Surgical release for lacertus syndrome in a pediatric patient: A case report and review of the literature

Lacertus syndrome (LS) is a rare median nerve compression neuropathy at the elbow level that is often overlooked, particularly in pediatric patients, while most reported cases have involved adults, we present the first documented Saudi pediatric case of LS: A 13-year-old active female with left-hand numbness, forearm pain, fatigue, and weakness in the hand muscles, which include flexor digitorum profundus of the second digit, flexor pollicis longus, and flexor carpi radialis. Examination revealed tenderness over the lacertus fibrosus and a positive scratch collapse test. Magnetic resonance imaging (MRI) confirmed compression beneath the lacertus. Conservative management was unsuccessful, but surgical release led to full symptom resolution and recovery. This case parallels adult presentations in etiology and treatment response but differs in the diagnostic process, highlighting the usefulness of MRI in contrast to the often-inconclusive results of electromyography and nerve conduction studies. It underscores the importance of clinical awareness and timely surgical intervention in pediatric cases.