Radial Tunnel Surgery

Transcript:

Let’s take a look at radial tunnel surgery. Radial tunnel syndrome is a very common condition affecting the radial nerve in the upper forearm, where this becomes pinched or entrapped, leading to a very painful condition. There are several day-to-day activities that can precipitate this, more commonly, computer keyboard and mouse use. Also, forceful chopping of food, gripping, and grasping, such as this chef here, can become quite irritable to the nerve throughout each workday. Finally, frequent lifting or over-lifting of weights at the gym can lead to swelling of the muscles around the nerve.
But let’s look at the anatomy closer now. The radial nerve is a nerve that comes down the arm outside of the elbow through the radial tunnel in the upper forearm, and it’s in this area that pressure can be applied to the nerve through swollen muscles. This nerve gives function to the muscles that extend the wrist and extend the fingers. The most common site of compression is where the nerve comes down here through the radial tunnel and it goes beneath this supinator muscle. It’s in this area where the nerve can definitely become entrapped and cause a lot of pain and in severe cases, actually even weakness.
So let’s take a look at the actual pain pattern or symptom pattern you get with this. RTS is radial tunnel syndrome. The blue rectangular box is the area of the pain pattern from the upper radial or outside forearm, and pain can radiate down towards the wrist joint. Now, some patients just come in and they have wrist pain; they have no mechanical symptoms whatsoever, like a wrist injury, and all in all, it is actually a pinched nerve in the upper forearm. The upper circle is tennis elbow; that’s the area on the outside or bony prominence part of the elbow that can be in close proximity to this. So, for patients that are being treated for tennis elbow and that even fail surgical intervention, you have to look at what else is going on, and they actually may have radial tunnel syndrome.
So the treatment for this is initially conservative, of course, and we’re going to look at this as an overuse problem, so we want to rest it. How do we rest it? Well, we can wear a brace on the wrist or elbow. In severe cases, NSAIDs or anti-inflammatory medications such as ibuprofen can be used. Ergonomic modifications are important because frequently this is work-related. What does this mean? It means that you look at the latest technology in computer keyboards and mice, looking at different equipment depending on what is really causing this. Work modifications mean doing less, resting more at work, frequent breaks, stretching, and sometimes some time away from work to help that. But if the conservative treatment fails, sometimes surgery is indicated.
So let’s take a look at the actual surgical incision. Some surgeons will make a smaller incision, but you can’t really decompress all the areas of compression other than that supinator muscle. So frequently, we’ll make a larger incision; it’s a zigzag incision. We go in and we decompress all the areas. But let’s look down through that incision now to what we’re really doing inside. Again, all the points of compression that may be a vein over the nerve, could be some fibrous bands over the nerve, but more commonly, we also release the supinator muscle, opening up the nerve. Now, do you lose any function with this? None whatsoever. Because the biceps tendon is a powerful supinator, which means rotating the forearm into a palm-up position, it takes over for any potential loss of function from cutting open this muscle.
So after the surgery, we place the patient in a brace immobilizing the whole arm, elbow, and wrist for about three weeks duration. After the period of immobilization, we start rehab. The overall total recovery back to full activities is about a three-month period. There is a 90% success rate with this type of surgery. For more on this condition and many other conditions, please check out our website.