Exploring Radial Tunnel Syndrome Treatment Options

Radial Tunnel Syndrome (RTS) is a painful condition that affects the forearm and can significantly impact activities of daily living. Radial Tunnel Syndrome is a type of nerve compression that occurs in the forearm. It happens when the radial nerve, which runs from the upper arm to the hand, becomes compressed or irritated.

Causes of Radial Tunnel Syndrome

• Repetitive Movements
• Overuse of muscle
• Direct Trauma
• Muscle Imbalance
• Inflammation
• Sports Activities

 

How do patient present with RTS

• Pain - deep, aching sensation that radiates from the posterior aspect of the elbow down the forearm.
• Weakness - impact your ability to grip objects, hold onto things, and perform fine motor tasks.
• Tingling and Numbness - paresthesia can be felt along the outer part of the forearm, extending down to the thumb, index finger, and middle finger.
• Pain with Certain Movements - involve extending the wrist or rotating the forearm can exacerbate the pain.
• Painful Points - Pressure applied to specific points may trigger or intensify the pain

 

Tests to diagnose RTS:

They are used to assess nerve function and identify areas of discomfort or pain. These tests include the following:

Maudsley's Test OR Resisted Middle Finger Extension Test: 

Patient is asked to extend your middle finger against resistance to see if it triggers pain.

Supination Test: 

Patient forearm is rotated while elbow being bent, it may reproduce your symptoms.

Tinel Test: 

Pressure is applied over the radial tunnel to check for tenderness and pain.

Differential Diagnosis of Radial Tunnel Syndrome:

Radial Tunnel Syndrome symptoms can overlap with other conditions like

• Lateral Epicondylitis (tennis elbow)
• Carpal Tunnel Syndrome

Treatment options for Radial Tunnel Syndrome

Stretching Exercises:

Stretching exercises are vital to prevent muscle tightness and reduce nerve compression. It helps to increase their flexibility and alleviate tension on the nerve.

Wrist Flexor Stretch:

This stretch targets the muscles on the anterior aspect of forearm.

1. Start by extending your affected arm straight in front of you, palm facing up or towards the wall.
2. With your opposite hand, gently grasp your fingers and apply a gentle pulling force, pulling them towards you.
3. You should feel a stretch along the anterior side of your forearm.
4. Hold the stretch for 15-20 seconds, then release. Repeat 3-4 times on each side.

Wrist Extensor Stretch:

This stretch focuses on the muscles on the posterior aspect of forearm.

1. Extend your affected arm straight in front of you, palm facing down.
2. With your opposite hand, gently grasp your fingers and apply a gentle pulling force, pulling them towards you.
3. You should feel a stretch along the posterior side of your forearm.
4. Hold the stretch for 15-20 seconds, then release. Repeat 3-4 times on each side.

Pronator Stretch:

This stretch targets the pronator muscles responsible for rotating the forearm.

1. Extend your affected arm straight in front of you, palm facing down.
2. Use your opposite hand to gently press down on the back of your hand, turning your palm towards the floor.
3. You should feel a stretch on the posterior aspect of your forearm.
4. Hold the stretch for 15-20 seconds, then release. Repeat 3-4 times on each side.

Nerve Gliding Exercises:

Nerve gliding exercises involve gentle movements that promote the sliding of the radial nerve within its tunnel. This technique helps reduce nerve irritation and improve its mobility, leading to decreased symptoms over time.

Nerve Gliding Exercise: Radial Nerve Glide

This exercise promotes the mobility of the radial nerve within its tunnel.

1. Extend your affected arm straight out in front of you, palm facing down.
2. Slowly bend your wrist and fingers downward, then gently extend your wrist and fingers.
3. As you extend, let your fingers drop back while keeping your wrist extended.
4. Perform this gliding movement 10 times, aiming for a comfortable, pain-free range of motion.

Manual Therapy Techniques:

Manual therapy helps release tension in the affected muscles and improve blood flow, facilitating the healing process.

Soft Tissue Mobilization:

Soft tissue mobilization involves applying gentle pressure and rhythmic movements to the affected soft tissues, such as the muscles and connective tissues around the radial tunnel. This technique helps improve blood flow, release muscle tension, and reduce adhesions that may contribute to nerve compression.

Myofascial Release:

Myofascial release targets the fascia, the connective tissue that surrounds muscles and nerves. By using sustained pressure and gentle stretching, this technique aims to release restrictions in the fascia, allowing for improved nerve mobility and reduced nerve irritation.

Joint Mobilization:

Joint mobilization involves the skilled application of controlled movements by the physiotherapist to the joints surrounding the radial tunnel.

• Grade I and II Joint Mobilizations:

For radial tunnel syndrome, low-grade joint mobilizations can be employed. Grade I mobilizations involve gentle gliding motions at the joint's beginning of the range to alleviate pain and improve joint nutrition. Followed by Grade I, Grade II mobilizations are slightly more forceful, working to increase joint motion. Always perform these techniques with a cautious and controlled approach.

• Distraction Technique:

The distraction technique involves gently pulling apart the joint surfaces. This technique can help relieve pressure on the radial nerve by creating space within the joint. The amount of force applied should be minimal and controlled to prevent any discomfort.

Cross-Friction Massage:

Cross-friction massage involves applying manual pressure perpendicular to the direction of the affected tissues. This technique can help break down scar tissue and improve tissue alignment.

Trigger Point Release:

Trigger points are localized areas of muscle tension that can contribute to nerve compression and pain.

• Compression Technique:

Compression technique is done by locating the tender or tight spot in the forearm muscles that may be contributing to your radial tunnel syndrome. Gentle  pressure is applied using your thumb or fingers, gradually increasing the pressure until you reach a tolerable level. Hold the pressure for about 20-30 seconds, allowing the muscle to release. Repeat this several times, applying pressure from different angles if needed.

•  Stripping Technique:

The stripping technique involves the use of fingers, knuckles, or a tool to apply pressure along the length of the affected muscle. Slowly move from one end to the other, focusing on any areas of increased tension. This technique helps stretch and release tight muscle fibers, reducing trigger points' influence on the radial nerve.

Clinical Scenario of Radial Tunnel Syndrome

Patient Background:

Alex is a 35-year-old individual, who works as a graphic designer. Alex frequently spends long hours at the computer, engaging in repetitive mouse and keyboard tasks. Recently, Alex has been experiencing discomfort and pain in the forearm area, which seems to worsen during these work-related activities. He have also noticed occasional tingling and numbness in the back of the hand and fingers.

Initial Assessment:

Alex comes in for a physiotherapy assessment due to his forearm pain and symptoms. During the assessment, the therapist takes a detailed medical history to understand any underlying conditions or contributing factors. He inquires about the nature of their symptoms, their work activities, and any previous injuries.

Physical Examination:

The physiotherapist then performs a thorough physical examination to assess Alex's range of motion, strength, and muscle tone in the forearm, wrist, and hand. He performs provocation test and determine if they are consistent with radial tunnel syndrome. These tests include the resisted middle finger extension test and the resisted supination test.

Diagnosis:

Based on the history, symptoms, and physical examination, it appears that Alex might be dealing with radial tunnel syndrome. The repetitive motions involved in graphic design work, coupled with the location and nature of the pain and numbness, point towards compression of the radial nerve as it passes through the radial tunnel.

Treatment Plan:

Goal as a physiotherapist would be to alleviate Alex's symptoms, address the root cause, and prevent future occurrences. Here's how the treatment plan might look:

1. Education: Therapist will educate Alex about radial tunnel syndrome, its causes, and the importance of ergonomic adjustments during work to reduce strain on the forearm muscles.
2. Soft Tissue Mobilization: Utilizing the soft tissue mobilization techniques to releasing muscle tension and promoting proper blood flow in the forearm muscles.
3. Joint Mobilization: Gentle joint mobilization techniques are applied to improve joint mobility and nerve glide in the radial tunnel region.
4. Trigger Point Release: If trigger points are contributing to the discomfort, therapist employ trigger point release techniques to target these areas and alleviate muscle tension.
5. Ergonomic Modifications: Physiotherapist will guide Alex in making ergonomic adjustments to their workspace, ensuring that their posture and equipment usage are conducive to minimizing strain on the forearm.
6. Stretching and Strengthening Exercises: A tailored exercise program would focus on stretching the forearm muscles and strengthening them to provide better support to the radial nerve.
7. Home Exercise Program: Therapist provide Alex with a set of exercises and self-care techniques to continue their progress at home.

The following treatment plan would gradually transition from pain management to functional activities that support their return to their regular work routine without discomfort.