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Back of Hand Numbness From Gaming

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Back of Hand Numbness From Gaming

Wartenberg Syndrome | Nintendo Numbness

Radial Nerve Distribution
  • Wartenberg syndrome is a less familiar condition of the hand/wrist wrist that can be relevant in the gaming population due to gaming accessories like watches or gaming gloves on the rise.
  • Wartenberg Syndrome is compression of the radial nerve which innervates (supplies) specific muscles in the hand and fingers
  • Nerves are responsible for providing muscles with necessary strength, coordination, sensation, and ultimately function which is hugely important in gaming

Wartenberg syndrome or “Nintendo Numbness” is a condition that affects the radial nerve in your wrist/forearm. The radial nerve is the least common nerve of the hand to become injured as cubital tunnel (Ulnar nerve) and carpal tunnel syndrome (Median nerve) are much more common. The radial nerve controls sensation in the thumb and first three fingers of the back of your hand. The nerve also controls the motor function of the muscles that extend (lift up) the wrist and finger. 

Wartenberg syndrome specifically is compression of the superficial branch of the radial nerve, resulting in sensory issues. This will present as pain over the dorsal aspect of the distal forearm (back of the arm near the wrist) and paresthesia (numbness/tingling) throughout the *radial nerve distribution of the hand. This may present from wearing a watch, bracelet, gloves, or wristband too tight around the wrist. This condition has seen a rise with the use of gaming gloves as a contributing issue. Additionally, this can happen as a result of direct trauma to the nerve from getting hit or even due to repetitive activity. It is also important to note that Wartenberg syndrome and Wartenberg’s sign are two distinctly different things. 

 

“An analogy that can be used to think of nerves is like a water hose. When someone steps on the hose there may be a little water sputtering out which can be like the tingling often first experienced with mild compression at the wrist. If someone comes along and steps on the hose with all their weight then the water flow may stop. Similarly, if someone is wearing a watch too tight then this external pressure may result in numbness in the hand and wrist. If there is no water coming from the hose to feed the plants then the plants will begin to die after months, similar to how our muscles can start to atrophy (die/weaken) if they are not getting proper innervation (supply) from the nerve.”

 

As the analogy states, external compression such as wearing a watch, bracelet, gloves, or wristband too tight around the wrist are the most common forms of this condition occurring. Repetitive hand and wrist movements can lead to irritation of the radial nerve as surrounding tissue becomes tight but this is less common. This compression of the radial nerve in this instance would result primarily in symptoms of numbness and tingling with some pain also being reported. Now this means it is no surprise where it may be relevant in gamers or office workers because a lot of what these require is repetition, but this does not seem to be a common issue. Instead, tendinopathies are much more commonly seen in gamers and when pain is reported at the wrist, this should first be considered.

The name “Wartenberg Syndrome” is derived from the neurologist who first described the condition in medical literature in 1932, Dr. Robert Wartenberg. At 1HP we like to call this “Nintendo Numbness” as gamers who would ever put a Nintendo Wii or Switch safety strap on too tight may be subject to experiencing this nerve compression. 


*Radial Nerve: The radial nerve divides into two branches: the superficial branch and the deep branch. The superficial branch provides innervation to the back (dorsal) side of the thumb, Index, middle, and the radial half of the ring finger just proximal to the IP joints as well as a small portion of the volar side of the thumb where it gives sensation. The deep branch or posterior interosseous nerve (PIN) is a motor branch which gives input to the supinator muscle as well as extensors of the wrist and digits.

Gamers are likely to begin experiencing tingling or numbness in the *radial nerve distribution. Gamers may find it challenging gripping or moving the mouse because of their decreased sensation. Finger dexterity is likely to be reduced which is likely to decrease performance and alter the gameplay of the individual. Individuals may also experience a burning sensation, but when pain is reported without numbness/tingling suspicion should then be placed on a tendon injury. Again, tendon injuries or tendinopathies are much more common in gaming and it is important to understand this as treatment differs.


The following information is provided for general educational purposes only and should not be considered medical advice. It is not intended to replace consultation with a qualified healthcare professional. If you have specific concerns or questions about your health or medical condition, please seek the guidance of a licensed physician or another qualified medical practitioner. Any reliance you place on the information provided is solely at your own risk. In no event will the author or 1HP be liable for any loss or damage arising from using this information. Always consult with a healthcare professional before starting or changing any medical treatment or regimen.

Gamers use their hands and fingers a lot! Gamers are at risk for injury because of the long durations we play. Gamers oftentimes take minimal rest breaks because they are so engaged and locked in and don’t always think to put their body first. Pain and discomfort is something that can be reduced from distractions and gaming is a good distractor which makes it hard for gamers to know when to stop due to pain/discomfort. Gamers are at risk however because of the excessive use required of the arm and hands. By sitting with the palms down (forearm pronation) there is increased compression on the radial nerve which is common in most gamers.

 

Most frequently, Wartenberg Syndrome will occur as a result of some external compression like wearing a watch, bracelet, gloves, or wristband too tight around the wrist. Other factors which may cause this condition would be direct trauma to the nerve from hitting it, wrist fractures, repetitive use of the hands/wrist, or other factors like a ganglion cyst or bony spur forming within the arm. Factors such as genetics, obesity, pregnancy, and underlying health conditions can contribute to the development of Wartenberg syndrome, but this does not seem to be a key contributor.

 

It should be known that numbness/tingling does not always indicate carpal tunnel syndrome. For this reason it is important to recognize the difference between conditions. It may also be helpful to detect these symptoms when they occur. For example, Carpal tunnel or cubital tunnel symptoms may occur at night while sleeping for those who sleep with wrists or elbows bent. Instead those who suffer from Wartenberg Syndrome may experience symptoms during the day after they have worn a watch or bracelet for a few hours.

 

Check out the video linked here for a video explanation about common nerve entrapment spots and what to know or do when this occurs

Returning from this injury takes a concerted effort, but can be done without much time away from the game. Below are a few steps that individuals need to understand and take when discomfort in this area occurs. 

 

  1. Identify the issue 
    • One of the most important factors is early detection
  2. Remove the source of compression
    • Begin by removing any and all bracelets, gloves, watches, or other wearables that may be compressing the nerve.
    • Splinting: For certain conditions splinting may be necessary in the acute stage of injury, but regarding Wartenberg Syndrome splinting may actually do more harm than good. Oftentimes individuals may wear a splint once hand issues arise. If a splint is worn tight then this may only further the compression on the radial nerve wrestling in worsening symptoms. 
  3. Relative rest
    • It is best to reduce the time playing or incorporate a few more breaks throughout the day if possible until symptoms start to subside
  4. Massage
    • Massaging the forearm can be helpful in reducing tightness and stiffness which may be contributing towards compressing the nerve
  5. Utilize heat/ice (Hot/cold packs, warm water soak)
    • Heat can be helpful before or during activity. Ice can be helpful during an acute flare of symptoms.
  6. Nerve Glides
    •  To restore mobility between the nerve and the surrounding tissue. 
  7. Stretching
    • Helpful in decreasing tightness and stiffness throughout the forearms

 

*Surgery is rarely required in order to effectively treat, but can be extremely effective if indicated

 

**For a comprehensive guide on the exercises discussed, check out the videos on our Fix Wrist Pain link here

The diagnosis was explained in short above, but for those wanting to know and learn more this is for you. 

 

Specifically, this diagnosis is looking at one nerve, the radial nerve and the surrounding tissue. The radial nerve is a mixed (sensory and motor) nerve and controls the muscles responsible for extending the wrist and fingers while also providing sensation to the back of the hand and wrist. Because the radial nerve divides into two branches, this condition is solely a result of compression of the superficial branch which provides the sensory innervation (Touch/sensation) to the hand and wrist.

 

The radial nerve is one of the three nerves that goes into the hand. To get to this point the nerve begins to branch off at the brachial plexus where it then travels down the arm and separates into the superficial and deep branch at approximately 9 cm proximal to the radial styloid. The nerve compression occurs between the brachioradialis and extensor carpi radialis longus (ECRL) tendons. Most commonly this occurs due to external compression being worn, but can also be a result of trauma (Fractures), overuse, or anatomical variations (Cyst, bone spur).

Nerve Responsible: 

  • Radial Nerve: The radial nerve divides into two branches: the superficial branch and the deep branch. The superficial branch provides innervation to the dorsal side of the thumb, Index, middle, and the radial half of the ring finger just proximal to the IP joints as well as a small portion of the volar side of the thumb where it gives sensation. The deep branch or posterior interosseous nerve (PIN) is a motor branch which gives input to the supinator muscle as well as extensors of the wrist and digits. 

Muscle/Tendon responsible

  • Brachioradialis
    • This muscle is located on the thumb side (dorsoradial side) of the forearm and is responsible for bending (flexing) the elbow. This is the muscle largely associated with compressing the nerve as it passes between itself and extensor carpi radialis longus.
  • Extensor Carpi Radialis Longus
    • This muscle is located on the thumb side (dorsoradial side) of the forearm and is responsible for lifting up (extending) and moving the wrist to the thumb side (radially deviating) the wrist. This is the muscle largely associated with compressing the nerve as it passes between itself and brachioradialis.
  • Several additional muscles are innervated by the radial nerve in the hand and forearm, but are not found to be responsible for the nerve compression

It should also be known that gaming is not the only activity to bring on this condition and certainly other lifestyle factors play a role. School, work, hobbies, and sleep positioning can also further irritate this nerve and can be important to thoroughly evaluate as well. 

Nerve conditions and distributions:

Carpal tunnel syndrome is irritation and compression of the median nerve represented in the BLUE, while cubital tunnel is irritation and compression of the ulnar nerve represented in the GREEN. Wartenberg Syndrome is compression of the radial nerve represented in the PINK.

  • DeQuervain’s Tenosynovitis

DeQuervain’s Tenosynovitis is irritation of two tendon sheaths which will cause pain on the thumb side of the wrist. Click the link here to learn more about this diagnosis.

 

  • Intersection Syndrome: 

Intersection Syndrome mimics Wartenberg’s Syndrome as it is within close proximity to the pain location. Intersection syndrome however will present (Proximal to the dorsal wrist crease) higher up on the back of the forearm roughly 4-6 cm from the wrist crease and should not provoke a feeling of numbness/tingling. This is a form of tenosynovitis between 2 sets of tendons intersecting near the wrist causing friction and pain. Click the link here to learn more about this diagnosis.

 

  • Thoracic Outlet Syndrome: 

Thoracic Outlet Syndrome (TOS) is another condition which should be assessed as the nerves discussed above all stem from something called the brachial plexus. The brachial plexus is a network of nerves that come off of the spinal cord and travel between the clavicle and the first rib down into the arm. The presentation can lead to confusion when interpreting pain or sensory disturbances throughout the arm, wrist, hand, and fingers as it may be a result of entrapment further up the chain near the neck as opposed to the radial nerve. Click the link here to learn more about this diagnosis.

The primary way to prevent this condition from developing is by avoiding significant compression on the wrist. Ultimately, this is the most important and simple preventative strategy. Remove or loosen all compressive wearables on the wrist or take them off for short durations to allow the nerves to “breath”.

 

There are also several other approaches listed below to take in order to prevent this injury along with others from occurring:

 

  1. Exercising
    • Strengthening 
      • Important for building up a foundational base to allow the tendon/muscle to keep up with the workload they are being asked of in a preventative approach for tendinopathies
    • Nerve Glides
      •  Restore and maintain mobility between the nerve and the surrounding tissue. 
  2. Intermittent stretching (During and after gaming sessions)
  3. Proper warm-up (Promotes blood flow to the muscles/tendons and lubricates stiff joints)
  4. Ergonomics/positioning 
    • Poor positioning could put the nerve in a compromised position causing excessive compression therefore making it more susceptible to injury
  5. Mental health
    • It is common for conditions affecting what we love (Gaming) to work against us. Make sure to take the right steps to control the mental side of what something like this condition can bring on to not let it become a bigger issue than it is.
  6. Rest breaks 
    • Pain/discomfort levels can be reduced through distractions. Gaming is a big distractor, meaning that individuals should take breaks every 45-60 minutes to assess how you are feeling.
    • Creating a schedule that works for you and your game is also recommended. For example, consider taking a 10 minute break after 2 ranked games (~60 minutes) or a short 5 minute break to stretch following 1 ranked game (~30 min). Certain games will vary in duration, but planning ahead and forming a routine will be beneficial in the long run. A general rule of thumb is, the longer you play, the longer the break should be to allow for some recovery.
  7. Massage 
    • A great way do decrease muscle tightness and increase blood flow to the muscles, tendons, and nerves
  8. Heat 
    • Prior to gaming sessions or stretches to increase blood flow
  9. Nutrition/Sleep
    • These underlie all of what is experienced in a day and cannot be ignored in injury prevention

Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part I: radial nerve. The Journal of hand surgery. 2009 Dec 1;34(10):1906-14.

 

Herma, T., Slezak, J., Baca, V., & Kachlik, D. (2023). Duplicated superficial branch of the radial nerve and brachioradialis muscle belly: Prevalence and significance. Folia Morphologica, 82(3), 558–561. https://doi.org/10.5603/fm.a2022.0064 

 

Lanzetta, M., Foucher, G. Entrapment of the superficial branch of the radial nerve (Wartenberg’s syndrome). International Orthopaedics 17, 342–345 (1993). https://doi.org/10.1007/BF00180450

 

Shields, L. B., Iyer, V. G., Zhang, Y. P., & Shields, C. B. (2023). Etiological study of superficial radial nerve neuropathy: Series of 34 patients. Frontiers in Neurology, 14. https://doi.org/10.3389/fneur.2023.1175612

Additional 1HP Articles on Wartenberg Syndrome

Written By: Brett Becker, OTR/L, MS, ACE-CPT