Jerome J Terrence Jose, Surendran G
Department of Orthopedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Olympia Hospital and Research Centre, Trichy, India.
Trichy SRM Medical College Hospital and Research Centre, Tiruchchirappalli, India.
Int Orthop. 2025 Jun 16. doi: 10.1007/s00264-025-06580-7.
Lacertus syndrome (LS) involves median nerve compression by the lacertus fibrosus at the elbow. Often misdiagnosed as carpal tunnel syndrome (CTS), it presents primarily with hand weakness, fatigue, and forearm pain, with less common sensory symptoms.
To review current knowledge on the clinical features, diagnostic methods, and treatment options for LS, highlighting the distinct characteristics that differentiate it from similar conditions.
A comprehensive review synthesizing literature on anatomy, pathophysiology, prevalence, diagnostic approaches, and treatment outcomes.
Clinical diagnosis relies heavily on specific provocative tests, including the clinical triad (muscle weakness, localized pain, positive Scratch Collapse Test), Lacertus Antagonist Test (LAT), and visible Lacertus Notch Sign. Diagnostic ultrasound is increasingly preferred for real-time, dynamic assessment. Electrodiagnostic studies have limited diagnostic value due to the dynamic nature of the compression. Conservative treatments include activity modification, nerve gliding exercises, kinesiotaping, and injections (corticosteroids, botulinum toxin). Surgical intervention, typically via minimally invasive or percutaneous release under Wide-Awake Local Anaesthesia No Tourniquet (WALANT), achieves immediate intraoperative strength improvement and high patient satisfaction rates (around 88%).
Improved clinical recognition of Lacertus syndrome through specific provocative tests and dynamic ultrasound enhances accurate diagnosis. Surgical decompression, especially using the WALANT approach, consistently yields excellent functional outcomes, emphasizing its role as the definitive treatment for resistant or severe cases.
肱二头肌肌腱膜综合征（LS）是指肱二头肌肌腱膜在肘部压迫正中神经。它常被误诊为腕管综合征（CTS），主要表现为手部无力、疲劳和前臂疼痛，感觉症状较少见。
回顾关于肱二头肌肌腱膜综合征的临床特征、诊断方法和治疗选择的现有知识，突出其与类似病症相区别的独特特征。
综合有关解剖学、病理生理学、患病率、诊断方法和治疗结果的文献进行全面综述。
临床诊断严重依赖特定的激发试验，包括临床三联征（肌肉无力、局部疼痛、阳性刮擦塌陷试验）、肱二头肌肌腱膜拮抗剂试验（LAT）和可见的肱二头肌肌腱膜切迹征。诊断性超声越来越多地被用于实时动态评估。由于压迫的动态性质，电诊断研究的诊断价值有限。保守治疗包括调整活动、神经滑动练习、肌内效贴和注射（皮质类固醇、肉毒杆菌毒素）。手术干预通常通过在清醒局部麻醉无止血带（WALANT）下进行微创或经皮松解，可在术中立即改善力量，患者满意度高（约88%）。
通过特定的激发试验和动态超声提高对肱二头肌肌腱膜综合征的临床认识，可增强准确诊断。手术减压，尤其是采用WALANT方法，始终能产生优异的功能结果，强调其作为难治性或严重病例的确定性治疗方法的作用。
