Introduction: Radial tunnel syndrome has been a controversial topic in the field of nerve decompressions. Variations exist in the diagnosis and treatment plan for this condition. Different outcomes of surgical intervention after failed non-operative methods prior to the development of significant extensor motor weakness exist in the literature. Methods: A retrospective review was performed from October 1997 to April 2003. Charts were assessed for radial tunnel releases. 11 patients had bilateral releases, one of which was simultaneous. A total of 69 decompressions were performed. A pre-operative diagnosis was made by history of proximal extensor forearm discomfort and physical exam findings of tenderness over the radial tunnel. The decompression was performed by releasing: the arcade of Frohse, the remaining superficial fibers of the supinator muscle, distal edge of supinator, extensor carpi radialis brevis, and ligation and transection of Leash of Henry vessels. Results: 55 out of 69 decompressions resulted in complete resolution of pre-operative symptoms, of which 24 had abnormal pre-operative NCV/EMG studies. 5 patients had weak extension as a pre-operative symptom. The other 14 decompressions resulted in a decrease in pre-operative symptoms, of which 3 had abnormal pre-operative NCV/EMG studies. One patient who underwent bilateral decompressions developed bilateral hematomas. The complications related to the radial tunnel release occurring in 4 patients included requirement for radial nerve neurolysis, transient posterior interosseous nerve palsy, and superficial radial nerve neuropraxia. One patient who had ipsilateral chronic shoulder pain was referred to a pain specialist. Two patients were excluded from this review because of inadequate follow-up. All patients who were employed pre-operatively returned to their work post-operatively, except for 7 patients whose work status was indeterminate. Conclusions: Decompression of the radial tunnel results in satisfactory outcomes in patients with pre-operative findings of proximal dorsal forearm pain and tenderness overlying the radial tunnel, 79.7% complete resolution of symptoms. An abnormal NCV/EMG was not required for a diagnosis of radial tunnel syndrome. Improvement in function was reported even in patients who continued to have mild intermittent persistence of pre-operative symptoms.