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Die operative Dekompression des Ramus superficialis des Nervus radialis

Das Wartenberg-Syndrom

Surgical decompression of the superficial radial nerve

Wartenberg syndrome

  • Operative Techniken
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Ziel ist die operative Dekompression des Ramus superficialis des Nervus radialis im Bereich der Durchtrittsstelle durch die Fascia antebrachii. Langstreckige Einengungen können durch endoskopisch assistierte Dekompressionen am Unterarm behoben werden.

Indikationen

Einengungen des Ramus superficialis des N. radialis entlang der Sehnen und Muskelbäuche der Musculi brachioradialis et extensor carpi radialis longus. Persistierender neuropathischer Schmerz mit Hoffmann-Tinel-Zeichen. Taubheit im Versorgungsgebiet des Ramus superficialis distal der Einengung. Frustrane konservative Behandlung. Pathologische elektrophysiologische Messparameter des Ramus superficialis.

Kontraindikationen

Endogene Neuropathie, Blutungsneigung, antikoagulatorische Medikation.

Operationstechnik

Hautinzision seitlich versetzt zum provozierten Hoffmann-Tinel-Zeichen am Unterarm. Präparation des Subkutangewebes und Darstellung der Unterarmfaszie. Eröffnen der Faszie und Identifikation des Ramus superficialis des N. radialis. Bei langstreckigen Einengungen kann nun die endoskopisch assistierte Dekompression nach proximal und distal erfolgen. Durch Einführen des Dissektors mit Optik nach proximal und distal kann der Ramus superficialis teils stumpf durch Abschieben, teils mit der Metzenbaum-Schere, freigelegt werden.

Weiterbehandlung

Regelmäßige Verbandwechsel, Fadenentfernung nach 14 Tagen, Aufbelastung nach definitiver Wundheilung.

Ergebnisse

Nach Dekompression des Ramus superficialis zeigten sich überwiegend gute bis sehr gute Ergebnisse bezüglich Schmerzreduktion und Sensibilität.

Abstract

Objective

Open decompression of the superficial radial nerve is performed at the distal forearm in cases of circumscript entrapment. Broad-based entrapments can be treated by endoscopically assisted decompression.

Indications

Entrapment of the nerve along its course between the brachioradialis and extensor carpi radialis longus muscles or tendons. Persistent neuropathic pain with Tinel’s sign. Numbness distal to the entrapment in accordance to nerval innervation. Futile conservative treatment. Pathological electrophysiological findings.

Contraindications

Endogeneous neuropathy, bleeding disorders, anticoagulation medication.

Surgical technique

Longitudinal skin incision at the Tinel’s sign at the forearm. The subcutaneous tissue is dissected until forearm fascia is detected. The fascia is opened cautiously under direct visualization and the superficial radial nerve is identified. In cases of broad-based entrapments, endoscopically assisted decompression can be performed. The dissector with attached optical device is introduced proximally and distally. Blunt mobilization using the dissector and preparation with the Metzenbaum scissors release the superficial radial nerve sufficiently.

Postoperative management

Bandaging allowing immediate motion, removal of sutures after 14 days, avoidance of excessive use for 2 weeks.

Results

Surgical decompression of the superficial radial nerve yields good to excellent results regarding pain reduction and sensory function.

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Authors and Affiliations

  1. Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland

    C. K. Spies, P. Hahn & F. Unglaub

  2. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland

    L. P. Müller & J. Oppermann

  3. Institut I für Anatomie, Medizinische Fakultät, Köln, Deutschland

    W. F. Neiss

  4. Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland

    F. Unglaub

Authors
  1. C. K. Spies
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  2. L. P. Müller
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  3. J. Oppermann
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  4. W. F. Neiss
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  5. P. Hahn
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  6. F. Unglaub
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Corresponding author

Correspondence to C. K. Spies.

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Interessenkonflikt

C.K. Spies und F. Unglaub erhielten finanzielle Unterstützung von der Richard und Annemarie Wolf Stiftung für Studien zur endoskopischen peripheren Nervenchirurgie. L.P. Müller, J. Oppermann, W.F. Neiss und P. Hahn geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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M. Langer, Münster

Zeichner

R. Himmelhan, Mannheim

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Spies, C.K., Müller, L.P., Oppermann, J. et al. Die operative Dekompression des Ramus superficialis des Nervus radialis. Oper Orthop Traumatol 28, 145–152 (2016). https://doi.org/10.1007/s00064-015-0431-7

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  • DOI: https://doi.org/10.1007/s00064-015-0431-7

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