Entrapment of the Lateral Cutaneous Nerve of the Forearm in Competitive Weightlifters

Background: Entrapment of the lateral cutaneous nerve of the forearm (LCNF), the terminal sensory branch of the musculocutaneous nerve, is rare and often overlooked in the differential diagnosis of lateral forearm paresthesia and anterior elbow pain. This study describes a cohort of competitive weightlifting athletes with LCNF neuropathy due to biceps tendon compression, who underwent surgical decompression after failed conservative treatment. Methods: We reviewed cases treated between 2009 and 2019 at a single orthopaedic center. Inclusion criteria were a clinical diagnosis of LCNF neuropathy (based on a positive Tinel sign lateral to the biceps tendon and paresthesia in the lateral forearm), a magnetic resonance imaging scan excluding other conditions, participation in competitive weightlifting, and failure of conservative treatment lasting ≥3 months. Outcome measures included symptom resolution, Tinel sign status, return to sport, and complications. Results: There were 5 male athletes (mean age, 28 years; range, 23-34) with LCNF entrapment lateral to the biceps tendon at the antecubital fossa. The mean interval from symptom onset to surgery was 12.8 months (range, 8-18). Mean follow-up was 74 months (range, 50-100). Within a month of the operation, all patients had complete symptom resolution and a negative Tinel sign and resumed competitions at their preinjury level. No complications occurred. Conclusions: LCNF entrapment should be considered in athletes performing repetitive elbow extension and pronation who present with unexplained lateral forearm paresthesia. When conservative measures fail, surgical decompression is safe, reproducible and has excellent long-term outcomes. Level of Evidence: Level IV, Case Series, Prognostic study. See Instructions for Authors for a complete description of levels of evidence.