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Arthritis und Rheuma 2008; 28(04): 203-209
DOI: 10.1055/s-0037-1620116
Diabetes und Rheuma
Schattauer GmbH

Karpaltunnelsyndrom bei Diabetes mellitus

Carpal tunnel syndrome and diabetes mellitus
P. Young
1   Klinik und Poliklinik für Neurologie, Münster
› Author Affiliations
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Publication History

Publication Date:
24 December 2017 (online)

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Zusammenfassung

Das Karpaltunnelsyndrom (KTS) ist die häufigste Mononeuropathie im klinischen Alltag. Die Ätiologie der Schädigung des N.medianus im Karpaltunnel am volaren Handgelenk sind vielfältig. Die zugrunde liegende häufigste Stoffwechselerkrankung ist der Diabetes mellitus, durch den eine vermehrte Vulnerabilität der peripheren Nerven für Kompressionen an physiologischen Engstellen entsteht. Neben dem Diabetes mellitus ist als exogener Faktor der vermehrte Gebrauch der Hände der wichtigste Risikofaktor für die Entstehung eines KTS. Klinische Zeichen eines KTS sind schmerzhafte Dysästhesien des Daumens, Zeigefingers und des Mittelfingers im Frühstadium, und im Spätstadium Paresen der Daumen-Abduktion und Atrophie der Thenarmuskulatur. Als klinische Tests sind der Phalen-Test und das Hoffmann- Tinel-Zeichen im klinischen Kontext sehr zuverlässig. Die wichtigste apparative Diagnostik ist die Messung der sensiblen und motorischen Nervenleitgeschwindigkeiten des N. medianus bei seinem Verlauf durch den Karpaltunnel. Als Therapieoptionen stehen im leichten Stadium volare Schienen und Injektionen mit Kortikosteroiden zur Verfügung, während bei fortschreitendem KTS die operative Entlastung des N. medianus die Therapie der Wahl ist.

Summary

The carpal-tunnel-syndrom (CTS) is the most clinically frequent mononeuropathy. The compression or lesion of the Median nerve in its course through the carpal tunnel is the underlying pathomechanism. The most important associated disease is diabetes mellitus, which seems to cause a liability of single nerves to repetitive trauma. Similarly the most important exogen factor to develop CTS is repetitive occupational use of the hands. Clinical early signs of CTS are pain paresthesia and pain of the volar first to third fingers. In the later course paresis and muscle wasting of thenar muscles are observed. Provocative testing include Phalen’s test and Hoffmann-Tinel’s sign. The most useful diagnostic tool is the recording of the nerve conduction velocity of the median nerve through its course in the carpal tunnel. Therapeutic options include splinting, local corticosteroid injections and surgical procedures.

Schlüsselwörter

Karpaltunnelsyndrom - Diabetes mellitus - N. medianus

Keywords

Carpal tunnel syndrome - diabetes mellitus - median nerve
 

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