2Ĭlip 20-2 Clinical examination of lacertus syndrome. You make the diagnosis of lacertus syndrome through a history and a thorough physical motor examination. Lacertus syndrome is characterized by positive scratch collapse test differential diagnosis is required to distinguish it from carpal tunnel syndrome. You will not make this diagnosis with nerve conduction studies. Pain over the median nerve at the medial edge of the lacertus fibrosus 1Ī positive scratch collapse test over the median nerve at the elbowĬlip 20-2 demonstrates clinical examination of lacertus syndrome showing weakness of FCR, FDP2, FPL, tenderness under lacertus fibrosis, and positive scratch collapse test.Īlthough less prominent than motor signs, sensory symptoms in the median nerve distribution are present in some patients, especially in the palmar cutaneous branch distribution.Ĭonsider this diagnosis if patients complain of weakness or numbness in the palmar cutaneous distribution, or after failed carpal tunnel release. Lacertus syndrome is a chronic exertional compartment syndrome of the forearm that is unlike exertional compartment syndrome of the lower extremity. Weakness in the flexor carpi radialis (FCR), flexor pollicis longus (FPL), and flexor digitorum profundus muscles of the index finger (FDP2) You make the diagnosis of lacertus syndrome on a clinical examination triad consisting of: Clip 20-1 What is lacertus syndrome? with arcade of Struthers which is a site of ulnar compression neuropathy in cubital tunnel syndrome. It is a simple procedure, similar to carpal tunnel release with WALANT. You can easily release this with good results in the right patients, as described in Clip 20-1. Numbness in the median nerve territory of the hand was found in all of the patients with combined lacertus and carpal tunnel syndromes. This study evaluates if a lacertus release alters the maximal perineural pressure (Pmax) of the median nerve at the level of the lacertus fibrosus during elbow flexion. Lacertus syndrome is characterized by compression of the median nerve under the lacertus fibrosus (bicipital aponeurosis) at the elbow. The three most common presenting symptoms in lacertus syndrome patients were loss of hand strength (95.6), loss of hand endurance/fatigue (73.3), and forearm pain (35.4). Lacertus syndrome with motor and/or sensory symptoms has been addressed with a minimally invasive surgical lacertus release. Lacertus syndrome has been well described by Hagert ( Hagert E. Chapter 20 Lacertus Syndrome: Median Nerve Release at the Elbow Elisabet Hagert, Donald H. Lacertus tunnel syndrome is a compression of the median nerve which occurs under a sheet of ligamentous tissue (lacertus fibrosus) just past the elbow joint. Lacertus syndrome is characterized by compression of the median nerve under the lacertus fibrosus (bicipital aponeurosis) at the elbow.
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