9/24/2023 0 Comments Lacertus syndromePossible areas of compression classically include between the 2 heads of the pronator muscle, beneath the lacertus fibrosus, proximal to the elbow at the ligament of Struthers, beneath the fibrous arch of the flexor digitorum superficialis, and more rarely as it crosses under the flexor palmaris longus or Gantzer muscle ( Fig. 1 ). Pronator teres syndrome is an uncommon but distinct condition in which the median nerve is compressed and irritated as it courses across the elbow region. This would suggest pronator teres syndrome and involvement of the median nerve. Specifically there are not any distal neurologic symptoms or findings, and a Tinel’s sign over the anteromedial elbow is not present. The discomfort is described as an achy painful tightness of the medial elbow, which develops in the first few hours after activity. To help distinguish this condition from pronator teres syndrome that involves compression of the median nerve, we have named it the lacertus syndrome.Īthletes with the lacertus syndrome usually present with a vague history of slowly increasing discomfort in the flexor-pronator muscles after throwing. Although Bennett did not fully understand the causes or even the mechanics involved (ie, he thought the pitcher supinates instead of pronates on release of the baseball), he did describe a simple operative treatment that has allowed us to prolong the careers of throwing athletes. This is the first known reference to a condition that has undoubtedly disabled many players and possibly ended careers of an untold number of throwing athletes. A simple linear and transverse division of the fascia covering the muscles has relieved tension on many occasions and rehabilitated these men so that they were able to return to the game.” A pitcher may be able to pitch for two or three innings but then the pain and swelling become so great that he has to retire. These are covered by a strong fascial band, a portion of which is the attachment of the biceps, which runs obliquely across the pronator muscle. On examination, one will note distinct fullness over the pronator radii teres. A pitcher in throwing a curveball is compelled to supinate his wrist with a snap at the end of his delivery. “There is a lesion which produces a different syndrome. The following paragraph is excerpted in its entirety from that article. In 1959, George Bennett summarized his experiences caring for throwing athletes. Include inspection of the flexor pronator muscle group and consider evaluating after throwing when examining a thrower with postexertional elbow pain. Other more common pathologies should be ruled out with a routine workup. The Lacertus syndrome is more common than pronator syndrome, which involves the median nerve, and can be distinguished with a careful workup. Lacertus syndrome is a postexertional compartment syndrome, and the history can help elucidate this. It is important to take a complete history and perform a careful examination in order to avoid confirmation bias when evaluating throwers with medial elbow pain.
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