Supinator tunnel syndrome

At the Supinator tunnel syndrome it is a rarely occurring bottleneck syndrome. It is caused by damage to the radial nerve within the forearm supinator box.

What is supinator tunnel syndrome?

The causes of supinator tunnel syndrome are different. In all cases, however, the motor branch of the radial nerve is narrowed and affected.
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In medicine it works Supinator tunnel syndrome also the names Supinatorlous syndrome, lower radial palsy or Posterior interosseus syndrome. What is meant is a nerve compression syndrome that shows up on the forearm near the elbow. This is where the radial nerve takes its course, which is one of the most important arm nerves. It pulls through the supinator muscle.

If there is compression of the radial nerve in this region, this results in a supinator tunnel syndrome. The branch of the radial nerve is affected, which leads to the weakening or paralysis of some muscles. However, a complete malfunction is not to be feared. The radial nerve is also known as the radial nerve.

It is a mixed nerve and has both sensory and motor fibers. At the elbow it is divided into a sensitive and a motor section. While the sensitive part extends towards the back of the hand, the motor part runs through the supinator muscle. There he supplies the muscles for hand extension.

The symptoms of supinator tunnel syndrome depend on the area in which the damage occurs. If the damage occurs in the upper section, the person concerned suffers from sensory disorders. If the motor area is damaged, however, muscle failure symptoms are possible. If there is damage in the upper arm region, both symptoms can exist.

causes

The causes of supinator tunnel syndrome are different. In all cases, however, the motor branch of the radial nerve is narrowed and affected. A fracture of the radius or ulna of the elbow is often responsible for this. A bruise or bone displacement results in a crushing of the nerves, which in turn is responsible for nerve damage.

Another possible cause is the ball of the spoke head from its tape guide. As a result, there is a risk of constriction at the point of entry to the supinator muscle. In some cases, fatty growths, inflammations or tumors at the nerve entry point for supinator tunnel syndrome. The same applies to an increase in muscles in the supinator muscle.

It is mostly formed by repetitive activities such as playing tennis or playing the piano. Another reason for supinatorlogic syndrome to develop is permanent external pressure. This is usually triggered by carrying heavy loads on one side.

Symptoms, ailments & signs

A supinator tunnel syndrome becomes noticeable through feelings of weakness when stretching the fingers. Sometimes the weakness is so intense that the fingers can no longer be stretched at all. Because only the motor part of the radial nerve is affected, only the motor part is affected.

On the other hand, the sensitive nerve part is spared from complaints, so that no sensory disorders occur on the arm or fingers. The third and fourth fingers are particularly affected by the weakness in extension. Furthermore, the affected person suffers from dull spontaneous pain in the forearm near the elbow. The pain worsens when you apply pressure.

The painful discomfort most often appears when the patient moves the palm of his hand in the upward direction. Occasionally, after several rotations of the forearm, symptoms of muscle fatigue can also be felt. In some cases the pain spreads to the wrist.

Diagnosis & course of disease

To diagnose supinator tunnel syndrome, the doctor first looks at the patient's medical history (anamnesis). The next step is a physical exam. A neurologist can also determine the performance speed of the damaged nerve. If the nerve and nerve sheath are impaired, there is usually a significant reduction in the speed of nerve conduction.

Other important examination procedures are sonography (ultrasound examination), taking X-rays and performing magnetic resonance imaging (MRI). While an X-ray examination can find fatty growths or benign soft tissue tumors such as ganglia, an X-ray examination can detect broken bones in the radius and ulna.

With magnetic resonance tomography it is possible to visualize the restricting structures. How supinator tunnel syndrome will develop is difficult to predict. The prognosis depends on the extent and duration of the nerve damage. Sometimes it even takes months until a nerve that has already been damaged and has led to paralysis is completely healed again, although there is no longer any pressure.

Complications

Because of the supinator tunnel syndrome, the patients primarily suffer from severe mobility restrictions. These mainly occur in the fingers, so that the fingers can no longer be properly stretched. In severe cases, movement of the fingers is completely restricted. Furthermore, the neighboring areas can be affected by paralysis or sensory disorders.

Due to these restrictions, the patient's everyday life is made significantly more difficult, so that many sufferers suffer from depression or other psychological disorders. Pain in the fingers or in the hand can also occur and in some cases also radiate to the wrist. Since the pain often also occurs at night, the supinator tunnel syndrome can also lead to sleep problems and thus irritability of the person concerned. In children, the supinator tunnel syndrome leads to restricted and delayed development.

Treatment for the syndrome depends on the cause. First and foremost, the load that is responsible for the paralysis is set. Various medications and therapies can also limit other ailments and pains. Surgical interventions are rarely necessary. In most cases, the disease progresses positively and the patient's life expectancy is not reduced by the disease.

When should you go to the doctor?

In the case of supinator tunnel syndrome, the person concerned is dependent on a visit to a doctor. Since this disease cannot heal itself, treatment by a doctor is unavoidable. As a rule, an early diagnosis also has a positive effect on the further course of the supinator tunnel syndrome and can prevent further complications and a worsening of the symptoms. In the case of supinator tunnel syndrome, the doctor should be consulted if the person concerned can no longer stretch his fingers properly.

As a rule, stretching is associated with severe pain and is hardly possible anymore. Sensory disturbances in the person's arm can also indicate this disease and should also be examined by a doctor. There may also be severe pain in the arms. These can occur without a particular reason and, above all, permanently and have a very negative effect on the quality of life of the person concerned.

A general practitioner or an orthopedic surgeon can be seen at the first signs of supinator tunnel syndrome. Further treatment depends on the exact cause of the syndrome. As a rule, this disease does not reduce the life expectancy of the person affected.

Treatment & Therapy

Treatment of supinator tunnel syndrome can be either conservative or surgical. If an unusual stress is responsible for the syndrome and this is eliminated, the radial nerve often recovers by itself, which reduces the symptoms. Pain relievers such as ibuprofen or diclofenac are suitable for treating acute pain. In addition to relieving pain, these preparations also fight inflammation.

Physiotherapy exercises and heat or cold applications are also helpful measures. If the conservative therapeutic measures do not improve the symptoms, an operation can be useful. If there is paralysis, the surgical procedure must be carried out as quickly as possible. During the operation, the surgeon exposes the deep motor branch of the radial nerve.

However, special care is required due to the delicacy of the nerve. The point of entry of the radial nerve into the muscle is also widened because it is covered by connective tissue fibers that can cause it to become trapped. Bounding structures such as connective tissue or fiber strands are cut.

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prevention

There are no known preventive measures against supinator tunnel syndrome. Full baths are recommended after an operation to prevent movement disorders in the elbow.

Aftercare

For a successful follow-up care, renouncing exercise is the first means of choice. In the case of intraoperative findings, immobilization is carried out using an upper arm cast in a 120 ° position. The plaster of paris remains in place for 10 to 14 days. During this time, the shoulder and fingers can be moved. In the further course, the arm may only be lightly loaded. Things of everyday life can be done easily. Physiotherapy can be prescribed as a support.

Alternatively, an underwater stress therapy is available. The algetic supinator syndrome is accompanied by medication as part of the aftercare. Ibuprofen and diclofenac are prescribed in low doses for a maximum of three weeks. Permanent stress disorders are excluded if the treatment proceeds properly. A renewed illness from the supinator tunnel syndrome is possible, however.

If CRPS (Sudeck's disease) occurs during follow-up care, occupational therapy and physiotherapy are prescribed. CRPS (Sudeck's disease) occurs as a result of tissue damage or surgical interventions. It occurs several weeks after the surgery and causes severe pain in the operated area. If the healing process is positive, the threads are removed from the 12th day after the operation. The removal is painless and takes a few minutes.

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If the supinator tunnel syndrome is treated conservatively or surgically, it is important to avoid excessive stress. Pain relieving medication such as diclofenac or ibuprofen are recommended for moderate to severe pain so that the pain does not become chronic. If the bottleneck syndrome has arisen due to excessive stress on the radial nerve, it usually recovers on its own if the stress does not occur. For this reason, excessive physical strain should be avoided.

Physiotherapy is another way to reduce symptoms in everyday life. Through the controlled movements in the therapy, the radial nerve is relieved and can regenerate better in this way. Cold and heat therapy can also help reduce pain and cure the bottleneck syndrome. Usually, cold therapy is used when there is inflammation and heat therapy for pain in the muscles and joints. Muscle and joint pain often occur in the congestion syndrome due to the relieving posture.

The red light lamp is popular in heat therapy and is ideal for use at home. Hot air and the use of the hot roller also relieve pain in the radial nerve. In order to reduce the pain in everyday life, compresses, packs and natural moor also help. Which variant helps the person affected the most depends on the individual case and must be tested.