An unexpected side effect: Wartenberg syndrome related to the use of splint during carpal tunnel syndrome treatment

Abstract

Isolated superficial radial neuropathy is a sensorial mononeuropathy and a rare clinical condition. In case of trapping of the sensorial branch of the radial nerve, symptoms such as burning type pain at proximal forearm and hand dorsoradial, hypoesthesia, numbness and tingling at hand dorsum and thumb radial side are observed. Muscular weakness and trophic changes are not seen, and electrophysiological assessment revealed normal motor nerve conduction values. Therefore, hand motor functions are not affected. The etiology of the isolated superficial radial nerve neuropathy is often associated with repeated use of wrist watches, forearm fractures, use of handcuffs, repetitive activities. In this report, we present a 59-year-old female case of isolated superficial radial nerve neuropathy diagnosed by electrophysiological evaluation who was treated for two months with carpal tunnel syndrome with altered symptoms and increased numbness. This is the first case of superficial radial nerve neuropathy following the splint use in the literature.

Etiological study of superficial radial nerve neuropathy: series of 34 patients

“…A thorough clinical history and comprehensive neurological examination of the upper extremities are important initial steps in the evaluation of a patient with pain and altered sensation in the dorsolateral forearm, hand, and fingers. Several conditions should be considered in the differential diagnosis of dorsoradial wrist pain, including de Quervain’s tenosynovitis, ganglion cysts, joint sprain, lateral antebrachial cutaneous nerve injury, CTS, cervical radiculopathy, brachial plexopathy, and arthritis ( 1 , 3 , 5 , 6 , 11 ). The diagnosis of SRN neuropathy is often delayed or misdiagnosed as de Quervain’s disease.…”

“…Focal neuropathy of the superficial radial nerve (SRN) causes pain, burning, numbness, tingling, and dysesthesias of the dorsolateral aspect of the distal forearm and hand involving the dorsolateral three and a half fingers extending to the distal interphalangeal joint (1)(2)(3)(4)(5)(6). Initially reported in a patient with wrist watch compression in 1926 by Schlesigner and Matzdorff, this condition was later referred to as Wartenberg's syndrome after Wartenberg described 5 patients in 1932 with neuropathy involving the SRN (1-4, 7, 8).…”

“…SRN neuropathy may also be idiopathic ( 10 ). Associated conditions comprise de Quervain’s tenosynovitis, carpal tunnel syndrome (CTS), diabetes mellitus, arthritis, ganglions of the first extensor compartment, and flexor carpi radialis tendinitis ( 2 , 3 , 6 , 10 ).…”