Is Your Forearm Pain More Than Just Tennis Elbow? Unmasking Radial Tunnel Syndrome
What is Radial Tunnel Syndrome?
Radial Tunnel Syndrome (RTS) is caused by radial nerve compression as it passes through the radial tunnel in the forearm. This compression leads to pain in the dorsal and radial proximal forearm, often without motor or sensory dysfunction.
The Causes
Radial Tunnel Syndrome (RTS) is caused by compression or irritation of the radial nerve as it passes through the radial tunnel in the forearm. The leading causes of RTS include:
Repetitive motions: Overuse of forearm muscles, primarily through gripping, wrist extension, and forearm rotation.
Occupational factors: Heavy manual labour, prolonged use of hand tools, or jobs requiring forceful wrist movements.
Trauma or injury: Direct blows to the forearm or elbow, leading to swelling near the radial tunnel.
Anatomical variations: Naturally narrow radial tunnels or unusual growths like ganglion cysts.
Soft tissue abnormalities: Noncancerous fatty tumours (lipomas), surrounding tissue inflammation, or the inflamed synovium.
Bone-related issues: Bone tumours or dislocated head of the radius.
Vascular compression: Radial recurrent vessels pressing on the nerve.
Muscular factors: Inflammation or hypertrophy of surrounding muscles, particularly the supinator muscle.
Fibrous bands: Compression due to bands of fascia in the radial tunnel
These factors can occur individually or in combination, leading to increased pressure on the radial nerve and the development of Radial Tunnel Syndrome.
The Symptoms
The main symptoms of radial tunnel syndrome include:
Deep, aching pain in the forearm, typically located just below the elbow
Pain on the outside of the elbow and back of the hand
Pain that worsens with specific activities:
Rotating the forearm (pronation and supination)
Extending fingers
Straightening the wrist
Lifting heavy weights
Tenderness on the outside of the elbow, about 2-5 cm distal to the lateral epicondyle
Difficulty gripping, lifting, or pushing objects
Weakness in forearm muscles and overall wrist strength
Pain that may interfere with sleep
Unlike other nerve compression syndromes, radial tunnel syndrome rarely causes numbness or tingling. In advanced cases, weakness in the muscles that extend the thumb and fingers may occur.
It's important to note that these symptoms can be similar to other conditions, such as tennis elbow, so a proper medical evaluation is necessary for an accurate diagnosis.
The Treatment
Radial Tunnel Syndrome (RTS) is typically treated using a combination of conservative methods and, in severe cases, surgical intervention. The treatment approach usually follows these steps:
Conservative Treatment
Activity modification: Avoiding movements exacerbating symptoms, such as forceful repeated wrist and finger extensions.
Rest and immobilisation: Short-term use of splints or braces to alleviate stress on the radial nerve.
Anti-inflammatory medications: Over-the-counter or prescription NSAIDs to reduce pain and inflammation.
Physical therapy: Exercises designed to improve strength, flexibility, and nerve mobility, including:
Soft tissue mobilisation
Nerve gliding techniques
Stretching and strengthening routines for forearm muscles
Occupational therapy: Ergonomic improvements to minimise pressure on the nerve.
Manual therapy: Techniques such as massage, trigger point release, and myofascial release to reduce muscle tightness and improve circulation.
Steroid injections: To relieve inflammation and pressure on the radial nerve.
Surgical Treatment
If conservative methods fail to provide relief after several months, surgical intervention may be considered:
Radial tunnel release: A procedure to decompress the radial nerve by releasing structures and compressing them.
Surgical approaches: Various techniques, including transbrachioradialis and anterior approaches, to access and release the nerve.
The success rate for surgical decompression in RTS patients ranges from 67% to 93%. However, due to a lack of comparative studies, the duration of appropriate nonoperative management and the natural history of untreated radial tunnel syndrome remains unclear.
Dr Clem Bonney & Radial Tunnel Syndrome
Dr Clem Bonney can assist with the diagnosis and treatment of Radial Tunnel Syndrome. Dr Bonney can assist in developing with the worker and employer suitable duties while recovery is underway.
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