Radial Tunnel Syndrome: Case Report and Comprehensive Critical Review of a Compression Neuropathy Surrounded by Controversy

Hand ◽  
2021 ◽  
pp. 155894472110290
Author(s):  
G. Gleda Ang ◽  
David G. Bolzonello ◽  
Bruce R. Johnstone
Keyword(s):  
Critical Review ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Provocative Test ◽  
Lateral Elbow Pain ◽  
Electrophysiological Studies ◽  
Tunnel Syndrome ◽  
Long Acting ◽  
Proximal Forearm ◽  
Radial Tunnel Syndrome

Radial tunnel syndrome (RTS) is an uncommon controversial entity thought to cause chronic lateral proximal forearm pain due to compression of the deep branch of the radial nerve, without paralysis or sensory changes. Diagnostic confusion for pain conditions in this region results from inconsistent definitions, terminology, tests, and descriptions in the literature of RTS and “tennis elbow,” or lateral epicondylitis. A case of bilateral RTS with signs discordant with traditionally used clinical diagnostic tests was successfully relieved with surgical decompression and led us to perform a comprehensive critical review of the condition. We delineate the controversy surrounding its diagnosis and aim to facilitate appropriate management and identify other areas for further study in this controversial condition. Clinical validity and evidence of anatomical rationale for the traditionally used Maudsley’s provocative test is unclear in diagnosis of RTS or in chronic lateral elbow pain, if at all. Neither imaging nor electrophysiological studies contribute to a clinical diagnosis which is supported by short-term improvement after an injection with long-acting local anesthetic and corticosteroid. Accurate diagnosis and treatment of RTS can significantly improve quality of life, but validity and evidence for traditional clinical tests and definitions must be clarified.

scholarly journals Identifying and Evaluating Vocation-Related Neuro-Musculoskeletal Deficiencies in Professional Musicians: A Review

2021 ◽  
Vol 11 (5) ◽  
pp. 2035
Author(s):  
Joseph Mizrahi
Keyword(s):  
Myofascial Pain ◽  
Tennis Elbow ◽  
Traumatic Injury ◽  
Lateral Epicondylitis ◽  
Upper Extremities ◽  
Upper Body ◽  
Professional Musicians ◽  
Shoulder Muscles ◽  
Repetitive Movements ◽  
Tunnel Syndrome

A combination of factors exposes musicians to neuro-musculoskeletal disorders, which lead to pain and damage. These involve overuse due to long playing hours, containing repetitive movements under stressful conditions, usually performed in an unnatural posture. Although the evoked disorders are usually non-traumatic, they may often lead to prolonged or even permanent damage. For instance, in upper string players, these include bursitis and tendinopathies of the shoulder muscles, tendonitis of the rotator cuff, injury at the tendon sheaths, medial or lateral epicondylitis (also known as tennis elbow), myofascial pain, and wrist tendonitis (also known as carpal tunnel syndrome, or De Quervein’s syndrome). In cases of intensive performance, a traumatic injury may result, requiring drastic means of intervention such as surgery. It should be pointed out that the upper body and upper extremities are the most commonly affected sites of playing musicians. This review provides a description of the playing-related motor disorders in performing musicians, and of the methodologies used to identify and evaluate these disorders, particularly for violinists and other upper string players.

Risk factors in lateral epicondylitis (tennis elbow): a case-control study

2012 ◽  
Vol 38 (2) ◽  
pp. 159-164 ◽  
Author(s):  
A. G. Titchener ◽  
A. Fakis ◽  
A. A. Tambe ◽  
C. Smith ◽  
R. B. Hubbard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Case Control ◽  
Smoking History ◽  
Health Improvement ◽  
Tunnel Syndrome ◽  
Associated Risk Factors ◽  
Control Study

Lateral epicondylitis is a common condition, but relatively little is known about its aetiology and associated risk factors. We have undertaken a large case-control study using The Health Improvement Network database to assess and quantify the relative contributions of some constitutional and environmental risk factors for lateral epicondylitis in the community. Our dataset included 4998 patients with lateral epicondylitis who were individually matched with a single control by age, sex, and general practice. The median age at diagnosis was 49 (interquartile range 42–56) years . Multivariate analysis showed that the risk factors associated with lateral epicondylitis were rotator cuff pathology (OR 4.95), De Quervain’s disease (OR 2.48), carpal tunnel syndrome (OR 1.50), oral corticosteroid therapy (OR 1.68), and previous smoking history (OR 1.20). Diabetes mellitus, current smoking, trigger finger, rheumatoid arthritis, alcohol intake, and obesity were not found to be associated with lateral epicondylitis.

Radial Tunnel Syndrome

1995 ◽  
Vol 20 (4) ◽  
pp. 454-459 ◽  
Author(s):  
T. LAWRENCE ◽  
P. MOBBS ◽  
Y. FORTEMS ◽  
J. K. STANLEY
Keyword(s):  
Radial Nerve ◽  
Tennis Elbow ◽  
Free Edge ◽  
Wrist Pain ◽  
Duration Of Symptoms ◽  
Supinator Muscle ◽  
Prolonged Duration ◽  
Tunnel Syndrome ◽  
Manual Tasks ◽  
Radial Tunnel Syndrome

Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery.

scholarly journals Examination of and Intervention for a Patient With Chronic Lateral Elbow Pain With Signs of Nerve Entrapment

2002 ◽  
Vol 82 (11) ◽  
pp. 1077-1086 ◽  
Author(s):  
Richard A Ekstrom ◽  
Kari Holden
Keyword(s):  
Nerve Entrapment ◽  
Elbow Pain ◽  
Examination Procedure ◽  
Lateral Elbow Pain ◽  
Strengthening Exercises ◽  
Lateral Elbow ◽  
Tension Testing ◽  
Tunnel Syndrome ◽  
Radial Tunnel Syndrome

AbstractBackground and Purpose. Lateral elbow pain has several causes, which can make diagnosis difficult. The purpose of this case report is to describe the examination of and the intervention for a patient with chronic lateral elbow pain who had signs of nerve entrapment. Case Description. The patient was a 43-year-old woman who had right lateral elbow pain for about 4 months, which she attributed to extensive keyboard work on a computer. She had a reduction in joint passive range of motion during “neural tension testing,” an examination procedure to detect nerve entrapment. This sign, in combination with other findings, suggested that the patient had a mild entrapment of the deep radial nerve (radial tunnel syndrome). The patient was treated 14 times over a 10-week period with “neural mobilization techniques,” which are designed to free nerves for movement; ultrasound; strengthening exercises; and stretching. Outcomes. The patient had minimal symptoms at discharge, was pain-free, and had resumed all activities at a 4-month follow-up visit. Discussion. Neural tension testing may be a useful examination procedure and mobilization may be useful for intervention for patients who have lateral elbow pain.

Tennis elbow--a radial tunnel syndrome?

1978 ◽  
Vol 60-B (2) ◽  
pp. 197-198 ◽  
Author(s):  
J van Rossum ◽  
OJ Buruma ◽  
HA Kamphuisen ◽  
GJ Onvlee
Keyword(s):  
Tennis Elbow ◽  
Tunnel Syndrome ◽  
Radial Tunnel Syndrome

Perineural injection as an alternative treatment of resistant lateral elbow pain

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hanaa Ahmed Hany Abd Eldayem Ahmed El-Naggar ◽  
Mona Mansour Mohammed Hasab El-Naby ◽  
Naglaa Youssef Mohammed Assaf ◽  
Mohja Ahmed Abd El-Fattah Elbadawy
Keyword(s):  
Clinical Improvement ◽  
Tennis Elbow ◽  
Functional Limitations ◽  
Lateral Epicondylitis ◽  
Elbow Pain ◽  
Lateral Epicondyle ◽  
Lateral Elbow Pain ◽  
Perineural Injection ◽  
Lateral Elbow ◽  
Tendon Thickness

Abstract Background Lateral elbow pain (LEP) or lateral epicondylitis (LE) is a common problem affecting both males and females. Multiple therapeutic modalities are used with different outcomes. Objective The current study aimed at description of the effectiveness of a newly introduced modality, Perineural Injection (PNI) therapy in comparison to the already used therapeutic ultrasound (TUS) as a conventional modality in the treatment of resistant LEP (LE). Patients and methods This is a longitudinal interventional study. Thirty patients of both sexes aged between 21 to 62 years old who had LE were randomly allocated into two groups (15 each). In PNI group, 5% buffered dextrose was injected subcutaneously around the lateral epicondyle once weekly for 8 weeks. In TUS group, continuous US was used 3 sessions per week for 4 weeks. Tenderness grading scale, visual analogue scale (VAS), Patient- Rated Tennis Elbow Evaluation Questionnaire (PRTEE) score, and ultrasonographic evaluation were used before and 12 weeks after treatment. Results In both groups, there was a high significant clinical improvement at 12th week after treatment. However, the improvement was better in the PNI group than the TUS group. By US evaluation at 12th week after treatment, there was a significant decrease in hypoechoic areas and disturbed fibrillar pattern in PNI group compared to before therapy (p < 0.001 and = 0.025) respectively. But in TUS group, there was decrease in hypoechoic areas and tendon thickness compared to before treatment (p = 0.02 and 0.026) respectively. Conclusion Both PNI and TUS therapies for LE gave clinical improvement for pain, functional limitations and some ultrasonographic findings (as echogenity, fibrillar pattern and tendon thickness). However, PNI therapy gave better outcome as compared to TUS.

scholarly journals Prospective Evaluation of a Single Corticosteroid Injection in Radial Tunnel Syndrome

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 741-745 ◽  
Author(s):  
Joseph Marchese ◽  
Kathleen Coyle ◽  
Mark Cote ◽  
Jennifer Moriatis Wolf
Keyword(s):  
Corticosteroid Injection ◽  
Nonoperative Treatment ◽  
Therapeutic Modality ◽  
Therapeutic Measure ◽  
Tunnel Syndrome ◽  
Proximal Forearm ◽  
Radial Tunnel Syndrome

Background: The role of corticosteroid injections in the treatment of radial tunnel syndrome (RTS) has not been evaluated in depth. The purpose of this study was to evaluate the utility of a single corticosteroid injection as a therapeutic modality for RTS. Methods: We enrolled 40 patients with a clinical diagnosis of RTS. Our primary outcome was the quick Disabilities of the Arm, Shoulder and Hand (qDASH) score at 1 year. Each patient was then treated with a single corticosteroid injection in the proximal forearm at the posterior interosseous nerve (PIN). Patient follow-up occurred at 2 weeks, 3 months, and 1 year. Results: The cohort had a mean age of 49 years, and 35 patients completed 1 year of follow-up. Outcomes based on qDASH and visual analog scale (VAS) showed significant improvement from baseline, with mean qDASH decreasing from 49.4 ± 7.0 points to 35.8 ± 7.5 points ( P = .03) and 28.5 ± 7.3 points ( P = .01) at 12 and 52 weeks, respectively, and VAS decreasing from 6.0 ± 0.8 points to 3.4 ± 0.9 points ( P = .005) and 2.9 ± 0.8 points ( P = .003) at 12 and 52 weeks, respectively. During the study period, 8 of 35 patients (23%) failed nonoperative treatment and went on to surgical decompression of the PIN. A minimal clinically important difference in qDASH was achieved in 57% of subjects at 1-year follow-up. Conclusions: Nonoperative management with corticosteroid injection can be used as a therapeutic measure with potential long-term benefits in the treatment of RTS.

scholarly journals ‘Carpal tunnel syndrome’ and ‘tennis elbow’ as prodromes for granulomatosis with polyangiitis (formerly Wegener’s granulomatosis)

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-227348
Author(s):  
Christian Geier ◽  
Kelly Steed
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Granulomatosis With Polyangiitis ◽  
Tennis Elbow ◽  
Leukocytoclastic Vasculitis ◽  
Lateral Epicondylitis ◽  
High Dose ◽  
Pulmonary Infiltrates ◽  
Tunnel Syndrome ◽  
Hands And Feet

A 62-year-old man presented with excruciating joint pains, back stiffness and numbness of his hands and feet. Over the past 18 months, he had experienced similar episodes for which the diagnoses of bilateral carpal tunnel syndrome and lateral epicondylitis had been made. Physical examination revealed polyarticular arthritis affecting the shoulders, wrists and right knee. Palpable purpura overlying the calves and ankles was present. Laboratory tests showed markedly elevated erythrocyte sedimentation rate and C-reactive protein in the setting of negative blood and urine cultures. Rheumatoid factor and antinuclear antibodies were negative. Chest CT demonstrated bilateral pulmonary infiltrates. A punch biopsy of the rash showed leukocytoclastic vasculitis. Anti-proteinase-3 titers returned strongly positive. A diagnosis of granulomatosis with polyangiitis was made. Treatment with high-dose steroids, followed by rituximab resulted in normalisation of inflammatory markers with subsequent resolution of joint pains, rash and pulmonary infiltrates and improvement of neuropathic symptoms.

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