Radial tunnel syndrome: Diagnostic and treatment algorithm

Volume 6 | Issue 1 | Jan-April 2018 | Page 14-17 | Monish Malhotra, Anil K Bhat, Ashwath Acharya

Authors: Monish Malhotra [1], Anil K Bhat [1], Ashwath Acharya [1].

[1]Department of Orthopedics, Kasturba Medical College, Manipal, India.

Address of Correspondence

Dr. Anil K. Bhat
Professor and Head, Department of Orthopedics, Kasturba Medical College, Manipal


Radial tunnel syndrome is a compressive neuropathy of Posterior interossei nerve(PIN) in the radial tunnel. Radial tunnel is commonly misdiagnosed and often treated as lateral epicondylitis. The difficulty in diagnoses is due to overlapping features among both the conditions. Understanding the anatomy of radial tunnel and possible sites of compression of PIN in the tunnel guides the surgical planning and management of radial tunnel syndrome. Dynamic ultrasonography helps in early diagnosis by assessing compression of the nerve during supination and pronation. Rule of 9 test and maudsley’s test are sensitive for detection of radial tunnel syndrome. Conservative treatment is less successful and surgical decompression is the treatment of choice. Complete release of possible sites of compression prevents recurrence.
Keywords: Radial Tunnel Syndrome, Conservative management, diagnosis


1. Roles NC, Maudsley RH. Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br. 1972;54(3):499-08.
2. Lister GD, Belsole RB, Kleinert HE. The radial tunnel syndrome. J Hand Surg Am. 1979;4(1):52-59.
3. Barnum M, Mastey RD, Weiss AP, Akelman E. Radial tunnel syndrome. Hand Clin. 1996;12(4):679-89.
4. Loh YC, Lam WL, Stanley JK, Soames RW. A new clinical test for radial tunnel syndrome-the Rule of- Nine test: a cadaveric study. J Orthop Surg (Hong Kong). 2004;12(1):83-86.
5. Bolster MA, Bakker XR. Radial tunnel syndrome: emphasis on the superficial branch of the radial nerve. J Hand Surg Eur. 2009; 34(3):343-47.
6. Werner CO. Lateral elbow pain and posterior interosseous nerve entrapment. Acta Orthop Scand Suppl 1979;174:1–62.
7. Rosén I, Werner CO. Neurophysiological investigation of posterior interosseous nerve entrapment causing lateral elbow pain. Electroencephalogr Clin Neurophysiol. 1980;50(1-2):125-33.
8. Kupfer DM, Bronson J, Lee GW, Beck J et al. Differential latency testing: a more sensitive test for radial tunnel syndrome. J Hand Surg Am. 1998;23(5):859-64.
9. Verhaar J, Spaans F. Radial tunnel syndrome. An investigation of compression neuropathy as a possible cause. J Bone Joint Surg Am. 1991;73(4):539-44.
10. Ferdinand BD, Rosenberg ZS, Schweitzer ME, Stuchin SA et al. MR Imaging Features of radial tunnel syndrome: Initial Experience. Radiology. 2006;240(1):161-8.
11. Cleary CK. Management of radial tunnel syndrome: a therapist’s clinical perspective. J Hand Ther. 2006; 19(2):186-91.
12. Moss SH, Switzer HE. Radial tunnel syndrome: A spectrum of clinical presentations. J Hand Surg Am. 1983;8(4):414-20.
13. Sarhadi NS, Korday SN, Bainbridge LC. Radial tunnel syndrome: diagnosis and management. J Hand Surg Br. 1998;23(5):617-19.
14. Dang AC, Rodner CM. Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve. J Hand Surg Am. 2009;34(10):1906-14.
15. Clavert P, Lutz JC, Adam P, Wolfram-Gabel R et al. Frohse’s arcade is not the exclusive compression site of the radial nerve in its tunnel. Orthop Traumatol Surg Res. 2009; 95(2):114-18.
16. Sotereanos DG, Varitimidis SE, Giannakopoulos PN, Westkaemper JG. Results of surgical treatment for radial tunnel syndrome. J Hand Surg Am. 1999; 24(3):566-70.
17. Atroshi I, Johnsson R, Ornstein E. Radial tunnel release. Unpredictable outcome in 37 consecutive cases with a 1-5 year follow-up. Acta Orthop Scand. 1995;66(3):255-7.

How to Cite this article: Malhotra M, Bhat AK, Acharya A. Radial tunnel syndrome: Diagnostic and treatment algorithm. J Kar Orth Assoc. July-Dec 2017; 5(2): 14-17

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