Cheiralgia paraesthetica (Wartenberg's syndrome) is a

neuropathy Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or o ...

of the

hand A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each "h ...

generally caused by

compression Compression may refer to: Physical science *Compression (physics), size reduction due to forces *Compression member, a structural element such as a column *Compressibility, susceptibility to compression * Gas compression *Compression ratio, of a ...

trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...

to the superficial branch of the

radial nerve The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial comp ...

. The area affected is typically on the back or side of the hand at the base of the thumb, near the

anatomical snuffbox The anatomical snuff box or snuffbox or foveola radialis is a triangular deepening on the Anatomical terms of location#Relative directions, radial, Dorsum (biology), dorsal aspect of the hand—at the level of the carpal bones, specifically, the S ...

, but may extend up the back of the thumb and index finger and across the back of the hand. Symptoms include numbness, tingling, burning or pain. Since the nerve branch is sensory there is no motor impairment. It may be distinguished from

de Quervain syndrome De Quervain syndrome is mucoid degeneration of two tendons that control movement of the thumb and their tendon sheath. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painful. On occasion, the ...

because it is not dependent on motion of the hand or fingers.

Cause

The most common cause is thought to be constriction of the wrist, as with a bracelet or watchband (hence reference to "wristwatch neuropathy"). It is especially associated with the use of

handcuffs Handcuffs are Physical restraint, restraint devices designed to secure an individual's wrists in proximity to each other. They comprise two parts, linked together by a Link chain, chain, a hinge, or rigid bar. Each cuff has a rotating arm whi ...

and is therefore commonly referred to as handcuff neuropathy. Other injuries or surgery in the wrist area can also lead to symptoms, including surgery for other syndromes such as de Quervain's. The exact

etiology Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, e ...

is unknown, as it is unclear whether direct pressure by the constricting item is alone responsible, or whether

edema Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's Tissue (biology), tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels t ...

associated with the constriction also contributes.

Diagnosis

Symptoms commonly resolve on their own within several months when the constriction is removed;

NSAID Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...

s are commonly prescribed. In some cases surgical decompression is required. The efficacy of

cortisone Cortisone is a pregnene (21-carbon) steroid hormone. It is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug; it is not synthesized in the adrenal glands. Cortisol is converted by the action of the enzy ...

and laser treatment is disputed. Permanent damage is possible.

History

This neuropathy was first identified by

Robert Wartenberg Robert Wartenberg (June 19, 1887 – November 16, 1956) was a clinical neurologist and professor. Born in the then-Russian Empire, he attended university and established his career in Germany. As a Jew, he was fired from his position as the U ...

in a 1932 paper. Recent studies have focused on handcuff injuries due to the legal liability implications, but these have been hampered by difficulties in followup, particularly as large percentages of the study participants have been inebriated when they were injured. Diagnostically it is often subsumed into compression neuropathy of the radial nerve as a whole (e.g.

ICD-9 The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...

), but studies and papers continue to use the older term to distinguish it from more extensive neuropathies originating in the forearm.

References

{{PNS diseases of the nervous system Neurological disorders Hand

Cause

Diagnosis

History

See also

References