Zusammenfassung
Das Karpaltunnelsyndrom (KTS) kann konservativ oder durch operative Durchtrennung
des Lig. carpi transversum behandelt werden. Bei fehlenden klaren Kriterien einer
Indikationsstellung muss diese vom individuellen Beschwerdebild und der Funktionsbeeinträchtigung
abhängig gemacht werden. Unter den konservativen Behandlungsmöglichkeiten erscheint
die volare Unterarmschiene in den Fällen sinnvoll, in denen die Beschwerdesymptomatik
durch bestimmte Auslösesituation provoziert wird und reversibel erscheint. Dies ist
insbesondere beim KTS in der Schwangerschaft zu erwägen. Andere konservative bzw.
semikonservative Verfahren, wie die Injektion von Kortison in den Karpaltunnel sollten
eher zurückhaltend eingesetzt werden und erscheinen in ihrer Wirkung nicht ausreichend
belegt. Persistieren die Beschwerden unter konservativer Therapie oder findet sich
elektrophysiologisch eine Schädigung des N. medianus, sollte eine frühzeitige Dekompression
des Nerven angestrebt werden. Die hierfür zur Verfügung stehenden Verfahren der offenen
und endoskopischen Dekompression erscheinen vom Ergebnis vergleichbar; möglicherweise
wird die Funktionsfähigkeit der Hand nach endoskopischer Entlastung etwas rascher
erreicht, im Gegenzug ist die Komplikationsrate etwas höher.
Treatment of Carpal Tunnel Syndrome
The carpal tunnel syndrome is the most common nerve entrapment syndrome which is determined
by individual complaints ranging from intermittent paraesthesia to persistent numbness
and muscular weakness and often by occupational problems. This article gives a review
of non-surgical and surgical procedures in the management of the disorder. In cases
without electrophysiologically proven nerve damage wrist splinting and occupational
rehabilitation is an otional conservative therapy. On the other hand oral steroids
or antiphlogistics and local steroid injections into the carpal tunnel give no convincing
long term effect. Surgical decompression of the median nerve is indicated if complaints
persist and nerve conduction is abnormal. The clinical outcome is excellent with surgical
treatment, both the standard open release and the endoscopic approach. While patients
may be able to use the hand earlier after endoscopic intervention, the rate of severe
complications is slightly lower with the open technique.
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PD Dr. Th. Vogt
Neurologische Universitätsklinik
Langenbeckstraße 1
55131 Mainz
Email: vogt@neurologie.klinik.uni-mainz.de
