Boyd W. Haynes III, MD
Most people have heard of Carpal Tunnel Syndrome or CTS, but far fewer have heard of its more rarely seen cousin Radial Tunnel Syndrome or RTS, which affects the top of the forearm, the wrist or back or the hand, or a combination of these. In this article, I will review the causes, the symptoms, how I diagnose this disorder and the treatment I prescribe.
To describe what RTS is, we first need a brief anatomy lesson. The radial nerve emanates from the cervical spine (neck), runs down the arm to the wrist and controls the movement of the triceps muscle in your upper arm. However, the radial tunnel is in your forearm and is comprised of muscle and bone which creates a “tunnel” through which the radial nerve passes. If anything compromises that space, such as inflammation of a muscle, the radial nerve can become irritated, causing pain, weakness, and dysfunction. Typically, inflammation is caused by overuse and repetitive motion in a job or while doing a hobby that requires pushing, pulling, grabbing or gripping with your hands and wrists. And, like Carpal Tunnel Syndrome, RTS happens more often to women between the ages of 30-50, although again, not nearly as often as CTS.
The symptoms of radial tunnel syndrome include:
- Pain and/or fatigue and or weakness of the forearm and may include –
- Pain which worsens when the fingers are extended
- Pain on the back of the hand
- Pain just below the elbow
- Pain which worsens when you rotate your wrists
- Soreness on the outside of the elbow
- Difficulty grasping or lifting objects
- Difficulty with wrist extension
When a patient comes to see me for a diagnosis, I typically order x-rays to rule out any mechanical problem, such as arthritis or a bone spur. I spend a lot of time asking the patient questions, all while asking them to move and getting them to do specific tests for me to determine if their radial nerve is compromised. I’ll ask about lifestyle, work, hobbies and any repetitive motion they may do.
If I suspect radial tunnel syndrome, I usually will start the patient on a regimen of rest, OTC pain relievers, perhaps oral steroids to reduce inflammation, Physical Therapy and prescribe a wrist or forearm brace to provide support and help to immobilize the area, giving it a chance to heal.
For more severe cases, I may inject cortisone into their inflamed muscle(s) to provide quicker and longer lasting inflammation relief off the radial nerve.
I may also order an (EMG) Electromyography which is comprised of two separate nerve tests, a Nerve Conduction Study (NCS) and (NEE) Needle Electrode Examination. These tests help to measure the health of your nerves and how fast and with what strength they carry messages to the brain from your muscles and back again. These tests are done with a mild electric current which is used to stimulate your muscles and nerves, which can be mildly uncomfortable to the patient. They provide excellent information to the physician about how well your nerves are or are not functioning and how severely they may be compromised.
For most patients, the conservative treatment described above will do the trick, over time. However, there are patients who may require surgery to widen the radial tunnel to make more space for the radial nerve. This surgery is controversial because the outcome is not guaranteed to alleviate the pain, and the recovery time is lengthy. I often recommend that the patient continue with bracing, Physical Therapy, and management of discomfort vs. the surgery. If the patient feels certain that surgery is the right path for them, I will refer them to an orthopaedic hand specialist who performs more of these uncommon procedures so the patient will have the best outcome.
Make an appointment with Dr. Haynes or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.