Tendinopathien der oberen Extremität I (allgemeiner Teil)

Sehnenverletzungen und -erkrankungen stellen häufige medizinische Behandlungsindikationen dar. Je nach Lokalisation verfügen Sehnen über einen spezifischen und zum Teil äußerst komplexen Aufbau, der unterschiedlicher Behandlungsoptionen bedarf. Die Kenntnis der anatomischen und (patho-)physiologischen Grundlagen sowie der zur Verfügung stehenden Therapieoptionen ist deshalb essenzielle Voraussetzung für eine erfolgreiche Behandlung.

Kernaussagen

• Tendinopathien bezeichnen primär Erkrankungen des Sehnengewebes, die durch eine Kombination aus Überbelastung in Form repetitiver Mikrotraumata, intrinsischen und extrinsischen Faktoren verursacht werden.

• Das Sehnengewebe ist streng hierarchisch angeordnet, wobei sich aus mehreren kleineren Organisationseinheiten stets eine übergeordneten Struktureinheit zusammensetzt.

• Die Folgen einer übermäßigen Beanspruchung des Sehnengewebes können anhand einer charakteristischen Stressbelastungskurve verdeutlicht werden. Ab > 8% Dehnung kommt es zu einer Ruptur des Sehnengewebes.

• Die Sehnenheilung erfolgt in 3 aufeinanderfolgenden, sich z. T. überlappenden Phasen: inflammatorische, proliferative und Remodelingphase.

• Zelluläre, molekulare und biomechanische Mediatoren spielen eine zentrale Rolle für die Sehnenheilung.

• Zu den Therapieoptionen gehören konservative, operative, genbasierte, augmentierende, pharmakologische, biologische und additive Verfahren.

• Zahlreiche Therapieoptionen wurden in der Literatur untersucht. Hierbei konnten vielversprechende Ergebnisse erzielt werden. Dennoch konnte sich in der Therapie bisher kein Goldstandard etablieren.

Schlüsselwörter

obere Extremität - Sehnenläsion - Sehnenverletzung - Sehnenruptur - muskulotendinöse Einheit

Publication History

Article published online:
24 March 2025

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