nieuwe vragen broos

Live forum: /viewtopic.php?t=13851

magdalena

11-04-2008 16:06:28

Iemand een idee waar dit te bestuderen?

varkje

11-04-2008 21:37:16

ik heb de papieren van locomotorisch terug gezocht (van die namiddag praktisch)

Anonymous

12-04-2008 15:26:50

OEI...die vind ik noooooit meer..slik! andere oplossingen, aub?

lommy

12-04-2008 15:33:20

KO hand en voeten RApt: CE p270, p286. Niet zoveel daar, maar volgens mij wel voldoende. Je inspecteert (zwelling, deformiteit, warm?) en palpeert de gewrichten (nodules, deformiteit?). Ook beweegiljkheid en pijn nagaan. Hand: vingers en pols. Voet: enkel en tenen.

Van die tibialis posterior tenosynovitis vind ik helemaal niets. :?

Ik heb die papieren ook niet meer. Ze liggen in Leuven en ik heb maandag examen... :(

helena

12-04-2008 18:32:20

hey,

ik weet niet wat jullie vorig jaar in practica's gezien hebben omdat ik er toen ni was, maar ik heb een document over 'semeiologie reumatologie' teruggevonden op internet, misschien is het dat?
Succes ermee!

Deborah

13-04-2008 21:44:26

In ons boek van reumatologie (die rooie van vorig jaar) is ook wel het een en ander te vinden over onderzoek bij de RA patiŽnt. Pagina's weet ik niet direct...

Anonymous

14-04-2008 09:03:24

hierbij de test van de tibialis posterior tenosynovitis:

http://www.jbjs.org.uk/cgi/reprint/86-B/7/939.pdf

Poemba

19-04-2008 17:21:53

Ik kan dat artikel niet openen..
iemand een idee van die test voor tibialis posterior?

varkje

19-04-2008 18:43:29

ik dacht inversie voet (kracht bepalen)
en voelen aan die pees of ze een worstvormig voorkomen heeft

Nupie

20-04-2008 09:00:10

Tekst uit artikel:


Diagnosis
History. In the early stages of dysfunction patients describe
discomfort medially along the course of the tendon as well
as fatigue and aching on the plantar medial aspect of the
foot and ankle. In the presence of tenosynovitis, swelling is
common. As the deformity progresses they report that the
shape of the foot changes. The pain is no longer on the
medial but on the lateral side where the fibula impinges
against the calcaneum. Patients find standing on their toes
difficult and painful and notice a gradual collapse of the
longitudinal arch with the development of valgus of the
hindfoot. A typical observation is abnormal wear of the
medial side of the shoes. Walking increases the pain and
participation in sports becomes difficult or impossible.9,10
Clinical examination. Careful clinical examination is essential.
Both feet should be examined with the patient standing
with the entire limb visible to assess overall alignment.
Genu valgum may accentuate the flat foot.
The foot should be inspected from above as well as from
behind the patient. Valgus angulation of the hindfoot and
abduction of the forefoot are best appreciated if the foot is
seen from behind. Johnson described the so-called Ďtoo
many toes signí; with more advanced deformity the lesser
toes become more visible if the foot is viewed from behind
(Fig. 1). Function of the hindfoot can best be assessed by
the double-limb heel rise. The patient is asked to attempt to
rise on to the ball of one foot while the other is lifted off the
floor. The affected hindfoot will stay in valgus while the
normal foot is brought into inversion by the functioning
tibialis posterior tendon. Furthermore, the patient will be
unable to perform a single heel rise with the affected foot.9
Hintermann and Gachter11 described the first metatarsal
rise sign. The patient stands, fully loading both feet. The
shin of the affected side is taken with one hand and externally
rotated. By doing this the heel is passively brought
into a varus position because of the mechanical coupling
between the tibia and calcaneum.12 The head of the first
metatarsal remains on the ground in normal function of the
tendon but is lifted in dysfunction.
With the patient seated, the strength of the tendon is
evaluated by asking the patient to plantar flex and invert
the foot against resistance. During the test, the examiner
holds the hindfoot in plantar flexion and eversion and the
forefoot in abduction. This eliminates the synergistic action
of tibialis anterior and allows the strength of the tendon to
be assessed more accurately.10,13 The integrity of the tendon
and the site of maximum tenderness should also be
assessed. The subtalar and ankle joints are then assessed for
mobility. Most important is assessment of the tendo Achillis
for contracture. With increased valgus angulation of the
heel, the tendo Achillis assumes a position lateral to the axis
of the subtalar joint and the gastrocnemius group shortens.
The position of the forefoot is assessed with the heel in
neutral. This is a critical part of the examination. As the
hindfoot deformity increases, the forefoot and midfoot
compensate by progressive supination. A fixed deformity
may occur. It is important to identify any fixed supination
deformity of the forefoot because it will affect the method
of treatment.9