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DOI: 10.1055/s-2001-16679
© Georg Thieme Verlag Stuttgart · New York
Therapie des Karpaltunnelsyndroms
Treatment of Carpal Tunnel SyndromePublication History
Publication Date:
27 August 2001 (online)
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Zusammenfassung
Das Karpaltunnelsyndrom (KTS) kann konservativ oder durch operative Durchtrennung des Lig. carpi transversum behandelt werden. Bei fehlenden klaren Kriterien einer Indikationsstellung muss diese vom individuellen Beschwerdebild und der Funktionsbeeinträchtigung abhängig gemacht werden. Unter den konservativen Behandlungsmöglichkeiten erscheint die volare Unterarmschiene in den Fällen sinnvoll, in denen die Beschwerdesymptomatik durch bestimmte Auslösesituation provoziert wird und reversibel erscheint. Dies ist insbesondere beim KTS in der Schwangerschaft zu erwägen. Andere konservative bzw. semikonservative Verfahren, wie die Injektion von Kortison in den Karpaltunnel sollten eher zurückhaltend eingesetzt werden und erscheinen in ihrer Wirkung nicht ausreichend belegt. Persistieren die Beschwerden unter konservativer Therapie oder findet sich elektrophysiologisch eine Schädigung des N. medianus, sollte eine frühzeitige Dekompression des Nerven angestrebt werden. Die hierfür zur Verfügung stehenden Verfahren der offenen und endoskopischen Dekompression erscheinen vom Ergebnis vergleichbar; möglicherweise wird die Funktionsfähigkeit der Hand nach endoskopischer Entlastung etwas rascher erreicht, im Gegenzug ist die Komplikationsrate etwas höher.
Treatment of Carpal Tunnel Syndrome
The carpal tunnel syndrome is the most common nerve entrapment syndrome which is determined by individual complaints ranging from intermittent paraesthesia to persistent numbness and muscular weakness and often by occupational problems. This article gives a review of non-surgical and surgical procedures in the management of the disorder. In cases without electrophysiologically proven nerve damage wrist splinting and occupational rehabilitation is an otional conservative therapy. On the other hand oral steroids or antiphlogistics and local steroid injections into the carpal tunnel give no convincing long term effect. Surgical decompression of the median nerve is indicated if complaints persist and nerve conduction is abnormal. The clinical outcome is excellent with surgical treatment, both the standard open release and the endoscopic approach. While patients may be able to use the hand earlier after endoscopic intervention, the rate of severe complications is slightly lower with the open technique.
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PD Dr. Th. Vogt
Neurologische Universitätsklinik
Langenbeckstraße 1
55131 Mainz
Email: vogt@neurologie.klinik.uni-mainz.de