AI Article Synopsis
- Carpal tunnel syndrome (CTS) is common, but proximal median nerve entrapments, like lacertus syndrome, are less recognized even though they show similar symptoms.
- A 37-year-old male experienced persistent symptoms after multiple CTS releases, leading to a correct diagnosis of lacertus syndrome, which was confirmed through EMG and ultrasound.
- The release of the lacertus syndrome resolved all symptoms, highlighting the need to check for other nerve compressions if CTS symptoms persist after surgery to avoid unnecessary treatments and costs.
Article Abstract
Background: Carpal tunnel syndrome (CTS) is well-known. Less familiar are proximal median nerve entrapments such as the lacertus syndrome. Lacertus syndrome symptoms are very similar to CTS, but often unknowledged.
Case Description: A 37 year old male with persistent tingling of the median nerve area after 3 CTS releases on both wrists. The diagnosis CTS was confirmed with EMG and ultrasound. In our outpatient clinic we saw weakness of the tip pinch (FPL, FDP2). Loss of sensibility in the proximal thenar and digits 1-3 and a positive scratch collapse test. We suspected the patient has lacertus syndrome and performed a lacertus release. All symptoms dissolved afterwards.
Conclusion: If symptoms do not resolve after CTS-release proximal median nerve compressions should be considered. Tip pinch strength and sensibility of the thenar can differentiate between the various locations of median nerve entrapment. Redo CTS-release lead to unnecessary treatment and costs, because of the wrong diagnosis.
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