Anterograde ultrasound guided lacertus fibrosus release at the elbow under WALANT - Technical note

Dynamic compression of the median nerve under the lacertus fibrosus at the elbow causes pain and weakness. It is a frequently overlooked pathology and a cause of failed recovery after carpal tunnel release. The purpose was to present a technical note on minimally invasive ultrasound-guided lacertus syndrome surgical treatment under WALANT. We believe the technique is indicated in patients who present with a positive Hagert's triad of pain over the median nerve at the lacertus, weakness on testing of the flexor pollicis longus, second flexor digitorum profundus, and flexor carpi radialis, and a positive sensitive collapse test. Contraindications include static median nerve compression at the elbow and allergy to lidocaine. The technique is preceded by local anesthesia, which is completed under ultrasound guidance for deeper or more proximal structures. The entry point is calculated proximal to the lacertus and the special knife is introduced through a 0.5 cm incision. The lacertus is divided anterogradely under ultrasound guidance. Full recovery of strength is evidenced by the completion of the division. The patient returns to full activity within days to a week after surgery. Minimally invasive, ultrasound-guided release allows for rapid return of full-strength motion with minimal scarring.