![]() It can occur on one side or be bilateral.Īll patients who report numbness, tingling, muscle loss, or loss of strength, dexterity, or manual endurance should be examined and tested not only for carpal tunnel syndrome, but also for lacertus syndrome.īecause lacertus syndrome is still widely unknown, its diagnosis is largely based on the knowledge and experience of the clinician consulted. The electromyogram (EMG) rarely detects lacertus syndrome, but can be useful in diagnosing associated carpal tunnel syndrome. 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. The test consists of comparing the resistance force of the lateral rotators by stimulating (scratching) the suspected compression zone. Diagnosis is made clinically with pain at the proximal volar forearm, sensory changes over the palmar cutaneous branch, and positive Tinel's over the proximal volar forearm. The scratch collapse test is not a very well-known provocative maneuver, but very useful in confirming the diagnosis. Pronator Syndrome is a compressive neuropathy of the median nerve at the level of the elbow. Pronator Syndrome is a compressive neuropathy of the median nerve at the level of the elbow. Diagnosis can be made with a careful neurological exam (weakness of thumb, index and middle finger flexion) with inability to make OK sign and normal median nerve sensory exam. Partial resolution or persistence of symptoms in a patient operated on for a carpal tunnel very often means that the site of the compression has not been properly identified or that there is a second area of compression.ĭiagnosis is based primarily on examination and systematic physical examination of the entire upper limb, not just the wrist. Compression of the AIN nerve (also known as Kiloh-Nevin's syndrome) is a forearm compressive neuropathy that results in motor deficits of the AIN nerve. This misdiagnosis is a very common cause of carpal tunnel surgery failure. Unfortunately, few clinicians have the knowledge to suspect and investigate lacertus syndrome. The Lacertus syndrome is more common than pronator syndrome, which involves the me- dian nerve, and can be distinguished with a careful workup. ![]() ![]() It also one of the most widely documented conditions. Its symptoms are frequently confused with those of carpal tunnel syndrome, which complicates the differential diagnosis and management of the patient. Carpal tunnel syndrome is one of those conditions that is caused by compression or swelling of a nerve. Because it is a rather unknown and non-documented condition, lacertus syndrome presents a particular diagnostic challenge. ![]()
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