Ulnar tunnel syndrome

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Ulnar tunnel syndrome
Other namesGuyon's canal syndrome
Ulnar tunnel syndrome, ulnar nerve distribution.png
Depiction of classic ulnar sensory distribution, including ulnar-4th and 5th fingers. Note that this diagram does not portray hand muscles affected by ulnar neuropathy.
Specialty Orthopedic surgery   OOjs UI icon edit-ltr-progressive.svg

Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is ulnar neuropathy at the wrist where it passes through the ulnar tunnel (Guyon's canal). [1] The most common presentation is a palsy of the deep motor branch of the ulnar nerve causing weakness of the interosseous muscles. Ulnar tunnel syndrome is usually caused by a ganglion cyst pressing on the ulnar nerve, other causes include traumas to the wrist and repetitive movements, but often the cause is unknown (idiopathic). [2] Long distance bicycle rides are associated with transient alterations in ulnar nerve function. [3] Sensory loss in the ring and small fingers is usually due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome, although it can uncommonly be due to compression at the wrist.

Contents

Causes

Ulnar neuropathy at the wrist is often associated with a mass such as a ganglion cyst or thrombosis or an aneurysm of the ulnar artery. [4] The role of activities and exposure is less certain.

Diagnosis

Classification

Three locations (zones) in which the ulnar nerve can be compressed within Guyon canal Guyon canal syndrome zones.svg
Three locations (zones) in which the ulnar nerve can be compressed within Guyon canal

Ulnar tunnel syndrome may be characterized by the location or zone within the Guyon's canal at which the ulnar nerve is compressed. The nerve divides into a superficial sensory branch and a deeper motor branch in this area. Thus, Guyon's canal can be separated into three zones based on which portion of the ulnar nerve are involved. The resulting syndrome results in either muscle weakness or impaired sensation in the ulnar distribution. [1]

ZoneLocationSymptomsAssociations
 1 Proximal (prior to ulnar nerve bifurcation)Mixed motor & sensoryGanglia & hook of hamate fractures
 2 Surrounding deep motor branch ulnar nerveMotor onlyGanglia & hook of hamate fractures
 3 Surrounding superficial sensory branch of ulnar nerveSensory onlyUlnar artery pathology

Zone 2 type syndromes are most common, while Zone 3 are least common.

Treatment

The role of gloves which help protect the ulnar nerve from compression is unclear. Palsy of the ulnar motor nerve isolated to the wrist is treated with operative decompression, often with concomitant ganglion excision. The surgery is to divide the volar carpal ligament which forms the roof of Guyon's canal, thereby reducing compression on the ulnar nerve. [5] [6]

See also

Related Research Articles

<span class="mw-page-title-main">Carpal tunnel syndrome</span> Compression of the median nerve in the wrist

Carpal tunnel syndrome (CTS) is a nerve compression syndrome associated with the collected signs and symptoms of compression of the median nerve at the carpal tunnel in the wrist. Carpal tunnel syndrome is an idiopathic syndrome but there are environmental, and medical risk factors associated with the condition. CTS can affect both wrists.

<span class="mw-page-title-main">Median nerve</span> Nerve of the upper limb

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.

<span class="mw-page-title-main">Ulnar nerve</span> Nerve which runs near the ulna bone

The ulnar nerve is a nerve that runs near the ulna, one of the two long bones in the forearm. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

<span class="mw-page-title-main">Nerve conduction study</span> Diagnostic test for nerve function

A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. These tests may be performed by medical specialists such as clinical neurophysiologists, physical therapists, physiatrists, and neurologists who subspecialize in electrodiagnostic medicine. In the United States, neurologists and physiatrists receive training in electrodiagnostic medicine as part of residency training and in some cases acquire additional expertise during a fellowship in clinical neurophysiology, electrodiagnostic medicine, or neuromuscular medicine. Outside the US, clinical neurophysiologists learn needle EMG and NCS testing.

<span class="mw-page-title-main">Tarsal tunnel syndrome</span> Compression of the tibial nerve in the foot

Tarsal tunnel syndrome (TTS) is a nerve compression syndrome or nerve entrapment syndrome causing a painful foot condition in which the tibial nerve is entrapped as it travels through the tarsal tunnel. The tarsal tunnel is found along the inner leg behind the medial malleolus. The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.

<span class="mw-page-title-main">Nerve conduction velocity</span> Speed at which an electrochemical impulse propagates down a neural pathway

In neuroscience, nerve conduction velocity (CV) is the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors, which include age, sex, and various medical conditions. Studies allow for better diagnoses of various neuropathies, especially demyelinating diseases as these conditions result in reduced or non-existent conduction velocities. CV is an important aspect of nerve conduction studies.

<span class="mw-page-title-main">Ulnar canal</span> Passageway through the wrist for the ulnar nerve and artery

The ulnar canal or ulnar tunnel (also known as Guyon's canal or tunnel) is a semi-rigid longitudinal canal in the wrist that allows passage of the ulnar artery and ulnar nerve into the hand. The roof of the canal is made up of the superficial palmar carpal ligament, while the deeper flexor retinaculum and hypothenar muscles comprise the floor. The space is medially bounded by the pisiform and pisohamate ligament more proximally, and laterally bounded by the hook of the hamate more distally. It is approximately 4 cm long, beginning proximally at the transverse carpal ligament and ending at the aponeurotic arch of the hypothenar muscles.

<span class="mw-page-title-main">Cubital tunnel syndrome</span> Compression of the ulnar nerve in the elbow

Cubital tunnel syndrome is an entrapment neuropathy, or nerve compression syndrome, a condition caused by compression, traction or friction, of the ulnar nerve at the elbow. Nerve compression is also known as a trapped nerve. The ulnar nerve travels from the shoulder down the length of the arm to the hand. Along its course it may become compressed at several sites. At the elbow the ulnar nerve passes through the cubital tunnel. Ulnar nerve compression most commonly occurs at the level of the cubital tunnel. The ulnar nerve provides motor and sensory innervation to the forearm, and hand and its compression can cause the numbness and other symptoms associated with cubital tunnel syndrome. In many cases the cause is unknown.

<span class="mw-page-title-main">Carpal tunnel</span> Structure of human wrist

In the human body, the carpal tunnel or carpal canal is a flattened body cavity on the flexor (palmar/volar) side of the wrist, bounded by the carpal bones and flexor retinaculum. It forms the passageway that transmits the median nerve and the tendons of the extrinsic flexor muscles of the hand from the forearm to the hand. The median artery is an anatomical variant. When present it lies between the radial artery, and the ulnar artery and runs with the median nerve supplying the same structures innervated.

<span class="mw-page-title-main">Ulnar neuropathy at the elbow</span> Medical condition

Idiopathic ulnar neuropathy at the elbow is a condition where pressure on the ulnar nerve as it passes through the cubital tunnel causes ulnar neuropathy. The symptoms of neuropathy are paresthesia (tingling) and numbness primarily affecting the little finger and ring finger of the hand. Ulnar neuropathy can progress to weakness and atrophy of the muscles in the hand. Symptoms can be alleviated by the use of a splint to prevent the elbow from flexing while sleeping.

<span class="mw-page-title-main">Ulnar neuropathy</span> Disease of the ulnar nerve in the forearm

Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. It may also cause weakness or paralysis of the muscles supplied by the nerve. Ulnar neuropathy may affect the elbow as cubital tunnel syndrome. At the wrist a similar neuropathy is ulnar tunnel syndrome.

<span class="mw-page-title-main">Nerve compression syndrome</span> Symptoms resulting from chronic, direct pressure on a peripheral nerve

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.

<span class="mw-page-title-main">Wrist pain</span>

Wrist pain or open wrist is a syndrome inhibiting use of a hand due to pain in anatomical structures of the wrist. It most commonly results from an injury to a ligament. The pain may be sharp from a traumatic injury or from chronic repetitive wrist activities.

Wartenberg's sign is a neurological sign consisting of involuntary abduction of the fifth (little) finger, caused by unopposed action of the extensor digiti minimi.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

<span class="mw-page-title-main">Carpal tunnel surgery</span> Surgery to relieve carpal tunnel syndrome

Carpal tunnel surgery, also called carpal tunnel release (CTR) and carpal tunnel decompression surgery, is a nerve decompression in which the transverse carpal ligament is divided. It is a surgical treatment for carpal tunnel syndrome (CTS) and recommended when there is constant (not just intermittent) numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms of pain in the carpal tunnel. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment. Approximately 500,000 surgical procedures are performed each year, and the economic impact of this condition is estimated to exceed $2 billion annually.

<span class="mw-page-title-main">Osborne's ligament</span> Connective tissue in the body

Osborne's ligament, also Osborne's band, Osborne's fascia, Osborne's arcade, arcuate ligament of Osborne, or the cubital tunnel retinaculum, refers to either the connective tissue which spans the humeral and ulnar heads of the flexor carpi ulnaris (FCU) or another distinct tissue located between the olecranon process of the ulna and the medial epicondyle of the humerus. It is named after Geoffrey Vaughan Osborne, a British orthopedic surgeon, who described the eponymous tissue in 1957.

Nerve glide, also known as nerve flossing or nerve stretching, is an exercise that stretches nerves. It facilitates the smooth and regular movement of peripheral nerves in the body. It allows the nerve to glide freely along with the movement of the joint and relax the nerve from compression. Nerve gliding cannot proceed with injuries or inflammations as the nerve is trapped by the tissue surrounding the nerve near the joint. Thus, nerve gliding exercise is widely used in rehabilitation programs and during the post-surgical period.

A nerve decompression is a neurosurgical procedure to relieve chronic, direct pressure on a nerve to treat nerve entrapment, a pain syndrome characterized by severe chronic pain and muscle weakness. In this way a nerve decompression targets the underlying pathophysiology of the syndrome and is considered a first-line surgical treatment option for peripheral nerve pain. Despite treating the underlying cause of the disease, the symptoms may not be fully reversible as delays in diagnosis can allow permanent damage to occur to the nerve and surrounding microvasculature. Traditionally only nerves accessible with open surgery have been good candidates, however innovations in laparoscopy and nerve-sparing techniques made nearly all nerves in the body good candidates, as surgical access is no longer a barrier.

References

  1. 1 2 Hatch, Daniel (August 20, 2014). "Ulnar Tunnel Syndrome". Orthobullets. Retrieved Sep 7, 2014.
  2. Taylor, Michele. "What Is Ulnar Tunnel Syndrome? Causes, Symptoms, Treatment". WebMD. Retrieved 15 June 2024.
  3. Akuthota, V.; Plastaras, C.; Lindberg, K.; Tobey, J.; Press, J.; Garvan, C. (2005). "The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy". The American Journal of Sports Medicine. 33 (8): 1224–30. doi:10.1177/0363546505275131. PMID   16000656.
  4. Depukat, Paweł; Mizia, Ewa; Kuniewicz, Marcin; Bonczar, Tomasz; Mazur, Małgorzata; Pełka, Piotr; Mróz, Izabela; Lipski, Marcin; Tomaszewski, Krzysztof (2015). "Syndrome of canal of Guyon - definition, diagnosis, treatment and complication". Folia Medica Cracoviensia. 55 (1): 17–23. ISSN   0015-5616. PMID   26774628.
  5. Okutsu I, Hamanaka I, Yoshida A (April 2009). "Pre- and postoperative Guyon's canal pressure change in endoscopic carpal tunnel release: correlation with transient postoperative Guyon's canal syndrome". J Hand Surg Eur Vol. 34 (2): 208–11. doi:10.1177/1753193408100122. PMID   19282410.
  6. Assmus H, Antoniadis G, Bischoff C, Hoffmann R, Martini AK, Preissler P, Scheglmann K, Schwerdtfeger K, Wessels KD, Wüstner-Hofmann M (May 2011). "Cubital tunnel syndrome - a review and management guidelines". Cent Eur Neurosurg. 72 (2): 90–8. doi:10.1055/s-0031-1271800. PMID   21547883.

Further reading