Skip to content

Patients › Elbow

Síndrome del túnel radial

PDF Evidence

Radial tunnel syndrome — causes forearm pain, weakness straightening fingers, and is distinct from tennis elbow.

Updated Sep 2026
Ilustración de una persona que se sujeta la parte superior y externa del antebrazo, mostrando signos de dolor.
El síndrome del túnel radial provoca un dolor sordo en la parte externa superior del antebrazo, justo debajo del codo. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

Qué está sintiendo

El síndrome del túnel radial provoca un dolor profundo en la parte externa del codo y del antebrazo. El punto doloroso suele encontrarse a unos 3 a 5 centímetros por debajo del bulto óseo en el exterior del codo; presionar allí genera más dolor que en cualquier otro lugar.

El dolor tiende a intensificarse con la actividad. Girar la palma de la mano hacia arriba, girar el antebrazo, o agarrar y levantar objetos pueden empeorarlo. El dolor puede extenderse hacia la parte posterior del antebrazo y la muñeca. El descanso suele aliviarlo, pero el dolor suele reaparecer la próxima vez que realice la misma tarea.

Las tareas diarias que requieren giros o agarres repetidos pueden volverse difíciles. Girar un destornillador, abrir un frasco, usar un martillo o retorcer un paño húmedo pueden desencadenar el dolor. Algunas personas lo notan más después de trabajar o hacer deporte, en lugar de durante la actividad en sí.

A diferencia de otros problemas nerviosos en la zona del codo y la muñeca, este síndrome generalmente no causa entumecimiento ni hormigueo; el nervio sigue funcionando con normalidad. Esta es una de las razones por las que la afección puede resultar confusa: el dolor es real, pero los exámenes de función nerviosa suelen dar resultados normales.

El nombre del síndrome resulta algo engañoso: el túnel radial no es un pasaje estrecho y único, sino una zona a lo largo del trayecto del nervio radial donde varias estructuras pueden ejercer presión sobre él. Entre ellas se incluyen el borde de un músculo, una banda fibrosa y pequeños vasos sanguíneos que cruzan el nervio. La presión en cualquiera de estos puntos puede provocar el mismo dolor profundo.

Dado que otras afecciones también pueden causar dolor similar en la parte externa del codo, su cirujano examinará detenidamente dónde se localiza el dolor y qué lo desencadena. Un diagnóstico correcto es fundamental, pues el tratamiento varía según la causa.

¿Qué está ocurriendo realmente?

El nervio radial desciende por el brazo y pasa junto al codo de camino a la mano. Justo debajo del codo, se divide en dos ramas: una transmite la sensibilidad a la parte dorsal de la mano; la otra, llamada nervio interóseo posterior, transmite las señales que mueven la muñeca y los dedos, además de las fibras nerviosas que transmiten el dolor desde la articulación de la muñeca.

A lo largo de este tramo del nervio hay varias estructuras cercanas: el borde de un músculo, una banda fibrosa resistente y pequeños vasos sanguíneos que cruzan el nervio; cada una de ellas puede ejercer presión sobre él. Cualquiera de estos puntos de presión puede provocar ese dolor profundo que se siente en la parte externa del codo.

Los nervios están diseñados para deslizarse. Cuando se dobla o estira el codo, o se gira el antebrazo, el nervio se desplaza ligeramente para seguir el movimiento. Si algo impide ese deslizamiento, el nervio queda sometido a tracción cada vez que se realiza un giro o un agarre. Esta tracción repetida lo irrita, y esa irritación se percibe como dolor.

Esta afección es poco común entre los problemas nerviosos: el nervio sigue funcionando con normalidad, por lo que la fuerza y la sensibilidad de la mano permanecen intactas, y los estudios nerviosos arrojan resultados normales. Lo afectado es un conjunto de fibras nerviosas encargadas de transmitir el dolor; por eso el síntoma principal es un dolor profundo, no entumecimiento ni debilidad.

Dado que los puntos de presión se localizan cerca de la parte externa del codo, esta afección suele confundirse con el codo de tenista, que es un desgaste en los tendones del antebrazo al unirse al hueso. Ambas condiciones pueden incluso coexistir. La diferencia es importante, pues los tratamientos difieren. Su cirujano evaluará el punto exacto de dolor y el comportamiento de sus síntomas para distinguirlas.

En la mayoría de los casos, la afección mejora sin necesidad de cirugía: primero se recomiendan reposo, cambios en las actividades y otros tratamientos no quirúrgicos. La cirugía para aliviar la presión se reserva para aquellos casos que no mejoran a pesar de estas medidas.

¿Qué podemos hacer al respecto?

El Dr. Kieran Hirpara, cirujano de extremidades superiores en el Mater Private Hospital Rockhampton, comienza con las opciones menos invasivas que se adapten a su condición. Por lo general, los pacientes son derivados a nuestra clínica por su médico de cabecera; si un fisioterapeuta le ha sugerido que nos consulte, igualmente necesitará una derivación de su médico de cabecera para poder acceder al reembolso de Medicare. En su primera visita, tomamos su historia clínica, examinamos su codo y solicitamos estudios de imagen si resultan útiles. Las radiografías simples suelen ser el primer examen. Una resonancia magnética puede confirmar si hay presión sobre el nervio y descartar otras causas del dolor.

Para esta afección, el tratamiento no quirúrgico es lo primero. Normalmente comenzamos con el reposo y con cambios en las actividades que desencadenan el dolor; eso podría implicar reducir temporalmente las torsiones repetidas, el agarre o el levantamiento de pesas. La fisioterapia tiene como objetivo calmar la irritación y permitir que el nervio se desplace sin sufrir tracción. El uso de férulas en la muñeca también puede formar parte de este tratamiento inicial. Probamos estas medidas durante un tiempo razonable antes de considerar cualquier otro enfoque.

No utilizamos inyecciones para esta condición, por lo que no le ofreceremos inyecciones de cortisona ni similares. Los analgésicos y antiinflamatorios de venta libre, aquellos que se pueden adquirir en la farmacia, pueden ayudar a aliviar el dolor mientras las demás medidas surten efecto; sin embargo, solo tratan los síntomas, no la causa.

La cirugía se considera cuando el dolor persiste a pesar de haber aplicado adecuadamente el tratamiento no quirúrgico. La intervención se denomina liberación del túnel radial; consiste en localizar cada punto a lo largo del nervio donde alguna estructura ejerce presión y liberar dicha presión, sin afectar el riego sanguíneo del nervio. Dado que pueden existir varios puntos de presión, se examina y libera toda la extensión del nervio. Analizaremos juntos si la cirugía es adecuada para usted y tomaremos la decisión en conjunto.

Qué esperar

En la mayoría de las personas, esta afección evoluciona de forma lenta y persistente, en lugar de aparecer de repente. El dolor suele disminuir con el reposo, pero reaparece al realizar las mismas actividades; por eso puede ir y venir durante meses si se siguen realizando las tareas que lo desencadenan. En primer lugar se recomienda el tratamiento no quirúrgico, y en muchos casos esto produce mejoría. Si el dolor persiste a pesar de haber aplicado dichas medidas, la cirugía para aliviar la presión es una opción en casos resistentes al tratamiento conservador.

La recuperación tras una irritación nerviosa lleva tiempo. Los nervios sanan lentamente, por lo que la mejoría suele observarse a lo largo de semanas o meses, no en días. Es posible que primero note que el dolor profundo disminuye; posteriormente, al disiparse la irritación, girar la muñeca, agarrar objetos o levantar peso resultará más cómodo. Algunas personas mejoran de forma constante; otras, en cambio, siguen sintiendo dolor o este vuelve cuando retoman las mismas actividades repetitivas. Es importante fijarse metas realistas, pues el objetivo es contar con un brazo funcional y cómodo, no garantizar la ausencia total de dolor.

Tras la cirugía, en la que se liberan los puntos de presión, muchas personas experimentan un alivio duradero del dolor. No obstante, la cirugía no es efectiva para todos; algunas personas siguen sintiendo dolor o lo vuelven a experimentar posteriormente. Tampoco existe un único factor que explique todos los casos, motivo por el cual los resultados varían. Si no se trata la afección y se continúan realizando las mismas actividades, el dolor suele persistir o reaparecer, en lugar de desaparecer por sí solo.

Existe otro problema distinto: cuando la rama nerviosa encargada de mover la muñeca y los dedos sufre una presión lo suficientemente fuerte como para afectar sus señales. En este caso, puede aparecer debilidad en la muñeca y los dedos; si esto ocurre tras una operación cercana, normalmente mejora en un plazo de 3 meses, y a más tardar en 5 meses. Su cirujano le indicará si este es su caso, ya que el pronóstico y el plan de tratamiento difieren de los de la afección que solo provoca dolor.

¿Cuándo consultar a un especialista?

Acuda a su médico de cabecera si experimenta un dolor profundo en la parte externa del codo que se repite con frecuencia; en particular, si hay un punto sensible a la presión situado a unos 3–5 centímetros por debajo del bulto óseo, y si girar el antebrazo empeora el dolor. Solicite una valoración especializada si el dolor persiste tras un período razonable de reposo y cambios en las actividades, o si le impide seguir trabajando. Por lo general, esta afección no provoca entumecimiento, hormigueo ni debilidad; sin embargo, si estos síntomas aparecen, infórmelo a su médico, pues indican la posibilidad de otro problema nervioso que requiere evaluación urgente.

En mayor profundidad

Esta sección profundiza más de lo necesario para que usted tome sus propias decisiones terapéuticas. El síndrome del túnel radial merece ser leído con atención, aunque sea por una razón desagradable: se trata de la afección en esta zona con la base de evidencia más débil; no existe ninguna prueba que la confirme, y conocer abiertamente el grado de incertidumbre debe formar parte de cualquier decisión quirúrgica.

No existe una prueba confirmatoria

La mayoría de las compresiones nerviosas pueden demostrarse. El síndrome del túnel carpiano provoca una disminución en la conducción nerviosa a nivel de la muñeca; el síndrome del túnel cubital, a nivel del codo. En cambio, el síndrome del túnel radial, por lo general, no presenta este fenómeno: la rama nerviosa afectada inerva músculos y no piel, por lo que no hay entumecimiento que pueda localizarse; además, los estudios de conducción nerviosa suelen ser normales.

Por consiguiente, el diagnóstico se basa en el patrón de dolor, en la sensibilidad al tacto a unos pocos centímetros distal al epicóndilo lateral (no justo sobre él) y en la respuesta al bloqueo anestésico local. Cada uno de estos signos resulta sugestivo, pero ninguno es concluyente. Revisiones recientes señalan la controversia persistente en torno al diagnóstico y los resultados [1].

La consecuencia práctica es una alta tasa de confusión con el codo de tenista, que se localiza justo al lado y puede coexistir con el síndrome del túnel radial. El “codo de tenista” crónico que no responde a un tratamiento adecuado constituye una de las situaciones más frecuentes en las que finalmente se sospecha del síndrome del túnel radial.

La evidencia sobre su tratamiento es realmente escasa

Una revisión sistemática de las distintas intervenciones reveló una tendencia a pensar que la descompresión quirúrgica podría ser efectiva; además, el hallazgo más destacado es que la eficacia de los tratamientos conservadores es desconocida, ya que para la mayoría de ellos no existen estudios en absoluto [2].

Esta no es la típica formulación de “la evidencia es limitada”. En el caso de la mayoría de los tratamientos no quirúrgicos disponibles para esta afección, simplemente no se han realizado estudios. Las revisiones actuales siguen recomendando el tratamiento no quirúrgico como primera opción; la descompresión quirúrgica se considera una alternativa viable para casos refractarios [1]. Este orden de prioridades refleja una prudencia razonable, más que una superioridad demostrada de alguna opción sobre las demás.

Qué implica esto a la hora de tomar una decisión

Se derivan dos consecuencias, que van en direcciones opuestas.

En contra de la cirugía temprana: no se puede confirmar el diagnóstico, por lo que la operación podría estar realizándose para descomprimir un nervio que no es el causante del problema. Cuando la descompresión fracasa, a menudo resulta imposible determinar si la intervención fue insuficiente o si el diagnóstico estaba equivocado.

Para considerar la cirugía en el paciente adecuado: tampoco existen bases científicas que respalden las alternativas; por lo tanto, la espera no es la opción respaldada por la evidencia como muchos suponen. Simplemente es la opción de menor riesgo.

La postura razonable es que, aquí más que en ningún otro punto de este sitio, un diagnóstico fiable es fundamental: se requiere una historia clínica coherente, un examen que localice el problema en el túnel radial y no en el epicóndilo, estudios de imagen que descarten la presencia de una lesión ocupante de espacio, y, a ser posible, una respuesta convincente al bloqueo diagnóstico antes de llevar a cabo una intervención irreversible.

Un problema relacionado pero distinto

La parálisis del nervio interóseo posterior, caracterizada por debilidad en la extensión de los dedos y el pulgar en lugar de dolor, constituye una entidad clínica distinta con un manejo más definido. Cuando las imágenes no revelan ninguna lesión compresiva, se debe intentar primero el tratamiento conservador; la cirugía queda reservada para casos en que se confirme la existencia de dichas lesiones o cuando el tratamiento conservador fracase [3]. En ausencia de lesiones que ocupen espacio, resulta recomendable optar por un manejo no quirúrgico; se aconseja realizar una exploración quirúrgica si no se observan signos de recuperación muscular tras 6 semanas de seguimiento, o si la debilidad progresa [4].

Estos son umbrales concretos, y su existencia ilustra claramente la diferencia: cuando el nervio deja de funcionar visiblemente, la literatura médica indica qué hacer y cuándo hacerlo. Cuando solo hay dolor, no puede hacerlo.

Referencias

[1] Wolf JM, Patel R, Ghosh K. Síndrome del túnel radial: revisión y mejores evidencias. J Am Acad Orthop Surg. 2023;31(15):813-9. https://doi.org/10.5435/JAAOS-D-23-00314

[2] Huisstede B, Miedema HS, van Opstal T, de Ronde MT, Verhaar JA, Koes BW. Intervenciones para el tratamiento del síndrome del túnel radial: una revisión sistemática de estudios observacionales. J Hand Surg Am. 2008;33(1):72.e1-72.e10. https://doi.org/10.1016/j.jhsa.2007.10.001

[3] McGraw I. Parálisis espontánea aislada del nervio interóseo posterior: revisión de su etiología y tratamiento. J Hand Surg Eur Vol. 2018;44(3):310-6. https://doi.org/10.1177/1753193418813788

[4] Sigamoney KV, Rashid A, Ng CY. Tratamiento de la parálisis no traumática del nervio interóseo posterior. J Hand Surg Am. 2017;42(10):826-30. https://doi.org/10.1016/j.jhsa.2017.07.026

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [3].
  • The primary issue surrounding radial tunnel syndrome has traditionally been properly identifying it clinically [2].
  • The Rule-of-Nine test effectively specifies the site of tenderness for the diagnosis of radial tunnel syndrome [4].
  • A prospective evaluation of corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome [5].
  • Nonsurgical management is first-line for radial tunnel syndrome [1].
  • Surgical decompression remains a viable option for refractory cases of radial tunnel syndrome despite ongoing controversy regarding diagnosis and outcomes [1].
  • Pain in patients with radial tunnel syndrome may be treated successfully by surgical decompression of the superficial branch of the radial nerve [12].
  • In high radial nerve entrapment neuropathy cases resistant to conservative treatment, surgery is advocated with emphasis on dissecting the entire length of the fibrous tunnel [6].
  • A study on high-resolution dynamic ultrasonography for posterior interosseous nerve compression acknowledges that it does not establish diagnostic accuracy or a reference standard for radial tunnel syndrome [15].

Anatomy & Pathophysiology

Radial Tunnel Anatomy

  • The radial tunnel is a potential space located anterior to the proximal radius through which the posterior interosseous nerve (PIN) passes [8].
  • The radial tunnel extends for approximately 5 cm starting from the level of the humeroradial joint and extending past the proximal edge of the supinator [8].
  • The radial tunnel is bound on the lateral side by the brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis muscles [8].
  • The radial tunnel is bound on the medial side by the supinator muscle [8].
  • The posterior interosseous nerve crosses the radial head midline [55].
  • Supination of the forearm increases the linear distance between the posterior interosseous nerve and the radial head [55].
  • Predictive accuracy for posterior interosseous nerve localization in the proximal forearm was highest when the arm was in a supinated position [66].

Pathophysiology & Etiology

  • Radial tunnel syndrome is a pain syndrome presumed to be caused by compression of the posterior interosseous nerve at the proximal forearm [8].
  • There is dispute over the etiology of radial tunnel syndrome, with skeptics noting that its signs and symptoms contrast from other well-described entrapment neuropathies [7].
  • Skeptics note that radial tunnel syndrome presents with prominent focal tenderness, normal neurologic function, and no confirmatory electrodiagnostic evidence of nerve dysfunction [7].
  • Focal tenderness at the radial tunnel in radial tunnel syndrome differs from a positive Phalen's test in carpal tunnel syndrome because symptoms do not occur in the distribution of the purportedly affected nerve [7].
  • The posterior interosseous nerve carries unmyelinated (group IV) afferent fibers from the wrist capsule [7].
  • The posterior interosseous nerve carries small myelinated (group IIA) afferent fibers from the muscles along its distribution [7].
  • Unmyelinated group IV fibers from muscles are associated with nociception and pain [7].
  • There are no specific electrodiagnostic findings for radial tunnel syndrome [8].

Classification

  • There is dispute over the etiology of radial tunnel syndrome, with skeptics noting that its signs and symptoms contrast from other well-described entrapment neuropathies such as carpal tunnel syndrome and cubital tunnel syndrome [7].
  • Focal tenderness at the radial tunnel in radial tunnel syndrome differs from a positive Phalen's test in carpal tunnel syndrome in that the symptoms do not occur in the distribution of the purportedly affected nerve [7].
  • Radial tunnel syndrome and posterior interosseous nerve compression are distinct entities with different clinical presentations but share identical potential sites of nerve interference [14].
  • The author proposes unifying radial tunnel syndrome and posterior interosseous nerve compression as mild and severe forms of one disease to simplify nomenclature [14].
  • The authors advocate for consistent use of the terminology distinguishing the deep branch of the radial nerve and the posterior interosseous nerve [24].
  • The authors recommend viewing radial tunnel syndrome and posterior interosseous nerve syndrome as a single condition presenting along a spectrum of nerve entrapment [24].
  • The study provides credence to the concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve [9].
  • The prevalence of radial tunnel syndrome in a representative United States insurance database was 0.091% [70].
  • The annual incidence of radial tunnel syndrome in a representative United States insurance database was 0.0091% [70].
  • Approximately 5.7% of the patients with radial tunnel syndrome also had a diagnosis of lateral epicondylitis on the same side within 6 months of radial tunnel syndrome diagnosis [70].

Clinical Presentation

Diagnostic Criteria and Physical Findings

  • Diagnosis of radial tunnel syndrome depends on clinical presentation and physical findings [8].
  • Prominent focal tenderness in the area of the radial tunnel is one of the principal diagnostic criteria for radial tunnel syndrome [7].
  • Clinical diagnosis criteria for radial tunnel syndrome include activity-related pain, maximal tenderness 3–5 cm distal to the lateral epicondyle, pain exacerbation with forearm supination, radiation to the dorsoradial aspect of the forearm, and a positive Lister test [42].
  • A positive Lister test is defined as pain with resisted middle finger extension [42].
  • Patients required to have at least 4 of the 5 diagnostic signs and symptoms for a clinical diagnosis of radial tunnel syndrome, with maximal tenderness 3–5 cm distal to the lateral epicondyle being mandatory [42].
  • Physical examination maneuvers to elicit radial tunnel syndrome include wrist flexion and forearm pronation, the Rule of Nines test, and weakness and pain with resisted long finger extension [46].
  • The history for radial tunnel syndrome is characterized by extensor musculature "forearm aching" [46].

Neurologic and Electrodiagnostic Features

  • Skeptics note that radial tunnel syndrome presents with normal neurologic function, contrasting with other well-described entrapment neuropathies [7].
  • Skeptics note that there is no confirmatory electrodiagnostic evidence of nerve dysfunction in radial tunnel syndrome [7].
  • Focal tenderness at the radial tunnel differs from a positive Phalen's test in carpal tunnel syndrome because symptoms do not occur in the distribution of the purportedly affected nerve [7].
  • The posterior interosseous nerve carries unmyelinated (group IV) afferent fibers from the wrist capsule and small myelinated (group IIA) afferent fibers from the muscles along its distribution [7].

Differential Diagnosis and Controversy

  • There is dispute over the etiology of radial tunnel syndrome, with skeptics noting its signs and symptoms contrast from carpal tunnel syndrome and cubital tunnel syndrome [7].
  • Radial tunnel syndrome and posterior interosseous nerve syndrome may be viewed as a single condition presenting along a spectrum of nerve entrapment [24].
  • Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve, leading to painful and dysesthetic symptoms at the lateral aspect of the elbow [16].
  • Patients with superficial radial nerve compression due to type A ganglion cysts are often initially diagnosed and managed as lateral epicondylitis [16].

Investigations

Clinical Diagnosis and Controversy

  • Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [8].
  • The diagnosis of radial tunnel syndrome depends on clinical presentation and physical findings [8].
  • The primary issue surrounding radial tunnel syndrome is properly identifying it clinically [2].
  • Radial tunnel syndrome is described as an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [3].
  • The lack of specific electrodiagnostic and pathophysiologic findings makes radial tunnel syndrome somewhat controversial [8].

Electrodiagnostics

  • Understanding the anatomic course and distribution of the radial nerve is important to make an accurate diagnosis [11].

Imaging

  • Magnetic resonance imaging provides credence to the concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve [9].
  • Dynamic ultrasonographic assessment of changes in the anteroposterior diameter and cross-sectional area is an effective diagnostic tool for identifying radial tunnel syndrome [64].
  • A study on high-resolution dynamic ultrasonography for posterior interosseous nerve compression does not establish diagnostic accuracy or a reference standard for radial tunnel syndrome [15].
  • Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve, which can present with symptoms initially diagnosed as lateral epicondylitis [16].
  • Magnetic resonance imaging can reveal the presence of a mass compatible with a ganglion cyst coming from the radiocapitellar joint that pushes up the superficial sensory branch of the radial nerve [16].

Treatment

Non-Operative

  • Nonsurgical management is the first-line treatment for radial tunnel syndrome [1].
  • The two most common nerve entrapment disorders about the elbow, including radial tunnel, should be initially managed conservatively before considering surgical intervention [41].
  • A prospective evaluation of a single corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome [5].
  • A prospective evaluation of a single corticosteroid injection in radial tunnel syndrome was conducted by authors who declared no potential conflicts of interest and received no financial support for the research [22].

Operative

  • Surgical decompression remains a viable option for refractory cases of radial tunnel syndrome [1].
  • There is a tendency that surgical decompression of the radial tunnel might be effective in patients with radial tunnel syndrome [48].
  • In high radial nerve entrapment neuropathy cases resistant to conservative treatment, surgery is advocated with an emphasis on dissecting the entire length of the fibrous tunnel [6].
  • There has been no randomized controlled trial that compares surgical with nonsurgical treatment or with a placebo for radial tunnel syndrome [7].

Complications

  • Nerve injury is an uncommon though troublesome complication of fractures or dislocations of the elbow [18].
  • Workers' compensation patients and those with associated lateral epicondylitis may have less successful outcomes following surgical treatment for radial tunnel syndrome [8].

Recovery

  • Prospective evaluation of corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome [5].
  • Isolated posterior interosseous nerve neurectomy has shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up [30].

Key Evidence

  • [L4] The article reviews the anatomy, diagnosis, and treatment of radial tunnel syndrome, noting that while nonsurgical management is first-line, surgical decompression remains a viable option for refractory cases despite ongoing controversy regarding diagnosis and outcomes. [1] (10.5435/jaaos-d-23-00314)
  • [L5] The issue surrounding radial tunnel syndrome traditionally has been properly identifying it clinically. [2] (10.1097/01.bth.0000231580.32406.71)
  • [L5] Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis. [3] (10.1016/j.jhsa.2010.03.020)
  • [L4] The Rule-of-Nine test effectively specifies the site of tenderness for the diagnosis of radial tunnel syndrome. [4] (10.1177/230949900401200115)
  • [L4] Prospective evaluation of corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome. [5] (10.1016/j.jhsa.2017.06.095)
  • [Case_report] The authors advocate for surgery in high radial nerve entrapment neuropathy cases resistant to conservative treatment, emphasizing the importance of dissecting the entire length of the fibrous tunnel. [6] (10.1016/j.jse.2025.02.060)
  • [L5] [7] (10.1016/j.jhsa.2009.10.016)
  • [L5] [8] (10.1016/j.ocl.2012.07.022)
  • [L4] The study provides credence to the somewhat disputed concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve. [9] (10.1148/radiol.2401050028)
  • [L5] It is important to understand the anatomic course and distribution of the radial nerve in order to make an accurate diagnosis. [11] (10.1007/s11420-011-9238-8)
  • [L4] This study indicates that pain in patients with radial tunnel syndrome may be treated successfully by surgical decompression of the superficial branch of the radial nerve. [12] (10.1177/1753193408099832)
  • [L5] Radial tunnel syndrome (RTS) and posterior interosseous nerve (PIN) compression are distinct entities with different clinical presentations but share identical potential sites of nerve interference; the author proposes unifying them as mild (RTS) and severe (PIN compression) forms of one disease to simplify nomenclature. [14] (10.1177/1753193420953990)
  • [Paper] The authors acknowledge that their study does not establish diagnostic accuracy or a reference standard for radial tunnel syndrome. [15] (10.1177/17531934261463150)
  • [L4] [16] (10.1016/j.otsr.2016.05.014)
  • [L4] Nerve injury is an uncommon though troublesome complication of fractures or dislocations of the elbow. [18] (10.1016/s0020-1383(79)80015-7)
  • [L4] [22] (10.1177/1558944718787282)
  • [L5] The authors advocate for consistent use of the terminology distinguishing the deep branch of the radial nerve (DBRN) and the posterior interosseous nerve (PIN), and recommend viewing radial tunnel syndrome and posterior interosseous nerve syndrome as a single condition presenting along a spectrum of nerve entrapment. [24] (10.1177/17531934241254706)
  • [L4] Isolated PINN have shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up. [30] (10.1177/1558944717692093)
  • [L2] [42] (10.1016/j.jhsa.2024.09.023)
  • [L4] There is a tendency that surgical decompression of the radial tunnel might be effective in patients with RTS. [48] (10.1016/j.jhsa.2007.10.001)
  • [L5] Supination increases the linear distance between the PIN and radial head and should be considered to increase the safe working volume whenever intra-articular procedures are performed on the anterolateral aspect of the elbow. [55] (10.1016/j.jse.2018.08.019)
  • [L4] Dynamic ultrasonographic assessment of changes in the AP diameter and CSA is an effective diagnostic tool for identifying radial tunnel syndrome. [64] (10.1177/17531934261443138)
  • [L5] Predictive accuracy was highest when the arm was in a supinated position. [66] (10.1016/j.arthro.2013.03.056)
  • [L3] [70] (10.1016/j.jhsa.2023.03.007)

References

[1] Radial Tunnel Syndrome: Review and Best Evidence. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00314

[2] A Unified Approach to Radial Tunnel Syndrome and Lateral Tendinosis. Techniques in Hand & Upper Extremity Surgery. 2006. DOI: 10.1097/01.bth.0000231580.32406.71

[3] Radial Tunnel Syndrome. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.03.020

[4] A New Clinical Test for Radial Tunnel Syndrome—The Rule-of-Nine Test: A Cadaveric Study. Journal of Orthopaedic Surgery. 2001. DOI: 10.1177/230949900401200115

[5] Prospective Evaluation of Single Corticosteroid Injection in Radial Tunnel Syndrome. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.095

[6] High radial nerve entrapment neuropathy: an anatomical cadaver study and case report. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.060

[7] Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.10.016

[8] Radial Tunnel Syndrome. Orthopedic Clinics of North America. 2012. DOI: 10.1016/j.ocl.2012.07.022

[9] MR Imaging Features of Radial Tunnel Syndrome: Initial Experience. Radiology. 2006. DOI: 10.1148/radiol.2401050028

[11] Posterior Interosseous Neuropathy: Electrodiagnostic Evaluation. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery. 2012. DOI: 10.1007/s11420-011-9238-8

[12] Radial Tunnel Syndrome: Emphasis on the Superficial Branch of the Radial Nerve. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408099832

[14] Radial tunnel syndrome: definition, distinction and treatments. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420953990

[15] Re: Role of high-resolution dynamic ultrasonography in the evaluation of posterior interosseous nerve compression at radial tunnel: a prospective case-control study. Journal of Hand Surgery (European Volume). 1934. DOI: 10.1177/17531934261463150

[16] Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.05.014

[18] Acute nerve injury as a complication of closed fractures or dislocations of the elbow. Injury. 1979. DOI: 10.1016/s0020-1383(79)80015-7

[22] Prospective Evaluation of a Single Corticosteroid Injection in Radial Tunnel Syndrome. HAND. 2018. DOI: 10.1177/1558944718787282

[24] Nomenclature of the radial nerve: distinguishing between the deep branch of the radial nerve and the posterior interosseous nerve. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241254706

[30] Outcomes Following Isolated Posterior Interosseous Nerve Neurectomy: A Systematic Review. HAND. 2017. DOI: 10.1177/1558944717692093

[41] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Elbow Degenerative Conditions and Nerve Disorders > Summary.

[42] Investigating the Effect of Triamcinolone Local Injection on Clinical Outcomes of Patients With Radial Tunnel Syndrome: A Placebo-Controlled Clinical Trial. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.023

[46] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Biomechanics > Clinical Examination.

[48] Interventions for Treating the Radial Tunnel Syndrome: A Systematic Review of Observational Studies. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.10.001

[55] The posterior interosseous nerve crosses the radial head midline and increases its distance from bony structures with supination of the forearm. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.019

[64] Role of high-resolution dynamic ultrasonography in the evaluation of posterior interosseous nerve compression at radial tunnel: a prospective case-control study. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261443138

[66] Posterior Interosseous Nerve Localization in the Proximal Forearm: A Cadaveric Study Establishing a Non‐invasive, Patient‐normalized Parameter (SS‐49). Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.03.056

[70] The Epidemiology of Radial Tunnel Syndrome and Its Overlap With Lateral Epicondylitis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.03.007

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.