FEATURE would have been an MRI of the hand to look for the cause of the ulnar neuropathy . However , during the past 10 years , ultrasonic evaluation of peripheral nerves has become a standard procedure in many centers ; the advantages are the ready availability at the point of care and the low cost compared to MRI . I proceeded with ultrasonic imaging and detected a cyst compressing the ulnar nerve at the Guyon ’ s canal . Following surgery , the pinky has become less obstinate and has started coming closer to the ring finger .
All that discussion about Dr . Wartenberg reminds me of another quote from William Osler . 3 “ It helps a man immensely to be a bit of a hero-worshipper , and the stories of the lives of the masters of medicine do much to stimulate our ambition and rouse our sympathies .”
References :
Figure 1 : Patient trying to keep fingers close together ; left small finger stays away ( Wartenberg sign )
standpoint , this sign is easily understandable . Adduction of the little finger is performed by the interosseous and abduction by the hypothenar muscles . Both groups of the muscles are innervated by the ulnar nerve . However , in abduction of the little finger , the extensor digiti minimi and the branch to the little finger of extensor digitorum communis also play a definite part . These both are innervated by radial nerve . If the muscles innervated by the ulnar nerve are weak , those innervated by the intact radial nerve predominate in strength and abduct the little finger . 1 ”
Dr . Wartenberg was born in Grodno , Belarus ; he studied at the University of Rostock in Germany and joined the faculty at University of Freiburg . Rising anti-Semitism in Germany forced him to emigrate to the US and he pursued a brilliant career in neurology at the University of California , San Francisco . He has the reputation of being one of the foremost medical semiologists of his time . His accolades include the best neurology teacher at UCSF and “ The Sherlock Holmes of neurology . 2 ” He authored close to 150 scientific papers and four books ; the most popular ones are : The Examination of Reflexes : A Simplification , and Diagnostic Tests in Neurology . While “ Wartenberg sign ” refers to the abducted posture of the small finger in ulnar nerve neuropathy , the term “ Wartenberg syndrome ” refers to isolated neuropathy of superficial radial nerve ( also known as cheiralgia paresthetica ). Since Wartenberg described many clinical signs , the term “ Wartenberg sign ” is also used in the context of thumb adduction on finger flexor stretching ( suggestive of corticospinal lesion ), finger flexor reflex and oculomandibular reflex . Wartenberg ’ s wheel is popular for sensory examination and is considered an essential tool in the neurologist ’ s bag .
In addition to a positive Wartenberg sign , the patient showed loss of sensation in the small finger , ulnar side of the palm and medial half of the ring finger . Nerve conduction and EMG studies confirmed ulnar neuropathy at the wrist . The next logical step
1
Wartenberg R . A sign of ulnar nerve palsy . JAMA . 1939 ; 112 ( 17 ): 1688 .
2
Boshes LD . Robert Wartenberg : stormy petrel of neurology ; rebel of book reviewers . J Hist Neurosci 1996 ; 5 : 288 – 306 .
3
William Osler . Aequanimitas “ Chauvinism in Medicine .” 1914:288
Dr . Iyer practices at the Neurodiagnostic Center of Louisville and is a retired professor of neurology at the University of Louisville School of Medicine .
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