If you are on this page reading this, it means you have a chronic painful condition of the outer aspect of the elbow.
If you are on this page reading this, it means you have a chronic painful condition of the outer aspect of the elbow of your dominant working hand which has been earlier diagnosed by many physicians as Tennis Elbow and you have taken multiple treatments and therapies for the same but have no relief.
There might be a possibility that you are suffering from tennis elbow and is in the recovering phase which is quite long and can last up to one year during treatment for tennis elbow. If you have not felt any relief or have chronic pain in the elbow region and at the back of the upper part of the forearm since many years then you should read this page.
There is one more entity known as radial tunnel syndrome which is often confused with tennis elbow. It also gives rise to pain around the same region which is affected by tennis elbow but has a completely different etiology and management. That is why radial tunnel syndrome is often called as resistant tennis elbow.
Radial tunnel syndrome occurs when a nerve called as radial nerve is compressed as it enters the radial tunnel in the forearm.
The radial nerve is one of three nerves in your forearm, traveling from the side of your neck, down the back of your arm, through your forearm and into your hand. Your radial nerve is responsible for a lot of different arm movements, including forearm rotation, elbow straightening, and wrist and finger movements.
When the nerve reaches the elbow, it passes through the radial tunnel, which is a very narrow space surrounded by a lot of muscles. The nerve when compressed here often causes nagging pain in the upper part of the back of forearm.
Radial tunnel syndrome is most common in women between the ages of 30 and 50 years.
When radial nerve passes through the radial tunnel which is surrounded by muscles covered with fascia (tissue fibers that enclose, separate or bind together muscles and other soft structures), it becomes vulnerable to compression and irritation by the surrounding structures. If any of the structures becomes inflamed, it puts too much pressure on the nerve, leading to this condition. But there are several different activities that can cause radial tunnel syndrome, including:
Radial tunnel syndrome is very frequently misdiagnosed as tennis elbow because of the same site of location of pain which also increases with twisting and turning movements of the wrist.
A careful history, proper physical examination can help in arriving at a diagnosis of radial tunnel syndrome.
The maximum pain in tennis elbow is at the region of the lateral epicondyle bone of the elbow region whereas in radial tunnel syndrome it is 2 to 3 centimetres distal to the bone.
The area can be examined for pain by applying light pressure and doing few provocative tests which can help in the diagnosis.
Pain while turning the palm up from a palm down position against resistance or pain while extension of the fingers against resistance is diagnostic of radial tunnel syndrome.
There are no formal imaging tests that can diagnose radial tunnel syndrome, though an X-ray, MRI or electromyography test, are done just to rule out other potential injuries or conditions.
The goal of treatment is to eliminate pain and prevent it from ever coming back. Proven nonsurgical techniques exists which can benefit the condition of radial tunnel syndrome.
If symptoms don't improve after nonsurgical treatment, then surgery is indicated which is done under brachial block or general anaesthesia. The goal of the surgical decompression is to take the unwanted pressure off the radial nerve as it passes through the radial tunnel. An incision is given right below the outside of the elbow and into the forearm. The area compressing the nerve is released, expanding the tunnel in the process.
After your surgery, you will be given an elbow splint that will immobilize your arm. Sutures are removed after 14 days. Around this time, you can also begin certain activities that will improve your range of motion, including:
Strength-building exercises for your forearm and hand, like squeezing rubber ball, under a therapist's supervision can be started 6 weeks after the surgery.
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, exercises to stabilize and strengthen your wrist, elbow and shoulder will be added.
Recovery from this surgery takes about four to six months, but it can sometimes take even longer.
If the patient has presented very late, then it can lead to radial nerve palsy with atrophy of the muscles of back of forearm. He or she would be having permanent wrist, finger and thumb drop.
Such condition of wrist drop and finger, thumb drop (inability to extend the wrist, thumb and fingers) is usually seen in long standing compression of the radial nerves due to tumors or injuries of the radial nerve after accidents or fractures.
During tendon transfers for radial nerve palsy, 3 tendons from the front of the forearm and hand are taken, re-routed and sutured to the tendons of the back of the forearm and hand so that the patient can extend his wrist, fingers and thumb. The surgery is usually done under brachial block or general anaesthesia and a splint or slab is given for immobilization in the post operative period. The patient is usually discharged second day after the surgery. Sutures are removed 14 days after surgery.
Splint is removed 3 to 4 weeks after the surgery and gradual training of the transferred muscles or tendons is started so that they regain their newly assigned function.
Indivisual results may vary from person to person.
These pictures are shown for the purpose of education only.
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Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
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This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
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