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Handchirurgie Scan 2017; 06(04): 291-307
DOI: 10.1055/s-0043-119724
CME-Fortbildung
Nervenkompressionssyndrome
© Georg Thieme Verlag KG Stuttgart · New York

Ultraschalldiagnostik von Kompressionsneuropathien: Karpaltunnelsyndrom

Sebastian Kluge
Subject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Dr. med. Sebastian Kluge.
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Publication History

Publication Date:
15 January 2018 (online)

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In der Diagnostik des Karpaltunnelsyndroms stellt die elektroneurografische Untersuchung den Goldstandard dar. Jedoch gewinnt die Ultraschalldiagnostik in den letzten Jahren als Ergänzung oder Alternative zur Elektroneurografie immer größere Bedeutung. Dieser Beitrag zeigt die Möglichkeiten und Grenzen der Sonografie bei Kompressionssyndromen an der Hand.
Kernaussagen

  • Ein direkter Vergleich von Elektroneurografie und Sonografie in der Diagnostik des Karpaltunnelsyndroms ist nur begrenzt möglich.

  • Die Sonografie ist insbesondere für die Patienten von Interesse, die bei klinischen Zeichen einer Kompressionsneuropathie elektroneurografisch unauffällig sind.

  • In der Ausschlussdiagnostik stellt die Sonografie ein wertvolles Verfahren dar, dessen Evidenzgrad ausreichend ist, um auch im Falle rechtlicher Fragestellungen als valide bewertet zu werden.

  • Viele Karpaltunnelsyndrome können durch die alleinige sonografische Bestimmung der prästenotischen Schwellung (Pseudoneurom) diagnostiziert werden, die in den meisten Fällen am Karpaltunneleingang lokalisiert ist.

  • Die Sonografie erlaubt auch dynamische Untersuchungen bei Nervenkompressionssyndromen.

  • Eine verlässliche Quantifizierung der Erkrankungsschwere ist sonografisch nur eingeschränkt möglich. Die Sonografie stellt in der Diagnostik des Karpaltunnelsyndroms daher eine dichotome Ausschlussdiagnostik dar, die orientierende Aussagen zur Erkrankungsschwere erlaubt, aber nicht die Genauigkeit der Elektroneurografie erreicht.

Schlüsselwörter

Karpaltunnelsyndrom - Sonografie - Ultraschalldiagnostik - Nervus medianus
 

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