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Komplexes regionales Schmerzsyndrom nach distaler Radiusfraktur

Aktuelle Epidemiologie, pathophysiologische Modelle, Diagnostik und Therapie

Complex regional pain syndrome following distal fractures of the radius

Epidemiology, pathophysiological models, diagnostics and therapy

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Zusammenfassung

Das „complex regional pain syndrome“ (CRPS) stellt nach wie vor eine nicht abschließend ätiologisch geklärte Komplikation nach distalen Radiusfrakturen dar. Die Inzidenz des Auftretens eines CRPS nach distalen Radiusfrakturen variiert zwischen 1 und 37 %. Pathophysiologisch wird nach aktuellen Erkenntnissen ein komplexes Zusammenspiel von inflammatorischen, somatosensorischen, motorischen und vegetativ-autonomen Veränderungen angenommen, die zu einer persistierenden maladaptiven Antwort und Sensibilisierung des zentralen und peripheren Nervensystems mit den entsprechenden Symptomen führen. Entscheidend für die Diagnosestellung sind eine detaillierte Anamneseerhebung sowie die klinisch-handchirurgische, neurologische und schmerzmedizinische Untersuchung mit Bestätigung der „Budapest-Kriterien“. Unter den apparativen Möglichkeiten haben die Dreiphasenskelettszintigraphie wie auch die Temperaturmessung einen gewissen Stellenwert. Eine möglichst früh begonnene multimodale Therapie ist am erfolgversprechendsten. Dabei stehen in aller Regel schmerzmedizinische und funktionelle Aspekte im Rahmen einer multimodalen Rehabilitation im Vordergrund.

Abstract

The complex regional pain syndrome (CRPS) still represents an incompletely etiologically understood complication following fractures of the distal radius. The incidence of CRPS following fractures of the distal radius varies between 1 % and 37 %. Pathophysiologically, a complex interaction of inflammatory, somatosensory, motor and autonomic changes is suspected, leading to a persistent maladaptive response and sensitization of the central and peripheral nervous systems with development of the corresponding symptoms. Decisive for the diagnostics are a detailed patient medical history and a clinical hand surgical, neurological and pain-related examination with confirmation of the Budapest criteria. Among the types of apparatus used for diagnostics, 3‑phase bone scintigraphy and temperature measurement have a certain importance. A multimodal therapy started as early as possible is the most promising approach for successful treatment. As part of a multimodal rehabilitation the main focus of therapy lies on pain relief and functional aspects.

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Authors and Affiliations

  1. Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    L. Harhaus, F. Neubrech, C. Hirche, T. Schilling, B. Bickert & U. Kneser

  2. Abteilung für Berufsgenossenschaftliche Rehabilitation und Heilverfahrenssteuerung, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    H. Kohler

  3. Abteilung für Schmerzmedizin, Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    A. Mayr & A. Riesmeier

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L. Harhaus, F. Neubrech, C. Hirche, T. Schilling, H. Kohler, A. Mayr, A. Riesmeier, B. Bickert und U. Kneser geben an, dass kein Interessenkonflikt besteht.

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Harhaus, L., Neubrech, F., Hirche, C. et al. Komplexes regionales Schmerzsyndrom nach distaler Radiusfraktur. Unfallchirurg 119, 732–741 (2016). https://doi.org/10.1007/s00113-016-0217-x

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