Wartenberg S Syndrome

• Unresponsiveness to corticosteroid injections and recurrent symptoms can occur because of the presence of the longitudinal septum

• Injection not placed correctly will lead to recurrence of symptoms

• Patient falling to follow conservative treatment regiment with hand therapy will in 5% of all patients necessitate surgical release

Physical Examination

Pain and swelling are localized over the region of the radial styloid (Fig. 30—1). The pain radiates down to the thumb and a thickened fibrous sheath is palpable over the radial styloid. Maximum tenderness is noted over the radial styloid, and tenderness is also noted along the long abductor tendon and muscle. Pain is increased with extension and abduction of the thumb against resistance. A Finkelstein test is positive and produces significant pain (Fig. 30-2).

Diagnostic Studies

Radiographs consisting of a posteroanterior (PA) and lateral view of the wrist as well as the important hyperpronated view or Robert's view were within normal limits. No carpometacarpal (CMC) arthritis was evident on the Robert's view.

Differential Diagnosis

Scaphoid fracture Arthritis

Flexor carpi radialis tendonitis Thumb carpometacarpal arthritis Intersection syndrome Wartenberg's syndrome

Scaphoid Fracture Finkelsteins Test

Figure 30—1. Physical exam will localize pain and swelling over the region of the radial styloid.

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