Betreffend der Wrist-to-Forearm-Ratio des N. medianus ist die Sonographie zur Verlaufskontrolle nach Operation eines Karpaltunnelsyndroms ungeeignet

 

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Zusammenfassung

Ziel Primäres Ziel der Untersuchung war es zu ermitteln, ob und inwieweit eine Korrelation zwischen dem klinischen Verlauf nach Karpaltunneldekompression bei Karpaltunnelsyndrom (KTS) und der sonographisch ermittelten Wrist-to-Forearm-Ratio (WFR) des N. medianus besteht und diese somit zur Verlaufskontrolle postoperativ geeignet ist.

Patienten und Methoden In einer prospektiven Studie wurden die klinischen, elektrophysiologischen und sonographischen Befunde von 40 Patienten, bei denen aufgrund klinischer sowie sonografischer und elektrophysiologischer Kriterien eines Karpaltunnelsyndroms eine Spaltung des Retinaculum flexorum erfolgte, präoperativ sowie 3 und 9 Monate postoperativ erfasst und miteinander verglichen. Letztlich kamen die Datensätze von 21 komplett untersuchten Patienten mit 23 operierten Händen zur Auswertung. Es handelte sich um 5 Männer und 16 Frauen mit einem Durchschnittsalter von 58 Jahren.

Ergebnisse Eine eindeutige Korrelation zwischen dem klinischen Verlauf nach Dekompression des Karpaltunnels bei KTS und der sonographisch ermittelten WFR konnte ebenso wenig festgestellt werden wie mit den elektrophysiologisch erhobenen Befunden.

Schlussfolgerung Die Sonographie ist in punkto WFR zur Verlaufsbeobachtung nach Operation eines Karpaltunnelsyndroms ungeeignet.

Abstract

Purpose The primary aim of the study was to analyze whether there is and – if so – how far a correlation between the clinical findings after carpal tunnel release (CTR) for carpal tunnel syndrome (CTS) and the Wrist-to-Forearm-Ratio (WFR) of the median nerve in ultrasound to answer is question whether the WFR can be used in controlling the operative result.

Patients and methods In a prospective study the clinical, electrophysiological, and sonographic data of 40 patients with CTR for CTS were collected preoperative and 3 and 9 months postoperative. The data of 21 patients with 23 operated hands completing the study were analyzed. There were 5 men and 16 women with an average age of 58 years.

Results Neither a correlation between the clinical findings postoperative and the WFR nor the electrophysiological findings postoperative was found.

Conclusion Concerning the Wrist-to-Forearm-Ration of the Median nerve ultrasound is not a suitable method for assessing the success of a carpal tunnel release.

• Literatur

• 1 Hobson-Webb LD, Massey JM, Juel VC. et al. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol 2008; 119: 1353-1357
  CrossrefPubMedGoogle Scholar
• 2 Smidt MH, Visser LH. Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve 2008; 38: 987-991
  CrossrefPubMedGoogle Scholar
• 3 Sezgin M, Incel NA, Serhan S. et al. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disabil Rehabil 2006; 28: 1281-1285
  CrossrefPubMedGoogle Scholar
• 4 American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 2002; 25: 918-922
  CrossrefPubMedGoogle Scholar
• 5 Schrijver HM, Gerritsen AA, Strijers RL. et al. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial. J Clin Neurophysiol 2005; 22: 216-221
  PubMedGoogle Scholar
• 6 Kabuto Y, Senda M, Hashizume H. et al. Time course changes of nerve conduction velocity in idiopathic carpal tunnel syndrome after endoscopic surgery. Acta Med Okayama 2001; 55: 185-191
  PubMedGoogle Scholar
• 7 Schlagenhauff RE, Glauser FE. Pre- and postoperative electromyographic evaluations in the carpal tunnel syndrome. J Neurosurg 1971; 35: 314-319
  CrossrefPubMedGoogle Scholar
• 8 Nolan WB, Alkaitis D, Glickel SZ. et al. Results of treatment of severe carpal tunnel syndrome. J Hand Surg Am 1992; 17: 1020-1023
  CrossrefPubMedGoogle Scholar
• 9 Finestone HM, Woodbury GM, Collavini T. et al. Severe Carpal tunnel syndrome: clinical and electrodiagnostic outcome of surgical and conservative treatment. Muscle Nerve 1996; 19: 237-239
  CrossrefPubMedGoogle Scholar
• 10 El-Hajj T, Thome R, Sawaya R. Changes in electrophysiological parameters after surgery for the carpal tunnel syndrome. J Clin Neurophysiol 2010; 27: 224-226
  CrossrefPubMedGoogle Scholar
• 11 Ginanneschi F, Milani P, Reale F. et al. Short term electrophysiological conduction change in median nerve fibers after carpal tunnel release. Clin Neurol Neurosurg 2008; 110: 1025-1030
  CrossrefPubMedGoogle Scholar
• 12 Mondelli M, Reale F, Sicurelli F. et al. Relationship between the selfadministered Boston Questionnaire and electrophysiological findings in followup of surgically- treated carpal tunnel syndrome. J Hand Surg Br 2000; 25: 128-134
  PubMedGoogle Scholar
• 13 Abicalaf CA, de Barros N, Serenik RA. et al. Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament. Clin Radiol 2007; 62: 891-896
  CrossrefPubMedGoogle Scholar