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DOI: 10.1055/a-2250-8389
Seltene Nervenkompressionssyndrome
Rare nerve compression neuropathies![](https://www.thieme-connect.de/media/hamipla/202401/lookinside/thumbnails/10.1055-a-2250-8389-1.jpg)
Zusammenfassung
Seltene Kompressionssyndrome
Angesichts ihrer langen Verläufe, den komplexen Topographien zwischen Muskeln, unter Bändern und Muskelfaszienkanten sowie dem Verlauf nahe knöcherner Strukturen sind periphere Nerven prädisponiert für lokale Kompressionen. Daraus resultieren viele Engpasssyndrome – für fast jeden Nerv ist ein solches beschrieben. Der Artikel soll eine systematische Übersicht über Symptome, Diagnostik und Therapie geben, wobei er sich auf die weniger bekannten Syndrome konzentriert.
Zu den seltenen Kompressionssyndromen im Bereich des Schultergürtels gehören das Suprascapularis-Syndrom, das Kompressionssyndrom des N. axillaris im spatium quadrilaterale und die Kompression des N. thoracicus longus. Im Unterarm sind das M. pronator-teres- und N. interosseus-anterior-Syndrom als seltenere Kompressionssyndrome des N. medianus beschrieben. Am Unterarmverlauf des N. radialis kann das Supinatorlogensyndrom auftreten. Das Loge de Guyon-Syndrom liefert das ulnarseitige Pendant zum weitaus bekannteren Karpaltunnelsyndrom der Hand. Bei der Cheralgia paraesthetica handelt es sich um eine Einengung des sensiblen N. radialis-Astes zum Daumenrücken.
An der unteren Extremität können sämtliche Nerven der Leisten- und Oberschenkelregion eingeengt werden, die Passage zwischen den Blättern der schrägen Bauchmuskulatur bzw. unter dem Leistenband ist hierfür prädisponierend. Die Meralgia paraesthetica mit einer Affektion des N. cutaneus femoris lateralis ist hier das bekannteste Syndrom. Nahezu nur iatrogen treten Engpässe des N. femoralis oder N. obturatorius auf. Bei lateralen Schmerzen in der distalen Oberschenkel-/Knieregion vor allem nach orthopädischen Eingriffen am Kniegelenk sollte an eine Kompression oder Läsion des intrapatellaren N. Saphenus-Astes gedacht werden. Das Piriformislücken-Syndrom beschreibt eine wahrscheinlich muskuläre Einengung des N. ischiadicus und gilt als unterdiagnostiziert. Im Unterschenkel- und Fußbereich existieren mehrere Kompressionssyndrome des N. peronaeus und des N. tibialis, darunter die Nervenkompression am Fibulaköpfchen, das vordere und hintere Tarsaltunnelsyndrom und die Morton-Metatarsalgie.
Abstract
Uncommon nerve compression syndromes
In regard to the complex anatomical relationship of peripheral nerves and muscles, tendons, fasciae as well as their long course within those anatomical structures and additional close contact to bony structures, they are prone to suffer from local compression syndromes. Hence creating a vast majority of entrapment syndromes - well described in literature for almost every single nerve. The purpose of this article is to give an overview of symptoms, signs, diagnostic studies and treatment options, addressing especially the less known syndromes.
Compression syndromes of the upper arm and shoulder region include the suprascapular nerve syndrome the compression of the axillary nerve within the spatium quadrilaterale and the compression of the long thoracic nerve at the chest wall.
The upper extremity offers a variety of infrequent entrapment syndromes, as the pronator teres syndrome and anterior interosseus syndrome, both resulting from pressure to the median nerve in the forearm. Compression neuropathy in the course of the radial nerve in the distal upper extremity is also known as supinator syndrome. Guyon’s canal syndrome is the ulnar side equivalent to the well-known carpal tunnel syndrome. In the case of a Cheiralgia paresthetica, a compression of a sensory branch of the superficial radial nerve can be seen.
In the lower extremities, a variety of nerves especially in the groin and thigh area can be compressed as they pass through the narrow spaces between the abdominal muscles or underneath the inguinal ligament. Compression of the lateral femoral cutaneous nerve is the most common syndrome. Compression syndromes of the femoral and obturator nerves are most often iatrogenic. Pain around the knee, especially the lateral part and following orthopedic procedures of the knee, can arise from a compression or a lesion of a small infrapatellar branch of the saphenous nerve. Another probably underdiagnosed syndrome is piriformis syndrome, resulting from an entrapment of the sciatic nerve as it passes through certain muscular structures.
In the distal lower extremity, the peroneal and tibial nerves can be compressed at multple sites, clinically known as peroneal nerve paralysis resulting from nerve compression around the fibular head, the anterior and posterior tarsal tunnel syndrome, and Morton’s metatarsalgia.
Keywords
decompression - Neuropathia - injection - neuropathy - nerve - upper extremity - lower extremityPublication History
Received: 29 October 2023
Accepted: 18 January 2024
Article published online:
20 March 2024
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