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桡骨管综合征

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

Updated Oct 2026
一个人因疼痛而紧抓前臂外侧上部的示意图。
桡骨管综合征导致前臂外侧上部（肘部稍下方）出现酸痛。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

主要症状是前臂外侧靠近肘部的位置出现疼痛。疼痛通常在肘部外侧骨性隆起下方几厘米处的一个压痛点最为明显。按压该部位时往往会有酸痛。疼痛可能沿前臂后侧向手腕方向放射。

某些动作会使疼痛加重。在有阻力的情况下把手掌转向上方，或在有阻力的情况下伸直中指，都可能诱发疼痛。持续让前臂承受负荷的活动也会如此。许多人注意到，疼痛往往在工作或运动之后加剧，而不是在休息时。

本病累及的是一条支配肌肉而非皮肤的神经。这意味着您不太可能出现麻木或刺痛，神经本身通常也工作正常。问题在于疼痛，而不是无力或感觉丧失。

在日常生活中，疼痛往往出现在需要抓握和扭转的任务中。提水壶、转动门把手、使用螺丝刀或拧干毛巾都可能引起疼痛。由于压痛点靠近肘部外侧，本病常被误认为网球肘，而且两者也可能同时存在。

没有哪一项检查可以确诊本病。您的外科医生会根据您的病史和体格检查做出诊断，检查是否存在那个特定的压痛点以及您的疼痛规律。

请留意以下信号。如果您的症状没有缓解、在数周内逐渐加重、让您夜间痛醒，或使您无法工作或无法使用手臂，请去看您的全科医生（GP），或要求专科医生评估。如果您的手臂变得发热、发红、肿胀和疼痛，尤其是伴有发烧，或者您的手变得苍白、发冷、发白或发青，请当日前往急诊科。如果在下班时间或周末无法联系到诊所，请前往离您最近的急诊科。

实际发生了什么

疼痛来自一条神经，而不是肘关节本身。神经就像一根电缆，在大脑和肌肉之间传递信号。桡神经的一个分支沿前臂外侧下行，经过肘部，支配那些伸直手腕和手指的肌肉。

在这一段路径上，有几个不同的结构紧挨着神经。肌肉的边缘、一条纤维带，或一小组横跨的血管，都可能各自压迫神经。这并不是一条单一的狭窄通道。它更像一条步道，沿途有几个可能的卡压点，其中任何一个都可能挤压旁边经过的这根电缆。

当其中某个结构压迫神经时，神经就会受到刺激并产生酸痛。这就是为什么疼痛位于肘部外侧骨性隆起下方的一个压痛点，也是为什么在有阻力的情况下把手掌转向上方或伸直中指会使疼痛加重。这些动作会牵拉这条神经所支配的肌肉，而受刺激的神经就会“发出抱怨”。

神经仍在工作，所以您的肌肉仍能正常工作，您也不会感到麻木或刺痛。问题在于刺激和疼痛，而不是信号丧失。由于酸痛点非常靠近肘部外侧，这种疼痛很容易被误认为网球肘，后者累及的是同一区域的一条肌腱。两者甚至可能同时发生。

我们如何处理该问题

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会从适合您病情的最微创方案入手。患者通常由全科医生（GP）转诊至我们的诊所；如果理疗师建议您就诊，您仍需获得全科医生的转诊才能符合 Medicare 报销资格。在诊所，我们会采集病史、检查您的手臂，并在有帮助时安排影像学检查。针对此病症，我们通常先尝试非手术治疗，在其未能带来足够改善时再考虑手术。

第一步是改变您使用手臂的方式。减少那些会使疼痛加剧的抓握和扭转任务，能让受刺激的神经有机会平复下来。手部治疗旨在缓解疼痛，并重建您前臂承受负荷的耐受力，使工作和日常任务重新变得舒适。在考虑任何进一步措施之前，我们请您对这些措施进行充分的尝试。

止痛药和抗炎药可以帮助您度过疼痛发作期。它们能在其他措施发挥作用的同时缓解酸痛。但它们并不能解除神经本身所受的压迫。

如果非手术治疗未能带来足够改善，手术是一个选择。这种手术称为桡骨管松解术。它的原理是在每一个有邻近结构压迫神经的部位把神经松解出来。在建议手术之前，我们会仔细检查神经在哪里受到挤压，使手术针对正确的部位，并尽量少地扰动周围组织。由于诊断依赖的是您的病史和体格检查，而不是某一项明确的检查，我们把是否手术视为一个共同的决定，在您了解手术能解决什么、不能解决什么之后，与您一起做出。

预期情况

对大多数人来说，本病不会损伤神经。神经仍在工作，所以您的肌肉仍能正常工作，您也不会丧失感觉。问题在于疼痛，而受刺激的神经引起的疼痛可能需要很长时间才能平复。它很少在一夜之间消失，而且往往会在抓握和扭转任务中反复加剧，然后才逐渐缓解。

坦白地说，本病的病程很难预测。有些人通过休息、调整活动和手部治疗就能好转。另一些人尽管接受了良好的非手术治疗，仍然持续疼痛。目前没有可靠的检查可以确诊，这使得我们更难事先判断您会属于哪一类。我们可以说的是，疼痛往往随您前臂承受的负荷时轻时重，而不是持续加重。

如果非手术治疗有效，随着神经所受的刺激减轻，疼痛会在数周至数月内逐渐缓解。您通常会先发现提水壶或转动门把手等日常任务没那么痛了，然后较重的工作才会重新感觉正常。如果是在非手术治疗帮助不够之后才进行手术，恢复同样是渐进的而不是立竿见影的，而且有些人术后仍会有一些疼痛。

如果对本病置之不理，它可能会自行缓解，但也可能持续存在，或每当您重新进行诱发疼痛的任务时就反复发作。无法事先知道会是哪种情况。通常重要的是对治疗进行充分的尝试，不要在疼痛没有缓解时硬撑着继续用力。

如果您的症状没有缓解、在数周内逐渐加重、让您夜间痛醒，或使您无法工作或无法使用手臂，请去看您的全科医生，或要求专科医生评估。如果您的手臂变得发热、发红、肿胀和疼痛，尤其是伴有发烧，或者您的手变得苍白、发冷、发白或发青，请当日前往急诊科。如果在下班时间或周末无法联系到诊所，请前往离您最近的急诊科。

何时就医

本病的警示信号关乎的是无法缓解的疼痛，而不是危险。如果经过充分的休息和调整活动后，您的前臂疼痛仍未缓解，或者它总是使您无法工作或无法使用手臂，请去看您的全科医生，或要求专科医生评估。如果肘部外侧下方的压痛点是一个突出的特征，或者在有阻力的情况下把手掌转向上方或伸直中指总会诱发疼痛，请尽早就诊，不要拖延。这些规律提示的是本病而不是网球肘，值得好好弄清楚。

本病通常不会损伤神经，因此手腕或手指突然无力并不是它的典型表现。如果您确实发现伸直手腕、手指或拇指时出现新的无力，请及时要求专科医生评估，不要等待，因为这种表现提示的是另一种神经问题，需要按其自身的时间安排进行评估。

如果您的手臂变得发热、发红、肿胀和疼痛，尤其是伴有发烧，或者您的手变得苍白、发冷、发白或发青，请当日前往急诊科。如果在下班时间或周末无法联系到诊所，请前往离您最近的急诊科。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您做出自身治疗决策所需的深度。桡骨管综合征值得额外阅读，原因令人不适：该网站所涉疾病中，其证据基础最为薄弱，且不存在可确诊该病的检查手段。明确告知其不确定性，应成为任何手术决策的一部分。

无确诊试验

大多数神经卡压均可被证实。腕管综合征表现为腕部传导速度减慢；肘管综合征表现为肘部传导速度减慢。桡骨管综合征通常不表现出此特征，因为受累的神经分支支配肌肉而非皮肤，因此没有麻木区域可供定位，且神经传导研究通常正常。

因此，诊断依赖于疼痛模式、位于外上髁远端数厘米处（而非外上髁上方）的压痛，以及对局部麻醉阻滞的反应。上述每一项均具有提示意义；但无一具有决定性。当代综述指出关于诊断和预后均存在持续争议 [1]。

其实际后果是与网球肘的高混淆率，后者位置紧邻且可共存。对良好治疗无反应的持续性“网球肘”是最终考虑桡骨管综合征的最常见情况之一。

治疗该疾病的证据确实非常薄弱

一项关于干预措施的系统性综述发现，手术减压可能有效，而更引人注目的发现是，保守治疗的有效性尚不明确，因为其中大多数根本没有相关研究 [2]。

这并非通常所说的“证据有限”的表述。对于该疾病提供的多数非手术治疗，相关研究尚未开展。目前的综述仍将非手术治疗置于首位，将减压手术作为难治性病例的可行选择 [1]，这种排序反映的是合理的谨慎态度，而非已证实的优越性。

这对决策意味着什么

由此可得出两点结论，且二者方向相反。

反对早期手术：由于诊断无法确诊，手术可能是在减压一个并非病因来源的神经。当减压手术失败时，往往难以判断是手术操作不充分，还是诊断本身有误。

支持在合适患者中考虑手术：同样缺乏支持替代方案的循证依据，因此等待并非人们所假设的有循证支持的选项。它仅仅是风险较低的选择。

合理的立场是：在此处，一个有把握的诊断比本站其他任何地方都更为重要。这包括：病史一致、体格检查将病变定位至桡骨管而非外上髁、影像学检查排除占位性病变，以及理想情况下，在采取不可逆步骤之前，诊断性神经阻滞产生令人信服的疗效反应。

相关但不同的问题

骨间后神经麻痹（表现为手指和拇指伸肌无力，而非疼痛）是一种独立的疾病实体，其管理策略更为明确。当影像学检查未发现压迫性病变时，应首先尝试保守治疗，手术仅保留用于已证实存在压迫性病变以及保守治疗失败的情况 [3]。若不存在占位性病变，建议先尝试非手术治疗；若观察 6 周后肌肉恢复无迹象，或肌无力呈进行性加重，则建议进行探查手术 [4]。

这些是具体的阈值，它们的存在最清晰地体现了这种对比：当神经功能明显停止工作时，文献可以明确说明该做什么以及何时做。而当仅表现为疼痛时，文献则无法给出明确指引。

参考文献

[1] Wolf JM, Patel R, Ghosh K. Radial tunnel syndrome: review and best evidence. 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. Interventions for treating the radial tunnel syndrome: a systematic review of observational studies. J Hand Surg Am. 2008;33(1):72.e1-72.e10. https://doi.org/10.1016/j.jhsa.2007.10.001

[3] McGraw I. Isolated spontaneous posterior interosseous nerve palsy: a review of aetiology and management. J Hand Surg Eur Vol. 2018;44(3):310-6. https://doi.org/10.1177/1753193418813788

[4] Sigamoney KV, Rashid A, Ng CY. Management of atraumatic posterior interosseous nerve palsy. 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 relatively uncommon but is an important cause of lateral forearm pain [1].
  • Clinical examination is a crucial part of the diagnosis of radial tunnel syndrome [1].
  • The duration of symptoms averaged 2.3 years before a definitive diagnosis of radial tunnel syndrome was made [2].
  • The diagnosis of radial tunnel syndrome remains clinical [5].
  • Adherence to a defined protocol is useful in diagnosing radial tunnel syndrome [5].
  • The issue surrounding radial tunnel syndrome traditionally has been properly identifying it clinically [7].
  • Compression of the radial nerve at the elbow is of moderate frequency compared to the ulnar tunnel syndrome [9].
  • A case of bilateral radial tunnel syndrome with signs discordant with traditionally used clinical diagnostic tests was successfully relieved with surgical decompression [6].
  • The Rule-of-Nine test effectively specifies the site of tenderness for the diagnosis of radial tunnel syndrome [11].

Anatomy & Pathophysiology

Clinical Presentation & Diagnostic Challenges

  • Radial tunnel syndrome is a relatively uncommon but important cause of lateral forearm pain [1].
  • Clinical examination is a crucial component of the diagnosis for radial tunnel syndrome [1].
  • The average duration of symptoms before a definitive diagnosis of radial tunnel syndrome was 2.3 years [2].
  • Prominent focal tenderness in the area of the radial tunnel is a principal diagnostic criterion for radial tunnel syndrome [20].
  • In radial tunnel syndrome, symptoms do not occur in the distribution of the purportedly affected nerve, which distinguishes focal tenderness from a positive Phalen's test in carpal tunnel syndrome [20].
  • Skeptics note that radial tunnel syndrome presents with normal neurologic function and no confirmatory electrodiagnostic evidence of nerve dysfunction, contrasting with other well-described entrapment neuropathies [20].

Etiology & Pathophysiology

  • There is dispute over the etiology of radial tunnel syndrome, with some skeptics questioning its status as a viable entrapment neuropathy [20].
  • The posterior interosseous nerve carries unmyelinated (group IV) afferent fibers from the wrist capsule and small myelinated (group IIA) afferent fibers from muscles along its distribution [20].
  • Unmyelinated group IV fibers are associated with nociception and pain [20].
  • The current best evidence for the conservative management of radial tunnel syndrome consists primarily of expert opinion and inferences from studies on other nerve compressions [3].

Relevant Elbow Anatomy

  • The elbow is a trocho-ginglymoid joint consisting of medial and lateral articulations that afford bony stability [63].
  • The ulnohumeral joint is formed by the articulation of the trochlea with the ulna within the greater sigmoid notch [63].
  • The radiocapitellar joint is formed by the articulation of the capitellum and radial head [63].
  • The radius is held in close approximation to the ulna at the proximal radioulnar joint by the annular ligament [63].
  • The lateral epicondyle is the origin of the lateral extensor musculature [63].
  • The radial nerve enters the interval between the brachialis and brachioradialis muscles in the proximal angle of the lateral approach to the elbow [66].
  • The deep branch of the radial nerve enters the supinator muscle [66].
  • The posterior interosseous nerve is located just superficial to the anterior joint capsule at the level of the radiocapitellar joint [75].
  • At the level of the radial neck, the posterior interosseous nerve may come in direct contact with the joint capsule [75].
  • Supination increases the linear distance between the posterior interosseous nerve and the radial head [107].

Classification

  • 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 [29].
  • The author of [29] proposes unifying RTS and PIN compression as mild and severe forms of one disease to simplify nomenclature [29].
  • The authors of [52] recommend viewing radial tunnel syndrome and posterior interosseous nerve syndrome as a single condition presenting along a spectrum of nerve entrapment [52].
  • Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [22].
  • The diagnosis of radial tunnel syndrome remains clinical, and adherence to a defined protocol is useful in diagnosing this condition [5].
  • A differential latency of ≥0.30 ms was considered indicative of radial tunnel syndrome [16].
  • Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [14].
  • Skeptics note that the signs and symptoms of RTS contrast from other well-described entrapment neuropathies in that there is prominent focal tenderness, normal neurologic function, and no confirmatory electrodiagnostic evidence of nerve dysfunction [20].
  • Prominent focal tenderness in the area of the radial tunnel remains one of the principal diagnostic criteria for RTS [20].
  • Focal tenderness at the radial tunnel in RTS 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 [20].
  • There has been no randomized controlled trial that compares surgical with nonsurgical treatment or with a placebo for RTS [20].
  • Skeptics of RTS point to the great variability of surgical results reported in the literature as one of the characteristics of placebo surgery [20].

Clinical Presentation

  • Radial tunnel syndrome is a relatively uncommon cause of lateral forearm pain [1].
  • Radial tunnel syndrome and posterior interosseous nerve compression are distinct entities with different clinical presentations [29].
  • The author proposes unifying radial tunnel syndrome and posterior interosseous nerve compression as mild and severe forms of one disease to simplify nomenclature [29].
  • The authors recommend viewing radial tunnel syndrome and posterior interosseous nerve syndrome as a single condition presenting along a spectrum of nerve entrapment [52].
  • Prominent focal tenderness in the area of the radial tunnel is one of the principal diagnostic criteria for radial tunnel syndrome [20].
  • In radial tunnel syndrome, symptoms do not occur in the distribution of the purportedly affected nerve, which differs from a positive Phalen's test in carpal tunnel syndrome [20].
  • A diagnosis of radial tunnel syndrome should be considered in patients with forearm and wrist pain that has not responded to more conventional treatment [13].
  • The diagnosis of radial tunnel syndrome remains clinical, and adherence to a defined protocol is useful in diagnosing the condition [5].
  • The issue surrounding radial tunnel syndrome has traditionally been properly identifying it clinically [7].
  • A case of bilateral radial tunnel syndrome presented with signs discordant with traditionally used clinical diagnostic tests [6].
  • Muscle denervation edema or atrophy along the distribution of the posterior interosseous nerve is the most common MR finding in radial tunnel syndrome [32].
  • A symptomatic double-level entrapment of the posterior interosseous branch of the radial nerve has been described [51].
  • Compression of the radial nerve at the elbow is of moderate frequency compared to ulnar tunnel syndrome [9].
  • The annual incidence rate of posterior interosseous nerve entrapment is estimated to be 0.03% [88].
  • The most frequent location of radial nerve entrapment is around the elbow, specifically involving the posterior interosseous nerve branch [88].
  • The radial tunnel spans 5 cm, extending from the humero-radial joint and running distally between the deep and superficial heads of the supinator [88].
  • The radial tunnel is bounded laterally by extensor carpi radialis longus and extensor carpi radialis brevis muscles and medially by biceps tendon and the brachialis [88].
  • The roof of the radial tunnel is formed by brachioradialis [88].
  • The floor of the radial tunnel is the elbow-joint capsule [88].
  • Potential sites of entrapment in the radial tunnel include capsular tissue of the radiocapitellar joint, hypertrophic crossing branches of leash of Henry, the leading proximal tendinous and medial edge of ECRB, the arcade of Frohse, and the distal border of the supinator between its two heads [88].
  • The arcade of Frohse is noted to be the most common site of entrapment in the radial tunnel [88].
  • Clinical 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 [81].
  • A clinical diagnosis of radial tunnel syndrome requires 4 of 5 diagnostic signs and symptoms, with one being maximal tenderness 3–5 cm distal to the lateral epicondyle [81].
  • Physical examination for radial tunnel syndrome includes wrist flexion and forearm pronation, the Rule of Nines test, and assessment of weakness and pain with resisted long finger extension [86].
  • The history for radial tunnel syndrome includes extensor musculature "forearm aching" [86].

Investigations

Clinical Diagnosis

  • A diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment [13].
  • It is important to understand the anatomic course and distribution of the radial nerve in order to make an accurate diagnosis [24].

Electrodiagnostic Studies

Imaging

  • Neuroimaging should be considered as a complementary diagnostic method in posterior interosseous neuropathy [132].
  • Dynamic ultrasonographic assessment of changes in the AP diameter and CSA is an effective diagnostic tool for identifying radial tunnel syndrome [121].
  • Ultrasonography, computed tomography, and magnetic resonance imaging revealed the location of the ganglion in every patient with radial nerve palsy caused by a ganglion [124].
  • The authors acknowledge that their study does not establish diagnostic accuracy or a reference standard for radial tunnel syndrome [49].

Treatment

Non-Operative Management

  • Current best evidence for the conservative management of radial tunnel syndrome consists primarily of expert opinion and inferences taken from studies on other nerve compressions and related syndromes [3].
  • The effectiveness of conservative treatments for radial tunnel syndrome is unknown because, for most treatments, no studies are available [48].
  • 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 [8].
  • Nonsurgical management is first-line for radial tunnel syndrome [4].
  • The two most common nerve entrapment disorders about the elbow, including radial tunnel, should be initially managed conservatively before considering surgical intervention [80].

Operative Management

  • Surgical decompression remains a viable option for refractory cases of radial tunnel syndrome despite ongoing controversy regarding diagnosis and outcomes [4].
  • There is a tendency that surgical decompression of the radial tunnel might be effective in patients with radial tunnel syndrome [48].
  • 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 [17].
  • 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 [104].
  • The results of radial tunnel release have been sufficiently good thus far as to warrant some attention, with an overall significant improvement in 99 of 108 cases (91.7%) when combined with other series [19].
  • Nineteen patients (20 extremities) felt satisfied and helped and believed they gained improved function because of surgical decompression of the radial tunnel [27].
  • The authors believe that a high rate of morbidity is associated with both the disease and its treatment, suggesting that great caution has to be taken before performing radial tunnel release [26].
  • The authors suggest that great caution be taken before performing radial tunnel release and strict adherence to the indications noted during the preoperative examination [50].

Evidence Limitations and Controversy

  • There has been no randomized controlled trial that compares surgical with nonsurgical treatment or with a placebo for radial tunnel syndrome [20].
  • Skeptics of radial tunnel syndrome point to the great variability of surgical results reported in the literature as one of the characteristics of placebo surgery [20].
  • Although radial tunnel syndrome is classically described as a nerve compression and entrapment syndrome, there is dispute over its etiology [20].

Complications

  • A high rate of morbidity is associated with both radial tunnel syndrome and its treatment [26].
  • In a case of congenital compression of the radial nerve, the patient was followed for an additional 3 months without clinical improvement in radial nerve function [12].
  • Nerve injury is an uncommon though troublesome complication of fractures or dislocations of the elbow [39].

Recovery

  • A patient with congenital compression of the radial nerve was followed for an additional 3 months without clinical improvement in radial nerve function [12].
  • In a patient with posterior interosseous-nerve syndrome secondary to rheumatoid synovitis where the duration of entrapment was more than two years, a tendon transfer was used as treatment [139].
  • Isolated posterior interosseous nerve neurectomy has shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up [123].

Key Evidence

  • [L5] Radial tunnel syndrome is relatively uncommon but is an important cause of lateral forearm pain, with clinical examination being a crucial part of the diagnosis. [1] (10.1197/j.jht.2006.02.005)
  • [L4] The duration of symptoms averaged 2.3 years before a definitive diagnosis of radial tunnel syndrome was made. [2] (10.1016/s0363-5023(83)80201-9)
  • [L5] Current best evidence for the conservative management of radial tunnel syndrome (RTS) consists primarily of expert opinion and inferences taken from studies on other nerve compressions and related syndromes. [3] (10.1197/j.jht.2006.02.020)
  • [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. [4] (10.5435/jaaos-d-23-00314)
  • [L4] The diagnosis of radial tunnel syndrome remains clinical, and adherence to a defined protocol is useful in diagnosing this condition. [5] (10.1016/s0266-7681(98)80015-6)
  • [L5] A case of bilateral radial tunnel syndrome with signs discordant with traditionally used clinical diagnostic tests was successfully relieved with surgical decompression. [6] (10.1177/15589447211029045)
  • [L5] The issue surrounding radial tunnel syndrome traditionally has been properly identifying it clinically. [7] (10.1097/01.bth.0000231580.32406.71)
  • [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. [8] (10.1016/j.jhsa.2017.06.095)
  • [Paper] Compression of the radial nerve at the elbow is of moderate frequency compared to the ulnar tunnel syndrome. [9] (10.1016/j.main.2004.10.006)
  • [L4] The Rule-of-Nine test effectively specifies the site of tenderness for the diagnosis of radial tunnel syndrome. [11] (10.1177/230949900401200115)
  • [L5] The patient was followed for an additional 3 months, without clinical improvement in radial nerve function. [12] (10.1016/s0363-5023(89)80099-1)
  • [L4] A diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. [13] (10.1016/s0266-7681(05)80152-4)
  • [L5] Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis. [14] (10.1016/j.jhsa.2010.03.020)
  • [L4] A differential latency of ≥0.30 ms was considered indicative of radial tunnel syndrome. [16] (10.1016/s0363-5023(98)80163-9)
  • [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. [17] (10.1016/j.jse.2025.02.060)
  • [L4] The results of radial tunnel release have been sufficiently good thus far as to warrant some attention, with an overall significant improvement in 99 of 108 cases (91.7%) when combined with other series. [19] (10.1016/s0363-5023(79)80105-7)
  • [L5] [20] (10.1016/j.jhsa.2009.10.016)
  • [L5] Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm. [22] (10.1016/j.ocl.2012.07.022)
  • [L5] It is important to understand the anatomic course and distribution of the radial nerve in order to make an accurate diagnosis. [24] (10.1007/s11420-011-9238-8)
  • [L5] The authors believe that a high rate of morbidity is associated with both the disease and its treatment, suggesting that great caution has to be taken before performing radial tunnel release. [26] (10.1097/00130911-200212000-00010)
  • [L4] Nineteen patients (20 extremities), however, felt satisfied and helped and believed they gained improved function because of surgical decompression of the radial tunnel. [27] (10.1016/s0363-5023(97)80086-x)
  • [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. [29] (10.1177/1753193420953990)
  • [L4] Muscle denervation edema or atrophy along the distribution of the posterior interosseous nerve is the most common MR finding in radial tunnel syndrome. [32] (10.1148/radiol.2401050028)
  • [L4] Nerve injury is an uncommon though troublesome complication of fractures or dislocations of the elbow. [39] (10.1016/s0020-1383(79)80015-7)
  • [L4] [48] (10.1016/j.jhsa.2007.10.001)
  • [Paper] The authors acknowledge that their study does not establish diagnostic accuracy or a reference standard for radial tunnel syndrome. [49] (10.1177/17531934261463150)
  • [L4] The authors suggest that great caution be taken before performing radial tunnel release and strict adherence to the indications noted during the preoperative examination. [50] (10.1053/jhsu.1999.0566)
  • [L5] A symptomatic double-level entrapment of the posterior interosseous branch of the radial nerve is described. [51] (10.1016/s0363-5023(83)80202-0)
  • [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. [52] (10.1177/17531934241254706)
  • [L2] [81] (10.1016/j.jhsa.2024.09.023)
  • [L5] [88] (10.1016/j.jisako.2024.03.001)
  • [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. [104] (10.1177/1753193408099832)
  • [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. [107] (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. [121] (10.1177/17531934261443138)
  • [L4] Isolated PINN have shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up. [123] (10.1177/1558944717692093)
  • [L4] Ultrasonography, computed tomography, and magnetic resonance imaging revealed the location of the ganglion in every patient. [124] (10.1016/s0363-5023(10)80102-9)
  • [L4] Neuroimaging should be considered as a complementary diagnostic method in PINS. [132] (10.1212/wnl.0000000000003287)
  • [L4] In the third patient, in whom the duration of entrapment was more than two years, a tendon transfer was used as treatment. [139] (10.2106/00004623-197355040-00009)

References

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[2] Radial tunnel syndrome: A spectrum of clinical presentations. The Journal of Hand Surgery. 1983. DOI: 10.1016/s0363-5023(83)80201-9

[3] Management of Radial Tunnel Syndrome: A Therapist's Clinical Perspective. Journal of Hand Therapy. 2006. DOI: 10.1197/j.jht.2006.02.020

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

[5] Radial Tunnel Syndrome: Diagnosis and Management. Journal of Hand Surgery. 1998. DOI: 10.1016/s0266-7681(98)80015-6

[6] Radial Tunnel Syndrome: Case Report and Comprehensive Critical Review of a Compression Neuropathy Surrounded by Controversy. HAND. 2021. DOI: 10.1177/15589447211029045

[7] 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

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

[9] Compressions du nerf radial au coude. Chirurgie de la Main. 2004. DOI: 10.1016/j.main.2004.10.006

[11] 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

[12] Congenital compression of the radial nerve. The Journal of Hand Surgery. 1989. DOI: 10.1016/s0363-5023(89)80099-1

[13] Radial Tunnel Syndrome. Journal of Hand Surgery. 1995. DOI: 10.1016/s0266-7681(05)80152-4

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

[16] Differential latency testing: A more sensitive test for radial tunnel syndrome. The Journal of Hand Surgery. 1998. DOI: 10.1016/s0363-5023(98)80163-9

[17] 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

[19] The radial tunnel syndrome. The Journal of Hand Surgery. 1979. DOI: 10.1016/s0363-5023(79)80105-7

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

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

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

[26] Radial Tunnel Syndrome. Techniques in Hand and Upper Extremity Surgery. 2002. DOI: 10.1097/00130911-200212000-00010

[27] Radial tunnel syndrome: Long-term results of surgical decompression. The Journal of Hand Surgery. 1997. DOI: 10.1016/s0363-5023(97)80086-x

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

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

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

[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

[49] 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

[50] Results of surgical treatment for radial tunnel syndrome. The Journal of Hand Surgery. 1999. DOI: 10.1053/jhsu.1999.0566

[51] Double-entrapment radial tunnel syndrome. The Journal of Hand Surgery. 1983. DOI: 10.1016/s0363-5023(83)80202-0

[52] 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

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

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

[75] Green S Operative Hand Surgery. PERTINENT ANATOMY AND PORTALS.

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

[81] 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

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

[88] Current concepts of surgical approach for radial nerve entrapment around the elbow. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2024.03.001

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

[107] 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

[121] 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

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

[124] Diagnosis of radial nerve palsy caused by ganglion with use of different imaging techniques. The Journal of Hand Surgery. 1991. DOI: 10.1016/s0363-5023(10)80102-9

[132] Posterior interosseous neuropathy. Neurology. 2016. DOI: 10.1212/wnl.0000000000003287

[139] Posterior Interosseous-Nerve Syndrome Secondary to Rheumatoid Synovitis. The Journal of Bone & Joint Surgery. 1973. DOI: 10.2106/00004623-197355040-00009

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