Läsionen des Nervus interosseus anterior – Differenzierung zwischen Nervenkompression und Neuritis

Zusammenfassung

Hintergrund Im klinischen Alltag ist bei einem Nervus-interosseus-anterior-Syndrom die Differenzierung der Ätiologie zwischen Kompressionsneuropathie und neuritischem Syndrom häufig komplex.

Material und Methoden Anhand eines aktuellen Literaturüberblicks erfolgt die Analyse der klinischen Besonderheiten sowie der Möglichkeit der diagnostischen Aufarbeitung des neuritischen Nervus-interosseus-anterior-Syndroms in Abgrenzung zur Kompressionsneuropathie, um darauf basierend die therapeutischen Möglichkeiten darzulegen.

Ergebnisse Das Nervus-interosseus-anterior-Syndrom geht oft auf eine Neuritis der Fasern des Nervus interosseus anterior im Hauptstamm des Nervus medianus zurück. Die diagnostische Differenzierung von der Kompressionsneuropathie des Nervus interosseus anterior ist mithilfe einer dezidierten neurophysiologischen Abklärung sowie der Bildgebung mittels MR-Neurografie und Neurosonografie zuverlässig möglich. Therapeutisch stehen konservative Maßnahmen im Vordergrund, operative, mikrochirurgische Interventionen gewinnen jedoch zunehmend an Bedeutung.

Schlussfolgerung Das Nervus-interosseus-anterior-Syndrom erfordert eine differenzierte Abklärung, um die Behandlung optimal steuern zu können. Während die konservative Therapie der Neuritis weiter der Goldstandard ist, kann bei bildmorphologischem Nachweis von Konstriktionen und Torsionen die interfaszikuläre Neurolyse erwogen werden und scheint hier zu einer Verbesserung der Ergebnisse zu führen.

Abstract

Background In cases of anterior interosseous nerve (AIN) syndrome, it is often difficult to differentiate between compression neuropathy and neuritis.

Material and Methods This review analyses the clinical aspects of the neuritic AIN syndrome and the different diagnostic tools for securing the diagnosis and differentiating the condition from compression neuropathy. Based on these data, the current therapeutic options are proposed.

Results The AIN syndrome often results from neuritis of the AIN fascicles within the trunk of the median nerve. The differentiation between neuritis and compression neuropathy of the AIN is based on dedicated neurophysiological examinations as well as nerve sonography and MRI neurography. Although conservative treatment is the gold standard, microsurgical interventions have become more important in recent years.

Conclusion A dedicated diagnostic workup of the AIN syndrome is paramount for optimal treatment. Conservative treatment remains the standard to date. However, if torsions and constrictions of nerve fascicles are detected, intrafascicular neurolysis should be considered, as current research shows the potential for an improved outcome in such cases.

Schlüsselwörter

Kompression - MR-Neurografie - Nerven - Neuritis - Neurosonografie

Key words

Compression - nerves - neuritis - peripheral nerve sonography - MRI neurography

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