Acute Compression of the Median Nerve at the Elbow by Lacertus Fibrosus

Author(s): Sykes WH, Matsuoka H, McAdoo J, et. al.

Source: J Shoulder and Elbow Surg 16: 91-4, 2007.


This is a retrospective case cohort of 7 consecutive cases of acute median nerve compression in the antecubital fossa resulting from a forceful injury to the elbow.  In all cases the patient suffered a sudden, severe attempt at elbow flexion against a substantial counterforce, resulting in immediate pain which radiated from the elbow down into the forearm.  The pain was described as persistent and unremitting.

Surgical decompression was performed in all cases.  At the time of surgery, the patients were found to have partial rupture of the musculotendinous junction of the biceps creating increased tension across the median nerve by the tethering of the lacertus fibrosus. Surgical decompression resulted in complete relief of symptoms in all 7 cases.

In this case cohort, the authors noted that the median nerve was compressed beneath the lacertus fibrosus as the elbow was brought into extension and pronation.  The authors noted that there was evidence of scar formation and granulation tissue inside of a partial rupture of the biceps, which appeared to change the vector of pull, resulting in increased tension on the lacertus fibrosus.  In all cases, the patients responded to the division and resection of the lacertus fibrosus.  All patients reported substantial improvement in their outcomes with normal elbow scores at 3 months following surgery.


Elbow, Median, Nerve, Lacertus, Fibrosis, Compression, Biceps

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