Why Does it Occur?
In Wartenberg Syndrome's, is another nerve compression syndrome like Carpal Tunnel Syndrome, however this is where the superficial radial nerve (a branch of the radial nerve) becomes compressed. The compressive pressure can be the result of an external force such as a tight wrist watch, elastic band, or purse strap. Sometimes, It can be caused by trauma or anything that can cause swelling near the nerve. The compression can also result from the scissoring of two wrist tendons (brachioradialis and ECRL) when the wrist is pronated (i.e. the hand is rotated downward). Sometimes it occurs for no apparent reason.
Symptoms include pain, numbness, or tingling on the non-palm side of the thumb, index, middle, and half of the ring finger and hand. Patients often instinctively avoid pressure on the area of the superficial radial nerve, as pressure will worsen their symptoms. Wartenberg's Syndrome is furthermore commonly associated with DeQuervain’s disease.
An x-ray is usually performed, especially if symptoms were the result of trauma or if the patient has a history of fracture in the area. An EMG nerve study may be recommended to assess the location and degree of nerve compression. While EMG's are not highly sensitive for this diagnosis, the EMG test is useful for ruling out other sites of nerve compression in the elbow and neck. If the EMG nerve study is negative but the patient's history and physical examination are consistent with Wartenberg's Syndrome, Dr. Lee will always treat the patient as opposed to solely relying on a diagnostic test.
Nonoperative treatment consists of a loosely applied wrist splint combined with activity modification. NSAIDs, such as Advil or Aleve, (if not contraindicated for the patient) may be considered to decrease pain and swelling. Cortisone injections may also be helpful in reducing pain and inflammation in the area surrounding the superficial radial nerve.
Surgery is normally recommended for patients who fail nonoperative treatment. Surgery is designed to create more space for the superficial radial nerve. It is highly recommended that you have this surgery performed by an experienced Hand Surgeon comfortable with nerves and using loupe magnification and/or microscopic techniques.
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Patients will be placed into a removable thumb spica splint at their first post-op visit. Patients will remain in this splint for 2-3 weeks, after which they will begin therapy. Therapy normally lasts for 2-3 weeks and patients can expect to return to normal activity within 4-6 weeks.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.