Sportverletzungen peripherer Nerven^[*]

Zusammenfassung

Periphere Nervenläsionen bedingt durch Sport gelten als relativ selten, aber die genaue Inzidenz ist aufgrund mangelnder Studienlage nicht bekannt. Prinzipiell können bei sportlicher Betätigung alle Nerven verletzt werden, wobei bei einzelnen Sportarten bestimmte Nervenschädigungen besonders häufig auftreten. Dazu gehören vor allem kompressions- und überlastungsbedingte Nervenschädigungen, aber auch direkte Verletzungen von Nerven im Rahmen von Sportunfällen, die mit Frakturen oder grossflächigen Wunden einhergehen. Diese Nervenverletzungen können die sportliche Leistungsfähigkeit eines Athleten erheblich beeinträchtigen und die Ursache für eine verzögerte Rehabilitation nach Sportunfällen sein [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]. Oft werden Schädigungen peripherer Nerven nicht oder zu spät festgestellt, insbesondere da der Neurologe bei Sportverletzungen zumeist nicht routinemässig hinzugezogen wird. Je nach Ätiologie erfolgt die Behandlung zumeist primär konservativ mit spezifischer Physiotherapie, Techniktraining, bei überlastungsbedingten Schädigungen auch Änderungen der Bewegungsabläufe oder Modifikationen des Sportgerätes, neuerdings wird auch die extrakorporale Schallwellenbehandlung eingesetzt. Medikamentös ist häufig die Gabe von Antiphlogistika erforderlich, nur selten sind lokale Injektionen mit Lokalanästhetika oder Glukokortikoiden indiziert. Ausser bei akuter mechanischer Nervenverletzung, kommen operative Verfahren erst bei Versagen der konservativen Methoden in Betracht [1] [2] [12] [13]. Die Prognose hängt wesentlich von der Ätiologie und der Möglichkeit der modifizierenden Massnahmen ab, die bisherige Studienlage lässt derzeit in den meisten Fällen keine evidenzbasierten Aussagen zur Prognose peripherer Nervenläsionen durch Sport zu.

Als Grundlage für diesen Artikel dienten die Veröffentlichungen „Reuter I, Mehnert S. Engpasssyndrome peripherer Nerven bei Sportlern“. Akt Neurol 2012;39:292-308 sowie Sportverl Sportschad 2013;27:130-146, aus denen Teile übernommen wurden.

Abstract

Peripheral nerve injuries due to sports are relatively rare but the exact incidence is not known due to a lack of epidemiological studies. Particular sports activities tend to cause certain peripheral nerve injuries including direct acute compression or stretching, repetitive compression and stretching over time, or another mechanism such as ischemia or laceration. These nerve lesions may be severe and delay or preclude the athlete’s return to sports, especially in cases with delayed diagnosis. Repetitive and vigorous use or overuse makes the athlete vulnerable to disorders of the peripheral nerves, and sports equipment may cause compression of the nerves. Depending on etiology, the treatment is primarily conservative and includes physiotherapy, modification of movements and sports equipment, shoe inserts, splinting, antiphlogistic drugs, sometimes local administration of glucocorticoids or, lately, the use of extracorporeal shock waves. Most often, cessation of the offending physical activity is necessary. Surgery is only indicated in the rare cases of direct traumatic nerve injury or when symptoms are refractory to conservative therapy. Prognosis mainly depends on the etiology and the available options of modifying measures.

This article is based on the publications “Reuter I, Mehnert S. Engpasssyndrome peripherer Nerven bei Sportlern“. Akt Neurol 2012;39:292-308 and Sportverl Sportschad 2013;27:130-146.

Schlüsselwörter

Sportneurologie - periphere Nerven - Engpasssyndrome - Druckschädigung - Sportverletzungen

Key words

sports neurology - peripheral nerves - entrapment syndromes - pressure injury - sport injuries

^* Dieser Beitrag ist eine ergänzte Version der Originalarbeit DOI: 10.1055/s-0041-108672, die am 15.12.2015 eFirst publiziert wurde.

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