Wartenberg’s Syndrome

Wartenberg’s syndrome is a specific mononeuropathy, caused by entrapment of the superficial branch of the radial nerve. Symptoms include numbness, tingling, and weakness of the posterior aspect of the thumb. Also called Cheiralgia paresthetica. Wartenberg’s syndrome is a specific mononeuropathy, caused by entrapment of the superficial branch of the radial nerve. Symptoms include numbness, tingling, and weakness of the posterior aspect of the thumb. Also called Cheiralgia paresthetica.

Wartenburg’s sign is a test used for assessing the integrity of the motor innervations of hand intrinsics in cases of suspected ulnar neuropathy.

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)
  • 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
  • Ligament Injuries
    • Gamekeepers Thumb (UCL)
    • Radial Collateral Ligament of the Thumb Injury (RCL)
    • Volar Plate Avulsion Injury
  • Neuropathies
    • Wartenberg’s 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
You Might Also Read  Posterior Interosseous Nerve Syndrome

Diagnosis

  • History
    • 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

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

Treatment

Nonoperative

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

Operative

  • Indications
    • Refractory to nonoperative therapy for 6 months.