gms | German Medical Science

Objectives/Interrogation: Wartenberg's syndrome, a mononeuropathy of the superficial branch of the radial nerve, is uncommon and the natural history and treatment outcomes are uncertain for individual patients. This study documents a case series of patients with chronic Wartenberg's syndrome, their investigations, treatment and outcomes.

Methods: Patients with isolated non-sharp trauma related superficial radial nerve dysfunction of greater than three months' duration and of sufficient severity to justify treatment were retrospectively collected in practise over a ten-year period. Patient demographics, aetiological factors, investigation results, treatments initiated and treatment outcomes were recorded.

Results and Conclusions: Eleven patients, seven female and four males, were treated for chronic Wartenberg's syndrome. The patients' ages ranged from 27 to 64 years. Apparent causative factors included distal radial fracture, blunt hand or forearm trauma, excessive occupational forearm rotation with no cases related to the use of hand cuffs. Two patients responded adequately to hand therapy alone. The remaining nine patients went on to formal ultrasound assessment of the superficial radial nerve by musculoskeletal radiologists with universally a normal appearance of the nerve but an ultrasound guided corticosteroid injection resolved symptoms in all patients, with resolution of symptoms in five patients and transient response in the other four patients. One of these four patients chose to accept his symptoms and the remaining three underwent surgical decompression, one open and two endoscopic, with two making a complete recovery and one patient making a good partial recovery with a follow-up of over a year.

Despite ultrasound being able to define the superficial radial nerve with accuracy there have not been previous publications reporting on ultrasound in Wartenberg's syndrome and this study suggests ultrasound is not a reliable diagnostic tool for this condition. This study represents a relatively small case series of this uncommon condition. However, the author could identify few larger case series and no randomized studies for this condition. This study has demonstrated a good recovery for the majority of patients with a step-wise approach to treatment of hand therapy, followed by corticosteroid injections if required and surgery should steroid injection not produce a sufficient resolution of Wartenberg's syndrome.