True neurogenic radial tunnel syndrome is an uncommon condition caused by entrapment of the radial or posterior interosseous nerve. It is a subjective pain syndrome with rare motor findings. The chief complaint is generally pain at the dorsal aspect of the upper forearm; any weakness is usually secondary to pain. Electrodiagnostic studies are unreliable in radial tunnel syndrome. Although previous studies have found a high rate of good results, the authors believe that a high rate of morbidity is associated with both the disease and its treatment. Based on their results they suggest that great caution has to be taken before performing radial tunnel release, and strict adherence to the indications should be noted during the preoperative examination. A trial of nonsurgical treatment is warranted in all patients. Patients who do not respond or continue to progress despite conservative treatment are candidates for surgical decompression. Based on the recent literature, surgical decompression leads to approximately 60 to 70% good and excellent results.