Question
With all the different ideas out there for radial nerve compression, have you changed your ideas about treatment and what do you think is the best combo?
Answer
I see many more patients with tennis elbow then I see with radial tunnel. I think from what I have learned from this review is to make sure that my diagnosis is very differential. I have used the rule-of-nine test a lot.
Rule-of-nine test
There is an interesting article by Loh et al., 2004, where they create nine circles right around that lateral epicondyle and into the dorsal aspect of the proximal forearm. They use the circles that are closer to the lateral epicondyle as identifying a tennis elbow type of syndrome, and those that are more down towards the supinator being more indicative of radial tunnel syndrome.
I have also tried to make sure that I am palpating and understanding where the radial nerve is in comparison to that lateral epicondyle. In terms of my treatment, I have moved towards wrist extension splinting. I think if you make a good, comfortable splint, you can get people to be adherent with wearing it to offset all of those tendinous insertions at and around the elbow. From a PT perspective, I believe in the movement system balance idea, that everything is an equal and opposite reaction. For example, the supinator and pronator are two muscles that we can overuse and can get tight and short. Trying to maintain the length of both of those muscles is a really important part of treatment. I am more prone to lengthening muscles and maintaining muscular balance, than I am doing nerve gliding. Nerve gliding is a growth area for myself.
