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Radial Tunnel Syndrome

What is radial tunnel syndrome?

Radial tunnel syndrome is a relatively uncommon condition where one of the major nerves of the forearm becomes compressed under multiple muscles inside the forearm. Essentially, it is a pinched nerve at the forearm level. The radial tunnel is an enclosed space within the forearm where multiple muscles and vessels intersect. Within this tunnel, the posterior interosseous nerve can be compressed by muscles or vessels and cause pain.

What causes radial tunnel syndrome?

Although there have been many theories for why radial tunnel syndrome occurs (related to work, repetitive activities, specific motions, lifting, etc), the reality is that the true cause is usually unknown. Generally speaking, it is an issue of space – when the nerve does not have enough space, it can become compressed, and this can in turn cause symptoms.

What are the symptoms of radial tunnel syndrome?

The main symptom that indicates radial tunnel syndrome is pain and discomfort in the forearm. The pain and discomfort is generally worse with usage of the forearm and wrist. It may be provoked by activities that involve gripping an object, lifting the wrist, or lifting the fingers. Patients often describe a heavy sensation in the forearm that is painful and causes weakness. In early radial tunnel syndrome, the symptoms will be temporary and intermittently return to normal. If the condition gets worse, the feeling may become continuous. Patients often described a feeling of weakness and drop objects easily. In severe cases, the muscles at the top of the forearm may irreversibly waste away.

How is radial tunnel syndrome diagnosed?

The diagnosis of radial tunnel syndrome is generally made on physical examination. Your doctor will perform numerous physical exam maneuvers, and combined with the story of your injury, will determine if radial tunnel syndrome is suspected. Testing will be requested to help confirm the diagnosis – a nerve conduction study and electromyography. Additional testing such as an ultrasound or x-ray may also be required to help diagnose the injury. Temporary nerve blocks may also be performed to determine if your diagnosis is correct.

What treatments are available for radial tunnel syndrome?

The goal in treating radial tunnel syndrome is to improve the feelings of pain and discomfort while also ensuring the disease process does not progress to cause irreversible damage to the posterior interosseous nerve. At The Center for Hand & Upper Extremity Surgery, we use an algorithmic approach to treating this very common problem.

Depending on how severe your case is, your doctor may start with non-operative measures to improve your symptoms. This will include changing the patterns of how you use and position your forearm as well as splinting to reduce pressure on the nerve. A steroid injection may be performed in an attempt to help reduce swelling and inflammation around the nerve.

If your symptoms continue, or if you have a severe case, we may recommend surgical treatment to decompress the nerve. The procedure involves an incision on your forearm, identification of the compressed nerve, and release of this nerve by eliminating any compressive structures.

Will I need therapy after radial tunnel syndrome surgery?

Most patients do not require formal hand therapy after radial tunnel release. Motion is started immediately after surgery, and stiffness is uncommon. Therapy may be required for strengthening if your condition is severe.