Wartenberg's Syndrome

Overview

Wartenberg's syndrome, also known as Cheiralgia paresthetica, is a neurological condition caused by compression or irritation of the superficial branch of the radial nerve. Unlike radial nerve palsy, Wartenberg’s syndrome does not involve motor deficits or muscle weakness, as the superficial radial nerve is purely sensory. The condition results in numbness, tingling, or burning pain over the dorsolateral aspect of the hand, particularly affecting the thumb and index finger. It is often misdiagnosed due to its similarity with other neuropathies and musculoskeletal disorders of the upper extremity.

Causes

Wartenberg’s syndrome is caused by compression or entrapment of the superficial radial nerve, typically near the wrist or forearm. Several factors can contribute to this compression, including:

• Tight wristbands or watches: External pressure on the distal forearm can compress the nerve.

• Repetitive movements: Activities involving frequent pronation and supination of the forearm, such as screwdriver use or racquet sports, may irritate the nerve.

• Trauma or injury: Direct blows, fractures, or lacerations near the radial nerve’s path may lead to entrapment.

• Surgical procedures: Orthopedic or vascular surgeries near the radial forearm may lead to nerve injury or scarring.

• Anatomic variations: Fibrous bands or tight fascia can naturally predispose individuals to nerve compression.

Symptoms

Wartenberg’s syndrome is characterized by sensory symptoms without motor involvement. Key features include:

• Numbness and tingling: Primarily over the dorsoradial aspect of the hand, thumb, and index finger.

• Burning or shooting pain: Often exacerbated by wrist movement, tight clothing, or pressure on the forearm.

• Hypersensitivity: The affected area may become sensitive to light touch or pressure (allodynia).

• Positive Tinel’s sign: Tapping over the superficial radial nerve may reproduce the patient’s symptoms.

• No muscle weakness: Unlike radial nerve palsy, there is no loss of motor function or muscle atrophy.

Diagnosis

Diagnosing Wartenberg’s syndrome is primarily clinical, based on the patient’s history and physical exam. Diagnostic steps include:

• Physical examination: Evaluation of sensory distribution, tenderness over the radial nerve, and positive Tinel’s sign at the distal forearm.

• Electrodiagnostic studies: Nerve conduction studies (NCS) and electromyography (EMG) may help confirm superficial radial nerve involvement and rule out other conditions.

• Imaging: Ultrasound or MRI may be used in selected cases to evaluate for masses, cysts, or anatomic causes of compression.

• Differential diagnosis: Conditions such as de Quervain’s tenosynovitis, cervical radiculopathy, and carpal tunnel syndrome must be excluded.

Treatment

Most cases of Wartenberg’s syndrome can be managed conservatively. Treatment focuses on relieving compression and controlling symptoms:

• Activity modification: Avoidance of wristbands, tight sleeves, and repetitive wrist motions that aggravate symptoms.

• Splinting: A wrist splint may help reduce nerve irritation and allow healing.

• Anti-inflammatory medications: NSAIDs can reduce inflammation and pain.

• Physical therapy: Stretching and nerve-gliding exercises may help reduce nerve tension and improve function.

• Corticosteroid injections: Targeted injections near the site of compression may provide temporary relief.

• Surgical decompression: Reserved for severe or persistent cases, surgery involves releasing the compressed segment of the superficial radial nerve.

Prognosis

The prognosis for Wartenberg’s syndrome is generally favorable. Most individuals respond well to conservative measures and experience symptom improvement over weeks to months. Early identification and intervention are key to preventing chronic nerve irritation and persistent discomfort. In cases where surgery is required, outcomes are typically good, with resolution of symptoms and return to normal function. However, recurrence is possible if aggravating factors are not adequately addressed.