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9.20 Cheiralgia Paresthetica (Handcuff Neuropathy)


Presentation

The patient may complain of pain around the thumb while tight handcuffs were in place. The pain decreased with handcuff removal, but there is residual paresthesia or decreased sensation over the radial side of the thumb metacarpal (or a more extensive distribution). The same injury may also be produced by pulling on a ligature around the wrist, or wearing a tight watchband.

What to do:

What not to do:

Discussion

A superficial sensory cutaneous twig of the radial nerve is the branch most easily injured by constriction of the wrist. Its area of innervation can vary widely (see figure). Axonal regeneration of contused nerves proceeds at about l mm per day (or about an inch a month); thus recovery may require two months (measuring from site of injury in wrist to end of area of paresthesia). Patients may want this injury documented as evidence of "police brutality," but it can be a product of their own struggling as much as too-tight handcuffs

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD