Wartenberg's Sign: Difference between revisions
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== Physiotherapy Management == | == Physiotherapy Management == | ||
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Definition[edit | edit source]
Wartenberg's Sign refers to the slightly greater abduction of the fifth digit, due to paralysis of the abducting palmar interosseous muscle and unopposed action of the radial innervated extensor muscles (digiti minimi, digitorum communis ).[1]
Purpose
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Wartenburg’s sign is a test used for assessing integrity of the motor innervations of hand intrinsics in cases of suspected ulnar neuropathy. The inability to perform adducted digital extension is due to weakness in ulnar innervated intrinsic muscles, and the unopposed action of the slightly medially attached extensor digiti minimi results in extension and abduction of the 5th digit.[2] A positive test indicates ulnar nerve neuropathy but does not determine site of compression (Guyon’s canal, cubital tunnel, arcade of Struthers).
Technique
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A study by Goldman et al (2009) [3] adopted the technique to assess Wartenberg's Sign - The patient is placed with wrist in neutral position and forearm fully pronated and instructed to perform full extension of all the fingers. Once digits are extended patient is asked to fully abduct all fingers and then adduct all fingers. A positive sign is indicated with the observation of abduction of the 5th digit, with inability to adduct the 5th finger when extended.
David J Magee [4] propose another technique with minor variation - The patient sits with his or her hand resting on the table. The examiner passively spreads the finger apart and asks the patient to bring them together again. Inability to squeeze the little finger to the remainder of the hand indicates positive test for ulnar neuropathy.
Physiotherapy Management[edit | edit source]
The treatment consists of:
• Electrical stimulation and decimeter wave therapy: According to a review (John Wiley & Sons, Ltd.) it is not yet clear if patients benefit from electrical stimulation and further study was needed. A year later an article was published about electrical stimulation and decimeter wave therapy. This treatment shortens the recovery time of peripheral nerve function (Li GF, et al.). This was however rated a 4 on PEDro an is only tested in patients who have received surgery before therapy started. It is possible to exclude the factor of surgery because there was a general effect of the treatment on peripheral nerve function.
• Conservative treatment: steroid injection, this is more a medical intervention.
• Operation (post-operative physiotherapy): The reason why to mention operation in physical therapy management is not the operation itself but the importance of early movement after the operation. This movement prevents recurrence of compression or traction lesion due to the formation of adhesions between the muscle tendons (Lanzetta M., Foucher G.). Early movement was mentioned under mobilisations and muscle strength exercises but further study is needed to prove its effectiveness.
• Rest
When it comes to physical therapy, there are not many articles who prove effectiveness. Wartenberg’s sign is rather a rare condition but it can be important to find more prove for treatment. The literature also shows us that the articles found about Wartenberg’s are rather old. Therefore it is of great importance to work out new studies to find new therapies.
Prevention can be:
• Conservative treatment: This consists of removal of tight watch-strap, splinting
Key Research[edit | edit source]
Evidence levels are necessary to prove the efficacy of the treatment. Electrical stimulation and decimetre wave therapy (Li GF, et al.) have a level of evidence of 1B because it’s an individual RCT. The next evidence is that of early movement after operation (Lanzetta M., Foucher G.). The evidence level is 4, which is rather poor. The last article just about electrical therapy is scored an evidence level of 1A because it’s a review of multiple RCT’s (John Wiley & Sons, Ltd.). This is very strong evidence but the review tells us that it is yet not certain that it’s effective in al neurologic conditions.
• Li GF, et al. Synergistic effects of compound physical factor treatment on neurological outcome after peripheral nerve entrapment surgery: a randomized controlled study. Neural Regeneration Research 2008 Jan;3(1):97-100 : 1B
• Lanzetta M., Foucher G. Entrapment of the superficial branch of the radial nerve (Wartenberg’s syndrome) : a report of 52 cases. International orthopaedics (SICOT) (1993) 17: 342-345 : 4
• John Wiley & Sons, Ltd. Efficacy of electrical stimulation to increase muscle strength in people with neurologic conditions: a systematic review. Physiotherapy research international 2007; 12/3; 175-194: 1A
Resources[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ A.J. Larner; A Dictionary of Neurological Signs; Springer Science & Business Media, 12-Nov-2010; page 369
- ↑ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
- ↑ Goldman SB, Brininger TL, Schrader JW, Curtis R, Koceja DM. Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow. Arch Phys Med Rehabil 2009;90:1846-52
- ↑ David J. Magee:Orthopedic Physical Assessment: chapter 6-elbow ;sixth edition;Elsevier Health Sciences, 2008
