Cheatography
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Radial Tunnel syndrome, Rx, Hx, PE
This is a draft cheat sheet. It is a work in progress and is not finished yet.
RTS
- Radial tunnel = space, made up of posterior forearm, radiocapitellar joint and supinator, surrounding radial nerve
- Irritation or compression of the radial nerve within the tunnel
- Compression of PIN = motor weakness of finger, hand and wrist extensors
- Compression more common at Arcade of Frohse (thickened proximal edge of supinator)
- Overuse - handgrip, wrist ext, pronation, supination vibration
- Other areas - distal border of supinator and beneath origin of ECRB
Hx
- Depends on mixed, sensory or motor branches affected |
- Superficial sensory = pain paresthesia/diminished sensitivity along dorsal aspect of forearm
Can radiate into hand (1st web space, back of the thumb and index finger) |
- Deep, aching and diffuse - mimicks lateral epicondylitis (difference being RTS tenderness is at 4 finger breadths below lateral epicodyle, LE has tenderness further up and RTS more likely to wake the patient up at night) |
- Compression of PIN - weakness of MCP joint extension and thumb extension |
PE
- +ve radial tunnel compression (4 fingerbreadths from lateral epicondyle) |
- Symptoms increased with resisted wrist ext, supination (arcade of Frohse), resisted middle finger ext (PIN beneath ECRB) and pronation |
- Tinels sign not always present |
- +ve NTT Radial |
- May have Cx and Tx findings (limited flex and ext) |
- Occurs less frequent than other entrapments |
- Assess for comorbitities - pronator syndrome, Guyvon's syndrome, medial epicondylitis, deQuervain's tenosynovities, trigger finger, lateral epicondylitis |
DDx
- Wartenberg's syndrome/cheiralgia paraesthica (distal radial nerve) |
- Brachial plexus injury |
- Cx radiculopathy |
- DeQuevains tenosynovtis |
- Bone pathology |
- Elbow bursitis |
- Elbow strain/sprain/tendinopathy |
- Peripheral neuropathy |
- TOS |
Imaging
- Usually not needed unless bony pathology/SOL |
- X-ray, MRI, US, EMG/NCS |
Management
- NSAIDs |
- Rest |
- Ice and Ice massage |
- Electrotherapy |
- US (1MHz, 1 watt, 25% duty cycle) |
- Limit excess/repetitive wrist ext, forearm pronation, supination |
- Splinting |
- tennis elbow counterforce brace aggravates RTS |
- STW and nerve flossing |
- Stretching and myofascial release of supinator, brachioradialis, wrist extensors (ECRB) |
- Cx and upper Tx manipulation/mobilisation |
- Surgery if failure to respond within 12 weeks or significant motor deficit |
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