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Long Term Outcome Of Surgical Treatment Of Radial Tunnel Syndrome in 223. Patients
Steven B. Carr, MD1; Nash Naam, MD2; Abdel Hakim A. Massoud, MD3
1University of Colorado Health Sciences Center, Aurora, CO; 2Southern Illinois Hand Center and Southern Illinois University, Effingham, IL; 3Al Azhar University, Effingham, IL

Purpose: Radial tunnel syndrome (RTS) is a pain syndrome due to entrapment of the posterior interosseous nerve (PIN) at the proximal forearm. In this study we analyze the long term outcome of its surgical treatment in 223 patients.
Materials and Methods: Between 1990 and 2012, 269 patients were surgically treated for RTS. 223 patients were available for review. There were 94 males and 129 females, with an average age of 43 years (23-72 years). Symptoms lasted an average of 9 months. (2-30 months). The dominant hand was involved in 159 patients. History of trauma was present in 67 patients. 162 patients were worker’s compensation patients.
Electrodiagnostic studies were obtained in all patients. The studies were positive for entrapment of the PIN in 36 patients (16%). Associated conditions were present in 37% of patients.
Patients were treated conservatively for an average of 3˝ months (6 weeks - 13 months). Surgery was performed using a dorsal approach under regional block anesthesia. The PIN was exposed between the extensor carpi radialis brevis and the extensor digitorum comminus. The anterior approach was used in 3 recurrent cases. Postoperative follow-up averaged 9 years (2-22 years).
Results: At the last follow-up, 162 patients had no pain (73%). 36 had minimal pain (16%), 18 had moderate of pain (8%) and seven had persistent pain (3%).
Of the seven patients who had persistent pain, five underwent re-exploration of the PIN; three through the anterior approach and 2 through the dorsal approach. Eventually three patients had complete improvement of the pain, but two patients continued to have persistent pain. The grip and pinch strength averaged 98% and 99% of the contralateral side respectively. Of the 162 worker’s compensation patients, 157 returned to their regular work activities, four returned to modified work activities, and one changed his job. All non-worker’s compensation patients resumed their normal daily activities.
Subjectively, patients classified their outcome as excellent in 78%, good 11%, fair 8% and poor 3%. There was no statistical difference in the outcome according to age, gender, duration of symptoms or any other associated condition except lateral epicondylitis (p<0.05). Discussion and
Conclusion: Proper diagnosis and management of patients with RTS are associated with good functional outcome. Worker’s compensation patients had slightly less favorable results, but not to a significant degree. Associated Lateral epicondylitis had a negative effect on long term outcome.

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