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Entrapment of Radial Nerve, Wartenberg's Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 3 เม.ย. 2014
- Educational video describing entrapment of the superficial radial nerve of the forearm. Wartenberg's Syndrome.
The superficial branch of the radial nerve has 3 or 4 terminal branches and is a purely sensory nerve as indicated by the shaded area. Sometimes the innervation area of the superficial radial nerve can overlap with the innervation of the lateral antebrachial cutaneous nerve. There is a difference between Wartenberg's syndrome and Wartenberg's sign. Wartenberg's sign is due to a low ulnar nerve injury and consists of abduction of the fifth finger caused by unopposed ulnar insertion of the extensor digiti quinti.
Anatomy of the superficial radial nerve
The superficial sensory branch arises from the radial nerve in the proximal forearm. The superficial branch of the radial nerve passes along the front of the radial side of the forearm beneath the brachioradialis muscle. The superficial branch exists from between the brachioradialis and extensor carpi radialis longus muscle about 9 cm proximal to the radial styloid process.
Wartenberg's syndrome is caused by entrapment of the superficial branch of the radial nerve at this point when the nerve arises from beneath the muscles. The nerve is likely to become compressed between the brachioradialis and the ECRL tendons especially during forearm pronation. Wartenberg's syndrome is more common to occur in women. Wartenberg's syndrome may also be associated with De Quervain’s syndrome.
Entrapment of the superficial branch of the radial nerve occurs where the nerve pierces the antebrachial fascia approximately 2/3 the way down the forearm at the lateral border between the brachioradialis and ECRL. Entrapment occurs with repetitive pronation of the forearm and the brachioradialis muscles close the space between these two tendons in a scissor like fashion while rotating the nerve. Pain can be elicited with forced pronation and ulnar deviation of the wrist.
Causes of Wartenberg's syndrome:
•Tight plaster cast
•Forearm fractures
•Wearing bracelets, watches, hand cuffs.
The patient will be unable to tolerate wearing a tight bracelet or wrist watch. Symptoms include numbness, tingling, and paresthesia on the posterior aspect of the thumb. There will be no weakness associated with this condition. The symptoms of Wartenberg's syndrome are also aggravated by motion such as repetitive wrist flexion and ulnar deviation.
Physical examination: tinel’s sign over the area of the superficial radial nerve is the most common finding for Wartenberg's syndrome. The Finkelstein test may be positive due to traction on the nerve or associated with De Quervain’s syndrome.
Differential diagnosis
•De Quervain’s syndrome: inflammation of the sheath or tunnel that surrounds the two tendons that control movement of the thumb. Pathology is distal.
•Insertion syndrome: the pain associated with intersection syndrome is felt on the top of the forearm where the two muscles that connect to the thumb cross the underlying wrist tendons. The pain is increased by flexion/ extension. Pain is more proximal than the pain associated with De Quervain’s syndrome.
Treatment
•Activity modification: avoid tight bands/ watches. Conservative treatment usually achieves about 70% good-excellent result.
•Injection: usually diagnostic
•Surgery: for decompression of the nerve. Usually done if the patient has a positive Tinel’s sign and the symptoms continue despite conservative treatment and injections. Surgery is done between the brachioradialis and extensor carpi radialis longus muscles. Knowing that the nerve exits between the brachioradialis and ECRL muscles is important.
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Background music provided as a free download from TH-cam Audio Library.
Song Title: Every Step
Great videos. You really explain the details well, and it helps me as a hand therapist!
This is the best. and the most articulated information on this subject presented in a simple and terse way, cant say thank enough Dr Nabil. 👍
you rock! Thanks for helping a fellow med student
Thanks for the great videos! I learn a lot from these.
Thank you
Great video. For the past 6 weeks I have had all the symptoms. My doctor diagnosed wrist tendonitis, but how do I suggest Wartenberg's syndrome?
When training pronation and hammer curls I got this nerve shock starting from exactly the position from where the nerve is being scissored. The shock sensation travel down to the hands first 2.5 digits. First it started on my right arm and then it calmed after abstaining from the training for about a month. Starting training again, the left arm went trough the exact same cycle. Now it's fine, however, I am not training pronation anymore.
Good, thanks
Thank
I got Wartenbergs syndrome. It is soooo annoying. Left hand is always cold/uncomfortable. Have had it for a couple of years and don't know how I got it.
Thanks, Great video. I have wartenberg's syndrome.
You get it worked out?
I’ve been having these symptoms for over a month. I’m a waitress and I can’t even hood a cup correctly… sometimes the nerve will come up and I bend down because it hurts so badddd 😢
Mine started after receiving a nerve block to my occipital nerve.
Has anyone thought of the possibility of a ganglion cyst underneath the superficial radial nerve?
I have had these cyst on my left wrist several times.
They go away on their own and usually never cause this much pain.
I have the symptoms of each syndrome, but I feel a small "cyst" pushing on that area just after where the thumb and wrist connect.
The pain is pretty brutal.
Just a thought.
I'm trying to figure out what's wrong with me. The top of my forearm closest to the elbow definitely feels bunched up and shortened, and often is tender or aching. I get a kind of burning irritation throughout the back of my hand and wrist, but also have pain on the bottom side of my arm about 2-3 inches below the wrist. My flexibility in my wrist is definitely limited, basically holding my arm straight out with hand extended in any direction causes a stretching sensation. The actual "pain" does tend to be concentrated in the hand and wrist, but my entire upper body is very tight, including chest, shoulder, neck, forearm, and wrist. I don't really feel numbness or tingling as if something is asleep... more like irritation and pain associated with inflammation. I have been told burning feeling is nerve pain, and it does feel like it burns across the back of my hand.
I'm on the computer the vast majority of my time though I am trying to use good ergonomic practice.
Any suggestions, deductions, or familiar anecdotes would help!
Hi have you had any improvement? I similar symptoms
Was a herniated disc in my neck
@@NorfairEbay ah ok, did you manage to sort it? I had an mri on my neck but they couldn’t find anything wrong.
Just here to learn about what the cops did to my hands
These dirty cunts fucked my arm 3 years ago it's only getting worst
Thank you