Elbow-Radial Tunnel Syndrome

Standard of Care: Radial Tunnel Syndrome

Case Type / Diagnosis / Anatomy:

Radial tunnel syndrome (RTS) was first reported as a unique clinical syndrome in 1956. RTS has
also been called radial pronator syndrome. It is a pain syndrome that is distinct from lateral
epicondalgia and is a syndrome arising from compression of the posterior interosseous nerve
(PIN), which results in refractory lateral elbow and forearm symptoms.
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 This compression
occurs in the proximal forearm where the radial nerve splits into the PIN (main trunk) and the
sensory branch of the radial nerve (minor trunk). Compression can occur either before or after
this split. Radial nerve anatomy around the elbow is highly variable. The radial tunnel originates
near the level of the radiocapitellar joint where the nerve lies against the joint capsule. The
tunnel’s medial border is the brachialis muscle proximally and the biceps tendon distally. The
roof and lateral border of the tunnel is comprised of the extensor carpi radialis longus (ECRL)
and the extensor carpi radialis brevis (ECRB). The tunnel continues to the distal border of the
supinator. There are five sites of potential compression of the PIN:

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