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Radial tunnel syndrome This is one of the rarer nerve compression syndromes in the upper limb. Symptoms are very much akin to tennis elbow and quite often patients are referred with tennis elbow up to the surgeon and symptoms are in fact from radial tunnel syndrome. Clinical features These tend to be pain and aching over the upper outer aspect of the arm. Generally there is not an area of acute sensitivity over the outer aspect of the elbow as in tennis elbow. There is a dull aching sensation and tiring on exercise. On examination There is often tenderness on the outer aspect of the elbow and there is also tenderness just inside a mobile muscle bulk on the outer aspect of the forearm and this often occurs directly in the crease of the elbow this is over where the radial tunnel is. The radial tunnel comprises of various rather nebulous structures such as blood vessels, venous arches fibrous bands on muscles through which the radial nerve travels. One of these bands comes from a muscle called supinator. This supinates the forearm (turns the palm to the ceiling if the elbow is resting on a hard surface) and if this movement is restricted i.e. the doctor tries to turn the palm towards the floor it can sometimes aggravate the pain if radial tunnel syndrome is present. One of the muscles that extends the wrist (cocks the wrist back) is also guilty in having an origin that has a fibrous band that can cover the radial nerve. Often pressure over one of these straightened fingers can give pain in the elbow which is indicative of radial tunnel. Radial tunnel syndrome is a clinical diagnosis and not an electrophysiological one which means that the electrophysiological tests or nerve conduction studies very often do not pick this syndrome up. If radial tunnel syndrome is diagnosed then surgery is indicated. 
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