Aktueller Stand in Diagnostik und Therapie des Karpaltunnelsyndroms

Zusammenfassung

Das Karpaltunnelsyndrom (KTS) hat eine relativ hohe Inzidenz und Prävalenz in der Bevölkerung. Mitunter stellt sich das Problem, bei gleichzeitiger Polyneuropathie ein Karpaltunnelsyndrom neurophysiologisch zu sichern. Die unterschiedlichen Verfahren sowie deren Wertigkeit werden hier dargestellt, wobei der fraktionierten sensiblen Neurographie über dem Karpalkanal ein hoher Stellenwert zukommt. Außerdem wird ein kurzer Überblick über den augenblicklichen Stand der sonographischen und MR-tomographischen Techniken und deren Stellenwert in der Diagnostik des KTS gegeben. Beide bildgebenden Verfahren sind derzeit nur komplementär und ermöglichen eher eine Beurteilung von Veränderungen im Karpalkanal, als dass sie die neurophysiologischen Testverfahren ersetzen können. In der Therapie ist die Operation allen anderen Verfahren überlegen. Die Schienung ist in Frühfällen mit geringer Ausprägung sinnvoll, hat aber eine unzureichende Langzeitwirkung. Auch bei einer gleichzeitig vorhandenen Polyneuropathie ist eine Dekompressionsoperation sinnvoll. Nach dem augenblicklichen Kenntnisstand konnte bisher keine Überlegenheit der endoskopischen Verfahren über die offenen Operationen gezeigt werden.

Summary

The carpal tunnel syndrome has a rather high incidence and prevalence in the general population. Sometimes it is not easy to diagnose a carpal tunnel syndrome in patients who suffer from a polyneuropathy. The various neurophysiological techniques to differentiate a carpal tunnel syndrome in this occasion, as well as their sensitivity and specificity are here discussed. Furthermore, the state of the art in sonographic and MR-imaging studies is given. Both are, at least at the moment, complementary to the neurophysiological tests and rather may show anatomical and pathological processes in the carpal tunnel than detect nerve conduction abnormalities. Surgical decompression of the nerve is the most effective therapy, whereas splinting only is successful in early stages of the entrapment without long lasting effects. Also patients with carpal tunnel syndrome and neuropathy do better after surgery. Until now no benefit of the endoscopic procedures could be shown compared with the open surgery technique.

Schlüsselwörter

Karpaltunnelsyndrom - Diagnose - Therapie - Ultraschall - MRT

Keywords

Carpal tunnel syndrome - diagnosis - therapy - ultrasound - MRI

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