Author/Editor		Lonzarić, Dragan
Title		Ultrazvočna diagnostika Ahilove in patelarne tendinopatije v rehabilitacijski medicini
Type		članek
Source		In: Čelan D, editor. Fizikalna in rehabilitacijska medicina nekoč, danes in jutri: zbornik strokovnih prispevkov ob 50 letnici Inštituta za fizikalno in rehabilitacijsko medicino v UKC Maribor. Maribor: Univerzitetni klinični center,
Publication year		2010
Volume		str. 61-71
Language		slo
Abstract		Ultrasound diagnostics is an ideal diagnostic method for soft tissue diagnosis of motor system diseases and injuries. Tendon injuries can be acute and chronic. Achilles and patellar tendinopathy is treated within overload syndromes where pathological entities are connected in a sequence; first it starts with tendinitis, continues with mucoid and calcific degeneration, and ends with complete tendons rupture. Achilles tendon is most frequently damaged in its middle part and patellar in the proximal insertion. The usual ultrasound signs of tendinopathy are swelling and hypoechogenity of the injured tendon part: it is also possible to demonstrate the calcifying changes, ruptures, enthesitis, bursitis, and paratenonitis. The process of neoneurovascularisation is decisive in pathohistology of tendinopathy and can be effectively monitored by Power-Doppler (PD). Treating tendinopathies is above all conservative: relative rests, non-steroid antirheumatics, and physical therapy. Steroid injections in the area besides the tendons and neighbouring bursae can be successfully applied under the control of a diagnostic ultrasound. The effect of eccentric exercises, which are the basis for kinesiotherapy of tendinopathy, is possible to objectivize with PD. Using ultrasound, it is also possible to perform a therapeutic hypervolume infiltration, which is one of latest therapeutic procedures to mechanically suspend neovascularization. Ultrasound used to be used for diagnostic confirmation of tendinopathy, but today it is an extension of the specialist's hand since besides the diagnostic possibilities also helps in applying therapies and evaluation of their effectiveness. With further development of ultrasound technology and education of physical and rehabilitation medicine specialists in ultrasound diagnosis and therapy, it is possible to expect larger clinical application and use of ultrasound diagnosis in rehabilitation of patients with motor system defects.
Summary		Ultrazvočna diagnostika je idealna diagnostična metoda za mehkotkivno diagnostiko bolezni in poškodb gibalnega sistema. Okvare kit so lahko akutne in kronične. Ahilova in patelarna tendinopatija se obravnava v okviru preobremenitvenih sindromov, kjer so patološke entitete povezane v soslednje, ki se začne s tendinitisom, nadaljuje z mukoidno in kalcifikantno degeneracijo ter zaključi s popolnim raztrganjem kite. Ahilova kita je najpogosteje okvarjena na srednjem delu, patelarna pa na proksimalnem narastišču (koleno skakalca). Običajni ultrazvočni znaki tendinopatije so zadebeljenost in hipoehogenost okvarjenega dela kite, možno pa je prikazati tudi kalcinirajoče spremembe, raztrganja, entezofite, burzitise in paratenonitis. Proces neonevrovaskularizacije je odločilen v patohistologiji tendinopatij in se lahko kakovostno spremlja s Power-Dopplerjem (PD). Zdravljenje tendinopatij je predvsem konzervativno: relativni počitek, nesteroidni antirevmatiki in fizikalna terapija. Steroidne injekcije v predel ob kitah in v sosednje burze se lahko uspešno aplicirajo pod kontrolo diagnostičnega ultrazvoka. Učinek ekscentričnih vaj, ki so osnova kinezioterapije tendinopatij, je možno objektivizirati s PD. S pomočjo ultrazvoka je možno izpeljati tudi terapevtsko hipervolumno infiltracijo, ki je ena od novejših terapevtskih postopkov s katero je možno mehanično prekiniti neovaskularizacijo. Nekoč se je ultrazvok rabil za diagnostično potrjevanje tendinopatij, danes pa je podaljšana roka specialista fizikalne in rehabilitacijske medicine, saj mu poleg diagnostičnih možnosti pomaga pri aplikaciji terapij ter ocenjevanja učinkovitosti le-teh. Z nadaljnim razvojem ultrazvočne tehnologije in edukacijo specialistov fizikalne in rehabilitacijske medicine v ultrazvočni diagnostiki in terapiji je možno pričakovati večjo klinično razširjenost in uporabo ultrazvočne diagnostike v rehabilitaciji bolnikov z okvarami gibalnega sistema.