RTS is a rare, potentially debilitating condition dominated by lateral elbow pain [3]. In affected individuals, repeated or forceful forearm rotation or elbow extension may exacerbate symptoms. This also applies for resisted forearm supination with an extended elbow and resisted middle finger extension [8]. Furthermore, palpation of the radial tunnel, i.e., the area located about 5 cm distal of the lateral epicondyle of the humerus, usually aggravates pain. Next to the moderate to severe pain there may be muscle weakness and decreased motion ranges. Sensory alterations, such as paresthesias and dysesthesias, are not present.

Of note, it is not uncommon that RTS patients present with what they refer to as tennis elbow. Although workup should yield a precise diagnosis, both conditions have been known to occur as comorbidities [9].

• Forearm Pain

  They and subsequent surgeons have decompressed the radial nerve to treat forearm pain and tenderness, even though it is debatable whether radial nerve entrapment causes the forearm discomfort. [ncbi.nlm.nih.gov]

  Introduction An uncommon syndrome that entails entrapment of the radial nerve somewhere along the course between the elbow joint and distal border of the supinator muscle resulting in forearm pain. [orthopaedicsone.com]

  Abstract Two of the most common diagnoses assigned to patients presenting with lateral elbow and proximal forearm pain are lateral tendinosis and radial tunnel syndrome. [doi.org]

• Soft Tissue Swelling

  The following techniques may be employed: Plain radiography is often carried out to rule out acute injuries of the skeleton, to visualize possible joint effusions, soft tissue swelling and solid neoplasms. [symptoma.com]

  Continued Conservative treatments for radial tunnel syndrome include medications such as nonsteroidal anti-inflammatory drugs to reduce soft tissue swelling, corticosteroid injections to relieve inflammation and pressure on the radial nerve, and wrist [webmd.com]

• Elbow Pain

  The latter is situated distal of the elbow and extends from the radiocapitellar joint to the supinator muscle. RTS is a rare, potentially debilitating condition dominated by lateral elbow pain. [symptoma.com]

  Symptoms include forearm and elbow pain. Diagnosis is clinical. Treatments include splinting and sometimes surgical decompression. Compression at the elbow can result from trauma, ganglia, lipomas, bone tumors, or radiocapitellar (elbow) synovitis. [msdmanuals.com]

  If you are experiencing Elbow pain, weakness of the Elbow, stiffness of the Elbow or night time Elbow pain, give us a call 972-250-5700 or make an appointment now. [posmc.com]

• Stiff Wrist

  Pain is worsen when one bends the wrist backward, upward, or hold something with a stiff wrist or straightened elbow. Our doctor provide consultation, treatment and surgery for sports injuries of the shoulder, elbow, wrist, hip, knee and ankle. [sgbonedoctor.com]

  […] hand upward, bending the wrist backward, or grasping an object with a stiff wrist or straightened elbow Dr. [loredohands.com]

  The pain gets worse when you bend your wrist backward, turn your palm upward, or hold something with a stiff wrist or straightened elbow. [lakesidephysio.com]

• Limitation of Elbow Movement

  This limits your elbow movements at night and eases further irritation. The splint can help your elbow rest, giving the nerve time to recover from irritation and pressure. Exercises are used to gradually stretch and strengthen the forearm muscles. [lakesidephysio.com]

• Long Arm

  Radial Tunnel Syndrome Associated Injuries / Differential Diagnosis Radial Tunnel Syndrome Complications Radial Tunnel Syndrome Follow-up Care Postoperative management: long-arm posterior splint with the wrist in neutral position. [eorif.com]

  The radial nerve is located extending from the side of the neck towards the long arm. The nerve is connected to our spinal nerve roots making it possible for our motor and sensory functions enabled. [syndromespedia.com]

  A long arm splint and NSAID’s are useful, but cortisone injections have minimal effect. Any coexisting tennis elbow should be simultaneously treated, in which case cortisone injections are a mainstay. [drdavidslutsky.com]

  This procedure can be done as an outpatient and the client goes home in a long arm splint. In 8-10 days the patient returns for suture removal and placement of a removable splint. [handandwristinstitute.com]

• Joint Effusion

  The following techniques may be employed: Plain radiography is often carried out to rule out acute injuries of the skeleton, to visualize possible joint effusions, soft tissue swelling and solid neoplasms. [symptoma.com]

• Suggestibility

  Stretching Exercises Novak (2004) suggests that tightnesses in the following muscles can contribute to upper extremity disorders such as radial tunnel syndrome: Supinator Extensor carpi radialis brevis Scapular muscles Cervical muscles It is suggested [thesportsphysiotherapist.com]

  Definitive evidence in the literature to support the conservative interventions suggested is lacking. Suggestions for clinical management and study are included in this therapist's clinical perspective. [ncbi.nlm.nih.gov]

  Some authors suggest surgical decompression to avoid permanent nerve damage. [radiopaedia.org]

  Resisted muscle testing can help localize the site of compression. (2) Reproduction of symptoms upon resisted supination, when the arm and wrist are in extension, suggests compression at the arcade of Froshe (Resisted supination test). [chiroup.com]

• Impulsivity

  The nerve conduction velocity (NCV) test measures the speed of an electrical impulse as it travels along the radial nerve. If the speed is too slow, then the nerve is probably pinched. [lakesidephysio.com]

• Motor Symptoms

  The Problem The radial nerve carries both motor and sensory nerve fibers from the brachial plexus into the distal forearm and hand. [clinicaladvisor.com]

If a patient presents symptoms consistent with RTS, he/she should be queried about their occupation and possibly prolonged elbow extension and forearm rotation. Alternatively, RTS patients may report prior trauma. While a considerable subset of cases is still deemed idiopathic, RTS may also indicate ongoing inflammatory processes or space-occupying lesions like cysts and neoplasms [10]. In this context, a tentative diagnosis based on anamnestic and clinical data should be supported by imaging findings. The following techniques may be employed [11]:

• Plain radiography is often carried out to rule out acute injuries of the skeleton, to visualize possible joint effusions, soft tissue swelling and solid neoplasms.
• Ultrasonography allows for a reliable assessment of the radial nerve's condition [5].
• Magnetic resonance imaging may be reserved for cases of chronic elbow pain and non-responders [4].

Electromyographic studies don't usually yield specific findings. Ferdinand et al. analyzed the electromyographic examination findings of 10 patients diagnosed with RTS and could not find evidence of RN or PIN dysfunction in either one [4].

The effectiveness of conservative treatments for RTS is unknown because, for most treatments, no studies were available. [ncbi.nlm.nih.gov]

Osteoarthritis Treatment Nonoperative treatment: Activity modification rest, stretching, splinting Consider corticosteroid injection near the nerve after 6-12 months of failed conservative treatment Operative treatment: Surgical release of PIN and potentially [orthopaedicsone.com]

Nonoperative treatment is favoured. [nerveclinic.co.uk]

With appropriate treatment, the prognosis is improved Please find comprehensive information on Radial Nerve Dysfunction regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis [dovemed.com]

Treatment and prognosis Treatment is usually conservative. Some authors suggest surgical decompression to avoid permanent nerve damage. [radiopaedia.org]

S upinator (distal border) Natural History Describe the natural history,epidemiology and prognosis Patient History and Physical Findings History: Forearm pain. There is no motor deficit as in posterior interosseous syndrome. [orthopaedicsone.com]

Esther J Waugh, Susan B Jaglal, Aileen M Davis, George Tomlinson and Molly C Verrier, Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy, Archives of Physical Medicine and Rehabilitation, 10.1016/S0003-9993(03 [doi.org]

Supraglenoid cysts of the shoulder, meniscal cysts in the knee, and dorsal wrist ganglia are routinely treated with arthroscopic decompression or excision with management of the underlying etiology of the cyst. [ncbi.nlm.nih.gov]

[…] synonyms: Radial Tunnel Syndrome ICD-10 G56.32 Lesion radial nerve, left upper limb G56.33 Lesion radial nerve, bilateral upper limbs G56.30 Lesion radial nerve, unspecified upper limb G56.31 Lesion radial nerve, right upper limb Radial Tunnel Syndrome Etiology [eorif.com]

Other possible etiologies for posterior interosseous nerve dysfunction include trauma (Monteggia fractures [21] ), synovitis (rheumatoid), tumors, and iatrogenic injuries. [emedicine.medscape.com]

Etiology The theory is that the radial nerve becomes irritated and/or inflamed from friction caused by compression by muscles in the forearm. [1] Some speculate that Radial Tunnel Syndrome is a type of repetitive strain injury (RSI), but there is no detectable [neuropaxclinic.com]

Radial tunnel syndrome: An etiology of chronic lateral elbow pain. J Orthop Sports Phys Ther. 1991;14(1):14-17 Novak CB. Upper extremity work-related musculoskeletal disorders: a treatment perspective. J Orthop Sports Phys Ther. 2004;34:628–37. [thesportsphysiotherapist.com]

S upinator (distal border) Natural History Describe the natural history,epidemiology and prognosis Patient History and Physical Findings History: Forearm pain. There is no motor deficit as in posterior interosseous syndrome. [orthopaedicsone.com]

Radial Tunnel Syndrome ICD-10 G56.32 Lesion radial nerve, left upper limb G56.33 Lesion radial nerve, bilateral upper limbs G56.30 Lesion radial nerve, unspecified upper limb G56.31 Lesion radial nerve, right upper limb Radial Tunnel Syndrome Etiology / Epidemiology [eorif.com]

Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention. Sports Med. 2006;36(2):151-170. Jalovaara P, Lindholm RV. Decompression of the posterior interosseous nerve for tennis elbow. [thesportsphysiotherapist.com]

Introduction A compressive neuropathy of the posterior interosseous nerve (PIN) with pain only no motor or sensory dysfunction, and EMG/NCS is not useful Pathophysiology involves same sites of compression as PIN syndrome, which include (from proximal [orthobullets.com]

The theory is that the radial nerve becomes irritated and/or inflamed from friction caused by compression by muscles in the forearm. [1] Some speculate that Radial Tunnel Syndrome is a type of repetitive strain injury (RSI), but there is no detectable pathophysiology [neuropaxclinic.com]

The theory is that the radial nerve becomes irritated and/or inflamed from friction caused by compression by muscles in the forearm.Some speculate that Radial Tunnel Syndrome is a type of repetitive strain injury (RSI), but there is no detectable pathophysiology [en.wikipedia.org]

Nens van Alfen, Clinical and pathophysiological concepts of neuralgic amyotrophy, Nature Reviews Neurology, 10.1038/nrneurol.2011.62, 7, 6, (315-322), (2011). Charles P. Toussaint, Edward C. Perry, Marc T. Pisansky and Douglas E. [doi.org]

My staff and I at the Nebraska Hand & Shoulder Institute, P.C. believe that prevention and elimination of painful or debilitating conditions of the upper and lower extremities can consistently be achieved. [carpaltunnelrelief.net]

The goal of treatment is to prevent the return of symptoms. If the job is causing the problem, the work site may need to be changed. More breaks may be needed during the workday and heavy pulling and pushing should be avoided if possible. [selectorthopedic.com]

[…] wrist extension Elbow splint Indicated for brief use to prevent Forearm supination Splint with elbow at 90 degrees (risk of loss of elbow range of motion) Surgical decompression Consider if persists beyond 3 months of therapy [fpnotebook.com]

As with most injuries, prevention is the best medicine. It’s important to take frequent breaks when twisting the forearm, extending the wrist or gripping to prevent an overuse injury from occurring. [reboundmd.com]

Prevention It may not be possible to prevent some injuries. [intermountainhealthcare.org]

The radial nerve (RN) originates from the brachial plexus, descends through the radial groove of the humerus, and pierces through the lateral intermuscular septum to emerge about 10 cm proximal of the lateral epicondyle of the humerus. The nerve comes to lie between the brachialis and brachioradialis muscles. Up to this point, branches innervating the triceps brachii, anconeus, brachioradialis, and extensor carpi radialis longus muscles, and cutaneous branches have emanated from the RN. Anterior to the lateral epicondyle of the humerus, the RN divides into its two terminal branches: a superficial sensory branch and a deep motor branch. The latter then travels through an enclosed space extending from the radiocapitellar joint to the proximal aspect of the supinator muscle. This space is known as the radial tunnel, and it is delimited by the joint capsule (proximally), the brachialis muscle and biceps tendon (medially), the brachioradialis, extensor carpi radialis longus and brevis muscles (laterally), and the supinator muscle (distally) [1]. After exiting the radial tunnel, the nerve penetrates the supinator muscle and gives off several minor branches that innervate the dorsally located extensor muscles.

The compressive entrapment of the nerve within the radial tunnel causes symptoms consistent with radial tunnel syndrome (RTS). A literature review reveals a certain inconsistency regarding the use of medical termini concerning RTS [2]. On the one hand, distal segments of the deep motor branch of the RN are also referred to as posterior interosseous nerve (PIN), but the point of transition is poorly defined. Therefore, RTS may be defined as an entrapment of the deep motor branch of the RN or PIN [3] [4]. The deep motor branch of the RN penetrates the supinator muscle after it passes under the arcade of Fröhse, a fibrous arch that constitutes the most common site of entrapment of the nerve [5]. Affected individuals are diagnosed with posterior interosseous nerve syndrome, an entity to be distinguished from RTS. Finally, RTS is different from tennis elbow, although historic publications refer to the former as "resistant tennis elbow with a nerve entrapment" [6] [7].

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