Radial Nerve Injury at the Elbow

Aka: Radial Nerve Injury at the Elbow, Radial Tunnel, Posterior Interosseus Nerve Injury at the Elbow, Wartenberg's Syndrome

1. See Also
   1. Peripheral Nerve Injury
2. Pathophysiology
   1. Lateral elbow compression of the Radial Nerve
   2. Radial Nerve divides at the lateral elbow into two branches
      1. Superficial branch (Sensory only)
      2. Posterior interosseus nerve (Deep branch)
3. Symptoms
   1. Radial Tunnel (superficial branch compression, sensory only, Wartenberg's Syndrome)
      1. Forearm pain
      2. Provoked with repetitive Forearm pronation
   2. Posterior interosseus nerve (Deep branch)
      1. Generalized hand weakness
4. Signs
   1. Radial Tunnel (superficial branch compression, sensory only, Wartenberg's Syndrome)
      1. Like Lateral Epicondylitis, Radial Tunnel is exacerbated by Forearm supination and wrist dorsiflexion against resistance
      2. Unlike Lateral Epicondylitis, maximal tenderness is over the anterior radial neck
   2. Posterior interosseus nerve (Deep branch)
      1. Weak wrist extension and especially weak finger extension against resistance
5. Differential Diagnosis: Radial Tunnel (Wartenberg's Syndrome)
   1. Lateral Epicondylitis
6. Management
   1. Radial Tunnel (superficial branch compression, sensory only, Wartenberg's Syndrome)
      1. Physical Therapy to work on wrist extensor muscles and Forearm supinatory muscles
      2. May respond to a single Corticosteroid Injection
      3. Consider surgical decompression if persists beyond 3 months of therapy
   2. Posterior interosseus nerve (Deep branch)
      1. Cock-up wrist splint
      2. Avoid provocative activities
   3. Consider brief Splinting with elbow at 90 degrees (risk of loss of elbow range of motion)
7. References
   1. Huisstede (2008) J Hand Surg Am 33(1): 72-8
   2. Neal (2010) Am Fam Physician 81(2): 147-55