We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Guyon Canal Syndrome

From WikiSM
Jump to: navigation, search

Other Names

  • Guyon's Canal Syndrome
  • Ulnar Neuropathy
  • Ulnar Tunnel Syndrome
  • Cyclist's Palsy

Background


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

Etiology

Epidemiology

  • Not well defined due to being a rare disease
  • Most commonly due to ganglion cyst (need citation)

Risk Factors

  • Sports
    • Bicycling

Differential Diagnosis


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

Evaluation

  • Typically a clinical diagnosis

Radiographs

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


References


Created by:
John Kiel on 4 November 2019 13:41:26
Authors:
Last edited:
28 October 2020 14:16:28
Categories:
Neurology | Hand | Wrist | Upper Extremity | Neuropathies | Overuse