Kann exzentrisches Training in der konservativen Therapie von chronischen Supraspinatus-Tendinopathien effektiv sein? Eine Übersicht zur aktuellen Literatur

Zusammenfassung

Exzentrisches Training (ET) hat sich als effektive Methode in der konservativen Therapie von chronischen Patellar- und Achillessehnen-Tendinopathien erwiesen. Bei muskulotendinösen Beschwerden der Schulterregion ist die Supraspinatussehne am häufigsten betroffen und weist in histopathologischen Untersuchungen starke Ähnlichkeiten zu Tendinopathien der unteren Extremität auf. Somit liegt die Frage nahe, ob ein Transfer des bekannten und etablierten exzentrischen Trainingskonzepts von der unteren auf die obere Extremität einen vergleichbar positiven Effekt erzielen kann. Evidenzbasierte Studien zur Unterstützung dieser Theorie sind bislang unter wissenschaftlichen Kriterien unzureichend. Dies liegt im Wesentlichen daran, dass die Supraspinatussehne Bestandteil einer biomechanisch komplexen Funktionseinheit ist und differenzialdiagnostisch häufig Begleitläsionen umliegender Strukturen vorliegen. Die grundsätzliche Ätiologie und Genese pathologischer Veränderungen der Supraspinatussehne und ihr individueller Einfluss auf Schulterbeschwerden sind noch nicht abschließend geklärt. Jedoch gibt der therapeutische Erfolg des ET im Bereich der unteren Extremität Anlass, diesen Ansatz wissenschaftlich aufzuarbeiten, um evidenzbasierte Leitlinien für die konservative Therapie von Tendinopathien der Schulter zu entwickeln. Vor dem Hintergrund des zugrunde liegenden, noch lückenhaften Fundaments und der anatomisch-funktionellen Einschränkungen soll dieser Artikel eine anwendungsorientierte Übersicht über den aktuellen Kenntnisstand geben.

Abstract

Eccentric training (ET) has been shown to be an effective conservative treatment option for chronic patellar and Achilles tendinopathies. As part of the four-muscle-tendon-complex of the rotator cuff, the supraspinatus is involved most commonly in shoulder disorders. Histopathologic alterations of the supraspinatus tendon are comparable to findings in lower extremity tendinopathies. Hence, the question arises whether the concept of eccentric training can be successfully transferred to the upper extremity. Yet, no randomised controlled trials have been published to support this theory. This problem emerges from the fact that the supraspinatus is part of a complex functional unit. Consequently, surrounding soft tissues are frequently concomitantly affected. The inherent etiology and genesis of pathologic alterations in the supraspinatus tendon and its influence on shoulder disorders is not clear to date. However, the apparent success of ET in managing tendinopathies of the lower extremity urges further scientific work for developing evidence-based guidelines for the conservative treatment of tendinopathies in the shoulder region. Taking into account this lack of data as well as the anatomical and functional constraints, the aim of this work is to review the current state of the literature.

Supraspinatus - Tendinopathie - exzentrisches Training - Rehabilitation - konservative Therapie

supraspinatus - tendinopathy - eccentric training - rehabilitation - conservative treatment

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