Introduction: Roles and Maudsley, in 1972, were the first to identify radial tunnel syndrome as an independent entity related to entrapment of the posterior interosseous nerve (PIN) at the proximal forearm. It is differentiated from posterior interosseous nerve syndrome by a lack of motor involvement. Several published reports documented mixed results of surgical treatment of radial tunnel syndrome. In this paper we present our experience with surgical treatment of radial tunnel syndrome in 213 patients.

Materials and Methods: Between 1990 and 2000, 249 patients were surgically treated for radial tunnel syndrome. 213 patients were available for review. There were 84 males and 129 females. Age ranged from 23 to 68 years, with an average of 43 years. Symptoms were present for an average of 9 months. History of trauma was present in 47 patients. 162 patients were worker’s compensation patients. Electrodiagnostic studies were positive in 131 patients (62%), and negative in 81 patients (38%). Associated conditions were present in 150 patients . Patients were treated conservatively for an average of 3½ months. Surgery was performed using dorsal approach under regional anesthesia. The PIN was exposed between the extensor carpi radialis brevis and the extensor digitorum communis muscles. The anterior approach was used in four recurrent cases. Postoperative follow-up ranged from 2-10 years, (average 4½ years.)

Results: At the time of last follow-up, 146 patients had no pain (69%), 36 patients had minimal pain (17%), 24 patients had moderate degree of pain (11%), and seven patients had persistent pain (3%). Of the seven patients who had persistent pain, five underwent re-exploration of the PIN. Eventually three patients had complete improvement, but two continued to have persistent pain. The grip strength compared to the contralateral side averaged 98%. Of the 162 worker’s compensation patients, 157 returned to their regular work activities, and four returned to modified work activities. One patient had to change his job. All the non-worker’s compensation patients resumed their normal daily activities. Subjectively, patients classified their outcome as excellent in 68%, good 17%, fair 12% and poor 3%. The worker’s compensation patients subjectively classified themselves as excellent in 61%, good in19%, fair in 15%, and poor in 4%.

Discussion and Conclusion: Proper diagnosis and management of patients with radial tunnel syndrome are associated with relatively good functional outcome. Worker’s compensation patients had slightly less favorable results, but not to a significant degree.