Radial Tunnel Syndrome

Radial tunnel syndrome

Radial tunnel syndrome, also known as radial nerve entrapment, occurs when the radial nerve in the forearm gets compressed or pinched. It has symptoms similar to Tennis Elbow.

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Radial nerve entrapment symptoms

The symptoms of radial nerve entrapment are very similar to those of tennis elbow.

  • Pain on the outside of the elbow.
  • Pins and needles, or tingling in the hand and outer forearm.
  • Tenderness may be felt in the muscles of the upper forearm.
  • In particular, maximum tenderness in the supinator muscle at a point about 4-6 cm down from the lateral epicondyle (a bony bit on the outside of the elbow).
  • You may also experience aching in the wrist, or pain may also radiate upwards into the upper arm.

Diagnosis

Specific tests to help diagnose radial nerve entrapment will reproduce pain on:

  • Resisted supination (turning the palm of the hand up against resistance).
  • Extending (straightening) the middle finger against resistance.
  • One aid to diagnosing radial nerve entrapment is to inject a local anesthetic into the muscle. If pain is reduced when ‘palpating’ (pressing in) at the tender spot on the muscle, then Radial nerve entrapment may be a cause.

Anatomy

Radial tunnel syndrome

The radial nerve divides into two branches at the elbow. These are the superficial radial nerve and the posterior interosseous nerve (PI nerve).

It is the posterior interosseous nerve that may become entrapped or compressed. This may occur at several locations in the elbow and upper forearm.

Radial tunnel syndrome causes

Radial tunnel syndrome is more common in those who pronate and supinate the arm repetitively. This simply means turning your hand/forearm over.

However, tennis elbow is usually caused more by repetitive wrist extension or bending the wrist back.

Treatment for Radial tunnel syndrome

The aim of treatment for Radial tunnel syndrome is to reduce painful symptoms followed by stretching and strengthening exercises.

Cold therapy

Apply the PRICE principles of protection, rest, ice/cold therapy to the elbow and forearm to reduce pain and inflammation.

Complete rest may or may not be needed depending on your symptoms, however it is particularly important to avoid any repetitive wrist movements.

Medication

A doctor may prescribe anti-inflammatory medication such as Ibuprofen to reduce pain and inflammation and relax the muscles (check with your doctor before taking any medication and do not take Ibuprofen if you have asthma).

Massage

A professional therapist may use soft tissue massage techniques to relax and release the supinator muscle in the forearm which is often the cause of entrapment.

Massage will pump blood into the muscle, reducing muscle spasm and helping to relax any tension in the muscle.

Surgery for Radial tunnel syndrome

In severe or persistent cases a surgeon may operate to decompress the nerve which is generally successful.

Stretching exercises

Exercises to stretch the forearm muscles and in particular, the supinator muscles can be done as soon as pain allows. Neural stretches will also be given as part of physical therapy.

Stretching should be maintained throughout the rehabilitation program and continued even after your injury has healed.

Wrist extensor stretch

The arm is placed in front with the hand pointing down.

Pull the hand towards the body to feel a stretch in the back of the wrist, forearm, and elbow.

The forearm can be rotated inwards to increase the stretch which will be felt more on the outside of the elbow. Hold for up to 20 seconds and repeated up to 5 times.

Neural stretch

Pain in the elbow may be contributed to by tension in the neck.

This neural stretch may be beneficial in helping to release tension, especially in conjunction with sports massage.

Hold neural stretches initially for a maximum of 5 seconds. Only do so if this is comfortable.

If there is any pain or tingling in the arm or hand then stop immediately. Gradually progress the duration of the stretch up to 10 seconds.

Strengthening exercises

Strengthening exercises to target the forearm muscles can be performed but only if they can be done pain-free.

If it hurts don’t do it! If your feel any adverse effects or pain either during, after or the next day, then rest and take a step back.

Applying ice or cold therapy after exercises may help keep inflammation under control.

Wrist extension exercise

Wrist extension targets the muscles on top of the forearm and can be performed using a resistance band or a dumbbell.

Rest your forearm on your knee, or the end of a table.

Start with the wrist in a flexed position (pointing down to the floor). Extend your wrist upwards, keeping your forearm still.

Slowly return back to the start position and repeat 10-15 times. Gradually increase the number of repetitions you perform.

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