Elektrophysiologische Differenzialdiagnosen bei den wichtigsten Engpasssyndromen der oberen Extremität

T. Paternostro-Sluga; O. Schuhfried

doi:10.1055/s-0032-1305331

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, Inhaltsverzeichnis

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2012; 22(05): 289-302
DOI: 10.1055/s-0032-1305331

Fortbildung

Elektrophysiologische Differenzialdiagnosen bei den wichtigsten Engpasssyndromen der oberen Extremität

Electrophysiological Examinations in the Diagnosis of Nerve Entrapment Syndromes

T. Paternostro-Sluga

Klinik für Physikalische Medizin und Rehabilitation, Medizinische Universität Wien

,

O. Schuhfried

Klinik für Physikalische Medizin und Rehabilitation, Medizinische Universität Wien

› Institutsangaben

Abstract

Zusammenfassung

Ziel der elektrophysiologischen Untersuchung in der Diagnose von Engpasssyndromen ist, die fokale Läsion des betroffenen Nervs nachzuweisen. In dieser Arbeit werden die Zielsetzung, das Untersuchungsprotokoll und praktische Aspekte der elektrophysiologischen Untersuchung in der Diagnostik des Karpaltunnelsyndroms, des Sulcus-N.-ulnaris-Syndroms, des Loge-de-Guyon-Syndroms, des N.-interosseus-anterior-Syndroms, des Supinator-Syndroms/N.-interosseus-posterior-Syndroms und des Thoracic-Outlet-Syndroms beschrieben und differenzialdiagnostische Abgrenzungen erörtert. Die Ergebnisse der elektrophysiologischen Untersuchung müssen in der Zusammenschau mit der klinischen Untersuchung, Zusatzbefunden wie bildgebende Verfahren und der Anamnese beurteilt werden.

Abstract

The aim of the electrophysiological examination in the diagnosis of nerve entrapment syndromes is to demonstrate a focal lesion of the affected nerve. In this paper, the objective, the examination protocol and practical aspects of the electrophysiological examination in the diagnosis of carpal tunnel syndrome, cubital tunnel syndrome, Guyon's canal syndrome, the N. interosseus anterior syndrome, supinator syndrome/N. interosseus posterior syndrome and the thoracic outlet syndrome are described and differential diagnosis are discussed. The results of the electrophysiological study should be viewed in the broader context of the clinical examination, additional findings, such as imaging techniques and history.

Schlüsselwörter

Elektrodiagnostik - Engpasssyndrom - Karpaltunnelsyndrom - periphere Nerven - Sulcus-N.-ulnaris-Syndrom

Keywords

Electrodiagnosis - Entrapment syndrome - Carpal tunnel syndrome - Peripheral nerves - Cubital tunnel syndrome

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Referenzen

Literatur
1 Mummenthaler M. Läsionen einzelner peripherer Nerven, CTS. In: Mummenthaler M, Mattle H, Hrsg. Neurologie. 12.. Aufl. Stuttgart, New York: Thieme; 2008: S660-S661
2 Geoghegan JM, Clark DI, Brainbridge IC et al. Risk factors in carpal tunnel syndrome. J Hand Surg (Br) 2004; 29: 315-320
3 de Krom MC, Knipschild PG, Kester ADM et al. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45: 373-376
4 Atroshi I, Gummesson C, Johnsson R et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282: 153-158
5 Bahrami MH, Rayegani SM, Feredouni M et al. Prevalence and severity of carpal tunnel syndrome (CTS) during pregnancy. Electromyogr Clin Neurophysiol 2005; 45: 123-125
6 Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med 2007; 57: 57-66
7 Wilbourn AJ. Diabetic Neuropathies. In: Brown WF, Bolton CF, Hrsg. Clinical Electromyography. 2.. Aufl. Stoneham: Butterworth-Heinemann; 1993: S477-S515
8 Jablecki CK, Andary MT, Floeter MK et al. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002; 58: 1589-1592
9 Werner RA, Andary M. AANEM Monograph: Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011; 44: 597-607
10 Schuhfried O, Vacariu G, Kopf A et al. Relative slowing of the median antidromic sensory nerve conduction velocity to the ring finger in screening for carpal tunnel syndrome. J Hand Surg Am 2004; 29: 947-952
11 Ginanneschi F, Milani P, Reale F et al. Short-term electrophysiological conduction change in median nerve fibres after carpal tunnel release. Clin Neurol Neurosurg 2008; 110: 1025-1030
12 Paternostro-Sluga T. Entrapment neuropathies: electrophysiological evaluation after surgery. 14th European Congress of Physical and Rehabilitation Medicine, Vienna, Mai 2004
13 Mondelli M, Giannini F, Ballerini M et al. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci 2005; 234: 5-10
14 Ludin HP. Praktische Elektromyographie. 4.. Aufl. Stuttgart: Enke; 1993: 36
15 AAN. Practice Parameter: Electrodiagnostic studies in ulnar neuropathy at the elbow. Neurology 1999; 52: 688-690
16 AAEM. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. Muscle Nerve 1999; 22: 408-411
17 Paternostro-Sluga T, Ciovika R, Turkof E et al. Short segment stimulation after subcutaneous anterior transpositon of the ulnar nerve at the elbow. Arch Phys Med Rehabil 2001; 82: 1171-1175
18 Mazurek MT, Shin AY. Upper extremity peripheral nerve anatomy: current concepts and applications. Clin Orthop Relat Res 2001; 383: 7-20
19 Rubin DI, Dimberg EL. Martin-Gruber Anastomosis and Carpal Tunnel 42: morphologic clues to identification. Muscle Nerve 2010; 42: 456-457
20 Brandsma JW, Birke JA, Sims Jr DS. The Martin-Gruber innervated hand. J Hand Surg (Am) 1988; 11: 538-539
21 Unver Dogan N, Uysal II, Seker M. The communications between the ulnar and median nerves in upper limb. Neuroanatomy 2009; 8: 15-18
22 Dumitru D, Walsh NE, Weber CF. Electrophysiologic study of the Riche Cannieu anomaly. Electromyogr Clin Neurophysiol 1988; 28: 27-31
23 Kimura J. Mononeuropathies and entrapment syndromes. In: Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practice. Chapter 23, 2.. Aufl. Philadelphia: FA Davis Company; 1989: 495-516
24 Stöhr M. Gibt es ein algetisches Supinatorsyndrom?. Handchir Mikrochir Plast Chir 2009; 41: 35-37
25 Dumitru D. Focal Peripheral neuropathies. In: Dumitru D. Electrodiagnostic Medicine. 1.. Aufl. St. Louis: Mosby; 1995: 851-927
26 Mummenthaler M. Läsionen einzelner peripherer Nerven, Armplexusläsionen. In: Mummenthaler M, Mattle H, Hrsg. Neurologie. 12.. Aufl. Stuttgart, New York: Thieme; 2008: S643-S655
27 Gilliat RW. Thoracic outlet syndromes. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R, Hrsg. Peripheral neuropathy. 2.. Aufl. Philadelphia: W B Saunders; 1984: S1409-S1424
28 Schein CJ, Haimovici H, Young H. Arterial thrombosis associated with cervical ribs. Surg 1956; 40: 428
29 Sanders RJ, Hammond SL. Management of cervical ribs and anomoulous first-ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg 2002; 36: 51-56
30 Buschbacher RM, Prahlow ND. Manual of Nerve Conduction Studies. 2nd. Ed, Demos Medical Pub; 2006: 106-109
31 Ferrante MA. Brachial plexopathies: classification, causes, and consequences. Muscle Nerve 2004; 30: 547-568
32 Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003; 27: 26-33
33 Lee CH, Kim TK, Yoon ES et al. Correlation of high-resolution ultrasonographic findings with the clinical symptoms an electrodiagnostic data in carpal tunnel syndrome. Ann Plast Surg 2005; 54: 20-23
34 Nakamichi KI, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: diagnostic accuracy. Muscle Nerve 2002; 6: 798-803
35 Ziswiler HR, Reichenbach S, Vogelin E et al. Diagnostic value of sonography in patients with suspected carpal tunnel syndrome. Arthritis & Rheumatism 2005; 52: 304-311
36 Jarvik JG, Yuen E, Haynor DR et al. MR nerve imaging in a prospective cohort of patients with suspected carpal tunnel syndrome. Neurology 2002; 58: 1597-1602
37 Khalil C, Hancart C, Le Thuc V et al. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol 2008; 18: 2283-2291
38 Kele H, Verheggen R, Bittermann HJ et al. The potential value of ultrasonography in the evaluation of carpal tunnel syndrome. Neurology 2003; 12: 389-391
39 Jarvik JG, Yuen E, Kliot M. Diagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation. Neuroimaging Clin N Am 2004; 14: 93-102
40 Koyuncuoglu HR, Kutluhan S, Yesildag A et al. The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests. Eur J Radiol 2005; 56: 365-369
41 Beekmann R, Schoenmaker MC, van der Plas JP et al. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology 2004; 62: 767-773
42 Martinoli C, Bianchi S, Pugliese F et al. Sonography of entrapment neuropathies in the upper limb (wrist excluded). J Clin Ultrasound 2004; 32: 438-450
43 Beekman R, van der Plas JP, Uitdehaag BM et al. Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow. Muscle Nerve 2004; 30: 202-208
44 Britz GW, Haynor DR, Kuntz C et al. Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery 1996; 38: 458-465
45 Vucic S, Cordato DJ, Yiannikas C et al. Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow. Clin Neurophysiol 2006; 117: 590-595