Wartenbergs Syndrome

Other Names

• Cheiralgia Paresthetica
• Compression Neuropathy of Superficial Branch of Radial Nerve
• Wartenbergs Syndrome

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Background

• This page refers to an entrapment of the superficial branch of the Radial Nerve

Epidemiology

• Incidence is rare (need citation)

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Pathophysiology

Illustration of the superficial branch of the radial nerve (click to enlarge).

• General
  • Entrapment of the superficial branch radial nerve
  • Sometimes termed superficial sensory radial nerve (SRN)
  • Sensory symptoms only, no motor
• Etiology
  • Entrapment between Brachioradialis and Extensor Carpi Radialis Longus tendons
  • Direct pressure (e.g. watch, wristband, handcuffs)
  • Stretching (e.g. forearm fracture)

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Risk Factors

• Females > Males

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Differential Diagnosis

• Fractures
  • Phalanx Fractures (Hand)
  • Metacarpal Fractures
    • Boxer's Fracture
    • Rolando Fracture
    • Bennett Fracture
• Dislocations
  • Metacarpophalangeal Joint Dislocation
  • Proximal Interphalangeal Joint Dislocation
  • Distal Interphalangeal Joint Dislocation
  • Carpometacarpal Joint Dislocation
• Tendinopathies
  • Extensor Tendon Injuries (Hand)
  • Central Slip Extensor Tendon Injury
  • Flexor Tendon Injuries (Hand)
  • Boutonniere Deformity
  • Swan Neck Deformity
  • Jersey Finger
  • Mallet Finger
  • Trigger Finger
  • De Quervains Tenosynovitis
  • Volar Plate Avulsion Injury
  • Sagittal Band Injury
• Ligament Injuries
  • Gamekeepers Thumb (UCL)
  • Radial Collateral Ligament of the Thumb Injury (RCL)
• Neuropathies
  • Wartenbergs Syndrome
  • Carpal Tunnel Syndrome
  • Guyon Canal Syndrome
• Arthropathies
  • Carpometacarpal Arthritis
  • Finger Arthritis
  • Rheumatoid Arthritis
• Nail Bed Injuries
  • Nail Bed Lacerations
  • Nail Bed Avulsions
  • Subungual Hematoma
  • Paronychia
  • Felon
• Pediatric Considerations
  • Proximal Phalanx Avulsion Fracture (Thumb)
  • Middle and Distal Phalanx Avulsion Fracture
• Other
  • Dupuytrens Contracture
  • Intrinsic Plus

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Clinical Features

• Historu
  • Often poorly defined pain over dorsal hand and fingers
  • Sensory symptoms of burning, numbness, and tingling over the dorsal radial aspect of the wrist and hand
• Physical Exam: Physical Examination Hand
  • Often normal
• Special Tests
  • Tinel’s Test can be positive
  • Finkelstein's Test due to stretching of tendons

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Evaluation

Radiographs

• Standard Radiographs Hand
  • Typically normal, evaluation for other etiology

EMG/NCS

• EMG/NCS can be helpful

Diagnostic nerve block

• Should be considered in equivocal cases

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Classification

• N/a

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Management

Nonoperative

• First line therapy, spontaneous resolution common
• Removal of offending compressive device
• NSAIDS
• Wrist splint
• Physical Therapy
• Role of Corticosteroid Injection is unclear

Operative

• Indications
  • Refractory to nonoperative therapy for 6 months.

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Rehab and Return to Play

Rehabilitation

• Needs to be updated

Return to Play/ Work

• Needs to be updated

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Complications and Prognosis

Prognosis

• Unknown

Complications

• Unknown

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See Also

• Hand and Wrist Anatomy (Main)
• Finger Pain (Main)
• Hand Pain (Main)
• Wrist Pain (Main)
• Physical Exam Wrist
• Neuropathies (Main)

External

• Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/

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