Diagnostik und Therapie des Karpaltunnelsyndroms

Ulrich Frank; Konstantin Frank

doi:10.1055/a-0977-4886

Handchirurgie Scan, Table of Contents

Handchirurgie Scan 2019; 08(04): 283-296
DOI: 10.1055/a-0977-4886

CME-Fortbildung

Nervenkompressionssyndrome

Diagnostik und Therapie des Karpaltunnelsyndroms

Ulrich Frank

,

Konstantin Frank

Subject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Dr. med. Ulrich Frank, Augsburg.

Abstract

Die Druckschädigung des N. medianus im Karpalkanal ist das häufigste Kompressionssyndrom eines peripheren Nerven beim Menschen. Die Diagnostik basiert auf Anamnese, klinischer und elektrophysiologischer Untersuchung sowie ggf. Bildgebung. Die konservativen und operativen Therapieoptionen werden in diesem Beitrag vorgestellt.

Schlüsselwörter

Karpaltunnel - Diagnostik - Karpaldachspaltung - Handchirurgie

Full Text

References

Literatur
1 Paget J. Lectures on Surgical Pathology. Philadelphia: Lindsay and Blakistone; 1854
2 Abbott L, Saunders J. Injuries of the median nerve in fractures of the lower end of the radius. Surg Gynecol Obs 1933; 57: 507-516
3 Gelberman RH, Szabo RM, Mortensen WW. Carpal tunnel pressures and wrist position in patients with collesʼ fractures. J Trauma 1984; 24: 747-749
4 Raynaud M. De l’asphysie Locale et de La Gangrène Symétrique Des Extrémités. Paris: Rignoux; 1888
5 Putnam J. A series of cases of paraesthesia, mainly of the hands, of periodical recurrence, and possibly of vaso-motor origin. Arch Med 1880; 4: 147-162
6 Keen W. The symptomatology, diagnosis and surgical treatment of cervical ribs. Am J Med Sci 1907; 133: 193
7 Learmonth J. The principle of decompression in the treatment of certain diseases of peripheral nerves. Surg Clin North Am 1933; 13: 905-913
8 Cannon B, Love J. Tardy median palsy; median neuritis; median thenar neuritis amenable to surgery. Surgery 1946; 20: 210-216
9 Phalen G, Gardner W, La Londe A. Neuropathy of the median nerve due to compression beneath the transverse carpal ligament. J Bone Joint Surg Br 1950; 32: 109-112
10 Schmidt HM, Lanz U. Chirurgische Anatomie der Hand. Stuttgart: Thieme; 2013
11 Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am 1977; 2: 44-53
12 Watchmaker GP, Weber D, Mackinnon SE. Avoidance of transection of the palmar cutaneous branch of the median nerve in carpal tunnel release. J Hand Surg Am 1996; 21: 644-650
13 Giersiepen K, Spallek M. Carpal Tunnel Syndrome as an Occupational Disease. Dtsch Aerzteblatt Online 2011;
14 Atroshi I, Gummesson C, Johnsson R. et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282: 153-158
15 Williams TM, Mackinnon SE, Novak CB. et al. Verification of the pressure provocative test in carpal tunnel syndrome. Ann Plast Surg 1992; 29: 8-11
16 Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet 1973; 18: 359-362
17 Katz JN, Larson MG, Sabra A. et al. The Carpal Tunnel Syndrome: Diagnostic Utility of the History and Physical Examination Findings. Ann Intern Med 1990; 112: 321
18 Werner RA, Bir C, Armstrong TJ. Reverse Phalenʼs maneuver as an aid in diagnosing carpal tunnel syndrome. Arch Phys Med Rehabil 1994; 75: 783-786
19 Durkan JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am 1991; 73: 535-538
20 Schmitt R, Lanz U. Bildgebende Diagnostik der Hand. Stuttgart: Thieme; 2014
21 Fischer W. MR-Atlas.com. Lehrbuch und Fallsammlung zur MRT des Bewegungsapparats. Mr-Verlag; 2014
22 Kluge S. Ultraschalldiagnostik von Kompressionsneuropathien: Karpaltunnelsyndrom. Handchir Scan 2017; 06: 291-307
23 Katz JN, Keller RB, Simmons BP. et al. Maine carpal tunnel study: Outcomes of operative and nonoperative therapy for carpal tunnel syndrome in a community-based cohort. J Hand Surg Am 1998; 23: 697-710
24 Tittiranonda P, Rempel D, Armstrong T. et al. Effect of four computer keyboards in computer users with upper extremity musculoskeletal disorders. Am J Ind Med 1999; 35: 647-661
25 Rempel D, Tittiranonda P, Burastero S. et al. Effect of keyboard keyswitch design on hand pain. J Occup Environ Med 1999; 41: 111-119
26 Burke DT, Burke MM, Stewart GW. et al. Splinting for carpal tunnel syndrome: in search of the optimal angle. Arch Phys Med Rehabil 1994; 75: 1241-1244
27 Walker WC, Metzler M, Cifu DX. et al. Neutral wrist splinting in carpal tunnel syndrome: A comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil 2000; 81: 424-429
28 Graham BA. Two weeks of prednisolone was as effective as four weeks in improving carpal tunnel syndrome symptoms. J Bone Joint Surg Am 2003; 85: 1624
29 Marshall SC, Tardif G, Ashworth NL. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; 2: CD001554. doi:10.1002/14651858.CD001554.pub2
30 Chow JC. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy 1989; 5: 19-24
31 Okutsu I, Ninomiya S, Takatori Y. et al. Endoscopic management of carpal tunnel syndrome. Arthroscopy 1989; 5: 11-18
32 Agee JM, McCarroll HR, Tortosa RD. et al. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am 1992; 17: 987-995
33 Klein RD, Kotsis SV, Chung KC. Open Carpal Tunnel Release Using a 1-Centimeter Incision: Technique and Outcomes for 104 Patients. Plast Reconstr Surg 2003; 111: 1616-1622
34 Lalonde D, Eaton C, Amadio P. et al. Wide-awake Hand and Wrist Surgery: A New Horizon in Outpatient Surgery. Instr Course Lect 2015; 64: 249-259
35 Koegst WHH, Wölfle O, Thoele K. et al. Der Wide Awake Approach in der Handchirurgie – ein komfortables Anästhesieverfahren ohne Blutleere. Handchirurgie Mikrochirurgie Plast Chir 2011; 43: 175-180
36 Hahn K, Urban P, Meliß RR. et al. Karpaltunnelsyndrom und ATTR-Amyloidose. Handchir Mikrochir Plast Chir 2018; 50: 329-334
37 Frank U, Giunta R, Krimmer H. et al. Neueinbettung des N. medianus nach Vernarbung im Karpalkanal mit der Hypothenar-Fettgewebslappenplastik. Handchir Mikrochir Plast Chir 1999; 31: 317-322