Anthony Jonathan H., Hadeed Andrew, Hoffler Charles E.
Larkin Community Hospital
The Hand Institute, Miami, FL
The radial nerve is susceptible to compression at many different locations throughout its course. Cheiralgia paresthetic is compression of the superficial branch of the radial nerve in the forearm. This condition was first described by Dr. Wartenberg in 1932 when he introduced the term cheiralgia paresthetica and reported five clinical cases. It is also commonly known as Wartenburg syndrome and superficial radial nerve palsy. The superficial radial nerve is purely sensory and does not have any motor component. The condition presents with symptoms such as pain and burning located on the dorsal and radial side of the hand. Often it is aggravated by activities such as pronation, pinching, and gripping. The radial nerve derives from the posterior cord of the brachial plexus and consists of fibers from the nerve roots at C5, C6, C7, C8, and sometimes T1. It descends between the long head of the triceps and axillary artery and enters the posterior compartment of the arm via the triangular interval. It continues to descend along the medial proximal upper arm between the long and medial head of the triceps until it reaches the spiral groove. The nerve passes distally and laterally around the posterior humerus, where it penetrates the lateral intermuscular septum and gains access to the anterior compartment of the brachium. The nerve enters the anterior compartment distal to the deltoid insertion at approximately 11 cm proximal to the elbow. It continues anteriorly to the lateral epicondyle between the brachialis and brachioradialis at the elbow to enter the forearm. Roughly 3 to 5 cm proximal to the supinator, the radial nerve separates into the posterior interosseous nerve and the superficial branch of the radial nerve. The posterior interosseous nerve proceeds deep to the supinator. The superficial branch of the radial nerve continues superficially to the supinator and deep to the ulnar margin of the brachioradialis in the anterolateral aspect of the forearm to where it briefly runs alongside the radial artery. At roughly 9 cm proximal to the radial styloid process, it then pierces the deep fascia between the middle and distal third of the forearm, to emerge between the brachioradialis and extensor carpi radialis longus to eventually become subcutaneous. The superficial branch of the radial nerve then ramifies again at approximately 4.9 cm proximal to the styloid process into dorsomedial and dorsolateral branches. These branches travel alongside the cephalic vein and proceed across the first dorsal compartment of the wrist and its tendons, the abductor pollicis longus and the extensor pollicis brevis. The dorsolateral branch supplies the dorsolateral thumb proximal to the interphalangeal joint. The dorsomedial branch supplies the dorsomedial thumb proximal to the interphalangeal joint, dorsoradial half of the hand and dorsal aspect of the index, long, and radial half of ring fingers proximal to the distal interphalangeal joint.
桡神经在其走行过程中的许多不同部位都易受到压迫。感觉异常性手痛是桡神经浅支在前臂受到压迫。这种情况最早由瓦尔滕贝格医生于1932年描述，当时他引入了“感觉异常性手痛”一词并报告了5例临床病例。它也通常被称为瓦尔滕贝格综合征和桡神经浅支麻痹。桡神经浅支仅为感觉神经，没有任何运动成分。该病的症状表现为手部背侧和桡侧的疼痛和烧灼感。通常，旋前、捏和抓握等活动会加重症状。桡神经发自臂丛后束，由C5、C6、C7、C8神经根的纤维组成，有时还包括T1神经根的纤维。它在肱三头肌长头和腋动脉之间下行，经三角肌间隙进入臂后区。它继续沿上臂近端内侧在肱三头肌长头和内侧头之间下行，直至到达螺旋沟。神经向远端和外侧绕过肱骨后方，在此处穿外侧肌间隔进入臂前区。神经在距肘关节近端约11厘米处，在三角肌止点的远侧进入臂前区。它继续向前至肘关节处肱肌和肱桡肌之间的外侧髁，进入前臂。在距旋后肌近端约3至5厘米处，桡神经分为骨间后神经和桡神经浅支。骨间后神经在旋后肌深面走行。桡神经浅支在旋后肌浅面、前臂前外侧肱桡肌尺侧缘深面继续走行，在此处它短暂地与桡动脉伴行。在距桡骨茎突近端约9厘米处，它穿过前臂中、下1/3交界处的深筋膜，在肱桡肌和桡侧腕长伸肌之间穿出，最终成为皮下神经。桡神经浅支在距茎突近端约4.9厘米处再次分支为背内侧支和背外侧支。这些分支沿头静脉走行，穿过腕背侧第一间隙及其肌腱，即拇长展肌和拇短伸肌。背外侧支供应近节指间关节近端的拇指背外侧。背内侧支供应近节指间关节近端的拇指背内侧、手的桡背侧半以及示指、中指和环指桡侧半的远节指间关节近端的背侧。
