The concept of multiple compression syndrome in the upper limb has gained significant attention in recent years, drawing interest from peripheral nerve surgeons worldwide. Managing concurrent nerve compressions remains a challenging task [1,2,3].

Patients may experience compression syndromes affecting different nerves in the same arm. This is evident when decompression of one nerve fails to relieve symptoms, and treatment outcomes are unsatisfactory due to the presence of another nerve compression [2]. As the understanding of multiple compression syndrome develops, it is becoming increasingly important to minimize the number of surgical incisions when addressing multiple nerve compressions. Multiple incisions, on the other hand, lead to scar formation, which can increase the risk of perineural scarring, limiting nerve glide and potentially causing traction neuropathy.

Perineural scarring, and the resulting traction neuropathy, have long been considered complications of nerve decompression surgery. Nerve tethering at the surgical site remains the primary cause of symptoms associated with perineural scarring. This condition is particularly challenging to manage. Reports suggest that compression symptoms persist in 40–90% of revision procedures, with approximately 20% of patients requiring a third surgery [6].

Furthermore, skin scarring can lead to structural stiffness, reduced elasticity, and hypersensitivity, all of which prolong post-operative rehabilitation. Thus, careful planning of surgical skin incisions is crucial when treating patients with multiple compression syndrome.

The concurrent lacertus syndome and cubital tunnel syndrome is not uncommon. However, it might be missed oweing to the close anatomical relation. The diagnosis of concurrent lacertus syndome and cubital tunnel syndrome is clinical due to limitations in electromyographic diagnosis and delayed diagnosis. The Hagert clinical triad, lacertus notch sign, W sign, lacertus antagonist test and taping help accurate diagnosis [7, 8]. Lacertus notch, an anatomical contour deformity on the anteromedial aspect of the proximal forearm that represent a pivotal physical sign for diagnosis of the concurrent lacertus syndrome and Cubital tunnel compression.

In conclusion, single-incision approach for releasing cubital tunnel syndrome and lacertus fibrosus offers advantages such as reducing the risk of nerve scaring, traction neuropathy, and painful scar. Additionally, it yields better cosmetic outcomes with a concealed scar.