Proximal Median Nerve Compression Around the Elbow: A Narrative Review
Keywords:
Median nerve compression; Lacertus syndrome; Pronator syndrome; Dynamic ultrasound; Clinical triad; Surgical release.Abstract
Background: Median nerve compression at the elbow exists on a biomechanical spectrum. Static compression involves persistent constriction within rigid tunnels, while dynamic compression occurs during specific movements and muscle activation. This fundamental distinction creates unique diagnostic and therapeutic challenges. The clinical presentation is a constellation of sensory, motor, and provocative symptoms that localize the pathology to the proximal forearm.
Objective: This review aims to summarize the anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and treatment of proximal median nerve compression around the elbow.
Conclusion: Diagnosis requires dynamic provocative testing rather than standard nerve conduction studies. Treatment must address motion-induced constrictors through targeted surgical releases, emphasizing the need for tailored approaches distinct from those used for static compression. When appropriate patient selection and complete decompression are achieved, proximal median nerve release generally provides excellent symptom relief and high patient satisfaction.