Radial Tunnel Syndrome Treatment in Nebraska

Incidence

5% or less of people who present with outer elbow and upper forearm pain are actually ultimately believed to have radial tunnel syndrome. In contrast to other nerve impingement syndromes, which typically occur much more frequently in women, such as carpal tunnel syndrome and cubital tunnel syndrome, this syndrome occurs almost equally in men and women. One-sided involvement is the exception rather than the rule, also in contrast to other entrapment neuropathies. It usually occurs in the dominant side. This has only been reported in adults, not in children, also contrasting with carpal tunnel syndrome.

Anatomy

The radial nerve courses from the upper outer arm to the outer elbow between the brachialis (elbow flexor) and the brachioradialis muscles. Almost directly in front of the elbow, the radial nerve divides into the superficial radial (pure sensory) and the posterior interosseous (pure motor) nerves. The posterior interosseous nerve (PIN) dives beneath the leading edge of the supinator muscle, otherwise known as the arcade of Frohse. It is here that compression of the PIN may occur.

The variation in the amount of tendon at the opening of the radial tunnel, i.e., the arcade, has a lot to do with whether or not the person develops the syndrome. The arcade acts like a gate, and the vigor of the supinator muscle contracting closes this gate on the underlying PIN resulting in radial tunnel syndrome. In severe cases, weakness of the muscle innervated by the PIN at the arcade has been carefully recorded by Werner Olaf at the time of surgery by stimulating the supinator muscle to contract.

Diagnosing Radial Tunnel Syndrome

The diagnosis of radial tunnel syndrome, a condition presenting as outer elbow and upper forearm pain, often poses a unique challenge. The condition must be accurately differentiated from lateral epicondylalgia, more commonly known as tennis elbow, a far more prevalent cause of similar symptoms. 

Radial tunnel syndrome diagnosis can often be the most contentious and challenging among nerve entrapment syndromes in the upper extremities. This is largely due to the variable symptoms, a typically normal physical exam save for local tenderness, and the absence of a reliable, objective diagnostic test. 

At Nebraska Hand & Shoulder Institute, we continue to investigate and debate the potential of nerve conduction studies for the posterior interosseous nerve as a part of our radial tunnel syndrome treatment methodology. These studies have proven remarkably useful for other nerve entrapment syndromes where the nerve is more superficial. 

It's crucial to correctly distinguish between tennis elbow and radial tunnel syndrome when assessing a patient's complaints. In some rare cases, it may also be necessary to rule out arthritis, although X-rays are typically not required as patients usually exhibit full motion, no swelling, and no grating of joints through the arc of motion. 

At Nebraska Hand & Shoulder Institute, our team specializes in providing top-tier diagnosis for radial tunnel syndrome, ensuring we lead in the latest diagnostic techniques and treatment options in Nebraska.

Radial Tunnel Syndrome Treatment

At the Nebraska Hand & Shoulder Institute, we focus on treating radial tunnel syndrome. In a minority of cases changing one's activities, i.e., modifying the way they use their forearm, will diminish or eliminate the symptoms. The activity most likely to precipitate symptoms of radial tunnel syndrome is forceful forearm rotation particularly palm upwards (supination). This puts pressure upon the nerve at the arcade of Frohse.

Prolonged splinting, nonsteroidal anti-inflammatory medication, elbow bands and sleeves, etc., have not proven beneficial for this or for lateral epicondylitis. In contrast, though cortisone injection does not have any place in the treatment of radial tunnel syndrome, it's the main treatment available for lateral epicondylalgia (tennis elbow). Neither is an inflammatory condition and often, surgery is necessary to relieve the symptoms.

Prognosis

The progression of radial tunnel syndrome varies among patients. From our observation, approximately half of the patients presenting with radial tunnel syndrome require surgical intervention to completely alleviate symptoms. The remaining patients either have mild symptoms that they choose to manage without surgery, or their symptoms subside through activity modification.

Specialized Radial Tunnel Syndrome Surgery in Nebraska

Surgery remains a viable and often necessary option for radial tunnel syndrome. Our surgical approach typically involves one of three incisions, either a longitudinal incision about 4 inches long or a less noticeable 2-inch transverse incision over the upper forearm. The goal is to release the arcade of Frohse, thereby reducing the pressure on the posterior interosseous nerve, offering relief to the patient.

Recovery

Some soreness, often persisting for 3-6 months, should be anticipated after surgery. The amount of pain experienced after this surgery is usually relatively minor, requiring strong analgesics for only a couple of days after surgery. The majority of symptoms are controlled with Tylenol or nonsteroidal anti-inflammatories such as Ibuprofen for a few weeks.

Return to work is usually prompt within 1-3 days of surgery, sometimes requiring temporary modification, i.e., light duty, while depending on the amount of activity and whether the problem arises in the dominant or nondominant extremity. No absolute restrictions are necessary, however. Exercise with Thera-Putty and lightweight is utilized while occupational and physical therapy are rarely indicated.

Results

Of five hundred cases reported in the literature, the majority of the studies reported indicate 70-80% of patients undergoing surgery for radial tunnel syndrome can anticipate improvement to elimination of symptoms after surgery. This means that perhaps 2 or 3 out of 10 persons operated upon will continue to have discomfort at the same or lesser degree as preoperatively. On the other hand, it also means that about 7 or 8 out of 10 can anticipate improvement of their preoperative symptoms.

Risks

Risk of infection is less than 1%. The other major concern is the potential for bruising one of three nerves in the area: the lateral antebrachiocutaneous which gives sensation to the upper outer forearm, the superficial radial nerve which gives sensibility to the top of part of the fingers and the wrist, or the posterior interosseous nerve. Posterior interosseous nerve weakness can result temporarily making lifting of the wrist or fingers difficult for a couple of months. However, this has been a rare occurrence in my experience. A dark complexioned person may experience a prominent scar.

Your Path to Radial Tunnel Syndrome Relief

Radial tunnel syndrome can be a challenging condition, but effective treatment options are available to alleviate symptoms and enhance your quality of life. If you're experiencing pain or discomfort in your forearm, it's important to seek evaluation and advice from a specialist.

At the Nebraska Hand & Shoulder Institute, our dedicated team is ready to guide you through your treatment journey and help you regain your strength and mobility. Contact us today to schedule a consultation and take the first step towards relief!