Arthrogene Hemmung: Gelenkdysfunktion mit Konsequenzen

Zusammenfassung

Muskuläre Schwäche oder Kontrollverlust sind klinische Erscheinungsbilder, denen Physiotherapeuten im Alltag häufig begegnen. Gelenke und ihre umgebenden Strukturen haben großen Einfluss auf die Muskelaktivität. Arthrogene Hemmung beschreibt die Auswirkungen von Dysfunktionen bzw. Störungen eines Gelenkkomplexes, die neurophysiologische Aktivitäten der auf das Gelenk einwirkenden Muskeln beeinträchtigen können. Die Folge davon ist eine in der Quantität und Qualität reduzierte Muskelaktivität. Somit kann ein muskulärer Kontrollverlust seine Ursache in einer Gelenkdysfunktion haben. Ziel dieser Arbeit ist, eine Übersicht über das Phänomen arthrogene Hemmung und ihrer Definition zu geben, um Verständnis für deren Entstehung und der zugrunde liegenden Mechanismen zu erhalten. Die Innervation eines Gelenks wird stellvertretend am Beispiel des Knies dargestellt. Außerdem wird erläutert, welche Konsequenzen das Phänomen auf umliegende Strukturen haben kann und welche Überlegungen für eine zielgerichtete effektive Therapie notwendig sind.

Abstract

Muscle weakness or loss of control are clinical manifestations which physiotherapists are often confronted with in daily practice. Joints and their surrounding structures have high influence on muscular activity. Arthrogenous inhibition describes the consequences of dysfunctions and disorders of a joint complex that can deteriorate the neurophysiological activities of the affecting articular muscles. The result is a qualitatively and quantitatively reduction of muscle activity. Therefore, a loss of muscular control can originate in joint dysfunction.The aim of this article is to give an overview of the phenomenon of arthrogenous inhibition and its definition in order to establish an understanding of its development and underlying mechanisms. Articular innervation is exemplary illustrated in the case of the knee. Furthermore, it is described which consequences the phenomenon can have on surrounding structures and which considerations have to be taken into account for a purposeful effective therapy.

Schlüsselwörter

Gelenkhemmung - Gelenkschaden - arthrogene Muskelschwäche und -hemmung - Reflexhemmung

Key words

Joint inhibition - joint disease - arthogenous muscle weakness and inhibition - reflex inhibition

Literatur

• 1 Berliner M, Schmidt K L. Extreme atrophy of the shoulder muscles in juvenile ankylosing spondylitis as a (misleading) main symptom.  Z Rheumatol. 1989;  48 254-257
• 2 Bjornland T, Brodin P, Larheim T A. et al . Reflex responses of the masseter muscle in patients with chronic arthritis or internal derangement of the temporomandibular joint. A comparison with symptomfree subjects.  J Oral Rehabil. 1996;  23 805-810
• 3 Comerford M J, Mottram S L. Functional stability re-training: principles and strategies for managing mechanical dysfunction.  Man Ther. 2001;  6 3-14
• 4 Deandrade J R, Grant C, Dixon A. Joint distension and reflex muscle inhibition.  Bone Joint Surgery. 1965;  47A 313-322
• 5 Fahrer H, Rentsch H U, Gerber N J. et al . Knee effusion and reflex inhibition of the quadriceps. A bar to effective retraining.  J Bone Joint Surg Br. 1988;  70 635-638
• 6 Freeman M A, Wyke B. Articular contributions to limb muscle reflexes. The effects of partial neurectomy of the knee-joint on postural reflexes.  Br J Surg. 1966;  53 61-68
• 7 Freeman M A, Wyke B. Articular reflexes at the ankle joint: an electromyographic study of normal and abnormal influences of ankle-joint mechanoreceptors upon reflex activity in the leg muscles.  Br J Surg. 1967;  54 990-1001
• 8 Freeman M A, Wyke B. The innervation of the ankle joint. An anatomical and histological study in the cat.  Acta Anat (Basel). 1967;  68 321-333
• 9 Freeman M A, Wyke B. The innervation of the knee joint. An anatomical and histological study in the cat.  J Anat. 1967;  101 505-532
• 10 Harding A EB. An investigation into the cause of arthritic muscular atrophy.  Lancet. 1929;  i 433-434
• 11 He X, Proske U, Schaible H G. et al . Acute inflammation of the knee joint in the cat alters responses of flexor motoneurons to leg movements.  J Neurophysiol. 1988;  59 326-340
• 12 Helliwell P S, Jackson S. Relationship between weakness and muscle wasting in rheumatoid arthritis.  Ann Rheum Dis. 1994;  53 726-728
• 13 Hides J A, Richardson C A, Jull G A. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.  Spine. 1996;  21 2763-2769
• 14 Hodges P, Richardson C, Jull G. Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function.  Physiother Res Int. 1996;  1 30-40
• 15 Hurley M V, Newham D J. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees.  Br J Rheumatol. 1993;  32 127-131
• 16 Hurley M V, Jones D W, Newham D J. Arthrogenic quadriceps inhibition and rehabilitation of patients with extensive traumatic knee injuries.  Clinical Science. 1994;  86 305-310
• 17 Hurley M V. The effects of joint damage on muscle function, proprioception and rehabilitation.  Man Ther. 1997;  2 11-17
• 18 Jayson M I, St Dixon A J. Intra-articular pressure in rheumatoid arthritis of the knee. I. Pressure changes during passive joint distension.  Ann Rheum Dis. 1970;  29 261-265
• 19 Jensen K, Graf B K. The effects of knee effusion on quadriceps strength and knee intraarticular pressure.  Arthroscopy. 1993;  9 52-56
• 20 Jull G, Barrett C, Magee R. et al . Further clinical clarification of the muscle dysfunction in cervical headache.  Cephalalgia. 1999;  19 179-185
• 21 Machner A, Pap G, Awiszus F. Evaluation of quadriceps strength and voluntary activation after unicompartmental arthroplasty for medial osteoarthritis of the knee.  J Orthop Res. 2002;  20 108-111
• 22 Meyers Lexikon, Band 5. Imol-Lanc. - 2. vollständig neubearb. Auflage. 1992
• 23 Mongia S K. H reflex from quadriceps and gastrocnemius muscles.  Electromyogr Clin Neurophysiol. 1972;  12 179-190
• 24 Newham D J, Hurley M V, Jones D W. Ligamentous knee injuries and muscle inhibition.  Journal of Orthopaedic Rheumatology. 1989;  2 163-173
• 25 Panjabi M M. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation, and enhancement.  J Spinal Disord. 1992;  5 383-389 u. 397
• 26 Pap G, Machner A, Awiszus F. Functional changes in the quadriceps femoris muscle in patients with varus gonarthrosis.  Z Rheumatol. 2000;  59 380-387
• 27 Raymond R. Recherches experimentales sur la pathogénie des atrophies musculaires consécutive aux arthrites traumatiques.  Rev Med. 1890;  10 374-392
• 28 Richardson C A, Jull G A. Muscle control-pain control. What exercises would you prescribe?.  Man Ther. 2000;  1 2-10
• 29 Schutte M J, Happel L T. Joint innervation in joint injury.  Clin Sports Med. 1990;  9 511-517
• 30 Shakespeare D T, Stokes M, Sherman K P. et al . Reflex inhibition of the quadriceps after meniscectomy: lack of association with pain.  Clin Physiol. 1985;  5 137-144
• 31 Sherrington C S. The muscular sense. Textbooks of physiology, Vol. 2. 1900
• 32 Sherrington C S. On the proprioceptive system, especially in its reflex aspects.  Brain. 1906;  29 467
• 33 Snyder-Mackler L, De Luca P F, Williams P R. et al . 3rd Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate ligament.  J Bone Joint Surg Am. 1994;  76 555-560
• 34 Spencer J D, Hayes K C, Alexander I J. Knee joint effusion and quadriceps reflex inhibition in man.  Arch Phys Med Rehabil. 1984;  65 171-177
• 35 Stener B. Reflex inhibition of the quadriceps elicited from a subperiosteal tumour of the femur.  Acta Orthop Scand. 1969;  40 86-91
• 36 Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint.  Acta Chir Scand. 1962;  124 396-411
• 37 Sterling M, Jull G, Wright A. Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity.  Man Ther. 2001;  6 72-81
• 38 Sterling M, Jull G, Wright A. The effect of musculoskeletal pain on motor activity and control.  J Pain. 2001;  2 135-145
• 39 Stevens J E, Mizner R L, Snyder-Mackler L. Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis.  J Orthop Res. 2003;  21 775-779
• 40 Stokes M, Young A. The contribution of reflex inhibition to arthrogenous muscle weakness.  Clin Sci (Lond). 1984;  67 7-14
• 41 Stratford P. Electromyography of the quadriceps femoris muscles in subjects with normal knees and acutely effused knees.  Phys Ther. 1982;  62 279-283
• 42 Wyke B. The neurology of joints.  Ann R Coll Surg Engl. 1967;  41 25-50
• 43 www.medpilot.de (2004). 
• 44 Young A. Current issues in arthrogenous inhibition.  Ann Rheum Dis. 1993;  52 829-834