Diagnostik und Therapie des Karpaltunnelsyndroms

Zusammenfassung

Evidenzbasierte fachübergreifende Leitlinie, die sich mit Epidemiologie, Pathogenese, Symptomatik, klinischer und elektrophysiologischer Diagnostik, der bildgebenden Zusatzdiagnostik, Differenzialdiagnose, der konservativen und operativen Behandlung, Prognose und Verlauf und den Komplikationen und Revisionseingriffen beschäftigt. Die Empfehlungen zu Diagnostik und Therapie gründen sich auf eine umfassende Literaturrecherche mit kritischer Bewertung und zwei Konsensusverfahren (Expertengruppe und Delphi-Verfahren) innerhalb der beteiligten Fachgesellschaften. Neben dieser Langversion können eine Kurzversion und eine Patientenversion über die AWMF-Plattform eingesehen werden. Entstehung der Leitlinie und die methodischen Grundlagen sind in einem Methodenreport dokumentiert. Die wichtigsten Aussagen: Neben der Anamneseerhebung und der klinisch-neurologischen Untersuchung (einschließlich klinischer Tests) kommt vor allem der elektrophysiologischen Diagnostik (distal-motorische Latenz und sensible Neurografie) eine wichtige diagnostische Bedeutung zu. Röntgen, MRT, hochauflösende Sonografie sind als fakultative Zusatzdiagnostik zu werten. Unter den konservativen Behandlungsverfahren sind die Behandlung mit einer nächtlichen Schiene und die lokale Infiltration eines Kortikoid-Präparats wirksam. Oral verabreichte Kortikoide, Schienung, Ultraschall, Magnettherapie u. a. zeigen nur eine zeitlich begrenzte Wirkung. Die operative Behandlung ist allen anderen Verfahren eindeutig überlegen. Offene und endoskopische Operation sind (bei ausreichender Erfahrung des endoskopischen Operateurs) gleichwertig. Eine routinemäßige Epineurotomie ist ebenso wenig zu empfehlen wie eine interfaszikuläre Neurolyse. Nach dem Eingriff ist eine frühe funktionelle Behandlung wichtig.

Abstract

Evidence-based supradisciplinary guideline that deals with the epidemiology, pathogenesis, symptoms, clinical and electrophysiological diagnosis, supplementary imaging investigations, differential diagnosis, conservative and surgical treatments, prognosis and course along with complications and revision surgery. The recommendations on investigation and treatment are based on a comprehensive literature search with critical evaluation and two consensus methods (expert group and Delphi technique) within the participating specialist societies. Besides this long version, a short version and a patient version can be viewed through the AWMF platform. The development of the guideline and the methodological foundations are documented in a method report. Main Statements: Apart from an accurate history and clinical neurological examination (including clinical tests), electrophysiological investigations (distal motor latency and sensory neurography) are particularly important. Radiography, MRI, high-resolution ultrasonography can be regarded as optional supplementary investigations. Among conservative treatment methods, treatment with a nocturnal splint and local infiltration of a corticosteroid preparation are effective. Oral steroids, splinting and ultrasound showed only short-term benefit. Surgical treatment is clearly superior to all other methods. Open and endoscopic procedures (when the endoscopic surgeon has sufficient experience) are equivalent. A routine epineurotomy and interfascicular neurolysis cannot be recommended. Early functional treatment postoperatively is important.

Schlüsselwörter

elektrophysiologische Diagnostik - Karpaltunnelsyndrom - Leitlinie - evidenzbasiert - Neurografie - operative Behandlung - Retinakulumspaltung - offen - Retinakulumspaltung - endoskopisch

Key words

electrophysiological diagnosis - carpal tunnel syndrome - guideline - evidence‐based - neurography - surgical treatment - carpal tunnel release - open - carpal tunnel release - endoscopic

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18 Schlussbemerkungen

Die Leitlinie wurde unter der methodischen Beratung von Prof. Dr. H. K. Selbmann/Tübingen und der Koordination von Frau Prof. Dr. M. Wüstner-Hofmann/Ulm und Dr. H. Assmus/Dossenheim-Heidelberg von einem Expertengremium (H. Assmus, G. Antoniadis, C. Bischoff, P. Haußmann, A. K. Martini, Z. Mascharka, K. Scheglmann, K. Schwerdtfeger, H. K. Selbmann, H. Towfigh, T. Vogt, K. D. Wessels, M. Wüstner-Hofmann) entwickelt. Konsensfindung und Entstehung der Leitlinie sind in einem gesonderten Leitlinienreport beschrieben. Außer dieser Langfassung sind eine Kurzfassung und eine Patientenfassung verfügbar.

Eine Leitlinie gibt begründete Empfehlungen und erlaubt persönliche und fallbezogene Entscheidungen. Sie ist keine Handlungsvorschrift und nicht mit einer Richtlinie zu verwechseln. Diagnose- und Behandlungsverfahren sind ständigen Wandlungen unterworfen. Eine Leitlinie ist somit immer verbesserungsfähig.

Die nächste Überarbeitung ist 2009 vorgesehen.