What is the treatment for radial tunnel syndrome?

Treatment of Radial Tunnel Syndrome

Conservative management should be the initial approach for radial tunnel syndrome, followed by surgical decompression if symptoms persist despite adequate non-operative treatment. 1, 2

Diagnosis

• Radial tunnel syndrome (RTS) is a pain syndrome resulting from compression of the posterior interosseous nerve at the proximal forearm 3
• Diagnosis is primarily clinical with no specific radiologic or electrodiagnostic findings 3
• Key diagnostic criteria include:
  • Reproduction of symptoms on pressure over a palpable tender spot along the course of the radial tunnel 1
  • Painful resisted supination or resisted middle finger extension 1
  • Relief of symptoms after infiltration of the tender area with local anesthetic 1
  • Weakness of finger extension and local tenderness at the ligament of Frohse 2

Treatment Algorithm

First-Line: Conservative Management

• Steroid injection at the site of tenderness provides long-term relief in approximately 60% of cases 1
• Physical therapy may be considered as an alternative conservative approach 1
• Anti-inflammatory medications and activity modification to avoid repeated supination of the forearm combined with extension of the elbow 2
• Conservative treatment should be attempted for 3-6 months before considering surgical intervention 3

Second-Line: Surgical Intervention

• Indicated when conservative management fails to provide adequate symptom relief 3, 1
• Surgical decompression involves:
  • Complete release of the superficial head of the supinator muscle 3
  • Division of the ligament of Frohse 2
  • Release of all potential sites of entrapment 3
• Surgical approaches:
  • Posterior (dorsal) approach 3
  • Anterior approach 3
  • Both approaches are effective; selection depends on surgeon preference and specific anatomical considerations 3

Outcomes and Prognosis

• Surgical treatment is generally successful in 70-80% of cases 3, 1
• Poorer outcomes are associated with:
  • Concurrent lateral epicondylitis 3
  • Workers' compensation claims 3
  • Delayed diagnosis 4
• Complete relief of pain can be expected in approximately 78% of surgical cases 1

Important Considerations and Pitfalls

• RTS is often confused with lateral epicondylitis (tennis elbow) and can coexist with it 2, 4
• Differential diagnosis should include cervical brachial neuritis and de Quervain's tenosynovitis 2
• Chronic aching muscle pain is the primary symptom; true motor paralysis is rare 4
• Repeated supination of the forearm combined with elbow extension may aggravate symptoms, though a direct causal relationship with work practices has not been scientifically established 2
• Radiographs of the elbow should be obtained to rule out bony abnormalities or joint pathology that may contribute to nerve compression 5