Radial Tunnel Syndrome
Radial Tunnel Syndrome is another nerve compression syndrome similar in concept to the more common Carpal Tunnel Syndrome or Cubital Tunnel Syndrome. It represents compression of the Radial Nerve or the Posterior Interosseous Nerve (which is a branch of the Radial Nerve) in and around the elbow to the mid-portion of the forearm. It sometimes can occur concomitantly with and/or be mistaken for Lateral Epicondylitis.
Patients usually experience pain in the elbow and forearm that often is worsened with use and activity of the hand and wrist, especially with gripping and wrist extension activities. Depending on which portion of the nerve is compressed and how severely it is compressed, patients may also experience numbness and tingling and even weakness in the muscles that extend the fingers and wrist.
On physical examination, there is often localized tenderness over Radial or Posterior Interosseous Nerve. Patients may also have pain with resisted extension of the wrist and middle finger, as well as with forced supination (rotating the forearm so that the palm faces the sky).
Radial tunnel syndrome is typically diagnosed clinically from the patient's history and physical exam findings. X-rays are normally ordered to determine whether there are other possible diagnoses that might be involved. While EMG/NCV tests are often utilized in nerve compression disorders, they tend to be much less reliable in helping to determine whether or not Radial Tunnel Syndrome is present. It however can be ordered to rule out other sources of the symptoms such as neck pathology
Patients are usually advised to try to decrease activities that causes pain, especially repetitive gripping, wrist extension, and forearm rotation. A wrist immobilizer can help reinforce the idea of emphasizing relative rest. Physical therapy is usually ordered emphasizing stretching, modalities to decrease swelling and inflammation, and then progressive gentle strengthening. Occasional use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs), if not contraindicated for other reasons, may help to decrease the symptoms.
Surgery is carefully recommended based on a number of different variables, but is usually indicated for patients who demonstrate weakness in the muscles that extend the wrist or fingers, or have severe symptoms despite trying the above mentioned nonoperative measures for at least 6 weeks.
Elbow surgery is an area requiring special expertise in order to master because some elbow surgery is typically performed by hand surgeons, and others by sports surgeons, yet neither of them typically do a large quantity of elbow surgery. This is especially true for Radial Tunnel Syndrome. Dr. Steven Lee is uniquely fellowship trained in both hand/upper extremity surgery as well as sports medicine, and has is one of the most experienced orthopaedic surgeons for Radial Tunnel Syndrome and elbow surgery in NYC. Learn more about scheduling surgery.
All surgical patients are immediately immobilized in a non-removable splint from above the level of the elbow to the hand for 7-10 days following surgery. During this time, patients are encouraged to elevate their hand above their heart, keep their dressings clean and dry, and to move their fingers. Patients are allowed to use their fingers to text and type, but not to lift anything heavier than a cup of coffee or that which causes them more than a 2/10 pain level.
Patients will then be transitioned into a wrist immobilizer for 3-6 weeks, and then patient will be required to start occupational therapy (OT) to regain back strength and mobility. It can often take 6-12 weeks to regain normal function again. However, like other nerve compression syndromes, whether or not the patient regains normal function depends more on how long and how severely the nerve has been compressed. Sometimes, if the nerve has been too severely damaged, the overall outcome can be compromised.
Learn more about post-operative care.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.