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May 18, 2021 · Images. Summary. Wartenberg's Syndrome, also called "cheiralgia paresthetica," is a compressive neuropathy of the superficial sensory radial nerve at the wrist. Diagnosis is made clinically with pain and paresthesias over the dorsoradial hand without any motor deficits. Treatment is conservative with rest, wrist splints and CSIs with surgical ...
- Introduction
- Background
- Anatomy
- Pathophysiology
- Differential Diagnosis
- Management
Wartenberg's Syndrome is described as the entrapment of the superficial branch of the radial nerve with only sensory manifestations and no motor deficits. In this condition, the patient reports pain over the distal radial forearm associated with paresthesia over the dorsal radial hand.This should not be confused with Wartenberg's Sign which refers ...
In 1932, Wartenberg described five cases of isolated neuropathy of the Superficial Radial Nerve (SRN) . He was so impressed by the similarity to the isolated involvement of the lateral cutaneous nerve of the thigh, Meralgia Paraesthetica, that he suggested the name Cheiralgia Paraesthetica. The condition is sometimes referred to as Wartenberg's Dis...
The SRN is the superficial sensory branch of the radial nerve. After the radial nerve bifurcates into the SRN and Posterior Interosseous Nerve (PIN), the SRN courses distally into the forearm deep to the brachioradialis. Approximately 9 cm proximal to the radial styloid, the SRN becomes a subcutaneous structure by traveling between the brachioradia...
The SRN can be compressed at any point along its course in the forearm, but it is believed to be at greatest risk at the posterior border of the brachioradialis as the nerve transitions from a deep to a subcutaneous structure. Trauma is also a common etiology for SRN compression, which can occur from direct pressure on the nerve (i.e. by a wristban...
Patients with SRN compression typically report pain or dysesthesias on the dorsal radial forearm radiating to the thumb and index finger, although the distribution of symptoms may vary owing to differences in anatomy. When such sensory disturbances present concomitantly with weakness of the PIN-innervated muscles, the clinician should consider alte...
Conservative Management
Patience is the cornerstone of therapy in patients with SRN compression symptomatology because spontaneous resolution is common. As external compression is a common underlying etiology, removal of the inciting element such as a wristwatch or bracelet is an essential component of nonsurgical management. Additionally, rest, splinting, and nonsteroidal anti-inflammatory drugs are appropriate first-line treatments.
Physiotherapy Management
Owing to the subcutaneous location of the SRN, a number of noninvasive therapeutic modalities centered around peripheral nerve stimulation (PNS) have been studied for the treatment of nerve pain, including pulsed low-intensity infrared laser, as well as direct electrical stimulation. The use of PNS to treat neuropathic pain is based on the gate control theory of pain. Although this theory has found support in the medical literature and is certainly intriguing, there is mixed evidence supporti...
Injection
The role of corticosteroid injection is less clear. Lanzetta and Foucher (1993) reported a 71% success rate in 29 patients who underwent conservative management alone, which was defined as removal of a tight watch strap, splinting, and, in 3 cases, a corticosteroid injection.
Aug 8, 2023 · Wartenberg syndrome Most patients experience spontaneous resolution of their symptoms, with up to 71% of patients reporting excellent outcomes from conservative management. Surgical outcomes have yielded mixed results with success rates as high as 74% in a study by Lanzetta and Foucher, whereas a report by Calfee et al. reported that 55% of ...
- Samir Sharrak, Joe M Das
- 2023/08/08
- 2019
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Wartenberg syndrome is a compressive neuropathy associated with sensory manifestations such as painful paresthesias on the dorsum of the thumb and radial hand. Wartenberg syndrome is not associated with any motor deficits. Pathophysiology. Due to its anatomic location, the SRN is highly vulnerable to compression from trauma, masses, and ...
Symptoms include pain, numbness, or tingling on the non-palm side of the thumb, index, middle, and half of the ring finger and hand. Patients often instinctively avoid pressure on the area of the superficial radial nerve, as pressure will worsen their symptoms. Wartenberg's Syndrome is furthermore commonly associated with DeQuervain’s disease.
Wartenberg’s syndrome is an underrecognized entity and is often comorbid with other pathologies of the hand or wrist. Due to overlapping symptoms and physical exam findings with conditions such as De Quervain’s tenosynovitis and other neuropathies involving the radial nerve, it is often misdiagnosed, leading to undertreatment.
Wartenberg's syndrome. Wartenberg's syndrome is a specific mononeuropathy, caused by entrapment of the superficial branch of the radial nerve. [1] Symptoms include numbness, tingling, and weakness of the posterior aspect of the thumb. Also called Cheiralgia paresthetica. [citation needed]
