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Konservative Therapie der chronischen Enthesiopathien

Conservative treatment of chronic tendinopathies

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Zusammenfassung

Bei der Entstehung von Enthesiopathien steht ätiologisch eine Überbelastung mit begleitenden repetitiven Mikrotraumen im Vordergrund. Bestimmte Sehnenansätze wie die der Achilles-, Patellar- und Supraspinatussehne sowie die der Unterarmextensoren/-flexoren sind besonders anfällig. Durch die Erkenntnis, dass es sich bei chronischen Enthesiopathien nicht um ein entzündliches, sondern ein degeneratives Krankheitsgeschehen handelt, veränderten sich die modernen Therapieoptionen nachhaltig. Durch exzentrisches Krafttraining können die Schmerzen signifikant gesenkt und die Funktion nachhaltig verbessert werden. Die gezielte Sklerosierung von Neogefäßen, die Stoßwellen- sowie die topische Nitroglyzerintherapie stellen weitere sinnvolle und evidenzbasierte Maßnahmen dar. Für Kortikosteroidinjektionen und nichtsteroidale entzündungshemmende Medikamente wurden außer einer vorübergehenden Schmerzlinderung keine langfristigen Therapieerfolge gefunden. Infiltrationen mit plättchenreichem Plasma zeigten ermutigende kurzfristige Ergebnisse.

Abstract

The majority of insertional and noninsertional tendinopathy cases are associated with repetitive or overuse injuries. Certain tendons are particularly vulnerable to degenerative pathology; these include the Achilles and patella tendon, the rotator cuff, and forearm extensors/flexors. Disorders of these tendons are often chronic and can be difficult to manage successfully in the long term. Eccentric exercise has the strongest evidence of therapeutic efficacy. Extracorporeal shock wave treatment, sclerosing agents as well as nitric oxide patches show promising early results but require long-term studies. Corticosteroid and nonsteroidal antiinflammatory medications have not been shown to be effective except for temporary pain relief for rotator cuff tendinopathy. Platelet-rich plasma injections show encouraging short-term results.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Diehl, H. Gollwitzer, J. Schauwecker, T. Tischer und L. Gerdesmeyer geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland

    P. Diehl & T. Tischer

  2. Orthopädiezentrum München Ost, Münchner Straße 14, 85540, Haar, Deutschland

    P. Diehl

  3. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    H. Gollwitzer, J. Schauwecker & L. Gerdesmeyer

  4. ATOS Klinik München, München, Deutschland

    H. Gollwitzer

  5. Sektion onkologische und rheumatologische Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    L. Gerdesmeyer

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  1. P. Diehl
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  2. H. Gollwitzer
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  3. J. Schauwecker
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  4. T. Tischer
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  5. L. Gerdesmeyer
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Correspondence to P. Diehl.

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Diehl, P., Gollwitzer, H., Schauwecker, J. et al. Konservative Therapie der chronischen Enthesiopathien. Orthopäde 43, 183–193 (2014). https://doi.org/10.1007/s00132-013-2249-z

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  • DOI: https://doi.org/10.1007/s00132-013-2249-z

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