Chiropractors are well suited to recognize and manage lateral epicondylopathy. In fact, we often jump to the diagnosis within seconds of hearing the patient’s history. Unfortunately, not all pain near the lateral epicondyle is simply tennis elbow. Radial tunnel syndrome can mimic or even coexist with lateral epicondylopathy in up to 10% of patients. (1) Differentiating these presentations will afford better clinical outcomes.
Presenting symptoms for Radial Tunnel Syndrome (RTS) depend on whether irritation affects the sensory branch, motor branch or both. Compression or irritation of the superficial sensory branch results in pain, paresthesia or diminished sensitivity along the dorsal aspect of the forearm sometimes radiating to the hand, including the first web space and back of the thumb and index finger. These symptoms are often described as deep, aching and diffuse- closely mimicking lateral epicondylopathy. In contrast, compression of the motor branch (posterior interosseous nerve) manifests as weakness of MCP and thumb extension, also called “finger drop”. (2) Wrist extension is generally not affected as noticeably thanks to cross-innervation.
Palpatory evaluation should elicit tenderness over the radial nerve four finger breaths distal to the lateral epicondyle (3) Symptoms generally intensify during resisted wrist extension, supination and pronation. Resisted muscle testing can help localize the site of compression. (2) Reproduction of symptoms upon resisted supination, when the arm and wrist are in extension, suggests compression at the arcade of Froshe (Resisted supination test). Reproduction of symptoms during resisted extension of the middle finger suggests compression of the posterior interosseous nerve beneath the extensor carpi radialis brevis (Resisted long finger extension, aka, Middle finger sign). (3) Tinel sign or reproduction of symptoms by percussion of the radial nerve is infrequently present.
Differentiation of lateral epicondylopathy from RTS will certainly improve clinical outcomes.
Please refer to the ChiroUp condition protocols for Radial Tunnel Syndrome and Lateral Epicondylopathy to learn more about the current “best practice” evaluation and management of these conditions. If you have any other suggestions concerning the identification and management of RTS we would love to hear from you. Lets work together to improve our outcomes and secure an even brighter professional future.
1. Spinner M, Spinner RJ. Management of nerve compression lesions of the upper extremity. In: Management of Peripheral Nerve Problems, 2nd ed. 1998, Philadelphia, WB Saunders, pp. 501-533.
2. Henry M, Stutz C. A unified approach to radial tunnel syndrome and lateral tendinosis. Tech Hand Up Extrem Surg. Dec 2006;10(4):200-5
3. Lister G. The Hand: Diagnosis and Indications. 1984, New York, Churchill Livingstone.
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