Outcomes of Corticosteroid Injection in Lacertus Syndrome
Michelle Frees, MD; Christina M. Ward, MD
University of Minnesota, Minneapolis, MN
IntroductionLacertus syndrome is a proximal median nerve compression neuropathy characterized byweakness of flexor pollicis longus (FPL), flexor digitorum profundus (FDP) to the index finger,and flexor carpi radialis (FCR); and pain with compression of the median nerve at the lacertusfibrosus. Lacertus syndrome is a clinical diagnosis, as electromyography/nerve conductionstudies and imaging often show no abnormalities. Surgical release of thelacertus fibrosus has been shown to improve mean DASH and patient satisfaction scores.Corticosteroid injections (CSI) have been used for diagnostic and therapeutic purposes incompression neuropathies such as carpal tunnel, radial tunnel, and pronator syndromes. Thepurpose of this study was to investigate the efficacy of CSI for symptom management inlacertus syndrome.
Material and Methods We performed a retrospective review of patients who presented with lacertus fibrosus symptomsand underwent lacertus CSI between 2016-2021. Patient demographics, co-morbidities, historyand physical examination were extracted from the electronic medical record. Outcomesincluded subjective improvement in symptoms, physical examination findings, and repeatlacertus CSI , and subsequent surgical lacertus fibrosus release.
ResultsA total of 73 patients met inclusion criteria. Chief complaint included hand/ forearm painin 50 patients (68%), median nerve paresthesias in 54 (74%), and hand weakness in 11 (15%).On exam, 72 (99%) had tenderness at the lacertus fibrosus and 63 (86%) had weakness in 1 ormore of FCR, FPL, and/or FDP index. Following CSI, 9 patients were lost to follow up. Of theremaining 64, 48 (75%) had subjective improvement in symptoms following CSI. Of those thatimproved, 24 (50%) had no other documented treatment for lacertus syndrome, 13 receivedrepeat injections (1-3 additional), and 19 patients (30%) subsequently underwent lacertusfibrosus surgical release. Of the 19 surgical patients, 17 (89%) experienced symptom reliefpostoperatively.
ConclusionsOverall, we found that 75% of patients who underwent CSI at the lacertus fibrosus for lacertussyndrome experienced subjective symptomatic relief and 50% of those patients had no furthertreatment for lacertus syndrome. For the patients who had recurrence of symptoms after CSIand underwent surgery, the vast majority experienced lasting relief of symptoms.
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