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Radial Tunnel Syndrome

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Radial tunnel syndrome — causes forearm pain, weakness straightening fingers, and is distinct from tennis elbow.

Updated Aug 20264 citations
Illustration of a person clutching the upper outer forearm in pain.
Radial tunnel syndrome causes aching pain in the upper outer forearm, just below the elbow. Kieran Hirpara 4.0

What you're feeling

You may notice a deep, aching pain on the outer side of your elbow. This discomfort often travels down the top of your forearm toward your thumb and index finger. Unlike the sharp sting of a sprain, this pain feels more like a persistent bruise or tightness in the muscles. You might feel a dull soreness that lingers long after you have stopped moving your arm.

The pain typically worsens when you use your forearm muscles. Activities that require repetitive gripping or twisting can trigger flare-ups. For example, turning a heavy door handle, using a screwdriver, or lifting a kettle full of water may cause the ache to intensify. You might also feel tenderness when pressing on the outer bump of your elbow. Simple tasks like shaking hands or holding a phone for a long time can become uncomfortable as the day goes on.

You may find that resting your arm provides some relief, but the discomfort often returns with activity. Many people report that the pain is more noticeable at night, especially if you sleep on the affected side. Waking up with a stiff or sore forearm is common. You might also notice that your grip feels weaker than usual, making it harder to open jars or carry shopping bags.

It is important to understand that the 'radial tunnel' is not a narrow pipe or canal. Instead, it refers to a stretch of path where your radial nerve runs. Along this path, several separate structures can press on the nerve. These pressure points include the edge of a muscle, a fibrous band of tissue, or a small group of crossing blood vessels. When any of these structures compress the nerve, it causes the pain and weakness you are experiencing. Your surgeon will look for these specific areas of compression to guide your treatment.

What's actually happening

The name 'radial tunnel' can be misleading. There is no single narrow pipe or canal in your arm. Instead, think of your radial nerve as a long electrical cable running down the back of your upper arm and into your forearm. The 'tunnel' is simply a stretch of path where this cable passes close to several different structures.

Along this path, the nerve can get squeezed or irritated by multiple separate pressure points. One point might be the edge of a muscle. Another could be a tight band of fibrous tissue. A third might be a small group of crossing blood vessels. Because these structures are close together, any one of them can press against the nerve and cause pain or weakness.

This compression is what causes your symptoms. When the nerve is pinched, it sends signals of pain to the outside of your forearm and wrist. It may also affect the muscles that help you lift your wrist or fingers. The pain often feels like a deep ache or burning sensation.

In many cases, this irritation happens without a clear injury. Sometimes it develops slowly over time due to repetitive movements. If conservative treatments do not help, your surgeon may consider surgery to relieve the pressure. This involves carefully releasing the structures that are squeezing the nerve. The goal is to give the nerve more space so it can heal and function normally again.

Understanding that there are several potential pressure points helps explain why diagnosis can be tricky. It also shows why a thorough examination is important. Your surgeon will look for signs of nerve irritation in specific areas along this path. This helps determine which structure might be causing the problem and guides the best treatment plan for you.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition.

We begin with self-management and physiotherapy. This approach aims to reduce pressure on the radial nerve by changing how you use your arm. Your physiotherapist will guide you through gentle exercises to improve strength and flexibility. We typically advise giving this non-surgical care a fair trial before considering other steps. If your symptoms persist despite these efforts, we may discuss medical management to help control pain and inflammation.

Medical options include pain medication and anti-inflammatory drugs to manage discomfort. In some cases, we may recommend an injection. Cortisone injections can reduce swelling around the nerve, while hyaluronic acid or platelet-rich plasma (PRP) injections aim to support tissue health. These treatments provide relief for a limited time, helping you stay active while your body heals. If conservative care does not bring enough improvement, we review your progress carefully.

Surgery is considered when non-surgical options have not given enough relief. We may recommend surgical decompression to release the pressure points along the nerve’s path. This involves identifying and protecting the radial nerve to ensure it has space to function normally. Surgery is also an option for acute injuries where early intervention can improve the chance of regaining nerve function. Patients who undergo surgical exploration within 3 weeks of injury had a significantly higher likelihood of regaining radial nerve function than patients who underwent nonsurgical management with or without late surgical exploration. We discuss all risks and benefits with you to make a shared decision about your care.

Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care — activity change, physiotherapy or hand therapy, splinting, and injections — and consider surgery when that has not given enough improvement. For structural or acute problems, surgery may be recommended straight away, without a preceding non-operative trial.

What to expect

Your outlook depends largely on the cause of your symptoms. If you have radial tunnel syndrome, non-surgical management is the first step. Most people find that their symptoms settle with rest and therapy. If your condition is linked to a closed humerus fracture, spontaneous recovery occurs in the majority of patients. Initial non-surgical management is usually recommended because your nerve often heals on its own.

For general radial nerve injuries, spontaneous recovery occurs in 70%–88% of cases. This means that for many, the condition improves without surgery. However, if you have a high radial nerve entrapment neuropathy that does not respond to conservative treatment, surgery may be advised. In these cases, we focus on dissecting the entire length of the fibrous tunnel to relieve pressure. If your symptoms persist despite ongoing care, surgical decompression remains a viable option.

Recovery timelines vary. Injuries to the posterior interosseous nerve typically resolve within 3 months, and at the latest, 5 months after surgery. If you require nerve repair or reconstruction, the radial nerve recovers better if this is done within 5 months of injury. For those with longstanding, irreparable nerve lesions, tendon transfers may be indicated to restore function. These procedures can help you regain efficient grip while awaiting reinnervation of your wrist extensors.

If you experience a radial nerve laceration, successful recovery can be achieved after nerve grafting. Good to excellent motor recovery can be expected in 83% of patients with a large gap of the radial nerve (nine centimeters or greater) when sural nerve autografts are used. We aim to set realistic expectations. While many recover well, some may face prolonged recovery or require reconstructive options. Your surgeon will guide you through the most appropriate path based on your specific injury and response to initial treatment.

When to see someone

Radial tunnel syndrome is a nerve compression issue, not a mechanical joint problem. You may feel pain in the outer elbow or forearm. See your GP if this pain persists or interferes with sleep or work. Nonsurgical management is usually the first step. However, if you have a recent injury, seek specialist review within 3 weeks. Early surgical exploration significantly improves the chance of regaining nerve function. If you experience sudden weakness in your hand or fingers, go to an emergency department immediately. This could signal acute nerve damage requiring urgent attention. Do not wait for symptoms to resolve on their own if they are severe or worsening rapidly.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Radial tunnel syndrome is worth the extra reading for an uncomfortable reason: it is the condition on this site with the weakest evidence base, there is no test that confirms it, and being told plainly how uncertain it is should form part of any decision to operate.

There is no confirmatory test

Most nerve compressions can be demonstrated. Carpal tunnel syndrome produces slowed conduction across the wrist; cubital tunnel produces it across the elbow. Radial tunnel syndrome characteristically does not — the nerve branch involved supplies muscle rather than skin, so there is no numbness to map, and nerve conduction studies are frequently normal.

The diagnosis therefore rests on the pattern of pain, tenderness a few centimetres distal to the lateral epicondyle rather than over it, and the response to a local anaesthetic block. Each of those is suggestive; none is definitive. Contemporary reviews describe ongoing controversy regarding both diagnosis and outcomes [1].

The practical consequence is a high rate of confusion with tennis elbow, which sits immediately adjacent and can coexist. Persistent "tennis elbow" that has not responded to good treatment is one of the commonest circumstances in which radial tunnel syndrome is eventually considered.

The evidence for treating it is genuinely thin

A systematic review of interventions found a tendency that surgical decompression might be effective, and — the more remarkable finding — that the effectiveness of conservative treatments is unknown, because for most of them no studies were available at all [2].

That is not the usual "evidence is limited" formulation. For most non-operative treatments offered for this condition, the studies have not been done. Current reviews still place non-surgical management first, with decompression a viable option for refractory cases [1], and that ordering reflects reasonable caution rather than demonstrated superiority.

What that means for a decision

Two things follow, and they pull in opposite directions.

Against early surgery: the diagnosis cannot be confirmed, so an operation may be decompressing a nerve that is not the source. Where a decompression fails, it is often impossible to determine whether the operation was inadequate or the diagnosis was wrong.

For considering it in the right patient: there is no evidence base supporting the alternatives either, so waiting is not the evidence-backed option people assume. It is simply the lower-risk one.

The reasonable position is that a confident diagnosis matters more here than anywhere else on this site — a consistent history, examination localising to the radial tunnel rather than the epicondyle, imaging excluding a space-occupying lesion, and ideally a convincing response to a diagnostic block before an irreversible step is taken.

Posterior interosseous nerve palsy — weakness of finger and thumb extension rather than pain — is a distinct entity with clearer management. Where imaging shows no compressive lesion, conservative management should be tried first, with surgery reserved for demonstrated compressive lesions and for failure of conservative treatment [3]. Where there is no space-occupying lesion, a trial of non-operative management is advisable, with exploration recommended if there is no sign of muscle recovery after 6 weeks of observation, or if weakness is progressive [4].

Those are concrete thresholds, and their existence is the clearest illustration of the contrast: when the nerve visibly stops working, the literature can say what to do and when. When it only hurts, it cannot.

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References for the advanced reading
  1. Wolf JM, Patel R, Ghosh K. Radial tunnel syndrome: review and best evidence. J Am Acad Orthop Surg. 2023;31(15):813-9.
  2. Huisstede B, Miedema HS, van Opstal T, de Ronde MT, Verhaar JA, Koes BW. Interventions for treating the radial tunnel syndrome: a systematic review of observational studies. J Hand Surg Am. 2008;33(1):72.e1-72.e10.
  3. McGraw I. Isolated spontaneous posterior interosseous nerve palsy: a review of aetiology and management. J Hand Surg Eur Vol. 2018;44(3):310-6.
  4. Sigamoney KV, Rashid A, Ng CY. Management of atraumatic posterior interosseous nerve palsy. J Hand Surg Am. 2017;42(10):826-30.
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [2].
  • The traditional clinical issue surrounding radial tunnel syndrome has been properly identifying it [1].
  • Radial tunnel syndrome is distinct from posterior interosseous nerve syndrome, though both are reviewed in the context of radial nerve pathology [8].
  • The Rule-of-Nine test effectively specifies the site of tenderness for the diagnosis of radial tunnel syndrome [4].
  • Nonsurgical management is considered first-line treatment for radial tunnel syndrome [3].
  • Surgical decompression remains a viable option for refractory cases of radial tunnel syndrome despite ongoing controversy regarding diagnosis and outcomes [3].
  • There is a tendency that surgical decompression of the radial tunnel might be effective in patients with radial tunnel syndrome [14].
  • Pain in patients with radial tunnel syndrome may be treated successfully by surgical decompression of the superficial branch of the radial nerve [11].
  • Corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome [5].
  • Surgical decompression of the median nerve or the anterior interosseous nerve (AIN) in the forearm is rarely indicated, and a prolonged nonsurgical approach is warranted in most cases [19].

Anatomy & Pathophysiology

  • It is important to understand the anatomic course and distribution of the radial nerve to make an accurate diagnosis [9].
  • The posterior interosseous nerve crosses the radial head midline and increases its distance from bony structures with supination of the forearm [26].
  • Supination increases the linear distance between the posterior interosseous nerve and the radial head, which should be considered to increase safe working volume during intra-articular procedures on the anterolateral aspect of the elbow [26].
  • The distance of the posterior interosseous nerve from the radial head appears to increase with forearm supination, potentially increasing safe working space [31].
  • Predictive accuracy for posterior interosseous nerve localization in the proximal forearm is highest when the arm is in a supinated position [32].
  • The posterior interosseous nerve moves farther from the radial head during elbow extension than flexion [35].
  • The posterior interosseous nerve moves farther from the radial head during forearm pronation than supination [35].
  • Distal migration of the posterior interosseous nerve is minimal (3.5 mm) across various elbow and forearm positions [35].
  • Wrist proprioception appears to be a multifactorial phenomenon [34].
  • There is controversy surrounding radial tunnel syndrome, dynamic compression theories, and the difficulty in differentiating it from tennis elbow [37].

Classification

  • Radial tunnel syndrome is traditionally defined as a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [7].
  • Radial tunnel syndrome and posterior interosseous nerve compression are distinct entities with different clinical presentations but share identical potential sites of nerve interference [12].
  • Radial tunnel syndrome and posterior interosseous nerve compression are proposed to be mild (radial tunnel syndrome) and severe (posterior interosseous nerve compression) forms of one disease to simplify nomenclature [12].
  • MR imaging features provide credence to the concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve [10].
  • The issue surrounding radial tunnel syndrome traditionally has been properly identifying it clinically [1].
  • It is important to understand the anatomic course and distribution of the radial nerve in order to make an accurate diagnosis [9].
  • Nomenclature advocates for consistent use of terminology distinguishing the deep branch of the radial nerve and the posterior interosseous nerve [17].
  • Radial tunnel syndrome and posterior interosseous nerve syndrome are recommended to be viewed as a single condition presenting along a spectrum of nerve entrapment [17].

Clinical Presentation

  • Radial tunnel syndrome is traditionally characterized by difficulty in proper clinical identification [1].
  • Radial tunnel syndrome is an illness construct based on speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [2].
  • There is ongoing controversy regarding the diagnosis and outcomes of radial tunnel syndrome [3].
  • Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm [7].
  • Radial tunnel syndrome and posterior interosseous nerve compression are distinct entities with different clinical presentations [12].
  • Radial tunnel syndrome and posterior interosseous nerve compression share identical potential sites of nerve interference [12].
  • Radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve [10].
  • Understanding the anatomic course and distribution of the radial nerve is important for making an accurate diagnosis [9].
  • Radial tunnel syndrome and posterior interosseous nerve syndrome may be viewed as a single condition presenting along a spectrum of nerve entrapment [17].

Investigations

  • Radial tunnel syndrome is traditionally identified through clinical evaluation [1].
  • MR imaging provides credence to the concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve [10].
  • Dynamic ultrasonographic assessment of changes in the anteroposterior diameter and cross-sectional area is an effective diagnostic tool for identifying radial tunnel syndrome [18].
  • Neuroimaging should be considered as a complementary diagnostic method in posterior interosseous neuropathy syndrome [33].

Treatment

Non-Operative Management

  • Nonsurgical management is the first-line treatment for radial tunnel syndrome [3].
  • A prolonged nonsurgical approach is warranted in most cases of nerve compression syndromes in the forearm, such as ulnar tunnel syndrome, radial tunnel syndrome, anterior interosseous nerve syndrome, and pronator syndrome [19].
  • Nonoperative management with corticosteroid injection can be used as a therapeutic measure with potential long-term benefits in the treatment of radial tunnel syndrome [27].
  • Prospective evaluation of a single corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome [5].

Operative Management

  • Surgery is advocated for high radial nerve entrapment neuropathy cases resistant to conservative treatment, emphasizing the importance of dissecting the entire length of the fibrous tunnel [6].
  • No single surgical approach was adequate for complete visualization and release of all compression points of the radial tunnel [13].

Complications

  • Isolated posterior interosseous nerve neurectomy (PINN) has shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up [21].

Recovery

  • Surgical decompression is a viable option for refractory cases of radial tunnel syndrome [3].
  • In a case of posterior interosseous-nerve syndrome secondary to rheumatoid synovitis with entrapment duration of more than two years, a tendon transfer was used as treatment [38].
  • Surgical excision can lead to rapid recovery of nerve sensation in cases of radial nerve compression by ganglion cysts [39].

Key Evidence

  • [L5] The issue surrounding radial tunnel syndrome traditionally has been properly identifying it clinically. [1] (10.1097/01.bth.0000231580.32406.71)
  • [L5] Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis. [2] (10.1016/j.jhsa.2010.03.020)
  • [L4] The article reviews the anatomy, diagnosis, and treatment of radial tunnel syndrome, noting that while nonsurgical management is first-line, surgical decompression remains a viable option for refractory cases despite ongoing controversy regarding diagnosis and outcomes. [3] (10.5435/jaaos-d-23-00314)
  • [L4] The Rule-of-Nine test effectively specifies the site of tenderness for the diagnosis of radial tunnel syndrome. [4] (10.1177/230949900401200115)
  • [L4] Prospective evaluation of corticosteroid injection demonstrated improvement in standardized outcomes measures of pain and function at one year in 75% of patients presenting with symptoms of radial tunnel syndrome. [5] (10.1016/j.jhsa.2017.06.095)
  • [Case_report] The authors advocate for surgery in high radial nerve entrapment neuropathy cases resistant to conservative treatment, emphasizing the importance of dissecting the entire length of the fibrous tunnel. [6] (10.1016/j.jse.2025.02.060)
  • [L5] Radial tunnel syndrome is a pain syndrome caused by compression of the posterior interosseous nerve at the proximal forearm. [7] (10.1016/j.ocl.2012.07.022)
  • [Paper] This article is a review of the history, anatomy, and clinical presentation of radial tunnel syndrome (RTS) and posterior interosseous nerve syndrome (PINS). [8] (10.1016/s0749-0712(21)00357-7)
  • [L5] It is important to understand the anatomic course and distribution of the radial nerve in order to make an accurate diagnosis. [9] (10.1007/s11420-011-9238-8)
  • [L4] The study provides credence to the somewhat disputed concept that radial tunnel syndrome is a distinct clinical entity related to compression of the posterior interosseous nerve. [10] (10.1148/radiol.2401050028)
  • [L4] This study indicates that pain in patients with radial tunnel syndrome may be treated successfully by surgical decompression of the superficial branch of the radial nerve. [11] (10.1177/1753193408099832)
  • [L5] Radial tunnel syndrome (RTS) and posterior interosseous nerve (PIN) compression are distinct entities with different clinical presentations but share identical potential sites of nerve interference; the author proposes unifying them as mild (RTS) and severe (PIN compression) forms of one disease to simplify nomenclature. [12] (10.1177/1753193420953990)
  • [L5] No single approach was adequate for complete visualization and release of all compression points of the radial tunnel. [13] (10.1016/j.jhsa.2015.03.009)
  • [L4] There is a tendency that surgical decompression of the radial tunnel might be effective in patients with RTS. [14] (10.1016/j.jhsa.2007.10.001)
  • [L5] The authors advocate for consistent use of the terminology distinguishing the deep branch of the radial nerve (DBRN) and the posterior interosseous nerve (PIN), and recommend viewing radial tunnel syndrome and posterior interosseous nerve syndrome as a single condition presenting along a spectrum of nerve entrapment. [17] (10.1177/17531934241254706)
  • [L4] Dynamic ultrasonographic assessment of changes in the AP diameter and CSA is an effective diagnostic tool for identifying radial tunnel syndrome. [18] (10.1177/17531934261443138)
  • [L5] Surgical decompression of the median nerve or the AIN in the forearm is rarely indicated; a prolonged nonsurgical approach is warranted in most cases. [19] (10.5435/jaaos-d-16-00010)
  • [L4] Isolated PINN have shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up. [21] (10.1177/1558944717692093)
  • [L5] Supination increases the linear distance between the PIN and radial head and should be considered to increase the safe working volume whenever intra-articular procedures are performed on the anterolateral aspect of the elbow. [26] (10.1016/j.jse.2018.08.019)
  • [L4] Nonoperative management with corticosteroid injection can be used as a therapeutic measure with potential long-term benefits in the treatment of RTS. [27] (10.1177/1558944718787282)
  • [L5] Furthermore, its distance from the radial head appears to increase with forearm supination, which could increase the safe working space. [31] (10.1055/s-0037-1605388)
  • [L5] Predictive accuracy was highest when the arm was in a supinated position. [32] (10.1016/j.arthro.2013.03.056)
  • [L4] Neuroimaging should be considered as a complementary diagnostic method in PINS. [33] (10.1212/wnl.0000000000003287)
  • [L1] Wrist proprioception appears to be a multifactorial phenomenon. [34] (10.1016/j.jht.2015.03.003)
  • [L3] The posterior interosseous nerve moved farther from the radial head during elbow extension than flexion and during forearm pronation than supination, but distal migration was minimal (3.5 mm). [35] (10.5397/cise.2024.00213)
  • [L5] The paper is a letter to the editor discussing the controversy surrounding radial tunnel syndrome, dynamic compression theories, and the difficulty in differentiating it from tennis elbow, noting that a combined operative procedure for both conditions will be reported in the future. [37] (10.2106/00004623-199274020-00024)
  • [L4] In the third patient, in whom the duration of entrapment was more than two years, a tendon transfer was used as treatment. [38] (10.2106/00004623-197355040-00009)
  • [L4] Surgical excision can lead to rapid recovery of nerve sensation in cases of radial nerve compression by ganglion cysts. [39] (10.1007/s11552-007-9083-x)

References

[1] A Unified Approach to Radial Tunnel Syndrome and Lateral Tendinosis. Techniques in Hand & Upper Extremity Surgery. 2006. DOI: 10.1097/01.bth.0000231580.32406.71

[2] Radial Tunnel Syndrome. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.03.020

[3] Radial Tunnel Syndrome: Review and Best Evidence. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00314

[4] A New Clinical Test for Radial Tunnel Syndrome—The Rule-of-Nine Test: A Cadaveric Study. Journal of Orthopaedic Surgery. 2001. DOI: 10.1177/230949900401200115

[5] Prospective Evaluation of Single Corticosteroid Injection in Radial Tunnel Syndrome. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.095

[6] High radial nerve entrapment neuropathy: an anatomical cadaver study and case report. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.060

[7] Radial Tunnel Syndrome. Orthopedic Clinics of North America. 2012. DOI: 10.1016/j.ocl.2012.07.022

[8] RADIAL TUNNEL SYNDROME. Hand Clinics. 1996. DOI: 10.1016/s0749-0712(21)00357-7

[9] Posterior Interosseous Neuropathy: Electrodiagnostic Evaluation. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery. 2012. DOI: 10.1007/s11420-011-9238-8

[10] MR Imaging Features of Radial Tunnel Syndrome: Initial Experience. Radiology. 2006. DOI: 10.1148/radiol.2401050028

[11] Radial Tunnel Syndrome: Emphasis on the Superficial Branch of the Radial Nerve. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408099832

[12] Radial tunnel syndrome: definition, distinction and treatments. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420953990

[13] Anatomical Study of the Surgical Approaches to the Radial Tunnel. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.03.009

[14] Interventions for Treating the Radial Tunnel Syndrome: A Systematic Review of Observational Studies. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.10.001

[17] Nomenclature of the radial nerve: distinguishing between the deep branch of the radial nerve and the posterior interosseous nerve. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241254706

[18] Role of high-resolution dynamic ultrasonography in the evaluation of posterior interosseous nerve compression at radial tunnel: a prospective case-control study. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261443138

[19] Ulnar Tunnel Syndrome, Radial Tunnel Syndrome, Anterior Interosseous Nerve Syndrome, and Pronator Syndrome. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00010

[21] Outcomes Following Isolated Posterior Interosseous Nerve Neurectomy: A Systematic Review. HAND. 2017. DOI: 10.1177/1558944717692093

[26] The posterior interosseous nerve crosses the radial head midline and increases its distance from bony structures with supination of the forearm. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.019

[27] Prospective Evaluation of a Single Corticosteroid Injection in Radial Tunnel Syndrome. HAND. 2018. DOI: 10.1177/1558944718787282

[31] Distance of the Posterior Interosseous Nerve from the Radial Head during Elbow Arthroscopy: An Anatomical Study. Joints. 2017. DOI: 10.1055/s-0037-1605388

[32] Posterior Interosseous Nerve Localization in the Proximal Forearm: A Cadaveric Study Establishing a Non‐invasive, Patient‐normalized Parameter (SS‐49). Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.03.056

[33] Posterior interosseous neuropathy. Neurology. 2016. DOI: 10.1212/wnl.0000000000003287

[34] Multiplanar wrist joint proprioception: The effect of anesthetic blockade of the posterior interosseous nerve or skin envelope surrounding the joint. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2015.03.003

[35] In vivo dynamic migration of the posterior interosseous nerve across various elbow and forearm positions. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2024.00213

[37] Radial tunnel syndrome. An investigation of compression neuropathy as a possible cause.. The Journal of Bone & Joint Surgery. 1992. DOI: 10.2106/00004623-199274020-00024

[38] Posterior Interosseous-Nerve Syndrome Secondary to Rheumatoid Synovitis. The Journal of Bone & Joint Surgery. 1973. DOI: 10.2106/00004623-197355040-00009

[39] Compression Neuropathy of the Radial Nerve Due to Ganglion Cysts. HAND. 2008. DOI: 10.1007/s11552-007-9083-x

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c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.