NHG-Richtlijnen
NHG-Standaard
M08
4.1
oktober 2019
december 2019
L. Bewegingsapparaat

Richtlijnen diagnostiek

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Evaluatie

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Indeling schouderklachten

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Richtlijnen beleid subacromiaal pijnsyndroom en glenohumerale klachten

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Voorlichting en adviezen

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Medicamenteuze behandeling

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Controle

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Consultatie en verwijzing

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Richtlijnen beleid overige schouderklachten

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Belangrijkste wijzigingen

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Kernboodschappen

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Inleiding

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Scope

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Buiten de scope

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Achtergronden

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Epidemiologie

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Beloop

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Etiologie

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Prognose

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Prognostische factoren

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Werkgerelateerde factoren

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Ziekteverzuim

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Indeling schouderklachten

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Meerdere typen schouderklachten naast elkaar

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Richtlijnen diagnostiek

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Anamnese

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Lichamelijk onderzoek

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Inspectie

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Bewegingsonderzoek van de schouder

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Specifieke testen
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AC-gewricht

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Cervicale wervelkolom en cervicothoracale overgang

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Aanvullend onderzoek

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Echografie

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Röntgenfoto

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Evaluatie

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Indeling schouderklachten

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Uitslag echografie: ruptuur van de rotator cuff en calcificerende tendinopathie

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Richtlijnen beleid subacromiaal pijnsyndroom en glenohumerale klachten

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Stapsgewijze behandeling

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Voorlichting en adviezen

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Aard van de aandoening

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Mate van activiteit

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Behandeling

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Arbeidssituatie

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Thuisarts.nl

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Medicamenteuze behandeling

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Analgetica

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Lokale injectie met corticosteroïd

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Praktische uitvoering
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Overige informatie en adviezen
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Herhaling injectie
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Corticosteroïdinjectie voorafgaand aan oefentherapie
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Niet-medicamenteuze behandeling

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Oefentherapie

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Controle

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Consultatie en verwijzing

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Verwijzing voor oefentherapie (door fysiotherapeut of oefentherapeut cesar/mensendieck)

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Verwijzing voor shockwavetherapie (1e lijn)

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Schouderklachten met calcificaties
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Schouderklachten zonder calcificaties
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Verwijzing naar de tweede lijn

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Ruptuur van de rotator cuff
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Persisterende calcificerende tendinopathie
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Bedrijfsarts

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Geen verwijzing

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Operatieve behandeling
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Richtlijnen beleid overige schouderklachten

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Nekklachten met bijkomende schouderklachten

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Aandoeningen van het acromio-claviculaire gewricht

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Praktische uitvoering en dosering
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Instabiliteit van het glenohumerale gewricht

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Organisatie van de zorg

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Lokale of regionale afspraken

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Kaderhuisarts, 1,5e-lijns spreekuur en fysiotherapeutische schoudernetwerken

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Schouder: intra-articulaire injectie
Schouder: subacromiale injectie
Schouder: lichamelijk onderzoek
NHG-werkgroep:
Damen GJ, Koel G, Kuijpers T, Ottenheijm RP, Schellingerhout JM, Van den Donk M, Winters JC, Wittenberg J
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