Elsevier

The Journal of Hand Surgery

Volume 33, Issue 1, January 2008, Pages 72.e1-72.e10
The Journal of Hand Surgery

Original scientific article
Interventions for Treating the Radial Tunnel Syndrome: A Systematic Review of Observational Studies

https://doi.org/10.1016/j.jhsa.2007.10.001Get rights and content

Purpose

For some disorders, such as radial tunnel syndrome (RTS), no randomized controlled trials and controlled clinical trials are available. To gain insight into the effectiveness of conservative and surgical interventions for treating RTS, we systematically reviewed all available observational studies on treatment of RTS. Although the validity of case series is inferior to that of controlled trials, the case series might provide valuable data about the efficacy of treatment options.

Methods

A literature search and additional reference checking resulted in 21 eligible case series for this review. Based on previous checklists, we constructed a new quality assessment and rating system to analyze the included case series. The methodological quality was assessed, and data extraction was performed. Studies with less than 50% of the maximum points on the methodological quality assessment were considered inadequate and were excluded from the analysis. To summarize the results according to the rating system for the strength of the scientific evidence for these case series, we introduced 4 levels: (1) tendency, (2) slight tendency, (3) conflicting tendency, and (4) no tendency.

Results

After the methodological quality assessment, 6 articles were included in the final analysis. They all reported on surgical treatment.

Conclusions

There is a tendency that surgical decompression of the radial tunnel might be effective in patients with RTS. The effectiveness of conservative treatments for RTS is unknown because, for most treatments, no studies were available. Additional high-quality controlled studies are needed to assess the level of conclusive evidence for surgical treatment and also to evaluate conservative treatments for RTS. For this, we recommend a multicenter, randomized clinical trial. Due to the lack of a clear protocol for diagnosing RTS, a reliable and valid diagnostic tool should be developed.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Literature Search

To identify relevant publications, the following databases—MEDLINE, EMBASE, PEDro, CINAHL, and CENTRAL—were searched, including studies up to February 2007. All the keywords related to the treatment of RTS were included in the literature search, such as radial tunnel syndrome, supinator syndrome, posterior interosseous nerve syndrome, PIN syndrome, RTS, radial nerve compression, treatment, therapy, surgical, and conservative. The complete search strategy is available on request. One author

Study Selection

In all, 282 potentially relevant abstracts were found after searching the 5 databases: 276 in MEDLINE, 6 in EMBASE, and none in CENTRAL, CINAHL, or PEDro. Of those 282 abstracts, 70 seemed to be relevant for our review. Reviewing the full text resulted in the inclusion of 16 articles. Citation tracking resulted in the identification of another 26 relevant abstracts, and 5 of those articles could be included. In all, 21 articles were included in this review.

Study Characteristics

All 21 included studies evaluated the

Conservative Treatment

Some case series mentioned an unsuccessful conservative treatment before surgical treatment or concluded that surgery should be reserved for those patients who fail to respond to conservative treatment. However, no articles presenting data on conservative treatment of RTS could be included. Therefore, no tendency was found for the effectiveness of conservative treatments.

Surgical Treatment

All 6 studies evaluated the effectiveness of surgical decompression of the radial tunnel. Table 4 gives the improvement

Discussion

This study systematically reviewed all available observational studies on the treatment of RTS and showed that there is a tendency for the effectiveness of surgical decompression of the radial tunnel. The use of observational studies was introduced because of a lack of published RCTs and CCTs. When no controlled studies are available and the results of case series are systematically evaluated, this can be a useful method to summarize and compare case series and to identify methodological flaws.

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    Copyright © 2008 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.