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Sportverletz Sportschaden 2018; 32(01): 47-54
DOI: 10.1055/s-0044-100849
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Das chronische Kompartmentsyndrom

Chronic Compartment Syndrome
Andreas Gösele-Koppenburg
  Swiss Olympic Medical Center, Crossklinik, Basel
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Publication History

Publication Date:
20 March 2018 (online)

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Zusammenfassung

Das chronische Kompartmentsyndrom (CKS) ist eine seltene und vor allem häufig übersehene Diagnose von chronischen Schmerzen am Bewegungsapparat. Ursache der Beschwerden ist ein Missverhältnis zwischen Kompartimentvolumen und Raumbedarf der Muskulatur. Durch eine Zunahme der Fasziendicke und eine Abnahme ihrer Elastizität kommt es unter Belastung zu einer pathologischen Drucksteigerung und damit verbunden zu Schmerzen. Der genaue Mechanismus ist jedoch immer noch unklar. Chronische Kompartmentsyndrome müssen von akuten Kompartmentsyndromen differenziert werden. Sie treten vor allem am Unterschenkel auf, aber auch der Oberschenkel, der Fuß, der Oberarm, der Vorderarm, die Hand und der Rücken können betroffen sein. Ein bilaterales Auftreten ist sehr häufig (80 %). Die Diagnosestellung basiert vor allem auf der Anamnese, der klinischen Untersuchung zur Abgrenzung der Differentialdiagnosen und der funktionellen Druckmessung. Weitere diagnostische Verfahren wie Nahinfrarotspektroskopie, MRI, Sonografie und Myotonometrie werden in der Literatur beschrieben. Die Therapie ist primär konservativ. Wenngleich meist erfolglos, sollte sie dennoch zunächst eingesetzt werden um eine Operation zu vermeiden. Bei den operativen Therapieformen unterscheiden wir die offene Fasziotomie, halboffene Verfahren und seit geraumer Zeit auch endoskopisch assistierte, minimalinvasive Methoden.

Abstract

Summary Chronic compartment syndromes are a rare, but frequently overlooked cause of pain in the locomotor system. Their aetiology is still not fully elucidated. There is an imbalance of muscle volume and space in the compartment. Thickening of the fascia and decreased elasticity lead to a pathological increase in pressure in the compartment under load. Chronic compartment syndromes are found in the foot, lower leg, thigh, forearm, hand, and even the spine. Bilateral compartment syndromes are very common (80 %). The main symptoms are pain in the compartment under physical activity. Compartment pressure measurement is the gold standard examination. Other diagnostic procedures are near-infrared spectroscopy, MRI and ultrasound. As conse rvative treatment often fails, surgical treatment becomes necessary. Different techniques are described in the literature. We prefer an endoscopy-assisted minimally-invasive approach.

Schlüsselwörter

Chronisches Kompartmentsyndrom - Druckmessung - Aktivität - Fasziotomie

Key words

chronic compartment syndrome - pressure measurement - activity - fasciotomy
 

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