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Complications of Radial Tunnel Release Surgery

By Christian Walker, Ph.D.

Radial tunnel syndrome can be a painful result of entrapment of the radial nerve in the forearm. Radial tunnel release surgery seeks to alleviate the affliction by decompressing the nerve. With an appropriately selected surgical candidate, the results are generally safe and effective. However, in any surgery, postsurgical complications can arise, which may be serious or minor.

Goal of Surgery

Radial tunnel syndrome can be a painful result of the radial nerve being pinched or entrapped anywhere along its path in the radial tunnel of the forearm. When this happens, the consequences can be severe pain in the forearm and hand. The only way to release the compression is with radial tunnel release surgery. The specific goal of surgery is to decompress the radial nerve by releasing it from entrapment by the surrounding tissues in the forearm. While generally successful, the surgery is not without potential complications, and their potential can be assessed before surgery.

Candidates and Considerations

Since complications can arise, the surgeon carefully evaluates each patient to ensure she is a good candidate for radial tunnel surgery. Candidacy depends on a number of factors, mostly related to the patient’s health going into the surgery. For instance, preexisting chronic illnesses such as diabetes and arthritis may increase the rate or severity of complications. Since these patients are at higher risk for complications they must be assessed by the surgeon prior to surgery. Additional considerations for surgical candidacy are allergies to anesthesia, pulmonary conditions, and overall health.

Types of Complications

The "Journal of Hand Surgery" reports that the most common complication of radial tunnel release surgery is permanent nerve damage. This can occur as a result of inadvertently cutting or nicking the nerve with instruments. The consequences can be partial to complete loss of wrist and hand movement, as well as loss of strength, depending on the amount of damage. This complication might also include partial or complete loss of sensation on the top of the thumb and index finger. In some instances, muscular atrophy, or wasting, may result. Another common complication is residual pain. The pain may never be alleviated, or may return shortly after surgery. Rarer complications include surgical damage to local blood vessels at the surgical site, and protracted pain anywhere from the elbow to the hand.

Additional Undesirable Outcomes

While the majority of complications can be permanent, most minor undesirable outcomes are temporary, and should be discussed with the surgeon. Most are generally easily treated with therapy or medications and usually include some pain and tenderness at the surgical site or prolonged scar tenderness. Minor bleeding, swelling and slight infection also are temporary. Sometimes the scar may heal with an abnormal appearance, but this is not harmful. The patient may have an allergic reaction to anesthesia, medications, ointments or to bandages, in addition to experiencing nausea and vomiting. These outcomes are not uncommon and easily treated. Among the rarest outcomes of surgery is death, although every effort is made to identify high-risk patients before surgery.

Misconceptions About Surgery

A misconception about radial tunnel surgery is its universal effectiveness. However, the outcome of this surgery is not always successful. In 2008 the "Journal of Hand Surgery" reported that in some instances up to 40 percent of patients are unsatisfied with their results. Thus, the potential for complications and expected surgical outcome must be discussed with the surgeon.

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