The real cause of frozen shoulder (FS), presenting as a stiff and painful shoulder, is sometimes difficult to determine, especially if it is postoperative19Martel M. Laumonerie P. Pecourneau V. Ancelin D. Mansat P. Bonnevialle N. Type 1 Complex Regional Pain Syndrome After Subacromial Shoulder Surgery: Incidence and Risk Factor Analysis.Indian J Orthop. 2020 Jun 13; 54: 210-215https://doi.org/10.1007/s43465-020-00174-8Crossref Scopus (2) Google Scholar,25Schiltz M. Goudman L. Moens M. Nijs J. Hatem S.M. The diagnostic value of physical examination tests in adhesive capsulitis: a systematic review.Eur J Phys Rehabil Med. 2023 Sep; 22https://doi.org/10.23736/S1973-9087.23.07940-6Crossref Scopus (0) Google Scholar. Indeed, it is easy to diagnose adhesive capsulitis (AC) or type1complex regional pain syndrome (CRPS1) without formal proof. The cause of a stiff and painful shoulder after surgery is usually capsuloligamentous24Saade F. van Rooij F. Saffarini M. Godenèche A. Management of shoulder stiffness following rotator cuff repair: a systematic review and meta-analysis.JSES Rev Rep Tech. 2023 Mar 24; 3: 324-330https://doi.org/10.1016/j.xrrt.2023.02.004Abstract Full Text Full Text PDF Scopus (0) Google Scholar. Very few authors have evaluated compression of a peripheral nerve of the upper limb, distal from the shoulder girdle, as a possible cause of shoulder pain and stiffness12Hagiwara Y. Nakamura T. Sonoki K. Moroi K. Morimoto S. Natsume Y. et al."Idiopathic" Shoulder Pain and Dysfunction from Carpal Tunnel Syndrome and Cubital Tunnel Syndrome.Plast Reconstr Surg Glob Open. 2022 Feb 17; 10e4114https://doi.org/10.1097/GOX.0000000000004114Crossref Scopus (1) Google Scholar. The physio-pathological hypothesis in these cases is that compression of a distal nerve branch affects the conduction of other proximal nerve branch impulses with a common origin7Decosterd I. Woolf C.J. Spared nerve injury: an animal model of persistent peripheral neuropathic pain.Pain. 2000 Aug; 87: 149-158Abstract Full Text Full Text PDF PubMed Scopus (1746) Google Scholar. We report two clinical cases of patients who were treated more than four years after shoulder surgery. These patients underwent neurolysis of the median nerve of the elbow by Lacertus Fibrosus release, resulting in immediate postoperative pain relief and improvement in shoulder range of motion. A 41-year-old, right-handed patient who was a farmer presented with a calcific tendinopathy of the right supraspinatus tendon following unsuccessful conservative treatment (physical therapy, shockwave therapy, glucocorticoid infiltrations). In 2017, arthroscopic excision of the calcification was performed, and exploration of the gleno-humeral joint was normal. (Figure 1) This intervention, associated with a postoperative physical therapy protocol only partially relieved the pain and loss of passive and active shoulder range of motion (ROM). The patient consulted again 5 years later with permanent, more severe pain, making it impossible to sleep. The diagnosis of a type 2 pectoralis minor syndrome was suggested due to scapulo-thoracic instability, presenting as scapular tilting during anterior flexion and abduction which disappeared when push-up movements were performed standing against a wall. This allowed it to be differentiated from a scapula alata. The patient also had severe pain during coracoid process palpation and anterior forearm numbness despite normal electromyography results. Arthroscopic surgery was performed again, with a combined anterior acromioplasty and a pectoralis minor tenotomy. Although there was marked regression of coracoid process pain after surgery, it recurred after four months. The patient continued reeducation, but his/her shoulder was still painful, day and night. One year after the second operation, the subjective shoulder value (SSV) was 30%, and the active ROM in the different sectors was: Flexion (F) 135°, Type 1 External Rotation (ER1) 30°, Abduction (Abd) 110°, Type 1 Internal Rotation (IR1): S1. Passive ROM was identical due to pain (9/10 on the Visual Analogic Scale -VAS). The patient also reported a loss of thumb-index pinch grip strength, thus proximal compression of the median nerve of the elbow was suspected. The clinical examination showed a positive Hagert's triad (a triad of muscle testing, the scratch collapse test (SCT) and pain)11Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study.Hand (N Y). 2013 Mar; 8: 41-46https://doi.org/10.1007/s11552-012-9483-4Crossref PubMed Scopus (67) Google Scholar. This included a loss of strength of the Flexor Carpi Radialis (FCR), the Flexor Digitorum Profundis of the index finger (FDP2) and the Extensor Policis Longus (EPL), severe pain during palpation 1cm below the anterior elbow flexion skin crease and a positive SCT at the same place. The SCT was negative at the carpal tunnel, the radial tunnel at Frohse's arch and at the cubital nerve of the elbow. A diagnosis of Lacertus syndrome (LS) was suggested. Another operation was proposed to release the Lacertus fibrosus by mini-open surgery and to treat the loss of digital strength, in particular. Measurement of passive ROM of the shoulder was performed immediately before surgery. Surgery was performed under WALANT (Wide Awake Local Anesthesia No Tourniquet), making it possible to immediately confirm recovery of strength in the three deficient hand muscles10Hagert E. Jedeskog U. Hagert C.G. Marín Fermín T. Lacertus syndrome: a ten year analysis of two hundred and seventy five minimally invasive surgical decompressions of median nerve entrapment at the elbow.Int Orthop. 2023 Apr; 47: 1005-1011https://doi.org/10.1007/s00264-023-05709-wCrossref PubMed Scopus (8) Google Scholar. Immediately after surgery, the patient was asked to test the ROM in the shoulder with the following results: F: 170°, ABD: 150°, ER: 40°, IR1: T12 – Figures 2 and 3. The patient described relief and disappearance of tension in the entire shoulder, especially the coracoid process and the VAS was 1/10.Fig 3Comparison of preoperative abduction (left) and just after lacertus release (right) in case 1.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The five-month postoperative clinical follow-up showed persistent very good thumb-index pinch grip strength as well as an SSV of 80% and regression of approximately 70% of overall shoulder pain compared to the preoperative status (2/10 on the VAS). Active ROM was: F160°, ABD 150°, ER1 30°, IR1 T10. A right-handed 43-year-old patient with a stage 2 acromio-clavicular joint sprain after a fall from a horse was treated in another hospital with immobilization then reeducation. (Figure 4). Three months after the injury, the shoulder was still very painful and arthroscopic resection of the lateral clavicle was performed in the same establishment. (Figure 5). The postoperative protocol included a splint for 3 weeks, then reeducation. The patient rapidly developed severe stiffness and was diagnosed with FS.Fig 5Post operative AP X ray in case 2 after arthroscopic lateral clavicle resection.View Large Image Figure ViewerDownload Hi-res image Download (PPT) More than four years after surgery and despite ongoing reeducation, the shoulder remained quite stiff and painful (VAS 2/10 at rest and 9/10 during active elevation) and an SSV of 45%. After consulting several orthopedic surgeons, the patient was sent to us for an opinion and management of loss of thumb-index pinch grip strength but no real pain in the hand or elbow. A complete clinical examination showed the presence of all clinical signs of Hagert's triad, confirming a diagnosis of LS11Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study.Hand (N Y). 2013 Mar; 8: 41-46https://doi.org/10.1007/s11552-012-9483-4Crossref PubMed Scopus (67) Google Scholar. Kinesio taping was used to recenter the pronator teres (PT) and confirm the diagnosis -Figure 6. It improved the thumb-index pinch grip strength and decreased FCR weakness. There was also nearly complete recovery of active shoulder ROM: F 170°, ER1 45°, Abd 135°. IR1 T6. (Figures 7 and 8). When the Kinesio Tape was removed, ROM decreased to: F-110°, ER1-10°, Abd-90°, IR1-L3. Based on the results of the Lacertus Antagonist Test20Martinel V. Apard T. The Lacertus Antagonist Test: A Predictive Test for Strength Recovery after Surgery for Lacertus Syndrome.Plast Reconstr Surg Glob Open. 2023 Oct 11; 11e5309https://doi.org/10.1097/GOX.0000000000005309Crossref Scopus (0) Google Scholar, ultrasound guided Lacertus release was performed under WALANT3Apard T. Mares O. Duparc F. Michelin P. Percutaneous Ultrasound-Guided Release of the Lacertus Fibrosus for Median Nerve Entrapment at the Elbow.Cardiovasc Intervent Radiol. 2022 Aug; 45: 1198-1202https://doi.org/10.1007/s00270-022-03123-0Crossref Scopus (10) Google Scholar. The patient recovered strength in FCR, FPL and FDP2 as well as a glenohumeral ROM comparable to levels recorded in the preoperative consultation (the physical therapist who had been managing the patient for 4 years was present during surgery to test shoulder girdle ROM). (Figure 9). At postoperative month 8, the range of motion was maintained with an SSV of 90%. Active ROM was: F 170°, Abd 150°, ER1 50°, IR1 T6.Fig 7Comparison of external rotation before (left) and just after taping (right) in case 2.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 8Comparison of anterior flexion before (left) and just after taping (right) in case 2.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 9Immediate postoperative ROM of right shoulder in case 2 performed by physiotherapist who treated patient for 4 years.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Video 1 presents details of the history and clinical examination of both cases. It is sometimes difficult to identify the cause of chronic shoulder pain, especially after surgery because there may be several associated causes23Ring D. Guss D. Malhotra L. Jupiter J.B. Idiopathic arm pain.J Bone Joint Surg Am. 2004 Jul; 86: 1387-1391https://doi.org/10.2106/00004623-200407000-00005Crossref PubMed Scopus (45) Google Scholar,25Schiltz M. Goudman L. Moens M. Nijs J. Hatem S.M. The diagnostic value of physical examination tests in adhesive capsulitis: a systematic review.Eur J Phys Rehabil Med. 2023 Sep; 22https://doi.org/10.23736/S1973-9087.23.07940-6Crossref Scopus (0) Google Scholar. The terms FS, AC and CRPS1 should not be considered synonymous:-FS defines a clinically stiff and painful shoulder.-CRPS1 may cause shoulder pain and stiffness, and in our opinion, CRPS1 is an etiology of FS-The estimated incidence of CRPS1 is between 5 and 25 per 100 000 inhabitants in the general population19Martel M. Laumonerie P. Pecourneau V. Ancelin D. Mansat P. Bonnevialle N. Type 1 Complex Regional Pain Syndrome After Subacromial Shoulder Surgery: Incidence and Risk Factor Analysis.Indian J Orthop. 2020 Jun 13; 54: 210-215https://doi.org/10.1007/s43465-020-00174-8Crossref Scopus (2) Google Scholar.-AC should be considered a separate form of CRPS1 of the shoulder. 9El Hasbani G. Uthman I. Jawad A.S. Is adhesive capsulitis of the shoulder a form of complex regional pain syndrome type I?.Saudi medical journal. 2020; 41: 1144-1145https://doi.org/10.15537/smj.2020.10.25421Crossref Scopus (0) Google Scholar Shoulder surgery may result in AC or CRPS119Martel M. Laumonerie P. Pecourneau V. Ancelin D. Mansat P. Bonnevialle N. Type 1 Complex Regional Pain Syndrome After Subacromial Shoulder Surgery: Incidence and Risk Factor Analysis.Indian J Orthop. 2020 Jun 13; 54: 210-215https://doi.org/10.1007/s43465-020-00174-8Crossref Scopus (2) Google Scholar,24Saade F. van Rooij F. Saffarini M. Godenèche A. Management of shoulder stiffness following rotator cuff repair: a systematic review and meta-analysis.JSES Rev Rep Tech. 2023 Mar 24; 3: 324-330https://doi.org/10.1016/j.xrrt.2023.02.004Abstract Full Text Full Text PDF Scopus (0) Google Scholar. The cause of postoperative loss of passive joint ROM is usually capsuloligamentous. The reported incidence of this event is between 2 and 40%, showing the difficulty of making a definite diagnosis19Martel M. Laumonerie P. Pecourneau V. Ancelin D. Mansat P. Bonnevialle N. Type 1 Complex Regional Pain Syndrome After Subacromial Shoulder Surgery: Incidence and Risk Factor Analysis.Indian J Orthop. 2020 Jun 13; 54: 210-215https://doi.org/10.1007/s43465-020-00174-8Crossref Scopus (2) Google Scholar or the risk of underestimating two other possible causes of FS25Schiltz M. Goudman L. Moens M. Nijs J. Hatem S.M. The diagnostic value of physical examination tests in adhesive capsulitis: a systematic review.Eur J Phys Rehabil Med. 2023 Sep; 22https://doi.org/10.23736/S1973-9087.23.07940-6Crossref Scopus (0) Google Scholar which are described below. However, severe pain can affect the outcome of a clinical examination, and incorrectly suggest stiffness, resulting in a misdiagnosis of AC24Saade F. van Rooij F. Saffarini M. Godenèche A. Management of shoulder stiffness following rotator cuff repair: a systematic review and meta-analysis.JSES Rev Rep Tech. 2023 Mar 24; 3: 324-330https://doi.org/10.1016/j.xrrt.2023.02.004Abstract Full Text Full Text PDF Scopus (0) Google Scholar. Arthrogenic Muscle Inhibition (AMI) may be the cause of pseudo FS, simulating joint stiffness. Although this phenomenon has been well described in the knee26Sonnery-Cottet B. Ripoll T. Cavaignac E. Prevention of knee stiffness following ligament reconstruction: Understanding the role of Arthrogenic Muscle Inhibition (AMI).Orthop Traumatol Surg Res. 2023 Dec; 11103784https://doi.org/10.1016/j.otsr.2023.103784Abstract Full Text Full Text PDF Scopus (0) Google Scholar, to our knowledge it has not yet been reported in the shoulder. These patients are sometimes diagnosed with CRPS1 after conventional physical therapy protocols have failed5Challoumas D. Biddle M. McLean M. Millar N.L. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis.JAMA Netw Open. 2020 Dec 1; 3e2029581https://doi.org/10.1001/jamanetworkopen.2020.29581Crossref Scopus (87) Google Scholar. When a diagnosis of AMI is suspected or confirmed, specific management with neuromotor reprogramming seems to be more beneficial than conventional physical therapy protocols8Dos Anjos T. Gabriel F. Vieira T.D. Hopper G.P. Sonnery-Cottet B. Neuromotor Treatment of Arthrogenic Muscle Inhibition After Knee Injury or Surgery.Sports Health. 2023 Apr; 2719417381231169285https://doi.org/10.1177/19417381231169285Crossref Scopus (6) Google Scholar. The aim is to stimulate the action of a muscle or group of muscles that is delayed, absent or over-activated. Reprogramming involves the acquisition of proprioceptive sensations, cortical integration and mentalization of the movement, then finally long-term anchoring of the movement at the subcortical level. Very few studies have evaluated the incidence of distal peripheral nerve compression as the cause of shoulder pain and stiffness12Hagiwara Y. Nakamura T. Sonoki K. Moroi K. Morimoto S. Natsume Y. et al."Idiopathic" Shoulder Pain and Dysfunction from Carpal Tunnel Syndrome and Cubital Tunnel Syndrome.Plast Reconstr Surg Glob Open. 2022 Feb 17; 10e4114https://doi.org/10.1097/GOX.0000000000004114Crossref Scopus (1) Google Scholar. On the other hand, proximal causes (such as C4 and C5 cervical nerve damage) or nearby causes such as the Thoracic Outlet Syndrome, are well recognized2Ahmed A.S. Graf A.R. Karzon A.L. Graulich B.L. Egger A.C. Taub S.M. et al.Pectoralis minor syndrome - review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome.JSES Rev Rep Tech. 2022 Jun 30; 2: 469-488https://doi.org/10.1016/j.xrrt.2022.05.008Abstract Full Text Full Text PDF Scopus (4) Google Scholar,23Ring D. Guss D. Malhotra L. Jupiter J.B. Idiopathic arm pain.J Bone Joint Surg Am. 2004 Jul; 86: 1387-1391https://doi.org/10.2106/00004623-200407000-00005Crossref PubMed Scopus (45) Google Scholar. Nerve compression below the shoulder is rarely discussed because it is contradictory to the neurological mechanisms that are usually taught. Nevertheless, occasionally, a patient has described relief from old shoulder pain after carpal tunnel release,18Lazaro R.P. Neuropathic symptoms and musculoskeletal pain in carpal tunnel syndrome: prognostic and therapeutic implications.Surg Neurol. 1997 Feb; 47 (; discussion 117-9): 115-117Abstract Full Text PDF PubMed Scopus (0) Google Scholar. Hagiwara and al reported their experience on the influence of the Carpal Tunnel Syndrome (CTS) and cubital elbow compression (CuTS) in chronic shoulder pain12Hagiwara Y. Nakamura T. Sonoki K. Moroi K. Morimoto S. Natsume Y. et al."Idiopathic" Shoulder Pain and Dysfunction from Carpal Tunnel Syndrome and Cubital Tunnel Syndrome.Plast Reconstr Surg Glob Open. 2022 Feb 17; 10e4114https://doi.org/10.1097/GOX.0000000000004114Crossref Scopus (1) Google Scholar. They reported a decrease in pain after medical or surgical management, as well as improvement in shoulder joint ROM, in particular flexion, abduction, and external rotation. The proximal forearm is a rare but possible site of median nerve compression1Ahmad A.A. Abdullah S. Thavamany A.S. Tong C.Y. Ganapathy S.S. Lacertus Syndrome: an Outcome Analysis After Lacertus Release.J Hand Surg Glob Online. 2023 Apr 7; 5: 498-502https://doi.org/10.1016/j.jhsg.2023.03.001Abstract Full Text Full Text PDF Scopus (2) Google Scholar,11Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study.Hand (N Y). 2013 Mar; 8: 41-46https://doi.org/10.1007/s11552-012-9483-4Crossref PubMed Scopus (67) Google Scholar,16Kong G. Brutus J.P. Vo T.T. Hagert E. The prevalence of double- and multiple crush syndromes in patients surgically treated for peripheral nerve compression in the upper limb.Hand Surg Rehabil. 2023 Dec; 42: 475-481https://doi.org/10.1016/j.hansur.2023.09.002Crossref Scopus (0) Google Scholar. In 2013, Hagert described a new entity called the Lacertus syndrome11Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study.Hand (N Y). 2013 Mar; 8: 41-46https://doi.org/10.1007/s11552-012-9483-4Crossref PubMed Scopus (67) Google Scholar. The diagnosis is almost always made by clinical examination alone. It is based on a clinical triad associating pain during Lacertus fibrosus/bicipital aponeurosis pressure, loss of strength and fatigue of the FCR, FPL and FDP2 and a positive SCT just below the elbow flexion crease6Cheng C.J. Mackinnon-Patterson B. Beck J.L. Mackinnon S.E. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome.J Hand Surg Am. 2008 Nov; 33: 1518-1524https://doi.org/10.1016/j.jhsa.2008.05.022Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar,13Jain N.S. Zukotynski B. Barr M.L. Cortez A. Benhaim P. The Scratch-Collapse Test: A Systematic Review and Statistical Analysis.Hand (N Y). 2023 May; 2415589447231174483https://doi.org/10.1177/15589447231174483Crossref Scopus (0) Google Scholar. Electromyography (EMG) is nearly always normal which excludes the participation of the CTS or CuTS in the painful shoulder. Like Hagiwara, and in addition to the two reported cases here, we have observed improvement or disappearance of shoulder pain following Lacertus fibrosus release surgery on several occasions in other patients. The pain has mainly been anterior, with retrograde neuropathic pain of the coracoid process in certain cases. In the first case report we emphasized the clinical presentation before the second operation. In particular, the presence of severe coracoid process pain and signs of nerve irritation that were not confirmed in the EMG suggested a diagnosis of type 2 pectoralis minor syndrome2Ahmed A.S. Graf A.R. Karzon A.L. Graulich B.L. Egger A.C. Taub S.M. et al.Pectoralis minor syndrome - review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome.JSES Rev Rep Tech. 2022 Jun 30; 2: 469-488https://doi.org/10.1016/j.xrrt.2022.05.008Abstract Full Text Full Text PDF Scopus (4) Google Scholar. The transient improvement, then recurrence suggested a « double crush » syndrome rather than a diagnostic error10Hagert E. Jedeskog U. Hagert C.G. Marín Fermín T. Lacertus syndrome: a ten year analysis of two hundred and seventy five minimally invasive surgical decompressions of median nerve entrapment at the elbow.Int Orthop. 2023 Apr; 47: 1005-1011https://doi.org/10.1007/s00264-023-05709-wCrossref PubMed Scopus (8) Google Scholar,27Upton A.R. McComas A.J. The double crush in nerve entrapment syndromes.Lancet. 1973 Aug 18; 2: 359-362https://doi.org/10.1016/s0140-6736(73)93196-6Abstract PubMed Google Scholar. The Lacertus release performed under WALANT made it possible to confirm the immediate perioperative relief of coracoid process pain (as well as recovery of thumb-index pinch grip strength4Ayhan E. Cimilli E. Cevik K. Pinch strength analyses in lacertus syndrome.Hand Surg Rehabil. 2023 Sep; 42: 305-309https://doi.org/10.1016/j.hansur.2023.04.007Crossref Scopus (2) Google Scholar). One explanation may be found in the experimental model of Decosterd et al suggesting that irritation or a lesion of a peripheral nerve branch can affect the conduction of other nerve branch impulses with common proximal origins7Decosterd I. Woolf C.J. Spared nerve injury: an animal model of persistent peripheral neuropathic pain.Pain. 2000 Aug; 87: 149-158Abstract Full Text Full Text PDF PubMed Scopus (1746) Google Scholar. These two cases, and case n°2 in particular, raise the question of recovery of active ROM immediately after surgery. Our hypothesis is that relieving compression of the nerve distal to the elbow could instantly release undiagnosed AMI of the shoulder. Martinel and Apard described the Lacertus Antagonist test using Kinesio tape during the consultation. This is helpful to evaluate whether preoperative thumb-index pinch grip strength is improved after recentering of the PT20Martinel V. Apard T. The Lacertus Antagonist Test: A Predictive Test for Strength Recovery after Surgery for Lacertus Syndrome.Plast Reconstr Surg Glob Open. 2023 Oct 11; 11e5309https://doi.org/10.1097/GOX.0000000000005309Crossref Scopus (0) Google Scholar. In the present patient, the original technique was modified to evaluate the role of the Lacertus syndrome in the loss of shoulder ROM. The test was positive, and surgery resulted in permanent improvement in shoulder ROM. These two cases suggest that systematic clinical examination of peripheral nerves is essential in any case of pain and stiffness of the shoulder, even if it is not postoperative12Hagiwara Y. Nakamura T. Sonoki K. Moroi K. Morimoto S. Natsume Y. et al."Idiopathic" Shoulder Pain and Dysfunction from Carpal Tunnel Syndrome and Cubital Tunnel Syndrome.Plast Reconstr Surg Glob Open. 2022 Feb 17; 10e4114https://doi.org/10.1097/GOX.0000000000004114Crossref Scopus (1) Google Scholar,15KENDALL D. Aetiology, diagnosis, and treatment of paraesthesiae in the hands.Br Med J. 1960 Dec 3; 2: 1633-1640Crossref Scopus (50) Google Scholar. This is especially true since imaging studies and peripheral nerve assessment tests were all normal. The method described by Hagert applies to compression of any nerves in the upper limbs1Ahmad A.A. Abdullah S. Thavamany A.S. Tong C.Y. Ganapathy S.S. Lacertus Syndrome: an Outcome Analysis After Lacertus Release.J Hand Surg Glob Online. 2023 Apr 7; 5: 498-502https://doi.org/10.1016/j.jhsg.2023.03.001Abstract Full Text Full Text PDF Scopus (2) Google Scholar,10Hagert E. Jedeskog U. Hagert C.G. Marín Fermín T. Lacertus syndrome: a ten year analysis of two hundred and seventy five minimally invasive surgical decompressions of median nerve entrapment at the elbow.Int Orthop. 2023 Apr; 47: 1005-1011https://doi.org/10.1007/s00264-023-05709-wCrossref PubMed Scopus (8) Google Scholar. It is easy and rapid to perform. A search for unilateral Sunderland 4 muscular weakness in the target muscles should first be determined – Table 1. In case of unilateral weakness, the examination is completed by looking for a painful spot and a positive SCT at the suspected site: mainly the CTS, CuT, Lacertus or Supinator Arch.Table 1Combination of tests for muscular weakness to search for and site of the corresponding nerve compressionA.P.B.Median nerve at Carpal TunnelF.R.C+F.P.L+ F.D.P-2Median Nerve at LacertusF.D.P-5 + A.D.MUlnar nerve at ElbowA.D.MUlnar nerve at GuyonE.C.URadial nerve at Frohse arcade Open table in a new tab One limitation could be the difficulty of performing or interpreting an SCT in a patient with severe shoulder pain. In these cases, collapse may be observed with muscles of the lower limbs when the scratch test is performed at different spots of potential nerve compression in the arm, such as those mentioned above for the CST et le CuTS14Kahn L.C. Yee A. Mackinnon S.E. Important Details in Performing and Interpreting the Scratch Collapse Test.Plast Reconstr Surg. 2018 Feb; 141: 399-407https://doi.org/10.1097/PRS.0000000000004082Crossref PubMed Scopus (32) Google Scholar,22Pisquiy J.J. Carter J.T. Gonzalez G.A. Validity of Using the Scratch Collapse Test in the Lower Extremities.Plast Reconstr Surg. 2022 Jul 1; 150: 194e-200ehttps://doi.org/10.1097/PRS.0000000000009237Crossref Scopus (2) Google Scholar. We test the hip abductors in our daily practice: the patient lies on an examination table, with bilateral hip abduction. The examiner asks him to resist and prevent his ankles from touching each other - figure 10. This is very helpful in daily practice with elderly patients and massive rotator cuff tears. The simulation test using a Kinesio tape («Lacertus Antagonist Tape ») may also be easily associated with the clinical examination of the shoulder to test ROM and for a visual evaluation of pain in the different sectors of motion. The examiner's hands are freed compared to the manual Lacertus Antagonist Test20Martinel V. Apard T. The Lacertus Antagonist Test: A Predictive Test for Strength Recovery after Surgery for Lacertus Syndrome.Plast Reconstr Surg Glob Open. 2023 Oct 11; 11e5309https://doi.org/10.1097/GOX.0000000000005309Crossref Scopus (0) Google Scholar. We have integrated this test into our clinical practice and patients can leave the consultation with the Kinesio Tape in place. This provides significant clinical improvement, shows the tape placement to the physical therapist, and allows patients to continue functional physical therapy on the median nerve21Mertens M.G. Meert L. Struyf F. Schwank A. Meeus M. Exercise Therapy Is Effective for Improvement in Range of Motion, Function, and Pain in Patients With Frozen Shoulder: A Systematic Review and Meta-analysis.Arch Phys Med Rehabil. 2022 May; 103: 998-1012.e14https://doi.org/10.1016/j.apmr.2021.07.806Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, based on nerve glides and stretching of fascias of the upper limb. This diagnostic approach based on a clinical examination and little-known clinical tests can help identify the actual cause of a FS. Even if it is usually due to AC, Lacertus syndrome, or another entrapment syndromes may be identified in certain cases (Figure 11). Like the CTS and le CuTS, the Lacertus syndrome may be suspected in case of postoperative shoulder pain and stiffness, based on the concept of Retrograde Neuropathic Pain. The presence of associated neurological signs should not only suggest the participation of the cervical spine or other nearby syndromes.
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