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 What is it? Radial Tunnel Syndrome (RTS) is a condition involving persistent pain in the outside elbow and forearm. The location of pain is similar to tennis elbow (lateral epicondylitis). RTS is caused by persistent irritation or compression of the radial nerve as it enters the radial tunnel in the elbow/forearm. Compression can be caused by bands of tissue, muscles, vessels or other space occupying lesions such as a tumor or bone. Anatomy: The radial nerve supplies motor function to the triceps muscle and the extensor muscles of the wrist and fingers. It also provides sensation down the back of the arm, forearm and hand. It is at risk for compression where it divides and crosses over and under the supinator muscle in the forearm. Symptoms/Risks Symptoms of Radial Tunnel Syndrome can include: • Deep, aching pain in the lateral elbow or dorsal forearm • Pain worsened with movement or twisting of the forearm and wrist • Numbness and tingling in the back of the hand • Weakness of the wrist and forearm if the posterior interosseous nerve is involved Sports Medicine Evaluation & Treatment A sports medicine physician will review your symptoms and any pertinent past medical history. A focused upper extremity physical examination will follow. He or she will evaluate both of your arms for any abnormal appearance and locate areas that may cause tenderness. They will then move your arms to evaluate the range of motion of the joints. It is also important to test for nerve function by assessing the arm and wrist strength, as well as sensation along the distribution of the median, ulnar and radial nerves. The doctor will finish the exam with specific tests that may reproduce your pain. Tenderness of the elbow can indicate RTS, especially when pain is made worse by resisted forearm extension and twisting (supination). X-rays and MRI of the affected area are commonly ordered for bony and soft tissue evaluation. Ultrasound may be used to evaluate the radial nerve to look for possible sites of nerve compression. Electromyography (EMG) and nerve conduction studies can sometimes show the locations of injuries to nerves. The diagnosis of radial tunnel syndrome is typically a clinical diagnosis but these studies help to rule out other causes of your symptoms. Initial treatment is generally non-operative. Patients may improve with activity modification, temporary splinting and oral anti-inflammatory medications. Your doctor may advise limitation of elbow flexion, wrist extension and repetitive forearm movements. Occasionally, physicians will inject corticosteroid into the affected area or other fluids around the nerve to help alleviate compression of the nerve. This procedure can be done under ultrasound guidance to ensure adequate placement of the medication in the radial tunnel. Physical therapy may be needed for arm rehabilitation and other pain alleviating procedures. Patients whom do not improve with conservative measures may need surgical consultation for radial tunnel decompression. Injury Prevention RTS can be prevented by: • Avoiding excessive and repetitive use of the affected extremity. It may be helpful to take frequent breaks if your job requires this type of movement. • Rehabilitation of the upper extremities and a combined strength and flexibility regimen • Controlling other comorbid medical conditions such as diabetes mellitus and thyroid disorder Return to Play Return to play is determined by management and symptoms. Non-surgical treatments should result in improvement in 4-6 weeks. Physical therapy and rehabilitation can facilitate this process. The athlete should focus on regaining full range of motion, strength and performance with minimal pain. Return to play decision after surgery is dependent on the procedure and the surgeon. AMSSM Member Authors References |
