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Guyon Canal Syndrome
From WikiSM
Contents
Other Names
- Guyon's Canal Syndrome
- Ulnar Neuropathy
- Ulnar Tunnel Syndrome
- Cyclist's Palsy
Background
- Rare periphal neuropathy of the Ulnar Nerve as it travels through Guyons Canal in the wrist
Pathophysiology
- Zone 1
- Proximal to the motor and sensory bifurcation
- Area of the distal portion of the ulnar nerve before it splits into its superficial sensory and deep motor divisions
- Symptoms: mixed motor, sensory symptoms
- Zone 2
- Distal to motor/sensory bifurcation, radial to zone 3
- Most commonly affected
- Symptoms: Motor only
- Zone 3
- Distal to motor/sensory bifurcation, ulnar to zone 2
- Symptoms: sensory only
Pathoanatomy
- Anatomic borders of Guyons Canal
- Volar: Volar Carpal Ligament
- Dorsal: Transverse Carpal Ligament
- Ulnar: Pisiform, Abductor Digiti Minimi, Pisohamate Ligament
- Radial: Hook of Hamate
Etiology
- Ganglion Cyst of Wrist
- Acute Trauma
- Hook of Hamate fracture
- Mass Effect (tumor, lipoma, etc)
- Repetitive trauma (cycling)
- Hypothenar Hammer Syndrome
- Injury to Ulnar Artery
Epidemiology
- Not well defined due to being a rare disease
- Most commonly due to ganglion cyst (need citation)
Risk Factors
- Sports
- Bicycling
Differential Diagnosis
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- History
- Typically history of repetitive or direct trauma
- Symptoms can be motor, sensory or mixed
- Physical Exam
- Hypothenar atrophy is typically a late finding
- Special Tests
- Tinels Test: Reproduce symptoms by tapping on canal
- Froments Sign: Inability to grip thumb between thumb and index finger
- Wartenbergs Sign: Exaggerated abduction of the fifth digit
Evaluation
- Typically a clinical diagnosis
Radiographs
- Standard Radiographs Wrist
- 3 view standard to evaluate for etiology
MRI
- Can show anatomical variance within canal, mass effect
Ultrasound
- Evaluate vascular structures
EMG/NCS
- Helpful to assess distribution and localize affected nerves
Classification
- Classified based on which part of ulnar nerve is affected
- Zone 1: Proximal to the motor/sensory bifurcation
- Zone 2: Distal to motor/sensory bifurcation, radial to zone 3
- Zone 3: Distal to motor/sensory bifurcation, ulnar to zone 2
Management
- Variable, depends on etiology
Nonoperative
- Indications
- Etiologies: chronic repetitive trauma
- Mild-moderate symptoms with acute, subacute duration
- Treatment
- Medications:
- Physical Therapy: Nerve glide exercises
- Avoidance of provocative activities
- Improve ergonomics
- Splint: Neutral position
- Not beneficial (need reference)
Operative
- Indications
- Mod-severe symptoms or duration > 3 months
Return to Play
- Depends on etiology and management approach
Complications
- Chronic pain
- Loss of function
- Inability to return to sport
See Also
- Neuropathies (Main)
- Physical Examination Wrist
- Hand and Wrist Anatomy (Main)
- Hand Pain (Main)
- Wrist Pain (Main)
- Forearm Pain (Main)
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
Created by:
John Kiel on 4 November 2019 13:41:26
Authors:
Last edited:
16 October 2022 00:21:28
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