Rehabilitation der chinoloninduzierten Tendinopathie der Achillessehne^[1]

Zusammenfassung

Hintergrund Der Einsatz von Antibiotika gehört zum medizinischen Alltag. Ein dabei häufig eingesetzter Wirkstoff ist die Gruppe der Chinolone. Physiotherapeutisch relevant sind deren muskuloskeletale Nebenwirkungen, insbesondere auf das Sehnengewebe. Meist sind die Achillessehnen durch Tendinopathien oder Rupturen betroffen. Es besteht ein Mangel an Literatur bezüglich der Pathophysiologie als auch der Rehabilitation dieser klinischen Muster.

Ziel Diese Fallstudie evaluierte die Anwendung eines exzentrischen Trainingsprotokolls bei chinoloninduzierter Tendinopathie der Achillessehne.

Methode Die physiotherapeutische Rehabilitation einer 48-jährigen Frau mit unilateraler Tendinopathie der Achillessehne unter Einnahme des Antibiotikums Ciprofloxacin nach Lungentransplantation wird beschrieben. Dabei wurde ein kriterienbasierter Ansatz mit ausschließlich Hands-off-Therapie unter Einsatz eines exzentrischen Belastbarkeitsaufbaus der Achillessehne angewendet.

Ergebnisse Nach 9 Einzeltherapien fanden sich Verbesserungen beim 1-Minute-Sitz-Stand-Test, der Range of Motion bei Dorsalextension des oberen Sprunggelenks rechts, beidseitige Kraft von Knieextensoren und -flexoren, Dorsalextensoren und Plantarflexoren des oberen Sprunggelenks, beim VISA-A-Fragebogen sowie bei Schmerz und Partizipation.

Schlussfolgerungen Bei chinoloninduzierter Tendinopathie der Achillessehne ist ein exzentrisch betontes Trainingsprotokoll durchführbar und wirksam, wobei die zahlreichen Komorbiditäten der primär betroffenen Population zu beachten sind. Da Physiotherapeuten aufgrund der demografischen Entwicklung zunehmend mit hochkomplexen Fällen konfrontiert werden, ist es für sie wichtig, die unerwünschten Wirkungen von Medikamenten zu kennen.

Abstract

Background The use of antibiotics is a common medical treatment. Frequently used agents are quinolones. Relevant in physiotherapy are their musculoskeletal side effects, predominantly on tendon tissues. The Achilles tendons are usually affected by tendinopathies and ruptures. There is a lack of literature regarding the pathophysiology as well as the rehabilitation of these clinical patterns.

Objective This case study evaluated the use of eccentric training in quinolone-induced Achilles tendinopathy.

Method The physiotherapeutic rehabilitation of a 48-year old woman with unilateral Achilles tendinopathy due to antibiotic ciprofloxacin therapy after lung transplantation is described. A criterion-based therapy regimen with exclusively hands-off treatment and focus on eccentric load development of the Achilles tendon was applied.

Results After 9 single-case sessions improvements of the 1-minute-sit-to-stand test, the range of motion in dorsal extension of the right talocrural ankle, the both-sided strength of knee extensors and flexors, dorsal extensors and plantar flexors of the talocrural ankle, the VISA-A questionnaire as well as of pain and participation were found.

Conclusions A heavy load eccentric training protocol is feasible and effective in quinolone-induced Achilles tendinopathy. The several comorbidities of the primarily affected population must, however be considered. Since physiotherapists will increasingly be faced with multi-dimensional cases, it is important for them to know about the unwanted side effects of drugs.

Schlüsselwörter

Tendinopathie - Physiotherapie - Rehabilitation - Antibiotika - Fallstudie

Key words

tendinopathy - physiotherapy - rehabilitation - antibiotics - case study

¹ Die Fallstudie verfasste D. Kohlbrenner als Leistungsnachweis im Studiengang MSc Physiotherapie der ZHAW Gesundheit, Winterthur.

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