Treatment Options for Radial Tunnel Syndrome
Conservative management should be the first-line treatment for radial tunnel syndrome symptoms, with surgical intervention reserved for cases that fail to respond to non-operative measures. 1
Diagnosis
- Diagnosis of radial tunnel syndrome relies primarily on clinical findings including:
- Reproduction of symptoms on pressure over a palpable tender spot along the course of the radial tunnel
- Pain with resisted supination or resisted middle finger extension
- Relief of symptoms after local anesthetic infiltration of the tender area 2
- At least two of these three objective signs should be present for diagnosis 2
- Weakness of finger extension and local tenderness at the ligament of Frohse are the two most important clinical findings 3
Conservative Treatment Options
- Steroid injection at the site of maximal tenderness is an effective first-line treatment, providing long-term relief in approximately 60% of cases 2
- Physical therapy may be considered as an alternative or adjunct to steroid injections 2
- Activity modification to avoid repeated supination of the forearm combined with extension of the elbow, which appears to aggravate symptoms 3
- Conservative treatment should be attempted before considering surgical intervention 4
Surgical Treatment Options
- Surgical decompression is indicated when conservative measures fail to provide adequate symptom relief 4
- Surgical approaches include:
- Dorsal approach
- Anterior approach
- Both approaches require complete release of all potential sites of nerve entrapment, including the superficial head of the supinator muscle 4
- Surgical release of the superficial head of the supinator muscle and division of the ligament of Frohse is usually successful in relieving symptoms 3
- Complete surgical decompression provides pain relief in approximately 78% of cases that fail conservative management 2
Considerations for Treatment Selection
- Radial tunnel syndrome can coexist with other conditions such as lateral epicondylitis (tennis elbow) and cervical brachial neuritis, which may complicate diagnosis and treatment 3
- Patients with associated lateral epicondylitis or those involved in workers' compensation claims tend to have less successful surgical outcomes 4
- The diagnosis should be considered in cases of atypical tennis elbow or de Quervain's tenosynovitis that are resistant to standard treatment 3
Potential Pitfalls and Caveats
- True neurogenic radial tunnel syndrome with motor weakness is uncommon and easily identifiable by focal motor weakness in the distribution of the posterior interosseous nerve 5
- The more common presentation involves proximal forearm pain and tenderness without neurologic deficit, which some experts debate whether it truly represents nerve entrapment 5
- There are no specific radiologic or electrodiagnostic findings that definitively confirm the diagnosis 4
- The relationship between radial tunnel syndrome and occupational activities remains unclear, with no scientific evidence suggesting a direct causal relationship between work practices and the condition 3