Abstract
BackgroundOccupational overuse syndrome (OOS) can present as Guyon's canal syndrome in computer keyboard users. We report a case of Guyon's canal syndrome caused by a ganglion in a computer user that was misdiagnosed as OOS.Case presentationA 54-year-old female secretary was referred with a six-month history of right little finger weakness and difficulty with adduction. Prior to her referral, she was diagnosed by her general practitioner and physiotherapist with a right ulnar nerve neuropraxia at the level of the Guyon's canal. This was thought to be secondary to computer keyboard use and direct pressure exerted on a wrist support. There was obvious atrophy of the hypothenar eminence and the first dorsal interosseous muscle. Both Froment's and Wartenberg's signs were positive. A nerve conduction study revealed that both the abductor digiti minimi and the first dorsal interosseus muscles showed prolonged motor latency. Ulnar conduction across the right elbow was normal. Ulnar sensory amplitude across the right wrist to the fifth digit was reduced while the dorsal cutaneous nerve response was normal. Magnetic resonance imaging of the right wrist showed a ganglion in Guyon's canal. Decompression of the Guyon's canal was performed and histological examination confirmed a ganglion. The patient's symptoms and signs resolved completely at four-month follow-up.ConclusionClinical history, occupational history and examination alone could potentially lead to misdiagnosis of OOS when a computer user presents with these symptoms and we recommend that nerve conduction or imaging studies be performed.
Highlights
Clinical history, occupational history and examination alone could potentially lead to misdiagnosis of Occupational overuse syndrome (OOS) when a computer user presents with these symptoms and we recommend that nerve conduction or imaging studies be performed
Occupational overuse syndrome (OOS) describes a range of ergonomic injuries that result from repetitive demand over time and may be induced by occupation, recreational or leisure activity [1,2]
Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:4 http://www.jbppni.com/content/3/1/4 canal syndrome caused by a ganglion in a computer user that was misdiagnosed as OOS
Summary
Occupational overuse syndrome (OOS) describes a range of ergonomic injuries that result from repetitive demand over time and may be induced by occupation, recreational or leisure activity [1,2]. Guyon's canal syndrome is a well described ulnar nerve entrapment syndrome at the wrist level, and OOS can present as Guyon's canal syndrome in computer keyboard users. Various aetiologies such as trauma, ganglia, ulnar artery aneurysm, anomalous muscle, lipoma, rheumatoid arthritis and fracture of carpal bones have been reported [3]. Four weeks prior to her referral, she was diagnosed by her general practitioner and physiotherapist with a right ulnar nerve neuropraxia at the level of the Guyon's canal. This was thought to be secondary to using a computer keyboard and direct pressure exerted on a wrist support. Magnetic resonance imaging of the right wrist showed a ganglion cyst arising from the wrist and penetrating the ulnar collateral ligament, medial to the carpal tunnel and the hook of hamate (Figure 1)
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