What is the treatment for radial tunnel syndrome?

Treatment for Radial Tunnel Syndrome

For patients with radial tunnel syndrome, initial conservative management should be attempted with splinting and anti-inflammatory medications, followed by surgical decompression for refractory cases that fail to respond to conservative measures.

Diagnosis and Clinical Presentation

• Radial tunnel syndrome results from compression of the radial nerve as it passes through the radial tunnel, particularly where the deep branch travels through the heads of the supinator muscle 1, 2
• Clinical presentation typically includes pain in the hand and forearm without motor weakness 1
• Diagnosis relies on clinical findings including:
  • Reproduction of symptoms with pressure over a tender spot along the radial tunnel
  • Pain with resisted supination or middle finger extension
  • Relief of symptoms with local anesthetic infiltration 3

Conservative Management

• First-line treatment should include:

  • Splinting to reduce nerve compression and provide rest to the affected area 1
  • Anti-inflammatory medications to reduce pain and inflammation 1, 3
  • Steroid injections at the point of maximal tenderness, which may provide long-term relief in approximately 60% of cases 3
  • Activity modification to avoid repetitive tasks that exacerbate symptoms 4

• Conservative treatment should be attempted for at least 3-4 months before considering surgical intervention 1

Surgical Management

• Surgical decompression is indicated for cases that fail to respond to conservative measures after an adequate trial period 1, 4

• The surgical approach involves:

  • Identifying and protecting the posterior cutaneous nerve of the forearm
  • Locating the interval between the brachioradialis and extensor carpi radialis longus muscles
  • Identifying and protecting the radial sensory nerve
  • Locating and decompressing the posterior interosseous nerve (PIN)
  • Dividing the fascia of the extensor carpi radialis brevis and carefully dividing the supinator muscle to decompress the PIN 1

• Surgical outcomes:

  • Excellent or good results can be achieved in approximately 70% of patients 4
  • Fair results in about 13% of cases 4
  • Poor results in approximately 17% of patients 4
  • Positive outcomes can be achieved even with prolonged duration of symptoms prior to surgery 4

Special Considerations

• Patients with occupations requiring repetitive manual tasks appear to be at higher risk for developing radial tunnel syndrome 4
• The condition is often misdiagnosed or confused with tennis elbow (lateral epicondylitis), chronic wrist pain, or tenosynovitis 4
• There is a tendency that surgical decompression may be effective for patients with radial tunnel syndrome who have failed conservative management, though high-quality controlled studies are limited 5
• Consider radial tunnel syndrome in the differential diagnosis for patients with forearm and wrist pain that has not responded to conventional treatments 4

Follow-up and Monitoring

• Patients should be monitored for symptom improvement following either conservative or surgical intervention
• Significant reduction in pain can be expected within several months following successful surgical decompression 1
• If symptoms persist after surgery, reassessment for incomplete decompression or alternative diagnoses may be necessary