Guyon Canal Syndrome Definition, Symptoms, Causes, Test, Treatment

What is Guyon Canal Syndrome?

Guyon Canal Syndrome, also known as ulnar tunnel syndrome or handlebar palsy, is a condition caused by compression of the ulnar nerve at the wrist. The ulnar nerve is a major nerve that runs from the forearm to the hand, providing sensation to the little finger and half of the ring finger, and controlling some of the muscles in the hand.

Definition

Guyon canal syndrome is defined as rare peripheral ulnar neuropathy that involves injury to the distal portion of the ulnar nerve as it travels through a narrow anatomic corridor at the wrist. The ulnar nerve originates from C8-T1 and is a terminal branch of the brachial plexus.

Symptoms

Tingling, numbness, or pain in the little finger and half of the ring finger: This is the most common symptom, often described as a pins-and-needles sensation.

Weakness in the hand: You may have difficulty gripping objects, pinching, or spreading your fingers.
Clumsiness: Dropping things due to weakness or numbness becomes more frequent.
Clawed hand: In severe cases, the muscles in the hand can waste away, causing the little finger and ring finger to curl inward.

Causes

Repetitive trauma: Activities that involve prolonged pressure on the palm or wrist, such as using vibrating tools, playing certain musical instruments, or cycling, can irritate the ulnar nerve.
Fractures or dislocations: Broken bones or misaligned joints in the wrist can compress the nerve.
Ganglion cysts: These fluid-filled sacs can put pressure on the nerve in
the Guyon canal.
Tumors: Although rare, tumors in the area can also compress the nerve.

Test

Physical Examination:

Detailed symptom history assessment.
Specific physical maneuvers (Tinel's, Froment's, Wartenberg's signs).
Muscle strength and sensation testing.

Imaging Tests:

X-rays: Reveal bone issues.
MRI: Detailed soft tissue images.

Electrodiagnostic Tests:

Nerve conduction studies: Detects compression-related signal slowing.
Electromyography: Identifies nerve-related muscle weakness.

Additional Tests:

Doppler ultrasound: Assesses ulnar artery blood flow, checking for dual compression effects.

Treatment

Conservative Measures:

Rest: Avoid activities causing symptoms (repetitive hand motions, forceful gripping).
Splinting: Wear a wrist splint to maintain a neutral wrist position, reducing nerve pressure.
Ice packs: Apply ice packs for 15-20 minutes multiple times daily to reduce inflammation and pain.
Pain medication: Use over-the-counter pain relievers (ibuprofen, acetaminophen) for pain management.
Physical therapy: Perform prescribed exercises to enhance flexibility, range of motion, and nerve gliding.
Steroid injections: Inject corticosteroids into Guyon canal to effectively reduce inflammation and pain.

Surgical Treatment:

If conservative measures fail or symptoms are severe:

Consider open carpal tunnel release surgery.
Release ligament compressing the ulnar nerve to create more space.

Recovery

Varies based on severity and treatment type.
Conservative measures often show improvement within weeks or months.
Surgical recovery typically takes 6-12 weeks, with gradual improvement over months.