Hội chứng ống cẳng tay quay Thông tin In-depth

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [3].
• The primary issue surrounding radial tunnel syndrome has traditionally been properly identifying it clinically [2].
• The Rule-of-Nine test effectively specifies the site of tenderness for the diagnosis of radial tunnel syndrome [4].
• A prospective evaluation of corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome [5].
• Nonsurgical management is first-line for radial tunnel syndrome [1].
• Surgical decompression remains a viable option for refractory cases of radial tunnel syndrome despite ongoing controversy regarding diagnosis and outcomes [1].
• Pain in patients with radial tunnel syndrome may be treated successfully by surgical decompression of the superficial branch of the radial nerve [12].
• In high radial nerve entrapment neuropathy cases resistant to conservative treatment, surgery is advocated with emphasis on dissecting the entire length of the fibrous tunnel [6].
• A study on high-resolution dynamic ultrasonography for posterior interosseous nerve compression acknowledges that it does not establish diagnostic accuracy or a reference standard for radial tunnel syndrome [15].

Anatomy & Pathophysiology

Radial Tunnel Anatomy

• The radial tunnel is a potential space located anterior to the proximal radius through which the posterior interosseous nerve (PIN) passes [8].
• The radial tunnel extends for approximately 5 cm starting from the level of the humeroradial joint and extending past the proximal edge of the supinator [8].
• The radial tunnel is bound on the lateral side by the brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis muscles [8].
• The radial tunnel is bound on the medial side by the supinator muscle [8].
• The posterior interosseous nerve crosses the radial head midline [55].
• Supination of the forearm increases the linear distance between the posterior interosseous nerve and the radial head [55].
• Predictive accuracy for posterior interosseous nerve localization in the proximal forearm was highest when the arm was in a supinated position [66].

Pathophysiology & Etiology

• Radial tunnel syndrome is a pain syndrome presumed to be caused by compression of the posterior interosseous nerve at the proximal forearm [8].
• There is dispute over the etiology of radial tunnel syndrome, with skeptics noting that its signs and symptoms contrast from other well-described entrapment neuropathies [7].
• Skeptics note that radial tunnel syndrome presents with prominent focal tenderness, normal neurologic function, and no confirmatory electrodiagnostic evidence of nerve dysfunction [7].
• Focal tenderness at the radial tunnel in radial tunnel syndrome differs from a positive Phalen's test in carpal tunnel syndrome because symptoms do not occur in the distribution of the purportedly affected nerve [7].
• The posterior interosseous nerve carries unmyelinated (group IV) afferent fibers from the wrist capsule [7].
• The posterior interosseous nerve carries small myelinated (group IIA) afferent fibers from the muscles along its distribution [7].
• Unmyelinated group IV fibers from muscles are associated with nociception and pain [7].
• There are no specific electrodiagnostic findings for radial tunnel syndrome [8].

Classification

• There is dispute over the etiology of radial tunnel syndrome, with skeptics noting that its signs and symptoms contrast from other well-described entrapment neuropathies such as carpal tunnel syndrome and cubital tunnel syndrome [7].
• Focal tenderness at the radial tunnel in radial tunnel syndrome differs from a positive Phalen's test in carpal tunnel syndrome in that the symptoms do not occur in the distribution of the purportedly affected nerve [7].
• Radial tunnel syndrome and posterior interosseous nerve compression are distinct entities with different clinical presentations but share identical potential sites of nerve interference [14].
• The author proposes unifying radial tunnel syndrome and posterior interosseous nerve compression as mild and severe forms of one disease to simplify nomenclature [14].
• The authors advocate for consistent use of the terminology distinguishing the deep branch of the radial nerve and the posterior interosseous nerve [24].
• The authors recommend viewing radial tunnel syndrome and posterior interosseous nerve syndrome as a single condition presenting along a spectrum of nerve entrapment [24].
• The study provides credence to the concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve [9].
• The prevalence of radial tunnel syndrome in a representative United States insurance database was 0.091% [70].
• The annual incidence of radial tunnel syndrome in a representative United States insurance database was 0.0091% [70].
• Approximately 5.7% of the patients with radial tunnel syndrome also had a diagnosis of lateral epicondylitis on the same side within 6 months of radial tunnel syndrome diagnosis [70].

Clinical Presentation

Diagnostic Criteria and Physical Findings

• Diagnosis of radial tunnel syndrome depends on clinical presentation and physical findings [8].
• Prominent focal tenderness in the area of the radial tunnel is one of the principal diagnostic criteria for radial tunnel syndrome [7].
• Clinical diagnosis criteria for radial tunnel syndrome include activity-related pain, maximal tenderness 3–5 cm distal to the lateral epicondyle, pain exacerbation with forearm supination, radiation to the dorsoradial aspect of the forearm, and a positive Lister test [42].
• A positive Lister test is defined as pain with resisted middle finger extension [42].
• Patients required to have at least 4 of the 5 diagnostic signs and symptoms for a clinical diagnosis of radial tunnel syndrome, with maximal tenderness 3–5 cm distal to the lateral epicondyle being mandatory [42].
• Physical examination maneuvers to elicit radial tunnel syndrome include wrist flexion and forearm pronation, the Rule of Nines test, and weakness and pain with resisted long finger extension [46].
• The history for radial tunnel syndrome is characterized by extensor musculature "forearm aching" [46].

Neurologic and Electrodiagnostic Features

• Skeptics note that radial tunnel syndrome presents with normal neurologic function, contrasting with other well-described entrapment neuropathies [7].
• Skeptics note that there is no confirmatory electrodiagnostic evidence of nerve dysfunction in radial tunnel syndrome [7].
• Focal tenderness at the radial tunnel differs from a positive Phalen's test in carpal tunnel syndrome because symptoms do not occur in the distribution of the purportedly affected nerve [7].
• The posterior interosseous nerve carries unmyelinated (group IV) afferent fibers from the wrist capsule and small myelinated (group IIA) afferent fibers from the muscles along its distribution [7].

Differential Diagnosis and Controversy

• There is dispute over the etiology of radial tunnel syndrome, with skeptics noting its signs and symptoms contrast from carpal tunnel syndrome and cubital tunnel syndrome [7].
• Radial tunnel syndrome and posterior interosseous nerve syndrome may be viewed as a single condition presenting along a spectrum of nerve entrapment [24].
• Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve, leading to painful and dysesthetic symptoms at the lateral aspect of the elbow [16].
• Patients with superficial radial nerve compression due to type A ganglion cysts are often initially diagnosed and managed as lateral epicondylitis [16].

Investigations

Clinical Diagnosis and Controversy

• Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [8].
• The diagnosis of radial tunnel syndrome depends on clinical presentation and physical findings [8].
• The primary issue surrounding radial tunnel syndrome is properly identifying it clinically [2].
• Radial tunnel syndrome is described as an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [3].
• The lack of specific electrodiagnostic and pathophysiologic findings makes radial tunnel syndrome somewhat controversial [8].

Electrodiagnostics

• Understanding the anatomic course and distribution of the radial nerve is important to make an accurate diagnosis [11].

Imaging

• Magnetic resonance imaging provides credence to the concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve [9].
• Dynamic ultrasonographic assessment of changes in the anteroposterior diameter and cross-sectional area is an effective diagnostic tool for identifying radial tunnel syndrome [64].
• A study on high-resolution dynamic ultrasonography for posterior interosseous nerve compression does not establish diagnostic accuracy or a reference standard for radial tunnel syndrome [15].
• Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve, which can present with symptoms initially diagnosed as lateral epicondylitis [16].
• Magnetic resonance imaging can reveal the presence of a mass compatible with a ganglion cyst coming from the radiocapitellar joint that pushes up the superficial sensory branch of the radial nerve [16].

Treatment

Non-Operative

• Nonsurgical management is the first-line treatment for radial tunnel syndrome [1].
• The two most common nerve entrapment disorders about the elbow, including radial tunnel, should be initially managed conservatively before considering surgical intervention [41].
• A prospective evaluation of a single corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome [5].
• A prospective evaluation of a single corticosteroid injection in radial tunnel syndrome was conducted by authors who declared no potential conflicts of interest and received no financial support for the research [22].

Operative

• Surgical decompression remains a viable option for refractory cases of radial tunnel syndrome [1].
• There is a tendency that surgical decompression of the radial tunnel might be effective in patients with radial tunnel syndrome [48].
• In high radial nerve entrapment neuropathy cases resistant to conservative treatment, surgery is advocated with an emphasis on dissecting the entire length of the fibrous tunnel [6].
• There has been no randomized controlled trial that compares surgical with nonsurgical treatment or with a placebo for radial tunnel syndrome [7].

Complications

• Nerve injury is an uncommon though troublesome complication of fractures or dislocations of the elbow [18].
• Workers' compensation patients and those with associated lateral epicondylitis may have less successful outcomes following surgical treatment for radial tunnel syndrome [8].

Recovery

• Prospective evaluation of corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome [5].
• Isolated posterior interosseous nerve neurectomy has shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up [30].

Key Evidence

• [L4] The article reviews the anatomy, diagnosis, and treatment of radial tunnel syndrome, noting that while nonsurgical management is first-line, surgical decompression remains a viable option for refractory cases despite ongoing controversy regarding diagnosis and outcomes. [1] (10.5435/jaaos-d-23-00314)
• [L5] The issue surrounding radial tunnel syndrome traditionally has been properly identifying it clinically. [2] (10.1097/01.bth.0000231580.32406.71)
• [L5] Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis. [3] (10.1016/j.jhsa.2010.03.020)
• [L4] The Rule-of-Nine test effectively specifies the site of tenderness for the diagnosis of radial tunnel syndrome. [4] (10.1177/230949900401200115)
• [L4] Prospective evaluation of corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome. [5] (10.1016/j.jhsa.2017.06.095)
• [Case_report] The authors advocate for surgery in high radial nerve entrapment neuropathy cases resistant to conservative treatment, emphasizing the importance of dissecting the entire length of the fibrous tunnel. [6] (10.1016/j.jse.2025.02.060)
• [L5] [7] (10.1016/j.jhsa.2009.10.016)
• [L5] [8] (10.1016/j.ocl.2012.07.022)
• [L4] The study provides credence to the somewhat disputed concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve. [9] (10.1148/radiol.2401050028)
• [L5] It is important to understand the anatomic course and distribution of the radial nerve in order to make an accurate diagnosis. [11] (10.1007/s11420-011-9238-8)
• [L4] This study indicates that pain in patients with radial tunnel syndrome may be treated successfully by surgical decompression of the superficial branch of the radial nerve. [12] (10.1177/1753193408099832)
• [L5] Radial tunnel syndrome (RTS) and posterior interosseous nerve (PIN) compression are distinct entities with different clinical presentations but share identical potential sites of nerve interference; the author proposes unifying them as mild (RTS) and severe (PIN compression) forms of one disease to simplify nomenclature. [14] (10.1177/1753193420953990)
• [Paper] The authors acknowledge that their study does not establish diagnostic accuracy or a reference standard for radial tunnel syndrome. [15] (10.1177/17531934261463150)
• [L4] [16] (10.1016/j.otsr.2016.05.014)
• [L4] Nerve injury is an uncommon though troublesome complication of fractures or dislocations of the elbow. [18] (10.1016/s0020-1383(79)80015-7)
• [L4] [22] (10.1177/1558944718787282)
• [L5] The authors advocate for consistent use of the terminology distinguishing the deep branch of the radial nerve (DBRN) and the posterior interosseous nerve (PIN), and recommend viewing radial tunnel syndrome and posterior interosseous nerve syndrome as a single condition presenting along a spectrum of nerve entrapment. [24] (10.1177/17531934241254706)
• [L4] Isolated PINN have shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up. [30] (10.1177/1558944717692093)
• [L2] [42] (10.1016/j.jhsa.2024.09.023)
• [L4] There is a tendency that surgical decompression of the radial tunnel might be effective in patients with RTS. [48] (10.1016/j.jhsa.2007.10.001)
• [L5] Supination increases the linear distance between the PIN and radial head and should be considered to increase the safe working volume whenever intra-articular procedures are performed on the anterolateral aspect of the elbow. [55] (10.1016/j.jse.2018.08.019)
• [L4] Dynamic ultrasonographic assessment of changes in the AP diameter and CSA is an effective diagnostic tool for identifying radial tunnel syndrome. [64] (10.1177/17531934261443138)
• [L5] Predictive accuracy was highest when the arm was in a supinated position. [66] (10.1016/j.arthro.2013.03.056)
• [L3] [70] (10.1016/j.jhsa.2023.03.007)

References

[1] Radial Tunnel Syndrome: Review and Best Evidence. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00314

[2] A Unified Approach to Radial Tunnel Syndrome and Lateral Tendinosis. Techniques in Hand & Upper Extremity Surgery. 2006. DOI: 10.1097/01.bth.0000231580.32406.71

[3] Radial Tunnel Syndrome. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.03.020

[4] A New Clinical Test for Radial Tunnel Syndrome—The Rule-of-Nine Test: A Cadaveric Study. Journal of Orthopaedic Surgery. 2001. DOI: 10.1177/230949900401200115

[5] Prospective Evaluation of Single Corticosteroid Injection in Radial Tunnel Syndrome. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.095

[6] High radial nerve entrapment neuropathy: an anatomical cadaver study and case report. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.060

[7] Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.10.016

[8] Radial Tunnel Syndrome. Orthopedic Clinics of North America. 2012. DOI: 10.1016/j.ocl.2012.07.022

[9] MR Imaging Features of Radial Tunnel Syndrome: Initial Experience. Radiology. 2006. DOI: 10.1148/radiol.2401050028

[11] Posterior Interosseous Neuropathy: Electrodiagnostic Evaluation. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery. 2012. DOI: 10.1007/s11420-011-9238-8

[12] Radial Tunnel Syndrome: Emphasis on the Superficial Branch of the Radial Nerve. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408099832

[14] Radial tunnel syndrome: definition, distinction and treatments. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420953990

[15] Re: Role of high-resolution dynamic ultrasonography in the evaluation of posterior interosseous nerve compression at radial tunnel: a prospective case-control study. Journal of Hand Surgery (European Volume). 1934. DOI: 10.1177/17531934261463150

[16] Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.05.014

[18] Acute nerve injury as a complication of closed fractures or dislocations of the elbow. Injury. 1979. DOI: 10.1016/s0020-1383(79)80015-7

[22] Prospective Evaluation of a Single Corticosteroid Injection in Radial Tunnel Syndrome. HAND. 2018. DOI: 10.1177/1558944718787282

[24] Nomenclature of the radial nerve: distinguishing between the deep branch of the radial nerve and the posterior interosseous nerve. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241254706

[30] Outcomes Following Isolated Posterior Interosseous Nerve Neurectomy: A Systematic Review. HAND. 2017. DOI: 10.1177/1558944717692093

[41] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Elbow Degenerative Conditions and Nerve Disorders > Summary.

[42] Investigating the Effect of Triamcinolone Local Injection on Clinical Outcomes of Patients With Radial Tunnel Syndrome: A Placebo-Controlled Clinical Trial. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.023

[46] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Biomechanics > Clinical Examination.

[48] Interventions for Treating the Radial Tunnel Syndrome: A Systematic Review of Observational Studies. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.10.001

[55] The posterior interosseous nerve crosses the radial head midline and increases its distance from bony structures with supination of the forearm. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.019

[64] Role of high-resolution dynamic ultrasonography in the evaluation of posterior interosseous nerve compression at radial tunnel: a prospective case-control study. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261443138

[66] Posterior Interosseous Nerve Localization in the Proximal Forearm: A Cadaveric Study Establishing a Non‐invasive, Patient‐normalized Parameter (SS‐49). Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.03.056

[70] The Epidemiology of Radial Tunnel Syndrome and Its Overlap With Lateral Epicondylitis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.03.007