Wartenberg syndrome is a complex of symptoms caused by compression of the radial nerve in the forearm. The syndrome is limited to compressions of the sensory nerve branch and therefore does not cause motor disorders, only sensory disorders. Treatment depends on the severity.
What is Wartenberg Syndrome?
The radial nerve is a nerve of the brachial plexus. As a mixed nerve, it is responsible for the motor innervation of various arm muscles and the sensory innervation of various skin areas. It is divided into a motor and a sensory branch. The sensory branch is also known as the superficial ramus. Wartenberg syndrome occurs when the radial nerve is compressed. For crps overview, please visit homethodology.com.
Nerve compression syndrome is also known as cheiralgia paraesthetica and is associated with sensory disturbances in the skin areas of the extensor thumb and index finger as well as sensory disturbances in the intermetacarpal space. Wartenberg syndrome was first described in the 1930s. Robert Wartenberg is considered to be the first to describe it.
The Wartenberg syndrome is to be distinguished from the paralysis of the radius, which is not necessarily caused by peripheral mechanical nerve damage, but can also be caused by central nerve lesions and thus affects the brain, the spinal cord or the motor branch of the radial nerve.
Wartenberg syndrome results from an injury to the superficial branch of the radial nerve. It is an isolated damage that does not affect the entire radial nerve, but only its sensory branch. An isolated lesion of the superficial branch is in most cases preceded by impact injuries or lacerations located dorsally and radially on the distal forearm.
In individual cases, the damage is mechanical compression injuries caused by shackles, bracelets or handcuffs. Sometimes the cause of the lesion is also an intravenous injection or a shunt operation in the area between the cephalic vein and the radial artery.
Plaster casts that are applied too tightly can also compress the superficial ramus on the radial nerve and thus cause Wartenberg syndrome. Due to the causal connection with shackles, the syndrome is also known as bondage syndrome. In isolated cases, the symptom complex is associated with diabetes mellitus.
Symptoms, Ailments & Signs
Patients with Wartenberg syndrome suffer from a complex of different symptoms. The main symptoms of the syndrome are sensory disturbances such as hypaesthesia, hypalgesia and dysesthesia, which occur predominantly in the region of the I interosseous space and are therefore clearly in the sensitive supply area of the radial nerve. The Wartenberg syndrome does not necessarily have to be associated with subjectively significant symptoms.
Many patients find themselves almost asymptomatic. Motor symptoms such as movement disorders or even paralysis of the arm muscles are never associated with the syndrome, since the motor branch of the radial nerve is completely intact. In individual cases, the syndrome can cause more or less severe pain that can radiate into the entire arm. If Wartenberg Syndrome is caused by being tied up, other symptoms may be present.
The blood circulation in the compressed area can also be affected by compression, for example. Such compression of blood vessels can promote reduced blood flow and ultimately even necrosis due to insufficient oxygen and nutrient supply. In some cases, the symptoms of Wartenberg syndrome have been limited to pain. In such a case, there are no sensory disturbances and the symptoms are similar to de Quervain’s tendovaginitis stenosans.
Diagnosis & course of disease
The doctor makes the diagnosis of Wartenberg syndrome on the basis of the clinical symptoms. He examines the patient for the so-called Hoffmann-Tinel sign, which is positive in the case of Wartenberg syndrome. The Finkelstein test can also be positive in individual cases. However, a positive Finkelstein test is not a mandatory characteristic of the disease. Electroneurography can be useful as part of the diagnosis.
With this procedure, a Wartenberg syndrome can be differentiated from carpal tunnel syndrome as well as from a different type of damage to the radial nerve. The prognosis for patients with Wartenberg syndrome is significantly better than that of patients with central nervous system lesions. Peripheral nerves may fully recover from damage.
The Wartenberg syndrome can cause various complications in its course. Emotional disturbances that typically occur, such as hypaesthesia, severely restrict those affected in their everyday lives, since everyday stimuli are no longer properly absorbed. Numbness is a typical side effect and causes significant movement restrictions when it occurs in the arms or legs.
Furthermore, problems with the eyes and/or ears can occur, such as impaired vision or hearing problems. In individual cases, the syndrome causes severe, mostly chronic pain, which further reduces well-being. Circulatory disorders, such as those that occur in Wartenberg syndrome, can promote reduced blood flow and ultimately necrosis. The affected body region is then permanently paralyzed or the limb in question even has to be amputated.
Surgical treatment can lead to additional damage to the affected nerves. There is also a risk of nerve inflammation. If the wound is not properly cared for after the procedure, wound healing disorders can occur.
This in turn results in scars and adhesions. The concomitant drug therapy can cause symptoms if the patient is allergic to one of the prescribed preparations. In general, various side effects and interactions can also occur.
When should you go to the doctor?
Those affected should definitely see a doctor if they have Wartenberg syndrome. This disease usually cannot heal on its own, so treatment by a doctor is always necessary. The sooner a doctor is contacted, the better the further course of the disease, so that the person concerned should see a doctor as soon as the first symptoms and signs appear.
The doctor should be consulted in the case of Wartenberg syndrome if the person concerned suffers from severe paralysis. In most cases, various muscles in particular are affected by this paralysis. If the paralysis occurs over a longer period of time and does not go away on its own, a doctor should definitely be consulted. Disturbed blood circulation in various regions of the body can also indicate Wartenberg syndrome, leading to sensory disturbances.
In the case of this syndrome, a general practitioner or a neurologist can be consulted in the first place. The further treatment itself depends heavily on the cause and the severity of the symptoms, so that no general prediction can be made.
Treatment & Therapy
The therapy of the Wartenberg syndrome depends on the severity of the development in the individual case. Less pronounced damage to the superficial branch of the radial nerve does not necessarily require treatment. The nerve branch will probably regenerate itself. If the patient subjectively perceives hardly any complaints or impairments, no therapy is given. Therapeutic intervention is only carried out in the case of pronounced symptoms or a complete interruption of nerve continuity, such as can occur as a result of cut injuries.
In such a case, an operative intervention is usually carried out. The doctor must rejoin the two ends of the superficial branch at the radial nerve so that they can grow together. After the operation, stabilization with a dorsal forearm splint may be necessary. The arm is immobilized by the splint so that the two nerve endings can grow together in peace.
For the treatment of Wartenberg syndrome, some conservative drug therapy steps are also possible. The most important conservative steps include steroid injections and administration of non-steroidal anti-inflammatory drugs. After the nerves have grown together, minimal sensory disturbances can remain in individual cases. As a rule, however, these remnants are so limited that the patient hardly notices them subjectively.
A preventive measure for Wartenberg syndrome is the judicious selection of bracelets, watches and other forearm jewelry. Jewelry that is too tight can compress the sensitive branch of the radial nerve and in this way cause Wartenberg syndrome.
Affected people with Wartenberg syndrome usually only have very limited direct follow-up care available. Therefore, in the case of this disease, a quick and, above all, early diagnosis should be carried out first and foremost in order to prevent the occurrence of further complications and symptoms.
As a rule, self-healing cannot occur, so that the person affected with this syndrome always has to be treated by a doctor. Since Wartenberg syndrome is also inherited, genetic testing and counseling should definitely be carried out if you wish to have children, so that the disease can be prevented from recurring.
As a rule, patients with this disease are dependent on taking various medications. It is always important to ensure that the dosage is correct and that it is taken regularly in order to counteract the symptoms properly and permanently.
The care and support of one’s own family can also be very useful with this disease and also reduce depression and other mental illnesses. The further course depends heavily on the time of diagnosis, so that a general prediction cannot be made. This disease may also reduce the life expectancy of those affected.
You can do that yourself
A weakly pronounced Wartenberg syndrome does not necessarily have to be treated. In the case of severe restrictions or pain, medication is necessary. Drug intake must be carefully monitored and recorded. Patients should also pay attention to any side effects and interactions and inform the doctor about them.
A severely pronounced Wartenberg syndrome must be treated surgically. After an operation, bed rest and rest apply. Again, the doctor’s instructions must be strictly adhered to in order to rule out complications. It is also important to determine the cause of Wartenberg syndrome. Tight watches or jewelry bracelets are often the cause of nerve damage. If the cause is unknown, the most important measure is to observe the symptoms and to consult the doctor if the symptoms worsen.
If you have Wartenberg syndrome, you should avoid sporting activities that could put additional strain on the nerve. Which measures are suitable for staying fit despite physical limitations is best discussed with a physiotherapist. The doctor can name specific exercises that can be used to relieve the pain at home. Massages or acupuncture treatments may also help.