Dr. Michie

Peripheral Entrapment Neuropathy #5: Radial Tunnel Syndrome

Another painful and frustrating muslce/nerve condition is known as Radial Tunnel Syndrome.  This condition elicits pain due to pressure on the radial nerve near the elbow.  The radial nerve courses out of the neck via nerve roots and course through small openings called foramen exiting the spine.  The nerve roots coalesce into the radial nerve and runs through the back of the upper arm and spirals laterally through the outer elbow and eventually innervating the wrist and hand.  At the elbow, the radial nerve is housed in a “tunnel” muscle – the Supinator Muscle.

Symptoms

Tenderness and pain on the outside of the elbow similar to the area of ”Tennis Elbow” or Lateral Epicondylitis.  The pain worsens with backward wrist bending or turning the palm upward or even holding something with a straightened/extended elbow.  Typically, a dull pain and/or fatigue in the forearm muscles occur and weakness in the muscles along the lateral forearm and wrist will result.  Grasping for objects and even “shaking hands” will be challenging.  This condition, if untreated, can lead to “wrist drop” or the inability to raise the back of the hand.

Causes

Repetitive and forceful squeezing, pushing, pulling and even bending movements of the elbow and/or wrist can lead to this condition.  In sports, a direct blow to the lateral elbow can cause the nerve pathology.  If the tunnel is too small, it can lead to a “squeezing” of this nerve.  Racquet sports and any repetitive athletic event that involves the elbow can lead to this painful condition.

Diagnosis

Many cases are misdiagnosed as “Tennis Elbow” so a detaield history and mechanism of injury/cause is paramount in the process of figuring out the true nature of the pain.  In Tennis Elbow, the lateral forearm muscles will elicit pain on palpation whereas with Radial Tunnel Syndrome, the pain will elicited with palpation over the Supinator muscle.  With Applied Kinesiology, manual muscle testing can uncover the exact muscle and/or region of nerve entrapment.  MRI will sometimes reveal cause but more specifically, a NCV or EMG (nerve testing) can be done for narrowing down the area of nerve entrapment.  I like the manual method and Applied Kinesiology technique as it reveals pinpoint weakness and/or deficiency and it is very revealing on an interactive level with the patient.

Management

Obvious avoidance of cause – repetitive stress mechanism such as overuse sports should be modified – I don’t like telling patients to stop their activities – just monitor them to allow healing to occur.  finding the actual mechanism of cause will allow pinpoint rehabiltation exercises to strengthen the weak support muscles that may have led the Supinator muscle to get over-activated in the first place.  This is done with anatomy knowledge and transfering this to proper muscel recruitment in the gym or on the field/court.  If symptoms are worse at night, a nocturnal splint will be recommended for about 6 weeks to minimize irritation and promote healing.  Myofascial release, electrical trigger point therapy, myofasical dry needling and kinetic chain manipulation (cervical spine, shoulder, elbow, wrist and hand) will open up joint and soft tissue blockages to promote healing.  specific stretching and kinesiotaping protocols will be applied to relase the binding of the Supinator muscle as well.  The addition of proteolytic enzymes (Protrypsin from Metagenics), magnesium (OptiMag 125  from Xymogen) and Omega three fatty acids (Omega Pure 600 fro Xymogen) along with topicals such as Traumeel will all contribute to healing and restoration of this condition.  In recalcitrant cases, surgery is recommended or at least considered after all else failed.

Stay in the game, get your kinetic chain evaluated via Applied Kinesiology to prevent injury occurence and if this condition is brewing, consider getting an evaluation early in the symptom process so the healing window will be quicker.  Most of these conditions can be treated successfully prior to these conditions becoming chronic.  The longer one waits, the more difficult and less likely an optimal outcome will occur.  Remember, staying in the game requires preventive measures!!

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Dr. John Michie

About Dr. John Michie

John L. Michie, D.C., C.C.S.P., founder of Whole Health Chiropractic, embraces Edison's wisdom and incorporates a balance of nutrition, exercise, physiotherapy and chiropractic care to positively impact his patients’ health. Whole Health Chiropractic is a holistic, patient-centered practice. "It's our goal to uncover the causes of debilitating symptoms and follow with an action plan that addresses necessary steps for sustained healing."

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