Radial Tunnel Syndrome
- Description / Cause
- Pain syndrome from compression of the posterior interosseous nerve (PIN) at the proximal forearm
- Anterior to radial head
- Brachial plexus C5-8, T1 involvement
- Radial tunnel is a space located anterior to the proximal radius that extends 5cm starting from humeroradial joint and past the proximal edge of the supinator
- Arcade of Frohse is most frequent site of entrapment
- Prevalence / Risk factors
- Work activities
- Handling tools with full elbow extension
- Signs / Symptoms
- Localized tenderness over anatomic landmark of PIN - HALLMARK
- Tenderness is 3-5cm distal to the lateral epicondyle over the supinator muscle
- Pain along dorsoradial aspect of proximal forearm
- Radiates proximally and distally
- Increases with forearm rotation
- Pain with resisted active forearm supination and active extension of the middle finger against resistance
- Does not increase by active extension of the wrist against resistance
- Weakness of wrist extensors
- No sensory symptoms
- Objective / Special Test
- No radiologic or electrodiagnostic findings
- MRI to examine radial tunnel area
- Manual muscle testing
- Supinator and wrist extensor weakness
- MDC - handheld dynamometer
- 4%
- Test-retest reliability
- 0.98
- Inter-rater reliability
- 0.94 - patients with spinal cord injury
- Treatment / Interventions
- Conservative treatment before consideration of surgery (3-6 months)
- Conservative
- Wrist splinting
- Activity modification
- NSAIDs
- Physical therapy
- Avoid prolonged elbow extension with forearm pronation and wrist flexion
- Ergonomic evaluation
- Steroid injection
- Surgery
- Dorsal approach
- Anterior approach
- Postoperative care
- AROM after 3-5 days
- Strengthening begins by 3-4 weeks
References
- Naam N, Nemani S. Radial Tunnel Syndrome. Orthopedic Clinics Of North America [serial online]. October 1, 2012;43(Management of Compressive Neuropathies of the Upper Extremity):529-536. Available from: ScienceDirect, Ipswich, MA. Accessed June 28, 2015.
- Robertson E, Reimche, D. Differential Diagnosis for Various Neuropathies at the Elbow. Accessed June 30, 2015.
Acknowledgements:
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015