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Radial Tunnel Release

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Radial tunnel release relieves pain from PIN compression – distinct from tennis elbow, and how surgery helps.

Updated Sep 2026

The radial nerve wraps around the outside of the elbow and divides in the forearm. Radial tunnel release frees the deep branch where it gets pinched between the supinator muscle layers. Kieran Hirpara 4.0

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. Our assessment, based on your history, examination and imaging where needed, establishes the diagnosis.

Radial tunnel syndrome causes pain on the outer part of your elbow and forearm. The radial nerve runs down your forearm, and several separate structures along its path can press on it. These may include the edge of a muscle, a fibrous band, or small blood vessels crossing the nerve. We usually begin with non-operative care such as activity change, physiotherapy or hand therapy, splinting, or injections. Surgery is considered when that has not given enough improvement. The operation, called a radial tunnel release, eases the pressure on the nerve at each of these points. We recommend it for people whose pain has continued despite other treatment. The main aim is to relieve your pain and help your forearm and wrist work normally again.

Before the operation

You will need to stop eating and drinking seven hours before your operation. We ask for a little longer than some other practices so your surgery can be brought forward if the theatre list runs early. Your surgeon will tell you which of your usual medicines to skip on the day, and which to take as normal. Please bring a written list of everything you take, including tablets, injections and any drops or creams. Arrange for someone to drive you home afterwards, as you will not be in a fit state to drive yourself. Wear loose, comfortable clothing with sleeves that are easy to slide over your arm. Some imaging, such as X-rays, an MRI or an ultrasound scan, helps us plan the operation. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.

On the day

You will arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You will meet the anaesthetist, the doctor who looks after your sleep and pain control during the operation. This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief; the anaesthetist decides on the day based on your individual circumstances. You are then taken into the operating theatre, where the operation is performed.

When the operation is finished, you will wake up in the recovery area. Nurses will monitor you there while the anaesthetic wears off. Once you are stable, you will either move to a ward or go home the same day, depending on the procedure and how your recovery is going. If you are going home, the person you arranged to drive you will take you there.

What the operation involves

The operation is called a radial tunnel release. It is done through one cut over the front of your forearm, just below the crease of your elbow. Your surgeon works through this single opening to reach the radial nerve.

Along the nerve's path, several separate structures can press on it. These may include the edge of a muscle, a fibrous band, or small blood vessels crossing the nerve. Your surgeon finds each of these pressure points and releases them, easing the squeeze on the nerve. The surrounding tissue is left as undisturbed as possible, and the blood supply to the nerve is preserved.

Once the pressure points have been released, your surgeon closes the cut. A fine self-adhesive mesh is laid over the closed wound first, holding the skin edges together. A liquid skin adhesive is then painted over the mesh, where it sets to seal the whole thing. This stays on for roughly one to two weeks and then lifts and peels away by itself, so there is nothing to be taken out.

After the operation

You will wake up in the recovery area with nurses nearby while the anaesthetic wears off. Your arm will have a soft dressing over the wound, and pain relief will be arranged so you stay comfortable. You can move around as soon as you feel ready, and you will use your hand for light tasks straight away. This is usually a day case, so you can expect to go home the same day, although occasionally patients stay overnight. Someone should stay with you for the first 24 hours after you get home. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you.

Recovery

Your arm will have a soft dressing on when you go home. Some soreness and swelling around the wound is normal in the first days. Rest your arm when you can, keep it raised when sitting, and take the pain relief that has been arranged for you. Most people find the discomfort settles steadily as the days pass.

You can use your hand for light tasks straight away. There is no cast or routine splint after this operation, so your wrist and fingers are free to move. Gentle movement helps the nerve glide and keeps stiffness away. Your hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. Ruby is a hand therapist: she will guide your exercises and make any splint you need along the way. At home, keep the wound dry and leave the dressing alone until we review it.

As the swelling settles, you will notice your grip and forearm strength returning bit by bit. Everyday tasks such as dressing, eating and typing usually come back early on. Heavier lifting and firm gripping come later, once your hand feels strong and the tenderness has gone. When your therapist is happy with your movement and strength, you can build back to your normal activities.

You can usually drive once any splint is off and the pain has settled enough to hold the wheel and react quickly. Patients in a splint must not drive. See our page on Driving after upper-limb surgery.

Recovery varies from person to person. Your timeline may differ, and your surgeon and therapist will guide you.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

The nerve being released runs close to the operating area, so it can be irritated or injured during surgery. If this happens, you might notice weakness when lifting your wrist or straightening your fingers, or numbness and tingling on the back of your forearm, wrist or hand. Some of these changes are temporary and settle on their own over weeks to months. If you notice new weakness or numbness after the operation, tell your surgeon at your next review, or call the clinic sooner if it comes on suddenly.

Sometimes scar tissue forms around the nerve as it heals. This can press on the nerve again and bring back the pain you had before, often weeks or months after things were going well. If your original pain returns, bring it up at your next appointment. Further surgery to release the scar tissue is possible if needed.

There is also a chance the first operation does not relieve your symptoms, or that they come back soon after. This can happen if a pressure point along the nerve was missed, or if the diagnosis was not quite right. If your pain continues or returns, tell your surgeon. They will reassess you and discuss what to do next, which may include further treatment.

Any operation on the forearm carries a small risk of problems with the wound itself. Watch for increasing redness spreading out from the cut, fluid or pus leaking from it, or a fever. If you see any of these, contact the clinic straight away, or go to the emergency department if you cannot reach us.

If you are ever worried about how your arm is healing, call the clinic rather than waiting for your next visit. The complications table on this page lists typical rates if you want the specifics.

When to call us

Call us if your pain suddenly gets much worse, or if new weakness or numbness comes on quickly. Call us if the wound becomes more red, leaks fluid or pus, or if you develop a fever. Go to emergency if you cannot reach us, or if you lose feeling in your arm or cannot move it. Go to emergency straight away for shortness of breath or calf swelling. If you are ever worried, call the clinic rather than waiting for your next visit.

Where to read more about the condition

This page is about the operation itself. The condition it treats, including what the evidence shows about when surgery helps and when it does not, is covered in more detail on the Radial Tunnel Syndrome page.

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Reviewed by Dr Kieran Hirpara · 7 August 2026.

Want the clinical detail? Read the clinician version.

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.

Anatomy & Pathophysiology

Bony Anatomy

• The elbow is a trocho-ginglymoid joint consisting of medial and lateral articulations that provide bony stability [3].
• The trochlea articulates with the ulna within the greater sigmoid notch to form the ulnohumeral, hinged, or trochoid portion of the elbow joint [3].
• The ulnohumeral articulation has highly congruent anatomy through almost 180° of articular contact, except for the bare area of the greater sigmoid notch which is devoid of cartilage [3].
• The coronoid process has medial and lateral facets that buttress the trochlea anteriorly [3].
• The sublime tubercle is located just distal and medial to the coronoid and serves as the attachment site for the anterior bundle of the medial ulnar collateral ligament [3].
• The medial epicondyle is larger and more posteriorly oriented than the lateral epicondyle and forms the attachment site for the origins of the flexor pronator mass [3].
• The capitellum and radial head form the radiocapitellar joint on the lateral side [3].
• The radius is held in close approximation to the ulna at the proximal radioulnar joint by the annular ligament [3].
• The area of the ulna that articulates with the margin of the radial head at the proximal radioulnar joint is known as the lesser sigmoid notch [3].
• The radial head is a concave elliptical structure covered with articular cartilage along the radiocapitellar joint and approximately 270° of the articular margin [3].
• The radial head articulates with both the capitellum and the lesser sigmoid notch [3].
• The lateral epicondyle is the origin of the lateral extensor musculature [3].
• The origin of the lateral ulnar collateral ligamentous complex is located just distal to the lateral epicondyle at the geometric center of the radiocapitellar articulation [3].
• The distal humeral articulation is angled 30° from the longitudinal axis [3].
• The anterior humeral line should pass through the center of the axis of rotation [3].
• The axis of rotation is angulated 5° to 7° in the coronal plane relative to the epicondylar axis, with the medial side more distal than the lateral side [3].
• The angulation of the distal humeral articulation accounts for the change from a valgus carrying angle to a more varus position as the elbow is flexed [3].
• There is a high correlation between the size of the radial head and capitellum on the left and right sides in the same individual [3].
• The olecranon provides a broad attachment site for the triceps posteriorly [3].
• The ulna bends approximately 8° medially at 8 cm from the tip of the olecranon [3].
• The articulation to the tip of the coronoid is approximately 30° from the long axis of the ulna in the sagittal plane [3].
• The radial head should line up with the capitellum at all arm positions on all radiographic views [4].

Ligaments and Capsule

• Elbow stability is determined by primary and secondary stabilizers [1].
• The three primary stabilizers of the elbow are the ulnohumeral articulation, the medial ulnar collateral ligament, and the lateral ulnar collateral ligament complex [1].
• Secondary stabilizers of the elbow include the radiocapitellar articulation, the common flexor tendon, the common extensor tendon, and the joint capsule [1].
• The medial ulnar collateral ligament is the primary valgus stabilizer of the elbow [4].
• The anterior bundle of the medial ulnar collateral ligament is the most important component for stability [4].
• The posterior bundle of the medial ulnar collateral ligament has the greatest change in length and becomes taut at flexion beyond 120 degrees [4].
• The lateral ulnar collateral ligament is the posterolateral stabilizer of the elbow [4].
• The joint capsule allows maximum distension at approximately 70 to 80 degrees of flexion [4].
• The anterior capsule attaches at a point approximately 6 mm distal to the tip of the coronoid [4].
• Tensile forces are present at the medial elbow and compressive forces are present at the lateral elbow [4].
• The LUCL origin center is 10.7 mm from the lateral epicondyle [2].
• The LUCL insertion is 3.3 mm from the apex of the supinator crest [2].

Muscles and Nerves

• The brachialis is the strongest elbow flexor and attaches to the coronoid 11 mm distal to the tip [4].
• The biceps brachii inserts at the ulnar margin of the radial tuberosity, with the long head inserting proximally and the short head distally [4].
• The biceps brachii is a powerful supinator of the forearm [4].
• The triceps is the primary elbow extensor and inserts on the olecranon process [4].
• The mobile wad consists of the brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis [4].
• The flexor-pronator mass consists of the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis [4].
• The radial nerve enters the interval between the brachialis and brachioradialis muscles in the proximal angle of the lateral approach wound [6].
• The deep branch of the radial nerve enters the supinator muscle [6].
• The common origin of the extensor muscles is attached to the lateral epicondyle [6].
• The common origin of the extensor muscles is attached to the lateral condylar fragment in lateral condyle fractures [6].
• The interval between the triceps posteriorly and the origins of the extensor carpi radialis longus and brachioradialis anteriorly is used to expose the lateral border of the humerus [6].
• The interval between the triceps posteriorly and the brachioradialis and extensor carpi radialis longus muscles anteriorly is used to expose the lateral condyle and capsule over the radial head [7].
• The extensor carpi ulnaris is separated from the anconeus distal to the radial head during the lateral J-shaped approach [7].
• The distal fibers of the anconeus are divided in line with the curved and transverse parts of the distal skin incision during the lateral J-shaped approach [7].
• The anconeus is reflected subperiosteally from the proximal ulna to dislocate and examine the joint during the lateral J-shaped approach [7].

Functional Anatomy

• The normal elbow has a range of motion from 0° to 140° from extension to flexion [1].
• The normal elbow has a range of motion of 75° in pronation and 85° in supination [1].
• A functional arc for elbow flexion and extension is 100° [1].
• A functional arc for forearm rotation is 100° [1].

Investigations

Physical Examination

• The physical examination of the elbow is directed by the history and the location of the patient's pain in the anterior, posterior, medial, or lateral aspect of the elbow [1].
• Pathologic entities associated with specific compartments aid the examiner in detecting pathologic conditions [1].
• Active and passive flexion, extension, supination, and pronation should be evaluated using a goniometer for accurate measurement [9].
• The contralateral elbow should be examined for comparison during range of motion assessment [9].
• Pain should be assessed during the mid-arc or at the terminal ends of motion [9].
• Mid-arc range of motion pain is more common with intrinsic disease and may not improve with contracture release alone [9].
• The ulnar nerve is of utmost importance in the neurovascular examination due to its anatomic proximity to the elbow [9].
• Electromyography and nerve conduction velocity studies should be performed if there is any question about neurologic dysfunction [9].
• An assessment for ulnar nerve subluxation should be performed [9].
• Subluxation of the ulnar nerve is a relative contraindication for an arthroscopic procedure secondary to possible iatrogenic nerve injury [9].
• If the elbow has less than 90° to 100° of flexion, the posterior bundle of the medial collateral ligament is contracted and must be released to restore flexion [9].

Imaging

• Plain radiographs remain the hallmark and the best screening test for elbow evaluation [1].
• Standard radiographic views include AP, lateral, and oblique views [9].
• Serial radiography is used as follow-up when heterotopic ossification is present [9].
• Primary bony landmarks assessed on radiographs include the ulnohumeral joint, coronoid process, radial head, capitellum, radiocapitellar joint, olecranon tip, coronoid/olecranon fossae, and trochlear ridge [9].
• CT is helpful when assessing for malunion architecture and the location and pattern of osteophytes and/or loose bodies [9].
• Three-dimensional CT is used to check for heterotopic ossification [9].
• CT is not necessary when the stiffness is entirely soft-tissue related [9].
• CT is beneficial if any joint incongruity or abnormal bony anatomy is present [9].
• MRI can be used to evaluate ligaments and tendons, but it is rarely indicated for elbow stiffness [9].
• AP, lateral, oblique, and axillary views of the elbow may reveal posteromedial olecranon osteophytes and/or loose bodies in valgus extension overload syndrome [11].
• CT with two-dimensional reconstruction and three-dimensional surface rendering best visualizes the pathology of valgus extension overload syndrome [11].
• MRI may be most helpful in evaluating associated injuries including partial or complete tears of the medial collateral ligament in valgus extension overload syndrome [11].
• Radiographic evaluations are essential when diagnosing an osteochondritis dissecans lesion of the elbow [12].
• Important aspects of osteochondritis dissecans lesions may be better seen with MRI [12].
• Standard AP and lateral radiographs should be obtained for the evaluation of elbow osteoarthritis [13].
• Radiographs for elbow osteoarthritis typically show osteophyte formation at the coronoid process, coronoid fossa, radial fossa, radial head, olecranon tip, and olecranon fossa [13].
• Joint spaces at the ulnohumeral joint are usually preserved in elbow osteoarthritis [13].
• Joint spaces at the radiocapitellar joint are mildly narrowed in elbow osteoarthritis [13].
• Loose bodies may be evident on radiographs, which typically underestimate the number present [13].
• CT may be useful for surgical planning of elbow osteoarthritis by allowing a detailed assessment of osteophytes and the presence of loose bodies [13].

References

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

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

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

[4] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > TABLE 2.3 Shoulder Spaces.

[6] Campbell S Operative Orthopaedics 4 Volume Set. LATERAL APPROACHES.

[7] Campbell S Operative Orthopaedics 4 Volume Set. LATERAL J-SHAPED APPROACH TO THE ELBOW.

[9] Aaos Comprehensive Orthopaedic Review 3. Elbow Stiffness* > IV. Evaluation.

[11] Aaos Comprehensive Orthopaedic Review 3. Elbow Injuries in the Athlete* > III. Valgus Extension Overload Syndrome and Posterior Impingement.

[12] Orthopaedic Knowledge Update. Osteochondritis Dissecans of the Knee and Elbow* > Summary.

[13] Aaos Comprehensive Orthopaedic Review 3. Arthritis and Arthroplasty of the Elbow > I. Osteoarthritis.