Lacertus syndrome is caused by compression of the median nerve at the level of the elbow, beneath a structure called the lacertus fibrosus.
It is a more focal form of median nerve compression and is sometimes considered part of the broader group of conditions known as pronator syndrome. However, lacertus syndrome refers specifically to compression at this distinct anatomical point.
The median nerve plays an important role in hand function, particularly grip and pinch strength. When compressed at this level, symptoms tend to affect strength and endurance rather than sensation.
Symptoms often develop gradually and may be associated with repetitive use of the arm.
Symptoms may include:
Unlike carpal tunnel syndrome, numbness and tingling are usually not the main features.
Symptoms may include:
Unlike carpal tunnel syndrome, numbness and tingling are usually not the main features.
Diagnosis is based on clinical assessment, including a detailed history and examination of grip strength and forearm function.
Lacertus syndrome is often identified through specific clinical signs rather than imaging alone.
It is important to distinguish this condition from other forms of median nerve compression, including pronator syndrome and carpal tunnel syndrome.
In some cases, nerve conduction studies or imaging may be used to exclude other causes.
Treatment depends on the severity of symptoms and their impact on function.
Non-surgical treatment may include:
If symptoms persist or significantly affect hand function, surgical decompression of the nerve may be recommended.
When non-surgical treatment is not effective, surgical decompression may be recommended.
The procedure involves releasing the lacertus fibrosus to relieve pressure on the median nerve. This allows the nerve to function more normally and can improve strength and endurance in the hand.
Surgery is typically performed as a day-case procedure under local anaesthetic.
Following surgery, a light dressing is applied and early movement is encouraged.
Recovery typically involves:
Improvement in strength and function is often seen within weeks, although full recovery may take longer depending on symptom severity.
As with any surgical procedure, there are potential risks, although these are uncommon.
Possible complications include:
Very rarely, a condition known as complex regional pain syndrome (CRPS) can occur, leading to prolonged pain and sensitivity.
You should seek medical advice if you experience persistent weakness, fatigue or reduced hand function, particularly if symptoms are affecting daily activities.
Early assessment is important to confirm the diagnosis and distinguish this condition from other types of nerve compression.
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