Cheiralgia Paresthetica: Nerve Involvement
Cheiralgia paresthetica involves the superficial radial nerve (Answer C). This is a sensory mononeuropathy affecting the superficial branch of the radial nerve, first described by Wartenberg in 1932 1, 2.
Clinical Definition
- Cheiralgia paresthetica is an isolated neuropathy of the cutaneous (superficial) branch of the radial nerve 1, 3, 2
- The condition is also known as Wartenberg's syndrome or Wartenberg's disease 1, 2
- It presents as pain and paresthesia over the lateral aspect of the wrist, thumb, and first web space 1
Anatomical Distribution
- The superficial radial nerve is purely sensory and provides sensation to the dorsoradial hand 2
- Symptoms typically occur in the distribution of this nerve: lateral wrist, thumb, and first web space 1
- The nerve is vulnerable to compression or trauma along its course near the wrist 2
Common Etiologies
- Local trauma to the wrist is the most common cause 4
- Handcuff placement can cause this condition 5
- Post-fracture complications, such as bony spikes after Colles' fracture 1
- Diabetes mellitus can predispose to this mononeuropathy 3
- Iatrogenic causes including local steroid injections for conditions like de Quervain's tenosynovitis 4
- External compression from tight wristwatches or bands 4
Clinical Pitfall
The superficial radial nerve must be carefully avoided during surgical procedures around the wrist, as iatrogenic injury can occur 2. Additionally, subcutaneous atrophy from steroid injections may follow lymphatic pathways and traverse the nerve, contributing to symptoms 4.