Radial Tunnel Release at the Elbow

Your radial nerve controls a lot of the motor functions in your arm, from rotating your forearm to straightening your wrist and fingers. Because of radial tunnel syndrome, which occurs when the nerve gets compressed as it travels through the radial tunnel in your forearm, these relatively simple motions can become difficult and painful. Radial tunnel release at the elbow is a procedure to help relieve these painful symptoms.

Why is my doctor recommending a radial tunnel release at the elbow?

The Omaha Shoulder & Elbow Orthopedic Specialists at MD West ONE can properly recommend if a radial tunnel release at the elbow is the best course of action based on your symptoms and situation. If you have the following symptoms, you may want to make an appointment with one of our Board Certified Specialists.

Shoulder dislocations
Torn labrum
Recurrent shoulder instability

Treatment

The best way to treat this condition is to stop, or drastically reduce, the activity that causes your symptoms. If you can, try to rest your arm and avoid any movements that cause pain. Rest and medical treatment is generally successful in relieving symptoms in 3 to 6 weeks for most patients.

There are a few different approaches you can take if you’re still feeling pain after avoiding these movements, including:

Taking over-the-counter, anti-inflammatory medications.
Taking steroid injections to relieve inflammation and pressure on the radial nerve
Wearing a wrist and/or elbow splint to reduce movement and irritation on your radial nerve (this treatment is particularly common at night, while you’re sleeping).

You can also utilize different physical therapy exercises to help stretch out and loosen the tight muscle/tissue around the radial nerve, some of which include:

Wrist Extension Stretch: Put your affected arm out straight in front of you, with your hand up and your fingers facing toward the sky. Use your other hand to pull back on your fingers, until you feel a stretch in your forearm.

Wrist Flexion Stretch: Put your affected arm out straight in front of you, with your hand down and your fingers facing toward the ground. Use your other hand to pull back on the back of your palm until you feel a stretch in your forearm.

Wrist supination: Place your affected arm by your side at a 90-degree angle, with your forearm and hand facing up. Put your other hand on your wrist and rotate your forearm inward, toward your body, without moving the other parts of your arm.

Radial nerve glides: Standing straight, drop your shoulders slightly and rotate your arms into your body. Flex your wrist on one side and raise your arm up to waist level as you tilt your head the opposite way. Once you feel the stretch, hold the position for three to five seconds.

You should do all of these exercises on both sides of your body, even though you’ll likely only be dealing with radial tunnel syndrome in one arm.

The goal of treatment is to eliminate your symptoms and prevent them from ever coming back. If your job is causing your symptoms, you may need to change your work site or talk about getting more breaks during the workday. Try to avoid any heavy push-and-pull movements if possible.

For athletes, practice strength and flexibility exercises and always remember to adequately warm up before playing or practicing.

Procedure

There is a surgical treatment for this condition, but your doctor will likely only recommend it when rest and non-operative therapy fails. The goal of surgical decompression is to take the unwanted pressure off your radial nerve as it passes through the radial tunnel.

Your surgeon will begin this procedure by making a cut right below the outside of your elbow and into your forearm. After moving around muscle tissues in the radial tunnel, they’ll be able to see where exactly the nerve is being pinched or compressed. Once they find the exact spot, your surgeon will simply cut the parts of the radial tunnel that are compressing the nerve, expanding the tunnel in the process. Once the procedure is done, they’ll stitch the cut back together.

This surgery is uncommon, and it can be performed as outpatient surgery, meaning you won’t stay in the hospital overnight.

After Surgery

After your surgery, you will be given an elbow splint to wear home that will immobilize your arm. About a week-and-a-half after the procedure, you’ll return to your doctor’s office so that they can remove your stitches and give you a removable splint.

Rehabilitation

About a week and a half after your surgery, you may be able to begin certain activities that will improve your range of motion, including:

A gentle exercise program
Soft-tissue massages
Stretching

Six weeks after your procedure, you may be able to begin practicing strength-building exercises for your forearm and hand, like squeezing silly putty, under a therapist’s supervision.

During this recovery phase, you need to avoid lifting and other activities that require you to bend your arm at the elbow.

In the final stage, your therapist will add exercises to stabilize and strengthen your wrist, elbow, and shoulder, and to improve fine motor control in your hand.

Your recovery timeline depends on a few different factors, including:

Your specific medical history/condition
How damaged your radial nerve was before the surgery
You should expect to be fully recovered from this procedure in four to six months, but it can sometimes take even longer

Long Term Outcomes

Medical treatment is typically successful with this condition, provided you carefully follow instructions and avoid any future injuries to your radial nerve. For those who don’t have success with medical treatment, surgery is an option that has worked very well in improving symptoms. There are some patients who do continue to experience mild pain, even after surgery.

Your primary goal after you’ve recovered, whether it be after surgery or non-surgical treatment, should be to avoid any sort of re-injury to your radial nerve.