Outcomes of Radial Tunnel Releases

ABSTRACT

Radial tunnel syndrome is a controversial topic in nerve decompression. Variations exist in the diagnosis and treatment plan for this condition. Different outcomes of surgical intervention after failed nonoperative methods prior to the development of significant extensor motor weakness exist in the literature.

A retrospective review was performed from October 1997 to April 2003. Charts were assessed for radial tunnel releases. Eleven patients had bilateral releases, 1 of which was simultaneous. A total of 69 decompressions were performed. A preoperative diagnosis was made by history of proximal extensor forearm discomfort and physical examination findings of tenderness over the radial tunnel. The decompression was performed by releasing the arcade of Frohse, the remaining superficial fibers of the supinator muscle, distal edge of supinator, extensor carpi radialis brevis, and ligation and transection of Leash of Henry vessels.

Fifty-five of 69 decompressions resulted in complete resolution of preoperative symptoms, of which 24 had abnormal preoperative nerve conduction velocity/electromyogram (NCV/EMG) studies. Five patients had weak extension as a preoperative symptom. The remaining 14 decompressions resulted in a decrease in preoperative symptoms, of which 3 had abnormal preoperative NCV/EMG studies. One patient who underwent bilateral decompressions developed bilateral hematomas. The complications related to the radial tunnel release occurring in 4 patients included radial nerve neurolysis, transient posterior interosseous nerve palsy, and superficial radial nerve neuropraxia. One patient who had ipsilateral chronic shoulder pain was referred to a pain specialist. Two patients were excluded from this review because of inadequate follow-up. All patients who were employed preoperatively returned to work postoperatively, excluding 7 patients whose work status was indeterminate.

Radial tunnel decompression results in satisfactory outcomes in patients with preoperative findings of proximal dorsal forearm pain and tenderness overlying the radial tunnel, 80% complete resolution of symptoms. An abnormal NCV/EMG was not required for a diagnosis of radial tunnel syndrome. Improvement in function was reported in patients who continued to experience mild intermittent persistence of preoperative symptoms.