Post on 10-Jun-2020
transcript
Marc DU BOIS, MD, PhD
ARBEIDSONGESCHIKTHEID DOOR LUMBO-ISCHIALGIE
“Thou cold sciatica, cripple our senators, that their
limbs may halt as lamely as their manners”
William Shakespeare 1564:Timon of Athens (act IV, scene I)
SETTING THE SCENE
Kellgren J. Sciatica. Lancet 1941;i:561-4.
ARBEIDSONGESCHIKTHEID : DEFINITIE
“Arbeidsongeschiktheid is hij/zij die om zijn/haar
of andermans ernstig bedreigde gezondheid te
beschermen of te herstellen, geheel of
gedeeltelijk niet in staat is een passende arbeid
op zich te nemen”
RISICO
TOLERANTIECAPACITEIT
Talmage JB, Melhorn JM, & Hyman MH. The AMA Guides to
the Evaluation of Work Ability and Return to Work, Second
Edition. American Medical Association, 2011.
• Werk RESTRICTIES
• Arts legt ze op
• Wat de patiënt NIET ZOU MOGEN DOEN op basis van risico
• B.v. geen onregelmatig nachtdienst bij bipolaire depressie, werk op gelijkvloers bij fobie liften, rijverbod na CVA,…
ARBEIDSONGESCHIKTHEID : RISICO
ARBEIDSONGESCHIKTHEID: RISICO
The
The Twin Spine Study: contributions to a changing view of disc degeneration.
ARBEIDSONGESCHIKTHEID : RISICO
McLean D, Pearce N, Walls CB, Wigley RD. The "Twin Study" and the misunderstanding of epidemiology that clouds occupational associations and low back disorder. N Z Med J. 2011 Jul 29;124(1339):109-11.
ARBEIDSONGESCHIKTHEID : RISICO
1997 NIOSH publication Musculoskeletal Disorders and Workplace Factors (p97–141)
ARBEIDSONGESCHIKTHEID : RISICO
Instrument voor het bepalen van de arbeidsgerelateerdheid
van aspecifieke lage rugklachten
ARBEIDSONGESCHIKTHEID : RISICO
ARBEIDSONGESCHIKTHEID : RISICO
In summer 2016, the North American Spine
Society (NASS) asked its members to rank
the professions they consider most “back-
breaking.”
• Werk BEPERKINGEN
• Arts BESCHRIJFT ze
• Wat de patiënt NIET KAN DOEN• B.v. door aandachtstoornis en
onbeheersbare gedachtestroom bij bipolaire depressie kan de concentratie maximaal 1 uur worden volgehouden, AROM, PROM, GFR, VO2max,…
ARBEIDSONGESCHIKTHEID : CAPACITEIT
ARBEIDSONGESCHIKTHEID : CAPACITEIT
arbeidsongeschiktheidsduur (3-4 weken) < herstelduur (3 maand)
ARBEIDSONGESCHIKTHEID : CAPACITEIT
ARBEIDSONGESCHIKTHEID : CAPACITEIT
ARBEIDSONGESCHIKTHEID : CAPACITEIT
ARBEIDSONGESCHIKTHEID : CAPACITEIT
ARBEIDSONGESCHIKTHEID : TOLERANTIE
Dr. Piers Steel :The Procrastination Equation:
How to Stop Putting Things Off and Start Getting Stuff Done (2010)
ARBEIDSONGESCHIKTHEID : TOLERANTIE
Tenderness (excess or widespread reaction)
• Superficial
• Nonanatomic
Simulation (pain reported with sham maneuvers)
• Axial loading
Simulation (pain reported with sham maneuvers)
• Rotation
ARBEIDSONGESCHIKTHEID : TOLERANTIE
Distraction (less pain when attention is diverted)
• Straight leg raising
Regional Symptoms (widespread give-way or dysesthesia)
• Weakness
• Sensory
Overreaction ("disproportionate" psychomotor responses)
ARBEIDSONGESCHIKTHEID : TOLERANTIE
Burn’s bench test
Mc Bride’s test
Magnuson’s test
ONE MORE THING : WALLET NEURITIS
2. CASE SERIES
2.1. Case-1
A 37-year-old specialist doctor reported with the complaint of right gluteal pain
that was more with sitting longer than 30 minutes. …
2.2. Case-2
A 50-year-old truck driver reported with the complaint of severe right gluteal
and lower limb pain that was more while prolonged sitting and side lying …
2.3. Case-3
A 44-year-old private bank manager presented with the complaint of right
gluteal deep ache with burning sensation down the right lower limb…
ONE MORE THING : WALLET NEURITIS
Conclusion: long-standing use of rear pocket wallet may compress and
sensitize ipsilateral sciatic nerve, generating features resembling lumbago
sciatica; thereby, remains a source of patients’ misery and diagnostic illusion
for pain physicians as well