Lateral Cutaneous Nerve of the Forearm Entrapment in Weightlifters

Giuseppe Bardellini, MD, ITALY Angelo De Crescenzo , MD, ITALY Andrea Pautasso, MD, ITALY

ISAKOS eNewsletters   Current Perspective 2026   rating

Introduction

The lateral cutaneous nerve of the forearm (LCNF) is the terminal branch of the musculocutaneous nerve (MCN). The LCNF is a purely sensory nerve and it lies subcutaneously at the level of the antecubital fossa. Under certain rare circumstances, the LCNF can become compressed and elicit sensory symptoms that may require surgical management.

We describe the principal causes of this infrequent pathology and analyze a series of competitive weightlifting athletes with LCNF neuropathy due to biceps tendon compression who underwent surgical decompression after failed conservative treatment.

Anatomical Considerations

The lateral cutaneous nerve of the forearm (LCNF) is the terminal branch of the musculocutaneous nerve (MCN). The LCNF is a purely sensory nerve that runs subcutaneously at the level of the antecubital fossa. After supplying the coracobrachialis, biceps, and brachialis muscles, the MCN continues distally in the intermuscular plane between the biceps and brachialis muscle, supplying the skin over the anterolateral aspect of the forearm. Its terminal branch emerges beneath the biceps tendon laterally and penetrates into the brachial fascia as the LCNF (Fig. 1). The LCNF exits laterally, below the long head of the biceps at the level of the intercondylar line, 2 to 5 cm from the elbow crease. When the biceps muscle contracts with the elbow in extension, the lateral free edge of the bicipital aponeurosis, which is tensed by forearm pronation, applies tension on the LCNF. The flat, sharp border of the biceps tendon tightens when the elbow is extended and becomes even tauter if muscle contracts against resisted flexion and pronation, whereas if the forearm is passively pronated with the elbow extended, the nerve is stretched and may be compressed against the biceps tendon. Compression can occur as a result of various factors, such as:

• External pressure with bandages, tight sleeves, or excessive leaning on the elbow.
• Trauma, including direct injuries from fractures, contusions, or postoperative complications (in procedures involving proximal forearm or anterior region of the elbow).
• Repetitive movements during activities requiring frequent elbow flexion and extension (weightlifting or tennis).
• Iatrogenic causes, such as venipunctures or intravenous catheter placement in the antecubital fossa, which can damage the nerve and lead to prolonged sensory deficits².

Figure 1

Clinical Presentation and Diagnosis

Patients usually report a history of repetitive movements with the elbow extended and the forearm pronated. They commonly describe pain and paresthesias in the lateral aspect of the elbow and volar forearm. The mechanism of injury includes overhead smashes or backhand strokes in tennis, during which the elbow shifts from supination to pronation with resisted hyperextension. Pain and paresthesias frequently occur on the lateral forearm, and symptoms may worsen with elbow extension and pronation. No motor deficits are encountered because the LCNF is a purely sensory nerve³ (Figs. 2 and 3).

Diagnosis is primarily clinical and is based on combination of patient history, physical examination findings, and diagnostic imaging or neurophysiological studies.

A Tinel sign at the elbow crease, just lateral to the biceps tendon, is often elicited by gently tapping the site where the nerve crosses the biceps tendon. Symptoms are worse when the elbow is extended and pronated. Hypoesthesias in the lateral forearm are often present⁴. In chronic cases, the condition can be confused with recalcitrant tennis elbow, refractory epicondylitis, bicipital tendinitis, or compression of the anterior interosseus or median nerve.

Figure 2

Figure 3

Diagnostic Imaging

Ultrasound or magnetic resonance imaging can aid in the diagnostic process by detecting nerve swelling, entrapment, or compression due to extrinsic causes. Nerve conduction studies and electromyography are often normal given the sensorial nature of the LCNF. However, these tests can be helpful in ruling out other elbow neuropathies.

Treatment Options

Conservative measures include anti-inflammatory medications, rest, and splinting to prevent extension and pronation. Targeted corticosteroid injections can provide temporary relief in patients with persistent symptoms. Surgical nerve decompression is indicated when symptoms fail to improve after 3 months of unsuccessful conservative treatment.

Surgical Technique

A 4 to 5 cm anterior incision is made over the antecubital fossa. The biceps tendon is identified centrally, and the LCNF is located approximately 2 cm lateral to the tendon at the level of the lateral epicondyle, typically between the cephalic and median cubital veins, which serve as key anatomical landmarks. Passive pronation of the forearm with the elbow extended reproduces visible nerve compression beneath the lateral border of the biceps tendon. The compression is often marked by focal nerve hyperemia and is localized at 2 to 3 cm proximal and lateral to the biceps tendon at the elbow crease (Fig. 4).

A triangular segment (1 × 3 cm) of the lateral biceps aponeurosis and tendon is excised, with care being taken to avoid injury to adjacent vascular structures. Successful decompression is checked by moving the forearm through full pronation and supination with the elbow extended, ensuring that no residual impingement remains (Fig. 5).

Figure 4

Figure 5

Surgical Outcomes in a Series of Competitive Weightlifters

We retrospectively reviewed the outcomes for 5 male professional weightlifters who had undergone surgical treatment of LCNF compression at a single center by an experienced upper-limb surgeon. The mean interval from diagnosis to treatment was 12.8 months, and the mean follow-up was 74 months. Surgical decompression was performed after 3 months of failed conservative treatment.

All patients experienced a complete symptom resolution within a month, and the Tinel sign was negative in all patients at the first follow-up. All patients returned to their pre-injury level of sports activity, without any residual complications⁵.

Conclusions and Future Directions

LCNF entrapment is an important, although rare, cause of anterolateral pain in the elbow of athletes. Accurate diagnosis and effective management require a thorough clinical evaluation combined with appropriate diagnostic studies. Early recognition through clinical assessment and imaging can lead to improved outcomes. While conservative treatment is often successful, surgical intervention remains a viable option for refractory cases. Competitive weightlifters are a high-risk population in whom recognition of these symptoms can be important. In carefully selected patients, surgical decompression provides excellent outcomes.

Future studies, especially those focusing on diagnostic tests and imaging, are needed to expand diagnostic and treatment options.

References

1. Bassett F 3rd, Nunley J. Compression of the musculocutaneous nerve at the elbow. J Bone Joint Surg Am. 1982;64(7):1050-1052.
2. Rayegani SM, Azadi A. Lateral Antebrachial Cutaneous Nerve injury induced by phlebotomy. J Brachial Plex Peripher Nerve Inj. Published online March 14, 2007:2-6. doi:10.1186/1749-7221-2.
3. Davidson JJ, Bassett Iii FH, Nunley Ii JA. Musculocutaneous nerve entrapment revisited. J Shoulder Elbow Surg. 1998;7(3):250-255. doi:10.1016/s1058-2746(98)90053-2.
4. Memon AB, Mahmood S, Waseem F, Sherburn F, Nardone A, Ahmad BK. Lateral Antebrachial Cutaneous Neuropathy: A Review of 15 Cases. Cureus. 2022;5(14). doi:10.7759/cureus.25203.
5. Bardellini G, Martinelli F, Abate B, Roda D, Celli A, Celli L. Entrapment of the Lateral Cutaneous Nerve of the Forearm in Competitive Weightlifters: A Case Series with Medium and Long-Term Follow-Up. JBJS Open Access. 2026;11(1). doi:10.2106/JBJS.OA.25.00247.

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