II. Causes
- Repetitive Forearm supination and pronation
- Carpenters
- Mechanics
- Lateral elbow compression of the Radial Nerve
- Results in radial nerve Entrapment Neuropathy
III. Pathophysiology
-
Radial Nerve divides at the lateral elbow into two branches
- Superficial branch (Sensory only)
- Posterior interosseus nerve (Deep branch, motor resulting in wrist extension weakness)
- Lesion of the Radial Nerve before splitting into superficial sensory and deep motor components
- May result in combined sensory and motor deficits
IV. Symptoms
- Radial Tunnel (superficial branch compression, sensory only, Wartenberg's Syndrome)
- Posterior interosseus nerve (Deep branch)
- Hand weakness in finger extension (finger drop)
- Lipoma or other space occupying lesion are most commonly cause
- May also be due to elbow synovitis
V. Signs
- Radial Tunnel
- Superficial branch compression, sensory only (Wartenberg's Syndrome)
- Motor weakness suggests posterior interosseus nerve (Deep branch) compression (see below)
- Like Lateral Epicondylitis, Radial Tunnel is exacerbated by Forearm supination and wrist dorsiflexion against resistance
- Unlike Lateral Epicondylitis, maximal tenderness is over the anterior radial neck
- Positive Tinel Sign (tapping over the Radial Tunnel reproduces symptoms)
- Superficial branch compression, sensory only (Wartenberg's Syndrome)
- Posterior interosseus nerve (Deep branch, sensory and motor findings)
- Pain features are the same as for Radial Tunnel
- Weak finger extension, especially middle finger extension against resistance
- Intact wrist extension (but may be weak) with radial deviation at wrist
- Preserved by an intact extensor carpi radialis longus
VI. Differential Diagnosis: Radial Tunnel (Wartenberg's Syndrome)
VII. Management: Radial Tunnel (sensory) and posterior interosseus nerve (motor and sensory)
- Eliminate provocative actvities (repetitive motion)
- NSAIDs
- Physical Therapy
- Work on wrist extensor Muscles and Forearm supinatory Muscles
- Start with Stretching after pain has ceased and then gradually introduce strengthening
- May respond to a single Corticosteroid Injection
- Diagnostic and therapeutic
- Cock-up Wrist Splint
- Prevent wrist extension
-
Elbow splint
- Indicated for brief use to prevent Forearm supination
- Splint with elbow at 90 degrees (risk of loss of elbow range of motion)
- Surgical decompression
- Consider if lack of improvement at 3-4 months of conservative therapy (motor deficits)
- Isolated sensory deficits (Radial Tunnel) rarely warrant surgical intervention
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Related Studies
Concepts | Injury or Poisoning (T037) |
SnomedCT | 302886004 |
English | Post interosseous nerve comp, Neurogenic tennis elbow, Posterior interosseous nerve compression, Posterior interosseous nerve compression (disorder) |
Spanish | compresión de nervio interóseo posterior (trastorno), compresión de nervio interóseo posterior |
Ontology: Radial tunnel syndrome (C0677499)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 443876008 |
English | radial tunnel syndrome (diagnosis), radial tunnel syndrome, Supinator syndrome, Radial tunnel syndrome (disorder), Radial tunnel syndrome, Radial tunnel syndrome (supinator syndrome) |
Spanish | síndrome del supinador, síndrome del túnel radial (trastorno), síndrome del túnel radial, Síndrome del túnel radial |
Czech | Syndrom radiálního tunelu |
Dutch | radialetunnelsyndroom |
French | Syndrome du canal radial |
German | Radialistunnelsyndrom |
Hungarian | Radialis alagút syndroma |
Italian | Sindrome del tunnel radiale |
Japanese | トウコツシンケイカンショウコウグン, 橈骨神経管症候群 |
Portuguese | Síndrome do canal radial |