliniek............................................................................................................................................................35
KO..................................................................................................................................................................35
Technisch onderzoek....................................................................................................................................35
Behandeling..................................................................................................................................................35
Oorzaak.........................................................................................................................................................36
Kliniek............................................................................................................................................................36
KO..................................................................................................................................................................36
Technisch onderzoek....................................................................................................................................36
Behandeling..................................................................................................................................................36
Verloop.........................................................................................................................................................36
Oorzaak.........................................................................................................................................................36
Kliniek............................................................................................................................................................36
KO..................................................................................................................................................................36
Technisch onderzoek....................................................................................................................................36
Therapie........................................................................................................................................................37
M. infraspinatus.................................................................................................................................................37
Oorzaak.........................................................................................................................................................37
Kliniek............................................................................................................................................................37
KO..................................................................................................................................................................37
Technisch onderzoek....................................................................................................................................37
Behandeling..................................................................................................................................................37
Kliniek............................................................................................................................................................37
KO..................................................................................................................................................................38
M. subscapularis................................................................................................................................................38
Oorzaak.........................................................................................................................................................38
Kliniek............................................................................................................................................................38
KO..................................................................................................................................................................38
Technisch onderzoek....................................................................................................................................38
Behandeling..................................................................................................................................................38
Biceps Barchii pathologie............................................................................................................................. 39
Oorzaak.........................................................................................................................................................39
4
,Fysische geneeskunde & revalidatie
Kliniek............................................................................................................................................................39
KO..................................................................................................................................................................39
Technisch onderzoek....................................................................................................................................39
Behandeling..................................................................................................................................................39
Oorzaak.........................................................................................................................................................39
Kliniek............................................................................................................................................................40
KO..................................................................................................................................................................40
Technisch onderzoek....................................................................................................................................40
Behandeling..................................................................................................................................................40
Oorzaak.........................................................................................................................................................40
Kliniek............................................................................................................................................................40
KO..................................................................................................................................................................40
Technisch onderzoek....................................................................................................................................40
Therapie........................................................................................................................................................40
GIRD............................................................................................................................................................ 40
Oorzaak..............................................................................................................................................................40
Belang.................................................................................................................................................................40
Behandeling........................................................................................................................................................41
Glenohumerale instabiliteit......................................................................................................................... 41
Instabiliteit.........................................................................................................................................................41
Anamnese.....................................................................................................................................................41
Oorzaak.........................................................................................................................................................41
Evolutie.........................................................................................................................................................41
KO..................................................................................................................................................................41
Technische onderzoek..................................................................................................................................41
Behandeling..................................................................................................................................................41
Complicatie...................................................................................................................................................41
Oorzaak.........................................................................................................................................................42
Kliniek............................................................................................................................................................42
Technisch onderzoek....................................................................................................................................42
Behandeling..................................................................................................................................................42
Glenohumerale laxiteit................................................................................................................................ 42
Behandeling........................................................................................................................................................42
Bursitis........................................................................................................................................................ 42
Acuut.................................................................................................................................................................42
Oorzaak.........................................................................................................................................................42
Kliniek............................................................................................................................................................42
KO..................................................................................................................................................................42
Technisch onderzoek....................................................................................................................................42
Behandeling..................................................................................................................................................43
Chronisch...........................................................................................................................................................43
Oorzaak.........................................................................................................................................................43
Kliniek............................................................................................................................................................43
Behandeling..................................................................................................................................................43
Oorzaak.........................................................................................................................................................43
Kliniek............................................................................................................................................................43
Technisch onderzoek....................................................................................................................................43
Behandeling..................................................................................................................................................43
Frozen shoulder........................................................................................................................................... 43
5
, Fysische geneeskunde & revalidatie
Epidemiologie.....................................................................................................................................................43
Oorzaak..............................................................................................................................................................43
Pathogenese.......................................................................................................................................................43
Kliniek.................................................................................................................................................................43
Klinisch onderzoek..............................................................................................................................................44
Technisch onderzoek..........................................................................................................................................44
Therapie.............................................................................................................................................................44
Acromio-claviculair lijden............................................................................................................................. 44
Degeneratief.......................................................................................................................................................44
Kliniek............................................................................................................................................................44
KO..................................................................................................................................................................44
Technisch onderzoek....................................................................................................................................44
Behandeling..................................................................................................................................................45
Scapulothoracale dysfunctie........................................................................................................................ 45
Primair...............................................................................................................................................................45
Secundair...........................................................................................................................................................45
Type 1............................................................................................................................................................45
Type 2............................................................................................................................................................45
Type 3............................................................................................................................................................45
Gerefereerde schouderpijn.......................................................................................................................... 45
Tendinopathie Extensor Carpi Radialis......................................................................................................... 46
Types volgens Cyriax.....................................................................................................................................46
Oorzaak.............................................................................................................................................................46
Kliniek................................................................................................................................................................46
KO......................................................................................................................................................................46
Technische onderzoeken...................................................................................................................................46
DD......................................................................................................................................................................46
Therapie.............................................................................................................................................................46
Tendinopathie Flexor Carpi Ulnaris + Radialis............................................................................................... 47
Oorzaak.............................................................................................................................................................47
Kliniek................................................................................................................................................................47
KO......................................................................................................................................................................47
Technische onderzoeken...................................................................................................................................47
Therapie.............................................................................................................................................................47
Bursitis olecranii.......................................................................................................................................... 47
Oorzaak..............................................................................................................................................................47
Kliniek.................................................................................................................................................................47
KO.......................................................................................................................................................................47
DD.......................................................................................................................................................................48
6
Inhoudsopgave
Doelstelling behandeling....................................................................................................................................13
Pijnstilling.................................................................................................................................................... 14
1. Oppervlakkige warmte-applicatie..................................................................................................................14
Indicaties........................................................................................................................................................14
Contra-indicatie.............................................................................................................................................14
Opletten bij....................................................................................................................................................14
Voorbeelden..................................................................................................................................................14
2. Koude therapie/cryotherapie.........................................................................................................................14
Doel................................................................................................................................................................15
Indicaties........................................................................................................................................................15
Contra-indicaties............................................................................................................................................15
Werking pijninhibitie.....................................................................................................................................15
Voorbeelden..................................................................................................................................................15
3. Elektrotherapie...............................................................................................................................................15
Mobilisatie.................................................................................................................................................. 16
Passieve mobilisatie...........................................................................................................................................16
Actieve mobilisatie.............................................................................................................................................16
Spierversterkende oefeningen......................................................................................................................17
Isokinetische oefeningen...............................................................................................................................17
Massage...................................................................................................................................................... 17
Indicaties............................................................................................................................................................17
Contra-indicaties................................................................................................................................................17
Andere technieken..............................................................................................................................................17
Hydrotherapie............................................................................................................................................. 18
Indicaties............................................................................................................................................................18
Contra-indicaties................................................................................................................................................18
Coördinatieoefeningen................................................................................................................................ 18
Trilplaat....................................................................................................................................................... 18
Indicatie..............................................................................................................................................................18
Extracorporele Shock Wave Therapie (ESWT)............................................................................................... 18
Indicaties............................................................................................................................................................18
Praktisch.............................................................................................................................................................18
Acute cervicale (< strain) spierpijn................................................................................................................ 19
Etiologie........................................................................................................................................................19
Behandeling..................................................................................................................................................19
Acute torticollis ~ acute lumbago......................................................................................................................19
Ontstaan.......................................................................................................................................................19
Gevolgen.......................................................................................................................................................20
Hyperflexie trauma........................................................................................................................................20
1
,Fysische geneeskunde & revalidatie
Hyperextensie trauma...................................................................................................................................20
Onderzoeken......................................................................................................................................................20
Behandeling........................................................................................................................................................20
Chronische cervicale strain – nekpijn............................................................................................................ 21
M. trapeziussyndroom..................................................................................................................................21
Behandeling chronische spieroverbelasting.......................................................................................................22
Facetdysfunctie............................................................................................................................................ 22
Ontstaan.............................................................................................................................................................22
Kliniek.................................................................................................................................................................22
Diagnose.............................................................................................................................................................22
KO...................................................................................................................................................................22
Beeldvorming.................................................................................................................................................22
Behandeling........................................................................................................................................................22
Cercivale spondylose / artrose..................................................................................................................... 23
Pathofysiologie...................................................................................................................................................23
Kliniek.................................................................................................................................................................23
Diagnose.............................................................................................................................................................23
Behandeling........................................................................................................................................................23
Cervicale discopathie................................................................................................................................... 24
Kliniek.................................................................................................................................................................24
Behandeling........................................................................................................................................................24
Syndroom van Barré-Liéou........................................................................................................................... 24
Kliniek.................................................................................................................................................................25
Behandeling........................................................................................................................................................25
Syndroom van Tietze................................................................................................................................... 25
Behandeling........................................................................................................................................................25
Facettaire dysfunctie.................................................................................................................................... 25
Behandeling........................................................................................................................................................25
Costovertebrale dysfunctie.......................................................................................................................... 25
Behandeling........................................................................................................................................................25
Ziekte van Scheuermann.............................................................................................................................. 26
Behandeling........................................................................................................................................................26
Discogene aandoeningen............................................................................................................................. 26
Artrosis deformans...................................................................................................................................... 26
Pseudoradiculaire pijnen.............................................................................................................................. 26
2
,Fysische geneeskunde & revalidatie
Musculaire pathologie................................................................................................................................. 26
Slipping-ribsyndroom/ribtipsyndroom......................................................................................................... 27
Kliniek.................................................................................................................................................................27
Behandeling........................................................................................................................................................27
Costo-iliacaal compressiesyndroom............................................................................................................. 27
Behandeling........................................................................................................................................................27
Klachten..............................................................................................................................................................27
Rode vlaggen......................................................................................................................................................27
Gele vlaggen.......................................................................................................................................................28
Hoe screenen.................................................................................................................................................28
Oorzaken............................................................................................................................................................28
Acute lumbago............................................................................................................................................. 28
Kliniek.................................................................................................................................................................28
Oorzaken............................................................................................................................................................28
Advies.................................................................................................................................................................28
Musculaire letsels........................................................................................................................................ 29
Behandeling..................................................................................................................................................29
Behandeling..................................................................................................................................................29
Discuslijden................................................................................................................................................. 29
Acuut.................................................................................................................................................................29
Kliniek............................................................................................................................................................29
Uitlokkende factoren....................................................................................................................................29
Aanpak..........................................................................................................................................................30
Chronisch...........................................................................................................................................................30
Kliniek............................................................................................................................................................30
Aanpak..........................................................................................................................................................30
Heelkunde.....................................................................................................................................................30
Met radiculaire compressie...............................................................................................................................30
Klinisch onderzoek........................................................................................................................................31
Technisch onderzoek....................................................................................................................................31
Aanpak...........................................................................................................................................................31
Heelkunde.....................................................................................................................................................31
Facettair probleem....................................................................................................................................... 31
Kliniek.................................................................................................................................................................32
Beleid..................................................................................................................................................................32
Artrosis deformans...................................................................................................................................... 32
Kliniek.................................................................................................................................................................32
Complicaties.......................................................................................................................................................32
Diagnose.............................................................................................................................................................32
Aanpak...............................................................................................................................................................32
3
,Fysische geneeskunde & revalidatie
Spondylolyse – spondylothisthesis............................................................................................................... 33
Oorzaken...........................................................................................................................................................33
Kliniek................................................................................................................................................................33
Diagnose............................................................................................................................................................33
Aanpak..............................................................................................................................................................33
Kliniek................................................................................................................................................................33
Behandeling.......................................................................................................................................................33
Sacro-iliacale dysfunctie............................................................................................................................... 33
Kliniek............................................................................................................................................................34
Diagnose.......................................................................................................................................................34
Behandeling..................................................................................................................................................34
Overgangsanomalie..................................................................................................................................... 34
Andere oorzaken van lage rugpijn................................................................................................................ 34
Rotatorcuff pathologie................................................................................................................................. 34
M. supraspinatus................................................................................................................................................35
Oorzaak.........................................................................................................................................................35
Kliniek............................................................................................................................................................35
KO..................................................................................................................................................................35
Technisch onderzoek....................................................................................................................................35
Behandeling..................................................................................................................................................35
Oorzaak.........................................................................................................................................................36
Kliniek............................................................................................................................................................36
KO..................................................................................................................................................................36
Technisch onderzoek....................................................................................................................................36
Behandeling..................................................................................................................................................36
Verloop.........................................................................................................................................................36
Oorzaak.........................................................................................................................................................36
Kliniek............................................................................................................................................................36
KO..................................................................................................................................................................36
Technisch onderzoek....................................................................................................................................36
Therapie........................................................................................................................................................37
M. infraspinatus.................................................................................................................................................37
Oorzaak.........................................................................................................................................................37
Kliniek............................................................................................................................................................37
KO..................................................................................................................................................................37
Technisch onderzoek....................................................................................................................................37
Behandeling..................................................................................................................................................37
Kliniek............................................................................................................................................................37
KO..................................................................................................................................................................38
M. subscapularis................................................................................................................................................38
Oorzaak.........................................................................................................................................................38
Kliniek............................................................................................................................................................38
KO..................................................................................................................................................................38
Technisch onderzoek....................................................................................................................................38
Behandeling..................................................................................................................................................38
Biceps Barchii pathologie............................................................................................................................. 39
Oorzaak.........................................................................................................................................................39
4
,Fysische geneeskunde & revalidatie
Kliniek............................................................................................................................................................39
KO..................................................................................................................................................................39
Technisch onderzoek....................................................................................................................................39
Behandeling..................................................................................................................................................39
Oorzaak.........................................................................................................................................................39
Kliniek............................................................................................................................................................40
KO..................................................................................................................................................................40
Technisch onderzoek....................................................................................................................................40
Behandeling..................................................................................................................................................40
Oorzaak.........................................................................................................................................................40
Kliniek............................................................................................................................................................40
KO..................................................................................................................................................................40
Technisch onderzoek....................................................................................................................................40
Therapie........................................................................................................................................................40
GIRD............................................................................................................................................................ 40
Oorzaak..............................................................................................................................................................40
Belang.................................................................................................................................................................40
Behandeling........................................................................................................................................................41
Glenohumerale instabiliteit......................................................................................................................... 41
Instabiliteit.........................................................................................................................................................41
Anamnese.....................................................................................................................................................41
Oorzaak.........................................................................................................................................................41
Evolutie.........................................................................................................................................................41
KO..................................................................................................................................................................41
Technische onderzoek..................................................................................................................................41
Behandeling..................................................................................................................................................41
Complicatie...................................................................................................................................................41
Oorzaak.........................................................................................................................................................42
Kliniek............................................................................................................................................................42
Technisch onderzoek....................................................................................................................................42
Behandeling..................................................................................................................................................42
Glenohumerale laxiteit................................................................................................................................ 42
Behandeling........................................................................................................................................................42
Bursitis........................................................................................................................................................ 42
Acuut.................................................................................................................................................................42
Oorzaak.........................................................................................................................................................42
Kliniek............................................................................................................................................................42
KO..................................................................................................................................................................42
Technisch onderzoek....................................................................................................................................42
Behandeling..................................................................................................................................................43
Chronisch...........................................................................................................................................................43
Oorzaak.........................................................................................................................................................43
Kliniek............................................................................................................................................................43
Behandeling..................................................................................................................................................43
Oorzaak.........................................................................................................................................................43
Kliniek............................................................................................................................................................43
Technisch onderzoek....................................................................................................................................43
Behandeling..................................................................................................................................................43
Frozen shoulder........................................................................................................................................... 43
5
, Fysische geneeskunde & revalidatie
Epidemiologie.....................................................................................................................................................43
Oorzaak..............................................................................................................................................................43
Pathogenese.......................................................................................................................................................43
Kliniek.................................................................................................................................................................43
Klinisch onderzoek..............................................................................................................................................44
Technisch onderzoek..........................................................................................................................................44
Therapie.............................................................................................................................................................44
Acromio-claviculair lijden............................................................................................................................. 44
Degeneratief.......................................................................................................................................................44
Kliniek............................................................................................................................................................44
KO..................................................................................................................................................................44
Technisch onderzoek....................................................................................................................................44
Behandeling..................................................................................................................................................45
Scapulothoracale dysfunctie........................................................................................................................ 45
Primair...............................................................................................................................................................45
Secundair...........................................................................................................................................................45
Type 1............................................................................................................................................................45
Type 2............................................................................................................................................................45
Type 3............................................................................................................................................................45
Gerefereerde schouderpijn.......................................................................................................................... 45
Tendinopathie Extensor Carpi Radialis......................................................................................................... 46
Types volgens Cyriax.....................................................................................................................................46
Oorzaak.............................................................................................................................................................46
Kliniek................................................................................................................................................................46
KO......................................................................................................................................................................46
Technische onderzoeken...................................................................................................................................46
DD......................................................................................................................................................................46
Therapie.............................................................................................................................................................46
Tendinopathie Flexor Carpi Ulnaris + Radialis............................................................................................... 47
Oorzaak.............................................................................................................................................................47
Kliniek................................................................................................................................................................47
KO......................................................................................................................................................................47
Technische onderzoeken...................................................................................................................................47
Therapie.............................................................................................................................................................47
Bursitis olecranii.......................................................................................................................................... 47
Oorzaak..............................................................................................................................................................47
Kliniek.................................................................................................................................................................47
KO.......................................................................................................................................................................47
DD.......................................................................................................................................................................48
6
