Disputed radial tunnel syndrome

Abstract

True neurogenic radial tunnel syndrome is an uncommon condition caused by entrapment of the radial or posterior interosseous nerve in the radial tunnel and is usually easily identifiable by focal motor weakness in the distribution of the posterior interosseous nerve. Roles and Maudsley, analogizing to carpal tunnel syndrome, believed "radial tunnel syndrome" had a different presentation: proximal forearm pain and tenderness in the region of the supinator muscle. However, their patients lacked weakness or other neurologic deficit. They and subsequent surgeons have decompressed the radial nerve to treat forearm pain and tenderness, even though it is debatable whether radial nerve entrapment causes the forearm discomfort. The term "radial tunnel syndrome" is best reserved for the truly neurogenic cases. Surgical approaches to "persistent tennis elbow" should be assessed in a controlled fashion, rather than adopted on the basis of a flawed analogy to carpal tunnel syndrome.

Posterior Interosseous Neuropathy: Electrodiagnostic Evaluation

“…It then enters the radial tunnel, which is a potential space formed by the capitellum of the humerus and radiocapitellar joint posteriorly, the brachialis muscle medially, and the brachioradialis and ECRB muscles anteriorly and laterally [21,23,24]. The radial tunnel is approximately 5 cm long [32], it encompasses the space between where the radial nerve pierces the lateral intermuscular septum of the arm and where the PIN pierces the proximal edge of the supinator [1].…”

“…Distal to the tunnel, the PIN carries sensory fibers to the ligaments and joints of the wrist, the interosseous membrane of the forearm, and the periosteum of the radius [24].…”

“…Entrapment of the nerve is actually very rare [28]. Patients present with weakness of finger and thumb extension at the MCP joint [24]. Extension at the interphalangeal joints is preserved as the interossei and lumbrical muscles are intact.…”

“…The wrist may deviate radially as the ECU is involved while the ECRL (and often the ECRB) are spared. Thumb abduction may also be weak as the APL is involved [24]. Partial PIN lesions are seen when isolated branches of the PIN are compressed.…”

Sindrome compressiva del nervo radiale all’arcata di Frohse

“…L'eziologia e la patogenesi di questa sindrome rimangono a tutt'oggi poco chiare [8]. La prima descrizione risale al 1972 a opera di Roles e Maudsley [7] che, nel tentativo di spiegare un'epicondilite cronica resistente a ogni terapia, descrissero il tunnel radiale come possibile sito di compressione nervosa.…”