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Review
. 2015 Jul;3(3):156-62.

Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma

Ali Moradi  1 , Mohammad H Ebrahimzadeh  1 , Jess B Jupiter  1
Affiliations
Review

Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma

Ali Moradi et al. Arch Bone Jt Surg. 2015 Jul.

Abstract

Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of the fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.

Keywords: Diagnosis; Radial Tunnel Syndrome; Treatment.

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Figures

Figure 1
Figure 1
Leash of Henry and arcade of Frohse are two possible sites of radial nerve compression.
Figure 2
Figure 2
The rule of nine test: Volar side of left proximal forearm, distal to elbow crease is divided to nine pressure points in three columns. Tenderness over two proximal lateral circles (red circles) indicates radial nerve irritation while tenderness over pressure points of 5 and 6 (yellow circles) indicates proximal median nerve irritation. Three medial points are control area.
Figure 3
Figure 3
Physical tests for Radial Tunnel Syndrome. A and B: Different sites of pain in RTS and lateral epicondylitis. Tenderness in lateral epicondylitis is directly on the lateral epicondyle while in RTS the tenderness is 5 cm distal to the epicondyle. C: Increased pain in the proximal radial forearm and over the radial tunnel, on hyperextension of the wrist against resistance. D: Pain during resisted extension of the middle finger is a valuable test in diagnosis of RTS.
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