Chirurgische Anatomie des Karpaltunnels

Zusammenfassung

Der Karpaltunnel ist der Verbindungsraum zwischen dem palmaren distalen Unterarm und dem mittleren Fach der tiefen Hohlhand. Er enthält die Sehnen der langen Finger- und Daumenbeugemuskeln sowie den N. medianus. Bei einem Missverhältnis zwischen dem Raumangebot des Karpaltunnels und seinem Inhalt kann es zu Druckerhöhungen im Tunnel kommen. Hierbei besteht die Gefahr eines Kompressionsschadens für den N. medianus. Der Karpaltunnel wird vom Retinaculum flexorum bedeckt. Dessen Längen- und Breitenausdehnungen entsprechen sehr genau den Größenmerkmalen des Tunnels. Er kann radial und ulnar durch randständige Handwurzelknochen ebenso eingeengt werden wie durch das Os capitatum in seinem Bodenbereich. Der N. medianus verläuft in der Regel radial von der Mitte des Retinaculum flexorum im Tunneldach weitgehend gerade zur Hohlhand. Zahlreiche Abweichungen seines Verlaufes, atypische Teilungen, akzessorische Äste und Besonderheiten der Verzweigungen des Ramus thenaris des N. medianus werden beschrieben.

Abstract

The carpal tunnel is the pathway between the flexor compartment of the distal forearm and the midpalmar space of the hand. It contains all the long finger and thumb flexor tendons including the median nerve. In cases of a discrepancy between the volume of the carpal tunnel in relation to its contents, high pressures in this region can result. There is a risk that the median nerve will be sustained by compression. The carpal tunnel is covered by the flexor retinaculum. Length and width of the retinaculum correspond to the extension of the tunnel. Radial und ulnar osseous walls can narrow the tunnel diameter as well as an prominent capitate bone at the floor. The median nerve normally courses the tunnel radially near the middle of the flexor retinaculum far reaching straight to the midpalmar region. Several deviations of its tunnel course, atypical divisions, accessory branches and variations of the ramification of the thenar branch of the median nerve are described.

Schlüsselwörter

Karpaltunnel - Retinaculum flexorum - N. medianus

Key words

Carpal tunnel - flexor retinaculum - median nerve

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