Entrapment of radial nerve at the wrist

• cheiralgia paraesthetica ('handcuff neuropathy' wristwatch neuropathy')
  
  
  • entrapment neuropathy of the radial nerve may occur at the wrist (cheiralgia paraesthetica)
    
    
    • radial nerve at this level provides sensation to the anterior aspect of the 1st MCPJ and the posterior lateral 3 1/2 fingers excluding the finger tips
      
      
    • 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
      • may be distinguished from de Quervain syndrome because it is not dependent on motion of the hand or fingers
        
        
    • causes of cheiralgia paraesthetica
      • cheiralgia paraesthetica may be seen in prisoners with tight handcuffs or where there has been excessive struggling against a normal handcuff
      • tight watches, bands or bracelets may also cause this condition
      • other injuries or surgery in the wrist area can also lead to symptoms, including surgery for other syndromes such as de Quervain's
      • exact aetiology is unknown, as it is unclear whether direct pressure by the constricting item is alone responsible, or whether oedema associated with the constriction also contributes
        
        
  • management:
    • usually settles with conservative therapy (avoidance of compression) but may take up to 2 months
    • complete anaesthesia suggests complete severance of the radial nerve and should prompt urgent surgical referral.

Reference:

• (1) Arthritis Research UK (April 2013). The upper limb in primary care. Part 2: Wrist, hand. Hands On 2(7).