Diagnostik und Therapie des Karpaltunnelsyndroms

H. Assmus; G. Antoniadis; C. Bischoff; P. Haußmann; A. K. Martini; Z. Mascharka; K. Scheglmann; K. Schwerdtfeger; H. K. Selbmann; H. Towfigh; T. Vogt; K. D. Wessels; M. Wüstner-Hofmann

doi:10.1055/s-2007-965464

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Table of Contents

Handchir Mikrochir Plast Chir 2007; 39(4): 276-288
DOI: 10.1055/s-2007-965464

Originalarbeit

Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie des Karpaltunnelsyndroms

Leitlinie der Deutschen Gesellschaften für Handchirurgie, Neurochirurgie, Neurologie, Orthopädie unter Mitbeteiligung der Gesellschaften für Unfallchirurgie, Klinische Neurophysiologie und Funktionelle Bildgebung sowie Plastische, Rekonstruktive und Ästhetische ChirurgieDiagnosis and Therapy of Carpal Tunnel SyndromeGuideline of the German Societies of Handsurgery, Neurosurgery, Neurology, Orthopaedics, Clinical Neurophysiology and Functional Imaging, Plastic, Reconstructive and Aesthetic Surgery, and Surgery for TraumatologyH. Assmus¹ , G. Antoniadis² , C. Bischoff³ , P. Haußmann⁴ , A. K. Martini⁵ , Z. Mascharka⁶ , K. Scheglmann⁷ , K. Schwerdtfeger⁸ , H. K. Selbmann⁹ , H. Towfigh¹⁰ , T. Vogt¹¹ , K. D. Wessels¹² , M. Wüstner-Hofmann¹³

¹Neurochirurgische Gemeinschaftspraxis, Dossenheim
²Neurochirurgische Klinik, Bezirkskrankenhaus Günzburg
³Neurologische Gemeinschaftspraxis, München
⁴Handchirurgie, DRK-Klinik Baden-Baden
⁵Handchirurgie, Orthopädische Universitätsklinik Heidelberg
⁶Handchirurgie, Klinikum Fulda
⁷Neurologische Klinik, Augsburg
⁸Neurochirurgische Universitätsklinik Homburg/Saar
⁹Institut für Medizinische Informationsverarbeitung, Universität Tübingen
¹⁰Unfall- und Handchirurgie, Malteser-Krankenhaus Hamm
¹¹Neurologische Universitätsklinik Mainz
¹²Orthopädische Abteilung, Marienhospital Gelsenkirchen
¹³Hand- und Plastische Chirurgie, Klinik Rosengasse, Ulm

Abstract

Zusammenfassung

Evidenzbasierte fachübergreifende Leitlinie, die sich mit Epidemiologie, Pathogenese, Symptomatik, klinischer und elektrophysiologischer Diagnostik, der bildgebenden Zusatzdiagnostik, Differenzialdiagnose, der konservativen und operativen Behandlung, Prognose und Verlauf und den Komplikationen und Revisionseingriffen beschäftigt. Die Empfehlungen zu Diagnostik und Therapie gründen sich auf eine umfassende Literaturrecherche mit kritischer Bewertung und zwei Konsensusverfahren (Expertengruppe und Delphi-Verfahren) innerhalb der beteiligten Fachgesellschaften. Neben dieser Langversion können eine Kurzversion und eine Patientenversion über die AWMF-Plattform eingesehen werden. Entstehung der Leitlinie und die methodischen Grundlagen sind in einem Methodenreport dokumentiert. Die wichtigsten Aussagen: Neben der Anamneseerhebung und der klinisch-neurologischen Untersuchung (einschließlich klinischer Tests) kommt vor allem der elektrophysiologischen Diagnostik (distal-motorische Latenz und sensible Neurografie) eine wichtige diagnostische Bedeutung zu. Röntgen, MRT, hochauflösende Sonografie sind als fakultative Zusatzdiagnostik zu werten. Unter den konservativen Behandlungsverfahren sind die Behandlung mit einer nächtlichen Schiene und die lokale Infiltration eines Kortikoid-Präparats wirksam. Oral verabreichte Kortikoide, Schienung, Ultraschall, Magnettherapie u. a. zeigen nur eine zeitlich begrenzte Wirkung. Die operative Behandlung ist allen anderen Verfahren eindeutig überlegen. Offene und endoskopische Operation sind (bei ausreichender Erfahrung des endoskopischen Operateurs) gleichwertig. Eine routinemäßige Epineurotomie ist ebenso wenig zu empfehlen wie eine interfaszikuläre Neurolyse. Nach dem Eingriff ist eine frühe funktionelle Behandlung wichtig.

Abstract

Evidence-based supradisciplinary guideline that deals with the epidemiology, pathogenesis, symptoms, clinical and electrophysiological diagnosis, supplementary imaging investigations, differential diagnosis, conservative and surgical treatments, prognosis and course along with complications and revision surgery. The recommendations on investigation and treatment are based on a comprehensive literature search with critical evaluation and two consensus methods (expert group and Delphi technique) within the participating specialist societies. Besides this long version, a short version and a patient version can be viewed through the AWMF platform. The development of the guideline and the methodological foundations are documented in a method report. Main Statements: Apart from an accurate history and clinical neurological examination (including clinical tests), electrophysiological investigations (distal motor latency and sensory neurography) are particularly important. Radiography, MRI, high-resolution ultrasonography can be regarded as optional supplementary investigations. Among conservative treatment methods, treatment with a nocturnal splint and local infiltration of a corticosteroid preparation are effective. Oral steroids, splinting and ultrasound showed only short-term benefit. Surgical treatment is clearly superior to all other methods. Open and endoscopic procedures (when the endoscopic surgeon has sufficient experience) are equivalent. A routine epineurotomy and interfascicular neurolysis cannot be recommended. Early functional treatment postoperatively is important.

Schlüsselwörter

elektrophysiologische Diagnostik - Karpaltunnelsyndrom - Leitlinie - evidenzbasiert - Neurografie - operative Behandlung - Retinakulumspaltung - offen - Retinakulumspaltung - endoskopisch

Key words

electrophysiological diagnosis - carpal tunnel syndrome - guideline - evidence‐based - neurography - surgical treatment - carpal tunnel release - open - carpal tunnel release - endoscopic

Full Text

References

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18 Schlussbemerkungen

Die Leitlinie wurde unter der methodischen Beratung von Prof. Dr. H. K. Selbmann/Tübingen und der Koordination von Frau Prof. Dr. M. Wüstner-Hofmann/Ulm und Dr. H. Assmus/Dossenheim-Heidelberg von einem Expertengremium (H. Assmus, G. Antoniadis, C. Bischoff, P. Haußmann, A. K. Martini, Z. Mascharka, K. Scheglmann, K. Schwerdtfeger, H. K. Selbmann, H. Towfigh, T. Vogt, K. D. Wessels, M. Wüstner-Hofmann) entwickelt. Konsensfindung und Entstehung der Leitlinie sind in einem gesonderten Leitlinienreport beschrieben. Außer dieser Langfassung sind eine Kurzfassung und eine Patientenfassung verfügbar.

Eine Leitlinie gibt begründete Empfehlungen und erlaubt persönliche und fallbezogene Entscheidungen. Sie ist keine Handlungsvorschrift und nicht mit einer Richtlinie zu verwechseln. Diagnose- und Behandlungsverfahren sind ständigen Wandlungen unterworfen. Eine Leitlinie ist somit immer verbesserungsfähig.

Die nächste Überarbeitung ist 2009 vorgesehen.

Dr. med. Hans Assmus

Neurochirurgische Gemeinschaftspraxis

Ringstraße 3

69221 Dossenheim

Email: hans-assmus@t-online.de