Ongoing Elbow Pain misdiagnosed as Tennis Elbow
Radial Tunnel Syndrome is a condition that causes pain and tenderness on the outer area of the elbow. Indeed many people who suffer from elbow pain are often misdiagnosed with Tennis Elbow. It is only after they have completed several sessions of treatment with no improvement in the condition that Radial Tunnel Syndrome, the true diagnosis of their elbow pain, is correctly diagnosed. Radial Tunnel syndrome involves compression of the radial nerve as it passes along the front of the elbow joint. The Radial nerve serves to control muscle movement in the forearm and wrist through its Posterior Interosseous nerve branch and also to provide sensation into the skin surrounding the wrist, thumb, index and big finger through its Superficial radial nerve branch (see illustration).
Radial Tunnel syndrome occurs in athletes and people who constantly perfrom repetitive twisting motions with their forearm for example, tennis players, golfers, Hurling players, Manual workers and people who consistently use their hands manually throughout the day. Overtime, this leads to tightening of the Supinator muscle close to its attachment point at the elbow joint. As the Radial nerve passes beneath the Supinator muscle, the tightened supinator muscle can compress the underlying radial nerve leading to elbow pain, elbow movement weakness and sensation deficits into the thumb. Indeed tightening of other surrounding muscles, namely Extensor Carpi radialis and extensor carpi radialis brevis that control extension of the wrist can also precipitate this condition.
Signs & Symptoms
Tenderness & pain on the outside area of the elbow
A noticeable weakening in your ability to grip an object with your hand
Pins & Needles and a Sensory weakness into the thumb, Index finger and Long finger
Twisting & turning of the wrist such as when using a screwdriver can aggravate the symptoms
Weakness in the ability to bend the elbow against resistance and also to extend the wrist backwards against resistance.
Weakness in the movement of the thumb outwards.
Dropped hand Deformity can often appear with the hand having a Claw-like appearance.
Treatment & Management
When Patients present at my clinic complaining of ongoing elbow pain, it is essential that I accurately diagnose the condition as Radial Tunnel syndrome as opposed to tennis elbow. This is achieved through accurate nerve testing. Once the condition is diagnosed as Radial Tunnel Syndrome, temporary avoidance of aggravating twisting movements of the wrist is important. In addition, Splinting of the wrist joint in an extended position can help release compression on the radial nerve. I would then commence manual stretching of the supinator and wrist extensor muscles coupled with radial nerve gliding techniques in order to mobilize the radial nerve from its compressed position.
Next week I will discuss painful conditions of middle spinal region.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
Contact Number: 086 3275 753
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