Supinator Tunnel Syndrome

By | June 10, 2022

Supinator tunnel syndrome is a rare bottleneck syndrome. It arises from damage to the radial nerve within the forearm supinator box.

What is supinator tunnel syndrome?

In medicine, supinator tunnel syndrome is also known as supinatorlog syndrome, inferior radial paralysis or posterior interosseous syndrome. What is meant by this is a nerve compression syndrome that shows up on the forearm near the elbow. The radial nerve, which is one of the important arm nerves, takes its course there. It pulls through the supinator muscle. For kashin-beck disease in English, please visit

Compression of the radial nerve in this region results in supinator tunnel syndrome. It affects the branch of the radial nerve, leading to weakening or paralysis of some muscles. However, a complete functional failure is not to be feared. The radial nerve is also known as the radial nerve.

It is one of the mixed nerves and has both sensory and motor fibers. At the elbow, it is divided into a sensitive and a motor section. While the sensitive part extends towards the back of the hand, the motor part runs through the supinator muscle. There it supplies the muscles for hand extension.

The symptoms of supinator tunnel syndrome depend on which area is damaged. If the damage occurs in the upper section, the person affected suffers from sensory disturbances. Damage to the motor area, on the other hand, can result in muscle failure. In the case of damage to the upper arm region, both symptoms can also exist.


The causes of supinator tunnel syndrome vary. In all cases, however, the motor branch of the radial nerve is constricted and affected. It is not uncommon for a fracture of the radius or ulna at the elbow to be responsible for this. A bruise or a bone displacement leads to a nerve crush, which in turn is responsible for nerve damage.

Another possible cause is the dislodging of the spoke head from its tape guide. As a result, there is a risk of narrowing at the entry point to the supinator muscle. In some cases, fatty lumps, inflammations or tumors at the nerve passage can also be considered for a supinator tunnel syndrome. The same applies to an increase in muscle mass in the supinator muscle.

It usually develops through constantly repetitive activities such as playing tennis or the piano. Another reason for the development of a supinatorlog syndrome is constant external pressure. This is usually triggered by carrying heavy loads on one side.

Symptoms, Ailments & Signs

A supinator tunnel syndrome becomes noticeable through feelings of weakness when stretching the fingers. Sometimes the weakness is so intense that the fingers can no longer be stretched at all. Because only the motor part of the radial nerve is affected, only the motor part is affected.

On the other hand, the sensitive part of the nerve is spared from complaints, so that there are no sensory disturbances on the arm or fingers. The third and fourth fingers are particularly affected by the weakness in extension. Furthermore, the affected person suffers from a dull spontaneous pain in the forearm near the elbow. When pressure is applied, the pain worsens.

Most often, the painful discomfort manifests itself when the patient moves the palm of his hand in the upper direction. Sometimes, after several rotations of the forearm, signs of muscle fatigue can also be felt. In some cases, the pain radiates to the wrist.

Diagnosis & course of disease

To diagnose supinator tunnel syndrome, doctors first look at the patient’s medical history (anamnesis). Next step is a physical exam. A neurologist can also determine the performance speed of the damaged nerve. If the nerve and nerve sheath are impaired, there is usually a significant reduction in nerve conduction speed.

Other important examination procedures are sonography (ultrasound examination), taking x-rays and performing magnetic resonance imaging (MRI). While an X-ray examination can be used to find fatty tumors or benign soft tissue tumors such as ganglia, an X-ray examination can be used to detect broken bones in the radius and ulna.

With magnetic resonance imaging, it is possible to visualize the constricting structures. How supinator tunnel syndrome progresses is difficult to predict. The prognosis depends on the extent and duration of the nerve damage. Sometimes it even takes months for a nerve that was already damaged and has led to paralysis to heal completely, even though the pressure is no longer applied.


Due to the supinator tunnel syndrome, patients primarily suffer from severe mobility restrictions. These occur mainly in the fingers, so that the fingers can no longer be stretched properly. In severe cases, finger movement is completely restricted. Furthermore, the neighboring areas can also be affected by paralysis or sensory disturbances.

Due to these restrictions, the patient’s everyday life is made significantly more difficult, so that many sufferers develop depression or other mental disorders. Pain in the fingers or hand can also occur and in some cases radiate to the wrist. Since the pain often also occurs at night, the supinator tunnel syndrome can also lead to sleep disorders and thus to irritability of the person concerned. In children, supinator tunnel syndrome results in restricted and delayed development.

Treatment of the syndrome depends on the cause. First and foremost, the load that is responsible for the paralysis is stopped. Various medications and therapies can also limit the other symptoms and pain. Surgical interventions are only rarely necessary. In most cases, the course of the disease is positive and the patient’s life expectancy is not reduced by the disease.

When should you go to the doctor?

In the case of supinator tunnel syndrome, the person concerned needs to see a doctor. Since this disease cannot heal itself, treatment by a doctor is essential. As a rule, an early diagnosis also has a positive effect on the further course of the supinator tunnel syndrome and can prevent further complications and a worsening of the symptoms. The doctor should be consulted for supinator tunnel syndrome when the person concerned can no longer stretch their fingers properly.

As a rule, stretching out is associated with severe pain and is hardly possible anymore. Sensory disturbances in the arm of the affected person can also indicate this disease and should also be examined by a doctor. There can also be severe pain in the arms. These can occur for no particular reason and above all permanently and have a very negative effect on the quality of life of those affected.

At the first signs of supinator tunnel syndrome, a general practitioner or an orthopedist can be consulted. Further treatment depends on the exact cause of the syndrome. As a rule, this disease does not reduce the life expectancy of the person affected.

Treatment & Therapy

Treatment of supinator tunnel syndrome can be either conservative or surgical. If an unusual stress is responsible for the syndrome and it is removed, the radial nerve often recovers on its own, reducing the symptoms. Pain relievers such as ibuprofen or diclofenac are suitable for the treatment of acute pain. In addition to relieving pain, these preparations also fight inflammation.

Physiotherapy exercises and heat or cold applications continue to be helpful measures. If the conservative therapeutic measures do not improve the symptoms, an operation can be useful. If there is paralysis, the surgical intervention must be carried out as quickly as possible. During the operation, the surgeon exposes the deep motor branch of the radial nerve.

However, due to the delicacy of the nerve, particular caution is required. In addition, the entry point of the radial nerve into the muscle is widened because it is covered with connective tissue fibers, which can cause its entrapment. Confining structures such as connective tissue or fiber strands are severed.


Preventive measures against a supinator tunnel syndrome are not known. Full baths are recommended after an operation to prevent movement disorders in the elbow.


For successful follow-up care, avoiding physical stress is the first choice. In the case of intraoperative findings, the immobilisation is carried out with an upper arm cast in a 120° position. The plaster stays in place for 10 to 14 days. During this time, the shoulder and fingers can be moved. In the further course of the arm may only be lightly loaded. Things of everyday life can be carried out without any problems. Physiotherapy may be prescribed to help.

Alternatively, underwater stress therapy can be used. The algetic supinator syndrome is accompanied by medication as part of the aftercare. Ibuprofen and diclofenac are prescribed in low doses for a maximum period of three weeks. Permanent stress disorders are excluded if the treatment is carried out professionally. However, recurrence of supinator tunnel syndrome is possible.

If CRPS (Sudeck’s disease) occurs during aftercare, occupational therapy and physiotherapy are prescribed. CRPS (Sudeck’s disease) occurs as a result of tissue injury or surgical intervention. It occurs several weeks after the surgical procedure and causes severe pain in the operated area. If the healing process is positive, the sutures are removed from the 12th day after the operation. The removal is painless and takes just a few minutes.

You can do that yourself

If the supinator tunnel syndrome is treated conservatively or surgically, it is important to avoid heavy loads. Pain-relieving drugs such as diclofenac or ibuprofen are recommended for moderate to severe pain so that the pain does not become chronic. If the bottleneck syndrome is due to excessive stress on the radial nerve, it usually recovers on its own if the stress is not applied. For this reason, heavy physical exertion should be avoided.

Physiotherapy is another way to reduce the symptoms in everyday life. The controlled movements in the therapy relieve the radial nerve and allow it to regenerate better. Cold and heat therapy can also help to reduce pain and cure bottleneck syndrome. Cold therapy is usually used when there is inflammation and heat therapy when there is pain in the muscles and joints. Muscle and joint pain often occurs in bottleneck syndrome due to adopting the relieving posture.

The red light lamp is popular in heat therapy and is ideal for home use. Hot air and the use of a hot roller also relieve pain in the radial nerve. Wraps, packs and natural mud also help to reduce the pain in everyday life. Which variant helps the affected person the most depends on the individual case and should be tested.

Supinator Tunnel Syndrome