Article
Wide Awake and ultrasound guided release of the lacertus fibrosis for chronic exertional compartment syndrome of the forearm. A prospective study
Search Medline for
Authors
-
Gilles Candelier
- Hand and Ultrasound Surgery Center, Private Hospital St Martin, Caen Cedex, France
-
Yann Erwan Favennec
- Hand and Ultrasound Surgery Center, Private Hospital St Martin, Caen Cedex, France
-
Thomas Apard
- Hand and Ultrasound Surgery Center, Private Hospital St Martin, Caen Cedex, France
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: Chronic exertional compartment syndrome is a common condition in athletes and motorcyclists. The purpose of this study was to confirm our hypothesis that exertional compartment syndrome was due to a pronator median nerve entrapment at the lacertus tunnel.
Methods: We conducted a prospective study from January 2016 to August 2017. All the patient who complains for an excertional compartment syndrome (ECS) were included. The diagnosis of ECS was base on the existence of a pain appearing with effort and disappearing at rest, a weakness (grip) during effort and an elevated compartment pressure (>50mmHg). All the patients have had a clinical exam including muscle testing, a scratch collapse test and the search of a Tinel sign at the elbow.
Surgical procedure:
Anesthesia: The patient is anesthetized 30 min preoperatively using 30- 40 ml 1 % lidocaine with epinephrine and buffered (sodium bicarbonate) solution. We performed an hydrodissection assisted with an ultrasound guidance. An ultrasound evaluation of the relative motion between the median nerve and pronator muscle was made entrapment.
A limited incision is done at the proximal edge of the lacertus fibosus. The release of the lacertus fibrosis was done from proximal to distal.
A second ultrasound evaluation is made to confirm that the median nerve entrapment had disappeared. A muscle testing was made. All the patients were review 6 months after surgery.
Results and Conclusions: We included 7 patients (all men) with an average of 26 years (17-42). The group included 5 competition motorcyclists, 2 around the world sailors. Symptoms have lasted an average of 12 months. Both hands were involved. In all patient the muscle testing revealed a typical pattern of weakness attesting to a pronator median nerve entrapment. The scratch collapse test was positive. Immediately after the release, muscle testing was normalized. One week after surgery all patients were free of symptoms. Two patients have had a second compartment pressure evaluation. It was normalized. At the last follow up all the patients could resume normal exertional activity.
In conclusion, the study emphase that ultrasound guided lacertus fibrosus release is a safe method to treated chronic exertional compartment syndrome. The length of surgery, recovery time and scar sequelae are less significant. Furthermore, this study point out the claw effect of the lacertus fibrosus as an etiology of the exertional compartment syndrome.
