Ultrasound-guided minimally invasive thread release of Guyon's canal: initial experience in cadaveric specimens.

OBJECTIVE: Guyon's canal syndrome is caused by compression of the ulnar nerve at the wrist, occasionally requiring decompression surgery. In recent times, minimally invasive approaches have gained popularity. The aim of this study was to assess the efficacy and safety of ultrasound-guided thread release for transecting the palmar ligament in Guyon's canal without harming surrounding structures, in a cadaveric specimen model. METHODS: After ethical approval, thirteen ultrasound-guided thread releases of Guyon's canal were performed on the wrists of softly embalmed anatomic specimens. Cadavers showing injuries or prior operations at the hand were excluded. Subsequently, the specimens were dissected, and the outcome of the interventions and potential damage to adjacent anatomical structures as well as ultrasound visibility were evaluated with a score from one to three. RESULTS: Out of 13 interventions, a complete transection was achieved in ten cases (76.9%), and a partial transection was documented in three cases (23.1%). Irrelevant lesions on the flexor tendons were observed in two cases (15.4%), and an arterial branch was damaged in one (7.7%). Ultrasound visibility varied among specimens, but essential structures were delineated in all cases. CONCLUSION: Ultrasound-guided thread release of Guyon's canal has shown promising first results in anatomic specimens. However, further studies are required to ensure the safety of the procedure. RELEVANCE STATEMENT: Our study showed that minimally invasive ultrasound-guided thread release of Guyon's canal is a feasible approach in the anatomical model. The results may provide a basis for further research and refinement of this technique. KEY POINTS: • In Guyon's canal syndrome, the ulnar nerve is compressed at the wrist, often requiring surgical release. • We adapted and tested a minimally invasive ultrasound-guided thread release technique in anatomic specimens. • The technique was effective; however, in one specimen, a small anatomic branch was damaged.

Postoperative ulnar neuropathy: a systematic review of evidence with narrative synthesis.

BACKGROUND: Postoperative ulnar neuropathy (PUN) is an injury manifesting in the sensory or motor distribution of the ulnar nerve after anaesthesia or surgery. The condition frequently features in cases of alleged clinical negligence by anaesthetists. We performed a systematic review and applied narrative synthesis with the aim of summarising current understanding of the condition and deriving implications for practice and research. METHODS: Electronic databases were searched up to October 2022 for primary research, secondary research, or opinion pieces defining PUN and describing its incidence, predisposing factors, mechanism of injury, clinical presentation, diagnosis, management, and prevention. RESULTS: We included 83 articles in the thematic analysis. PUN occurs after approximately 1 in 14 733 anaesthetics. Men aged 50-75 yr with pre-existing ulnar neuropathy are at highest risk. Preventative measures, based on consensus and expert opinion, are summarised, and an algorithm of suspected PUN management is proposed, based upon the identified literature. CONCLUSIONS: Postoperative ulnar neuropathy is rare and the incidence is probably decreasing over time with general improvements in perioperative care. Recommendations to reduce the risk of postoperative ulnar neuropathy are based on low-quality evidence but include anatomically neutral arm positioning and padding intraoperatively. In selected high-risk patients, further documentation of repositioning, intermittent checks, and neurological examination in the recovery room can be helpful.

Conservative Treatment of Ulnar Nerve Compression at the Elbow: A Systematic Review and Meta-Analysis.

Background The clinical results of conservative treatment options for ulnar compression at the elbow have not been clearly determined. The aim of this review was to evaluate available conservative treatment options and their effectiveness for ulnar nerve compression at the elbow. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. Literature search was performed using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Results Of the 1,079 retrieved studies, 20 were eligible for analysis and included 687 cases of ulnar neuropathy at the elbow. Improvement of symptoms was reported in 54% of the cases receiving a steroid/lidocaine injection (95% confidence interval [CI], 41-67) and in 89% of the cases using a splint device (95% CI, 69-99). Conclusions Conservative management seems to be effective. Both lidocaine/steroid injections and splint devices gave a statistically significant improvement of symptoms and are suitable options for patients who refuse an operative procedure or need a bridge to their surgery. Splinting is preferred over injections, as it shows a higher rate of improvement.

Anatomical and histomorphometric study of the ulnar nerve at the wrist / Estudio anatómico e histomorfométrico del nervio ulnar en la muñeca

SUMMARY: The ulnar nerve (UN) is the main nerve responsible for innervation of the intrinsic musculature of the hand. It is of great importance to have a deep anatomical knowledge of the UN. The aim of this study is to enrich the knowledge of the UN anatomy at the wrist and provide useful reference information for clinical and surgical applications. In this descriptive cross-sectional study, 44 upper limbs of fresh cadavers were evaluated. The UN, the superficial branch of the ulnar nerve (SBUN), and the deep branch of the ulnar nerve (DBUN) were evaluated. Morphometric variables were measured using a digital caliper, and samples of nervous tissue were taken to evaluate the histomorphometry. Before entering the Guyon's canal, the UN had a diameter of 3.2 ± 0.4 mm. In 36 samples (82 %) the UN presented a bifurcation pattern and in the remaining 8 samples (18 %) a trifurcation was shown. The diameter of the DBUN was 1.9 ± 0.33 mm and that of the SBUN was 1.29 ± 0.22 mm. In the bifurcation patterns, the SBUN had a trunk of 5.71 ± 1.53 mm before bifurcating into the common digital nerve (fourth and fifth fingers) and an ulnar digital collateral nerve (fifth finger). The DBUN had an area of 2.84 ± 0.7 mm2 and was made up of 8 ± 1.4 fascicles and 3595 ± 465 axons. The SBUN area was 1.31 ± 0.27 mm2, it was made up of 6 ± 1.1 fascicles and 2856 ± 362 axons. The reported findings allow the hand surgeon to improve his understanding of the clinical signs of patients with UN pathologies at the wrist level and thus achieve greater precision while planning and performing surgical approaches and dissections.

El nervio ulnar (NU) es el principal nervio responsable de la inervación de la musculatura intrínseca de la mano. Es de gran importancia tener un profundo conocimiento anatómico del NU. El objetivo de este estudio fue enriquecer el conocimiento de la anatomía del NU en la muñeca y proporcionar información de referencia útil para aplicaciones clínicas y quirúrgicas. En este estudio descriptivo transversal se evaluaron 44 miembros superiores de cadáveres frescos. Se evaluó el NU, el ramo superficial del nervio ulnar (RSNU) y el ramo profundo del nervio ulnar (RPNU). Las variables morfométricas se midieron con un caliper digital y se tomaron muestras del nervio para evaluar la histomorfometría. Antes de ingresar al canal del nervio ulnar (canal Guyon), el ONU tenía un diámetro de 3,2 ± 0,4 mm. En 36 muestras (82 %) el ONU presentó un patrón de bifurcación y en las 8 muestras restantes (18 %) se presentó una trifurcación. El diámetro del RPNU fue de 1,9 ± 0,33 mm y el del RSNU de 1,29 ± 0,22 mm. En los patrones de bifurcación, el RSNU presentó un tronco de 5,71 ± 1,53 mm antes de bifurcarse en el nervio digital común (cuarto y quinto dedo) y un nervio digital colateral ulnar (quinto dedo). El RPNU tenía un área de 2,84 ± 0,7 mm2 y estaba formado por 8 ± 1,4 fascículos y 3595 ± 465 axones. El área del RSNU fue de 1,31 ± 0,27 mm2, estaba formado por 6 ± 1,1 fascículos y 2856 ± 362 axones. Los hallazgos reportados permiten al cirujano de mano mejorar su comprensión de los signos clínicos de los pacientes con patologías del NU a nivel de la muñeca y así lograr una mayor precisión en la planificación y realización de abordajes y disecciones quirúrgicas.

Characteristics of surgically treated Guyon canal syndrome: A multicenter retrospective study.

Guyon canal (GC) syndrome is a rare peripheral neuropathy involving the distal part of the ulnar nerve. Several causes are associated with GC syndrome, including anatomic variations, space-occupying tumors, and trauma. Because of disease rarity, the only reported studies of GC syndrome are case series with small sample size. We conducted a multicenter study to identify the basic characteristics of patients with surgically treated GC syndrome and the risk factors for the disease. This retrospective multicenter study was conducted between January 2001 and December 2020. We screened 70 patients who underwent GC release surgery by seven hand surgeons at six institutes. A total of 56 patients were included in this study, including 38 patients (67.9%) who underwent isolated GC decompression and 18 (32.1%) who underwent combined peripheral nerve decompression. The mean patient age was 48.4 years (range: 20-89 years), and 40 patients (71.4%) were male. The average preoperative symptom duration was 18.5 months, and most patients were office workers. Ultrasound was positive for GC syndrome in 7/10 patients evaluated, CT in 2/5, MRI in 17/23, and electrodiagnostic studies in 35/44. The most common cause of GC syndrome was tumor (n = 23), followed by idiopathic (n = 17), trauma (n = 12), anatomic variants (n = 3), and inflammation (n = 3). In conclusion, most patients with GC syndrome in this study were male and had symptoms in one wrist. The most common cause of GC syndrome in this study was a tumor, including a ganglion cyst. Level of Evidence: Level IV case series.

Carpal Tunnel Syndrome and Ulnar Nerve Entrapment at the Elbow Are Not Associated With Plasma Levels of Caspase-3, Caspase-8 or HSP27.

Background: Nerve compression disorders, such as carpal tunnel syndrome (CTS) and ulnar entrapment at the elbow (UNE), may be associated with apoptosis and neuroprotective mechanisms in the peripheral nerve that may be detected by biomarkers in the blood. The relationships between CTS and UNE and two biomarkers of apoptosis, i.e., caspase-3 and caspase-8, and the neuroprotective factor Heat Shock Protein 27 (HSP27) in plasma were examined in a population-based cohort. Method: The biomarkers caspase-3, caspase-8 and HSP27 were measured in plasma at inclusion of 4,284 study participants aged 46-68 years in the population-based Malmö Diet and Cancer study (MDCS). End-point retrieval was made from national registers concerning CTS and UNE. Independent t-test was used to examine the association between caspase-3, caspase-8 and HSP27 plasma levels and incidence of CTS and UNE. Cox proportional hazards regression was used to investigate if plasma levels of caspase-3, caspase-8 and HSP27 affected time to diagnosis of CTS or UNE. Results: During the mean follow-up time of 22 years, 189/4,284 (4%) participants were diagnosed with CTS and 42/4,284 (1%) were diagnosed with UNE. No associations were found between incident CTS or UNE and the biomarkers caspase-3, caspase-8 and HSP27 in plasma. Conclusion: The apoptotic biomarkers caspase-3 and caspase-8 and the neuroprotective factor HSP27 in plasma, factors conceivably related to a nerve injury, are not associated with the nerve compression disorders CTS and UNE in a general population.

Enrollment in Treatment at a Specialized Pain Management Clinic at a Tertiary Referral Center after Surgery for Ulnar Nerve Compression: Patient Characteristics and Outcome.

Purpose: To study patients who enroll in treatment at a specialized pain management clinic at a tertiary referral center following ulnar nerve decompression. Methods: Data from medical charts and postoperative questionnaires were collected for all patients after surgery for ulnar nerve compression at the elbow from 2011 to 2014 (n = 173) at a tertiary referral center. Differences in characteristics between patients who enrolled in treatment at the pain management clinic (study group, n = 26) and the rest of the patients (reference group, n = 147) were analyzed. The study group was further evaluated using questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP) and regarding outcome of pain treatment. Results: The study group was characterized by prior pain conditions, earlier contact with a pain management clinic, and high degrees of kinesiophobia, depression/anxiety, low quality of life, and low life satisfaction. These patients had significantly higher postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, were significantly younger, and had bilateral surgery significantly more often than the reference group. For patients with unilateral surgery, simple decompression was significantly more common in the reference group. The most common treatments at the clinic were antidepressants and anticonvulsants for neurogenic pain. In 5 of 26 patients, pain relief, or pain reduction was the documented reason for discharge. Conclusions: Pain is a relevant outcome measure for ulnar nerve decompression among complicated cases at a referral center. Severe postoperative pain is connected to higher disability, reduced life satisfaction, and overall low health status. This study maps out characteristics of patients who postoperatively enroll in treatment at a specialized pain management clinic following ulnar nerve decompression. Further studies are needed to define predictive factors for such pain. Type of study/level of evidence: Prognostic III.

Estratégia de tratamento nos tumores benignos de nervo / Treatment strategy for benign nerve tumors

Introdução: Os tumores de nervo periférico normalmente são benignos, raros, de crescimento lento e pouco sintomáticos. O objetivo é descrever estratégias para o diagnóstico e tratamento de pacientes com tumores benignos que afetam o nervo ulnar. Métodos: Estudo retrospectivo dos pacientes operados entre 2010 e 2015 com tumor benigno de nervo ulnar, segundo os sintomas, exames complementares, técnicas cirúrgicas realizadas e características demográficas. Resultados: O estudo incluiu 17(8%) pacientes, prevalência sexo feminino (65%) na quarta década de vida; e, natureza extrínseca, o lipoma, em seis casos (35%), seguido do tumor de origem intrínseca, o Schwannoma em 17% e hamartoma em 11%. A excisão tumoral foi total em 83% casos e parcial em 17% casos; em doze casos realizou-se a descompressão neural. Conclusão: Com as estratégias realizadas para o tratamento foi possível bons resultados funcionais em 88% dos pacientes operados. Os piores resultados foram nos tumores de origem vascular.

Introduction: Peripheral nerve tumors are usually benign, rare, slow-growing and little symptomatic. The objective is to describe strategies for the diagnosis and treatment of patients with benign tumors of the ulnar nerve. Methods: This retrospective study of patients who underwent surgery between 2010 and 2015 for the treatment of benign tumor of the ulnar nerve analyzed patient symptoms and demographic characteristics, complementary examinations, and surgical techniques performed. Results: The study included 17 (8%) patients, with a prevalence of women (65%) in the fourth decade of life. The tumors tended to be extrinsic, with lipoma in 6 cases (35%); others were intrinsic, including schwannoma in 17% and hamartoma in 11% of the cases. Tumor excision was complete in 83% of cases and partial in 17% of cases; nerve decompression was performed in 12 cases. Conclusion: The strategies performed here yielded good functional results in 88% of patients. The worst results were in tumors of vascular origin.

Dynamic Nerve Compression of Guyon Canal Secondary to Variation of the Deep Branch of the Ulnar Artery: Etiology, Diagnosis, Treatment, and Outcome.

A patient presented with an ulnar-sided left wrist injury that was sustained while batting. Advanced imaging was obtained to rule out common causes of nerve compression and evaluate the patient's anatomy. Dynamic nerve conduction studies were necessary to confirm a diagnosis of nerve compression. Failing conservative treatments, the patient underwent exploration of Guyon canal and decompression of the ulnar nerve with complete symptom resolution. The patient presented a unique diagnostic challenge because he did not display the typical findings of chronic nerve entrapment syndromes. To the best of our knowledge, dynamic nerve compression at Guyon's canal has not previously been described. It is important to use a systematic approach to diagnosis, eliminating all other sources of compression. With appropriate diagnostic tools, nerve decompression can result in symptom relief.

Diagnosis of Pure Ulnar Sensory Neuropathy Around the Hypothenar Area Using Orthodromic Inching Sensory Nerve Conduction Study: A Case Report.

Ulnar neuropathy at the wrist is an uncommon disease and pure ulnar sensory neuropathy at the wrist is even rarer. It is difficult to diagnose pure ulnar sensory neuropathy at the wrist by conventional methods. We report a case of pure ulnar sensory neuropathy at the hypothenar area. The lesion was localized between 3 cm and 5 cm distal to pisiform using orthodromic inching test of ulnar sensory nerve to stimulate at three points around the hypothenar area. Ultrasonographic examination confirmed compression of superficial sensory branch of the ulnar nerve. Further, surgical exploration reconfirmed compression of the ulnar nerve. This case report demonstrates the utility of orthodromic ulnar sensory inching test.

Ulnar Nerve Cross-Sectional Area for the Diagnosis of Cubital Tunnel Syndrome: A Meta-Analysis of Ultrasonographic Measurements.

OBJECTIVE: To examine the performance of sonographic cross-sectional area (CSA) measurements in the diagnosis of cubital tunnel syndrome (CuTS). DATA SOURCES: Electronic databases, comprising PubMed and EMBASE, were searched for the pertinent literature before July 1, 2017. STUDY SELECTION: Fourteen trials comparing the ulnar nerve CSA measurements between participants with and without CuTS were included. DATA EXTRACTION: Study design, participants' demographic characteristics, diagnostic reference of CuTS, and methods of CSA measurement. DATA SYNTHESIS: Among different elbow levels, the between-group difference in CSA was the largest at the medial epicondyle (6.0mm2; 95% confidence interval [CI], 4.5-7.4mm2). The pooled mean CSA in participants without CuTS was 5.5mm2 (95% CI, 4.4-6.6mm2) at the arm level, 7.4mm2 (95% CI, 6.7-8.1mm2) at the cubital tunnel inlet, 6.6mm2 (95% CI, 5.9-7.2mm2) at the medial epicondyle, 7.3mm2 (95% CI, 5.6-9.0mm2) at the cubital tunnel outlet, and 5.5mm2 (95% CI, 4.7-6.3mm2) at the forearm level. The sensitivities, specificities, and diagnostic odds ratios pooled from 5 studies, using 10mm2 as the cutoff point, were .85 (95% CI, .78-.90), .91 (95% CI, .86-.94), and 53.96 (95% CI, 14.84-196.14), respectively. CONCLUSIONS: The ulnar nerve CSA measured by ultrasound imaging is useful for the diagnosis of CuTS and is most significantly different between patients and participants without CuTS at the medial epicondyle. Because the ulnar nerve CSA in healthy participants, at various locations, rarely exceeds 10mm2, this value can be considered as a cutoff point for diagnosing ulnar nerve entrapment at the elbow region.

Diagnosis of Pure Ulnar Sensory Neuropathy Around the Hypothenar Area Using Orthodromic Inching Sensory Nerve Conduction Study: A Case Report

Ulnar neuropathy at the wrist is an uncommon disease and pure ulnar sensory neuropathy at the wrist is even rarer. It is difficult to diagnose pure ulnar sensory neuropathy at the wrist by conventional methods. We report a case of pure ulnar sensory neuropathy at the hypothenar area. The lesion was localized between 3 cm and 5 cm distal to pisiform using orthodromic inching test of ulnar sensory nerve to stimulate at three points around the hypothenar area. Ultrasonographic examination confirmed compression of superficial sensory branch of the ulnar nerve. Further, surgical exploration reconfirmed compression of the ulnar nerve. This case report demonstrates the utility of orthodromic ulnar sensory inching test.

Type III Guyon Syndrome in 'B Boy' Break-Dancer: A Case Report.

Although the musculoskeletal injuries associated with break-dancing which is gaining more popularity among adolescent and young people has been reported, the report regarding a peripheral nerve injury associated with breakdance is scarce. We report a rare case of a young amateur break-dancer, 'b-boy' who suffered from a painful paresthesia in his left hand, later diagnosed as type III Guyon's canal syndrome. A 23-year-old, right handed college man presented with a tenderness over the left hypothenar eminence and painful paresthesia over the ring and little fingers of 3 months duration. He trained himself as an amateur 'b boy' break-dancer for the last 10 months. Conservative management under the diagnosis of wrist sprain before presentation did not improve his hand pain. An magnetic resonance imaging and electrodiagnostic study revealed that painful paresthesia was caused by type III Guyon's canal syndrome, and 4 weeks of corticosteroid treatment was given with resolution of pain and paresthesia.

Type III Guyon Syndrome in 'B Boy' Break-Dancer: A Case Report / 대한신경손상학회지

Although the musculoskeletal injuries associated with break-dancing which is gaining more popularity among adolescent and young people has been reported, the report regarding a peripheral nerve injury associated with breakdance is scarce. We report a rare case of a young amateur break-dancer, 'b-boy' who suffered from a painful paresthesia in his left hand, later diagnosed as type III Guyon's canal syndrome. A 23-year-old, right handed college man presented with a tenderness over the left hypothenar eminence and painful paresthesia over the ring and little fingers of 3 months duration. He trained himself as an amateur 'b boy' break-dancer for the last 10 months. Conservative management under the diagnosis of wrist sprain before presentation did not improve his hand pain. An magnetic resonance imaging and electrodiagnostic study revealed that painful paresthesia was caused by type III Guyon's canal syndrome, and 4 weeks of corticosteroid treatment was given with resolution of pain and paresthesia.

Misdiagnosed Handlebar Palsy: Giant Cell Tumor of the Tendon Sheath in Guyon's Canal / 대한스포츠의학회지

Ulnar tunnel syndrome (UTS) is a compressive neuropathy of the upper extremity that shows various clinical symptoms according to the anatomic region of the compression site. Numerous factors may cause UTS, and most publications are case reports describing various etiologies; thus, obtaining a correct diagnosis is often challenging. Giant cell tumor of the tendon sheath (GCTTS) is well described to be a common benign soft tissue tumor of the hand; however, it is rarely reported to cause UTS. We report a case of GCTTS in Guyon's canal causing UTS that was misdiagnosed as handlebar palsy.

The Snapping Elbow Syndrome as a Reason for Chronic Elbow Neuralgia in a Tennis Player - MR, US and Sonoelastography Evaluation.

BACKGROUND: Ulnar neuropathy is the second most common peripheral nerve neuropathy after median neuropathy, with an incidence of 25 cases per 100 000 men and 19 cases per 100 000 women each year. Skipping (snapping) elbow syndrome is an uncommon cause of pain in the posterior-medial elbow area, sometimes complicated by injury of the ulnar nerve. One of the reason is the dislocation of the abnormal insertion of the medial triceps head over the medial epicondyle during flexion and extension movements. Others are: lack of the Osboune fascia leading to ulnar nerve instability and focal soft tissue tumors (fibromas, lipomas, etc). Recurrent subluxation of the nerve at the elbow results in a tractional and frictional neuritis with classical symptoms of peripheral neuralgia. As far as we know snapping triceps syndrome had never been evaluated in sonoelastography. CASE REPORT: A 28yo semi-professional left handed tennis player was complaining about pain in posterior-medial elbow area. Initial US examination suggest golfers elbow syndrome which occurs quite commonly and has a prevalence of 0.3-0.6% in males and 0-3-1.1% in women and may be associated (approx. 50% of cases) with ulnar neuropathy. However subsequently made MRI revealed unusual distal triceps anatomy, moderate ulnar nerve swelling and lack of medial epicondylitis symptoms. Followed (second) US examination and sonoelastography have detected slipping of the both ulnar nerve and the additional band of the medial triceps head. DISCUSSION: Snapping elbow syndrome is a poorly known medical condition, sometimes misdiagnosed as the medial epicondylitis. It describes a broad range of pathologies and anatomical abnormalities. One of the most often reasons is the slipping of the ulnar nerve as the result of the Osborne fascia/anconeus epitrochlearis muscle absence. Simultaneously presence of two or more "snapping reasons" is rare but should be always taken under consideration. CONCLUSIONS: There are no sonoelastography studies describing golfers elbow syndrome, additional triceps band and ulnar neuritis. Our data suggest that the sonoelastography signs are similar to those seen in well described lateral epicondylitis syndrome, Achilles tendinitis and medial nerve neuralgia.

Symptomatic Neural Loop of the Distal Ulnar Nerve / 대한정형외과학회잡지

We found a unique anatomical variant of the distal ulnar nerve, a neural loop encompassing the flexor carpi ulnaris during Guyon's canal exploration. Compression by the flexor carpi ulnaris during active wrist movement was suspected as the cause of ulnar neuropathy. The symptom was relieved after neurolysis and release of surrounding tissue. With regard to the ulnar side wrist pain, which is suspicious for ulnar compression syndrome at the wrist level, the surgeon should always suspect anomalous nerve branch as source of compressive neuropathic pain.

GUYON'S CANAL SYNDROME DUE TO A SYNOVIAL CYST.

We present a case of Guyon's canal syndrome caused by a synovial cyst within the left wrist of a 48-year-old female patient. The patient presented pain and paresthesia in the region of the ulnar nerve, with loss of muscle strength and left-hand deformity. Electroneuromyography showed a compression of the ulnar nerve at the wrist level. Surgical decompression of the nerve at Guyon's canal with resection of the cyst was performed. After the surgery, the patient presented an improvement in the pain and paresthesia, as well as an increase in muscle trophism and correction of the deformity.

Síndrome do canal de Guyon causada por cisto sinovial / Guyon's canal syndrome due to a synovial cyst

Apresentamos um caso de síndrome do canal de Guyon por um cisto sinovial no punho esquerdo de uma paciente do sexo feminino, de 48 anos. A paciente apresentava dor e parestesia na topografia do nervo ulnar, diminuição da força muscular e deformidade na mão esquerda. A eletroneuromiografia evidenciava compressão do nervo ulnar no nível do punho. Realizada a ressecção do cisto e descompressão do nervo no canal de Guyon. Após a cirurgia a paciente apresentou melhora da dor e da parestesia, além de aumento do trofismo muscular e correção da deformidade.

The authors present a case of Guyon's canal syndrome due to a synovial cyst within the left wrist of a 48-year-old female patient. The patient reported pain and paresthesia in the topography of the ulnar nerve, loss of muscular strength and left hand deformity. Electromyography showed a compression of the ulnar nerve at the wrist level. Surgical decompression at the Guyon canal with resection of the cyst was performed. After surgery, the patient presented with improvement of pain and paresthesia, as well as an increase in muscular trophism and correction of the deformity.