Mateusz Gładysz FESSH prep

FESSH prep Compressive neuropathies radial nerve

Wartenberg syndrome

Last reviewed v1.0

FESSH-001Compressive neuropathies●●○ intermediate

Regarding compression of the superficial branch of the radial nerve (commonly referred to as Wartenberg syndrome):

  1. 1.Supination combined with ulnar deviation of the wrist reliably reproduces symptoms.

  2. 2.de Quervain's tenosynovitis should be considered in the differential diagnosis; the two conditions co-exist in approximately 50% of cases.

  3. 3.A negative Eichhoff's test rules out Wartenberg syndrome.

  4. 4.Symptoms typically resolve with conservative management consisting of forearm splinting alone.

  5. 5.Surgical decompression involves releasing the nerve in the interval between extensor carpi radialis brevis (ECRB) and brachioradialis tendons.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-001
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Supination combined with ulnar deviation of the wrist reliably reproduces symptoms.

    False

    The classical provocative manoeuvre is forced forearm hyperpronation combined with wrist ulnar deviation, often with wrist flexion — not supination. In the Dellon–Mackinnon series of 51 patients, symptoms were aggravated by forced pronation with wrist ulnar flexion, and the companion paper in Archives of Neurology describes a positive hyperpronation provocative test as a key diagnostic feature.

    • Dellon AL, Mackinnon SE. Radial sensory nerve entrapment in the forearm. J Hand Surg Am. 1986;11(2):199-205. PMID 3958447
    • Dellon AL, Mackinnon SE. Radial sensory nerve entrapment. Arch Neurol. 1986;43(8):833-835. PMID 3729765

  2. 2. de Quervain's tenosynovitis should be considered in the differential diagnosis; the two conditions co-exist in approximately 50% of cases.

    True

    In the Lanzetta–Foucher series of 50 patients (52 cases), de Quervain's disease was associated in 50% of cases. The authors emphasise the importance of identifying Wartenberg syndrome before operating on a presumed de Quervain to avoid postoperative complications.

    • Lanzetta M, Foucher G. Entrapment of the superficial branch of the radial nerve (Wartenberg's syndrome). A report of 52 cases. Int Orthop. 1993;17(6):342-345. PMID 8163306

  3. 3. A negative Eichhoff's test rules out Wartenberg syndrome.

    False

    Eichhoff's test (passive thumb-in-fist with ulnar wrist deviation) provokes the first dorsal compartment and is a manoeuvre for de Quervain's tenosynovitis, not for compression of the superficial branch of the radial nerve. Wu et al. demonstrated high false-positive rates of Eichhoff's test even in asymptomatic individuals. Diagnosis of Wartenberg syndrome requires nerve-specific provocation — Tinel's sign over the SBRN, and the hyperpronation/ulnar-flexion test described by Dellon and Mackinnon — so a negative Eichhoff has no diagnostic bearing on the condition.

    • Wu F, Rajpura A, Sandher D. Finkelstein's Test Is Superior to Eichhoff's Test in the Investigation of de Quervain's Disease. J Hand Microsurg. 2018;10(2):116-118. PMID 30154628
    • Dellon AL, Mackinnon SE. Radial sensory nerve entrapment in the forearm. J Hand Surg Am. 1986;11(2):199-205. PMID 3958447

  4. 4. Symptoms typically resolve with conservative management consisting of forearm splinting alone.

    False

    Conservative management of Wartenberg syndrome is multimodal, not splinting in isolation. Lanzetta and Foucher employed activity modification, removal of constricting wrist accessories, a forearm/wrist splint, NSAIDs and selective steroid injection, achieving good or excellent results in 71% of cases treated non-operatively. The Dellon–Mackinnon series and the Ehrlich translation of Wartenberg's 1932 description similarly emphasise multimodal management, with surgical neurolysis reserved for failure of an adequate non-operative trial.

    • Lanzetta M, Foucher G. Entrapment of the superficial branch of the radial nerve (Wartenberg's syndrome). A report of 52 cases. Int Orthop. 1993;17(6):342-345. PMID 8163306
    • Ehrlich W, Dellon AL, Mackinnon SE. Classical article: Cheiralgia paresthetica (entrapment of the radial nerve). A translation in condensed form of Robert Wartenberg's original article published in 1932. J Hand Surg Am. 1986;11(2):196-199. PMID 3514740

  5. 5. Surgical decompression involves releasing the nerve in the interval between extensor carpi radialis brevis (ECRB) and brachioradialis tendons.

    False

    The superficial branch of the radial nerve becomes subcutaneous as it emerges from beneath brachioradialis at the junction of the proximal two-thirds with the distal one-third of the forearm. In the Robson–See–Ellis cadaveric series, the SBRN emerged from beneath brachioradialis at a mean of 8.31 cm proximal to the radial styloid. Surgical decompression therefore lies in the interval between brachioradialis and extensor carpi radialis longus (ECRL), not between ECRB and brachioradialis.

    • Robson AJ, See MS, Ellis H. Applied anatomy of the superficial branch of the radial nerve. Clin Anat. 2008;21(1):38-45. PMID 18092362
    • Abrams RA, Brown RA, Botte MJ. The superficial branch of the radial nerve: an anatomic study with surgical implications. J Hand Surg Am. 1992;17(6):1037-41. PMID 1430933