Aşil Tendinopatisi ve Klinik Değerlendirilmesi
Özet
Aşil tendinopatisi, genellikle sporcuları etkilese de aktif olmayan kişileri de etkileyen bir durumdur. Genel popülasyonda Aşil tendonunun rüptürünün insidansı 100.000 kişide 5 ila 10 arasında olsa bile, bazı gruplarda daha yüksek gözlenebilmektedir. Bu durum artış da gösterebilir. Aşil tendon rüptürü yaralanmalarının büyük bir kısmı rekreasyonel sporlar sırasında ortaya çıkmaktadır. Rekabetçi sporcular arasında Aşil tendinopatisi yaşam boyu insidansı yüzde 24 civarında seyrederken ve genç sporcularda bu durum daha sık gözlenmektedir. Özellikle koşu sporlarıyla uğraşan sporcularda Aşil tendinopatisi riski daha yüksektir. Bununla birlikte, rekreasyonel koşucularda rüptür olasılığı daha düşük gözlenmesine rağmen, yine de koşu yaralanmalarının önemli bir kısmını aşil tendon rüptürü oluşturur.. Aşil tendinopatisi risk faktörleri arasında soğuk hava, daha önceden geçirilen tendon hastalıkları, uygun olmayan koşu mekaniği ve kullanılan ayakkabılar, yaş, erkek cinsiyet ile obezite gibi durumlar bulunmaktadır. İlaçlar arasında florokinolon grubu antibiyotikler nadiren Aşil tendinopatisi veya tendon rüptürü ile ilişkilendirilirken, oral glukokortikoidler tek başına tendinopati riskini artırabilmektedir. Ayrıca, hipertansiyon, psoriasis ve ankilozan spondiloz gibi sistemik hastalıklar da Aşil tendinopatisi ile ilişkilendiği çalışmalar mevcuttur. Aşil tendon ağrısı genellikle spor aktivitelerinin kasların kaldırabileceğinden fazla artırılmasıyla ortaya çıkar, ancak kronik tendon ağrısı sürekli stres veya kötü koşu mekaniği gibi nedenlerle de olabilir. Tendon rüptürü, zaten zayıflamış veya dejenerasyon gösteren bir tendona ani bir kesme stresi uygulandığında meydana gelir. Tanıda klinik muayene önemlidir ve tanıda ultrason veya manyetik rezonans görüntüleme gibi görüntüleme yöntemlerine başvurulmaktadır. Aşil tendinopatisi ve rüptürü, tedavi ve rehabilitasyon süreçlerinin uygun şekilde yönetilmesi için doğru tanının konması ve uygun yöntemlerin seçilmesi açısından önemlidir.
Achilles tendinopathy is a condition that usually affects athletes but can also affect inactive people. Although the incidence of rupture of the Achilles tendon in the general population is between 5 and 10 per 100,000, it may be higher in some groups. The incidence may also increase. The majority of Achilles tendon rupture injuries occur during recreational sports. The lifetime incidence of Achilles tendinopathy among competitive athletes is around 24 per cent, with a higher incidence in young athletes. The risk of Achilles tendinopathy is particularly high in athletes involved in running sports. However, although the probability of rupture is lower in recreational runners, Achilles tendon rupture still accounts for a significant proportion of running injuries. Risk factors for Achilles tendinopathy include cold weather, previous tendon diseases, inappropriate running mechanics and footwear, age, male gender and obesity. Among medications, fluoroquinolone group antibiotics are rarely associated with Achilles tendinopathy or tendon rupture, while oral glucocorticoids alone may increase the risk of tendinopathy. In addition, systemic diseases such as hypertension, psoriasis and ankylosing spondylosis have also been associated with Achilles tendinopathy.
Achilles tendon pain usually occurs when sporting activities are increased beyond what the muscles can handle, but chronic tendon pain can also be caused by constant stress or poor running mechanics. Tendon rupture occurs when a sudden shear stress is applied to an already weakened or degenerating tendon. Clinical examination is important in the diagnosis and imaging modalities such as ultrasound or magnetic resonance imaging are used in the diagnosis. Achilles tendinopathy and rupture are important for making the correct diagnosis and selecting the appropriate methods to manage the treatment and rehabilitation processes appropriately.
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