Summary Wartenberg's Syndrome, also called "cheiralgia paresthetica," is a compressive neuropathy of the superficial sensory radial nerve at the wrist. Diagnosis is made clinically with pain and paresthesias over the dorsoradial hand without any motor deficits. Treatment is conservative with rest, wrist splints and CSIs with surgical decompression reserved for refractory cases. Epidemiology Incidence rare < 1 per 100,000 annually Demographics male:female ratio is 1:4, more common in women age bracket is 20-70 years Etiology Pathoanatomy SRN compressed by scissoring action of brachioradialis and ECRL tendons during forearm pronation also by fascial bands at its exit site in the subcutaneous plane Associated conditions associated with De Quervain's disease in 20-50% Anatomy The superficial sensory branch of the radial nerve arises from the bifurcation of the radial nerve in the proximal forearm travels deep to the brachioradialis in the forearm emerges from between brachioradialis and ECRL 9 cm proximal to radial styloid bifurcates proximal to the wrist dorsal branch lies 1-3cm radial to Lister's tubercle supplies 1st and 2nd web space palmar branch passes within 2cm of 1st dorsal compartment, directly over EPL supplies dorsolateral thumb Presentation History may have history of trauma forearm fracture handcuffs tight wrist band, wristwatch band, bracelet or plaster cast Symptoms ill-defined pain over dorsoradial hand (does not like to wear watch) paresthesias over dorsoradial hand numbness symptom aggravation by motions involving repetitive wrist flexion and ulnar deviation no motor weakness Physical exam provocative tests Tinel's sign over the superficial sensory radial nerve (most common exam finding) wrist flexion, ulnar deviation and pronation for one minute Finkelstein test increases symptoms in 96% of patients because of traction on the nerve Imaging Radiographs of limited value may demonstrate old forearm fracture Studies Electrodiagnostic tests EMG and NCV of limited value Diagnostic injection diagnostic wrist block may temporarily relieve pain Differential De Quervain's tenosynovitis pain is not aggravated by wrist pronation, unlike Wartenberg Syndrome Lateral antebrachial cutaneous nerve (LACN) neuritis positive Tinel's sign over LACN can be mistaken for positive Tinel's over superficial sensory radial nerve Intersection syndrome may have dorsoradial forearm swelling symptom exacerbation and "wet leather" crepitus on repeated wrist flexion/extension Diagnosis Clinical diagnosis is made with careful history and physical examination Treatment Nonoperative rest, activity modification, NSAIDS, and wrist splints indications first line of treatment techniques avoid aggravating activities remove inciting factors (e.g. tight wristwatch band) corticosteroid injection although evidence to support this is limited Operative surgical decompression indications symptoms persist after 6 months Surgical Technique Surgical Decompression approach longitudinal incision volar to Tinel's sign to avoid injury to LACN to avoid tethering of incision scar over SRN decompression technique neurolysis and release of fascia between brachioradialis and ECRL Complications Failed decompression Persistent pain and numbness Wound dehiscence Infection Prognosis Spontaneous resolution of symptoms is common Treatment outcomes 74% success after surgical decompression