Konservative Ansätze beim Karpaltunnelsyndrom

Zusammenfassung

Ziel dieser Literaturübersicht ist es, die konservativ-therapeutischen Möglichkeiten des Karpaltunnelsyndrom (KTS) darzustellen. Eine EDV-unterstützte Literatursuche wurde unter Verwendung gängiger Literaturdatenbanken zur Beantwortung o. g. Fragestellung durchgeführt. Berücksichtigt wurden systematische Übersichtsarbeiten über randomisierte kontrollierte Studien und Originalarbeiten, die sich mit diesem Thema beschäftigen. Lege artis erfolgt die Diagnose des KTS durch Anamnese, klinische und elektrodiagnostische Untersuchung. Die the-rapeutischen Möglichkeiten beinhalten 1) ein operatives oder 2) ein nicht operatives Vorgehen. Dabei können primär konservative Therapiemaßnahmen wie z. B. Infiltrationen (Evidenzgrad B), Schienenbehandlung (Evidenzgrad B), Ultraschalltherapie (Evidenzgrad B), Iontophorese (unkontrollierte Studien) angeboten werden. Bei operierten Patienten besteht die Rehabilitation einerseits in einer Bewegungstherapie und einem Funktionstraining der Hand (Evidenzgrad B), andererseits in einer konsequenten Narbenbehandlung mittels Ultraschall- und Lasertherapie und einer Behandlung von postoperati-ven Schwellungen mittels z. B. Lymphdrainagen, CO2-Bädern, etc. Die Behandlung postoperativer Schmerzzustände der Hand erfolgt mittels medikamentöser (Evidenzlevel A) und physikalischer Therapiemaßnahmen. Die Etablierung sog. „State of the art”-Regime in Diagnostik und Therapie ist ein wichtiger Schritt zur Optimierung der Betreuung von KTS-Patienten mit konservativen Maßnahmen. Aufgrund der limitierten Datenlage erscheinen künftige, randomisierte, kontrollierte klinische Studien zu diesem Thema dringend notwendig.

Abstract

The purpose of this study was to investigate the effects of non-operative treatment options for carpal tunnel syndrome (CTS). These treatment options include 1) (only) conservative treatments and 2) postoperative rehabilitation. Meta-analyses and original articles concerning this topic were included in this investigation. State of the art CTS can be diagnosed by anamnesis, physical examination, and electrophysiological investigation. Treatment-options of CTS are 1) surgical treatment and 2) non surgical treatment options like splinting (evidence level B), steroid injections (evidence level B), ultrasound treatment (evidence level B), iontophoresis. After surgical treatment, rehabilitation goals are achieved by using different active and passive modalities. These are physiotherapy and ergotherapy (to accelerate recovery) (evidence Level B), ultrasound and Laser-therapy (for treatment of scars), lymph-massage and Co2-baths (for treatment of swelling and oedema). After surgical treatment pain is treated using pharmacological (evidence level A) and physical-medical modalities. Establishing so called “state of the art regimen” in diagnosis and therapy is a very important step to optimize the treatment of patients suffering from CTS. Due to the lack of knowledge about this topic, further randomised controlled high quality clinical studies investigating the non-surgical treatment options of CTS would be necessary.

Schlüsselwörter

Karpaltunnelsyndrom - konservative Therapiemaßnahmen - postoperative Rehabilitaion - „state of the art”

Key words

Carpal tunnel syndrome - non-surgical treatment options - postoperative Rehabilitation - “state of the art”

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