Abstracts & Literature Review
Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma
Ali Moradi, MD; Mohammad H Ebrahimzadeh, MD; Jess B Jupiter, MD
Research performed at Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
JACO Editorial Reviewer J. Chris Romney DC FACO
Published: September 2016
Journal of the Academy of Chiropractic Orthopedists
September 2016, Volume 13, Issue 1
The original article copyright belongs to the original publisher. This review is available from: http://www.dcorthoacademy.com © 2015 Romney and the Academy of Chiropractic Orthopedists. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: It is evident that radial tunnel syndrome should be considered in the diagnosis of lateral elbow and dorsal forearm pain that may radiate to the wrist and dorsum of fingers. Clinical examination of the elbow has been found to be the best method for the diagnosis of radial tunnel syndrome. The paraclincal study options such as, electrodiagnostics, imaging studies, or diagnostic ultrasound are utilized to rule out other pathologies to differentiate the several conditions of lateral elbow pain. The most valuable examination is at the direct site of pain and can be best identified by rule of nine test and detecting weakness of the third finger and wrist extension. Treatment of radial tunnel syndrome should utilize various conservative non-surgical efforts before undergoing surgical intervention.
Methods: The study identifies the prevalence of compression of the superficial radial nerve is at 0.003%, in comparison to carpal tunnel syndrome which has an annual incidence between 0.1% and 0.35%. The entrapment of the radial nerve and its deep branch has been found to occur at five different sites within the radial tunnel. The study by Bolster reported 5 out of 12 patients with the diagnosis of RTS had previous surgical intervention on the ipsilateral upper extremity such as, trigger finger, CTS, and shoulder instability. Studies also indicate that patients with RTS disease is more prevalent in women age 30-50 years, significantly right hand dominant with bilateral involvement being rare.
Results: RTS is relatively uncommon but has distinct signs and symptoms that include localized tenderness over the radial nerve 5cm distal to the lateral epicondyle. Patients report aggravated pain at night that disturbs sleep and can become more severe when increased traction is applied to the nerve by extending, flexing, or pronating the elbow. There are two accepted clinical tests to confirm the diagnosis. although X-ray, MRI, and EMG have not been found to play a key role in RTS diagnosis.
Conclusion: Because of the limited number of confirmatory diagnostic tests, RTS is diagnosed by exclusion and is dependent on clinical signs and symptoms. Common non surgical methods are recommended, however, the success rate is in doubt. Steven at al report shows only 4 out of 15 patients with the diagnosis of RTS had improvement with conservative treatment. Surgical treatment was found to result in 93% success rate. RTS is a disease that should be consider in the differential diagnosis of lateral elbow pain.
JACO Editorial Summary
Clinical Relevance: Lateral elbow pain is commonly diagnosed as lateral epicondylitis, when in some cases a closer look can identify the evidence of radial tunnel syndrome. This study includes an allopathic conservative care regimen with little success. The chiropractic physician can differentiate the diagnosis of lateral elbow pain by utilizing the proper historical and diagnostic techniques. Once the doctor has arrived at the diagnosis of RTS, the treatment plan might include the following: manipulation of the spinal segments of the cervical and thoracic spine, deep tissue massage , ultrasound modality, exercise rehabilitation, and manipulation of the radial head. If these efforts do not accomplish the preferred outcome then prolozone therapy or steroid injection may be a viable option prior to referral for surgical intervention.