What is radial tunnel syndrome and how is it treated?

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's several day-to-day activities that can precipitate this, more commonly computer keyboard and mouse use, also forceful chopping of food, gripping, grasping, such as this chef here. You can see throughout each workday this can become quite irritable to the nerve.

And finally, we all like to go to the gym. Frequent lifting or over lifting of weights 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. And this nerve gives function of the muscles that extend the wrist and extend the fingers.

Now the most common site of compression is, the nerve again comes down here through the radial tunnel and it goes beneath this supinator muscle, and it's in this area where the nerve is, uh, 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, can radiate, 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 a, 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. And so for patients that are being treat, treated for tennis elbow, and that even failed the 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 initially, conservatively of course, and we're going to look at, this is 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. Ergonomic modifications, because frequently this is work related. So how do you, what does this mean? It means that you look at the latest technology and computer keyboard, uh, keyboards, mice, looking at different equipment depending on what is really causing this.

Work modifications, meaning doing less, resting more at work, frequent break, stretching, uh, 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. Uh, 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, and we go in and we decompress all it, 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 bands over, fibrous bands over the nerve, but more commonly we also release the supinator muscle, opening up the nerve. Now does this, do you lose any function with this? Uh, none whatsoever, because the biceps tendon is a powerful supinator, which means rotating the for, the forearm into a palm-up position, so that takes over for any potential loss of function from cutting open this muscle.

So after the, uh, after the surgery, uh, we place the patient in a brace immobilizing the whole arm, elbow and wrist, for about three weeks duration. After the, uh, period of immobilization we start rehab, and the overall total recovery back to full activities is about a three-month period. There's a 90% success rate with this type of surgery. For more on this condition and many other conditions, please check out our website.