b'tenderness over the radial nerve and sometimes over theNerve flossing is thought to enhance the neurodynamic flexi-lateral epicondyle making differentiation of the two conditionsbility of a nerve by releasing adhesions. Nerve flossing should challenging. The pain of radial tunnel syndrome should benot provoke symptoms. Radial nerve flossing is performed more acute distally. (16)Nocturnal pain is more common in radialwith the patient standing, shoulder blade pressed down, and tunnel patients than those with lateral epicondylitis. (17) wrist flexed with the fingers pointing backwards, i.e., Butler tip Radial tunnel syndrome occurs less frequently than its moreposition, while bending the head in the contralateral direction common upper extremity cousins: carpal tunnel syndrome andand reaching back with the arm. Since cervical and upper cubital tunnel syndrome. (7,8)Radial tunnel syndrome frequentlythoracic involvement is common, clinicians should assess for accompanies these and other co-morbidities including:and manipulate any spinal restrictions. (15) pronator syndrome, Guyons syndrome, medial epicondylitis,Surgery may be indicated for patients who fail 12 weeks of de Quervains tenosynovitis, trigger finger and lateral epicon-dylitis. (9)Research suggests that up to 10% of patients withconservative care or in those with significant motor deficit. (26)lateral epicondylitis have co-existent radial tunnel syndrome. Please visit https://anjc.info/wp-content/uploads/(10)Radial tunnel syndrome is thought to result from overuse,sites/9/2020/05/Tennis-Elbow-or-Radial-Tunnel-Syndrome- especially forceful handgrip work, excessive wrist extension,References.pdf for supporting references. Download the pronation, supination or vibration. (27,28) Radial Tunnel e-Guide, with written and video demonstrations Diagnostics & Differential of all pertinent assessments, treatments and exercises,here: https://anjc.info/wp-content/uploads/sites/9/2020/05/Radiographs are seldom indicated unless needed to ruleRadial-Tunnel-Syndrome.pdfout osseous pathology. Ultrasound and MRI may be used to detect space occupying lesions and to localize the specific site of nerve involvement. (18,19)EMG/NCS studies are typicallyTim Bertelsman, DC, practices in Belleville, IL. He is a board- negative but may highlight muscle innervation deficits in casescertified Chiropractic Sports Physician and a Diplomate ofwith significant posterior interosseous nerve the Academy of Chiropractic Orthopedists. Dr. Bertelsmaninvolvement. (20,21) is Co-founder of the online clinical and business resourceOther differential diagnostic considerations for radial tunnelChiroUp.com.syndrome include: Wartenbergs syndrome/cheiralgia paresthetica (aka handcuff neuropathy from compression of the distal radial nerve) brachial plexus injury, cervicalTMradiculopathy, de Quervains tenosynovitis, bone pathology, elbow bursitis, elbow sprain/strain/tendinopathy, peripheral neuropathy and thoracic outlet syndrome.ManagementConservative management of radial tunnel syndrome isMember support of the ANJC Political Action generally successful.(22)Initial management of radial tunnelCommittee allows the ANJC to continue furthering syndrome includes anti-inflammatory measures, rest andour profession while protecting your right to practice avoidance of aggravating activities. Ice, ice massage andas a chiropractic physician.electrotherapy may provide benefit. Pulsed ultrasound hasWe ask that you donate towards the ANJC PAC been shown to be effective in the management of other upperso that we may continue fighting for the rights of extremity compressive neuropathies. The suggested settingschiropractors. are: frequency1 MHz; intensity1 watt/cm squared; duty cycle25%. (23) ANJC PAC supports legislators who defend the issues and interests of our patients and our profession.Patients should limit excessive or repetitive wrist extension,PAC initiatives include:forearm pronation, and supination. Splinting may be used in more severe cases. (24)Sources of external compression should Greater patient access to chiropractic carebe identified and removed. A tennis elbow counter-force Improved public relationsbrace, commonly used in the treatment of lateral epicondylitis, will likely aggravate the symptoms of radial tunnel syndrome. (25) Veterans benefits to access chiropractic care Soft tissue manipulation and nerve flossing are useful tools Opening Workers Compensation in the management of radial tunnel syndrome. Good clinicalfor chiropractic carejudgment is required to assess the point at which benefits of Stopping improper denials of yoursoft tissue mobilization outweigh the risks of symptom exac- care by payerserbation. When the symptoms are no longer acute, stretching And much more!and myofascial release techniques should be directed at the supinator, brachioradialis and wrist extensors, including theTo make an easy online donation, visit:extensor carpi radialis brevis.associationdatabase.com/aws/ANJC/pt/sp/pacwww.njchiropractors.com I 19'