Do you have pain, weakness, and paresthesia (tingling, numbness or “pins and needles”) in your arm/forearm (below the elbow)? You may have dull, sore achiness in the extensor muscles (muscles that extend wrist/hand) below your elbow. The pain may be more prominent at night and after use. These are all symptoms of Radial Neuropathy/Entrapment below the elbow. Read on to learn about Elbow and Forearm Pain Due to Radial Neuropathy: Chiropractic Can Help.
Anatomy of the Radial Nerve
The radial nerve is the terminal (end) continuation of the posterior (back) part of the brachial plexus. And the brachial plexus is a bundle of nerves that originate from nerve roots in the cervical (neck) and upper thoracic (torso) sections of the spinal cord (C5-T1). Ultimately, the brachial plexus creates a network that connects to the nerves in the arm. Therefore, the radial nerve contains fibres from nerve roots C5 – T1.
It arises from the axilla and exits the axilla inferiorly (below). Next, it supplies branches to the long and lateral heads of the triceps brachii muscle.
The radial nerve then descends down the arm. It travels in a shallow depression within the surface of the humerus (long upper arm bone), known as the radial groove.
To enter the forearm, the radial nerve travels anterior (front of) to the epicondyle of the humerus, through the cubital fossa of the elbow. The nerve then ends by dividing into two branches:
- Deep branch (motor) – innervates (supplies) the muscles in the posterior (back) compartment of the forearm.
- Superficial branch (sensory) – contributes to the cutaneous (skin) innervation of the dorsal (back) hand and fingers.
Compression of the Radial Nerve from Elbow to the Wrist
The Radial nerve divides into its two major branches, the posterior interosseous and the superficial radial nerve at the level of the radiocapitellar joint (elbow joint). Above the elbow the radial nerve innervates the brachioradialis and extensor carpi radialis longus and brevis. Therefore, entrapment below the elbow joint does not affect these muscles.
Posterior interosseous nerve compression depends on where the compression occurs. There may be involvement at the radial tunnel, causing what is known as the radial tunnel syndrome or along the distal course of the nerve (including the radial tunnel) in which case it’s called the posterior interosseous nerve syndrome.
Radial Tunnel Syndrome aka Resistant Tennis Elbow:
If you have what appears to be tennis elbow, but is resistant to therapy, it could actually be radial tunnel syndrome. And you may have unremitting pain around the lateral epicondyle (bump on outer side of elbow) of the elbow.
What is radial tunnel syndrome?
This is a compressive neuropathy of the posterior interosseus nerve (PIN) branch of radial nerve in the radial tunnel. The radial tunnel is about 2 inches long. It goes from the capitellum (rounded knob-like structure at end of humerus where meets elbow) of the humerus (long bone of upper arm) and the radial head of radius to the supinator muscle.
The boundaries of the radial tunnel is formed by the supinator (broad muscle in the posterior compartment of the forearm, curved around the upper third of the radius), extensor carpi radialis longus/extensor carpi radialis brevis (both muscles in forearm extend hand a wrist), and brachioradialis ( muscle of the forearm that flexes the forearm at the elbow).
Locations of compression within the Radial Tunnel
Locations of compression within the radial tunnel include:
–fibrous bands over the anterior (front of) radial head and capsule (of elbow joint) at the the entrance to the tunnel
-a recurrent fan of blood vessels that supplies the brachioradialis and the extensor carpi radialis longus, the ulnar half of the tendon and fascia of the extensor carpi radialis brevis muscles
–under the fibrous arch at the proximal edge of of the supinator called the arcade of frohse and below the fascial arcade at the distal lateral border of the supinator muscle.
The arcade of frohse seems to be the most common area of entrapment in this area. Researchers stated that in 10% of patients with lateral epicondylitis (tennis elbow) there is a co-existent radial tunnel syndrome due to radiocapitellar bursitis (inflamed bursa at elbow).
Causes of Radial Tunnel Syndrome
Radial tunnel syndrome is caused by direct compression by anatomic structures as mentioned above. Additionally, in athletes by vigorous contraction of the extensor musculature can trigger it. Furthermore, it can occur with one very strenuous effort. However, more often it is due to repetitive pronation and supination (rotating palm downward or upward), although wrist extension can aggravate it. The syndrome is found especially in athletes who lift weights, golf, swim and participate in racquet sports.
Posterior Interosseous Nerve Syndrome:
Radial tunnel syndrome refers to a rare compressive neuropathy of the posterior interosseous nerve (PIN) as it passes through the radial tunnel as described above. So radial tunnel syndrome has pain without motor or sensory dysfunction. And with the PIN compression syndrome, a more severe compressive neuropathy occurs. Ultimately, with PIN there is wrist extensor muscle weakness as well as pain. Again, the PIN is a branch of the radial nerve at the elbow. It supplies motor innervation to the dorsal (top) extensor compartment of the forearm and sensory innervation to the dorsal wrist.
Causes of Posterior Interosseous Nerve Syndrome (pins)
The main site of compression is at the arcade of frohse at the elbow. Other causes can be vascular anomalies (abnormalities), synovitis, edema, ganglion, bursa or lipoma. Of course, overuse such as repetitive pronation and supination are culprits as well.
Treatment at Meiri Chiropractic for Radial Neuropathy:
Firstly, soft tissue techniques will be rendered to the contracted fibrotic muscle and collagen at entrapment sites.
Secondly, Chiropractic adjustments (chiropractic manipulative therapy) to the elbow, wrist, and associated restricted joints. This would be along the kinetic chain and spine which is important.
Thirdly, Therapeutic exercise will be given for stretching and strengthening.
Fourthly, if trauma or swelling is involved, ice, compression, elevation, and physical therapy modalities is utilized to reduce swelling. Ergonomic recommendations to change the inciting activity is necessary.
Are your suffering from elbow or forearm pain from Radial Neuropathy?
We offer excellent Chiropractic care for Radial Neuropathy. At Meiri Chiropractic, we spend the time necessary to examine, diagnose and treat every neuromusculoskeletal condition and various ailments you have. Indeed, Chiropractic is a holistic and natural way to not only treat shoulder and arm pain, but to keep your body in its best working condition. We have been offering effective chiropractic care in West Palm Beach since 2006. Many of our patients reviews note our excellence. Call us today at 561-253-8984 to make an appointment or to find out more about Elbow and Forearm Pain Due to Radial Neuropathy: Chiropractic Can Help.