Cheiralgia paresthetica
Encyclopedia
Cheiralgia paresthetica is a neuropathy of the hand
generally caused by compression or trauma
to the superficial branch of the radial nerve
. The area affected is typically on the back or side of the hand at the base of the thumb, near the anatomical snuffbox, 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 because it is not dependent on motion of the hand or fingers.
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
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
is unknown, as it is unclear whether direct pressure by the constricting item is alone responsible, or whether edema
associated with the constriction also contributes.
Symptoms commonly resolve on their own within several months when the constriction is removed; NSAIDs are commonly prescribed. In some cases surgical decompression is required. The efficacy of cortisone
and laser treatment is disputed. Permanent damage is possible.
This neuropathy was first identified by Robert Wartenberg
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 ), but studies and papers continue to use the older term to distinguish it from more extensive neuropathies originating in the forearm.
Hand
A hand is a prehensile, multi-fingered extremity located at the end of an arm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs...
generally caused by compression or trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
to the superficial branch of the radial nerve
Radial nerve
The radial nerve is a nerve in the human body that supplies the upper limb. It supplies the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin.It...
. The area affected is typically on the back or side of the hand at the base of the thumb, near the anatomical snuffbox, 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 because it is not dependent on motion of the hand or fingers.
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
Handcuffs are restraint devices designed to secure an individual's wrists close together. They comprise two parts, linked together by a chain, a hinge, or rigid bar. Each half has a rotating arm which engages with a ratchet that prevents it from being opened once closed around a person's wrist...
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
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
is unknown, as it is unclear whether direct pressure by the constricting item is alone responsible, or whether edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
associated with the constriction also contributes.
Symptoms commonly resolve on their own within several months when the constriction is removed; NSAIDs are commonly prescribed. In some cases surgical decompression is required. The efficacy of cortisone
Cortisone
Cortisone is a steroid hormone. It is one of the main hormones released by the adrenal gland in response to stress. In chemical structure, it is a corticosteroid closely related to corticosterone. It is used to treat a variety of ailments and can be administered intravenously, orally,...
and laser treatment is disputed. Permanent damage is possible.
This neuropathy was first identified by Robert Wartenberg
Robert Wartenberg
Robert Wartenberg was an American neurologist.Wartenberg was born in 1886 in Grodno, Belarus, then in the Russian Empire. He graduated from the University of Rostock, Germany in 1919. He worked with Max Nonne in Hamburg and Otfrid Foerster in Breslau. In 1933, he became head of the neurological...
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 ), but studies and papers continue to use the older term to distinguish it from more extensive neuropathies originating in the forearm.