Bone & Joint Expert Care

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Radial tunnel syndrome

What is radial tunnel syndrome?

Radial tunnel syndrome is a nerve disorder in the elbow and upper arm that causes pain and hand and wrist weakness. It involves compression of the radial nerve (particularly the posterior interosseous branch) at the elbow or forearm by muscles or ligament-like tissues. That nerve has no sensory component; thus, there is no numbness associated with it.

Because its symptoms are similar in type and location to lateral epicondylitis (tennis elbow), it is often known as “resistant tennis elbow.” Posterior interosseous nerve dysfunction may decrease athletic performance in sports that require strong hand or wrist action.

How does radial tunnel syndrome occur?

Radial tunnel syndrome is caused by pressure on the radial nerve at the elbow or in the forearm, caused by pressure under one of the forearm muscles or swollen, inflamed, or scarred tissue, ligament-like tissue, or an artery pressing on the nerve. It may also occur due to a direct blow to the nerve at the back of the upper arm.

What increases the risk?

  • Sports or occupations that require repetitive and strenuous rotation motions of the wrist
  • Contact sports, such as football, soccer and rugby
  • Poor physical conditioning (strength and flexibility)
  • Inadequate warm-up before practice or play
  • Diabetes mellitus
  • Hypothyroidism (underactive thyroid gland)

What are the symptoms of radial tunnel syndrome?

  • Vague, activity-related pain in the outer elbow that may shoot down the forearm
  • Sharp pains that may shoot from the elbow to the wrist and hand
  • Wrist and finger weakness
  • Tenderness of the outer elbow
  • Pain or weakness with gripping activities
  • Pain with twisting motions of the wrist, such as when playing tennis, using a screwdriver, or opening a door or a jar; also, with resistance, turning the palm up or passively turning the palm down.

How is radial tunnel syndrome treated?

Non-operative treatment: Initial treatment consists of rest from the offending activity and medications and ice to help reduce inflammation. Elbow splinting may be recommended. Stretching and strengthening exercises of the muscles of the forearm and elbow are important. Referral to physical therapy or an athletic trainer may be recommended for treatment.

Operative treatment

If this treatment is not successful within three to six months, surgery may be necessary to free the pinched nerve.

What are the complications of treatment?

Possible complications of operative treatment include:

  • Surgical complications not specifically associated with elbow repair/reconstruction, such as pain, bleeding (uncommon), infection (<1%), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity.

When can you return to your sport/activity?

This condition is usually curable with appropriate treatment, and sometimes it heals spontaneously. Uncommonly, surgery is necessary. Surgery is usually needed if muscle wasting (atrophy) or nerve changes have developed.

How can radial tunnel syndrome be prevented?

  • Appropriately warm up and stretch before practice or competition
  • Maintain appropriate conditioning:
    • Cardiovascular fitness
    • Wrist, forearm, and elbow flexibility
    • Muscle strength and endurance
  • Wear proper protective equipment, including elbow pads