Bewegungsverhalten des N. medianus bei Karpaltunnelsyndrom während physiologischer Bewegungen der HWS, Schulter und Hand

Zusammenfassung

Der N. medianus besitzt die Fähigkeit, bei Extremitätenbewegungen in seinem umliegenden Gewebe zu gleiten. Dieses wichtige physiologische Phänomen minimiert bei Engpasssyndromen Zug und Druck auf den Nerv. Das Karpaltunnelsyndrom (CTS) stellt in der Praxis die am häufigsten auftretende und stark behandlungsresistente periphere Neuropathie dar. Die verminderte Dynamik des N. medianus kann ein beitragender Faktor eines lange bestehenden CTS sein.

Die vorliegende Querschnittstudie untersuchte die transversale Gleitfähigkeit des N. medianus mittels sonografischer Diagnostik an CTS-Patienten (Gruppe A). Die Nervenbewegung wurde hierfür durch passive Bewegungsmanöver an der HWS mittels einer Kontralateralflexion und einem Cervical lateral glide sowie durch aktive Bewegungen der Finger und der Schulter provoziert. Die Ergebnisse wurden im Anschluss mit den Resultaten einer früheren Untersuchung gleicher Art an gesunden Probanden (Gruppe B) verglichen. Die Bewegungsmanöver der oberen Extremität wurden zudem an gesunden Probanden durchgeführt (Gruppe B 2).

Das Ziel der Studie war es herauszufinden, ob die Manöver einen signifikanten Einfluss auf die Gleitfähigkeit sowie auf die Größe des Flächeninhalts des N. medianus ausüben und ob sich die Veränderungen in der CTS-Gruppe im Gegensatz zur Kontrollgruppe signifikant unterschiedlich darstellen.

Sowohl distale Bewegungen der Fingergelenke als auch die zervikalen Bewegungsmanöver beeinflussten das transversale und longitudinale Gleiten des N. medianus. Am Unterarm zeigten sich deutliche Unterschiede in der Nervenbewegung zwischen den gesunden und den CTS-Probanden, was auf einen möglichen Einfluss des Cervical lateral glide auf die Neurodynamik des N. medianus bei CTS hindeutet.

Abstract

During limb movements the median nerve has the ability to glide against its surrounding tissues. This important physiological phenomenon minimises tension and compression on the nerve in the case of entrapment syndrome. In everyday practice the carpal tunnel syndrome (CTS) is the most common and extremely treatment resistant peripheral neuropathy. Decreased median nerve dynamics can be a contributing factor of persisting CTS.

This cross-sectional study investigated transverse gliding of the median nerve in CTS patients (group A) using sonographic diagnosis. Neural movement was provoked by passive movement manoeuvres in cervical spine through contralateral side flexion and cervical lateral glide as wells as active movements of fingers and shoulder. The results were compared to those of an earlier similar investigation with healthy subjects (group B). In addition, upper extremity movement manoeuvres were performed in healthy subjects (group B 2).

The purpose of this article was to investigate whether the manoeuvres have significant influence on gliding as well as on the medial nerve’s surface area size and whether the CTS group’s changes can significantly distinguished from those of the control group.

Transverse and longitudinal glide of the median nerve are affected by distal finger joint movements as well as by cervical movement manoeuvres. Distinct nerve movement differences between the healthy and the CTS subjects were demonstrated at the forearm which suggests a possible influence of cervical glide on median nerve neurodynamics in cases of CTS.

Sonografie - Nervenmobilisation - Nervengleiten - N. medianus - Karpaltunnelsyndrom

sonography - nerve mobilisation - nerve gliding - median nerve - carpal tunnel syndrome

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