synonyms: superficial branch of the Radial Nerve compression, Wartenberg's syndrome
Wartenberg's Syndrome ICD-9
Wartenberg's Syndrome Etiology / Epidemiology / Natural History
- Caused by compression of the superficial branch of the radial nerve which innervates the dorsum of the thumb and first dorsal web space.
- Most common occurs as the nerve exits brom beneath the brachioradialis in the forearm. Other causes: chronic pressure on the nerve, repetitive provocative activities, mass effect, direct trauma.
Wartenberg's Syndrome Anatomy
- Sensory branch of Radial Nerve becomes subcutaneous 5-10cm proximal to radial styloid in the interval between brachioradialis and ECRL. It bifurcates before wrist.
- Dorsal branch 1-3cm radial to Listers. Supplies 1st and 2nd web spaces.
- Palmar branch passes within 2cm of 1st dorsal compartment provides sensation to dorsolateral thumb after passing directly over EPL.
Wartenberg's Syndrome Clinical Evaluation
- Numnbess +/- pain in the dorsal and radial hand.
- Symptoms may be exacerbated by forced grip of pinch and resisted pronation of the forearm.
Wartenberg's Syndrome Xray / Diagnositc Tests
- Forearm and wrist xrays: generally normal.
Wartenberg's Syndrome Classification / Treatment
- Conservative: steriod injection, NSAID's, activity modification, splinting, occupational therapy
- Surgical: Exploration and decompression. Consider for failure of prlolonged conservative treatment. Limited outcomes.
Wartenberg's Syndrome Associated Injuries / Differential Diagnosis
- de Quervain's tenosynovitis
- Intersection syndrome
- Lateral antebrachial cutaneous nerve compression
Wartenberg's Syndrome Complications
- Failure of decompression
- Persistent numbness/pain
- Wound dehiscence
Wartenberg's Syndrome Follow-up Care
- Post-op: Volar splint, NWB
- 7-10 Days: Remove sutures, consider night time splinting. Start gentle ROM exercises
- 6 Weeks: Begin strengthening exercises
- 3 Months:Return to full activities / sport
Wartenberg's Syndrome Review References