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Radial Nerve Injury at the Elbow
Aka: Radial Nerve Injury at the Elbow, Radial Tunnel, Radial Tunnel Syndrome, Posterior Interosseous Nerve Syndrome, Posterior Interosseus Nerve Injury at the Elbow, Wartenberg's Syndrome, Neurogenic Tennis Elbow
- See Also
- Radial Nerve Injury at the Humerus (Saturday Night Palsy, Crutch Palsy, Wrist Drop)
- Radial Nerve Injury at the Elbow
- Radial Nerve Injury at the Wrist
- Peripheral Nerve Injury
- Causes
- Repetitive Forearm supination and pronation
- Carpenters
- Mechanics
- Lateral elbow compression of the Radial Nerve
- Results in radial nerve Entrapment Neuropathy
- 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)
- Symptoms
- Radial Tunnel (superficial branch compression, sensory only, Wartenberg's Syndrome)
- Gradual onset, or poorly localized Forearm pain
- Provoked with repetitive Forearm pronation
- Posterior interosseus nerve (Deep branch)
- Hand weakness in wrist extension
- 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)
- Posterior interosseus nerve (Deep branch, sensory and motor findings)
- Pain features are the same as for Radial Tunnel
- Weak wrist extension and especially weak middle finger extension against resistance
- Differential Diagnosis: Radial Tunnel (Wartenberg's Syndrome)
- Lateral Epicondylitis
- Management: Radial Tunnel (sensory) and posterior interosseus nerve (motor and sensory)
- Eliminate provocative actvities (repetitive motion)
- 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
- 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 persists beyond 3 months of therapy
- References
- Hariri (2010) Clin Sports Med 29(4): 655-75 [PubMed]
- Huisstede (2008) J Hand Surg Am 33(1): 72-8 [PubMed]
- Kane (2014) Am Fam Physician 89(8): 649-57 [PubMed]
- Neal (2010) Am Fam Physician 81(2): 147-55 [PubMed]