Radial Tunnel Syndrome is an uncommon, painful, progressive condition that is caused by compression of the radial nerve at the elbow/forearm area.
Symptoms
Common symptoms of radial tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in forearm, hand and wrist that may radiate up to the shoulder and weakness in forearm/ hand with diminished grip strength.
Causes
Exact causes of the condition are not known. However certain factors increase the risk of developing radial tunnel syndrome and they include repetitive use of the forearm and elbow muscles especially seen in this age of digital gadgets such as computers, laptops, tablets and mobile phones. It is also caused by congenital abnormalities, repetitive motion of forearm, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst, tumour or abnormal muscle in the tunnel. Rarely acute trauma or old trauma such as a malunited fracture of the radius shaft can cause secondary radial tunnel syndrome.
Investigations
While the diagnosis of Radial tunnel syndrome is mainly clinical, an ultrasound can identify radial nerve atrophy/ soft tissue compression of the nerve by entities such as a ganglion, aberrant muscle or other SOL’s. It is commonly mistaken for tennis elbow or tendinitis of the outer elbow and can often coexist with lateral epicondylitis. It is also an important cause of failed surgery for tennis elbow. Thorough clinical manual muscle testing and special clinical tests are a much better diagnostic tool than investigations such as an MRI or a nerve conduction study. It is critical to screen with Xrays and an MRI of the neck to diagnose a double crush syndrome where the nerve can be both compressed in the forearm and in the neck. Typically the pain is distal to the elbow tendon origin.
Conservative Treatment Options
Radial tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:
- Treating underlying medical conditions
- Immobilisation of the elbow with a splint or an elbow brace for 4-6 weeks (Sometimes a tennis elbow brace can worsen the symptoms of a radial tunnel syndrome)
- Rest the hand
- Avoid activities that tend to worsen the symptoms
- Medications such as non-steroidal anti-inflammatory drugs and ultrasound guided steroid injections
- Strengthening and stretching exercises once symptoms diminish
Surgery
If conservative treatment options fail to resolve the condition Dr Bala may recommend a surgical procedure.
Radial Tunnel Release Surgery
Radial tunnel syndrome can be treated with radial tunnel release Surgery. During the surgery, the tendinous origin of a muscle will be dissected to release the pressure on the radial nerve and release the radial tunnel. The leash of blood vessels covering the nerve in the tunnel are also sometimes removed to decompress the tunnel. Dr Bala will decide which options are best for you based on your general and medical conditions.
Dr Bala believes that adequate decompression is difficult to achieve through keyhole surgery for this condition while addressing other conditions present in the radial tunnel. Although he is trained to perform this keyhole, he also believes that the nerve is best visualized and freed in an open procedure. He prefers general anaesthesia over local anaesthesia for faster recovery and to better visualise important structures to protect. He may choose to do it under local anaesthesia or under WALANT (wide awake local anaesthesia no tourniquet) if medically indicated.
Post-Operative Care
Dr Bala may suggest you practice certain post-operative procedures for better recovery and to avoid further complications.
- Elevate the hand above heart level to reduce swelling.
- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
- Physiotherapy may be ordered to restore wrist strength.
- Eating a healthy diet and not smoking will promote healing
Risks and Complications
Most patients suffer no complications following radial tunnel release surgery. However, in rare cases a patient may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the forearm and elbow area.
Dr Bala uses special magnification loupes to visualize and protect these structures to minimize complications. In the event you may have a tattoo on the forearm Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures.