Wartenberg’s syndrome is an uncommon but vital condition to recognise, particularly in sports medicine. It is caused by an injury to a superficial branch of the radial nerve, resulting in symptoms in the hand and wrist. In this blog, we will explore the causes, symptoms, diagnosis, and treatment options for Wartenberg’s syndrome.  

Wartenberg’s Syndrome Causes 

Wartenberg’s syndrome results from compression, injury, or irritation of the superficial branch of the radial nerve. This branch runs down the forearm and becomes superficial near the wrist, making it vulnerable to external pressure or trauma.

Common causes include:

  • Compression from tight wristwatches, bracelets, or handcuffs or growths such as lipomas or ganglions.
  • Activities that involve frequent wrist movements, such as playing tennis or performing manual labour. 
  • Direct blows or trauma to the forearm or wrist.
  • Surgery involving the wrist or forearm inadvertently injures the nerve, such as De Quervain’s release, wrist arthroscopy or fracture fixation. 
  • Thumb tendon injections for De Quervain’s tenosynovitis that damages the nerve. 
  • Anatomical variations, such as tight fascial bands, can compress the nerve. 

Symptoms of Wartenberg’s Syndrome

injury to nerves of the hand including superficial branch of radial nerve

The symptoms are purely sensory, as the affected nerve does not control any muscles. Common symptoms include:

  • Numbness, tingling or burning pain over the back of the thumb spreading to the index and middle finger. Sometimes, symptoms can spread to the upper arm or forearm. These symptoms are exacerbated by repetitive wrist movements, such as gripping or pinching, as well as wearing tight wristbands or watches. Strength of the wrist, thumb and fingers is unaffected. 
  • Sensitivity to light touch over the involved area, often referred to as allodynia.
  • Finkelstein’s test for De Quervain’s tenosynovitis may be positive despite the absence of tendon pathology. 

Diagnosis of Wartenberg’s Syndrome

Diagnosis is based on a careful history and physical examination by your doctor. It affects women more than men. Generally, tapping the superficial branch of the radial nerve reproduces symptoms. The skin over the back of the thumb is less sensitive or painful to touch. Moving the wrist into flexion or ulnar deviation also brings on symptoms. 

Your doctor must exclude other causes such as cervical nerve root compression, carpal tunnel syndrome or tendon disorders like De Quervain’s tenosynovitis, Intersection syndrome or base of thumb arthritis. Sometimes, De Quervain’s tenosynovitis may co-exist with Wartenberg’s syndrome (studies suggest 50% of cases have these two pathologies). 

Imaging such as MRI is not usually necessary unless another pathology is suspected. Detailed ultrasound can reveal nerve injury at the wrist. Additionally, nerve conduction studies can help confirm a superficial branch of the radial nerve injury and exclude other causes of a trapped nerve in the carpal tunnel, arm, or neck. 

Treatment 

Most cases of Wartenberg’s syndrome respond well to simple treatment. Studies suggest that about 70% of patients respond. The primary goal is to minimise nerve irritation and facilitate healing.

Treatments include the following: 

  • Avoid repetitive forearm movements and remove compressive items, such as tight watches or wristbands.
  • Using a wrist splint, particularly at night, can help protect the nerve from further irritation.
  • Gentle nerve gliding exercises supervised by a physiotherapist can help improve nerve mobility and reduce symptoms.
  • Topical and oral Non-steroidal anti-inflammatory drugs (NSAIDS) can help reduce inflammation and pain. Sometimes, nerve medication such as Amitriptyline or Duloxetine can also help. 
  • In some cases, a corticosteroid injection around the nerve can provide significant symptom relief by reducing local inflammation. Nerve hydrodissection, using local anaesthetic, cortisone, or dextrose, can free the nerve from any surrounding compression. Generally, we recommend performing injections under ultrasound guidance to improve the accuracy and effectiveness of the injection. 

Surgical decompression of the superficial branch of the radial nerve is only considered when symptoms fail to respond to simple measures after several months. Surgery typically involves releasing any constricting structures around the nerve.

Final Word from Sportdoctor London about the Supercial Branch of the Radial Nerve Injury 

Wartenberg’s syndrome is a sensory nerve condition caused by injury to the superficial branch of the radial nerve. Recognising the symptoms and differentiating them from other causes is essential for early diagnosis and effective treatment. Most patients improve with simple treatments, but a small percentage may require surgical intervention.

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