tendinopatier-ankel-og-laeg (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Typisk lokalisation, sygehistorie og kliniske fund</li>
</ul>
<h3>Sygehistorie</h3>
<ul>
    <li>Akut inds&aelig;ttende smerter ved belastning af l&aelig;g og ankel ved aktivitet, f.eks. l&oslash;b</li>
    <li>Smerterne er lokaliseret over den aktuelle sene</li>
</ul>
<h3>Kliniske fund</h3>
<ul>
    <li>Sj&aelig;ldent h&aelig;velse, bortset fra ved akilles- og tibialis anterior-tendinopati</li>
    <li>&Oslash;mhed ved palpation over senen</li>
    <li>Krepitation ved palpation af muskelseneovergangen kan forekomme ved tibialis anterior syndrom</li>
    <li>Positiv isometrisk belastningstest af senen</li>
    <li>Tibialis anteriorsyndrom
    <ul>
        <li>M. tibialis anterior har sit udspring fra den laterale kondyl p&aring; tibia og f&aelig;ster hovedsagelig p&aring; os naviculare</li>
        <li>Isometrisk dorsalfleksion af foden udl&oslash;ser smerter</li>
        <li>Palpations&oslash;mhed ved:
        <ul>
            <li>Muskelseneovergang ca. 10 cm proximalt for ankelleddet. (ogs&aring; ben&aelig;vnt som myosynovit, ofte med krepitation)</li>
            <li>Muskelbug</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Tibialis posteriorsyndrom
    <ul>
        <li>M. tibialis posterior udspringer fra proksimale 2/3 af tibias og fibulas bagsider og f&aelig;ster sig hovedsagelig til os naviculare, samt plantart p&aring; flere tarsale og metatarsale knogler</li>
        <li>Senen l&oslash;ber ned bagved mediale malleol</li>
        <li>Isometrisk inversion samt plantarfleksion af foden udl&oslash;ser smerter</li>
        <li>Palpations&oslash;mhed ved:
        <ul>
            <li>Senef&aelig;stet &ndash; in regio os naviculare</li>
            <li>Senen &ndash; ved mediale malleol</li>
            <li>Muskelseneovergang &ndash; mediale aspekt af nederste halvdel af tibia</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Peroneustendinopatier
    <ul>
        <li>Lokaliseret lateralt i l&aelig;ggen, anklen eller foden</li>
        <li>Isometrisk eversion af foden udl&oslash;ser smerte</li>
        <li>Palpations&oslash;mhed ved:
        <ul>
            <li>Senef&aelig;stet p&aring; 5. metatarsalknogle synes at v&aelig;re hyppigst afficeret</li>
            <li>Der kan ogs&aring; v&aelig;re &oslash;mhed langs senen b&aring;de i foden, rundt om laterale malleol, og langs nedre halvdel af fibula - pr&aelig;cis palpation afd&aelig;kker det afficerede omr&aring;de</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Akillestendinopati
    <ul>
        <li>Isometrisk plantarfleksion af foden udl&oslash;ser smerter (samt test: st&aring; p&aring; t&aelig;er)</li>
    </ul>
    </li>
</ul>
<h3>Supplerende unders&oslash;gelser i almen praksis</h3>
<ul>
    <li>Ingen</li>
</ul>
<h3>Andre unders&oslash;gelser hos specialist eller unders&oslash;gelse p&aring; sygehus</h3>
<ul>
    <li>Ultralyd og MR scanning til optimeret diagnostik</li>
</ul>
<h3>Differentialdiagnoser</h3>
<ul>
    <li><a href="~/link.aspx?_id=75D5F5FA88E74990A9044775A2CE8863&amp;_z=z">Tibiaperiostit</a></li>
    <li><a href="~/link.aspx?_id=D267FACA6C0C4A77B239ACC746B1C3A6&amp;_z=z">Tr&aelig;thedsbrud i l&aelig;ggen</a></li>
</ul>
<h2>Behandling</h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Lindre smerte</li>
    <li>&Oslash;ge funktion</li>
    <li>Forhindre recidiv</li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>Aflastning</li>
    <li><a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a></li>
    <li>Alternativ tr&aelig;ning</li>
    <li>Behandling af underliggende &aring;rsag
    <ul>
        <li>Det er vigtig at afd&aelig;kke underliggende &aring;rsager og f&aring; korrigeret disse</li>
        <li>Hos idr&aelig;tsud&oslash;vere vil det v&aelig;re n&oslash;dvendig at justere tr&aelig;ningen</li>
    </ul>
    </li>
</ul>
<h3>H&aring;ndtering i almen praksis</h3>
<ul>
    <li>R&aring;dgivning om relevant aktivitetsmodifikation, henvisning til fysioterapi og opstart af NSAID behandling</li>
</ul>
<h3>R&aring;d til patienten</h3>
<ul>
    <li>Aflastning til symptomfrihed</li>
    <li>Idr&aelig;tsud&oslash;vere
    <ul>
        <li>Alternativ tr&aelig;ning med aktiviteter som ikke medf&oslash;rer smerter i det aktuelle omr&aring;de</li>
    </ul>
    </li>
</ul>
<h3>Medicinsk behandling</h3>
<ul>
    <li>Evt.&nbsp;<a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a>&nbsp;i &eacute;n uge</li>
    <li>Evt.&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/215000#a000">lokalbehandling</a>, f.eks.&nbsp;[DliActiveSubstance;6083;ibuprofen gel]<a href="EditorPage.aspx?da=core&amp;id=%7B9DB19632-ED44-475D-A868-94B6512B3F94%7D&amp;ed=FIELD3138445316&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H3138445381&amp;mo&amp;pe=0&amp;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">1</a></li>
</ul>
<h3>Anden behandling</h3>
<ul>
    <li>Fysioterapi og tr&aelig;ning
    <ul>
        <li>Tv&aelig;rfriktionsmassage af afficeret seneomr&aring;de kan have god effekt</li>
        <li>Tilpasset tr&aelig;ningsprogram med &oslash;velser</li>
    </ul>
    </li>
    <li>Akillestendinopati
    <ul>
        <li>Underlag/opbygning under h&aelig;len (indl&aelig;g) i nogle uger</li>
    </ul>
    </li>
</ul>
<h3>Kirurgi</h3>
<ul>
    <li>Der findes ingen effektive kirurgiske behandlinger for tendinose tilstandene</li>
</ul>
<h3>Forebyggende behandling</h3>
<ul>
    <li>Fornuftig optrapning af tr&aelig;ningsintensitet</li>
    <li>Gode l&oslash;besko</li>
    <li>Undg&aring; belastning p&aring; for h&aring;rdt underlag</li>
</ul>
<h2>Henvisning</h2>
<ul>
    <li>Ved l&aelig;ngerevarende symptomer mere end 3 m&aring;neder kan der henvises til idr&aelig;tsklinik eller ortop&aelig;dkirurgisk afdeling med idr&aelig;tstraumatologisk sektor</li>
</ul>
<h2>Sygdomsforl&oslash;b, komplikationer og prognose</h2>
<h3>Sygdomsforl&oslash;b</h3>
<ul>
    <li>Symptomerne forsvinder i reglen i l&oslash;bet af 1-2 uger</li>
</ul>
<h3>Komplikationer</h3>
<ul>
    <li>Tendinose - kroniske gener</li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>God hvis tidlig aflastning og anden behandling iv&aelig;rks&aelig;ttes</li>
    <li>Tilstanden kan blive kronisk, hvis vedkommende forts&aelig;tter belastningen p&aring; trods af smerterne</li>
    <li>Recidiver er almindelige, hvis ikke underliggende &aring;rsag bliver korrigeret</li>
</ul>
<h2>Baggrundsoplysninger</h2>
<h3>Definition</h3>
<ul>
    <li>Forskellige tendinopatier som kan opst&aring; ved ankel og l&aelig;g:
    <ul>
        <li>Tibialis anteriorsyndrom </li>
        <li><a href="~/link.aspx?_id=20F595CBC2664D6287E7E95598CE0048&amp;_z=z">Tibialis posteriorsyndrom</a></li>
        <li>Peroneustendinopati </li>
        <li><a href="~/link.aspx?_id=4F93DAB603914C51894C41EC2D7B700D&amp;_z=z">Akillestendinopati</a></li>
    </ul>
    </li>
</ul>
<h3>Forekomst </h3>
<ul>
    <li>Ikke ualmindelige lidelser </li>
    <li>Hyppig blandt l&oslash;bere</li>
</ul>
<h3>&AElig;tiologi og patogenese</h3>
<ul>
    <li>For hurtig &oslash;gning af belastningsm&aelig;ngde og -intensitet </li>
    <li>Ensidigt l&oslash;b p&aring; h&aring;rdt underlag, d&aring;rligt fodt&oslash;j</li>
</ul>
<h3>Disponerende faktorer</h3>
<ul>
    <li>Fodfejlstillinger </li>
    <li>Ved tibialis anteriorsyndrom foreligger ofte &oslash;get lateral rotation og overpronation af forfoden </li>
    <li>Ved resterende tendinopatier foreligger gerne overpronation af fod</li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]&nbsp; &nbsp; &nbsp; &nbsp;</p>
<h2>Patientinformation</h2>
<h3>Link til patientinformation</h3>
<ul>
    <li><a href="~/link.aspx?_id=7A6679EF017F48E488204FFC208CDB61&amp;_z=z">Akut senebet&aelig;ndelse i l&aelig;ggen</a></li>
</ul>
<h3>Tr&aelig;ningsfilm for underben og fod</h3>
<ul>
    <li><a href="~/link.aspx?_id=1F6D4E5CBD3F4692BA93BE7541182DB7&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser</a><br>
    <br>
    <a href="~/link.aspx?_id=66FD9B729628437E98D9A0A38C191DB8&amp;_z=z"><img alt="" src="E5F85279BD074A85A25EAE999BECACD2-135-84" style="height: 84px; width: 135px;" height="84" width="135"></a></li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li>Forl&oslash;bsbeskrivelser og regionale pakkeforl&oslash;b [ICPC]</li>
</ul>]]></HtmlField>
      <HtmlField Name="Resume"><![CDATA[<h2>Resum&eacute;</h2>
<h4>
Diagnose
</h4>
<ul>
    <li>F&oslash;lgende&nbsp;tendinopatier kan opst&aring; ved ankel og l&aelig;g:
    <ul>
        <li>Tibialis anteriorsyndrom&nbsp;</li>
        <li>Tibialis posteriorsyndrom</li>
        <li>Peroneustendinopati&nbsp;</li>
        <li>Akillestendinopati</li>
    </ul>
    </li>
    <li>Anamnese med relevant overbelastning (fx &oslash;gning af l&oslash;beaktivitet)</li>
    <li>Kliniske fund af &oslash;mhed ved senetilh&aelig;ftning og muskulotendin&oslash;se overgange</li>
    <li>Smerteudl&oslash;sning ved isometrisk muskelbelastning</li>
</ul>
<h4>
Behandling
</h4>
<ul>
    <li>Aktivitetsmodifikation</li>
    <li>Fysioterapi</li>
    <li>NSAID</li>
</ul>
<h4>
Henvisning
</h4>
<ul>
    <li>Ved l&aelig;ngerevarende symptomer mere end 3 m&aring;neder kan der henvises til idr&aelig;tsklinik eller ortop&aelig;dkirurgisk afdeling med idr&aelig;tstraumatologisk sektor</li>
</ul>]]></HtmlField>
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]]></Media>
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