Skip to main content
SpringerLink
Log in

Intraoperative immediate strength recovery following lacertus fibrosus release in patients with proximal median nerve compression at the elbow

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

In the literature, we find that patients with lacertus syndrome (LS), proximal median nerve compression at the elbow, present subjective improvement of thumb, and index flexion strength after lacertus fibrosus (LF) release. The aim of this study is to objectively evaluate the immediate change in intraoperative flexion strength after LF release.

Method

We retrospectively reviewed prospectively collected data of a cohort of 24 patients with a double crush syndrome of the median nerve with no response to conservative treatment. All patients had surgery with LF and carpal tunnel release (CTR) under wide-awake local anaesthesia and no tourniquet (WALANT) and were evaluated intraoperatively with a dynamometer immediately before and after LF release. Flexor digitorum profundus of the second finger (FDP2) and Flexor pollicis longus (FPL) were tested in peak strength to failure. The primary outcome was the percentage of change in strength before and after the release in both assessed muscles. CTR was done after evaluating the change in flexor strength.

Results

A percentage of 79.2 women with an average age of 43.3 years. The average strength of FDP2 before LF release was 15.5 pounds (lbs.) (7.0 kg) (SD, 7.2 lbs (3.3 kg)) and 27.1 lbs. (12.2 kg) (SD, 7.1 lbs. (3.2 kg)) after LF release, which corresponds to a 96% (SD, 70%) change in strength (p=0.000). For FPL, the average pre-release strength was 17.7 lbs. (8.0kg) (SD, 4.8 lbs. (2.2 kg)) and 27.4 lbs. (12.4 kg) (SD, 5.2 lbs. (2.4 kg)) post-release, this corresponded to a 65% (SD, 38%) change in strength (p=0.000).

Conclusions

Peak strength to failure in FDP2 and FPL has an immediate significant recovery after LF surgical release in patients with Lacertus syndrome.

Level of evidence: IV, retrospective study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Upton AM, Mccomas A (1973) The double crush in nerve-entrapment syndromes. Lancet 302:359–362. https://doi.org/10.1016/s0140-6736(73)93196-6

    Article  Google Scholar 

  2. Molinari WJ, Elfar JC (2013) The double crush syndrome. J Hand Surg 38:799–801. https://doi.org/10.1016/j.jhsa.2012.12.038

    Article  Google Scholar 

  3. Gessini L, Jandolo B, Pietrangeli A (1983) Entrapment neuropathies of the median nerve at and above the elbow. Surg Neurol 19:112–116. https://doi.org/10.1016/0090-3019(83)90405-6

    Article  CAS  PubMed  Google Scholar 

  4. Olehnik WK, Manske PR, Szerzinski J (1994) Median nerve compression in the proximal forearm. J Hand Surg 19:121–126. https://doi.org/10.1016/0363-5023(94)90235-6

    Article  CAS  Google Scholar 

  5. Swiggett R, Ruby LK (1986) Median nerve compression neuropathy by the lacertus fibrosus: report of three cases. J Hand Surg 11:700–703. https://doi.org/10.1016/s0363-5023(86)80015-6

    Article  CAS  Google Scholar 

  6. Hagert E (2013) Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study. Hand 8:41–46. https://doi.org/10.1007/s11552-012-9483-4s

    Article  PubMed  PubMed Central  Google Scholar 

  7. Laha RK, Lunsford LD, Dujovny M (1978) Lacertus fibrosus compression of the median nerve: case report. J Neurosurgs 48:838–841. https://doi.org/10.3171/jns.1978.48.5.0838

    Article  CAS  Google Scholar 

  8. Tang JB (2021) Median nerve compression: lacertus syndrome versus superficialis-pronator syndrome. J Hand Surg Eur Vol 46:1017–1022. https://doi.org/10.1177/17531934211024092

    Article  PubMed  Google Scholar 

  9. Tang JB (2022s) Some misconceptions in the treatment of cubital tunnel syndrome, radial tunnel syndrome, and median nerve compression in the forearm. Hand Clin 38:321–328. https://doi.org/10.1016/j.hcl.2022.02.003

    Article  PubMed  Google Scholar 

  10. Adler JA, Wolf JM (2020) Proximal median nerve compression: pronator syndrome. J Hand Surg 45:1157–1165. https://doi.org/10.1016/j.jhsa.2020.07.006

    Article  Google Scholar 

  11. Hagert E, Jedeskog U, Hagert CG, Marín Fermín T (2023) Lacertus syndrome: a ten year analysis of two hundred and seventy five minimally invasive surgical decompressions of median nerve entrapment at the elbow. Int Orthops 47(4):1005–1011. https://doi.org/10.1007/s00264-023-05709-w

    Article  Google Scholar 

  12. Archambault G, Boudier-Revéret M, Hagert E, Effatparvar MR, Sobczak S (2023) Effect of lacertus fibrosus release on perineural pressure of the median nerve at the elbow: a cadaveric study. Int Orthops 47(5):1277–1284. https://doi.org/10.1007/s00264-023-05735-8

    Article  Google Scholar 

  13. Zancolli ER, Zancolli EP, Perrotto CJ (2012) New mini-invasive decompression for pronator teres syndrome. J Hand Surg 37:1706–1710. https://doi.org/10.1016/j.jhsa.2012.05.033

    Article  Google Scholar 

  14. Seitz WH, Matsuoka H, McAdoo J et al (2007) Acute compression of the median nerve at the elbow by the lacertus fibrosus. J Shoulder Elb Surg 16:91–94. https://doi.org/10.1016/j.jse.2006.04.005

    Article  Google Scholar 

  15. Lalonde D, Bell M, Benoit P et al (2005) A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the dalhousie project clinical phase. J Hand Surg 30:1061–1067. https://doi.org/10.1016/j.jhsa.2005.05.006

    Article  Google Scholar 

  16. Lalonde D, Martin A (2013) Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. J Am Acad Orthop Sur 21:443–447. https://doi.org/10.5435/jaaos-21-08-443

    Article  Google Scholar 

  17. Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE (2008) Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg 33:1518–1524. https://doi.org/10.1016/j.jhsa.2008.05.022

    Article  Google Scholar 

  18. Asheghan M, Hollisaz MT, Aghdam AS, Khatibiaghda A (2016) The prevalence of pronator teres among patients with carpal tunnel syndrome: cross-sectional study. Int J Biomed Sci 12:89–94

    Article  PubMed  PubMed Central  Google Scholar 

  19. Luangjarmekorn P, Tsai TM, Honsawek S, Kitidumrongsook P (2016) Role of pronator release in revision carpal tunnel surgery. SICOT J 2:9. https://doi.org/10.1051/sicotj/2016006

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tang DT, Barbour JR, Davidge KM et al (2015) Nerve entrapment. Plast Reconstr Surg 135:199e–215e. https://doi.org/10.1097/prs.0000000000000828

    Article  CAS  PubMed  Google Scholar 

  21. Evangelista TMP, Pua JHC, Evangelista-Huber MTP (2019) Wide-Awake local anesthesia no tourniquet (WALANT) versus local or intravenous regional anesthesia with tourniquet in atraumatic hand cases in orthopedics: a systematic review and meta-analysis. J Hand Surg Asian Pac Vol 24(4):469–476. https://doi.org/10.1142/S2424835519500619

    Article  PubMed  Google Scholar 

  22. Lalonde DH (2017) Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol 42(9):886–895. https://doi.org/10.1177/1753193417728427

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hand Surgery, Microsurgery and Wrist Arthroscopy, Orthopaedics and Trauma Department, INDISA Clinic, Av. Sta. Maria 1810, Providencia, Santiago, Chile

    Camila Azócar, Gonzalo Corvalán, Pablo Orellana, Peter Cobb & Javier Román

  2. Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile

    Rodrigo Liendo

Authors
  1. Camila Azócar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gonzalo Corvalán
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pablo Orellana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Cobb
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rodrigo Liendo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Javier Román
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation was done as part of a previous pilot study performed by the authors. Data collection was performed by Gonzalo Corvalán MD, and analysis were performed by Camila Azócar MD and Rodrigo Liendo MD. The first draft of the manuscript was written by Camila Azócar MD, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gonzalo Corvalán.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Clínica INDISA on march 31st, 2023.

Consent to participate

As part of the process to consent and perform the surgeries by our team patients give their consent to confidentially use their data to conduct scientific studies, therefore no additional written consent was required by the Ethics Committee of Clínica INDISA.

Consent to publish

There is no personal data included in this study that require consent to publish according to this journal’s instructions.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

(MP4 8069 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azócar, C., Corvalán, G., Orellana, P. et al. Intraoperative immediate strength recovery following lacertus fibrosus release in patients with proximal median nerve compression at the elbow. International Orthopaedics (SICOT) 47, 2781–2786 (2023). https://doi.org/10.1007/s00264-023-05888-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-05888-6

Keywords

Search

Navigation