Clinical Outcomes of Operative Management for Radial Tunnel Syndrome According to Surgical Approach: A Systematic Review

Abstract

The diagnosis and optimal management of radial tunnel syndrome (RTS) is controversial with little consensus among the many possible pathophysiological mechanisms and surgical approaches. Thus, we performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on studies reporting outcomes of surgical treatment for RTS. PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases were queried. Patient demographics, surgical approach, intraoperative findings, postoperative patient-reported outcomes, and complications were recorded and synthesized. We included 11 studies comprising 401 upper extremities (381 patients). Of the included forearms, 54% (n = 155) were approached dorsally, and 46% (n = 130) were approached volarly. Studies that utilized a dorsal approach between the extensor carpi radialis brevis and extensor digitorum communis had the most favorable Roles and Maudsley scores and patient satisfaction when compared with volar approaches. However, volar approaches identified a greater number of constrictions at the arcade of Frohse (19% vs 7%) when compared with dorsal approaches. Wide variability of surgical approaches used for treatment of RTS is present in the literature. Compared with volar approaches, dorsal approaches are associated with favorable reported outcomes. However, in RTS secondary to vascular constriction, volar approaches may be better suited for release.