Radial Tunnel Syndrome
Recognising the Symptoms and Signs
Ali Phillips | Hand & Wrist Specialist
A deep ache on top of your forearm?
I'm Ali Phillips. If you're experiencing a persistent, deep ache on the top of your forearm that feels different from tennis elbow, you might have Radial Tunnel Syndrome. I have this myself, so I truly understand how frustrating it can be. This guide will help you understand this tricky condition and the steps we can take to find relief.
Book a ConsultationWhat is Radial Tunnel Syndrome?
Radial Tunnel Syndrome is a condition where the radial nerve is compressed or irritated as it travels from the neck down to the hand. The nerve passes through several "tunnels" made of muscle and bone, and can get squeezed at multiple points: in the neck, under the armpit, at the back of the triceps, or most commonly, in the forearm just below the elbow.
Unlike other nerve conditions, it's known for causing a deep, aching pain rather than significant numbness or tingling. The nerve is often simply irritated and swollen, and getting the right diagnosis is the critical first step to managing it effectively.
What are the symptoms of Radial Tunnel Syndrome?
Deep Forearm Ache
The main symptom is a deep, aching, or tired pain on the top of your forearm that worsens with activity, especially after exercise.
Pain with Resistance
Pain is often triggered when you try to straighten your wrist or middle finger against resistance.
Tenderness
You will likely feel tenderness when pressing on the specific points where the nerve is being compressed in the forearm.
Is This Your Forearm Pain?
If this deep, aching pain sounds familiar, getting an accurate diagnosis is the first step towards relief. Let's find the true source of your symptoms and create a plan to help.
Get a Clear DiagnosisHow will I diagnose your forearm pain?
Diagnosing Radial Tunnel Syndrome can be tricky and relies heavily on a thorough physical examination. A key test is resisting the extension of your middle finger. You can try this gently at home, but stop if it causes pain.
1️⃣
Place your hand palm-down on a table.
2️⃣
With your other hand, place a finger on the back of your affected middle finger's knuckle.
3️⃣
Try to lift your middle finger straight up against the gentle pressure.
Pain on the top of your forearm during this movement is a strong indicator of Radial Tunnel Syndrome. A diagnostic injection of local anaesthetic can also be very helpful in confirming that the radial nerve is the source of the pain.
How can I help you get better?
We'll create a personalised treatment plan together, always starting with the simplest options first.
Rest & Taping Resting the arm and avoiding aggravating activities is critical. I often manage my own symptoms with intermittent taping to offload the nerve, which can be very effective.
Splinting Wearing a wrist splint, particularly at night, can help keep the wrist in a neutral position and reduce tension on the radial nerve.
Hand Therapy A skilled therapist can guide you through specific nerve gliding exercises designed to help the radial nerve move more freely through its tunnel.
Injections A steroid injection can sometimes provide good pain relief and is also a powerful tool to confirm that the radial nerve is the source of your pain.
Surgery for Radial Tunnel Syndrome is rare and is only considered if your pain is severe and has not responded to a prolonged course of non-surgical treatment.
What does a Radial Tunnel Release involve?
The surgery involves making an incision over the top of the forearm to carefully explore the path of the radial nerve. I then identify and release the specific bands of muscle or fibrous tissue that are compressing the nerve, giving it more space and relieving the pressure.
Benefits
- Can provide lasting relief from deep aching pain
- Allows a return to activities without discomfort
Small Risks
- Infection
- Nerve injury (temporary or permanent)
- Scar tenderness
- Incomplete relief of symptoms
Frequently Asked Questions
While the pain can be in a similar area, tennis elbow pain is usually very localised to the bony point on the outside of the elbow. Radial tunnel syndrome pain is typically a more diffuse, deep ache further down the forearm. It's not uncommon for the two conditions to coexist.
Radial tunnel syndrome is a "dynamic" compression, meaning the nerve is squeezed during activity but may not be damaged enough to show changes on a nerve test performed at rest. This is a key reason why the diagnosis is often missed and requires a specialist examination.
Surgery is considered when your pain is significant and has not improved with a dedicated course of non-surgical treatments like rest, splinting, and hand therapy. Because it's such a tricky diagnosis, we need to be very confident before proceeding with surgery.
The surgery involves making an incision over the top of your forearm to carefully explore the path of the radial nerve. I then identify and release all the potential points of compression, giving the nerve more space to move freely.
Recovery typically involves a couple of weeks of rest to allow the wound to heal, followed by a course of hand therapy to restore strength and movement. A full return to all activities can take a few months, but most patients experience significant pain relief much sooner.
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