Cheiralgia paresthetica

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Cheiralgia paresthetica
Other namesWartenberg's syndrome
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Radial nerve
Specialty Neurology

Cheiralgia paraesthetica (Wartenberg's syndrome) is a neuropathy of the hand generally caused by compression or trauma to the superficial branch of the radial nerve. [1] [2] The area affected is typically on the back or side of the hand at the base of the thumb, near the anatomical snuffbox, but may extend up the back of the thumb and index finger and across the back of the hand. [1] [3] Symptoms include numbness, tingling, burning or pain. Since the nerve branch is sensory there is no motor impairment. [3] It may be distinguished from de Quervain syndrome because it is not dependent on motion of the hand or fingers. [4]

Contents

Cause

The most common cause is thought to be constriction of the wrist, as with a bracelet or watchband (hence reference to "wristwatch neuropathy"). It is especially associated with the use of handcuffs and is therefore commonly referred to as handcuff neuropathy. Other injuries or surgery in the wrist area can also lead to symptoms, including surgery for other syndromes such as de Quervain's. [5] The exact etiology is unknown, as it is unclear whether direct pressure by the constricting item is alone responsible, or whether edema associated with the constriction also contributes. [3]

Diagnosis

Symptoms commonly resolve on their own within several months when the constriction is removed; NSAIDs are commonly prescribed. [4] In some cases surgical decompression is required. [4] The efficacy of cortisone and laser treatment is disputed. [4] Permanent damage is possible.

History

This neuropathy was first identified by Robert Wartenberg in a 1932 paper. [6] Recent studies have focused on handcuff injuries due to the legal liability implications, but these have been hampered by difficulties in followup, particularly as large percentages of the study participants have been inebriated when they were injured. [7] Diagnostically it is often subsumed into compression neuropathy of the radial nerve as a whole (e.g. ICD-9 354.3), but studies and papers continue to use the older term to distinguish it from more extensive neuropathies originating in the forearm.[ citation needed ]

See also

Related Research Articles

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<span class="mw-page-title-main">Anterior interosseous nerve</span>

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<span class="mw-page-title-main">Nerve compression syndrome</span> Human disease

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.

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<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

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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.

<span class="mw-page-title-main">Radial nerve dysfunction</span> Medical condition

Radial nerve dysfunction is a problem associated with the radial nerve resulting from injury consisting of acute trauma to the radial nerve. The damage has sensory consequences, as it interferes with the radial nerve's innervation of the skin of the posterior forearm, lateral three digits, and the dorsal surface of the lateral side of the palm. The damage also has motor consequences, as it interferes with the radial nerve's innervation of the muscles associated with the extension at the elbow, wrist, and fingers, as well the supination of the forearm. This type of injury can be difficult to localize, but relatively common, as many ordinary occurrences can lead to the injury and resulting mononeuropathy. One out of every ten patients with radial nerve dysfunction do so because of a fractured humerus.

References

  1. 1 2 Buttaravoli, Philip M.; Stair, Thomas O. "9.20 Cheiralgia Paresthetica (Handcuff Neuropathy)". Common Simple Emergencies. Washington: Longwood Information. Archived from the original on 2019-01-20. Retrieved 2010-09-16.
  2. Wartenberg, R. (1932). "Cheiralgia paraesthetica.(Isolierte neuritis des Ramus superficialis nervi radialis.)" (PDF). Zeitschrift für die gesamte Neurologie und Psychiatrie (in German). 141 (1): 145–155. doi:10.1007/BF02909851.
  3. 1 2 3 Pećina, Marko; Krmpotić-Nemanić, Jelena; Markiewitz, Andrew D. (2001). "Chapter 26: Syndrome of the Superficial Branch of the Radial Nerve". Tunnel syndromes: peripheral nerve compression syndromes. CRC Press. pp. 152–155.
  4. 1 2 3 4 Dang, Alan C.; Rodner, Craig M. (December 2009). "Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve" (PDF). Journal of Hand Surgery. 34A (10): 1912–1914. doi:10.1016/j.jhsa.2009.10.016. PMID   19969199. Archived from the original (PDF) on 2016-03-03. Retrieved 2010-09-16.
  5. Chodoroff, G.; Honet, J. C. (Sep 1985). "Cheiralgia paresthetica and linear atrophy as a complication of local steroid injection". Archives of Physical Medicine and Rehabilitation. 66 (9): 637–639. PMID   4038032.
  6. Braidwood, A. S. (1975). "Superficial Radial Neuropathy". Journal of Bone and Joint Surgery. 57-B (3): 380–383. doi:10.1302/0301-620X.57B3.380.
  7. Grant, Arthur C.; Cook, Albert A. (2000). "A Prospective Study of Handcuff Neuropathies" (PDF). Muscle and Nerve. 23 (6): 933–938. doi:10.1002/(SICI)1097-4598(200006)23:6<933::AID-MUS14>3.0.CO;2-G. PMID   10842271. S2CID   45600162. Archived from the original (PDF) on 2011-07-08.