Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
College of Medicine, University of Florida, Gainesville, FL, USA.
Eur J Orthop Surg Traumatol. 2024 Aug;34(6):2813-2821. doi: 10.1007/s00590-024-04003-8. Epub 2024 May 24.
Radial tunnel syndrome (RTS) is a controversial diagnosis due to non-specific exam findings and frequent absence of positive electromyography (EMG) and nerve conduction study (NCS) findings. The purpose of this study was to identify the methods used to diagnose RTS in the literature.
We queried PubMed, Embase, Web of Science, and Cochrane databases per PRISMA guidelines. Extracted data included article and patient characteristics, diagnostic assessments utilized and their respective findings, and treatments. Objective data were summarized descriptively. The relationship between reported diagnostic findings (i.e., physical exam and diagnostic tests) and treatments was assessed via a descriptive synthesis.
Our review included 13 studies and 391 upper extremities. All studies utilized physical exam in diagnosing RTS; most commonly, patients had tenderness over the radial tunnel (381/391, 97%). Preoperative EMG/NCS was reported by 11/13 studies, with abnormal findings in 8.9% (29/327) of upper extremities. Steroid and/or lidocaine injection for presumed lateral epicondylitis was reported by 9/13 studies (46/295 upper extremities, 16%), with RTS being diagnosed after patients received little to no relief. It was also common to inject the radial tunnel to make the diagnosis (218/295, 74%). The most common reported intraoperative finding was narrowing of the PIN (38/137, 28%). The intraoperative compressive site most commonly reported was the arcade of Frohse (142/306, 46%).
There is substantial heterogeneity in modalities used to diagnose RTS and the reported definition of RTS. This, in conjunction with many patients having concomitant lateral epicondylitis, makes it difficult to compare treatment outcomes for RTS.
Level III. Systematic review of retrospective and prospective cohort studies.
由于非特异性检查结果和常缺乏阳性肌电图（EMG）和神经传导研究（NCS）结果，桡管综合征（RTS）的诊断存在争议。本研究的目的是确定文献中用于诊断 RTS 的方法。
我们按照 PRISMA 指南检索了 PubMed、Embase、Web of Science 和 Cochrane 数据库。提取的数据包括文章和患者特征、使用的诊断评估及其各自的结果以及治疗方法。客观数据以描述性方式进行总结。通过描述性综合评估报告的诊断发现（即体格检查和诊断性检查）与治疗之间的关系。
我们的综述包括 13 项研究和 391 例上肢。所有研究均使用体格检查诊断 RTS；最常见的是，患者在桡管处有压痛（381/391，97%）。11/13 项研究报告了术前 EMG/NCS，其中 8.9%（29/327）的上肢有异常发现。9/13 项研究（46/295 上肢，16%）报告了对疑似外上髁炎的类固醇和/或利多卡因注射，在患者接受很少或没有缓解后诊断为 RTS。对桡管进行注射以做出诊断也很常见（218/295，74%）。最常报告的术中发现是 PIN 变窄（38/137，28%）。最常报告的术中受压部位是 Frohse 弓（142/306，46%）。
用于诊断 RTS 的方法和报告的 RTS 定义存在很大的异质性。再加上许多患者同时患有外上髁炎，这使得比较 RTS 的治疗结果变得困难。
三级，回顾性和前瞻性队列研究的系统评价。
