Introduction
Radial tunnel syndrome is a clinical condition characterized by a set of symptoms which are dullness or tiredness, stinging pain in the forearm with its usage. These symptoms can also be experienced in the back but it is rare. These symptoms are due to pressure developed on the radial nerve, commonly in the elbow region. One of the main three nerves supplying the arm is the radial nerve which extends from the neck to the backside of the upper arm. Then, it goes to the outside of the elbow and then the forearm and hand. At the elbow level, it reaches the radial tunnel.
What Are the Signs And Symptoms?
There can be various signs and symptoms of this syndrome which are as follows:
1. One of the commonly experienced symptoms is pain which is dull aching in nature and occurs commonly at the top of the forearm, and in the outside of the elbow, or the backside of the hand. The various natures of pain that patients can experience are as cutting, piercing, or stabbing and this type is less common but has been mentioned by some patients. It occurs more commonly when the person tries to straighten the wrist or fingers.
2. The next symptom is tiredness or dullness in the muscles of the forearm and also, sometimes weakness in the wrist.
3. This syndrome usually affects the muscles and not really the nerves. Hence, the patient does not experience any tingling or numbness in the forearm, legs, or fingers.
How Is It Caused?
Whenever the radial nerve gets pinched at any point, it can cause pain in the arm. The radial tunnel is the most commonly affected area. The following can be the cause for this syndrome:
1. Overusing the arm to push or pull.
2. Over usage of the hands as gripping, pinching, or bending the wrist which can cause nerve irritation and thus, lead to pain.
3. Repetition of the same movement, like the twisting of the arm or wrist or while doing sports activities might affect the radial nerve.
All this in a long turn can lead to radial tunnel syndrome.
What Are the Risk Factors?
Following are the risk factors that might lead to radial tunnel syndrome:
- Activities that require constant and frequent twisting motion of the wrist like sports, etc.
- Poor strength and flexibility of the wrist.
- Diabetes mellitus.
- Inadequate warm-up before exercise or sports.
- Presence of tumors or any cyst that may put pressure on the nerve.
- Hypothyroidism.
- Presence of fluid or swelling in the arm leading to compression of the nerves.
- An injury like a direct hard hit to the arm.
- Inflammation involving the radial nerve.
How Can It Be Diagnosed?
When you visit your physician, you will be initially asked for the signs and symptoms that you are facing. The most commonly told symptom by the patient is pain. As there are no specific tests to diagnose this syndrome, the doctor usually performs a physical examination and relies on the same. The physical examination is done to locate the pain and the intensity of pain.
The basic examination includes the patient turning his or her palm up with a straight elbow and the doctor tries to restrict the movement of the arm and hand. Pain while restriction of the movement is an indication of this syndrome. Another test that can be performed is the patient pointing the middle finger against the resistance. Again, if the pain is there during resistance, it is an indication of this syndrome.
How Can It Be Treated?
Various treatment options are available to manage this syndrome. The initial management is giving rest to the affected arm from any activity that can cause pain. Most of the patients show improvement or get cured with rest and medical management within three weeks to six weeks.
Following are the treatment strategies that can be followed:
- Swelling can be reduced using over-the-counter medications.
- Doing various relaxation exercises.
- Inflammation and pressure on the radial nerve can be reduced or relieved using steroid injections.
- Usage of wrist and elbow splints. This can reduce the irritation to the radial nerve.
The main idea of the treatment is to prevent relapse or recurrence. Strength and flexibility exercises with an adequate warm-up before the physical activity can prove beneficial for sports-related injuries. An arm splint usage at night can help keep the arm in position thus, the pain can be avoided.
Is There Any Surgical Management for This Syndrome?
Yes, there is a surgery option available to treat this syndrome but the outcome may vary. Also, it is the last option that can be utilized when rest and medical management therapy fails.
The surgery when carried out is done as an outpatient surgery where the patient does not have to stay in the hospital overnight. It can be done either under total anesthesia or partial anesthesia. Partial anesthesia only numbs the affected area and the patient is awake.
The surgery that is done is called a radial tunnel release. In this surgery, the compression on the nerve is released and the tunnel becomes bigger which gives more space to the nerve. Post-surgery, new tissues are formed and maintain the position of the bigger tunnel and also, prevent relapse.
After surgery, patients are advised to wear an elbow splint with the wrapping of the arm. The patient begins a gentle exercise program after one week of the surgery. Also, the patients can use ice packs, soft-tissue massages, and stretching to improve their range of motion. Strength-building exercises are started after six weeks for the forearm and hand movements under the supervision of the therapist. Lifting, bending or any hard physical activity of the arm is avoided during the recovery phase. Exercises to stabilize and strengthen the wrist, elbow, and shoulder, are added by the therapist in the final stage, and also, they help to improve and control the motor movements of the hand. Full recovery post-surgery can be observed after six months to eight months or it may take longer. The recovery period depends on the extent of nerve compression or injury.
How Is the Prognosis?
Medical management and rest give a better improvement in most of the patients. Surgery can be used in severe cases but mild pain may continue in some patients. The main way to prevent recurrence is to avoid any re-injury to the nerve.
Conclusion
Radial tunnel syndrome is a rare condition but can be managed with a doctor's supervision and advice. Online medical platforms can be used to connect to your physician or specialist to get more details on the same.
