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Demographics and Outcomes of Radial Tunnel Syndrome Release: A Single Surgeon's Experience of 97 Cases
Ryan W. Schmucker, MD; Shaun D. Mendenhall, MD; Timothy H. Daugherty, MD; James N. Winters, MD; Jordan J. Myhre, BS, BA; Michael W. Neumeister, MD
Southern Illinois University School of Medicine, Springfield, IL

Introduction: Compression of the radial nerve in the proximal forearm can cause two distinct syndromes, termed radial tunnel syndrome (RTS) and posterior interosseous nerve (PIN) syndrome. While patients with PIN syndrome have distinct motor symptoms, radial tunnel syndrome is a clinical diagnosis of pain over the radial tunnel in the dorsal forearm. Radial tunnel syndrome can be a repetitive use injury or can occur idiopathically. Patients often have multiple medical comorbidities and concomitant upper extremity compression neuropathies. The treatment of RTS is surgical release of the radial nerve.

Materials and Methods: After IRB approval, a retrospective chart review was conducted of all patients undergoing radial tunnel release (RTR) between 2008-2014. Charts were analyzed for patient demographics, comorbidities, concomitant compression neuropathies, preoperative symptoms, nerve conduction study findings, anatomic sites of release, as well as surgical outcomes and complications.

Results: In total 81 patients (66 female, 15 male) who underwent 97 radial tunnel releases were included in the study. Overall 86% of patients undergoing RTR also underwent a concomitant nerve decompression surgery. Medical comorbidities occurring most often in RTS patients included depression/anxiety (60%), obesity (48%) and diabetes (17%). 53% of patients were smokers. Preoperatively 98% of patients had pain with palpation over the radial tunnel while only 15% had muscle weakness and 7% had numbness. Preoperative nerve conduction studies were positive for RTS in 22% of patients. The most common anatomic site of compression was the arcade of Frohse which required release in 96% of patients, while secondary sites of compression included the extensor carpi radialis brevis (68%) and the vascular leash of Henry (67%). We experienced a 12% complication rate, which included patients with persistent pain, dysethesias, and weakness. Our recurrence rate was 3% and 98% of patients went on to recover fully.

Conclusions: Careful physical examination is required to diagnose radial tunnel syndrome as patients often present with multiple compression neuropathies. The most reliable diagnostic sign is pain with palpation of the dorsal forearm overlying the radial tunnel. While the most conspicuous site of compression is the arcade of Frohse, it is necessary to release all sites of compression including the vascular leash of Henry, the ECRB, and the distal supinator. To our knowledge this is the largest reported single surgeon series in the literature demonstrating that radial tunnel release is a safe, effective procedure that can provide dramatic relief of symptoms for affected patients.

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