Definition
Entrapment neuropathy of the superficial branch of the radial nerve in the distal forearm, also called cheiralgia paraesthetica.
Anatomy
- Superficial branch emerges from beneath brachioradialis about 9 cm proximal to the radial styloid
- Passes between the brachioradialis and ECRL tendons, which scissor the nerve in pronation
- Pure sensory supply to the dorsoradial hand, see Radial Nerve
Aetiology
- Tight watch straps, handcuffs and casts
- Forearm trauma and fractures
- Repetitive pronation with wrist ulnar deviation
- Diabetes mellitus
Clinical Features
- Burning pain and paraesthesia over the dorsoradial hand and thumb
- Tinel sign over the nerve in the distal forearm
- Symptoms provoked by forearm pronation with wrist ulnar flexion
- Finkelstein test may be positive
- No motor deficit
Investigations
- Clinical diagnosis
- Local anaesthetic block confirms the source
- Nerve conduction studies often normal
- Ultrasound for neuroma or a compressive mass
Differential Diagnosis
- De Quervain’s syndrome
- Intersection syndrome
- C6 radiculopathy
- Lateral antebrachial cutaneous neuritis
Management
- Removing compression. Loosen straps and casts, splint and avoid repetitive pronation
- Corticosteroid injection. Around the nerve at its fascial exit point
- Neurolysis. Fascial release between brachioradialis and ECRL after failed non-operative care
Prognosis
- Non-operative care gives good or excellent results in about 70%
- Surgery gives good or excellent results in about 74%
- Coexists with de Quervain’s in up to half, so both need assessment before surgery
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 19 October 2026.