Differentialtherapeutische Herangehensweisen zur Behandlung des Karpaltunnelsyndroms

Zusammenfassung

Das Karpaltunnelsyndrom (KTS) stellt die häufigste kompressionsbedingte Neuropathie dar. Die Therapieführung ist patientenindividuell zu gestalten. Die initiale konservative Therapie hat insbesondere im Anfangsstadium einen hohen Stellenwert. Die Indikation zur primären chirurgischen Therapie besteht bei therapierefraktären Situationen, ab mittelschweren Stadien oder bei Vorliegen relevanter Begleiterkrankungen (Raumforderungen, komplex regionalem Schmerzsyndrom, diabetische Polyneuropathie) und zunehmend auch beim KTS in der Schwangerschaft. Die unterschiedlichen Operationstechniken, deren differentialtherapeutische Anwendung, sowie deren Vor- und Nachteile sollen in dieser Arbeit pragmatisch dargestellt werden. Auch die herausfordernden Rezidivsituationen und -eingriffe werden hierbei herausgehoben. Vor dem Hintergrund der neu erschienenen aktualisierten S3-Leitlinie „Diagnostik- und Therapie des Karpaltunnelsyndroms“ hat dieser Themenbereich eine aktuelle Relevanz.

Abstract

Carpal tunnel syndrome (CTS) is one of the most common compression neuropathies. The therapeutic concept should be tailored to each patient individually, with initial non-surgical treatment being the standard of care for early CTS. Primary surgical intervention should be considered in more advanced diseases stages, in case of concomitant pathologies (including space-occupying lesions, complex regional pain syndrome or diabetic neuropathy), if non-surgical strategies have failed or in pregnancy-related CTS. This work aims to discuss common surgical approaches, their clinical application as well as benefits and disadvantages in a pragmatic style. Further, we highlight surgical strategies to address recurrent CTS following failed primary surgery. In view of the recently updated S3 guidelines “Diagnosis and Therapy of Carpal Tunnel Syndrome”, this topic is timely and relevant for hand and nerve surgeons.

Schlüsselwörter

Nervenkompression - Karpaltunnelsyndrom - Rezidiv - Indikationen - konservative Therapie - OP-Techniken - offene Dekompression - endoskopische Dekompression - biportale Dekompression

Key words

Compression neuropathy - carpal tunnel syndrome - recurrent CTS - indications - conservative therapy - surgical techniques - open release - endoscopic release - biportal release

Publication History

Received: 01 March 2022

Accepted: 26 April 2022

Article published online:
10 June 2022

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