Radial Tunnel Syndrome
What is Radial Tunnel Syndrome?
The radial nerve is one of three nerves that provide motor and sensory function to the arm. The radial nerve begins at the brachial plexus extends downward to the wrist and into the hand. As it travels down the arm it branches several times to provide movement to the muscles of the dorsal arm and sensation to the skin covering the forearm and the back of the hand. This nerve is responsible for extension of the arm wrist and finger as well as supination (outward rotation) of the forearm. Compression of the radial nerve results in Radial Tunnel Syndrome. In comparison to Cubital Tunnel Syndrome and Carpal Tunnel Syndrome, Radial Tunnel Syndrome is the least common of the three.
What causes Radial Tunnel Syndrome?
At the lateral aspect of the elbow, the radial nerve branches into the posterior interosseous nerve (PIN) and enters the radial tunnel. The radial tunnel (arcade of Frohse) is formed by bone and the muscles used for supination of the forearm. Most frequently, Radial Tunnel Syndrome occurs from compression in the proximal forearm associated with these muscles. Bone fractures, trauma to the soft tissues surrounding the nerve, or repetitive motion resulting in inflammation of the muscle can all result in Radial Tunnel Syndrome.
What are the symptoms of Radial Tunnel Syndrome?
The most common symptom is pain in the forearm a couple inches below the elbow. Generally, the pain will increase with activity, heavy lifting or by extending the elbow and pronating (inward rotation) the forearm. The pain can be described as achy, and is occasionally associated with muscle weakness and may worsen at night. Radial Tunnel Syndrome is often confused with Tennis Elbow, so accuracy is important when describing symptoms.
How is Radial Tunnel Syndrome diagnosed?
In addition to a detailed history of pain, symptoms, and activity, physical examination and testing may be required. Determining the precise location of pain is important for proper diagnosis. Localized tenderness to the entrance of the radial tunnel should be compared bilaterally along with the radial head and lateral epicondyle. The physician may extend and maneuver the arm to compare pain levels during pronation and supination or resistance to these motions. X-rays of the elbow, MRI of the cervical spine, electromyography and nerve conduction studies may also be helpful for a definitive diagnosis.
How is Radial Tunnel Syndrome treated?
In cases where Radial Tunnel Syndrome is caused by repetitive motion injury the simplest and most effective treatment is to avoid or modify the causative movement. Increased rest and splinting the arm can be quite helpful. Limit heavy pulling, pushing, twisting or grasping as this can aggravate symptoms. Physical therapy involving exercises and stretching along with electrical stimulation or ice may provide substantial pain relief. Over the counter or prescription NSAIDS (ei. ibuprofen, naproxen) can also ease pain and reduce inflammation.
When non-surgical methods fail to provide adequate relief or pain returns shortly after beginning activity, it may be time to consider surgical decompression. The goal is to release any points of abnormal pressure as the radial nerve passes through the radial tunnel. An incision is made at the outer aspect of the forearm near the elbow and the muscle tissues are manipulated so the surgeon can visualize any pressure points where the nerve is being pinched. The tunnel is expanded in those areas relieving pressure and ultimately pain.
This procedure can be done as an outpatient and the client goes home in a long arm splint. In 8-10 days the patient returns for suture removal and placement of a removable splint. In two more weeks therapy begins and the removable splint is only worn when not active and at night. Therapy lasts approximately two months.
How can Dr. Knight help you with radial tunnel syndrome?
Dr. Knight will look at all of the possible causes of pain in your forearm from the neck down. Once he confirms the diagnosis he will work with you to maximize conservative treatment to relieve your symptoms. He will only recommend surgery for this condition if exhaustive conservative care has failed. If radial tunnel surgery is needed, Dr. Knight will perform as minimally invasive procedure as necessary to minimize scarring and expedite a full recovery.
Note: The following video contains graphic images.
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