General Guideline Principles for Radial

Nerve Entrapment (Including Radial Tunnel Syndrome)

for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Radial Nerve Entrapment (Including Radial Tunnel Syndrome).

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Radial Nerve Entrapment (Including Radial Tunnel Syndrome)

Aching and soreness in the proximal forearm are symptoms of radial nerve entrapment, particularly when it affects the posterior interosseous branch of the nerve. It is frequently referred to as “resistant tennis elbow” or “supinator syndrome,” is regarded as contentious, and is clinically a little challenging to separate from non-specific forearm and elbow pain.

Radial nerve entrapment is thought to be a relatively uncommon disorder, 30 to 100 times less frequent than carpal tunnel syndrome. There are numerous places where you could get trapped.

The extensor carpi radialis brevis origin, fibrous bands covering the radial head, the radial recurrent arterial fan, and the arcade of Frohse at the entry to the supinator muscle are among the locations that are most frequently affected. It is advised to have a confirmatory electrodiagnostic motor examination, which is frequently challenging to do.

It is advised that the treatments for ulnar neuropathy at the elbow (summarised below) be used to infer treatment for radial neuropathies in the lack of high-quality data for treating these radiculopathies.

Medications of Radial Nerve Entrapment (Including Radial Tunnel Syndrome)

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, Chronic, or Postoperative Pronator Syndrome Pain

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, Chronic, or Postoperative Pronator Syndrome Pain are recommended for the management of postoperative, chronic, or subacute Pronator Syndrome pain

    Indications – NSAIDs are advised as a kind of treatment for pain associated with postoperative Pronator Syndrome, chronic pain, or subacute pain. OTC medications should be tried first as they might work well.

    Frequency/Duration – Many patients could find it reasonable to use as needed.

    Indications for Discontinuation – The easing of elbow pain, a lack of effectiveness, or the appearance of side effects that require stopping the treatment.

     

  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleedin

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are commonly used together by individuals who are at high risk of gastrointestinal bleeding

    Indications – Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a longer course of treatment is being explored. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

    Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

    Indications for Discontinuation – Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

     

  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effect

    NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended Acetaminophen or aspirin as the first-line therapy appears to be the safest considering cardiovascular effects.If necessary, non-selective NSAIDs are recommended to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

     

  4. Acetaminophen for Treatment of Elbo

    Acetaminophen for Treatment of Elbow Pain is recommended for the treatment of elbow discomfort, especially in those with NSAID contraindications

    Indications – All patients, including those with acute, subacute, chronic, and post-operative elbow pain.

    Dose/Frequency – As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.

    Indications for Discontinuation – pain, side effects, or intolerance are gone.

     

  5. Glucocorticosteroids – Oral or Injections

    Glucocorticosteroids – Oral or Injections are not recommended for radial nerve entrapment that is acute, subacute, or persistent

     

  6. Opioids of Radial Nerve Entrapment (Including Radial Tunnel Syndrome)

    Opioids of Radial Nerve Entrapment (Including Radial Tunnel Syndrome) is not recommended for radial nerve entrapment discomfort that is either persistent or subacute.

    Opioids of Radial Nerve Entrapment (Including Radial Tunnel Syndrome) is recommended for no more than one week, to control radial nerve pain following surgery.

    Rationale for Recommendations – Opioids have not been adequately studied for the treatment of radial nerve entrapment. Opioids have serious side effects, including poor tolerance, constipation, drowsiness, impaired judgment, memory loss, and the possibility of overuse or dependency, which has been recorded in up to 35% of patients.

    Patients should be warned against using machinery or motor vehicles and aware of these possible side effects prior to receiving an opioid prescription. The majority of musculoskeletal complaints can be treated with safer analgesics, and opioids should only be taken in extreme cases of pain or for a brief period of time (no longer than one week) after surgery. Except for a brief postoperative course, opioids are not advised for the treatment of radial nerve entrapment.

     

  7. Vitamins

    Vitamins is recommended for acute, subacute, or chronic radial nerve entrapment, vitamins, particularly pyridoxine

     

  8. Lidocaine Patches

    Lidocaine Patches is recommended for radial nerve entrapment discomfort that is either acute, subacute, or ongoing.

     

  9. Ketamine

    Ketamine is recommended for radial nerve entrapment that is acute, subacute, or persistent.

Treatments of Radial Nerve Entrapment (Including Radial Tunnel Syndrome)

Rehabilitation: Therapy / Devices

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritized.

To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

To facilitate functional gains, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.

Therapy (Active and Passive)

  1. Physical or Occupational Therapy for Acute, Subacute, Chronic, or Postoperative Radial Nerve Entrapment

    Physical or Occupational Therapy for Acute, Subacute, Chronic, or Postoperative Radial Nerve Entrapment are recommended to treat Radial Nerve Entrapment that is either post-operative, chronic, subacute, or acute.

    Frequency/Dose/Duration – With verification of continued objective functional progress, the total number of visits may be as low as two to three for individuals with minor functional deficits or as high as 12 to 15 for those with more severe deficits.

    If there is evidence of functional improvement toward particular objective functional goals (e.g., enhanced grip strength, key pinch strength, range of motion, or improving capacity to execute work activities), more than 12 to 15 visits may be necessary to address persistent functional impairments.

    A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.

    Indications for Discontinuation – Resolution of elbow discomfort, intolerance, lack of effectiveness, or non-compliance, including failure to perform the recommended at-home exercises.

     

  2. Magnets

    Magnets are recommended for radial nerve entrapment that is acute, subacute, or persistent

     

  3. Elbow and Wrist Splinting

    Elbow and Wrist Splinting are recommended for radial nerve entrapment that is acute, subacute, or persistent.

    Other

     

  4. Acupuncture, Biofeedback, Manipulation and Mobilization, Massage, Soft Tissue Massage, Iontophoresis, Phonophoresis

    Acupuncture, Biofeedback, Manipulation and Mobilization, Massage, Soft Tissue Massage, Iontophoresis, Phonophoresis are not recommended radial nerve entrapment that is sudden, gradual, or persistent.

     

  5. Low-Level Laser Therapy

    Low-Level Laser Therapy is not recommended for radial nerve that is acute, subacute, or chronic entrapment.

     

  6. Ultrasound

    Ultrasound is recommended for radial nerve entrapment that is acute, subacute, or chronic.

Surgery of radial Nerve Entrapment (Including Radial Tunnel Syndrome)

Radial Nerve Operations Referrals for surgery may be necessary for patients who exhibit major warning signs (such as compressive neuropathy following an acute fracture) or who have not improved with non-surgical treatment, such as wrist splints.

Considerations for surgery rely on the symptoms’ established diagnosis. Counselling regarding potential outcomes, risks, advantages, and especially expectations is crucial if surgery is being considered.

Setting expectations before surgery about the need to follow the rehabilitative exercise routine and cope with post-operative pain is also crucial. To prevent frozen shoulder (also known as adhesive capsulitis), range-of-motion exercises during the post-operative phase should also target the elbow, wrist, and shoulder.

Surgical Release for Treatment of Subacute or Chronic Radial Neuropathies

Surgical Release for Treatment of Subacute or Chronic Radial Neuropathies are recommended for patients with emergency or urgent indications, such as acute compression from a fracture or compartment syndrome with persistent symptoms of nerve damage, who fail non-operative treatment for subacute or chronic radial neuropathies.

Indications – elbow radial neuropathy symptoms, considerable function loss as evidenced by significant activity limits brought on by nerve entrapment, and the patient’s failure to respond to nonoperative treatment, typically for at least three to six months. In general, patients should be fully compliant with therapy, wear failing wrist splints, and avoid aggravating exposures.

Early surgical candidates may include persistent tingling and numbness, the progression of symptoms, or functional impairment. Many surgeons won’t operate on a patient if the electrodiagnostic results are negative.

The EDS should ideally use the inching technique. The preoperative electrodiagnostic investigations, the surgeon’s comfort level and expertise, and surgical anatomy all influence the kind of surgical treatment that is chosen.

What our office can do if you have workers compensation injuries causing Radial Nerve Entrapment

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

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