Radial nerve syndrome is a condition in which the radial nerve becomes compressed in a small passage on the outside (lateral aspect) of the elbow.  Its symptoms are very similar to tennis elbow and it can be hard to differentiate between the two conditions.  The radial nerve is vulnerable to compression as it passes beneath the supinator muscle.  This muscle is responsible for turning the right hand clockwise for example when closing a jar or tightening a screw.  Overuse of the supinator muscle can therefore cause compression of the radial nerve.  The nerve can also be stretched and irritated by repeated forceful pushing and pulling, gripping, pinching and bending of the wrist.

Symptoms

• The symptoms are similar to those of tennis elbow
• Pain on the outside of the elbow.  The pain is typically further towards the wrist (about 4cm away from elbow) than with tennis elbow.
• Weakness of the wrist, especially bending wrist backwards (wrist extension).
• Reduced sensation around outside aspect of the wrist is a rare symptom
• Pain aggravated by
• Bending wrist backwards
• Turning palm upwards (supinating wrist).
• Holding something with stiff wrist or straightend elbow

What you can do

• Rest and avoidance of aggravating activites
  • Wrist extension
  • Supinating wrist
  • Pushing/pulling heavy objects

• Use of adjuncts to take load of elbow
  • Wrist strap
  • Wrist splint
  • Elbow pad

What we can do

• Massage and stretching to reduce tension in the supinator muscle
• Prescription of stretching and strengthening exercises

Tennis elbow involves inflammation of the tendons (tendonitis) on the outside of the elbow at or below the lateral epicondyle due to repetitive strain.  It is caused by repetitive extension (bending backwards) of the wrist and fingers or tasks that require repetitive squeezing and gripping.  Occupational repetitive strain may be due to excessive tool use or typing.  Sporting overuse during tennis may be due to

• Poor backhand and forehand technique – hitting the ball with a bent or limp wrist.  Hitting the shot late and therefore not getting the body behind the ball to generate the power from the body not just the arm.
• Snapping and turning the wrist during service.

Tennis Elbow Symptoms

• Elbow pain and tenderness at or below the lateral epicondyle (the outer bony part of the elbow)
• Tenderness to the touch around the same area.
• Weakness of the wrist with difficulty performing simple tasks
• Symptoms worse in the morning
• Tennis Elbow pain aggravated by
  • Extending (bending backwards) wrist and fingers
  • Grasping or holding objects with the hand

What you can do

• Ice therapy
• Rest with gradual return to normal activity level.  A training diary may be useful to help monitor the level of activity that can be performed without aggravating symptoms and regulate progress.
• Take anti-inflammatory medication (speak to pharmacist or doctor about a suitable product)
• Use of wrist band.  This is worn below the elbow and takes the strain off the muscles attachments at the elbow

Prevention

Tennis specific advice – the following changes can help reduce the load on the elbow

• Racquet material – the use of a graphite frame and nylon strings
• Racquet size – midsize racquets better than oversized
• Decrease string tension
• Grip size – not to large or too small

At home

• The avoidance or reduction of repetitive tasks that aggravate symptoms.

What we can do

Massage

• Cross friction massage (short deep strokes at 90 degrees to fibre direction) is used to stimulate healing.  Inflammation can cause a sticking together (adhesions) between the muscle tendons and tendons sheaths preventing the muscle from gliding smoothly within its sheath.  Cross friction can help prevent adhesions forming
• Stripping massage (long deep strokes throughout the width of the muscle) can help break down and release tight/knotted areas of muscle and reduce the strain at the elbow

Tennis Elbow Exercises

• Prescription of stretches of finger and wrist extensors to limit of pain free range.  Initially held for 10-15 seconds and building up to 40 seconds duration repeated 5 times daily.
• Prescription of strengthening exercises as permitted by pain
  • Initially isometric exercises – muscle held in fixed position
  • Then Concentric exercises – muscles working and shortening
  • Finally Eccentric exercises – muscle working but lengthening

Medical treatment (if physical therapy does not work)

• Steroid injection – up to 2 or 3 injections per year to reduce inflammation (more injections will decrease strength of tendon)
• Surgery – last resort, good success rates.