Lacertus Syndrome
Recognising the Symptoms and Signs
Ali Phillips | Hand & Wrist Specialist
Forearm pain that's not Carpal Tunnel?
I'm Ali Phillips. If you have aching forearm pain, weakness, and numbness that hasn't improved with carpal tunnel treatment, you might have Lacertus Syndrome. Let's explore this often-missed diagnosis and how a simple procedure can bring immediate relief.
Book a ConsultationWhat is Lacertus Syndrome?
Lacertus Syndrome is a nerve compression condition that is often misdiagnosed as Carpal Tunnel Syndrome. It happens when the median nerve gets squeezed at the elbow by a tight, fibrous band called the lacertus fibrosus, which connects your biceps muscle to your forearm.
This compression can cause an aching pain in the forearm, hand weakness, and numbness in the same fingers affected by carpal tunnel. It's a "dynamic" problem, meaning the pressure on the nerve often increases with activities like lifting or carrying, especially with a bent elbow.
What are the symptoms of Lacertus Syndrome?
Aching Forearm Pain
A deep, aching pain in the upper forearm that gets worse with exercise, lifting, or carrying objects with a bent elbow.
Hand Weakness & Fatigue
Your hand may feel weak or get tired quickly when gripping or performing tasks. Some patients report immediate strength recovery after surgery.
Numbness and Tingling
You may experience numbness or pins and needles in your thumb, index, middle, and half of your ring finger, just like in carpal tunnel syndrome.
Think You Might Have Lacertus Syndrome?
If your symptoms haven't responded to carpal tunnel treatment, it's time to consider other possibilities. An accurate diagnosis is the key to effective relief. Let's find the true source of your discomfort.
Get a Clear DiagnosisHow will I diagnose your forearm pain?
Diagnosis is based on your symptoms and a physical examination. Nerve conduction tests are often normal, which can be misleading. A key test involves resisting a specific arm movement. You can try this gently at home, but stop if it causes pain.
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Rest your arm on a table with your elbow bent at a right angle and your palm facing up.
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Place your other hand on your affected wrist.
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Try to bend your elbow further while your other hand provides gentle resistance.
Pain in your upper forearm during this movement is a strong indicator of Lacertus Syndrome. An ultrasound scan can also be very helpful in confirming the diagnosis by showing the nerve compression.
How can I help you get better?
The good news is that Lacertus Syndrome is very treatable. The goal is to release the tight band and free the nerve.
Activity Modification Avoiding activities that aggravate your pain, particularly forceful elbow bending and forearm rotation, can be helpful.
Splinting / Taping A splint or specific kinesiotaping techniques can sometimes help to alter the tension in the forearm muscles and provide temporary relief.
Hand Therapy A skilled hand therapist can provide exercises to improve the flexibility and movement of the median nerve and surrounding tissues.
Injections A steroid injection can sometimes help reduce inflammation and pain, and also assist in confirming the diagnosis.
For most patients with Lacertus Syndrome, a minor surgical procedure offers the most effective and definitive solution, with a very high success rate.
What does a Lacertus Release involve?
This is a quick and minimally invasive procedure that I perform under local anaesthetic, so you are awake but the area is numb. I make a small incision in the crease of your elbow and simply divide the tight lacertus fibrosus band. This immediately relieves the pressure on the median nerve. The procedure is highly effective, with many patients reporting an instant recovery of hand strength right there on the operating table.
Benefits
- Immediate relief of nerve compression
- High success rate in restoring strength and reducing pain
- Minimally invasive with a quick recovery
Small Risks
- Infection (less than 1 in 50 cases)
- Nerve injury (less than 1 in 50 cases)
- Scar tenderness or bruising
- Recurrence of symptoms (rare)
Understanding Consent for Surgery
If we decide surgery is the right path, it is imperative that you understand the process, the risks, and your rights. This is a partnership, and your informed consent is the most important part.
You have every right to choose not to have surgery, even after we have discussed it. We can always continue with non-surgical treatments or decide on no treatment at this time. The decision is always yours.
It is critical to appreciate that all surgery has risks. The decision to proceed is a fine balance between the potential benefits and these risks.
The only person who can judge that balance is you. My role is to give you the clearest possible information so you can make the choice that is right for you.
All surgeries carry some general risks, which are important to be aware of. These include infection, swelling, stiffness, scar pain, and the potential for nerve irritation causing numbness. The specific risks for each type of wrist surgery are detailed in the section above, but these general possibilities apply to any procedure.
Frequently Asked Questions
Because both conditions involve compression of the median nerve, they can produce very similar symptoms of numbness and tingling in the thumb, index, and middle fingers. However, the location of the compression is different – at the elbow for Lacertus Syndrome and at the wrist for Carpal Tunnel Syndrome.
Yes, this is known as "double crush syndrome," where the same nerve is compressed at two different points. If you've had carpal tunnel surgery but still have persistent symptoms, especially forearm pain and weakness, it's very important to be assessed for Lacertus Syndrome.
Nerve conduction studies are often normal in Lacertus Syndrome because the compression is "dynamic" – it gets worse with activity but may not be severe enough to cause permanent nerve changes that show up on the test when your arm is at rest. This is a key reason why the condition is often missed.
It is a very quick and minimally invasive procedure. I perform it under local anaesthetic, meaning you are awake but the area is completely numb. I make a small incision in the crease of your elbow and simply divide the tight lacertus fibrosus band to free the nerve. The results are often immediate.
Recovery is very fast. You can start using your hand for light activities immediately after the procedure. The small wound needs to be kept clean and dry, but most people are back to their normal activities, including work and sports, very quickly.
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