What is Radial Tunnel Syndrome?
Radial tunnel syndrome is a painful condition caused by pressure on the radial nerve of the forearm. The entrapment or compression occurs in the proximal forearm in the radial tunnel; a narrow space formed by muscles, bone, and tendon near the elbow joint.
The radial nerve is one of the three major nerves of the arm that supplies the wrist and hand extensor muscles helping in movement of the hand and wrist.
Symptoms
Symptoms include a dull aching pain at the back of your hand, outside of the elbow or on top of the forearm. Pain worsens when you straighten your elbow and fingers. You may also experience weakness of your hand and wrist and decreased ability to grip objects. Radial tunnel syndrome often occurs in conjunction with tennis elbow (lateral epicondylitis).
Diagnosis
- Your doctor will review your medical history and perform a thorough physical examination of your elbow.
- Electrodiagnostic tests such as electromyography and nerve conduction studies may be used in determining how well the nerve is functioning and locate areas of muscle wasting and nerve compression. However, these are often normal in radial tunnel syndrome.
- You may be asked to move your middle finger against resistance. Pain while performing this movement can be associated with radial tunnel syndrome.
- Imaging studies such as X-ray or MRI can be useful to exclude other pathology.
Treatment
Non-surgical Treatment
Your treatment plan may include the following options:
- Using prescribed non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation.
- Applying ice packs over a towel to the injury to help reduce swelling and pain.
- Avoid pressure on the nerve.
- Avoid activities that tend to bring on the symptoms.
- Steroid injections may be administered to reduce pain and inflammation.
- Physical therapy may be recommended for improving flexibility, range of motion and strength-building.
Surgery
Surgery may be recommended if you do not respond to non-surgical treatment options. The goal of the surgery is to reduce the pressure on the radial nerve by providing more space for the nerve to move freely and to increase blood flow for the nerve to heal.
The most common surgery is the radial tunnel release procedure that is performed under general anaesthesia. This is often combined with tennis elbow release surgery. The muscles causing compression are identified and incised to create more space for the nerve. A bulky dressing with a plaster splint is usually applied following surgery for 10-14 days. Physical therapy will be ordered a few weeks after surgery to maximise the use of the hand and forearm.