Radial Tunnel Syndrome

Radial Tunnel Syndrome
July 29, 2017

Radial tunnel syndrome is a set of certain symptoms that you will experience at your elbow, forearm, hand or wrist but excessively at the elbow. These symptoms of pain and weakness arise because of the compression of the radial nerve while passing through a tunnel at the elbow. Do you know that this nerve is very important and one of the three main nerves that provide motor and sensory functions to the hand. Radial tunnel syndrome though in comparison is uncommon yet damage in this nerve has the potential to hinder functional activities of the arm and hand”, gushes Dr. Vikas Gupta when speaking about Radial Tunnel Syndrome.

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Considering his experience in the field and his designation as head of the Hand and Shoulder division at Max Healthcare, it seems only appropriate to believe in him when he refers to the condition as non- threatening if treated by an efficient and skilled surgeon. He furthers his views on RT Syndrome by saying, “This syndrome affects the muscles not the nerves even though it is an inflammation in the radial nerve and therefore the muscles in the forearm and wrist become weak when affected by this debilitation. People with diabetes, thyroid, any cysts or bone tumors and people involved with strenuous sport activities involving the elbow, arm or wrist are more susceptible to this syndrome as the nerve is more prone to getting pinched or squeezed by these factors. It is relatively easy for us to identify radial tunnel syndrome with just physical examination and the exact location of the injury. Still we do refer to electromyography and nerve conduction studies to validate our diagnosis.”
“We usually wait for three months before going in for surgical release. In severe cases where the wrist becomes very weak or extending the fingers become difficult. The technique by which we release the pressure on the nerve and make the tunnel bigger is known as Radial Tunnel release. It is an outpatient surgery and helps the patient in regaining strength, stability and motor functions in six to eight months.

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FAQ – Radial Tunnel Syndrome

When Radial Nerve while passing near the elbow gets compressed in a tunnel resulting in a dull aching pain and weakness at the forearm, it is referred to as Radial Tunnel Syndrome.
Radial Nerve is one of the three main nerves that starting from the side of the neck runs down through the back of the upper arm, outside region of the elbow, forearm and the wrist to finally end into the hand and enables motor and sensory functions in the arm.
A narrow tunnel made of tendons, muscles and bones through which the radial nerve enters at the elbow is called Radial Tunnel.
The most common signs that indicate the presence of Radial Tunnel Syndrome are-
  • Mild, subtle and constant pain in the forearm, outside region of the elbow or at the back of the hand
  • Intense and stabbing pain when wrist or fingers are straightened
  • Weakness in the wrist
  • Weakness in the muscles of the forearm
While running through its course from the side of the neck into the hand, the radial nerve gets compressed or pinched at many spots. The radial tunnel at the elbow is the most common place where the radial nerve gets squeezed. This compression of the nerve results in a subtle underlying pain. Causes that may result in radial tunnel syndrome are-
  • Twisting the arm or wrist
  • Too much pushing or pulling of objects by the arm resulting in its overuse
  • Bending the wrist repeatedly
  • Repeated movements like gripping or pinching by the hand resulting in its overuse
Radial Tunnel syndrome can affect anyone but there are certain factors that increase its risk. These factors are-
  • Being involved in sports or activities that require strenuous pressure on the wrist, hand or arm
  • If the forearm has received a heavy blow
  • Persons suffering from diabetes, underactive thyroid gland, tumors or cysts
  • Swelling or injury in the arm resulting in inflammation or squeezing of the nerve
  • Weak and poor arm or wrist flexibility and strength
Diagnosing radial tunnel syndrome is not easy because there are no definite diagnostic tests to clinically exhibit its presence. It is often misinterpreted as Tennis Elbow. It is extremely important to know the medical history of the patient, the exact location of the pain, the type of pain felt by the patient to be conclusive about its presence. Physical examinations also act as diagnostic tools for the elbow specialist in which the pain in the patient’s elbow is tested against restrictions. Diagnostic tests which may be run on the patient to help differentiate between tennis elbow and radial tunnel syndrome are X-Ray of the elbow, MRI, Electromyography or nerve conduction study.
Treatment may begin with non- surgical techniques comprising of anti inflammatory medications, steroid injections, wrist or elbow splints and exercises that relieve pressure on the radial nerve. Surgical excision is only taken up as a treatment technique when non operative techniques fail to provide relief. The technique to surgically treat it is referred to as radial tunnel release under which the tunnel is comprehensively divided thus increasing the space in it, making the tunnel bigger which in turn relieves the nerve from being compressed in it. An incision is made near the elbow to get access to the tunnel and with the help of an arthroscope the points where the nerve is seen compressed are increased to relieve pressure on it. This surgical decompression is an outpatient surgery.
Surgery is extremely successful in eliminating the problem yet some patient may be subjected to certain mild pain thereafter. Intervention by a skilled therapist in form of supervising an exercising regime to restore strength in the arm and hand is introduced after 6 weeks. Activities that may incur pressure on the nerve or require bending of the arm are strictly prohibited for a certain period. Gradually exercises to regain strength, stability and motor skills are introduced in the regime though complete recovery may take 6 to 8 months.
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