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A Unified Approach to Radial Tunnel Syndrome and Lateral Tendinosis

Henry, Mark MD; Stutz, Christopher MD

Techniques in Hand and Upper Extremity Surgery: December 2006 - Volume 10 - Issue 4 - p 200-205
doi: 10.1097/01.bth.0000231580.32406.71
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Two of the most common diagnoses assigned to patients presenting with lateral elbow and proximal forearm pain are lateral tendinosis and radial tunnel syndrome. Traditionally, these 2 conditions have been treated as distinct and separate entities with most patients being diagnosed with either one or the other, but not both. The extensor carpi radialis brevis (ECRB) and, to a lesser the degree, a portion of the extensor digitorum communis that form the conjoined lateral extensor tendon are thought to be primarily responsible for the excessive traction that induces lateral tendinosis (a degenerative process of microtears in the tendon with impaired healing), but the supinator blends with these same fibers and shares a role in the pathology. The supinator, primarily the arcade of Frohse, has been thought to play the majority role in compressing the posterior interosseous nerve in radial tunnel syndrome, but the undersurface thick tendon of the ECRB may also cause substantial nerve compression. Reduction of the linear tension transmitted by the ECRB is the common element in the various surgical treatments for lateral tendinosis, performed anywhere from directly at the lateral epicondyle to the distal myotendinous junction. Nerve decompression by division of fascial bands is the goal in surgery for radial tunnel syndrome. These 2 surgical approaches need not be mutually exclusive. In fact, this separation of the 2 clinical entities may play a role in the unpredictable results reported in the literature. This article presents a unified approach to treating both pathologies simultaneously including short-term clinical results.

Hand and Wrist Center of Houston, Houston, TX

Department of Orthopaedic Surgery, University of Texas, Houston, TX

Address correspondence and reprint requests to Mark Henry, MD, Hand and Wrist Center of Houston, 1200 Binz Street, Suite 1200, Houston, TX 77004. E-mail: mhenry@houstonhand.com.

© 2006 Lippincott Williams & Wilkins, Inc.