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<Provider Id="sundheddkcms"> <Item Id="{75D5F5FA-88E7-4990-A904-4775A2CE8863}" Name="tibiaperiostit" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{02851690-7266-4B57-B98E-D30DB1AE8AB3}" SortOrder="2600" PublishDate="2010-05-20T13:01:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <ul> <li>Sygehistorie med smerter udløst af belastning langs mediale del af tibia</li> <li>Tydelig ømhed ved palpation, specielt langs nedre 1/3 af tibias posteromediale kant</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Smerter i mediale del af læggen under og efter træning (f.eks. løb)</li> <li>Initialt murrende smerter og ubehag, ofte efter relativt hårde belastninger</li> <li>Efterhånden stadig mindre tolerance for belastning</li> <li>Hvis træningen fortsætter, vil der efterhånden kunne komme hvilesmerter. Smerterne forværres ved minimale belastninger. Udøveren tvinges til at holde op med løbetræning og træning, hvor der indgår hop og spring</li> </ul> <h3>Kliniske fund</h3> <ul> <li>Tydelig palpationsømhed langs tibias mediale kant. Generne er typisk lokaliseret i midterste og nedre 1/3 af tibia</li> <li>Aktiv plantarflektion og supination kan provokere smerte</li> <li>Der kan udvikles ødem i området svarende til den ømme zone</li> <li>I nogen tilfælde mærkes også en knudret overflade langs knoglen</li> <li>Mange med denne lidelse har enten noget udadroterede lægge eller overpronerede fødder<a href=" " data-type="journal-reference" data-value="Reinking MF, Austin TM, Richter RR, Krieger MM, Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health 2017;9: 252-261" data-value-piped="Reinking MF, Austin TM, Richter RR, Krieger MM|Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors.|Sports Health|2017|9|252-261|27729482" data-url="reference-link" data-pubmedid="27729482" title="Reinking MF, Austin TM, Richter RR, Krieger MM, Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health 2017;9: 252-261">1</a></li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Ingen ud over klinisk undersøgelse</li> </ul> <h3>Andre undersøgelser hos specialist</h3> <ul> <li>Knoglescintigrafi <ul> <li>Kan være nyttig ved mistanke om stressfraktur, men er ikke nødvendig ved typisk klinik og bruges efterhånden sjældent</li> <li>Ved periostit i mediale tibia viser scintigrafi en moderat og diffus optagelse i midterste og nederste del af tibia, ved stressfraktur ses en lokaliseret og skarp optagelse</li> </ul> </li> <li>Røntgen <ul> <li>Bruges primært til at udelukke eventuelle knogleabnormiteter som fx sarcom</li> <li>Kan i typiske og kroniske tilfælde vise en periostal reaktion langs mediale tibia - der ses som en fortykket, noget uskarpt afgrænset medial corticalis i tibia</li> </ul> </li> <li>MR-scanning har mere eller mindre afløst scintigrafi, og kan vise periostalt ødem<a title="McClure CJ, Oh R, Medial Tibial Stress Syndrome . 2019;: " href="EditorPage.aspx?da=core&id=%7B75D5F5FA-88E7-4990-A904-4775A2CE8863%7D&ed=FIELD9067196656&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H9067196883&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-url="reference-link" data-value-piped="McClure CJ, Oh R|Medial Tibial Stress Syndrome ||2019|||30860714" data-value="McClure CJ, Oh R, Medial Tibial Stress Syndrome . 2019;: " data-pubmedid="30860714">2</a></li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li>Tibialis anterior syndrom, lokaliseret lateralt for tibia</li> <li><a href="~/link.aspx?_id=D267FACA6C0C4A77B239ACC746B1C3A6&_z=z">Stressfraktur</a> i mediale tibia</li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Fjerne inflammation og gener</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Konservativ behandling med aflastning fra udløsende årsager</li> <li>Operation kan anvendes ved manglende effekt af konservativ behandling, men resultaterne er dårligt videnskabeligt underbyggede<a title="Winters M, The diagnosis and management of medial tibial stress syndrome : An evidence update. Unfallchirurg 2019;: " href="EditorPage.aspx?da=core&id=%7B75D5F5FA-88E7-4990-A904-4775A2CE8863%7D&ed=FIELD9067196656&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H9067196883&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-url="reference-link" data-value-piped="Winters M|The diagnosis and management of medial tibial stress syndrome : An evidence update.|Unfallchirurg|2019|||31098646" data-value="Winters M, The diagnosis and management of medial tibial stress syndrome : An evidence update. Unfallchirurg 2019;: " data-pubmedid="31098646">3</a></li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Instruer patienten i aflastning og at undgå de aktiviteter, der udløser symptomerne herunder modificering af eventuel træning</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Undgå eller reducere udløsende belastninger, evt. skift til alternativ træning, udfør jævnlig udspænding af lægmuskulaturen</li> <li>Hvile indtil de akutte symptomer er ovre</li> <li>Derefter optræning med justerede træningsmetoder <ul> <li>Undgå/reducer løb på hårdt underlag</li> <li>Brug stabilt fodtøj med god støddæmpning</li> <li>Brug løbesko med god støddæmpning. Undgå de hårde hælsko ved opvarmning og "nedjogging"</li> </ul> </li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Sandsynligvis kun begrænset effekt</li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a> kan forsøges i korte perioder med akutte og udtalte gener</li> <li>Evt. <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/215000">lokalbehandling</a>, f.eks. [DliActiveSubstance;6083;ibuprofen gel]</li> </ul> <h3>Anden behandling</h3> <h4>Ortoser/såler</h4> <ul> <li>Løbsanalyse kan vise, at foden overpronerer i belastningsfasen, dvs. valgusstilling af hælen <ul> <li>Korriger med specielle løbesko, der kompenserer for pronation</li> <li>Korriger alternativt med indlægssål som giver god støtte under fodbuen, og som er bygget lidt op under caput af første metatars</li> <li>Det kan ofte være vanskeligt at lave den korrekte sål ved første forsøg. Patienterne skal da tilbage til fodterapeuten for korrektion</li> </ul> </li> </ul> <h4>Fysioterapi</h4> <ul> <li>Nogle kan have nytte af optræning vejledt af fysioterapeut. Der bør lægges vægt på alsidig træning og øvelser, som ikke belaster det skadede sted unødvendigt</li> <li>Hjælp til at korrigere eller kompensere for eventuelle disponerende fejlstillinger i fødder</li> <li>Instruktion i udspændingsøvelser og alternativ træning</li> </ul> <h3>Kirurgi</h3> <ul> <li>Dokumentationen for effekt er generelt dårlig</li> <li>Operation bør derfor først forsøges, når konservativ behandling ikke virker, men vurderes tidligst efter 3-6 måneder med adækvat konservativ behandling</li> <li>Der foretages en spaltning af soleusfascien og fascien til den dybe, bagerste muskelloge langs medialkanten af tibia ca. 1-2 cm fra mediale tibiakant</li> <li>Postoperativt lægges en komprimerende bandage, som patienten bør have i 8-10 dage</li> <li>Aflastning med krykker varer almindeligvis i ca. en uge eller til smertefrihed. Udøveren kan genoptage løbetræningen efter 4-6 uger</li> <li>Vellykket resultat hos 80-90 % er beskrevet, men der foreligger kun få studier af lav videnskabelig kvalitet, hvorfor operation ikke generelt kan anbefales<a title="Winters M, The diagnosis and management of medial tibial stress syndrome : An evidence update. Unfallchirurg 2019;: " href="EditorPage.aspx?da=core&id=%7B75D5F5FA-88E7-4990-A904-4775A2CE8863%7D&ed=FIELD9067196656&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H9067196883&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-url="reference-link" data-value-piped="Winters M|The diagnosis and management of medial tibial stress syndrome : An evidence update.|Unfallchirurg|2019|||31098646" data-value="Winters M, The diagnosis and management of medial tibial stress syndrome : An evidence update. Unfallchirurg 2019;: " data-pubmedid="31098646">3</a> </li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Brug fjedrende fodtøj</li> <li>Løb mindst muligt på hårdt underlag, asfalt og lignende</li> <li>Reducer eller læg træningen om, hvis generne melder sig</li> <li>Evt. <a href="~/link.aspx?_id=2446F62F32F04509A09735C1CD896065&_z=z">tapening af læggen</a></li> </ul> <h2>Henvisning</h2> <ul> <li>Ved manglende effekt af konservativ behandling</li> <li>Ved stadige recidiver efter konservativ behandling</li> </ul> <h2>Opfølgning</h2> <ul> <li>Ved konservativ behandling kan opfølgning ske i almen praksis</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>De fleste bliver relativt raske ved hvile og omlægning af træningen</li> <li>Tilstanden har alligevel tendens til at komme igen. Man skal ofte tage hensyn til dette i lang tid</li> <li>Nogle patienter får kroniske gener, som forhindrer aktiv idræt</li> </ul> <h3>Komplikationer</h3> <ul> <li>Efter kirurgisk behandling er der set skader på n. saphenus</li> </ul> <h3>Prognose</h3> <ul> <li>Prognosen er generelt god, hvis patienten følger et konservativt behandlingsoplæg med nedtrapning af smerteudløsende aktivitet og sko-/såltilpasning</li> <li>Kirurgisk behandling er beskrevet at give bedring af symptomer hos 80-90 % af patienterne, men topidrætsudøvere skal regne med at være borte fra idræt på højt niveau i indtil et halvt år</li> </ul> <h2>Baggrundsoplysninger </h2> <h3>Definition<a title="Winkelmann ZK, Anderson D, Games KE, Eberman LE, Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train 2016;51(12): 1049-52" href=" " data-type="journal-reference" data-url="reference-link" data-value-piped="Winkelmann ZK, Anderson D, Games KE, Eberman LE|Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review|J Athl Train|2016|51(12)|1049-52" data-value="Winkelmann ZK, Anderson D, Games KE, Eberman LE, Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train 2016;51(12): 1049-52">4</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Hamstra-Wright KL, Bliven KC, Bay C, Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis.. Br J Sports Med 2015;49: 362-9" data-value-piped="Hamstra-Wright KL, Bliven KC, Bay C|Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis.|Br J Sports Med|2015|49|362-9|25185588" data-url="reference-link" data-pubmedid="25185588" title="Hamstra-Wright KL, Bliven KC, Bay C, Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis.. Br J Sports Med 2015;49: 362-9">5</a></h3> <ul> <li>Betændelse i muskel og senefæstet langs postero-mediale kant af tibia </li> <li>Synonyme betegnelser: Medialt tibialt stresssyndrom, shin splint, prætibial periostit, knoglehindebetændelse, medial traktionsperiostit </li> </ul> <h3>Forekomst</h3> <ul> <li>Dette er den hyppigst forekommende kroniske belastningsskade hos idrætsudøvere </li> <li>Specielt hyppig blandt løbere, hos idrætsfolk der hopper meget og i hal-idræt </li> <li>Langrendsløbere og skøjteløbere er også udsatte</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>Gentagne træk i muskel/sene-fæstet for mediale del af soleus eller tibialis posterior langs mediale del af tibia, specielt de distale 2/3 </li> <li>Ved langvarige og gentagne belastninger udvikles en inflammation i muskelfæstet i periost </li> <li>Muskelhypertrofi og stivhed i forbindelse med intense træningsperioder antages at være en vigtig udløsende årsag. Smerterne kommer fra en betændelse, fibrosering og fasciefortykkelse ind mod knoglehinden på medialkanten af tibia, specielt de distale 2/3 af denne </li> <li>Tibiaperiostit kan forekomme isoleret eller sekundært til anden skade, f.eks. stressfraktur eller kronisk forreste kompartmentsyndrom</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Løb på hårdt underlag </li> <li>Overvægt</li> <li>Øget udadrotation af læggen og hyperpronation menes muligvis at kunne være en medvirkende faktor <ul> <li>Det vil sige varusstilling i bagre del af foden, øget pronation af forreste del af foden, genu valgum </li> <li>Medfører at udøveren afvikler foden over mediale fodrand, hvilket igen resulterer i øget belastning ved muskelfasciens fæste på knoglehinden medialt</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 du bør informere patienten om</h3> <ul> <li>Nødvendigheden af at undgå de udløsende aktiviteter</li> <li>Råd for egenbehandling</li> </ul> <h3>Hvad findes der af skriftlig information?</h3> <ul> <li><a href="~/link.aspx?_id=67D50E254217413C9571854442680A0A&_z=z">Knoglehindebetændelse i læggen</a></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>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og regionale pakkeforløb [ICPC]</li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h3>Diagnose</h3> <ul> <li>Belastningsudløste smerter fortil på medialsiden af crus</li> <li>Ømhed ved palpation langs tibias mediale kant</li> <li>Ofte overproneret fodstilling</li> </ul> <h3>Behandling</h3> <ul> <li>Korrektion af fodtøj ved overpronering samt stødabsorberende sål</li> <li>Tilpasning af aktivitetsniveau og reduktion i træningsmængde</li> <li>Kirurgi er kun sjælden nødvendig, og evidensen er for lav</li> </ul> <h3>Henvisning</h3> <ul> <li>Ved persisterende symptomer og manglende effekt af konservativ behandling</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">2803</TextField> <TextField Name="PageTitle">Tibiaperiostit</TextField> <TextField Name="NavigationTitle">Tibiaperiostit</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField Name="RevisedDate">2022-07-01T10:36:00</DateTimeField> <LinkListField Name="Authors"> <LinkField linktype="internal">{10F0E7D2-8D6D-49AE-94B3-998114356326}</LinkField> <LinkField linktype="internal">{D71FC9B8-8D14-48C6-920F-BE9256067C0B}</LinkField> </LinkListField> <LinkListField Name="Organization"> <LinkField linktype="internal">{CF77E8B9-9937-42B2-85DF-76B0F4E401F0}</LinkField> </LinkListField> <TextField Name="ICD10">M76.8</TextField> <TextField Name="ICPC2">L99</TextField> <LinkListField Name="SearchAreaID"> <LinkField linktype="internal">2</LinkField> </LinkListField> <TextField Name="Description">Tibiaperiostit er en betændelse i muskel og senefæstet langs postero-mediale kant af tibia. 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]]></Media> 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