Skip to content

Patients › Elbow

Radial Tunnel Syndrome

PDF Evidence

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

Updated Aug 2026
Illustration of a person clutching the upper outer forearm in pain.
Radial tunnel syndrome causes aching pain in the upper outer forearm, just below the elbow. Kieran Hirpara 4.0

What you're feeling

You may notice a deep, aching pain on the outer side of your elbow. This discomfort often travels down the top of your forearm toward your wrist and hand. Unlike other nerve issues, you typically do not lose the ability to move your fingers or wrist. Instead, the main issue is pain and tenderness when you press on specific spots along the back and side of your upper forearm.

The pain often worsens with activities that involve gripping or twisting your forearm. You might feel it intensify when you try to lift objects, turn a doorknob, or use tools like a screwdriver. Simple tasks, such as carrying a heavy shopping bag or typing for long periods, can become uncomfortable. The ache may feel like a constant dull throb that makes it hard to focus on daily work or hobbies.

Symptoms often flare up after you have been active. You might notice the pain is worse in the evening after a day of using your arm. Some people find the discomfort is more noticeable when they first wake up in the morning, especially if they slept with their arm bent or pressed against their body. Resting your arm and avoiding repetitive twisting motions usually helps to ease the tension.

Because this condition affects the radial nerve, you might also experience a strange sensation on the back of your hand. This can feel like tingling, numbness, or a mild burning sensation. It is important to know that while the pain can be persistent and frustrating, it does not typically cause weakness in your hand grip. However, the constant ache can make it difficult to perform routine tasks that require steady, pain-free movement of your forearm and wrist.

What's actually happening

The radial nerve is a major cable of electrical signals that runs down your arm. It controls the muscles that lift your wrist and fingers. It also carries sensation from the back of your hand. When this nerve gets squeezed in the elbow area, it causes pain and weakness. This condition is called radial tunnel syndrome.

Think of the radial nerve like a garden hose running through a narrow pipe. The pipe is made of tight bands of tissue and muscle. If the pipe narrows or swells, it presses against the hose. Your brain receives pain signals from this pressure. You might feel a deep ache in the outer part of your elbow. This pain often travels down your forearm. It can make it hard to straighten your fingers or lift your wrist.

The squeeze usually happens where the nerve passes under a muscle called the supinator. This muscle helps rotate your forearm. When the tissue around it becomes inflamed, it acts like a tight grip on the nerve. This is different from tennis elbow, which affects the tendons on the bone. Radial tunnel syndrome affects the nerve itself.

Your surgeon will check if the nerve is truly compressed. Sometimes, pain in this area comes from other issues. We look at how your elbow moves and where the pain starts. If conservative care does not help, we may suggest surgery. The goal is to release the tight tissue around the nerve. This gives the nerve more room to breathe. It reduces the pressure and lets your arm function normally again.

In some cases, the nerve damage is more severe. If the nerve is injured for a long time, muscles may weaken significantly. We might discuss other options to restore movement. These can include moving healthy tendons to take over the work of damaged ones. This helps you regain control of your hand and wrist. The aim is to improve your daily function and reduce pain.

What we can do about it

The approach we use for radial tunnel syndrome reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, manages this condition in our clinic. Patients reach our care through referral from a GP or physiotherapist. We begin with a thorough assessment, including a history, physical examination, and imaging when needed, to confirm the diagnosis. For most cases, we start with non-operative care. This includes changing your daily activities to avoid aggravating movements, working with a physiotherapist or hand therapist to strengthen and stretch the arm, using splints for support, and considering injections if pain persists. We view this initial phase as a shared decision, giving your body time to settle before considering more invasive steps.

Self-management is the first line of treatment. Your physiotherapist will guide you through exercises aimed at reducing pressure on the radial nerve and improving movement in your elbow and wrist. You should give this conservative care a fair trial, typically several weeks, to see if symptoms improve. If pain remains significant, we may discuss medical management options. This often involves pain medication or anti-inflammatory drugs to reduce swelling and discomfort around the nerve. In some cases, we might recommend an injection, such as cortisone, to calm inflammation directly at the site. These treatments aim to relieve symptoms and restore function without surgery. The effect of these measures varies, but they are effective for many people who do not require operative intervention.

Surgery is considered only when conservative care has not provided enough improvement or if your condition is structural or acute. In our practice, we advocate for surgical decompression in cases where high radial nerve entrapment neuropathy resists non-operative treatment. The procedure involves releasing the tight areas around the radial nerve to relieve pressure. We ensure the entire length of the fibrous tunnel is examined to address all potential compression points. If you have suffered a recent injury, early surgical exploration within 3 weeks of injury offers a significantly higher likelihood of regaining radial nerve function compared to delayed or non-surgical management. For longstanding or irreparable nerve lesions, we may discuss tendon transfers to restore movement. We discuss all options with you, ensuring you understand the benefits and risks before proceeding.

What to expect

For most people, radial tunnel syndrome improves without surgery. If you have a radial nerve injury from a closed humerus fracture, spontaneous recovery occurs in 70%–88% of cases. Your surgeon will likely recommend initial nonsurgical management because the majority of patients recover on their own. Symptoms from posterior interosseous nerve injuries typically resolve within 3 months, and at the latest, 5 months after the incident.

If your symptoms persist despite conservative care, surgery may be considered. However, outcomes vary. Surgery for lateral epicondylitis (tennis elbow) is not associated with greater improvement than nonsurgical treatment alone. For high radial nerve entrapment resistant to conservative treatment, surgery aims to dissect the entire length of the fibrous tunnel. If you require surgical exploration within 3 weeks of a humeral fracture injury, you have a significantly higher likelihood of regaining radial nerve function compared to late exploration or nonsurgical management.

Recovery is not always guaranteed. If nerve repair or reconstruction is needed, the radial nerve recovers better if performed within 5 months of injury. In cases of large nerve gaps (nine centimeters or greater), good to excellent motor recovery can be expected in 83% of patients when sural nerve autografts are used. Tendon transfers are an option for longstanding, irreparable lesions and can quickly restore efficient grip while awaiting reinnervation.

Some patients remain dissatisfied. Overall, 20% of patients remain dissatisfied with their outcomes. Complications from reconstructive surgery can persist, sometimes leading to profound disability. We advise you to discuss these realistic timelines and potential outcomes with your surgeon to set clear expectations for your specific situation.

When to see someone

See your GP if you have persistent pain in the outer elbow that does not improve with rest. Ask for a specialist review if you notice weakness or instability in your wrist or fingers. Seek urgent care if symptoms suddenly worsen or interfere with your sleep or work. Early action matters. Patients who undergo surgical exploration within 3 weeks of injury have a significantly higher likelihood of regaining radial nerve function. Nonsurgical management is the first-line treatment for radial tunnel syndrome, but persistent symptoms may require further assessment. Do not wait if your condition affects your daily activities.

Reviewed by Dr Kieran Hirpara · 10 June 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

Overview

  • Radial tunnel syndrome is a compression neuropathy of the radial nerve [2].
  • Most publications regarding uncommon upper extremity compression neuropathies, including radial tunnel syndrome, are small retrospective series or case reports [2].
  • Treatment decisions for uncommon upper extremity compression neuropathies are not typically based on high levels of evidence [2].
  • Nonsurgical management is the first-line treatment for radial tunnel syndrome [1].
  • Surgical decompression is a viable option for refractory cases of radial tunnel syndrome [1].
  • There is ongoing controversy regarding the diagnosis and outcomes of radial tunnel syndrome [1].
  • Surgery is advocated for high radial nerve entrapment neuropathy cases resistant to conservative treatment [14].
  • Dissection of the entire length of the fibrous tunnel is important in the surgical management of high radial nerve entrapment neuropathy [14].

Anatomy & Pathophysiology

  • The humeral trochlea protrudes into the cubital tunnel during elbow flexion, causing dynamic morphologic changes in the ulnar nerve [38].
  • Shoulder position increases ulnar nerve strain at the elbow of patients with cubital tunnel syndrome [47].
  • Increased elbow flexion in patients with cubital tunnel syndrome influences the intraneural blood flow of the ulnar nerve [49].
  • The mechanism of symptom provocation in cubital tunnel syndrome by the elbow flexion test is not explained simply by dynamic pressure in the cubital tunnel, suggesting other pathophysiological factors contribute [54].
  • Ulnar nerve gliding is most severe during passive wrist movement in elbow flexion and forearm supination [55].
  • Dynamic ulnar nerve compression at the elbow due to the anconeus epitrochlearis muscle is an uncommon disorder with unknown incidence and pathophysiologic mechanisms [66].
  • The throwing elbow is a common source of nerve injuries due to the unique combination of anatomy, high forces, and sheer repetition associated with throwing sports [60].
  • The study documents the incidence and distribution pattern of motor damage in patients with radiohumeral epicondylopathy and illustrates variations in topographical and functional neuroanatomy to describe a pathoanatomic substrate for this clinical picture [61].
  • A cadaveric study could not detect a definitive effect of elbow deformity (cubitus valgus/varus) on ulnar nerve strain or demonstrate the extent of acceptable clinical elbow deformity [59].
  • No significant relationships were found between chronic structural adaptations of the shoulder (strength or ROM) and chronic structural adaptations of the elbow in professional baseball pitchers [34].

Classification

  • Radial tunnel syndrome is defined as a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [10].
  • Radial tunnel syndrome is considered an illness construct based on speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [5].
  • Radial tunnel syndrome and posterior interosseous nerve syndrome are viewed as a single condition presenting along a spectrum of nerve entrapment [37].
  • Radial tunnel syndrome is distinguished from posterior interosseous nerve syndrome and superficial radial nerve compression (Wartenberg's syndrome) within the context of unusual compression neuropathies of the forearm [11].
  • Radial neuropathies are rare compared to other entrapment neuropathies [3].
  • Radial tunnel syndrome is classified as an uncommon compression syndrome of the upper extremity [2].

Clinical Presentation

  • Radial tunnel syndrome is characterized as a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [10].
  • Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [5].
  • Radial neuropathies are rare [3].
  • Radial tunnel syndrome and posterior interosseous nerve syndrome are distinct clinical entities that share overlapping clinical presentations [6].

Investigations

  • Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [5].
  • Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [10].
  • Dynamic ultrasonographic assessment of changes in the anteroposterior (AP) diameter and cross-sectional area (CSA) is an effective diagnostic tool for identifying radial tunnel syndrome [68].
  • Magnetic Resonance Imaging (MRI) may depict coexistent or alternative conditions such as lateral epicondylitis, which may explain the patient's symptoms or may identify compressive lesions that may be amenable to surgical resection or decompression [45].
  • MRI has emerged as the imaging modality of choice for the evaluation of elbow pain in the athlete due to its high spatial resolution, excellent soft tissue contrast, and multiplanar imaging capabilities [70].
  • Most clinicians order preoperative tests before offering surgery for cubital tunnel syndrome, but only 6% order both electrodiagnostic (EDX) testing and ultrasound as per expert consensus [7].
  • Clinical evaluation is paramount in the diagnosis of cubital tunnel syndrome because electrodiagnostic testing often is not sufficiently sensitive to detect changes associated with the syndrome [9].
  • Ultrasound may be able to better identify patients with early stages of ulnar neuropathy with negative electrodiagnostic findings [72].
  • MRI is an effective diagnostic modality, and clinicians should be aware of primary synovial chondromatosis as a causative factor of cubital tunnel syndrome [20].
  • Only a small number of individuals with MRI evidence of an anconeus epitrochlearis muscle (AEM) had clinical evidence of ulnar neuropathy [48].

Treatment

Non-Operative Management

  • Nonsurgical management is the first-line treatment for radial tunnel syndrome [1].
  • Initial treatment of most compressive neuropathies at the elbow is nonoperative, consisting of rest and avoidance of elbow flexion [35].
  • Most cases of ulnar nerve compression improve with nonsurgical treatment [43].
  • A prolonged nonsurgical approach is warranted in most cases for median nerve or anterior interosseous nerve (AIN) compression [46].

Operative Management: Indications and Outcomes

  • Surgical decompression remains a viable option for radial tunnel syndrome cases refractory to nonsurgical management [1].
  • Surgery is advocated for high radial nerve entrapment neuropathy cases resistant to conservative treatment [14].
  • Reoperation after primary surgery of cubital tunnel syndrome gives satisfactory results for patients who fail conservative treatment [28].
  • The majority of ulnar nerve compression cases get better with surgical decompression [43].
  • Surgery is effective in treating cubital tunnel syndrome, with more than 90% of patients cured or showing improvement [19].
  • Patient-reported outcomes of surgical treatment for cubital tunnel syndrome are good but are affected by preoperative symptom severity [13].
  • In situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome with a low failure rate [39].

Operative Techniques: Decompression vs. Transposition

  • Current evidence suggests that different surgical methods to treat ulnar neuropathy at the elbow do not differ in their clinical outcomes [15].
  • Simple decompression and anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome have been compared in a meta-analysis [18].
  • Both minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve can be used for the treatment of cubital tunnel syndrome with a high rate of satisfaction [36].
  • In situ decompression and partial epicondylectomy both represent efficient and safe methods for cubital tunnel syndrome management [56].
  • Medial epicondylectomy is recommended for patients with cubital tunnel syndrome associated with abnormal nerve-conduction velocity [25].

Operative Techniques: Endoscopic vs. Open

  • Endoscopic and open cubital tunnel release techniques demonstrate similar effectiveness, outcomes, complication profiles, and reoperation rates for idiopathic cubital tunnel syndrome [40].
  • An open randomized controlled trial (EVOCU) aims to provide evidence-based recommendations on the efficacy, patient treatment experience, and safety profile of endoscopic versus open release for cubital tunnel syndrome [24].
  • The endoscopic technique has proven effective in the treatment of cubital tunnel syndrome [42].

Operative Technical Considerations

  • Clinical evaluation is paramount in the diagnosis of cubital tunnel syndrome because electrodiagnostic testing often is not sufficiently sensitive to detect changes associated with the syndrome [9].
  • For high radial nerve entrapment neuropathy, it is important to dissect the entire length of the fibrous tunnel during surgery [14].

Complications

  • Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [5].
  • Most publications regarding uncommon compression syndromes of the radial, ulnar, and median nerves are small retrospective series or case reports [2].
  • Treatment decisions for uncommon compression syndromes are not typically based on high levels of evidence [2].
  • Radial neuropathies are rare [3].
  • The short-term complication rates of cubital tunnel surgery are low (3.2%) [27].
  • Short-term complication rates for cubital tunnel surgery are higher for patients with chronic kidney disease [27].
  • Results of revision surgery for recurrent or persistent cubital tunnel syndrome are less predictable and satisfying than primary surgery [29].
  • The risk of revision surgery following in situ ulnar nerve decompression for idiopathic cubital tunnel syndrome is low [69].
  • The risk of revision surgery following in situ ulnar nerve decompression for idiopathic cubital tunnel syndrome is increased in patients younger than 50 years [69].

Recovery

  • Surgical decompression is a viable option for refractory cases of radial tunnel syndrome, despite ongoing controversy regarding diagnosis and outcomes [1].
  • Most publications on uncommon compression syndromes of the radial nerve are small retrospective series or case reports, and treatment decisions are not typically based on high levels of evidence [2].
  • Radial neuropathies are rare [3].

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)
  • [L4] This article reviews uncommon compression syndromes of the radial, ulnar, and median nerves, noting that most publications are small retrospective series or case reports and treatment decisions are not typically based on high levels of evidence. [2] (10.1016/j.hcl.2013.04.014)
  • [L3] Ulnar and radial neuropathies were less common, with ulnar neuropathies more frequent in men and radial neuropathies being rare. [3] (10.1177/1753193419886741)
  • [L5] Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis. [5] (10.1016/j.jhsa.2010.03.020)
  • [Paper] This article is a review of the history, anatomy, and clinical presentation of radial tunnel syndrome (RTS) and posterior interosseous nerve syndrome (PINS). [6] (10.1016/s0749-0712(21)00357-7)
  • [L4] Most clinicians order preoperative tests before offering surgery for cubital tunnel syndrome, but only 6% order both EDX and ultrasound as per expert consensus. [7] (10.1177/17531934261434155)
  • [L4] Clinical evaluation is paramount in the diagnosis of cubital tunnel syndrome because electrodiagnostic testing often is not sufficiently sensitive to detect changes associated with the syndrome. [9] (10.1016/j.hcl.2013.08.019)
  • [L5] Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm. [10] (10.1016/j.ocl.2012.07.022)
  • [L5] This article is a review examining unusual compression neuropathies of the forearm, specifically focusing on the radial nerve, including posterior interosseous nerve syndrome, radial tunnel syndrome, and superficial radial nerve compression (Wartenberg's syndrome). [11] (10.1016/j.jhsa.2009.10.016)
  • [L3] The patient-reported outcome of surgical treatment of cubital tunnel syndrome is good but is affected by preoperative symptom severity. [13] (10.1016/j.jhsa.2009.05.014)
  • [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. [14] (10.1016/j.jse.2025.02.060)
  • [L4] Current evidence suggests that different surgical methods to treat ulnar neuropathy at the elbow do not differ in their clinical outcomes. [15] (10.1016/j.hcl.2013.04.013)
  • [L1] This report represents the best cumulative evidence to date examining the surgical management of cubital tunnel syndrome. [18] (10.1016/j.jhsa.2008.03.006)
  • [L4] Surgery was effective in treating cubital tunnel syndrome with more than 90% of patients cured or showing improvement. [19] (10.1016/j.otsr.2014.03.009)
  • [Case_report] MRI is an effective diagnostic modality, and clinicians should be aware of primary synovial chondromatosis as a causative factor of cubital tunnel syndrome. [20] (10.1177/1758573216683396)
  • [L2] This study aims to provide an evidence-based recommendation on which method has the best efficacy, patient treatment experience, and safety profile for cubital tunnel syndrome by comparing open and endoscopic release. [24] (10.1186/s12891-023-06234-y)
  • [L4] The procedure is recommended for patients with cubital tunnel syndrome associated with abnormal nerve-conduction velocity. [25] (10.2106/00004623-198062060-00016)
  • [L4] The short-term complication rates of cubital tunnel surgery are low (3.2%), but higher for patients with chronic kidney disease. [27] (10.1016/j.jhsa.2017.01.020)
  • [L4] Results of revision surgery for recurrent or persistent cubital tunnel syndrome are less predictable and satisfying than primary surgery. [29] (10.1016/j.jhsa.2011.11.024)
  • [L3] However, no significant relationships between adaptations in shoulder strength or ROM were related to chronic structural adaptations of the elbow. [34] (10.1177/03635465251317509)
  • [L5] Initial treatment of most compressive neuropathies at the elbow is nonoperative, consisting of rest and avoidance of elbow flexion. [35] (10.5435/00124635-199809000-00004)
  • [L3] Both methods can be used for the treatment of cubital tunnel syndrome with a high rate of satisfaction. [36] (10.1016/j.jse.2005.10.007)
  • [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. [37] (10.1177/17531934241254706)
  • [L5] The humeral trochlea protrudes into the cubital tunnel during elbow flexion, causing dynamic morphologic changes in the ulnar nerve. [38] (10.1016/j.jse.2022.05.026)
  • [L4] In situ decompression of the ulnar nerve is a reliable treatment for cubital tunnel syndrome with a low failure rate. [39] (10.1177/1753193408101467)
  • [L1] The current study demonstrates similar effectiveness between the endoscopic (ECTuR) and open (OCTuR) techniques for treatment of idiopathic cubital tunnel syndrome with similar outcomes, complication profiles, and reoperation rates. [40] (10.1177/1558944715616097)
  • [L4] The technique has proven effective in the treatment of cubital tunnel syndrome. [42] (10.1177/1753193408094443)
  • [L4] MR imaging may depict coexistent or alternative conditions such as lateral epicondylitis, which may explain the patient's symptoms or may identify compressive lesions that may be amenable to surgical resection or decompression. [45] (10.1148/radiol.2401050028)
  • [L5] Surgical decompression of the median nerve or the AIN in the forearm is rarely indicated; a prolonged nonsurgical approach is warranted in most cases. [46] (10.5435/jaaos-d-16-00010)
  • [L4] To the best of our knowledge, this is the first study showing that shoulder position changes the ulnar nerve strain around the elbow in living patients with CubTS. [47] (10.1016/j.jse.2015.01.014)
  • [L4] Only a small number of individuals with MRI evidence of an AEM had clinical evidence of ulnar neuropathy. [48] (10.1016/j.jse.2018.03.021)
  • [L3] Increased elbow flexion in patients with CuTS influences the intraneural blood flow of the ulnar nerve. [49] (10.1016/j.jhsa.2021.06.024)
  • [L3] The mechanism of provocation of symptoms of cubital tunnel syndrome by the elbow flexion test could not be explained simply by dynamic pressure in the cubital tunnel, and other pathophysiological factors could also be contributing. [54] (10.1016/j.jhsa.2010.11.013)
  • [L4] Ulnar nerve gliding was most severe during passive wrist movement in elbow flexion and forearm supination. [55] (10.5397/cise.2024.00934)
  • [L3] In situ decompression and partial epicondylectomy both represent efficient and safe methods for cubital tunnel syndrome management. [56] (10.1016/j.jse.2009.10.014)
  • [L5] The study could not detect a definitive effect of elbow deformity on ulnar nerve strain or demonstrate the extent of acceptable clinical elbow deformity. [59] (10.1186/s12891-022-05786-9)
  • [L5] The throwing elbow is a common source of nerve injuries due to the unique combination of anatomy, high forces, and sheer repetition associated with throwing sports. [60] (10.1016/j.csm.2004.04.012)
  • [L4] Dynamic ulnar nerve compression at the elbow due to the anconeus epitrochlearis muscle is an uncommon, little-known disorder with much remaining to be elucidated about its incidence and pathophysiologic mechanisms. [66] (10.1016/j.jhsg.2022.11.002)
  • [L4] Dynamic ultrasonographic assessment of changes in the AP diameter and CSA is an effective diagnostic tool for identifying radial tunnel syndrome. [68] (10.1177/17531934261443138)
  • [L3] For patients with idiopathic cubital tunnel syndrome, the risk of revision surgery following in situ ulnar nerve decompression is low, but increased in patients younger than 50 years. [69] (10.1016/j.jhsa.2015.12.012)
  • [L5] MRI has emerged as the imaging modality of choice for the evaluation of elbow pain in the athlete due to its high spatial resolution, excellent soft tissue contrast, and multiplanar imaging capabilities. [70] (10.1016/j.csm.2010.06.004)
  • [L4] Ultrasound may be able to better identify patients with early stages of ulnar neuropathy with negative electrodiagnostic findings. [72] (10.1016/j.jhsa.2023.08.014)

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] Uncommon Upper Extremity Compression Neuropathies. Hand Clinics. 2013. DOI: 10.1016/j.hcl.2013.04.014 [3] Incidence and operations of median, ulnar and radial entrapment neuropathies in Finland: a nationwide register study. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419886741 [5] Radial Tunnel Syndrome. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.03.020 [6] RADIAL TUNNEL SYNDROME. Hand Clinics. 1996. DOI: 10.1016/s0749-0712(21)00357-7 [7] Preoperative tests before cubital tunnel decompression in 2025. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261434155 [9] Minimal-Incision In Situ Ulnar Nerve Decompression at the Elbow. Hand Clinics. 2014. DOI: 10.1016/j.hcl.2013.08.019 [10] Radial Tunnel Syndrome. Orthopedic Clinics of North America. 2012. DOI: 10.1016/j.ocl.2012.07.022 [11] Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.10.016 [13] Patient-Rated Outcome of Ulnar Nerve Decompression: A Comparison of Endoscopic and Open In Situ Decompression. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.05.014 [14] 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 [15] Ulnar Neuropathy at the Elbow. Hand Clinics. 2013. DOI: 10.1016/j.hcl.2013.04.013 [18] Simple Decompression Versus Anterior Subcutaneous and Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Meta-Analysis. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.03.006 [19] Cubital tunnel syndrome: Comparative results of a multicenter study of 4 surgical techniques with a mean follow-up of 92 months. Orthopaedics & Traumatology: Surgery & Research. 2014. DOI: 10.1016/j.otsr.2014.03.009 [20] Ulnar nerve palsy caused by synovial protrusion in synovial chondromatosis of the elbow: a case report and literature review. Shoulder & Elbow. 2016. DOI: 10.1177/1758573216683396 [24] Protocol for Endoscopic Versus Open Cubital tunnel release (EVOCU): an open randomized controlled trial. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06234-y [25] Cubital tunnel syndrome. Treatment by medial epicondylectomy.. The Journal of Bone & Joint Surgery. 1980. DOI: 10.2106/00004623-198062060-00016 [27] Rates of Complications and Secondary Surgeries After In Situ Cubital Tunnel Release Compared With Ulnar Nerve Transposition: A Retrospective Review. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.01.020 [28] 10.1055-s-2001-19937. 2001. [29] Recurrent or Persistent Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.11.024 [34] Chronic Structural Adaptations of the Shoulder and Elbow Are Correlated in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251317509 [35] Compressive Ulnar Neuropathies at the Elbow: II. Treatment. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199809000-00004 [36] Comparative study between minimal medial epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. Journal of Shoulder and Elbow Surgery. 2006. DOI: 10.1016/j.jse.2005.10.007 [37] 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 [38] Dynamic analysis of the ulnar nerve and cubital tunnel morphology using ultrasonography: a cadaveric study. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.05.026 [39] Incidence of Re-Operation and Subjective Outcome Following in Situ Decompression of the Ulnar Nerve at the Cubital Tunnel. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408101467 [40] Endoscopic Versus Open Cubital Tunnel Release. HAND. 2016. DOI: 10.1177/1558944715616097 [42] Endoscopic Anatomical Nerve Observation and Minimally Invasive Management of Cubital Tunnel Syndrome. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408094443 [43] 10.1007-s12593-009-0020-9. n.d.. [45] MR Imaging Features of Radial Tunnel Syndrome: Initial Experience. Radiology. 2006. DOI: 10.1148/radiol.2401050028 [46] Ulnar Tunnel Syndrome, Radial Tunnel Syndrome, Anterior Interosseous Nerve Syndrome, and Pronator Syndrome. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00010 [47] Shoulder position increases ulnar nerve strain at the elbow of patients with cubital tunnel syndrome. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.01.014 [48] Quantitative magnetic resonance imaging analysis of the cross-sectional areas of the anconeus epitrochlearis muscle, cubital tunnel, and ulnar nerve with the elbow in extension in patients with and without ulnar neuropathy. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.03.021 [49] Dynamic Evaluation of Intraneural Microvascularity of the Ulnar Nerve Using Contrast-Enhanced Ultrasonography in Patients With Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.06.024 [54] Association Between the Elbow Flexion Test and Extraneural Pressure Inside the Cubital Tunnel. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.11.013 [55] Biomechanical analysis of ulnar nerve gliding and elongation: implications for nonsurgical ulnar nerve release in cubital tunnel syndrome. Clinics in Shoulder and Elbow. 2025. DOI: 10.5397/cise.2024.00934 [56] Comparative study of surgical treatment of ulnar nerve compression at the elbow. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.10.014 [59] A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05786-9 [60] Nerve injuries in the throwing elbow. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.04.012 [61] 10.1007-bf00426065. n.d.. [66] Dynamic Compression of the Ulnar Nerve Associated With the Anconeus Epitrochlearis Muscle: Do We Really Know Everything?. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.11.002 [68] 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 [69] Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.12.012 [70] Magnetic Resonance Imaging of the Elbow in Athletes. Clinics in Sports Medicine. 2010. DOI: 10.1016/j.csm.2010.06.004 [72] Diagnosis of Ulnar Neuropathy at the Elbow Using Ultrasound — A Comparison to Electrophysiologic Studies. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.08.014

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.