Konservativni pristopi pri obravnavi tendinopatije fleksorjev kolena - pregled literature : diplomsko delo

Janežič, Blaž (author), Vauhnik, Renata (mentor), Hlebš, Sonja (reviewer)

Uvod: Tendinopatija fleksorjev kolena je poškodba proksimalnih tetiv teh mišic, ki se je začela prvič opisovati leta 1988 kot ''hamstring syndrome''. Klinično se redko opisuje kot poškodba s točno določenim dogodkom nastanka; večinoma se pojavlja ob telesni dejavnosti, kot stopnjujoča bolečina v proksimalnem posteriornem področju stegna blizu zadnjice. Ta tip tendinopatije je pogosto spregledan ali napačno diagnosticiran. Etiologija še ni natančno opisana, najpogosteje jo utrpijo športniki, sploh tisti, ki veliko pretečejo. Pojavljajo se rezultati, ki nakazujejo na korelacijo med tendinopatijami in sladkorno boleznijo. Trenutno se tendinopatijo fleksorjev kolena najpogosteje obravnava s tradicionalnim konservativnim pristopom s poudarkom na ekscentričnih vajah fleksornih mišic kolena. Namen: Namen pregleda je bil ugotoviti najprimernejše konservativne oblike zdravljenja za obravnavo pacientov s tendinopatijo fleksorjev kolena, fizioterapevtske ali druge ustaljene tehnike. Metode dela: Iskanje člankov je potekalo v podatkovnih bazah PubMed in PEDro ter v arhivu revije Fizioterapija s ključnima besedama ''hamstring tendinopathy''. Vključitveni kriteriji so bili randomizirane kontrolirane raziskave in klinične raziskave, dostopnost celotnega besedila članka ter datum objave članka po letu 2010. Izključitveni kriteriji so bili pregledi literature in drugi ne-raziskovalni članki, raziskave s preiskovanci z drugimi tendinopatijami ter objava članka pred 2010. Po uvodnem pregledu sta bili zaradi majhnega števila randomiziranih kontroliranih in kliničnih raziskav dodani tudi dve retrospektivni raziskavi. Rezultati: Iz vključenih raziskav je jasno vidno, da sta terapija z laserjem in udarnimi globinskimi valovi učinkovitejša pristopa v primerjavi s tradicionalnim pristopom. Dokazov za učinkovitost tradicionalnega pristopa ni. Možno je tudi zdravljenje z injekcijami trombocitne plazme ali polne krvi, obe možnosti sta pokazali podobne učinke. Obetavne rezultate sta pokazali tudi retrospektivni raziskavi na področju zdravljenja z injekcijami s kortikosteroidi. Razprava in zaključek: Rezultati kažejo na učinkovitost uporabe laserja in udarnih globinskih valov, vendar metodi v veliki meri še nista na voljo v javnem zdravstvenem sistemu. Tradicionalni pristop s poudarkom na ekscentričnih vajah ostaja zaenkrat standardna obravnava, kljub temu pa je treba raziskati, do kakšne mere ima znanstveno podlago. Možna učinkovita oblika podpornega zdravljenja je tudi obravnava z injekcijami trombocitne plazme, polne krvi ali kortikosteroidov. Zaenkrat še ni dovolj raziskav za kakovosten pregled literature.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, tendinopatija, fleksorji kolena, udarni globinski valovi, laser, ekscentrika
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [B. Janežič]
• Year: 2023
• Number of pages: 29 str.
• PID: 20.500.12556/RUL-152024
• UDC: 615.8
• COBISS.SI-ID: 170483459
• Publication date in RUL: 28.10.2023

Secondary language

• Language: English
• Title: Conservative approaches in treatment of tendinopathy of knee flexors - literature review : diploma work

Abstract

Introduction: Tendinopathy of knee flexors is an injury of the proximal tendons of these muscles. It was firstly described in 1988 as ''hamstring syndrome''. Clinically it is rarely an injury with a specific onset event; it usually appears with physical activity as a progressing pain in the proximal posterior part of the thigh near the buttocks. This type of tendinopathy is often wrongly diagnosed or missed altogether. Aetiology has yet to be thoroughly described. Athletes that run a lot suffer from this injury most often. Recent research shows a possible correlation between diabetes and tendinopathy. Tendinopathy of knee flexors is currently most commonly treated with the traditional conservative approach with focus on eccentric training of knee flexors. Purpose: The purpose of this review was to find out the best conservative approaches in the treatment of patients with hamstring tendinopathy, either with physiotherapeutic or other recognized techniques. Methods: PubMed and PEDro were used to search for appropriate research articles with keywords ''hamstring tendinopathy''. Inclusion criteria were randomized control trials and clinical trials, access to full text of the article as well as that the article was published in 2010 or after. Exclusion criteria included literature reviews and other non-research articles, research including patients with other tendinopathies and publish date prior to 2010. Following the initial review of search results, 2 retrospective research articles were included due to small amount of randomized controlled and clinical trials. Results: Laser therapy and extracorporeal shockwave therapy are more efficient in comparison to the traditional approach. Clear proof for efficiency of traditional approach does not exist. Possible treatment also includes injections of platelet-rich plasma or whole blood, both showed similar effect. Two retrospective studies showed promising results in treatment with corticosteroid injections. Discussion and conclusion: Results show efficiency of laser therapy and extracorporeal shockwave therapy, but they are yet to be available in public healthcare on a larger scale. Traditional approach with emphasis on eccentric exercise stays the standard treatment for now, although its scientific foundation should be more thoroughly researched. Possible effective treatment also includes local injections of platelet-rich plasma, whole blood, or corticosteroids. Currently, there isn't enough research done for a quality literature review.

• Keywords: diploma theses, physiotherapy, tendinopathy, knee flexors, extracorporeal shockwave therapy, laser, eccentric