Assessing, diagnosing and managing radial tunnel syndrome

Assessing, diagnosing and managing radial tunnel syndrome Blog

A disorder affecting the elbows and causing 4 percent of cases involving suspected lateral epicondylalgia, radial tunnel syndrome, or RTS, is a painful condition that athletes experience more frequently than others. Correctly assessing and diagnosing RTS is particularly challenging because there are several alternative diagnoses that clinicians must rule out. After it has been diagnosed, there are several approaches to managing the symptoms of RTS.

Why radial tunnel syndrome occurs

When a person’s muscles or upper-arm bones place pressure on the radial nerve, radial tunnel system may develop. The nerve compression may result in inflammation and neuropathy. Normally, the pressure occurs between the head of the radius and the supinator muscle. The nerve runs through a cavity called the radial tunnel, which lies between the supinator muscle and the joint of the humerus and radius. When the nerve is compressed, it may then cause pain to radiate along it and into the elbow.

Evaluating radial tunnel syndrome

The assessment of RTS may involve subjective and objective evaluations combined with differential diagnoses. Imaging is not as useful for proper identification of the syndrome, but it may help to rule out degenerative elbow disorders.

Subjective assessment of RTS

People who are suffering from RTS commonly report the following:

  • Aggravation of the pain when using the upper arms
  • Pain that expresses at night, waking the patient
  • Pain in the central area of the elbow
  • No weakness in motor functioning

Clinicians will still need to rule out some other potential diagnoses in patients reporting these symptoms, including lateral epicondylalgia and others, however.

Objective assessment of radial tunnel syndrome

An objective assessment will involve a postural and neural examination. The clinician will also use palpitation and resistance supination and extension. In the postural examination, the clinician will assess the patient’s whole-body posture, looking for pathological signs in the proximal region. People who have radial tunnel syndrome often have positive results on tension tests that are performed on their radial nerves during the neural examination.

The clinician may palpitate the supinator muscle on the side of the elbow to determine whether doing so causes any pain. If it does, he or she may then ask t he patient to place his or her forearm in a pronated position to see if the pain is relieved. If both are true, radial tunnel syndrome may be the culprit. Clinicians may also perform resistance supination and extension tests. People with radial tunnel syndrome will experience pain when they contract their supinators, and they may find that resistance extension is painful and weak.

Management of RTS

The management of radial tunnel syndrome is poorly understood because of a lack of research. Some studies have indicated that there is a potential benefit of corticosteroid injections or physiotherapy. Other management techniques may include nerve gliding and stretching exercises. Manual therapies that may be beneficial include spinal manipulation, manual soft tissue and peripheral therapies.

The incidence of the disorder in the workplace may be prevented by making ergonomic changes to the workstations of workers. Finally, functional strength training exercises may help to decrease the pressure and alleviate the pain.

Radial tunnel syndrome presents a diagnostic challenge for clinicians. When it is correctly identified, the symptoms may be managed so that the patient’s pain symptoms may be alleviated.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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