1058 - Functional Improvement in Radial Tunnel Syndrome after Ultrasound-Guided Perineural Hydrodissection and Corticosteroid Injection

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

MM

Mohammed Y. Mirza, n/a

Medical Student
Rosalind Franklin University of Medicine and Science
Elmhurst, Illinois, United States

Co-Author(s)

KV

Kelly Joy Valignota, DO

Physiatrist
Captain James A Lovell Federal Health Care Center
North Chicago, Illinois, United States

Case Diagnosis: Radial Tunnel Syndrome

Case Description: A 47-year-old right-handed male was referred to an outpatient PM&R clinic with an 18-month history of right lateral elbow pain, wrist extensor weakness, and dorsoradial hand paresthesias. No improvement in symptoms after steroid and PRP injections for lateral epicondylitis or with course of occupational therapy.

Physical exam revealed pain limited 4/5 strength in wrist extension and supination. There was hyperesthesia in the right radial nerve distribution, positive Tinel’s at radial tunnel, tenderness along the proximal dorsoradial forearm, and pain with passive wrist flexion. There was no tenderness along the lateral epicondyle. Although electrodiagnostic testing was normal, history and exam were consistent with radial tunnel syndrome.

Patient underwent a right radial nerve ultrasound-guided perineural hydrodissection and

corticosteroid injection at the radial tunnel. 4 weeks post injection, he reported resolution of dorsoradial elbow pain and paresthesias. Patient noted improved grip strength and he was able to return to his prior weightlifting routine.

Discussions: Radial tunnel syndrome is a controversial diagnosis that can present with symptoms similar to other conditions, most frequently lateral epicondylitis, leading to misdiagnosis and ineffective treatments. In this case, the accurate diagnosis of radial tunnel syndrome with subsequent ultrasound-guided injection led to resolution of the patient's pain and paresthesias with improved strength and return to normal activity. This case provides further evidence of the efficacy of ultrasound guided injections for radial tunnel syndrome.

Conclusions: Radial tunnel syndrome is a less common entrapment neuropathy that is not commonly diagnosed nor treated with injections. This case highlights the importance of precise diagnosis of radial tunnel syndrome for subsequent successful treatment using ultrasound-guided perineural hydrodissection and corticosteroid injection.