Lacertus syndrome consists in proximal median nerve entrapment with median nerve compression at the lacertus fibrosus, causing hand weakness and fatigue, forearm pain and occasional numbness. Recent advances emphasized the importance of clinical examination, due to limitations in electromyographic diagnosis and delayed diagnosis. The Hagert clinical triad, lacertus notch sign, lacertus antagonist test and taping help accurate diagnosis. Non-operative treatment should be tried; and surgical techniques, whether open or ultrasound-guided under WALANT (wide-awake, local anesthesia, no tourniquet) show promising outcomes. Improved awareness, accurate diagnosis and innovative treatments enhance patient care for this challenging condition.