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Entrapment of Radial Nerve, Wartenberg's Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim

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. Become a friend on facebook:   / drebraheim   Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Background music provided as a free download from YouTube Audio Library. Song Title: Every Step