Ulnar tunnel syndrome

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Cartoon depiction of classic ulnar sensory distribution, including mid-4th and 5th fingers. Note that this diagram does not portray hand muscles affected by ulnar neuropathy.

Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is caused by entrapment of the ulnar nerve in the Guyon canal as it passes through the wrist.[1] Symptoms usually begin with a feeling of pins and needles in the ring and little fingers before progressing to a loss of sensation and/or impaired motor function of the intrinsic muscles of the hand which are innervated by the ulnar nerve. Ulnar tunnel syndrome is commonly seen in regular cyclists due to prolonged pressure of the Guyon's canal against bicycle handlebars.

Classification[edit]

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 motor branch and a deeper sensory 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]

Location Symptoms Associations
  Zone 1   Proximal (prior to ulnar nerve bifurcation) Mixed motor & sensory Ganglia & hook of hammate fractures
  Zone 2   Surrounding deep motor branch ulnar nerve Motor only Ganglia & hook of hammate fractures
  Zone 3   Surrounding superficial sensory branch of ulnar nerve Sensory only Ulnar artery pathology

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

Treatment[edit]

Massage therapy, acupuncture, physical therapy, occupational therapy, chiropractic and osteopathic care are a common start to musculoskeletal treatment programs because they work directly with the areas affected (muscles, fascia and skeleton).[2][3][4] All of these treatments can be both cost-effective and produce minimal negative side effects. If these options do not produce the desired results, some doctors may recommend working with a pharmaceutical or surgical option.

Initial line of treatment is with anti-inflammatory drugs or cortisone injections. There have been trials with gloves which help protect the ulnar nerve from compression. The most radical treatment option is surgery to relieve tension in the volar carpal ligament which forms the roof of Guyon's canal, thereby reducing compression on the ulnar nerve.[5]

See also[edit]

References[edit]

  1. ^ a b Hatch, Daniel (August 20, 2014). "Ulnar Tunnel Syndrome". Orthobullets. Retrieved Sep 7, 2014. 
  2. ^ http://www.webmd.com/pain-management/guide/musculoskeletal-pain
  3. ^ http://www.massagetherapy.com/articles/index.php/article_id/1918/Massage-Science-and-Your-Health
  4. ^ http://www.medscape.com/viewarticle/747199
  5. ^ Okutsu, I.; Hamanaka, I.; Yoshida, A. (2009). "Pre- and Postoperative Guyon's Canal Pressure Change in Endoscopic Carpal Tunnel Release: Correlation with Transient Postoperative Guyon's Canal Syndrome". Journal of Hand Surgery 34 (2): 208–11. doi:10.1177/1753193408100122. PMID 19282410. 

Further reading[edit]