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<Provider Id="sundheddkcms"> <Item Id="{4F93DAB6-0391-4C51-894C-41EC2D7B700D}" Name="akillestendinose" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{02851690-7266-4B57-B98E-D30DB1AE8AB3}" SortOrder="200" PublishDate="2010-02-17T14:57:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <ul> <li>Smerter og hævelse bag hælen og op over akillessenen under gang eller løb</li> <li>Positiv test ved isometrisk plantarfleksion</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Tilstanden kan ramme både yngre aktive idrætsudøvere og ældre motionister</li> <li>Symptomer <ul> <li>Typisk starter smerterne i forbindelse med den fysiske aktivitet (fx jogging). De aftager noget under aktivitet og forværres efterfølgende</li> <li>Stivhed i akillessenen timer til dage efter en øget træningsbelastning, også stivhedsfornemmelse ved hvile</li> <li>Ved fremskredne tilfælde er der smerte også i hvile</li> </ul> </li> <li>Afdæk om der har været en udløsende årsag <ul> <li>Omlægning af træning, skift af sko, træningsunderlaget, etc.</li> </ul> </li> </ul> <h4>Smertegradering (hos idrætsudøvere)</h4> <ul> <li>Stadium 1 <ul> <li>Smerte kun efter aktivitet, forsvinder efter nogen tids hvile</li> </ul> </li> <li>Stadium 2 <ul> <li>Smerte under aktivitet uden at denne begrænser aktiviteten</li> </ul> </li> <li>Stadium 3 <ul> <li>Smerte under aktivitet, som er så generende, at den hindrer udøveren i normal træning</li> </ul> </li> <li>Stadium 4 <ul> <li>Kroniske smerter, som vedvarer også i hvile</li> <li>Morgenstivhed og smerter er et typisk tidligt tegn</li> </ul> </li> </ul> <h3>Kliniske fund</h3> <ul> <li>Palpation <ul> <li>Akillessenen kan palperes fortykket og øm, især omkring senefæstet på calcaneus</li> <li>Overgangen sene-muskelbug og sene-knogle er ofte smertefri</li> <li>Ved langvarige gener kan der hos nogle palperes knuder i senevævet, som repræsenterer intratendinøse degenerative forandringer</li> <li>Ved smerter ned mod calcaneus kan der foreligge bursit i den retrocalcaneale bursa</li> </ul> </li> <li>Funktionsundersøgelser <ul> <li>Positiv isometrisk test ved plantarflektion, evt. også smerter ved passiv dorsalflektion</li> <li>Tågang er smertefuldt</li> </ul> </li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Ingen</li> </ul> <h3>Andre undersøgelser hos specialist eller undersøgelse på sygehus</h3> <ul> <li>Normalt ikke påkrævet</li> <li>Ultralyd evt. <ul> <li>Giver en dynamisk vurdering af senen og fastslår graden af fortykkelse og evt. mikrorupturer, men kræver ekspertise</li> </ul> </li> <li>MR <ul> <li>Tilsvarende som for ultralyd</li> </ul> </li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li><a href="~/link.aspx?_id=24EA311CD5954CADA7683C52C9E8F248&_z=z">Akillesseneruptur</a></li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Symptomlindring og bedret funktion</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Excentrisk (muskelforlængende) træning og øvelser kombineret med reduceret aktivitet er basisbehandlingen</li> <li>I tidlig fase <ul> <li>Aflastning, udspænding af underbensmuskulaturen, alternativ træning og <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a>-behandling er ofte tilstrækkeligt</li> <li>I tillæg hertil korrektion af udløsende faktorer som fx overpronation og træningsfejl hos idrætsudøvere</li> <li>Korrekt fodtøj</li> </ul> </li> <li>I tidlige kroniske fase <ul> <li>Lav-energi laser terapi i kombination med excentrisk træning (udspændinger) kan være virksom</li> <li>Evt. lokal <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">kortikosteroidbehandling</a>. NB: Kræver erfaring og dokumentation mangler</li> <li>Ved svigt af ovennævnte behandlinger kan man overveje henvisning til High volume injection therapy (HVI) på ortopædkirurgisk afdeling</li> </ul> </li> <li>Operation <ul> <li>Ved manglende effekt af konservativ behandling</li> </ul> </li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Klinisk undersøgelse. Rådgivning og opstart af behandling,</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Reduceret aktivitet bestemt af graden og varigheden af smerter</li> <li>Is kan bruges til lindring af akut smerte efter aktivitet</li> <li>Et skoindlæg (0,5-2 cm) under hælen vil kunne aflaste senen og give smertelindring. Denne bør anvendes, indtil der er væsentlig forbedring i smerter, hvilket kan tage 3-12 måneder</li> <li>Løbesko <ul> <li>Sørg for god støddæmpende hælløft i skoene, ofte i tillæg til korrigerende skoindlæg</li> </ul> </li> </ul> <h4>Optræningsprogram</h4> <ul> <li>Enkel udstrækkende (muskelforlængende, excentrisk) træning giver god effekt <ul> <li>3 måneders træningsprogram er ofte nødvendigt</li> </ul> </li> <li>Udspændinger <ul> <li>Kan udføres stående på trappe med hælene ud over trinkanten</li> <li>Udspændingsøvelser er antaget at være hovedelementet i træningen, giver bedre fleksibilitet i anklen. Men videnskabelig dokumentation for effekt mangler</li> <li>Udspændingerne skal være langsomme. Hver udspænding bør vare 20-30 sekunder, med repetitioner</li> </ul> </li> <li>Ændringer i træning, undgå belastning af akillessenen</li> <li>Styrkeøvelser<a href="EditorPage.aspx?da=core&id=%7B4F93DAB6-0391-4C51-894C-41EC2D7B700D%7D&ed=FIELD14073785715&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H14073785774&us=sitecore%5Ctins&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Alfredson H, Pietila T, Lorentzon R, Chronic Achilles tendinitis and calf muscle strength. Am J Sports Med 1996;24: 829-33" data-value-piped="Alfredson H, Pietila T, Lorentzon R|Chronic Achilles tendinitis and calf muscle strength|Am J Sports Med|1996|24|829-33" data-url="reference-link" title="Alfredson H, Pietila T, Lorentzon R, Chronic Achilles tendinitis and calf muscle strength. Am J Sports Med 1996;24: 829-33">1</a></li> </ul> <h3>Medicinsk behandling</h3> <ul> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a> <ul> <li>Ved behov for smertelindring, eks.:</li> <li>[DliActiveSubstance;6367;Ibuprofen] 400 mg: 1 tbl. 3 gange daglig</li> <li>Evt. <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/215000">lokalbehandling</a>, fx [DliActiveSubstance;6083;ibuprofen gel]<a href="EditorPage.aspx?da=core&id=%7B4F93DAB6-0391-4C51-894C-41EC2D7B700D%7D&ed=FIELD14073785715&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H14073785774&us=sitecore%5Ctins&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Mazieres B, Rouanet S, Guillon Y, Scarsi C, Reiner V, Topical ketoprofen patch in the treatment of tendinitis: a randomized, double blind, placebo controlled study. J Rheumatol 2005;32: 1563-70" data-value-piped="Mazieres B, Rouanet S, Guillon Y, Scarsi C, Reiner V|Topical ketoprofen patch in the treatment of tendinitis: a randomized, double blind, placebo controlled study|J Rheumatol|2005|32|1563-70" data-url="reference-link" title="Mazieres B, Rouanet S, Guillon Y, Scarsi C, Reiner V, Topical ketoprofen patch in the treatment of tendinitis: a randomized, double blind, placebo controlled study. J Rheumatol 2005;32: 1563-70">2</a></li> </ul> </li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">Steroidinjektioner</a> <ul> <li>Den videnskabelige dokumentation for effekt mangler</li> <li>Det hænder, at erfarne behandlere anlægger injektioner langs senen (i periteniet) med stor forsigtighed</li> <li>Må ikke anlægges af behandlere uden stor erfaring med denne type af tilstande. Intratendinøs injektion er associeret med seneruptur</li> <li>Hvis en korrekt injektion ikke giver effekt, skal der ikke fortsættes med en ny injektion</li> </ul> </li> </ul> <h3>Andre medicinske behandlinger</h3> <ul> <li>Ingen</li> </ul> <h3>Anden behandling</h3> <h4>High Volume Injection Terapi (HVI) </h4> <ul> <li>Ved denne behandling injiceres 20 ml lokalbedøvelse i mellem sene og peritendinium UL vejledt</li> <li>Der er nyere studie som viser, at denne behandling i kombination med eksentrisk træning er mere effektiv end træning alene<a href="EditorPage.aspx?da=core&id=%7B4F93DAB6-0391-4C51-894C-41EC2D7B700D%7D&ed=FIELD14073785715&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H14073785774&us=sitecore%5Ctins&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H, Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. Am J Sports Med 2017;45: 2034-2043" data-value-piped="Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H|Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study.|Am J Sports Med|2017|45|2034-2043|28530451" data-url="reference-link" data-pubmedid="28530451" title="Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H, Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. Am J Sports Med 2017;45: 2034-2043">3</a></li> </ul> <h4>Lav-energi laserterapi</h4> <ul> <li>Lavdosis laserterapi sammen med excentrisk træning er i en RCT vist at være bedre end excentrisk træning alene<a href="EditorPage.aspx?da=core&id=%7B4F93DAB6-0391-4C51-894C-41EC2D7B700D%7D&ed=FIELD14073785715&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H14073785774&us=sitecore%5Ctins&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Stergioulas A, Stergioula M, Aarskog R et al, Effects of low-level laser therapy and exentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy. Am J Sports Med 2008;36: 881-7" data-value-piped="Stergioulas A, Stergioula M, Aarskog R et al|Effects of low-level laser therapy and exentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy|Am J Sports Med|2008|36|881-7" data-url="reference-link" title="Stergioulas A, Stergioula M, Aarskog R et al, Effects of low-level laser therapy and exentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy. Am J Sports Med 2008;36: 881-7">4</a> <ul> <li>Laser med bølgelængde 820 nm blev givet á 12 omgange, totalt 5,6 J per behandling</li> <li>Effekten på smerter ved fysisk aktivitet var signifikant bedre i gruppen med laser + træning sammenlignet med placebo/laser + træning</li> </ul> </li> </ul> <h4>Chokbølgebehandling</h4> <ul> <li>Har i følge et studie en noget bedre effekt end placebo<a href="EditorPage.aspx?da=core&id=%7B4F93DAB6-0391-4C51-894C-41EC2D7B700D%7D&ed=FIELD14073785715&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H14073785774&us=sitecore%5Ctins&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Rasmussen S, Christensen M, Mathiesen I, Simonson O, Shockwave therapy for chronic Achilles tendinopathy: a double-blind, randomized clinical trial of efficacy. Acta Orthop 2008;79: 249-56" data-value-piped="Rasmussen S, Christensen M, Mathiesen I, Simonson O|Shockwave therapy for chronic Achilles tendinopathy: a double-blind, randomized clinical trial of efficacy|Acta Orthop|2008|79|249-56" data-url="reference-link" title="Rasmussen S, Christensen M, Mathiesen I, Simonson O, Shockwave therapy for chronic Achilles tendinopathy: a double-blind, randomized clinical trial of efficacy. Acta Orthop 2008;79: 249-56">5</a></li> </ul> <h4>Operativ tenosynovektomi<a href="EditorPage.aspx?da=core&id=%7B4F93DAB6-0391-4C51-894C-41EC2D7B700D%7D&ed=FIELD14073785715&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H14073785774&us=sitecore%5Ctins&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Lohrer H, David S, Nauck T, Surgical treatment for achilles tendinopathy - a systematic review. BMC Musculoskelet Disord 2016;17: 207-215" data-value-piped="Lohrer H, David S, Nauck T|Surgical treatment for achilles tendinopathy - a systematic review|BMC Musculoskelet Disord|2016|17|207-215" data-url="reference-link" title="Lohrer H, David S, Nauck T, Surgical treatment for achilles tendinopathy - a systematic review. BMC Musculoskelet Disord 2016;17: 207-215">6</a></h4> <ul> <li>Overvejes ved kroniske akillessenebetændelser hvor konservativ behandling ikke har hjulpet, og hvor det er vigtigt for vedkommende at fortsætte idrætsaktiviteten <ul> <li>Kræver 6 måneders postoperativ optræning</li> </ul> </li> <li>Indgrebet indebærer lyse af adhæsioner gennem frigørelse af akillessenen fra den inflammerede skede</li> <li>Senen frigøres på dorsal-, medial- og lateralsiden. Den forreste del af skeden bevares for at sikre blodforsyningen og undgå udtalt ardannelse</li> <li>Operationen efterfølges af en kort periode med passive bevægelser, senere tiltagende vægtbelastning og styrkeøvelser i 2-3 uger</li> <li>Når vedkommende kan bevæge sig uden smerter, startes med fx cykling og trappegang</li> <li>Løb kan forsigtigt genoptages ca. 3 mdr. efter kirurgi</li> <li>Deltagelse i konkurrenceidræt kan genoptages efter ca. 6 måneder</li> <li>Ca. 70 % bliver symptomfrie efter rehabilitering som består i styrketræning, udspændinger og balancetræning</li> </ul> <h4>Fysioterapi<a href=" " data-type="journal-reference" data-value="Couppé C, Svensson RB, Silbernagel KG, Langberg H, Magnusson SP, Eccentric or Concentric Exercises for the Treatment of Tendinopathies?. J Orthop Sports Phys Ther 2015;45: 853-63" data-value-piped="Couppé C, Svensson RB, Silbernagel KG, Langberg H, Magnusson SP|Eccentric or Concentric Exercises for the Treatment of Tendinopathies?|J Orthop Sports Phys Ther|2015|45|853-63|26471850" data-url="reference-link" data-pubmedid="26471850" title="Couppé C, Svensson RB, Silbernagel KG, Langberg H, Magnusson SP, Eccentric or Concentric Exercises for the Treatment of Tendinopathies?. J Orthop Sports Phys Ther 2015;45: 853-63">7</a></h4> <ul> <li>Excentrisk styrketræning af triceps surae <ul> <li>Har vist gode resultater ved kroniske akillestendinoser</li> <li>Træningen skal udføres regelmæssigt, to gange dagligt syv dage per uge i indtil tre måneder, med gradvis tiltagende belastning</li> </ul> </li> <li>Postoperativt <ul> <li>Efter evt. operativ behandling skal optræningen individualiseres efter de fund, som blev gjort under indgrebet. Men generelt skal udøveren aflaste med krykker i to uger, og derefter have yderligere to uger med gradvis stigende belastning til normal gang efter 4-6 uger</li> <li>Bevægelsestræning i ankelleddet uden belastning startes, så snart smerterne tillader det, for at man kan undgå adhærencer mellem sene og hud</li> <li>Fra 6. postoperative uge skal udøveren gradvist øge styrketræningen af triceps surae, og løbetræning tillades som regel fra ca. tre måneder</li> </ul> </li> <li>Tværfriktionsmassage for at mobilisere afficeret bindevæv kan have god effekt</li> <li>Evt. laserbehandling, se "anden behandling" </li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Reducér løb på hårdt underlag</li> <li>Evt. hælindlæg</li> <li>God udspænding efter træning</li> </ul> <h2>Henvisning</h2> <ul> <li>Ved vedvarende gener og manglende effekt af excentriske øvelser, kan HVI eller operation i ortopædkirurgisk regi undtagelsesvist være aktuel</li> </ul> <h2>Opfølgning</h2> <h3>Plan</h3> <ul> <li>Patienten følges op efter behov</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Tilstanden bedres gradvist ved aflastning, normalt i løbet af nogle dage til uger</li> </ul> <h3>Komplikationer</h3> <ul> <li>Overgang til kronisk tilstand</li> <li>Langvarig betændelse kan føre til <a href="~/link.aspx?_id=24EA311CD5954CADA7683C52C9E8F248&_z=z">akillesseneruptur</a></li> </ul> <h3>Prognose</h3> <ul> <li>God, men tendens til recidiver og kronisk forløb hos aktive idrætsudøvere</li> <li>Rehabiliteringen både ved konservativ og efter operativ behandling kan være langvarig</li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Kronisk inflammation i akillessenen og dens seneskede<a href="http://emedicine.medscape.com/" data-type="other-reference" data-value="Lin DY, Marano H. Achilles tendonitis. eMedicine, Sept 19, 2002; www.emedicine.com. " data-url="http://emedicine.medscape.com/" title="Lin DY, Marano H. Achilles tendonitis. eMedicine, Sept 19, 2002; www.emedicine.com. ">8</a></li> <li>Opstår typisk når patienten negligerer symptomerne ved en akut peritendinit eller mikrorupturer med tendinit, og der herved opstår degenerative forandringer i senen (tendinose)</li> <li>Opstår også som aldersrelateret degenerativ forandring </li> </ul> <h3>Forekomst</h3> <ul> <li>Lidelsen ses først og fremmest hos motionister og idrætsudøvere</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>Langvarig uvant belastning giver små mikrorupturer i kollagenfibrene, og der opstår reaktiv inflammation, granulationsvæv og endelig fibrose</li> <li>Opstår typisk efter ændringer i aktivitetsniveau, brug af forkert fodtøj, træning på hårdt skridfast underlag, koldt klima</li> <li>I nogle tilfælde påvises patoanatomiske forandringer i det omgivende væv uden, at senen er væsentligt afficeret </li> <li>Ved visse kroniske gener er der sjældent inflammatoriske forandringer i senen, men fibrosering i det peritendinøse væv</li> </ul> <h4>Funktionel anatomi<a href="http://emedicine.medscape.com/" data-type="other-reference" data-value="Lin DY, Marano H. Achilles tendonitis. eMedicine, Sept 19, 2002; www.emedicine.com. " data-url="http://emedicine.medscape.com/" title="Lin DY, Marano H. Achilles tendonitis. eMedicine, Sept 19, 2002; www.emedicine.com. ">8</a></h4> <ul> <li>Akillessenen dannes af senerne til gastrocnemius og soleus musklerne og samler sig til én sene ca. 15 cm ovenfor fæstet på calcaneus </li> <li>I forløbet på bagsiden af læggen roterer senen 30-150°, før den fæster på calcaneus tuberositeten </li> <li>Senens evne til at glide er gjort lettere, ved at den er omkranset af en tynd seneskede </li> <li>I området 2-6 cm proksimalt for fæstet på calcaneus er blodtilførslen markant ringere end ellers ("watershed" området). Dette område er derfor ekstra sårbart overfor mikrotraumer og reagerer hyppigere med irritation, degeneration og nogle gange med ruptur</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Høj alder er associeret med svagere kollagent bindevæv, som disponerer for ruptur </li> <li>Proneret fod, platfodethed <ul> <li>Overpronation er en vigtig årsag til kroniske smerter i akillessenen </li> <li>Øget belastning på mediale fibre med mikrorupturer eller kronisk irritation</li> </ul> </li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS-koder</h3> <p>[ICD10]</p> <h2>Patientinformation</h2> <h3>Hvad man bør informere patienten om</h3> <ul> <li>Risiko knyttet til provokerende aktiviteter</li> <li>Vigtigt med gradvis mobilisering og optræning</li> <li>Betydningen af udspænding før og efter træning/idræt</li> </ul> <h3>Link til patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=20084FF275944B0DA0430AA986BAEBC0&_z=z">Kronisk betændelse i akillessenen</a></li> </ul> <h2>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og regionale pakkeforløb [ICPC]</li> </ul> <h3>Træningsfilm for underben og fod</h3> <ul> <li><a href="~/link.aspx?_id=1F6D4E5CBD3F4692BA93BE7541182DB7&_z=z">Øvelsesprogram, 3 øvelser</a><br> <br> <a href="~/link.aspx?_id=66FD9B729628437E98D9A0A38C191DB8&_z=z"><img alt="" src="E5F85279BD074A85A25EAE999BECACD2-135-84" style="height: 84px; width: 135px;" height="84" width="135"></a></li> </ul> <h2>Illustrationer</h2> <h3>Plancher eller tegninger</h3> <ul> <li> <a href="~/link.aspx?_id=4713EBE9C23248B8AC9C1195885F532C&_z=z">Akillestendinit</a> </li> <li> <a href="~/link.aspx?_id=3A210B2BEAD24C89BF4A7C7DEC4C3F3F&_z=z">Kortisonindsprøjtning</a></li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h3> Diagnose </h3> <ul> <li>Smerter og hævelse bag hælen og op over akillessenen under gang eller løb</li> <li>Positiv test ved isometrisk plantarfleksion</li> </ul> <h3> Behandling </h3> <ul> <li>Relevant aktivitetsmodifikation</li> <li>Eksentrisk træning</li> <li> HVI behandling eller kirurgi ved kroniske tilstande</li> </ul> <h3> Henvisning </h3> <ul> <li>Ved vedvarende gener og manglende effekt af excentriske øvelser, kan HVI eller operation i ortopædkirurgisk regi undtagelsesvist være aktuel</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">1221</TextField> <TextField Name="PageTitle">Akillestendinose</TextField> <TextField Name="NavigationTitle">Akillestendinose</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField Name="RevisedDate">2024-06-25T09:01:00</DateTimeField> <LinkListField Name="Authors"> <LinkField linktype="internal">{FEF92A09-6D85-4D34-BBCA-9423A48FDAB3}</LinkField> <LinkField linktype="internal">{ED7CEC94-3F7A-4FB5-BBB0-A3681BCFC481}</LinkField> </LinkListField> <LinkListField Name="Organization"> <LinkField linktype="internal">{CF77E8B9-9937-42B2-85DF-76B0F4E401F0}</LinkField> </LinkListField> <TextField Name="ICD10">DM766</TextField> <TextField Name="ICPC2">L87</TextField> <LinkListField Name="SearchAreaID"> <LinkField linktype="internal">2</LinkField> </LinkListField> <TextField Name="Description">Akillestendinose opstår typisk, når patienten negligerer symptomerne ved en akut peritendinit eller mikrorupturer med tendinit, og der herved opstår degenerative forandringer i senen (tendinose)</TextField> <LinkListField Name="LHPHEditor" /> <TextField Name="__Updated by">sitecore\anda</TextField> <TextField Name="MetaKeywords">akillessenetendinit, Akillestendinose, senebetændelse, hælsene, tendinit, tendinose</TextField> <LinkListField Name="InformationCategory"> <LinkField linktype="internal">IC_13</LinkField> </LinkListField> <LinkListField 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]]></Media> 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