Journal of the Peripheral Nervous System 7:229–232 (2002) © 2002 Peripheral Nerve Society, Inc. 229 Radial tunnel syndrome in an elite power athlete: a case of direct compressive neuropathy Rob D. Dickerman, Qualls E.J. Stevens, Anders J. Cohen, and S. Jaikumar Surgical Neurology Branch, National Institutes of Neurological Disease and Stroke, National Institutes of Health, Bethesda, Maryland Abstract Radial tunnel syndrome (RTS) is thought to result from intermittent and dy- namic compression of the posterior interosseous nerve (PIN) in the proximal part of the forearm associated with repeated supination and pronation. The diagnostic criteria encom- passing RTS are purely clinical and the term “radial tunnel syndrome” has become contro- versial because of the lack of focal motor weakness in the majority of patients diagnosed with RTS. Retrospective cadaveric and surgical studies have revealed several areas within the forearm in which the PIN may become entrapped. Recent studies have suggested that the PIN is “fixed” in the supinator muscle and that wrist pronation is the actual movement that places the most stress on the PIN. The patients most often afflicted with RTS appear to be those who perform repetitive manual tasks involving rotation of the forearm and athletes involved in racket sports. Surgical exploration with decompression of the PIN is often re- quired in patients with RTS. We present the first case of RTS occurring in an elite power athlete and believe this case represents a direct compressive sensory neuropathy. The opti- mum nonsurgical treatment plan for the elite athlete in training for competition and the cause of this compressive neuropathy in power athletes will be discussed. Key words: palsy, peripheral nerve, posterior interosseous nerve, powerlifting, supinator muscle Introduction In 1956, radial tunnel syndrome (RTS) was first re- ported as a distinct entity and described as “radial pro- nator syndrome” (Michele and Krueger, 1956). The term radial tunnel syndrome was coined in 1972; it de- fined the anatomic boundaries of the region and identi- fied the structures that could entrap or compress the posterior interosseous nerve (PIN) (Roles and Mauds- ley, 1972). It was not until 20 years after recognizing RTS as a clinical syndrome that sufficient evidence was found to demonstrate compression of PIN in the radial tunnel (Werner, 1979). RTS has been reported in swim- mers, Frisbee players, tennis players, violinists, and or- chestra conductors secondary to repetitive trauma re- lated to stressful pronation and supination (Cravens and Kline, 1990). Posterior interosseous nerve entrapment is thought to occur within 4 possible structures: 1) fas- cial bands connecting the brachialis and brachioradialis; 2) the “leash of Henry,” a fan of vessels arising from the radial recurrent artery; 3) the extensor carpi radialis brevis (ECRB) muscle; and 4) the arcade of Frohse, which represents the proximal border of the superficial head of the supinator muscle and is the most common cause of RTS. In contrast to previous reports of RTS oc- curring with repetitive stress from repeated pronosupi- nation, we report a case of RTS occurring in a power athlete secondary to direct compression within the ra- dial tunnel. The pathophysiology of this direct compres- sive RTS in an elite power athlete, the biomechanical and anatomical cause of direct compressive RTS, and Address correspondence to: Rob D. Dickerman, DO, PhD, Long Is- land Jewish Medical Center, Department of Surgery, Division of Neu- rosurgery, 260-12 74th Avenue, Glen Oaks, New York 11004 USA. Tel: 516-354-3401; Fax: 516-354-8597; E-mail: drrdd@yahoo.com