Radial Tunnel Syndrome

with Rehab

Radial tunnel syndrome is a condition of the nervous system in which the radial nerve is compressed by surrounding structures in the elbow or forearm. Weakness in the hand and wrist characterizes the condition. The particular branch of the medial nerve that is usually affected (posterior interosseous branch) does not include sensory nerve cells; therefore, this condition does not usually involve severe pain or numbness.

SYMPTOMS

  • Diffuse pain in the forearm and hand during activity.

  • Decreased grip and forearm strength.

  • Outer (lateral) elbow tenderness.

  • Pain that worsens when rotating the wrist (using a screwdriver or opening a door).

CAUSES

An increased pressure placed on the radial nerve causes radial tunnel syndrome. The compression usually occurs in the elbow or forearm by muscles and ligament-like tissue known as the interosseous membrane. The condition may also be caused by direct trauma to the elbow or forearm.

RISK INCREASES WITH:

  • Activities that involve repetitive and/or strenuous wrist and forearm movements (tennis or carpentry).

  • Contact sports (football, soccer, lacrosse or rugby).

  • Poor strength and flexibility

  • Failure to warm-up properly before activity.

  • Diabetes mellitus.

  • Underactive thyroid gland (hypothyroidism ).

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment (elbow pads and slash guards).

PROGNOSIS

If treated properly, then the symptoms of radial tunnel syndrome typically resolve. Rarely, surgery is necessary to free the compressed nerve.

RELATED COMPLICATIONS

  • Permanent nerve damage that results in paralysis or weakness of the forearm and hand.

  • Prolonged healing time, if improperly treated or re-injured.

  • Prolonged disability (uncommon).

TREATMENT

Treatment initially involves resting from any activities that aggravate the symptoms. Ice and medications may be used to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. If there are signs of muscle wasting (atrophy) or symptoms persist for greater than 6 months despite conservative (non-surgical) treatment, then surgery may be recommended.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Radial Tunnel Syndrome (Radial [Posterior Interosseous] Nerve)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION – Wrist Flexion, Active-Assisted

  • Extend your right / left elbow with your fingers pointing down.*

  • Gently pull the back of your hand towards you until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent rather than extended.

STRETCH - Wrist Flexion

  • Place the back of your right / left hand on a tabletop leaving your elbow slightly bent. Your fingers should point away from your body.

  • Gently press the back of your hand down onto the table by straightening your elbow. You should feel a stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Radial Tunnel Syndrome (Radial [Posterior Interosseous] Nerve)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit holding on to the rubber exercise band/tubing with your arm supported.

  • Raise your hand upward in front of you or pull up on the rubber tubing.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Grip

  • Grasp a tennis ball, a dense sponge, or a large, rolled sock in your hand.

  • Squeeze as hard as you can without increasing any pain.

  • Hold this position for __________ seconds. Release your grip slowly.

Repeat __________ times. Complete this exercise __________ times per day.