Schmerzen, Kribbeln, Taubheit – Wenn ein Nerv klemmt !

Armschmerzen in Verbindung mit Taubheitsempfinden und Kribbeln einzelner Finger ist ein häufig auftretendes Krankheitssymptom.

Die betroffenen Patienten sind durch diese Beschwerden in ihrem Alltagsleben oftmals sehr gestört und gar beeinträchtigt. Hinter diesen Symptomen können verschiedene Krankheitsursachen verborgen sein.

Hier ist der erfahrene Arzt für Neurologie gefragt. Ein häufiges Krankheitsbild stellt, das Ulnarisrinnensyndrom oder auch Kubitaltunnelsyndrom dar.

Die Diagnosestellung erfolgt in der Regel durch die ausführlich Befragung des Betroffenen und eine genaue klinische Untersuchung.

Zur Diagnosesicherung sind zusätzlich elektrophysiologische Untersuchungen erforderlich. Um die Ursache der Erkrankung genau zu beleuchten, ist eine Nervensonographie die Methode der Wahl.

 

Im folgenden Artikel der DGN  wird das Krankheitsbild ausführlich dargestellt.

„Zitat“

 

 

Diagnostik und Therapie der chronischen Ulnarisneuropathie am Ellenbogen (ulnar neuropathy at the elbow, UNE)

Entwicklungsstufe: S1
Stand: September 2012
Federführend
Dr. Oliver Kastrup, Essen

oliver.kastrup@uni-due.de

PDF-Download der Leitlinie
Clinical Pathway

Inhaltsverzeichnis

Was gibt es Neues?

  • Die präoperative Evaluation der nervalen Morphologie mittels MRT und dynamischem Ultraschall ist in bestimmten Fällen hilfreich, der Wert der Techniken ist noch nicht abschließend beurteilbar.
  • Der diagnostische Wert von Provokationstests ist gering.

Die wichtigsten Empfehlungen auf einen Blick

  • Leichtere Ulnarisläsionen am Ellenbogen werden zunächst konservativ therapiert. Ursächliche Faktoren wie repetitive exogene Druckeinwirkung oder Unterarmflexion sollen durch Verhaltensänderung, Polsterung bzw. nächtliche Schienung des Ellenbogens vermieden werden. Beim Vorliegen einer Ulnarisneuropathie und fehlender Besserung unter konservativer Therapie oder bereits fortgeschrittenen sensomotorischen Ausfallserscheinungen ist eine Operation indiziert.
  • Hierzu stehen 3 Operationsverfahren zur Verfügung:
    • Dekompression ohne Vorverlagerung
    • Dekompression mit medialer Epikondylektomie
    • submuskuläre Transposition des N. ulnaris, ggf. mit muskulofaszialer Verlängerung
  • Reine subkutane Volarverlagerungen und interfaszikuläre Neurolysen sollten unterbleiben.

Definition

Bei der UNE handelt es sich um eine chronisch-progrediente mechanische Schädigung des N. ulnaris im Bereich des Ellenbogens, der bei einheitlicher Klinik verschiedene Ursachen zugrunde liegen können. Die UNE umfasst das Kubitaltunnelsyndrom, das Sulcus-ulnaris-Syndrom sowie die Ulnarisspätlähmung. Sie ist nach dem Karpaltunnelsyndrom die zweithäufigste nicht traumatische Mononeuropathie.

Symptome

Unabhängig von der jeweiligen Ursache führt eine chronische N.-ulnaris-Kompression initial zu Parästhesien und teilweise Schmerzen in der ulnaren Handpartie. Hinzutretende sensible Ausfälle betreffen den Kleinfinger, die ulnare Hälfte des Ringfingers, die ulnare Partie der Handinnenfläche (R. superficialis) und des Handrückens (R. dorsalis manus) sowie das Areal des R. palmaris (proximaler Anteil des Kleinfingerballens und des angrenzenden Handgelenks). Paresen und Atrophien entwickeln sich zunächst in der Ulnaris-innervierten Handmuskulatur – mit allmählicher Ausbildung einer Krallenstellung der Finger IV und V und Abduktionsstellung des Kleinfingers – und erst später in den Ulnaris-versorgten Finger- und Handgelenkbeugern (M. flexor carpi ulnaris und ulnarer Anteil des M. flexor digitorum profundus).

Pathogenese und Ursachen

Dem einheitlichen klinischen Bild der chronisch progredienten Ulnarisläsion in Höhe des Ellenbogens liegen verschiedene Pathomechanismen zugrunde.

Als Engpasssyndrom im engeren Sinne ist das Kubitaltunnelsyndrom anzusehen. Hierbei handelt es sich um eine Kompression des Ellennervs bei dessen Verlauf durch den Kubitaltunnel unter dem M. flexor carpi ulnaris, dessen Eingang von einer Aponeurose gebildet wird, die von diesem Muskel zum Olekranon verläuft.

Aus der bei Beugung des Unterarms stattfindenden Anspannung dieser Aponeurose resultiert eine Kompression des Ellennervs. Sowohl bei repetitiven Beuge- und Streckbewegungen als auch bei länger dauernder Unterarmbeugung, z. B. im Schlaf, kann sich hieraus ein Nervenkompressionssyndrom mit Störung der Mikrozirkulation, Ödembildung und nachfolgender Myelin- und Axonschädigung entwickeln.

Das Sulcus-ulnaris-Syndrom (Ulnarisrinnensyndrom) ist Folge einer chronischen Mikrotraumatisierung des Nervs im Bereich der Ulnarisrinne. Ursächlich ist eine repetitive oder chronische exogene Druckeinwirkung anzuschuldigen, die durch eine flache Ulnarisrinne sowie eine bei Unterarmbeugung eintretende (Sub-)Luxation des N. ulnaris begünstigt wird. Diesen Mechanismus findet man bei einem habituellen, beschäftigungs- oder krankheitsbedingten Aufstützen bzw. Aufliegen des Ellenbogens auf einer schlecht gepolsterten Unterlage. Selten führen auch eine Hypertrophie oder eine Dislokation des medialen Trizepskopfes über den Epicondylus medialis bei Unterarmbeugung zu einer Ulnariskompression. (Ein aus den genannten Mechanismen resultierendes Pseudoneurom kann zur Einklemmung des N. ulnaris im Kubitaltunnel führen, sodass in diesen Fällen auch von einem sekundären Kubitaltunnelsyndrom gesprochen wird, obwohl beim Ulnarisrinnensyndrom die Nerven proximal des Engpasses häufig aufgetrieben sind).

Der Sulcus nervi ulnaris wird von unterschiedlich starkem sehnenähnlichem Gewebe – dem sog. Sulkusdach – bedeckt, das gelegentlich durch den atavistischen M. epitrochleo-anconaeus verstärkt wird und eine N.-ulnaris-Kompression bewirken kann.

Des Weiteren können knöcherne Veränderungen im Bereich des medialen Ellenbogens wie eine Arthrosis deformans, primär-chronische Polyarthritis, Osteochondromatose, aneurysmatische Knochenzyste, Akromegalie oder ein Morbus Paget eine chronische N.-ulnaris-Kompression hervorrufen. Knöcherne und narbige Veränderungen nach Verletzungen sind – unter Umständen in Verbindung mit einer Valgusfehlstellung – die Ursache der posttraumatischen Ulnarisspätlähmung. Schließlich kommen (manchmal erst intraoperativ entdeckte) Ganglien, Nerven- oder Weichteiltumoren ursächlich infrage.

Proximal des Sulcus ulnaris lokalisierte Kompressionen des Ellennervs sind selten und können durch einen Processus supracondylaris oder die sog. Struther’s Arkade hervorgerufen werden (Tackmann et al. 1989).

Differenzialdiagnose

Die wichtigste Differenzialdiagnose ist die akute exogene Druckschädigung des N. ulnaris in der Ulnarisrinne, wie sie beim längeren Aufstützen bzw. Aufliegen des Ellenbogens auf einer harten Unterlage oder als Lagerungsschaden auftreten kann. Der typische neurografische Befund besteht in einem partiellen Leitungsblock ohne begleitende Leitungsverzögerung mit und ohne axonale Schädigung (je nach Dauer und Schwere des Drucksschadens) bzw. Ausfall motorischer Einheiten im EMG. Je nach Schweregrad (Neurapraxie oder Axonotmesis) kann die Rückbildung der Lähmungen bis zu einem Jahr dauern.

Die Abgrenzung einer proximalen Ulnarisläsion von einer unteren Armplexusparese (Thoracic-outlet-Syndrom, Schwannom, kostoklavikuläres Syndrom usw.) und einem C 8-Syndrom gelingt klinisch durch Nachweis einer Sensibilitätsstörung im Versorgungsgebiet des N. cutaneus antebrachii medialis am medialen (ulnaren) Unterarm bei diesen mehr proximal gelegenen Schädigungsorten.

Neurophysiologisch kann zur Bestätigung einer Läsion des medialen Faszikels eine sensible Neurografie des N. cutaneus antebrachii medialis durchgeführt werden und bildgebend eine Plexusdarstellung im MRT erfolgen.

Ein C 8-Syndrom zeigt sich anamnestisch und klinisch meist durch das typische radikuläre, auf die HWS bezogene Schmerzsyndrom; die Zusatzdiagnostik stützt sich besonders auf die bildgebenden Verfahren. Neurophysiologisch sind die sensiblen Nervenaktionspotenziale des N. ulnaris bei C 8-Syndrom nicht reduziert. Außerdem ist hierbei eine Ausdehnung der Nadel-Elektromyografie von der Ulnaris-innervierten Muskulatur auf den M. abductor pollicis brevis (Nachweis einer unteren Armplexusläsion) und die paraspinale Muskulatur (Nachweis einer Radikulopathie) zu empfehlen.

Falls klinisch und elektromyografisch nur die Ulnaris-innervierten Handmuskeln betroffen sind, müssen ein Syndrom der Guyon-Loge sowie eine N.-ulnaris-Kompression in Höhe des Handgelenks durch das abnorm verdickte distale Ende der Unterarmfaszie und schließlich eine R.-profundus-Läsion in der Hohlhand ausgeschlossen werden (Dawson et al. 1999). Dieses tritt auch akut nach längerer ungewohnter Handextension (Fahrradtouren) auf.

Schließlich sind bei rein motorischen Ausfällen differenzialdiagnostisch eine multifokale motorische Neuropathie (MMN) und eine Motoneuronerkrankung (z. B. ALS) zu erwägen.

Diagnostik

Klinische Untersuchungen

Nach sorgfältiger anamnestischer Erfassung der aktuellen Symptomatik und des bisherigen Verlaufs erfolgen die motorische Funktionsprüfung der Ulnaris-innervierten Hand- und Unterarmmuskulatur sowie die visuelle und palpatorische Prüfung der Muskeltrophik. Das Fromment-Zeichen ist häufig positiv. Die Testung der Oberflächensensibilität kann sich auf das Berührungsempfinden beschränken, muss aber die Hautareale der Rr. palmaris und dorsalis manus – die proximal des Handgelenks vom N. ulnaris abzweigen – miterfassen, um eine Ulnarisläsion in Höhe des Handgelenks abzugrenzen.

Von großer Wichtigkeit ist die visuelle und palpatorische Exploration der Ulnarisrinne bei gestrecktem und gebeugtem Unterarm, um (Sub-)Luxationen des N. ulnaris und/oder Dislokationen des medialen Trizepskopfes bei Unterarmbeugung sowie anatomische Besonderheiten im Verlauf des Sulkus zu erfassen. Umschriebene Verdickungen des Ellennervs weisen auf eine Pseudoneurombildung hin.

Durch Palpation des N. ulnaris lassen sich oft auch bei Gesunden elektrisierende Parästhesien in der ulnaren Handpartie auslösen, sodass höchstens eine abnorme Druckempfindlichkeit als diagnostischer Hinweis auf eine dort lokalisierte Nervenläsion zu werten ist. Grundsätzlich ist die diagnostische Aussagekraft klinischer Untersuchungsverfahren (Tinel-Zeichen, Flexion Compression Test, Palpation auf Verdickung oder Druckempfindlichkeit) sehr gering (Beekman et al. 2009).

Elektromyografie und Neurografie

Die klinische Verdachtsdiagnose einer chronischen Ulnarisneuropathie am Ellenbogen muss durch eine elektrophysiologische Diagnostik verifiziert werden, die folgende Maßnahmen umfassen sollte (Stöhr 1998):

  • Die motorische Neurografie des N. ulnaris erfolgt mittels Oberflächenelektroden, wobei auf eine konstante Armhaltung (70–90 ° flektierter Unterarm) und auf eine Hauttemperatur von mindestens 34 °C geachtet werden muss.
  • Die Messung muss fraktioniert erfolgen, mit getrennter Bestimmung der Nervenleitgeschwindigkeit (NLG) und Amplituden der Muskelsummenpotenziale im Unterarm- und im Ellenbogensegment des Ellennervs, am besten fraktioniert mit „Inching“ über den Ellenbogen.
  • Die Ableitung der motorischen Antwortpotenziale ist sowohl vom M. abductor digiti minimi als auch vom (oft stärker betroffenen) M. interosseus dorsalis I möglich. Bei pathologischen Messwerten ist stets ein Vergleich mit der NLG des ipsilateralen N. medianus erforderlich, um eine hereditäre oder erworbene Polyneuropathie auszuschließen.

Typisch für eine chronische Ulnariskompression in Höhe des Ellenbogens sind folgende Befunde:

  • eine um mehr als 16 m/s herabgesetzte motorische NLG im Ellenbogensegment im Vergleich zum Unterarmsegment
  • eine signifikante Amplitudenminderung des motorischen Antwortpotenzials nach Nervenstimulation proximal im Vergleich zur Stimulation distal der Ulnarisrinne um mindestens 20 % (wobei ein solcher partieller Leitungsblock als isolierter neurografischer Befund auch bei akuten exogenen Druckschädigungen vorkommt
  • eine Aufsplitterung und Verlängerung des motorischen Antwortpotenzials nach Stimulation proximal, nicht aber distal des Sulkus (temporale Dispersion)
  • Die konventionelle motorische Neurografie des N. ulnaris kann ergänzt werden durch die sog. Inching-Technik, bei welcher der Sulcus nervi ulnaris mit der Reizelektrode von distal nach proximal in 10-mm-Schritten abgefahren wird. Nach Überschreiten der Läsionsstelle resultiert in typischen Fällen ein Latenz- und Amplitudensprung, der dann eine sehr genaue Schädigungslokalisation erlaubt.
  • In fortgeschrittenen Fällen kann die NLG des N. ulnaris auch im Unterarmabschnitt herabgesetzt sein oder es lässt sich in der Ulnaris-innervierten Handmuskulatur kein verwertbares Antwortpotenzial evozieren. Hier kann die motorische Überleitungszeit vom N. ulnaris (bei Stimulation 2 cm proximal des Epicondylus medialis) zum M. flexor carpi ulnaris – 10 cm distal des Epicondylus medialis – bestimmt werden; eine Latenz > 4,0 ms spricht dann für eine Impulsleitungsverzögerung.
  • Ein Leitungsblock über dem Ellenbogen zum M. interosseus dorsalis und ein normales EMAP vom Abductor digiti minimi scheint stark mit einer guten Prognose und Erholung assoziiert (Friedrich u. Robinson 2011).
  • Sensible Nervenleitgeschwindigkeitsmessungen des Ellenbogenabschnitts des N. ulnaris sind nur mittels nervennah eingestochener Nadelelektroden möglich und daher sehr zeitaufwendig. Alternativ kann das gemischte Nervenaktionspotenzial proximal der Ulnarisrinne nach Ulnarisstimulation am Handgelenk mit Oberflächenelektroden abgeleitet und im Seitenvergleich bezüglich Latenz, Amplitude, Dauer und Form (temp. Dispersion?) bewertet werden, wobei dieses häufig nicht gelingt. Selbst bei Gesunden, vor allem bei Adipositas oder auch wenn der Nerv bei Ableitung distal des Ellenbogens schon in der Tiefe liegt, kann zum Teil gar kein Potenzial registriert werden.
  • Die konventionelle sensible Neurografie des N. ulnaris zwischen Kleinfinger und Handgelenk mittels Oberflächenelektroden erlaubt bei einer signifikanten Amplitudenreduktion des sensiblen Nervenaktionspotenzials lediglich den Nachweis eines Untergangs sensibler Nervenfasern ohne Hinweis auf den Schädigungsort. Dagegen weist ein erniedrigtes sensibles Nervenaktionspotenzial des R. dorsalis manus auf eine proximale Schädigungslokalisation hin, da dieser sensible Ast bereits in Höhe des distalen Unterarms vom Hauptstamm des N. ulnaris abzweigt. Das Ausmaß der SNAP-Minderung scheint ein prognostischer Marker bezüglich eines günstigen postoperativen Ergebnisses zu sein (Mondelli et al. 2004).
  • Der elektromyografische Nachweis von pathologischer Spontanaktivität und/oder einem neurogenen Umbau und Ausfall motorischer Einheiten im M. flexor digitorum profundus beweist den proximalen Sitz einer Ulnarisschädigung, ist jedoch unspezifisch im Hinblick auf deren Ursache. Sofern klinisch keine eindeutigen motorischen Ausfallserscheinungen vorliegen, sollte auch eine elektromyografische Ableitung aus dem meist am frühesten und stärksten betroffenen M. interosseus dorsalis I erfolgen, um den Nachweis oder Ausschluss der partiellen Denervierung zu führen.

Fakultative Untersuchungen

Eine bildgebende Diagnostik ist zweckmäßig vor einer geplanten operativen Therapie sowie bei Hinweisen auf knöcherne Veränderungen im Verlauf der Ulnarisrinne, wobei folgende Verfahren eingesetzt werden:

  • Röntgenaufnahmendes Ellenbogens a.-p. und seitlich sowie Tangentialaufnahmen des Sulcus n. ulnaris
  • Sonografiemit hochauflösender (z. B. 13-MHz-)Sonde, mit der im Sinne einer dynamischen Untersuchung auch Subluxationen nachgewiesen werden können, auch die Verdickung und die Verschieblichkeit („gliding“). Obwohl die Methode vielversprechend scheint, bleibt nach aktueller Analyse aller relevanten Studien aufgrund der methodologischen Unterschiede die praktische Bedeutung unklar (Beekmann et al. 2011)
  • Magnetresonanztomografie, die besonders Veränderungen am Nerv (Ödem, Neurom o. ä.) gut nachweist

Therapie

Konservative Behandlung

  • Leichtere Ulnarisläsionen am Ellenbogen sollten zunächst konservativ therapiert werden, vor allem wenn ursächliche Faktoren wie eine repetitive exogene Druckeinwirkung oder Unterarmflexion durch Verhaltensänderung, Polsterung bzw. nächtliche Schienung des Ellenbogens vermieden werden können.
  • Unterstützend ist in diesen Fällen eine krankengymnastische Anleitung zur Kräftigung paretischer Muskeln zweckmäßig.
  • Akute exogene Druckschäden – z. B. in Narkose oder im Koma – sollten auch bei schweren sensomotorischen Ausfällen einer konservativen Behandlung unterzogen werden, da die spontane Besserungstendenz bei Vermeidung weiterer Druckeinwirkungen gut ist. Bei Schädigung vom Typ der Axonotmesis erfolgt die Reinnervation der Handmuskulatur erst nach 8–12 Monaten.

Operative Behandlung

Akute exogene Druckschädigungen des N. ulnaris in der Ulnarisrinne stellen keine Operationsindikation dar!

Beim Vorliegen einer UNE und fehlender Besserung unter konservativer Therapie oder bereits fortgeschrittenen sensomotorischen Ausfallserscheinungen ist eine Operation indiziert. Diese setzt eine spezielle Expertise voraus, die in erster Linie durch Neurochirurgen und Handchirurgen erfüllt wird.

Die Vielfältigkeit der Ursachen lässt keine einheitliche Empfehlung zum operativen Vorgehen zu. Randomisierte, prospektive Studien zum Vergleich der Operationstechniken fehlen. In den publizierten Studien bestehen deutliche Diskrepanzen zwischen klinischer Beurteilung und Patientenselbsteinschätzung. Ein aktuelles Cochrane Review kommt zu dem Schluss, dass die Evidenzlage nicht ausreicht, um die beste Behandlung der UNE anhand von klinischen, neurophysiologischen und bildgebenden Verfahren zu identifizieren (Caliandro et al. 2011). Die aktuellen deutschen chirurgischen Leitlinien (AWMF) und eine Übersicht (Assmus et al. 2011) empfehlen primär eine einfache Dekompression.

Es stehen 2 operative Grundprinzipien zur Verfügung:

  1. Dekompression ohne Vorverlagerung:
  • Beim Kubitaltunnelsyndrom ist eine Spaltung der dessen Eingang bildenden Aponeurose erfolgreich. Dieser technisch einfache, ambulant und in Regionalanästhesie durchführbare Eingriff scheint auch beim Ulnarisrinnensyndrom in vielen Fällen einen positiven Effekt zu erbringen und sollte deshalb zumindest als ergänzende Maßnahme in allen operativ behandelten Fällen durchgeführt werden. Der Standardeingriff für die UNE ist somit die Dekompression, bei der alle den Nerv komprimierenden Strukturen wie ein verdicktes Lig. epicondylico-olecranicum, der Sehnenbogen des M. flexor carpi ulnaris und ggf. ein akzessorischer M. epitrochleo-anconaeus gespalten werden (Pavelka et al. 2004).
  • In den letzten Jahren wird über eine vergleichbare Erfolgsraten nach endoskopischer Operationstechnik berichtet (Hoffmann u. Siemionow 2006, Krishnan et al. 2006), bestätigende Studien stehen aus.
  • Die Indikation zur Exoneurolyse des Ellennervs ist bei stärkeren narbigen Veränderungen sowie bei progredientem Verlauf trotz Durchführung des erstgenannten Eingriffs gegeben.
  • Narbige Veränderungen kommen fast nur bei einem Teil der Patienten mit Ulnarisspätparese (z. B. nach supra- oder transkondylärer Humerusfraktur im Kindesalter) oder z. B. mit erheblicher Arthrose des Ellenbogengelenks vor.
  1. Submuskuläre Transposition des N. ulnaris, ggf. mit muskulofaszialer Verlängerung:
    • Problematisch ist die früher oft durchgeführte Technik der Volarverlagerung des N. ulnaris, die bei kurzstreckiger Verlagerung zur Abknickung, bei langstreckiger Transposition zur lokalen Ischämie des betreffenden Nervensegments infolge Unterbindung von Vasa nervorum führen kann. Diese Maßnahme ist daher nur bei ausgeprägten knöchernen Veränderungen im Sulcus nervi ulnaris, bei starkem Cubitus valgus oder bei einer Luxation des N. ulnaris angezeigt, wobei die das betroffene Nervensegment versorgenden Vasa nervorum mit diesem transponiert werden müssen (Dellon u. Coert 2004). Die Verlagerung kann prinzipiell subkutan, intramuskulär oder submuskulär erfolgen, wobei die letztgenannte Technik die besten Resultate erbrachte (Fitzgerald et al. 2004). Diese Operationstechnik wird als „submuscular ulnar nerve transposition“ (SMUNT) bezeichnet. Eine interfaszikuläre Neurolyse ist kontraindiziert.
    • Bei schweren knöchernen Veränderungen ist bei Valgusstellung eine suprakondyläre Umstellungsosteotomie des Humerus zweckmäßig.

Postoperativ wird bei allen Techniken ein leichter Kompressionsverband angelegt. Nach einfacher Dekompression sowie nach subkutaner Verlagerung ist keine Ruhigstellung erforderlich, nach tiefer submuskulärer Verlagerung allenfalls für 2 Wochen.

Redaktionskomitee

Prof. Dr. G. Antoniadis, Neurochirurgische Universitätsklinik, Ulm
Dr. H. Assmus, Praxis für Neurochirurgie, Dossenheim
Prof. Dr. Ch. Bischoff, Neurologe, München
Priv.-Doz. Dr. A. Hufschmidt, Abt. Neurologie, St.-Elisabeth-Krankenhaus, Wittlich
Dr. O. Kastrup, Neurologische Klinik, Universität Duisburg-Essen
Prof. Dr. K. Reiners, Neurologische Klinik, Universität Würzburg
Dr. K. Scheglmann, Neurologische Klinik, Klinikum Augsburg
Priv.-Doz. Dr. Th. Vogt, Neurologische Universitätsklinik, Mainz

Für die Schweiz:
Priv.-Doz. Dr. W. Z’Graggen, Neurologische Universitätsklinik, Inselspital, Bern

Für Österreich:
Prof. Dr. W. Grisold, Neurologische Klinik, Wiener Krankenanstaltenverbund, Wien

Federführend: Dr. Oliver Kastrup, Neurologische Klinik, Universität Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Tel.: 0201/7232463, E-Mail: oliver.kastrup@uni-due.de

Diese Kurzform basiert auf der S3-Leitlinie „Kubitaltunnelsyndrom“ (AWMF-Registernummer 005-009)

Interessenkonflikte

Keine

Die Leitlinie wurde abgestimmt mit der Deutschen Gesellschaft für Neurochirurgie, der Deutschen Gesellschaft für Handchirurgie sowie dem BDN, der Schweizerischen Neurologischen Gesellschaft und der Österreichischen Gesellschaft für Neurologie.

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Mondelli M, Giannini F, Morana P et al. Ulnar neuropathy at the elbow: predictive value of clinical and electrophysiological measurements for surgical outcome. Electromyogr Clin Neurophysiol 2004; 44: 349–356

Mumenthaler M, Stöhr M, Müller-Vahl H. Läsionen peripherer Nerven und radikuläre Syndrome, 8. Aufl. Stuttgart: Thieme; 2002

Pavelka M, Rhomberg M, Estermann D et al. Decompression without anterior transposition: an effective minimally invasive technique for cubital tunnel syndrome. Minim Invasive Neurosurg 2004; 47: 119–123

Rochet S, Obert L, Lepage D et al. [Should we divide Osborn’s ligament during epicondylectomy and in situ decompression of the ulnar nerve?] Chir Main 2004; 23: 131–136

Stöhr M. Atlas der klinischen Elektromyographie und Neurographie, 4. Aufl. Stuttgart: Kohlhammer; 1998

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Aus: Hans-Christoph Diener, Christian Weimar (Hrsg.): Leitlinien für Diagnostik und Therapie in der Neurologie, Herausgegeben von der Kommission „Leitlinien“ der Deutschen Gesellschaft für Neurologie, Thieme Verlag, Stuttgart, September 2012

 

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