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Wartenberg's Syndrome S44.20XA 955.3

 

synonyms: superficial branch of the Radial Nerve compression, Wartenberg's syndrome

Wartenberg's Syndrome ICD-10

 

A- initial encounter

D- subsequent encounter

S- sequela

Wartenberg's Syndrome ICD-9

  • 955.3 Injury to peripheral nerve: radial nerve

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
  • Infection

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

Green's Operative Hand Surgery: 2-Volume Set , 6e, 2010

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