Consultant hand surgeon · Wide-awake local anaesthetic · Day case
Lacertus syndrome surgery in Cardiff
Weak pinch grip, forearm ache, or carpal tunnel symptoms that never went away? Lacertus syndrome release under wide-awake local anaesthetic with consultant hand surgeon Mr Alistair Phillips.
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At a glance
Surgery fee
£2,050 all-inclusive
Procedure time
About 15 to 20 minutes
Anaesthetic
Local (WALANT), you stay awake
Back to light use
Within a few days
First step
Free video consultation
Lacertus syndrome release in Cardiff
Lacertus syndrome is compression of the median nerve just below the elbow, where the nerve passes under a tight band of tissue called the lacertus fibrosus. It is often missed, or mistaken for carpal tunnel syndrome, because it affects the same nerve.
Lacertus release is a short operation to divide this band and free the nerve. At Excel Clinic it is done by consultant hand surgeon Mr Alistair Phillips under WALANT (wide awake local anaesthetic, no tourniquet). Because you are awake, he can check the strength of your hand during the operation. There is no overnight stay and no GP referral is needed.
Medically reviewed by Mr Alistair Phillips, MBBS FRCS (Tr & Orth), consultant hand, wrist and elbow surgeon (GMC 4718495). Last updated November 2026.
What is lacertus syndrome?
The median nerve runs down the front of the arm. Just below the elbow crease it passes beneath the lacertus fibrosus, a band of tissue that fans out from the biceps tendon into the forearm. In some people this band squeezes the nerve, especially with repeated gripping and twisting of the forearm.
Unlike carpal tunnel syndrome, the main problem is usually weakness rather than numbness. The muscles that bend the thumb and index finger and flex the wrist become weak, so pinch grip, writing and opening jars get harder. Nerve conduction studies are often normal, which is one reason the condition is easily missed. Diagnosis relies on careful examination by a hand surgeon who knows what to look for.
Risk factors
- Repetitive gripping and twisting of the forearm
- Manual work, weight training and racquet sports
- Musicians and people who use tools for long periods
- A naturally tight lacertus band
- It can occur alongside carpal tunnel syndrome
Symptoms
- Weak pinch grip between the thumb and index finger
- Difficulty writing, opening jars or turning keys
- Aching in the front of the forearm, worse with use
- The hand and forearm tiring quickly during repetitive tasks
- Sometimes pins and needles in the thumb and fingers
- Hand symptoms that continue after carpal tunnel surgery
Could it be lacertus syndrome?
Mr Phillips may suspect lacertus syndrome if you have:
Weak thumb and index finger
Weakness bending the tip of the thumb or index finger, or flexing the wrist, found on examination.
Symptoms after carpal tunnel surgery
Hand weakness or pain that did not improve after a carpal tunnel release.
Normal nerve tests
Nerve conduction studies that are normal or near normal despite clear symptoms.
Treatment options
Mild symptoms sometimes settle with rest and activity changes. Surgery is offered when weakness or pain persists.
Rest and activity changes
Reducing repetitive gripping and forearm twisting can ease mild symptoms.
Hand therapy
Stretches and advice from a hand therapist help some people.
Lacertus release
A short wide-awake operation to divide the tight band and free the median nerve.
Your surgeon
Consultant Hand, Wrist & Elbow Surgeon
Mr Alistair Phillips
MBBS FRCS (Tr & Orth) · GMC 4718495
Mr Phillips is a consultant hand, wrist and elbow surgeon in private practice in Winchester and London, and now operates at Excel Clinic in Cardiff. He holds a Visiting Academic Fellowship at the University of Southampton and sits on the Council of the Association of Surgeons in Primary Care.
He specialises in hand surgery under local anaesthetic, with the patient awake and no tourniquet (WALANT). He co-authored the standard textbook on the technique and the BSSH/GIRFT White Paper on hand surgery outside main operating theatres, and was an early adopter of ultrasound-guided carpal tunnel release.
At Excel Clinic he performs cubital tunnel release, lacertus syndrome release and Dupuytren’s treatment, as well as ultrasound-guided carpal tunnel and trigger finger release.
What our patients say
What happens during surgery
- Local anaesthetic is injected just below the elbow crease. You stay awake and comfortable, with no tourniquet.
- A small incision is made in the crease at the front of the elbow.
- The lacertus fibrosus is divided to release the pressure on the median nerve.
- With you awake, Mr Phillips checks the strength of your thumb, index finger and wrist. The skin is then closed and a light dressing is applied.
The operation takes around 15 to 20 minutes and you go home the same day. You cannot drive yourself home, so please arrange a lift.
Your lacertus syndrome journey, step by step
Send your booking form
Free video consultation
Consultation with Mr Phillips
Your procedure
Recovery and aftercare
Follow-up
Tap each step for more detail.
1. Send your booking form
Complete the short form at the bottom of this page and tell us about your symptoms and any treatment you have already had.
2. Free video consultation
A free 15-minute video call to talk through your symptoms and whether treatment is the right next step.
3. Consultation with Mr Phillips
An in-person consultation with Mr Phillips (£250) to examine you and confirm the diagnosis. Have your consultation and surgery on the same day (a one-stop appointment) and the consultation is included in the package.
4. Your procedure
Walk in, walk out. The release is done under wide-awake local anaesthetic in our theatre at Cardiff Gate and takes around 15 to 20 minutes.
5. Recovery and aftercare
You go home with clear written aftercare instructions and WhatsApp access to our team if you have any questions.
6. Follow-up
A follow-up review is included to check your wound and your recovery.
Recovery timeline
After lacertus release
Many people notice their grip feels stronger soon after the release. Ache and fatigue in the forearm can take a few weeks to settle.
Results and risks
What to expect
Many people notice their pinch and grip strength improve soon after the band is released, sometimes while still on the operating table. Forearm ache usually settles over the following weeks.
Possible risks
Possible risks include infection, bruising, a tender scar at the elbow crease, numbness of the skin of the forearm and, rarely, nerve or blood vessel injury or symptoms persisting. Mr Phillips will go through these with you.
Long-term outlook
Lacertus release is intended as a permanent solution. If you also have carpal tunnel syndrome, Mr Phillips will advise whether to treat both.
Excel Clinic compared with NHS treatment
| Excel Clinic | NHS treatment | |
|---|---|---|
| Waiting time | Usually 2–4 weeks | Often many months |
| GP referral | Not needed | Required |
| Assessment | Consultant hand surgeon experienced in lacertus syndrome | Can be missed, as nerve tests are often normal |
| Anaesthetic | Wide awake local anaesthetic (WALANT) | Varies |
| Aftercare | WhatsApp access to our team | Standard follow-up |
| Cost | £2,050, fixed price | Free |
Tip: scroll sideways to see the full table on a phone.
Lacertus syndrome surgery cost in Cardiff
| Treatment | Fee |
|---|---|
| Video consultation Free 15-minute video consultation | Free |
| In-person consultation with Mr Phillips Included in the package with a one-stop appointment | £250 |
| Lacertus syndrome release Includes anaesthetic, surgery, aftercare and follow-up | £2,050 |
| Follow-up review | Included |
Fixed, all-inclusive prices with no hidden costs. Have your consultation and surgery on the same day (a one-stop appointment) and the consultation is included in the package.
Why choose Excel Clinic?
Specialist hand surgeon
Mr Alistair Phillips, consultant hand, wrist and elbow surgeon and co-author of the standard textbook on wide-awake hand surgery.
Wide-awake surgery
Local anaesthetic with no tourniquet, no general anaesthetic and no overnight stay.
Fixed, transparent prices
One all-inclusive fee covering the procedure, anaesthetic, aftercare and follow-up.
Easy to reach
Designated patient parking, just off Junction 30 of the M4.
Frequently asked questions
What is lacertus syndrome?
Lacertus syndrome is compression of the median nerve just below the elbow, under a band of tissue called the lacertus fibrosus. It mainly causes weakness of the thumb, index finger and wrist, with aching in the forearm.
How much does lacertus syndrome surgery cost in Cardiff?
Lacertus syndrome release at Excel Clinic costs £2,050. It is a fixed, all-inclusive price covering the anaesthetic, surgery, aftercare and follow-up. The first video consultation is free.
How is lacertus syndrome different from carpal tunnel syndrome?
Both affect the median nerve. Carpal tunnel syndrome is compression at the wrist and mainly causes numbness and tingling, often at night. Lacertus syndrome is compression just below the elbow and mainly causes weakness of the thumb, index finger and wrist, with forearm ache. Some people have both.
Why did my carpal tunnel surgery not help?
One possible reason is that the median nerve is also compressed higher up, at the lacertus. Mr Phillips can examine you for lacertus syndrome and other causes of persistent symptoms.
How is lacertus syndrome diagnosed?
Mainly by examination. A hand surgeon tests the strength of specific muscles and checks for tenderness over the nerve below the elbow. Nerve conduction studies are often normal, so a normal test does not rule it out.
What is WALANT?
WALANT stands for wide awake local anaesthetic, no tourniquet. The area is numbed with local anaesthetic mixed with a medicine that reduces bleeding, so no tourniquet, sedation or general anaesthetic is needed. You stay awake and comfortable, and can go home straight afterwards.
Is lacertus release painful?
The local anaesthetic stings briefly, then the area goes numb and you should feel no pain during the operation. Afterwards most people need only simple painkillers for a few days.
How long is recovery after lacertus release?
Most people use the hand for light tasks straight away and are back at desk work within a few days. Heavier lifting and gym work are built up over 2 to 4 weeks.
Can I have my consultation and treatment on the same day?
Yes, where it is clinically appropriate. With a one-stop appointment Mr Phillips assesses you and carries out the procedure in the same visit, and the consultation fee is included in the package. If you would rather have a separate consultation first, it costs £250.
Do I need a GP referral?
No. You can refer yourself. Complete the booking form and we will arrange your free video consultation.
Still have a question? Send us a message or call 02922 645305.
Book your lacertus syndrome consultation
Free video consultation, a fixed all-inclusive price and wide-awake surgery with a consultant hand surgeon.
Book your free video consultation
Tell us about your symptoms and any previous treatment, such as carpal tunnel surgery, and our team will be in touch to arrange your video consultation.
Find us
Excel Clinic
3 Oaktree Court, Mulberry Drive
Cardiff Gate Business Park
Cardiff CF23 8RS
Just off Junction 30 of the M4, with designated patient parking. Open Monday to Friday, 9am to 5pm.