Radial tunnel syndrome is irritation of a branch of the radial nerve as it passes through a narrow tunnel of muscle just below the outer elbow. It causes a deep, aching pain in the top of the forearm that is worse with repeated twisting and gripping. It is uncommon and easily mistaken for tennis elbow, and the two can occur together.
Also known as radial nerve entrapment, posterior interosseous nerve entrapment
Anatomy: where the problem is
Front view of the elbow. Highlighted in the diagram: radial nerve and radial tunnel.
Symptoms
- A deep ache in the top of the forearm, a few centimetres below the outer elbow
- Pain that is worse with repeated twisting of the forearm, gripping or lifting with a straight elbow
- Tenderness over the muscle below the elbow, not on the bony point itself
- An ache that can linger at night or after activity
- Usually no numbness and little true weakness
Causes and risk factors
- Repeated twisting of the forearm, such as using a screwdriver
- Forceful gripping and wrist extension at work or in sport
- A tight band of muscle or tissue pressing on the nerve
- A blow to the outer forearm
- It can occur alongside tennis elbow
What the evidence says helps
- Diagnosis is based on the site of the pain and tenderness and on ruling out other causes. Nerve tests are usually normal, and there is no agreed diagnostic test.12
- Treatment starts with avoiding the aggravating movements for a period, pain relief and sometimes a wrist splint, followed by a gradual return to loading.1
- A systematic review found no good studies of conservative treatments, so advice is based on clinical experience.2
- Surgery to release the nerve is considered if symptoms persist. Studies report that it is generally successful, although results are less good when tennis elbow is also present.12
Things you can try at home
- Cut back on repeated twisting, gripping and lifting with the palm down for a few weeks
- Lift with the palm facing up and the elbow slightly bent
- Vary your tasks and take short breaks during repetitive work
- Reintroduce strengthening gradually once the ache has settled
- Check the grip size of tools and rackets
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A hot, red, swollen elbow with a fever or feeling unwell: see a GP the same day or call NHS 111
- An elbow that looks deformed, or cannot be bent or straightened after a fall: go to A&E
- Arm pain with chest pain, breathlessness or sweating: call 999
- Numbness, pins and needles or weakness in the hand that is getting worse: see your GP promptly
- Sudden difficulty lifting the wrist or straightening the fingers: see a GP urgently
How Apollo can help
We examine the elbow, forearm and neck to work out whether the pain comes from the tendon, the nerve or both, because the treatment differs. We look at the work or sport movements that load the area and agree how to change them for a while. Treatment may include soft tissue work for the forearm muscles, gentle nerve movement exercises and a graded strengthening plan. If symptoms do not settle or we find weakness, we refer you to your GP for nerve tests or a specialist opinion.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How is radial tunnel syndrome different from tennis elbow?
Tennis elbow is tender on the bony point at the outer elbow and hurts with gripping. Radial tunnel syndrome is tender a few centimetres further down, in the muscle of the forearm, and feels more like a deep ache. The two can be present together.
How is radial tunnel syndrome diagnosed?
It is diagnosed from your symptoms and examination. Nerve conduction tests and scans are usually normal and are mainly used to rule out other problems.
Does radial tunnel syndrome need surgery?
Most people start with activity changes and rehabilitation. Surgery to release the nerve is considered when symptoms continue for several months despite this.
References
- Naam NH, Nemani S (2012). Radial Tunnel Syndrome. Orthopedic Clinics of North America 43:529-536. View source
- Huisstede B, Miedema HS, van Opstal T, de Ronde MT, Verhaar JA, Koes BW (2008). Interventions for Treating the Radial Tunnel Syndrome: A Systematic Review of Observational Studies. The Journal of Hand Surgery 33:72.e1-72.e10. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
