Mateusz Gładysz FESSH prep

FESSH prep Compressive neuropathies Radial nerve compression at the elbow

Radial tunnel syndrome

Last reviewed v1.0

FESSH-009Compressive neuropathies●●○ intermediate

Concerning radial tunnel syndrome (RTS).

  1. 1.The most common site of compression is the arcade of Frohse, the fibrous proximal margin of the superficial head of supinator.

  2. 2.It commonly presents with weakness of wrist extensors.

  3. 3.In Loh's Rule-of-Nine test the volar forearm is divided into nine squares and tenderness over the lateral column localises pain to the territory of the posterior interosseous nerve.

  4. 4.Corticosteroid injection within the radial tunnel is never indicated due to nerve irritation.

  5. 5.Nerve conduction studies are always abnormal in radial tunnel syndrome.

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Question ID
FESSH-009
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. The most common site of compression is the arcade of Frohse, the fibrous proximal margin of the superficial head of supinator.

    True

    Five potential sites of compression in the radial tunnel were described by Lister, Belsole and Kleinert: fibrous bands anterior to the radiocapitellar joint, the leash of Henry (recurrent radial vessels), the tendinous edge of extensor carpi radialis brevis, the arcade of Frohse, and the distal edge of supinator. Among these, the arcade of Frohse — the fibrous proximal margin of the superficial head of supinator — is consistently identified as the most common site of compression in operative and imaging series.

    • Moradi A, Ebrahimzadeh MH, Jupiter JB. Radial tunnel syndrome, diagnostic and treatment dilemma. Arch Bone Jt Surg. 2015;3(3):156-162. PMID 26213698
    • Węgiel A, Karauda P, Zielinska N, Tubbs RS, Olewnik Ł. Radial nerve compression: anatomical perspective and clinical consequences. Neurosurg Rev. 2023;46(1):53. PMID 36781706

  2. 2. It commonly presents with weakness of wrist extensors.

    False

    Radial tunnel syndrome is defined by lateral proximal forearm pain without motor or sensory deficit. The presence of extensor weakness redefines the entity as posterior interosseous nerve syndrome; the two share an anatomical substrate but are distinguished clinically by the presence or absence of motor involvement.

    • Sarhadi NS, Korday SN, Bainbridge LC. Radial tunnel syndrome: diagnosis and management. J Hand Surg Br. 1998;23(5):617-619. PMID 9821607
    • Moradi A, Ebrahimzadeh MH, Jupiter JB. Radial tunnel syndrome, diagnostic and treatment dilemma. Arch Bone Jt Surg. 2015;3(3):156-162. PMID 26213698

  3. 3. In Loh's Rule-of-Nine test the volar forearm is divided into nine squares and tenderness over the lateral column localises pain to the territory of the posterior interosseous nerve.

    True

    Loh and colleagues mapped the posterior interosseous nerve consistently to the lateral column of three of nine squares constructed over the volar aspect of the forearm in 19 cadaveric upper limbs. The test is intended as a structured way of localising RTS pain — distinct from the point tenderness over the lateral epicondyle in lateral epicondylitis — but its validation rests on cadaveric anatomy rather than prospective clinical sensitivity or specificity data.

    • Loh YC, Lam WL, Stanley JK, Soames RW. A new clinical test for radial tunnel syndrome--the Rule-of-Nine test: a cadaveric study. J Orthop Surg (Hong Kong). 2004;12(1):83-86. PMID 15237127

  4. 4. Corticosteroid injection within the radial tunnel is never indicated due to nerve irritation.

    False

    Sarhadi reported long-term pain relief in 16 of 25 patients (64%) at two years following a single triamcinolone-with-lignocaine injection along the radial tunnel; nine patients (36%) progressed to surgical decompression. Marchese subsequently confirmed clinically meaningful improvement on qDASH and visual analogue scores at six weeks following a single corticosteroid injection in a prospective cohort of 40 patients.

    • Sarhadi NS, Korday SN, Bainbridge LC. Radial tunnel syndrome: diagnosis and management. J Hand Surg Br. 1998;23(5):617-619. PMID 9821607
    • Marchese J, Coyle K, Cote M, Wolf JM. Prospective evaluation of a single corticosteroid injection in radial tunnel syndrome. Hand (N Y). 2019;14(6):741-745. PMID 29998772

  5. 5. Nerve conduction studies are always abnormal in radial tunnel syndrome.

    False

    In Verhaar and Spaans's series of sixteen patients with a clinical diagnosis of RTS, only one had a major increase in posterior-interosseous-nerve latency on forced supination; conventional electromyographic and nerve-conduction studies were normal in the remainder. Subsequent series have consistently reported absent or non-specific electrodiagnostic findings, and the diagnosis remains primarily clinical.

    • Verhaar J, Spaans F. Radial tunnel syndrome. An investigation of compression neuropathy as a possible cause. J Bone Joint Surg Am. 1991;73(4):539-544. PMID 1849515
    • Moradi A, Ebrahimzadeh MH, Jupiter JB. Radial tunnel syndrome, diagnostic and treatment dilemma. Arch Bone Jt Surg. 2015;3(3):156-162. PMID 26213698