Radial Tunnel Syndrome (RTS)


 

Radial Tunnel Syndrome is a nerve irritation condition that affects the radial nerve as it travels through a narrow space in the forearm called the radial tunnel. Even though it’s less well-known than tennis elbow, it often mimics elbow pain and is commonly misdiagnosed.

What’s Actually Happening?

The radial nerve passes between muscles and connective tissue near the elbow. When those tissues become tight, inflamed, or overloaded, the nerve gets compressed or irritated.

👉 Unlike carpal tunnel syndrome, radial tunnel syndrome usually does NOT cause numbness or tingling.
👉 The pain is more deep, aching, or burning, especially with use.

Common Symptoms

  • Deep, aching pain on the top/outside of the forearm

  • Pain that worsens with:

    • Gripping

    • Lifting

    • Twisting (opening jars, using tools)

  • Tenderness 1–2 inches below the outer elbow

  • Fatigue or weakness in the forearm

  • Pain that feels worse later in the day

💡 Many patients are told they have tennis elbow, but treatments don’t fully help—that’s a big clue.

Common Causes

  • Repetitive gripping or wrist extension

  • Overuse from:

    • Weight training

    • Tennis, pickleball, golf

    • Manual labor or tool use

  • Prolonged computer or mouse use

  • Poor elbow, wrist, or shoulder mechanics

  • Muscle tightness in the forearm extensors or supinator

How Radial Tunnel Syndrome Is Different from Tennis Elbow

Radial Tunnel Syndrome Tennis Elbow
Deep, aching nerve pain Sharp tendon pain
Pain slightly below elbow Pain right on elbow
Worse with resisted forearm rotation Worse with wrist extension
Nerve irritation Tendon inflammation

Conservative Treatment & Rehab (What Actually Helps)

1. Activity Modification (Short-Term)

  • Reduce repetitive gripping and twisting

  • Avoid lifting with palm facing down

  • Take breaks from aggravating activities

  • Use neutral wrist positioning when possible

2. Gentle Stretching (Daily)

Forearm Extensor Stretch

  • Arm straight, palm down

  • Gently bend wrist downward with the opposite hand

  • Hold 20–30 seconds, repeat 2–3 times

Supinator Stretch

  • Elbow bent at side

  • Slowly rotate palm downward and hold

  • Gentle, no forcing

⚠️ Stretch should feel relieving, not sharp or nerve-like.

3. Strengthening (Progress Gradually)

Start pain-free and light.

Isometric Wrist Extension

  • Elbow bent, forearm supported

  • Push up gently against resistance without moving

  • Hold 5–10 seconds, repeat 5–10 reps

Eccentric Wrist Extension

  • Lift wrist up with assistance

  • Slowly lower under control

  • 2–3 sets of 8–12 reps

Grip Endurance

  • Light putty or towel squeezes

  • Focus on endurance, not max strength

4. Nerve-Friendly Movement (Very Important)

Radial Nerve Glides

  • Arm at side, elbow straight

  • Wrist flexed, palm facing inward

  • Slowly move into gentle tension, then release

  • 5–10 slow reps

👉 These should feel freeing, not aggressive.

5. Supportive Therapies

  • Ice or contrast therapy after use

  • Soft tissue work (manual therapy, massage, or instrument-assisted techniques)

  • Bracing only short-term if needed (not long-term)

When to Seek Professional Help

You should get evaluated if:

  • Pain lasts longer than 2–3 weeks

  • Symptoms worsen despite rest

  • You’ve been treated for tennis elbow without success

  • Pain interferes with work, sleep, or exercise

A clinician trained in nerve mechanics, joint alignment, and forearm biomechanics can help identify why the nerve is irritated—not just calm symptoms.

Prognosis (Good News)

✅ Most cases respond very well to conservative care
✅ Early treatment = faster recovery
✅ Addressing mechanics prevents recurrence

Final Thought

Radial Tunnel Syndrome is often overlooked, but when properly identified and treated, patients recover fully and return to activity without chronic pain. The key is restoring space, movement, and balance around the nerve—not just resting forever.