Cheiralgia paresthetica ? entrapment of the superficial branch of the radial nerve: a report of 15 cases

Abstract

Abstract. Attention is drawn to the relatively rare and poorly appreciated clinical featues of entrapment of the superficial sensory branch of the radial nerve (SBR) in the forearm. In a series of 15 patients with cheiralgia paresthetica, alleviation of pain and discomfort was achieved in 66.6% of the conservatively-treated patients and in 80% of the five non-responsive patients who required neurolysis of the nerve. Job-related symptoms were exhibited by 33.3% of the patients, which subsided upon job modification or less hand-intensive work and conservative treatment. We suggest that modalities of treatment should be appropriate for the pathophysioloy of the SBR injury, while early recognition of the syndrome reduces the necessity for surgery.

Wartenberg’s Syndrome: Diagnosis and Treatment

“…Furthermore, other causes reported in literatures include tight application of handcuffs, which lead to its other notorious name of handcuff neuropathy [10,11], overexertion (repetitive pronation and supination) [1,12], Diabetes [1,13,14], mass-occupying lesions including lipoma, abscess formation, and neuroma [15,19], as well as post steroid injection for De Quervain's tenosynovitis [20]. Iatrogenic causes include previous hand or wrist surgeries causing deep scar tissue formation and keloid scar formation as well as following an Opponens transfer in which the ring finger flexor digitorum superficialis tendon was inadvertently brought over top of the SRN [21,22]. An anatomical cause that can predispose to SRN compression is a variant of the first dorsal extensor compartment causing inflammation and its subsequent irritation of the SRN [23].…”

“…Another condition that can make a patient more susceptible to Wartenberg's syndrome is a phenomenon known as double crush syndrome in which there is compression at a site proximal to the symptomatic area, and has been documented following radial nerve compression in the spiral groove as well as a mass at the elbow [19,24]. Lastly, Wartenberg's syndrome following trauma has been documented in a few cases in which a distal radius fracture with excessive bone spur formation and a non-union following a distal radius and ulna fracture [21].…”

Peripheral Nerve Entrapment and their Surgical Treatment

“…In the first case, it can be due to repetitive pronation and supination [58]. In this second case, it is usually due to external compression by handcuffs [130] or a wristwatch [131]. The best provocative test is to ask the patient to place their arm under maximum pronation with the wrist flexed to the ulnar side [132].…”

“…The treatment is the removal of the cause. In case of persistence, surgical decompression of this nerve, particularly as it crosses the edge of the tendon of the BRM muscle, is indicated [131,133] (Figures 7A-D).…”

Ultrasound‐Guided Hydrodissection Is a Safe and Effective Nonsurgical Treatment for Superficial Radial Sensory Neuropathy

“…Standard treatments for cheiralgia paresthetica primarily consist of nonsurgical measures such as orthoses. Although these may prove successful in some patients, it may take months to achieve complete relief from symptoms, and in some patients, symptoms persist …”