Tendinopathien bei rheumatischen Erkrankungen

Abstract

Involvement of tendons and tendon sheaths is frequently found in the most common inflammatory systemic diseases, rheumatoid arthritis and spondyloarthritis. In rheumatoid arthritis tendon manifestations occur as tenosynovitis, with swelling and pain of the tendons mainly on the hands and feet. In spondyloarthritis the involvement of tendons presents as enthesitis with pain and swelling directly at the attachment points of tendons to the bony structures and more commonly in the lower extremities. Pathological alterations of tendons can be normally visualized by sonography and only sometimes with magnetic resonance imaging (MRI) or scintigraphy. Furthermore, it is important for diagnostics and effective therapy to detect all joints involved by means of clinical, sonographic and radiological examination as well as laboratory parameters of inflammation, antibody serology (e.g. anti-CCP antibodies) and HLA-B27. The histopathological alterations of tendinopathy in rheumatic diseases differ from degenerative/posttraumatic tendinopathy in their expression of the changes; however, a clear differentiation of the different rheumatic inflammatory systemic diseases is histopathologically not possible. Therapeutically, systemic medication is the most important part of treatment in rheumatic diseases. Local therapeutic measures can be employed in the treatment of tenosynovitis and enthesitis. In the case of failure or lack of efficacy of the medication and conservative therapy, tenosynovectomy is performed for persistent tenosynovitis and reconstructive surgical procedures are necessary for tendon ruptures.

Operative Eingriffe im Bereich der Hand und des Handgelenkes bei rheumatischen Affektionen in der Jugend

“…Nahezu alle operativen Eingriffe an der rheumatischen Hand bedürfen einer konsequenten, oft langwierigen und mühseligen krankengymnastischen und ergotherapeutischen Nachbehandlung 3 . In vielen Fällen ist auch eine präoperative Behandlung unter Anwendung dynamischer Handorthesen, die nach der Operation weiterverwendet werden, erforderlich 14 Die krankengymnastische Nachbehandlung muss möglichst früh nach der Operation (manchmal noch am Operationstag) einsetzen. Sie muss unter Vermeidung von Schmerzen und unterstützt durch lokale Kryotherapie allmählich gesteigert werden, wobei aktiven Bewegungen der Vorrang vor passiven zu geben ist.…”

“…Die Arthrodese ist an den Endgelenken und insbesondere am Daumengrundgelenk ein dankbarer Eingriff 14 , zur Verbesserung der Griffkraft und zur Reduzierung der Schmerzen verbunden mit wiederkehrender Stabilität.…”

Effects of hyaluronic acid injections on pain and functioning in patients affected by tendinopathies: A narrative review

“…As suggested by Maffulli et al [2], the term tendinopathy can be used as a general descriptor of the clinical conditions arising from tendon overuse, independently from histopathological damage. The term "tendinopathy" should include different pathologies such as tendinitis, tendinosis, and para-tendinitis (which includes peritendinitis, tenosynovitis and tenovaginitis) [2,3]. Focusing on different changes that may occur in tendon structure in tendinopathies, it could be distinct: tendinitis, inflammation and pathological changes of tendons; tendinosis, non-inflammatory tendon degeneration; peri-tendinitis, inflammation due to friction against a surface during tendon movement; tenosynovitis and tenovaginitis, single or double-layer inflammation of tendon sheath [2,3].…”

“…The term "tendinopathy" should include different pathologies such as tendinitis, tendinosis, and para-tendinitis (which includes peritendinitis, tenosynovitis and tenovaginitis) [2,3]. Focusing on different changes that may occur in tendon structure in tendinopathies, it could be distinct: tendinitis, inflammation and pathological changes of tendons; tendinosis, non-inflammatory tendon degeneration; peri-tendinitis, inflammation due to friction against a surface during tendon movement; tenosynovitis and tenovaginitis, single or double-layer inflammation of tendon sheath [2,3]. Therefore, considering all these different definitions, Maffulli et al [2] suggested to use the term "tendinopathy" as a general descriptor of all these clinical conditions.…”

Tendinosis in Trigger Finger

“…In patients with rheumatoid arthritis or other inflammatory systemic diseases, it is impossible to separate an idiopathic trigger finger from a triggering due to a rheumatoid manifestation 119 . A rheumatic trigger finger usually presents as tenosynovitis, and is associated with swelling and pain.…”