Engpasssyndrome peripherer Nerven bei Sportlern

Zusammenfassung

Sportbedingte Verletzungen und Überlastungsschäden betreffen meistens das muskuloskelettale System. Überlastungsschäden der Nerven durch sportliche Aktivität sind weniger bekannt, können jedoch alle Nerven betreffen, für die auch außerhalb sportlicher Betätigung Engpasssyndrome bekannt sind. Da Nervenverletzungen die sportliche Leistungsfähigkeit der Athleten erheblich beeinträchtigen und bei zu später Diag­nosestellung die sportliche Karriere beenden können, ist es Ziel dieser Arbeit eine Übersicht der sportbedingten Nervenschädigungen und der zugehörigen Pathomechanismen zu geben. Hierzu wurde eine Literatursuche zu sportbedingten Nervenläsionen durchgeführt. Akute Verletzungen blieben unberücksichtigt. Aufgrund fehlender prospektiver epidemiologischer Erhebungen wurden auch Fallberichte eingeschlossen. Die Arbeit gibt eine Übersicht der bei den jeweiligen Sportarten auftretenden Engpasssyndrome, der klinischen Symptome, der Diagnostik und Behandlung. Ursächlich sind meistens sportartspezifische einseitige Bewegungen mit hoher Wiederholungszahl, sportartspezifische Muskelhypertrophien sowie eine Kompression der Nerven durch Sportgeräte und Schuhe. Die Behandlung ist zunächst konservativ und schließt Techniktraining, Änderung von Bewegungsabläufen, Einlagen, Schienenbehandlung, Modifikationen des Sportgerätes, Antiphlogistikagabe und auch lokale Injektionen von Glukokortikoiden ein. Meistens ist auch eine Reduktion von Trainingsintensität und Trainingsumfang notwendig. Operative Therapien sind nach erfolgloser konservativer Behandlung indiziert. Bezüglich der Prognose, das sportliche Niveau postoperativ wieder zu erreichen, liegen für viele Engpasssyndrome unzureichende Daten vor.

Der Artikel ist zuerst erschienen in „Akt Neurol 2012; 6: 292–308“.

Abstract

Sports-related injuries most commonly involve the musculoskeletal system. However, physicians are less familiar with damage to the peripheral nerves attributable to particular sports activities. Nerve entrapment syndromes associated with physical activity may affect all nerves for which entrapment syndromes are known. Peripheral nerve lesions are serious and may delay or preclude the athletes’ return to sports, especially in cases with a delayed diagnosis. The aim of the paper is to give an overview of chronic sports-related nerve lesions. Acute nerve injuries are not the focus of this review. A literature search regarding sports-related nerve lesions was conducted. Due to the lack of prospective epidemiological studies, case reports were included (evidence level 4). Nerve entrapment syndromes specific for particular sports activities are described including clinical presentation, diagnostic work-up and treatment. Repetitive and vigorous use or overuse makes the athlete vulnerable to disorders of the peripheral nerves, additionally sports equipment may cause compression of the nerves. The treatment is primarily conservative and includes modification of movements and sports equipment, shoe inserts, splinting, antiphlogistic drugs and local administration of glucocorticoids. Most often cessation of the offending physical activity is necessary. When symptoms are refractory to conservative therapy a referral to surgery is indicated. The outcome of surgical treatment regarding the return of the athlete to competitive sports is not sufficiently investigated in many nerve entrapment ­syndromes.

This article was primarily published in “Akt Neurol 2012; 6: 292–308”.

Schlüsselwörter

Sport - Engpasssyndrome - Überbelastung der peripheren Nerven - Muskelhypertrophie - Druckschädigung - Nerventransfer

Keywords

sports - entrapment-syndromes - overuse injuries - muscle dysbalance - pressure - nerve transfer

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