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Radial Tunnel Syndrome
 

Author: Milan Oxspring, MD
Affiliation: Mayo Clinic, Department of Physical Medicine and Rehabilitation
Co Author(s): James B. Meiling, DO
Senior Editor: Carlton Covey, MD, MEd

Clinical Vignette: A 38-year-old right-handed male construction worker presents with chronic exertional dorsal right forearm pain. He has been experiencing these pain symptoms chronically for 5+ years and they are provoked with exertion, especially at his job with using jackhammers and saws. Symptoms are able to generally be relieved with rest. Exam is notable for tenderness to palpation approximately 5cm distal of the lateral epicondyle on the dorsal side of the forearm, without any tenderness at the lateral epicondyle itself. Pain is reproduced with resisted wrist, finger, and thumb extension without focal weakness.

Type of Probe Used: 4-18 MHz linear-array ultrasound transducer



Unlabeled long axis view of the right deep radial nerve distal to radiocapitellar joint prior to the radial tunnel.


Labeled long axis view of the right deep radial nerve distal to the radiocapitellar joint. The deep radial nerve (dashed lines) is seen to descend underneath the arcade of Frohse. There is focal enlargement of the nerve just prior to entering the radial tunnel in between the deep and superficial heads of the supinator muscle, indicating a site of peripheral nerve entrapment (arrows). The extensor carpi radialis longus (ECRL) and brachioradialis (BR) are seen superficial.


Unlabeled short axis view of the right deep radial nerve just proximal to its entrance into the radial tunnel.


Labeled short axis view of the right deep radial nerve just proximal to the entrance into the radial tunnel. There is focal enlargement of the deep radial nerve (dashed circle, cross-sectional area 7.16 mm2) just proximal to the radial tunnel, indicating entrapment of the peripheral nerve just distal to this site. The nerve is visualized as a hypoechoic circle with complete loss of intraneural fascicular architecture.


Unlabeled Short Axis View of the Deep Radial Nerve Proximal to Radial Tunnel with Doppler.


Labeled Short Axis View of the Deep Radial Nerve Proximal to Radial Tunnel with Doppler focal enlargement of the deep radial nerve (dashed circle) just proximal to the radial tunnel, indicating entrapment of the peripheral nerve just distal to this site. The nerve is visualized as a hypoechoic circle with complete loss of intraneural fascicular architecture. Vascularity can be seen around and in the fascial plane superficial to the nerve, representing the Leash of Henry. BR, brachioradialis; ECRL, extensor carpi radialis longus; ECRB, extensor carpi radialis brevis.


Labeled Short Axis View of the Posterior Interosseous Nerve within the Radial Tunnel with mild flattening of the posterior interosseous nerve within the tunnel (dashed circle) between the two supinator heads. The nerve is visualized as a hypoechoic oval and is typically only seen as 1-2 fascicles within this area. BR, brachioradialis; ECRL, extensor carpi radialis longus; ECRB, extensor carpi radialis brevis.


Unlabeled Short Axis View of the Posterior Interosseous Nerve within the Radial Tunnel.


Unlabeled Short Axis View of the Posterior Interosseous Nerve After the Radial Tunnel.


Labeled Short Axis View of the Posterior Interosseous Nerve After the Radial Tunnel. The nerve (dashed circle) runs adjacent to the recurrent radial artery (hypoechoic circle to the left of the nerve) and surrounded by all of the muscles it supplies innervation to. EDC, extensor digitorum communis; EDM, extensor digiti minimi; ECU, extensor carpi ulnaris; EPL, extensor pollicis longus; APL, abductor pollicis longus.
View Video

The right deep radial nerve is scanned in short axis from just prior to its entrance into the radial tunnel then into the radial tunnel, becoming the posterior interosseous nerve (PIN). Focal enlargement of the deep radial nerve is seen as the nerve rapidly enlarges and then returns to a more normal size within the radial tunnel.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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