Guyon's canal syndrome
Guyon’s Canal Syndrome
Guyon’s canal compression is similar to carpal tunnel syndrome except
that Guyon’s involves the ulnar nerve as is passes into the hand. With
carpal tunnel syndrome patients will experience numbness and tingling
in the thumb, index, long and half of the ring finger. With Guyon’s the
symptoms of numbness and tingling are in the ring and small finger.
40 year old male is seen in the clinic for numbness and tingling in the
ring and small finger for the past two months. He states that he had a
wrist fracture that was treated conservatively six months ago. He rides
his bicycle daily and goes to the gym and lifts weights. He states that his
job involves tight gripping and he operates a jack hammer. His other
complaints involve hand fatigue and weakness. He denies elbow pain or
injury to the elbow.
Physical exam reveals no atrophy to the thenar or hypothenar muscles.
Patient has full function of the hand. He has a negative Froment and
Jeanne’s sign. He has some mild clawing of the ring and small finger and
decrease strength with abduction and adduction. The ulnar nerve is
nontender at the elbow. No subluxation of the nerve with active or
passive extension and flexion. Compression over Guyon’s canal in the
hand increases the tingling into the ring and small finger. Two point
discrimination is intact at 5mm.
The clinical diagnosis for this patient would be Guyon’s canal
compression. The next step would be to obtain NCV/EMG studies to
confirm the diagnosis. Depending on the results of the study you will
proceed with conservative management such as occupational therapy
and bracing or surgical management to decompress the canal.