High radial palsy is not a specific sports injury, but is seen with trauma or longer compression (e.g. from sleeping on the arm in state of drunkenness). Symptoms are mixed sensory and motoric with numbness on the dorsal side of the hand and reduction of extension force in the wrist and fingers. The triceps muscle may be involved.
The radial nerve can be entrapped in the radial tunnel at five sites (Fig. 6.7.10) : fibrous bands anterior to the radial head, vessels to brachioradialis, the tendon of the extensor carpi radialis brevis, Frohse's arcade (the fibrous arch at the proximal edge of the supinator muscle) and a fibrous band at the distal edge of the supinator muscle. It may probably also be compressed in the supinator muscle. Entrapment in the radial tunnel or by the supinator muscle is termed radial tunnel syndrome, and if motor symptoms are prominent it is termed posterior interosseous nerve syndrome (PINS), after the branch of the radial nerve which supplies the
extensor muscles . The syndrome is seen with repetitive pronation/supinations, as in racquet sports, and in particular with stressed wrist extension, as in weight-lifting, bowling, rowing and golf.
Symptoms are pain laterally in the forearm during activity, and in the quite rare cases of PINS also decreased strength of the muscles extending the wrist. On examination there is often pain at the supinator muscle, 4-5 cm distally to the elbow, and pain can be provoked by resisted supination with the elbow extended. There is often pain at the proximal part of the extensor muscles, especially with resisted extension of the fingers, in particular the middle finger, but this is also typical of tennis elbow. If there are motor nerve symptoms, extension strength of the fingers and the wrist is decreased. There are no sensory symptoms in this syndrome.
Most cases resolve with conservative treatment, and cure after injection of corticosteroid at the tender point of compression has been described. In unresolved cases after 3-6 months surgical decompression can be performed with 50-80% successful results.
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