Radial tunnel syndrome

Radial tunnel syndrome causes posterolateral elbow pain that is similar to tennis elbow and may sometimes occur in conjunction with that condition. Patients may typically have weakness of extension at the wrist and third digit. The pain is often reproduced upon resisted supination of the forearm, and pain at the radial tunnel on resisted hyperextension of the wrist.

The theory is that the radial nerve becomes irritated and/or inflamed from friction caused by compression by muscles in the forearm.{{cite journal |last1=van den Ende |first1=Kimberly I. M. |last2=Steinmann |first2=Scott P. |title=Radial Tunnel Syndrome |journal=The Journal of Hand Surgery |volume=35 |issue=6 |pages=1004–6 |year=2010 |pmid=20434275 |doi=10.1016/j.jhsa.2010.03.020}}

Some speculate that radial tunnel syndrome is a type of repetitive strain injury (RSI), but there is no detectable pathophysiology and even the existence of this disorder is questioned.

The term "radial tunnel syndrome" is used for compression of the posterior interosseous nerve, a division of the radial nerve, at the lateral intermuscular septum of arm, while "supinator syndrome" is used for compression at the arcade of Frohse.{{cite book|author1=Lyn D. Weiss|author2=Jay M. Weiss|author3=Thomas Pobre|title=Oxford American Handbook of Physical Medicine and Rehabilitation|url=https://books.google.com/books?id=aFuYCAiW0hsC&pg=PA96|access-date=11 November 2010|year=2010|publisher=Oxford University Press US|isbn=978-0-19-536777-5|pages=96–}}

The "radial tunnel" is the region from the humeroradial joint past the proximal origin of the supinator muscle. Some scientists believe the radial tunnel extends as far as the distal border of the supinator. The radial nerve is commonly compressed within a 5 cm region near the elbow, but it can be compressed anywhere along the forearm if the syndrome is caused by injury (e.g. a fracture that puts pressure on the radial nerve).{{cite journal |last1=Sarris |first1=Ioannis K. |last2=Papadimitriou |first2=Nikolaos G.|last3=Sotereanos |first3=Dean G. |title=Radial Tunnel Syndrome |journal=Techniques in Hand and Upper Extremity Surgery |volume=6 |issue=4 |pages=209–212 |year=2002 |doi=10.1097/00130911-200212000-00010 |pmid=16520604}} The radial nerve provides sensation to the skin of posterior arm, posterior and lateral forearm and wrist, and the joints of the elbow, wrist and hand. The nerve also provides sensory branches that travel to the periosteum of the lateral epicondyle, the anterior radiohumeral joint, and the annular ligament. It provides motor function through innervation to most extensor muscles of the posterior arm and forearm. Therefore, it is extremely important in upper body extremity movement and can cause significant pain to patients presenting with radial tunnel syndrome.{{cite book | last = Saladin | first = Kenneth S. | title =Anatomy & Physiology: The Unity of Form and Function | publisher = McGraw Hill |year=2012 |page=496|isbn=978-0-07-337825-1}} Unlike carpal tunnel syndrome, radial tunnel syndrome does not present tingling or numbness, since the posterior interosseous nerve mainly affects motor function.{{cite web |title=Cubital and Radial Tunnel Syndrome |url=http://www.webmd.com/pain-management/cubital-radial-tunnel-syndrome |access-date=4 December 2011}}

This problem is often caused by: bone tumors, injury (specifically fractures of the forearm), noncancerous fatty tumors (lipomas), and inflammation of surrounding tissue.

The diagnosis is based on symptoms and signs alone and objective testing is expected to be normal. This syndrome may be clinically tested by flexing the patients long finger while the patient extends the wrist and fingers. Pain is a positive finding.

The chief complaint of this disease is usually pain in the dorsal aspect of the upper forearm, and any weakness described is secondary to the pain. Tenderness to palpation occurs over the area of the radial neck. Also, the disease can be diagnosed by a positive "middle finger test", where resisted middle finger extension produces pain. Radiographic evaluation of the elbow should be performed to rule out other diagnoses.

Non-surgical treatment of radial tunnel syndrome includes rest, NSAID, therapy with modalities, work modification, ergonomic modification, injection if associated with lateral epicondylitis.{{cite web |title=Radial Tunnel Syndrome |date=30 July 2010 |url=http://www.handandwristinstitute.com/radial-tunnel-syndrome/ |access-date=4 December 2011}}

Patients whose conditions are more adapted to surgical intervention are those who do not respond to prolonged conservative treatment. The patient must have pain with resisted supination, positive middle finger test, positive electrodiagnostic findings, and pain relief after a nerve block in the radial tunnel. Based on 2002 data, nerve decompression leads to 60–70% good or excellent results.

• Golfer's elbow
• Repetitive strain injury
• Tennis elbow
• Nerve compression syndrome

{{reflist}}

• {{cite book |first1=Libi |last1=Rind |first2=Thomas |last2=Pobre |first3=Frederick |last3=Weiss |first4=Yasha |last4=Magyar |first5=Charles |last5=Ruotolo |first6=Tamir |last6=Aldad |first7=Shahab |last7=Mahboubian |first8=Alexander |last8=Knijnikov |first9=Wilbur J. |last9=Asheld |chapter=Radial tunnel syndrome and supinator syndrome |chapter-url=https://books.google.com/books?id=aFuYCAiW0hsC&pg=PA96 |editor1-first=Lyn D. |editor1-last=Weiss |editor2-first=Jay M. |editor2-last=Weiss |editor3-first=Thomas |editor3-last=Pobre |title=Oxford American Handbook of Physical Medicine & Rehabilitation |publisher=Oxford University Press |year=2010 |pages=96–7 |isbn=978-0-19-536777-5 }}
• {{cite book |first1=Jacqueline J. |last1=Wertsch |first2=Anne Zeni |last2=Hoch |chapter=Radial Tunnel Syndrome |chapter-url=https://books.google.com/books?id=MfG0632WzhYC&pg=PA79 |editor1-first=Venu |editor1-last=Akuthota |editor2-first=Stanley A. |editor2-last=Herring |title=Nerve and Vascular Injuries in Sports Medicine |publisher=Springer |location=Berlin |year=2009 |pages=79–80 |isbn=978-0-387-76599-0}}
• {{cite book |first1=Stephen M. |last1=Russell |chapter=Radial Tunnel Syndrome |chapter-url=https://books.google.com/books?id=_NxeENi2lVAC&pg=PA62 |title=Examination of peripheral nerve injuries: an anatomical approach |publisher=Thieme |location=Stuttgart |year=2006 |page=62 |isbn=978-3-13-143071-7}}
• {{cite book | last = Saladin | first = Kenneth S. | title =Anatomy & Physiology: The Unity of Form and Function | publisher = McGraw Hill |year=2012 |page=496|isbn=978-0-07-337825-1}}

• {{cite journal |last1=Dickerman |first1=Rob D. |last2=Stevens |first2=Qualls E. J. |last3=Cohen |first3=Anders J. |last4=Jaikumar |first4=S. |title=Radial tunnel syndrome in an elite power athlete: a case of direct compressive neuropathy |journal=Journal of the Peripheral Nervous System |volume=7 |issue=4 |pages=229–32 |year=2002 |pmid=12477169 |doi=10.1046/j.1529-8027.2002.02030.x|s2cid=11798735 |url=https://zenodo.org/record/1236502 }}
• {{cite journal |last1=Huisstede |first1=Bionka |last2=Miedema |first2=Harald S. |last3=van Opstal |first3=Twan |last4=de Ronde |first4=Manon T. |last5=Verhaar |first5=Jan A. |last6=Koes |first6=Bart W. |title=Interventions for Treating the Radial Tunnel Syndrome: A Systematic Review of Observational Studies |journal=The Journal of Hand Surgery |volume=33 |issue=1 |pages=72–8 |year=2008 |pmid=18261668 |doi=10.1016/j.jhsa.2007.10.001}}
• {{cite journal |last1=Henry |first1=Mark |last2=Stutz |first2=Christopher |title=A Unified Approach to Radial Tunnel Syndrome and Lateral Tendinosis |journal=Techniques in Hand and Upper Extremity Surgery |volume=10 |issue=4 |pages=200–5 |year=2006 |pmid=17159475 |doi=10.1097/01.bth.0000231580.32406.71|s2cid=9709553 }}
• {{cite journal |last1=Cleary |first1=C |title=Management of Radial Tunnel Syndrome: A Therapist's Clinical Perspective |journal=Journal of Hand Therapy |volume=19 |issue=2 |pages=186–91 |year=2006 |pmid=16713866 |doi=10.1197/j.jht.2006.02.020}}
• {{cite journal |last1=Sarris |first1=Ioannis K. |last2=Papadimitriou |first2=Nikolaos G. |last3=Sotereanos |first3=Dean G. |title=Radial Tunnel Syndrome |journal=Techniques in Hand and Upper Extremity Surgery |volume=6 |issue=4 |pages=209–12 |year=2002 |pmid=16520604 |doi=10.1097/00130911-200212000-00010}}
• {{cite journal |last1=Smola |first1=C. |trans-title=About the problem of radial tunnel syndrome or 'where does the tennis elbow end and where does the radial tunnel syndrome begin?' |title=Zur Problematik des 'algetischen Supinatorsyndroms' oder 'Wo hört der Tennisarm auf und wo fängt das Supinatorsyndrom an?' |language=de |journal=Handchirurgie, Mikrochirurgie, Plastische Chirurgie |volume=36 |issue=4 |pages=241–5 |pmid=15368151 |year=2004 |doi=10.1055/s-2004-817947}}
• {{cite journal |last1=Loh |first1=YC |last2=Lam |first2=WL |last3=Stanley |first3=JK |last4=Soames |first4=RW |title=A new clinical test for radial tunnel syndrome—the Rule-of-Nine test: A cadaveric study |journal=Journal of Orthopaedic Surgery |volume=12 |issue=1 |pages=83–6 |year=2004 |pmid=15237127 |url=http://www.josonline.org/pdf/v12i1p83.pdf |doi=10.1177/230949900401200115|s2cid=14049155 |doi-access=free }}
• {{cite journal |last1=Rosenbaum |first1=Richard |title=Disputed radial tunnel syndrome |journal=Muscle & Nerve |volume=22 |pages=960–7 |year=1999 |doi=10.1002/(SICI)1097-4598(199907)22:7<960::AID-MUS26>3.0.CO;2-C |issue=7|pmid=10398221 |s2cid=28370678 }}
• {{cite journal |last1=Portilla Molina |first1=A. E. |last2=Bour |first2=C. |last3=Oberlin |first3=C. |last4=Nzeusseu |first4=A. |last5=Vanwijck |first5=R. |title=The posterior interosseous nerve and the radial tunnel syndrome: an anatomical study |journal=International Orthopaedics |volume=22 |issue=2 |pages=102–6 |year=1998 |pmid=9651775 |doi=10.1007/s002640050218|pmc=3619716 }}
• {{cite journal |last1=Jebson |first1=Peter J. L. |last2=Engber |first2=William D. |title=Radial tunnel syndrome: Long-term results of surgical decompression |journal=The Journal of Hand Surgery |volume=22 |issue=5 |pages=889–96 |year=1997 |pmid=9330150 |doi=10.1016/S0363-5023(97)80086-X}}
• {{cite journal |last1=Sarris |first1=Ioannis K. |last2=Papadimitriou |first2=Nikolaos G.|last3=Sotereanos |first3=Dean G. |title=Radial Tunnel Syndrome |journal=Techniques in Hand and Upper Extremity Surgery |volume=6 |issue=4 |pages=209–212 |year=2002 |doi=10.1097/00130911-200212000-00010 |pmid=16520604}}

{{Medical resources

| DiseasesDB =

| ICD10 = G56.3

| ICD9 = {{ICD9|354.3}}

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{{PNS diseases of the nervous system}}

Category:Musculoskeletal disorders

Category:Occupational diseases

Category:Overuse injuries

Category:Syndromes