Digital illustration of the median nerve in the elbow joint.

Unlocking Elbow Pain Relief: Surgical Insights into Nerve Compression

Elliot Brynn in Health & Wellness August 2025 • 4 min read.

"Exploring innovative surgical techniques to alleviate median nerve compression at the elbow and restore functionality."

Elbow pain, often dismissed as a minor inconvenience, can significantly impact daily life, especially when caused by median nerve compression. This condition, characterized by pressure on the median nerve as it passes through the elbow, can lead to pain, numbness, tingling, and weakness in the forearm and hand. Understanding the causes, diagnosis, and treatment options for median nerve compression is crucial for those seeking lasting relief.

While conservative treatments like physical therapy and medication can provide temporary relief, surgical intervention may be necessary in more severe cases. Recent advancements in surgical techniques offer promising solutions for decompressing the median nerve and restoring functionality. One such technique involves the isolated section of the lacertus fibrosus, a fibrous band that can contribute to nerve compression.

This article delves into the surgical approach for treating median nerve compression at the elbow, focusing on the innovative technique of sectioning the lacertus fibrosus and highlighting the importance of accurate diagnosis and comprehensive care for individuals suffering from this debilitating condition.

Surgical Decompression: A Closer Look at Lacertus Fibrosus Section

Digital illustration of the median nerve in the elbow joint.

The surgical release of the median nerve at the elbow involves carefully addressing the lacertus fibrosus, a common source of compression. The surgical team, led by A. Hamouya and colleagues, conducted a study involving 13 cases to evaluate the effectiveness of this isolated sectioning technique. The study included 12 patients (6 women and 5 men) with a mean age of 43 years, all experiencing symptoms of median nerve compression at the elbow. One patient presented with bilateral compression, resulting in a total of 13 affected nerves.

The diagnostic process involved a thorough clinical assessment, focusing on the presence of a specific triad of symptoms. This included: (1) elbow pain, reported in 10 cases; (2) muscular weakness, observed in all patients, affecting muscles such as the Flexor Pollicis Longus (FPL), Flexor Digitorum Profundus (FDP) of the 2nd digit, and Flexor Carpi Radialis (FCR); and (3) a positive Scratch Collapse Test (SCT) at the elbow, noted in 11 cases.

Diagnostic Triad for Median Nerve Compression: Elbow pain Muscular weakness Positive Scratch Collapse Test (SCT)

Electromyography (EMG), a diagnostic test used to assess the electrical activity of muscles and nerves, only confirmed nerve compression at the elbow in one case. The surgical procedure consisted of a mini-invasive anterior transverse section of the lacertus fibrosus, performed under WALANT (Wide Awake Local Anesthesia No Tourniquet) surgery in 7 cases and under axillary block in 6 cases, depending on whether additional surgical procedures were required. Postoperatively, muscle strength was assessed, revealing that all patients regained muscular strength in the thumb-index finger pinch. Notably, those who underwent WALANT surgery experienced immediate recovery.

Embracing Innovation for Enhanced Recovery

The study underscores that median nerve compression at the elbow is often underdiagnosed and can be isolated or associated with carpal tunnel syndrome. Prompt and accurate diagnosis, combined with innovative surgical techniques like lacertus fibrosus section, can restore muscular strength and improve the quality of life for those affected by this condition. By staying informed and proactive, individuals experiencing elbow pain and related symptoms can find effective solutions and regain control over their hand and arm function.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.hansur.2018.10.219, Alternate LINK

Title: Diagnostic Et Traitement Chirurgical De La Compression Du Nerf Médian Au Coude Par Section Isolée Du Lacertus Fibrosus. À Propos De 13 Cas

Subject: Rehabilitation

Journal: Hand Surgery and Rehabilitation

Publisher: Elsevier BV

Authors: A. Hamouya, G. Meyer Zu Reckendorf, J.L. Roux

Published: 2018-12-01

Everything You Need To Know

What are the primary symptoms of median nerve compression at the elbow, and what anatomical structure is often implicated in this condition?

Median nerve compression at the elbow can cause pain, numbness, tingling, and weakness in the forearm and hand. It occurs when there's pressure on the median nerve as it passes through the elbow. While conservative treatments exist, surgery might be needed for lasting relief, particularly focusing on structures like the lacertus fibrosus, a fibrous band contributing to the compression.

How does the surgical approach of sectioning the lacertus fibrosus alleviate median nerve compression at the elbow, and what anesthesia methods are used during this procedure?

The surgical approach described involves the sectioning of the lacertus fibrosus, aiming to release the median nerve at the elbow. A study by A. Hamouya and colleagues evaluated this technique in 13 cases, achieving restoration of muscular strength postoperatively. The procedure can be performed under WALANT (Wide Awake Local Anesthesia No Tourniquet) or axillary block.

What constitutes the diagnostic triad used to identify median nerve compression at the elbow, and which specific muscles are commonly affected by muscular weakness?

The diagnostic triad includes elbow pain, muscular weakness (affecting muscles such as the Flexor Pollicis Longus (FPL), Flexor Digitorum Profundus (FDP) of the 2nd digit, and Flexor Carpi Radialis (FCR)), and a positive Scratch Collapse Test (SCT) at the elbow. Electromyography (EMG) may also be used, though it is not always conclusive.

What advantages does WALANT (Wide Awake Local Anesthesia No Tourniquet) surgery offer in the treatment of median nerve compression at the elbow, particularly in terms of recovery time?

WALANT (Wide Awake Local Anesthesia No Tourniquet) surgery allows for immediate recovery, as observed in the study. Patients undergoing WALANT experienced immediate recovery of muscular strength. This approach avoids the need for a tourniquet and general anesthesia, potentially leading to quicker rehabilitation.

If sectioning the lacertus fibrosus can alleviate median nerve compression, what other potential factors or related conditions should be considered for a comprehensive treatment strategy?

While the sectioning of the lacertus fibrosus can address median nerve compression, it's important to note that the compression may also arise from other factors, such as carpal tunnel syndrome or other anatomical structures. Comprehensive care should consider these possibilities for a complete treatment strategy, which might involve addressing multiple compression points along the nerve's path.