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Radial Tunnel Syndrome

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Other Names

  • Resistant tennis elbow with a nerve entrapment
  • Radial Pronator Syndrome
  • Supinator Syndrome

Background

  • Compressive neuropathy of the Posterior Interosseus Nerve, a branch of the Radial Nerve
  • Characterized by pain only, with no motor or sensory dysfunction
  • Some controversy associated with this diagnosis

Epidemiology

  • Not well documented in literature
  • Annual incidence rate of the posterior interosseous nerve (PIN) compression is estimated 0.03%[1]

Pathophysiology

Pathoanatomy

  • Radial Tunnel
    • Extends from radiocapitellar joint to just past the proximal edge of supinator
    • Approximately 5 cm in length
    • Anatomic borders
  • Posterior Interosseus Nerve
    • Branch of radial nerve
    • Function: innervates extensor muscles of forearm and wrist

Associated Conditions


Risk Factors

  • Repetitive pronation-supination activities
  • Female > Male
  • Age 30s to 50s

Differential Diagnosis

Differential Diagnosis Forearm Pain

Differential Diagnosis Elbow Pain


Clinical Features

  • General: Physical Exam Forearm
  • History
    • Most commonly affects dominant arm
    • Patients describe a deep, aching pain in the proximal dorsal-radial forearm
    • Worse with lifting, pronation, supination
    • Often worse at night
  • Physical Exam
    • Tender over 3-5 cm distal to lateral epicondyle
    • Pain with resisted finger extension, wrist extension and supination
    • Pain with passive pronation
    • Typically no motor or sensory deficits
    • Rule of Nine Test: Proposed special test to aid in diagnosis

Evaluation

  • Radiographs
    • Screening imaging of choice, typically normal
  • MRI
    • Usually negative but useful when considering other etiologies
    • May help evaluate compressive sites, muscle changes (edema, atrophy), causes of entrapment
  • Diagnostic Radial Tunnel Injection
    • Injection of anesthetic under ultrasound
    • Positive if resolution of symptoms and pain, development of PIN palsy
  • EMG/NCS
    • Often inconclusive

Classification

  • N/A

Management

Nonoperative

  • First line treatment
  • Activity modification: avoid prolonged extension, pronation, wrist flexion
  • Splinting
  • NSAIDS
  • Corticosteroid Injection
    • Therapeutic and diagnostic
  • Physical Therapy
  • Success rate of conservative management has been questioned
    • Steven et al report only 4 out of 15 patients with the diagnosis of RTS had improvement with non-surgical treatments[3]

Operative

  • Indications
    • Failure of nonoperative management at roughly 3 months
  • Technique
    • Radial tunnel release

Return to Play

  • Needs to be updated

Complications

  • Chronic pain
  • Missed diagnosis
  • Loss of ADLs

See Also


References

  1. Dang AC, Rodner CM. Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve. J Hand Surg Am. 2009;34(10):1906–14.
  2. Clavert P, Lutz JC, Adam P, Wolfram-Gabel R, Liverneaux P, Kahn JL. Frohse's arcade is not the exclusive compression site of the radial nerve in its tunnel. Orthop Traumatol Surg Res. 2009;95(2):114–8.
  3. Moss SH, Switzer HE. Radial tunnel syndrome: A spectrum of clinical presentations. J Hand Surg Am. 1983;8(4):414–20.
Created by:
John Kiel on 9 July 2019 23:37:42
Authors:
Last edited:
31 October 2020 00:27:37
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