| Sign In to gain access to subscriptions and/or personal tools. |
DOI: 10.1016/J.JHSB.2005.10.003
Ulnar Nerve Compression in Guyon’s Canal in the Presence of a Tortuous Ulnar ArteryFrom the Department of Plastic Surgery, George Eliot Hospital, Nuneaton, Warwickshire, UK Correspondence: Mr Rajive Mathew Jose, MS, MCh, FRCS, 2, Magyar Crescent, Whitestone, Nuneaton, Warwickshire, CV11 4SG, UK. Tel.: +44 247 634 4493; fax: +44 247 635 1351. E-mail: rajivemathew{at}yahoo.com
A case of ulnar nerve compression in Guyon’s canal occurring in the presence of a tortuous ulnar artery in the canal is presented and the pathology and classification of ulnar nerve compression in Guyon’s canal discussed.
Key Words: ulnar nerve compression • Guyon’s canal • tortuous artery
Felix Guyon, intrigued by the appearance of small subcutaneous swellings on the palmar aspect of his wrist when he applied digital pressure to the hypothenar eminence, undertook cadaveric dissections of the fibroosseous canal which now bears his name (Guyon, 1861). Entrapment in this canal is a rare, but recognized, form of compression neuropathy of the ulnar nerve. Although Gessler, Huet and Guillain had all reported muscle atrophy of hands in people with certain occupations, it was Hunt, in 1908, who recognized this as being due to an ulnar neuropathy and related it to occupational trauma to the ulnar nerve in the hand (Rengachary and Arjunan, 1981). Compression of the ulnar nerve at this site has also been reported in association with the presence of anomalous muscles or ossicles, ganglia, neoplastic lesions, arthritis and diseases of the ulnar artery (Shea and McClain, 1969). This paper considers a patient who developed ulnar nerve compression neuropathy at the wrist in association with a tortuous ulnar artery.
An 81 year-old man of Asian origin was referred with numbness and tingling along the ring and little fingers of his right hand and poor grip, of 1 year duration. His medical history included hypertension and non-insulin dependent diabetes mellitus. He also had a low HDL and elevated triglycerides. Both hands appeared grossly normal. He was noted to have decreased sensation to light touch over the ring and little fingers and a positive Tinel’s sign over Guyon’s canal. There was also slight weakness of the finger adductor muscles. A clinical diagnosis of ulnar nerve compression at the wrist was made and he underwent Guyon’s canal decompression under local anaesthesia. The ulnar artery was found to be very tortuous and impingeing on the ulnar nerve, which appeared grossly normal (Fig 1). At the final review, 3 months after surgery, he had complete relief of symptoms and the weakness of the finger adductor muscles had improved.
At the wrist, the ulnar neurovascular bundle lies radial to the flexor carpi ulnaris tendon, with the artery radial to the nerve. It then enters Guyon’s canal. In the middle part of the canal, the nerve divides into superficial and deep branches. The superficial branch supplies the palmaris brevis and the skin of the hypothenar eminence, then continues as the sensory branches to the ring and little fingers. The deep branch of the nerve and the ulnar artery take an acute radial turn around the hook of the hamate bone and pass under a tough fibrotendinous arch called the pisohamate hiatus which, in part, gives origin to the muscles of the hypothenar eminence (Rengachary and Arjunan, 1981). Ulnar nerve compression can occur anywhere along its course into and through Guyon’s canal, giving rise to sensory and/or motor symptoms. Shea and McClain (1969) have divided ulnar nerve compression in the wrist and hand into three types (Fig 2).
Although we did not carry out any pre-operative investigations, electrophysiological studies and magnetic resonance imaging (MRI) can aid in diagnosis. The usefulness of electrophysiology in localising the lesion has been described in the literature (Aguiar et al., 2001; Gozke et al., 2003; Seror, 1999). MRI depicts the ulnar tunnel very well (Zeiss et al., 1992) and can reveal compression of the nerve (Bordalo-Rodrigues et al., 2004) Lesions of the ulnar artery have been reported in association with symptoms of ulnar nerve compression in Guyon’s canal (Kalisman et al., 1982; Rainer et al., 2002) The commonest of these lesions of the ulnar artery are aneurysmal dilatations and thromboses. A tortuous ulnar artery in association with ulnar nerve compression has only been reported once before in the literature (Segal et al., 1992). It is difficult to prove conclusively that a tortuous artery is the cause of the nerve compression, particularly as this arterial pathology may have been present for the preceding period of the patient’s life or some considerable part of it. However, the presence of the arterial pathology and the clinical improvement after release of the confined space surrounding nerve and artery are supportive of the arterial problem being, at least, contributory. Tortuosity of arteries in association with neural symptoms have been described commonly in relation to intracranial vessels (Boeri and Passerini, 1964; Kerber et al., 1972).
Received for publication March 23, 2005. Accepted for publication October 6, 2005.
  CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
|
|
 |
 |
Sign In to gain access to subscriptions and/or personal tools.
TOP
Abstract
INTRODUCTION
