Lacertus syndrome: a ten year analysis of two hundred and seventy five minimally invasive surgical decompressions of median nerve entrapment at the elbow

Abstract

Purpose This study aims to assess the clinical presentation and surgical outcomes of lacertus syndrome (LS) and concomitant median nerve entrapments. Methods A retrospective study of prospectively collected data was conducted on patients undergoing lacertus release (LR) from June 2012 to June 2021. Available DASH (Disability of the Arm Shoulder Hand questionnaire) scores and post-operative Visual Analogue Scale (VAS) of pain, numbness, subjective satisfaction with surgical outcome, and intra-operative return of strength were analyzed. Results Two-hundred-seventy-five surgical cases were identified of which 205 cases (74.5%) underwent isolated LR, and 69 cases (25.1%) concomitant lacertus and carpal tunnel release. The three most common presenting symptoms in LS patients were loss of hand strength (95.6%), loss of hand endurance/fatigue (73.3%), and forearm pain (35.4%). Numbness in the median nerve territory of the hand was found in all patients with combined LS and carpal tunnel syndrome. Quick-DASH significantly improved (pre-operative 34.4 (range 2.3–84.1) to post-operative 12.4 (range 0–62.5), p < 0.0001) as did work and activity DASH (p < 0.0001). The postoperative VAS scores were pain VAS 1.9 and numbness VAS 1.8. Eighty-eight percent of patients reported good/excellent satisfaction with the surgical outcome. Intra-operative return of strength was verified in 99.2% of cases. Conclusion LS is a common median nerve compression syndrome typically presenting with loss of hand strength and hand endurance/fatigue. Minimally invasive LR immediately restores hand strength, significantly improves DASH scores, and yields positive outcomes regarding VAS pain, numbness, and subjective satisfaction with surgery in patients with proximal median nerve entrapment at a minimum six month follow-up.

State of the art review. Complications after carpal tunnel release

“…We prefer the abductor digiti minimi flap above the palmaris brevis flap because of its ease to dissect, its muscle bulk and better vascularization (de Roo et al, 2022b). If other sites of compression, like the lacertus fibrosus, have been demonstrated, they should be decompressed (Hagert et al, 2023). If other underlying causes have been demonstrated to explain the symptoms, treatment should be focused on addressing these as well.…”

State of the art review. Upper extremity revision nerve compression surgery

“…Persistent symptoms can be caused by several factors, including incomplete release of the carpal tunnel, compression at a secondary more proximal site of the forearm (Hagert et al., 2023), incorrect original diagnosis or symptoms that align with the recovery process of the affected median nerve (Pripotnev and Mackinnon, 2022). New symptoms resulting from iatrogenic damage to the median or ulnar nerve (UN) or its branches are rare (Karl et al., 2016).…”

Entrapment Neuropathies of the Median Nerve: An Updated Review

“…Lacertus fibrosus is a ligamentous tissue attaching the biceps to the ulna, over the MN in the proximal forearm (Figure 3). Despite the compression location is not exactly the same in LS than in PTS, the symptoms, physical examination, diagnosis and treatments are very similar [15,16]. The pain in the forearm and paresthesias in the median-innervated digits is exacerbated by resisted flexion of the elbow with the forearm in supination.…”