Physical therapy treatment for radial tunnel syndrome

Radial tunnel syndrome can be a debilitating cause of lateral/outer elbow pain. Physical therapy treatment may include several techniques to increase the tunnel “wall” flexibility so that the radial nerve is relieved of pressure and slides freely within the tunnel. These techniques may include any (or likely all) of the following: 

1. Soft tissue mobilization of the extensor carpi radialis longus and extensor carpi radialis brevis muscles. This treatment is often performed with instrument assistance (e.g., tools such as SASTM, ASYTM, Graston, and IASTM) and followed by stretching exercises for these muscles.

2. Radial nerve flossing exercises to improve circulation and nerve function.

3. Dry needling, including trigger point technique, of the supinator muscle that surrounds the nerve.

4. Strength training of the supinator and scapular stabilizer muscles to improve arm and shoulder control. A weak shoulder or arm can create excess muscle tension and compensations during activity that may lead to pressure on the nerve over time.

5. Joint manipulation/adjustment of the proximal radioulnar joint. This joint creates the “floor” of the tunnel; stiffness or altered movement can affect muscle tension throughout the rest of the tunnel.

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