Radial Tunnel Syndrome Workup: Initial Management
The recommended initial management for radial tunnel syndrome workup should include radiographs of the elbow to rule out bony abnormalities or joint pathology that may contribute to nerve compression, followed by conservative treatment with splinting and anti-inflammatory medications before considering surgical intervention. 1, 2
Diagnostic Approach
- Initial evaluation should include a thorough clinical examination focusing on the exact site of pain, which can be more specifically identified using the rule of nine test, and assessment for weakness of the third finger and wrist extension 3
- Radiographs of the elbow are recommended as the first imaging study to exclude bony abnormalities or joint pathology that could contribute to nerve compression 1
- Electrodiagnostic tests and advanced imaging studies like MRI may be considered but are less valuable than clinical examination for diagnosis 3
- MRI may show muscle edema or atrophy along the distribution of the posterior interosseous nerve in some cases 3
Conservative Management
First-line treatment should include:
- Rest and activity modification, particularly for patients with occupations requiring repetitive manual tasks 4
- Non-steroidal anti-inflammatory medications (NSAIDs) 2, 3
- Splinting to limit movements that aggravate symptoms 2, 5
- Ergonomic interventions to modify activities that may contribute to compression 5
Although conservative treatments may not provide permanent relief in all cases, they are justified before considering surgical intervention 3
Surgical Considerations
- Surgical decompression should be considered when conservative measures fail to provide relief after an appropriate trial period 2, 6
- Surgical outcomes are generally better in patients with simple radial tunnel syndrome (86% good results) compared to those with additional nerve compression syndromes (57% good results) or coexisting lateral epicondylitis (70% vs 43% good results) 6
- Surgical decompression typically involves identifying and releasing compression points along the radial nerve path, particularly at the arcade of Frohse, which is the most common site of compression 2, 3
Prognosis and Outcomes
- Surgical decompression can provide complete pain relief and symptom resolution in 67-93% of patients 3
- Long-term outcomes after surgical decompression show good results in approximately 67% of cases, with better outcomes in simple radial tunnel syndrome cases 6
- One-third of patients may still experience moderate to severe disability affecting their ability to work, but 82% typically experience relief from pain following surgery 6
Important Considerations
- Radial tunnel syndrome can be misdiagnosed as tennis elbow (lateral epicondylitis), chronic wrist pain, or tenosynovitis due to similar presentation 4
- The condition is more prevalent in women aged 30-50 years 3
- Workers' compensation cases may have slightly less favorable outcomes (73% vs 58% good results) 6
- Proper positioning during any surgical intervention is critical to prevent additional nerve injury, with recommendations to avoid excessive elbow flexion (>90°) 1