Seltene Nervenkompressionssyndrome

Zusammenfassung

Seltene Kompressionssyndrome

Angesichts ihrer langen Verläufe, den komplexen Topographien zwischen Muskeln, unter Bändern und Muskelfaszienkanten sowie dem Verlauf nahe knöcherner Strukturen sind periphere Nerven prädisponiert für lokale Kompressionen. Daraus resultieren viele Engpasssyndrome – für fast jeden Nerv ist ein solches beschrieben. Der Artikel soll eine systematische Übersicht über Symptome, Diagnostik und Therapie geben, wobei er sich auf die weniger bekannten Syndrome konzentriert.

Zu den seltenen Kompressionssyndromen im Bereich des Schultergürtels gehören das Suprascapularis-Syndrom, das Kompressionssyndrom des N. axillaris im spatium quadrilaterale und die Kompression des N. thoracicus longus. Im Unterarm sind das M. pronator-teres- und N. interosseus-anterior-Syndrom als seltenere Kompressionssyndrome des N. medianus beschrieben. Am Unterarmverlauf des N. radialis kann das Supinatorlogensyndrom auftreten. Das Loge de Guyon-Syndrom liefert das ulnarseitige Pendant zum weitaus bekannteren Karpaltunnelsyndrom der Hand. Bei der Cheralgia paraesthetica handelt es sich um eine Einengung des sensiblen N. radialis-Astes zum Daumenrücken.

An der unteren Extremität können sämtliche Nerven der Leisten- und Oberschenkelregion eingeengt werden, die Passage zwischen den Blättern der schrägen Bauchmuskulatur bzw. unter dem Leistenband ist hierfür prädisponierend. Die Meralgia paraesthetica mit einer Affektion des N. cutaneus femoris lateralis ist hier das bekannteste Syndrom. Nahezu nur iatrogen treten Engpässe des N. femoralis oder N. obturatorius auf. Bei lateralen Schmerzen in der distalen Oberschenkel-/Knieregion vor allem nach orthopädischen Eingriffen am Kniegelenk sollte an eine Kompression oder Läsion des intrapatellaren N. Saphenus-Astes gedacht werden. Das Piriformislücken-Syndrom beschreibt eine wahrscheinlich muskuläre Einengung des N. ischiadicus und gilt als unterdiagnostiziert. Im Unterschenkel- und Fußbereich existieren mehrere Kompressionssyndrome des N. peronaeus und des N. tibialis, darunter die Nervenkompression am Fibulaköpfchen, das vordere und hintere Tarsaltunnelsyndrom und die Morton-Metatarsalgie.

Abstract

Uncommon nerve compression syndromes

In regard to the complex anatomical relationship of peripheral nerves and muscles, tendons, fasciae as well as their long course within those anatomical structures and additional close contact to bony structures, they are prone to suffer from local compression syndromes. Hence creating a vast majority of entrapment syndromes - well described in literature for almost every single nerve. The purpose of this article is to give an overview of symptoms, signs, diagnostic studies and treatment options, addressing especially the less known syndromes.

Compression syndromes of the upper arm and shoulder region include the suprascapular nerve syndrome the compression of the axillary nerve within the spatium quadrilaterale and the compression of the long thoracic nerve at the chest wall.

The upper extremity offers a variety of infrequent entrapment syndromes, as the pronator teres syndrome and anterior interosseus syndrome, both resulting from pressure to the median nerve in the forearm. Compression neuropathy in the course of the radial nerve in the distal upper extremity is also known as supinator syndrome. Guyon’s canal syndrome is the ulnar side equivalent to the well-known carpal tunnel syndrome. In the case of a Cheiralgia paresthetica, a compression of a sensory branch of the superficial radial nerve can be seen.

In the lower extremities, a variety of nerves especially in the groin and thigh area can be compressed as they pass through the narrow spaces between the abdominal muscles or underneath the inguinal ligament. Compression of the lateral femoral cutaneous nerve is the most common syndrome. Compression syndromes of the femoral and obturator nerves are most often iatrogenic. Pain around the knee, especially the lateral part and following orthopedic procedures of the knee, can arise from a compression or a lesion of a small infrapatellar branch of the saphenous nerve. Another probably underdiagnosed syndrome is piriformis syndrome, resulting from an entrapment of the sciatic nerve as it passes through certain muscular structures.

In the distal lower extremity, the peroneal and tibial nerves can be compressed at multple sites, clinically known as peroneal nerve paralysis resulting from nerve compression around the fibular head, the anterior and posterior tarsal tunnel syndrome, and Morton’s metatarsalgia.

Schlüsselwörter

Nerv - obere Extremität - untere Extremität - Körperregion und Anatomie

Keywords

decompression - Neuropathia - injection - neuropathy - nerve - upper extremity - lower extremity

Publication History

Received: 29 October 2023

Accepted: 18 January 2024

Article published online:
20 March 2024

• Literatur

• 1 Kim TU, Chang MC. Neuralgic amyotrophy: an underrecognized entity. J Int Med Res 2021; 49: 3000605211006542
• 2 Habermeyer P, Rapaport D, Wiedemann E. et al. Incisura scapulae syndrome. Handchir Mikrochir Plast Chir 1990; 22: 120-124
• 3 Dalagiannis N, Tranovich M. Ebraheim et al. N. Teres minor and quadrilateral space syndrome: A review. J Orthop 2020; 20: 144-146
• 4 Brown SA, Doolittle DA, Bohanon CJ. et al. Quadrilateral space syndrome: the Mayo Clinic experience with a new classification system and case series. Mayo Clin Proc 2015; 90: 382-394
• 5 Hong CC, Thambiah MD, Manohara R. Quadrilateral space syndrome: The forgotten differential. J Orthop Surg (Hong Kong) 2019; 27: 2309499019847145
• 6 Chautems RC, Glauser T, Waeber-Fey MC. et al. Quadrilateral space syndrome: case report and review of the literature. Ann Vasc Surg 2000; 14: 673-676
• 7 Zurkiya O. Quadrilateral space syndrome. Cardiovasc Diagn Ther 2021; 11: 1112-1117
• 8 Pratt N. Anatomy of nerve entrapment sites in the upper quarter. J Hand Ther 2005; 18: 216-229
• 9 Nath RK, Lyons AB, Bietz G. Microneurolysis and decompression of long thoracic nerve injury are effective in reversing scapular winging: long-term results in 50 cases. BMC Musculoskelet Disord 2007; 8: 25
• 10 Götz Penkert JB, Schelle Thomas. Focal Peripheral Neuropathies, 1 ed. Springer; Berlin, Heidelberg: 2015
• 11 Megele R. Anterior interosseous nerve syndrome with atypical nerve course in relation to the pronator teres. Acta Neurochir (Wien) 1988; 91: 144-146
• 12 Poetschke J, Schwarz D, Kremer T. et al. Lesions of the anterior interosseous nerve: differentiating between compression neuropathy and neuritis. Handchir Mikrochir Plast Chir 2021; 53: 31-39
• 13 Kollmer J, Preisser P, Bendszus M. et al. Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis. J Neurosurg 2019; 132: 1925-1929
• 14 Yasunaga H, Shiroishi T, Ohta K. et al. Fascicular torsion in the median nerve within the distal third of the upper arm: three cases of nontraumatic anterior interosseous nerve palsy. J Hand Surg Am 2003; 28: 206-211
• 15 Pham M, Bäumer P, Meinck HM. et al. Anterior interosseous nerve syndrome: fascicular motor lesions of median nerve trunk. Neurology 2014; 82: 598-606
• 16 Gregor Antoniadis LH, Assmus Hans. Chirurgie peripherer Nerven kompakt. Springer; 2020
• 17 Ummel JR, Coury JG, Lum ZC. et al. Transbrachioradialis Approach to the Radial Tunnel: An Anatomic Study of 5 Potential Compression Sites. Hand (N Y) 2019; 14: 329-332
• 18 Strohl AB, Zelouf DS. Ulnar Tunnel Syndrome, Radial Tunnel Syndrome, Anterior Interosseous Nerve Syndrome, and Pronator Syndrome. J Am Acad Orthop Surg 2017; 25: e1-e10
• 19 Węgiel A, Karauda P, Zielinska N. et al. Radial nerve compression: anatomical perspective and clinical consequences. Neurosurg Rev 2023; 46: 53
• 20 Dong Q, Jamadar DA, Robertson BL. et al. Posterior interosseous nerve of the elbow: normal appearances simulating entrapment. J Ultrasound Med 2010; 29: 691-696
• 21 Shields LBE, Iyer VG, Zhang YP. et al. Etiological study of superficial radial nerve neuropathy: series of 34 patients. Front Neurol 2023; 14: 1175612
• 22 Haas LF. Félix Guyon 1831–1920. Journal of Neurology, Neurosurgery & Psychiatry 2003; 74: 698
• 23 Earp BE, Floyd WE, Louie D. et al. Ulnar nerve entrapment at the wrist. J Am Acad Orthop Surg 2014; 22: 699-706
• 24 Reinpold W, Schroeder AD, Schroeder M. et al. Retroperitoneal anatomy for the iliohypogastric, ilioinguinal, genitofemoral and lateral femoral cutaneus nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia 2015; 19: 539-548 DOI: 10.1007/s10029-015-1396-z..
• 25 Elsakka KM, Das M, Allam J. et al. Ilioinguinal Neuralgia. StatPearls; Treasure Island (FL): 2022
• 26 Kohan L, McKenna C, Irwin A. Ilioinguinal Neuropathy. Curr Pain Headache Rep 2020; 24: 2 DOI: 10.1007/s11916-020-0833-6.
• 27 Scholz C, Hohenhaus M, Pedro MT. et al. Meralgia paraesthetica: relevance, diagnosis and treatment. Detsch. Arztebl Int 2023; 120: 655-661 DOI: 10.3238/arztebl.m2023.0170.
• 28 Timptom JS. Obturator neuropathy. Curr Rev Musculoskelet Med 2008; 1: 234-237 DOI: 10.1007/s12178-008-9030-7.
• 29 Luciano AP, Honda RTM, Kamar AR. et al. Anatomical Study of the Infrapatellar Branch of the Saphenous Nerve in Humans. Rev Bras Ortop (Sao Paolo) 2020; 55/5: 557-563 DOI: 10.1055/s-0040-1701287.
• 30 Boyle J, Eason A, Hartnett N. et al. Infrapatellar branch of the saphenous nerve: A review. J Med Imaging Radiat Oncol 2021; 65: 195-200 DOI: 10.1111/1754-9485.13141.
• 31 Vij N, Kiernan H, Bisht R. et al. Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesth Pain Med 2021; 11: e112825 DOI: 10.5812/aapm.112825.
• 32 Kean Chen C, Nizar AJ. Prevalence of piriformis syndrome in chronic low back pain patients. A clinical diagnosis with modified FAIR test. Pain Pract;13(4):276-81. 33. Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. StatPearls; Treasure Island (FL): 2023. PMID: 28846222
• 33 Vij N, Kiernan H, Bisht R. et al. Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesth Pain Med 2021; 11: e112825 DOI: 10.5812/aapm.112825..
• 34 Misirlioglu TO, Akgun K, Palamar D. et al. Piriformis syndrome: comparison oft he effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study. Pain Physician 2015; 18: 163-171
• 35 Ripellino P, Cianfoni A, Izzo MGA. et al. Relapsing piriformis syndrome treated with botulinum toxin injections. BMJ case Rep 2019; 12 DOI: 10.1136/bcr-2019-230981.
• 36 Kay J, de Sa D, Morrison L. et al. Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review. Arthroscopy 2017; 22: 2263-2278e1 DOI: 10.1016/j.atrhro.2017.06.041.
• 37 Cassidy L, Walters A, Bubb K. et al Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat 2012; 34 479
• 38 Robert R, Prat-Pradal D, Labat JJ. et al. Anatomic basis of chronic perineal pain: role of pudendal nerve. Surg Radiol Anat 1998; 20: 93-98
• 39 Filler AG. Diagnosis and treatment of pundendal nerve entrapment syndrome subtypes: imaging, injections and minimal access surgery. Neurosurg Focus 2009; 26: E9
• 40 Kaur J, Leslie SW, Singh P. Pudendal Nerven Entrapment Syndrome. StatPearls; Treasure Island (FL): 2023
• 41 Labat JJ, Riant T, Robert R. et al. Diagnostic criteria for pundendal neuralgia by pundendal nerve entrapment (Nantes criteria). Neurourol Urodyn 2008; 27: 306-310
• 42 Carolus AE, Becker M, Cuny J. et al. The Interdisciplinary Management of Foot Drop. Dtsch Arztebl Int 2019; 116: 347-354 DOI: 10.3238/arztebl.2019.0347.
• 43 Stevoska S, Pisecky L, Stadler C. et al. Tendon transfer in foot drop: a systematic review. Arch Orthop Trauma Surg 2023; 143: 773-784
• 44 Daigeler A, Tofaute A, Lenhardt M. et al. 125. Kongress der Deutschen Gesellschaft für Chirurgie. 2008
• 45 KOPELL HP, THOMPSON WA. Peripheral entrapment neuropathies of the lower extremity. N Engl J Med 1960; 262: 56-60
• 46 Dreyer MA, Gibboney MD. Anterior Tarsal Tunnel Syndrome. StatPearls; Treasure Island (FL): 2023
• 47 Rodríguez-Merchán EC, Moracia-Ochagavía I. Tarsal tunnel syndrome: current rationale, indications and results. EFORT Open Rev 2021; 6: 1140-1147 DOI: 10.1302/2058-5241.6.210031.
• 48 Lorenzon P, Rettore C, Scalvi A. Infiltrative Therapy of Morton’s Neuroma. Acta Biomed 2022; 92: e2021556 DOI: 10.23750/abm.v92iS3.12545.
• 49 M, Thomson L. Morton’s neuroma – Current concepts review. J Clin Orthop Trauma 2020; 11: 406-409 DOI: 10.1016/j.jcot.2020.03.024.