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Guyon's Canal , Ulnar tunnel syndrome .Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубликовано: 19 авг 2024
- Dr. Ebraheim’s educational animated video describes the compression of the ulnar nerve in the Guyon's canal.
The ulnar nerve rises from the medial cord of the brachial plexus. After the ulnar nerve passes through the arm, it runs from the medial epicondyle to the pisiform bone in the wrist in a direct trajectory. Two carpal bones are important in relation to the ulnar nerve in the wrist:
1-Pisiform
2-Hamate
Both the ulnar nerve and artery enter the Guyon’s canal. The Guyon’s canal is approximately 4 cm long. The ulnar nerve enters the wrist medial to the ulnar artery. The Guyon’s canal has one proximal entrance and 2 distal exits: one superficial, one deep. The Guyon’s canal contains the ulnar nerve with its superficial sensory and deep motor branches.
Ulnar nerve compression neuropathy can occur in the Guyon’s canal.
Zones of Guyon’s canal compression
•Zone I:
Location: proximal bifurcation of the nerve
Symptoms: mixed motor and sensory
Common causes: ganglia and hook of hamate fractures.
•Zone II:
Location: deep motor branch
Symptoms: motor only.
Common causes: ganglia and hook of hamate fractures.
•Zone III:
Location: superficial sensory branch
Symptoms: sensory only
Common causes: ulnar artery thrombosis or aneurysm.
The deep branch of the ulnar nerve innervated all of the interosseous muscles and the 3rd and 4th lumbricals . it also innervates the hypothenar muscles, the adductor pollicis muscles, and the deep head of the flexor pollicis brevis muscle. The superficial branch of the ulnar nerve is mainly sensory. It gives supply to the digitial nerves if the 4th and 5th fingers and a motor branch to the palmaris brevis muscle.
Presentation/symptoms
•Based on the location of compression in the Guyon canal, the affected area of the nerve may be purely motor, purely sensory or a mixture or motor and sensory.
•Pain and paresthesia in the ulnar 11/2 digits
•Clawing of the 4th and 5th fingers
•Loss of the intrinsic (it normally flexes the MCP and extends the IP joints)
•In low ulnar nerve injury, the flexor digitorum profundus is working, flexing the 4th and 5th fingers and casuing the clawing.
•Ulnar nerve palsy resulting in paralysis of the intrinsic muscles, test the first dorsal interosseous muscle and check for atrophy.
•Weak pinch: 70% of pinch is lost due to loss of adductor muscles.
•Froment;s test is positive: when pinching a piece of paper between the thumb and index, the thumb IP joint will flex if the adductor pollicis muscle is weak due to ulnar nerve palsy.
•Weak grasp due to intrinsic weakness
•Wartenberg’s sign: abduction of 5th finger due to ulnar nerve palsy.
•Allen’s test: should be done to check for ulnar artery thrombosis.
•Carpal tunnel view x-rays and CT scans are useful to evaluate hook of hamate fractures and nonunions.
•Ultrasound is useful to check vascular status and diagnose ulnar artery thrombosis.
•EMG and nerve studies are helpful.
Differential diagnosis-high or low ulnar nerve injury
•In low ulnar nerve injury or compression, the flexor digitorum profundus muscle is working, flexing the 4th and 5th fingers and causing clawing.
•High ulnar nerve palsy
Less clawing of the hand
Sensory deficit to the dorsum of the hand
In cubital tunnel syndrome you can also find:
Tinel’s sign at the elbow
Positive elbow flexion test.
The dorsal cutaneous branch arises before the Guyon’s canal. If you have high ulnar nerve palsy, there will be sensory deficit on the dorsum of the hand.
Treatment
•Non-operative: activity modification, NSAIDS, splinting.
•Surgery: release of the carpal tunnel: in patients diagnosed with both carpal tunnel and ulnar tunnel, the Guyon’s canal is adequately decompressed by the release of the carpal tunnel. Local decompression especially if non-operative treatment fails. Decompression of the ulnar nerve by addressing the cause. The success of surgery depends on finding a cause.
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Background music provided as a free download from RUclips Audio Library.
Song Title: Every Step
I just had ulnar release at the guyon canal less than a week ago. I was searching for anatomical information for quite sometime leading up to the surgery. There is more out there about the ulnar at the elbow but I needed info about the wrist. This video finally popped up in my recommendations. It was very informative and descriptive of what I’ve been experiencing. My issue came up from the repetitive trauma of resting my head in my hand at the computer. Went numb 3 mos ago and slowly wasted as well. Surgery went well. I still have the stitches. Feels better though the numbness is still there, i now feel more of the pain in the nerve. I’m going to watch the other recommended videos now. Thank you for producing this. ❤ 12/25/2022 Merry Christmas.
How did your recovery go? any atrophied muscle regained post surgery?
As an educated patient, this video exceeds all others Ive looked at and will help me with communication with doctros about my needs to restore my ulnar nerve dysfunction which occured after I had heart surgery. I am 7 weeks out with no improvement. I am trying to avoid surgerical intervention.
Awesome - you're the best of the whole internet, Dr.! Greetings from Brazil
Dr. Ebraheim,
This is simply one of the finest educational videos on hand conditions I have ever seen. Thank you very much for sharing, Bravo! Elliott Skorupa, MSEP Certified Disability Examiner
Elliott Skorupa lol k!kjfjhr
very helpful. thank you for posting!
*Outstanding presentation, again. Merci infiniment. Johnnie de Bangkok*
I have spent months investigating exercises to cure carpal tunnel syndrome pain and found a great resource at Dariks Pain Destroyer (google it if you're interested)
So pain in the ulnar nerve can be caused by carpal tunnel. Interesting. Maybe the carpal tunnel surgery will help with that too then. Fingers crossed (if I could lol)
Super sir thank you so much
How to heal this
I am so tired for this injury
I am really so sad
Did u fix it?
you have more knowledge that any I have encountered - thanks
God bless you Sir.
Excellent video!
comprehensive. Few suggestions:
1. Resolution could be much better
2. There is NO clawing in higher ulnar nerve palsy (NOT less clawing)
3. Froment's sign can be tested better by using both hands of the patients so that comparision can be done.
thanks
You're welcome
dr. nabil, thank you for uploading your videos. I learn so much from them and they always help out with class and in the OR. :)
thank you so much
Thank you, and good work
thank you for videos posting!
Great video!! Thanks!!
Simply excellent. Very grateful for clear, concise and well presented video. Thank you for the great channel. 6/8/2018 😊
Good effort as always.....
Physical Therapy helps with this condition as well which was missing in your treatment section. Overall, great illustration.
I had 8 weeks of physical therapy and dry needling. It helped with the muscle spasms but did not decompress the nerve. I just had surgery and I’m looking forward to 6 weeks from now comparison. Merry Christmas!
VERY NICE WORK.
thanks for sharing this...
pei broker I
very good.a slower write-up will be welcome.
Thank you...
Hi doctor, I know you would need to see the patient for what I'm about to say, but any input would be appreciated. A friend of mine has had a ganglion cyst removed at the wrist and has since had pain and weakness of the pinkie and ring finger. The cyst grew back and a second surgery was performed (cyst was wrapped around the artery). Months after the second surgery, another MRI was taken showing no cyst. However, the patient continues to have pain and some weakness of the pinkie/ring finger area. Its been one year since second surgery. The doctor wants to now do surgery at the elbow for the ulnar nerve. She does have mild "stingy" sensation at the elbow, but her main concern is the wrist pain. What would you do? I understand there are differing opinions and treatment outcomes. Would a cortisone shot in the wrist rule out the elbow as the problem if the pain subsides?
Excellent
I believe that's what I have going on. I have a lump on side wrist on pinky side hurts bad at times
Is it healed?
thank you
eliad
i enjoyed your video.
Juan David Live
Juan David Live गदजतक
Is surgery the only option for guyon tunnel or can i do exercises? Any drugs to help with the pain??
THANK YOUU !!
excellent video. thank you for posting this. I noticed nerve hydrodissection not mentioned as an initial non operative treatment. any thoughts on that?
Cannot express enough the appreciation I have for your educational videos.
Please excuse my ignorance but could you please clarify at segment :38...Does the Ulnar artery pass laterally to the hook of the hamate? Because in segment 2:37 it shows the artery being within the medial side of the hook of the hamate, which would make it the radial border.
I just found this video in searching for an issue with my right hand ulnar region. I cut that are fairly deeply 4 months ago while washing a drinking glass which broke. 6 stitches and after it healed I am still in quite a bit of pain.
Dr's have noted that I seem to have full strength and movement in my fingers and wrist, so have ruled out a ligament issue, but I am of the opinion that the scar tissue from my injury is now impinging on my Ulnar nerve and causing something similar to Guyon's canal syndrome.
Any opinions or similar experiences and how to treat? Cheers!
thx
As always great video!
Is it reversable without a surgery?
Sir, please tell me what are the causes occur with gayon's canol
If we ignore the pain
I am suffering from 1½ years
I have too..on my left side. I didnt feel pain. Only numbness on little finger n a bit weak. Currently on splint. The doctor just give me a vitamin. Any suggestion to reduce the numb? Tq
Pain life's 38 Year strong love's help life's Work..... Blessing loves life's
Could the ulnar nerve been damaged during CTS release intervention?
Christian Verhoeven Same question here! . . . tks
Can this ever be caused by cycling and leaning on one's hands too much? Can it be caused by typing at a computer too long? Thank you!
Another name for this is Handlebar palsy because it is often seen in cyclists
🙏🙏🙏🙏🙏🙏🙏
This is my problem and my brother , my brother too much problem 😪
Ikut donk
Plz help me 😭
3monthe lla saeriakema sir
illa mone