The Elbow

literature

Int Orthop 1994 Oct;18(5):268-70

The radial tunnel syndrome.

Younge DH, Moise P

Orthopaedic Service, Centre Hospitalier Universitaire, Sherbrooke, Quebec, Canada.

The authors present their experience with 35 cases of radial tunnel syndrome, which is caused by compression of the posterior interosseus nerve in the proximal dorsal forearm related to exertion. Chronic aching muscle pain is the problem. Real paralysis is very rare, and is usually considered as a separate entity. The syndrome is often confused with tennis elbow, although the patient may have both problems. The diagnosis remains clinical, and surgical decompression of the nerve in the region of the supinator will give relief in most cases.

J Hand Surg [Am] 1979 Jan;4(1):52-9

The radial tunnel syndrome.

Lister GD, Belsole RB, Kleinert HE

Twenty patients with symptoms present for an average of 21.1 months and who in most cases had been treated by several conservative techniques for chronic tennis elbow were diagnosed as having radial tunnel syndrome, as originally described by Roles and Maudsley. Release of the tunnel was followed by eventual relief in 19 instances (95%).

J Bone Joint Surg [Am] 1991 Apr;73(4):539-44

Radial tunnel syndrome. An investigation of compression neuropathy as a possible cause.

Verhaar J, Spaans F

Department of Orthopaedic Surgery, University Hospital, Maastricht, The Netherlands.

Conventional electromyographic and nerve-conduction studies usually do not show abnormalities in patients who have a clinical diagnosis of radial tunnel syndrome. Therefore, posterior interosseous nerve-conduction measurements were performed during forced supination in patients who had this syndrome. Only one of sixteen patients had a major increase in latency. Our data do not support the hypothesis that the signs and symptoms in most patients who have a diagnosis of radial tunnel syndrome are caused by compression of the posterior interosseous nerve.

Sportverletz Sportschaden 1992 Jun;6(2):71-6

[Supinator tunnel syndrome--a differential diagnosis of so-called tennis elbow]. [Article in German]

Pfandl S, Wetzel R, Hackspacher J, Puhl W

Orthopadische Klinik im RKU, Forschungs- und Lehrbereich, Universitat Ulm.

The increasing activity in sport lead especially in untrained persons to overstress of the elbow joint. Often one tends to diagnose a epicondlylits humeri radialis i.E. tennis elbow. In 1873, Runge (16) first described what we now call epicondylitis humeri radialis, i.e. what Morris (10) 1882 called "Tennis elbow." Its etiology is still under discussion, and the diagnosis of tennis elbow necessitates exact and detailed differential diagnostic efforts. In the work presented, we describe one major differential diagnosis, the posterior interosseous nerve syndrome or supinator entrapment syndrome. With sketches and anatomical preparations we describe the course of the radial nerve around the elbow joint and of its ramus profundus within the supinator muscle pouch. Listing representative causes of this syndrome, we also comment on clinical aspects and our surgical method of choice. We have interviewed and reexamined 6 of our patients suffering from a so called therapy-resistant epicondylitis humeri radialis. Due to their clinical picture all six had been operated for posterior interosseous nerve syndrome/supinator muscle entrapment syndrome. We present our results including neurophysiological evaluations. In relapsing, therapy resistant and diagnostically untypical humeral radial epicondylitis, a posterior interosseous nerve syndrome should be considered. After clinical and electromyographic examination a revision of the supinator channel is justified in selected cases.

Clin Orthop 1987 Jun;(219):201-5

Radial tunnel syndrome. A ten-year surgical experience.

Ritts GD, Wood MB, Linscheid RL

In a ten-year experience with radial tunnel syndrome surgery, 34 of 42 patients had follow-up examination of more than six months (average, 24 months). although 74% of the patients were improved after surgery, about one-third had some persistent pain and functional restriction. Static electromyographic analysis was not diagnostically helpful. However, diagnostic radial tunnel block was prognostically helpful. Patients selection was important in predicting surgical outcome. In worker's compensation cases, symptoms would often persist. Some patients also appeared to have symptoms referable to compression of the posterior interosseous nerve and tendinitis of the extensor origin, and others had additional ipsilateral compressive neuropathies.

Orthop Clin North Am 1996 Apr;27(2):305-15

Radial nerve entrapment.

Kleinert JM, Mehta S

Department of Orthopaedic Surgery, University of Louisville School of Medicine, Kentucky, USA.

The radial nerve is frequently more involved in entrapment syndromes than the ulnar and median nerves. Common sites of compression are the juncture of the middle and distal third of the arm (especially with fractures of the humerus), just distal to the elbow (radial tunnel), and proximal to the wrist between the brachioradialis and extensor carpi radialis longus. Often in entrapment syndromes involving the radial nerve, the true diagnosis is not evident and is arrived at only by exclusion, which sometimes delays initiation of effective treatment. Radial tunnel syndrome is rare, but decompression when indicated, can provide relief. Radial sensory nerve entrapment in the forearm (distal third) does occur, but patients often respond to temporary thumb spica splinting.

Clin Orthop 1985 Jul-Aug;(197):231-6

Clinical and neurophysiologic characteristics of the pronator syndrome.

Werner CO, Rosen I, Thorngren KG

Nine patients were clinically diagnosed as having a pronator syndrome, i.e., high median nerve compression. The main symptom was pain at the proximal volar aspect of the forearm increasing for several hours after exercise. All patients showed local tenderness over the median nerve 4-5 cm distal to the elbow and pain on active forearm pronation against resistance. Two patients had been previously operated upon for carpal tunnel syndrome. Preoperative routine neurographic-electromyographic studies were normal. In the differential diagnosis, the exclusion of carpal tunnel syndrome and anterior interosseous nerve entrapment is most important. On active isometric forearm pronation, interference with median nerve motor conduction occurred in three patients preoperation. This phenomenon had disappeared following median nerve decompression at the level of the pronator muscle. Fibrous bands from the pronator muscle, encircling the nerve, seemed to be an etiological factor. Eight of nine patients were either improved or recovered completely by surgical treatment.

J Hand Surg [Br] 1998 Oct;23(5):617-9

Radial tunnel syndrome: diagnosis and management.

Sarhadi NS, Korday SN, Bainbridge LC

Pulvertaft Hand Surgery Centre, Derbyshire Royal Infirmary, Derby, UK.

This study presents a review of 26 cases of radial tunnel syndrome in 25 patients seen in a single hand consultant's practice over a period of 2.5 years. The protocol for diagnosis was the reproduction of patient's symptoms on pressure over a palpable tender spot along the course of the radial tunnel, painful resisted supination or resisted middle finger extension, all of which were abolished on infiltration of the tender area with a local anaesthetic solution. The presence of at least two out of three objective signs was necessary for the diagnosis. Initially all cases were treated conservatively, by steroid injection in 25 and physiotherapy in one, with long-term relief of pain in 16. Nine failures were treated surgically, with complete relief of pain in seven. Radial tunnel syndrome should be considered in the differential diagnosis of pain around the hand and or elbow.

J Bone Joint Surg [Br] 1978 May;60-B(2):197-8

Tennis elbow--a radial tunnel syndrome?

van Rossum J, Buruma OJ, Kamphuisen HA, Onvlee GJ

The hypothesis that the chronic tennis-elbow syndrome is caused by an entrapment neuropathy of the radial nerve (Roles and Maudsley 1972) was put to the test prospectively in ten patients. Detailed orthopaedic, neurological and neurophysiological examinations did not reveal any involvement of the radial nerve. It is concluded that this syndrome cannot be explained by an entrapment neuropathy.

Hand Clin 1992 May;8(2):345-57

Radial nerve compression.

Eaton CJ, Lister GD

University of Utah, Salt Lake City.

Symptomatic radial nerve compression is relatively uncommon. A relatively high incidence of compressive neuropathy involves other major nerves in the same extremity. Because sensory complaints are minor, radial nerve compression may successfully masquerade as tendonitis or tendon rupture. The most common site of radial nerve compression is in the forearm, at the arcade of Frohse. Spontaneous onset of dense paralysis is often due to space-occupying lesions in the forearm. Trauma-related compression in the forearm is most often due to radial head dislocation and either humeral fracture or local external pressure in the upper arm. Compression resulting in weakness that does not improve with several months of splinting, anti-inflammatory medication, and activity changes should be treated surgically to reduce the extent of permanent deficit. After decompression, early active motion is instituted to encourage nerve gliding. Results after decompression are not as favorable as those for carpal or cubital tunnel release. The worst results of decompression are seen in patients who have work-related injuries, chronic pain, and poor localization of symptoms on physical examination.

Int Orthop 1998;22(2):102-6

The posterior interosseous nerve and the radial tunnel syndrome: an anatomical study.

Portilla Molina AE, Bour C, Oberlin C, Nzeusseu A, Vanwijck R

Department of Microsurgery, Universite Catholique de Louvain, Brussels, Belgium.

Twenty anatomical specimens were carefully studied in order to establish a possible connection between the posterior interosseous nerve and the radial tunnel syndrome. Our results show that the posterior interosseous nerve distal to the supinator muscle may be compressed by various structures. These include the distal border of the supinator muscle, the ramifications of the anterior and posterior interosseous vessels, and the septum between the extensor carpi ulnaris and the extensor digitorum minimi. The posterior interosseous nerve is also stressed during passive supination (elongation and rotation), and during passive pronation (compression). This suggests that the interosseous nerve distal to the supinator muscle should be explored in radial tunnel compression syndromes.