Delayed onset ulnar nerve neuropathy following hand injury: a case report

Abstract

We present a 40-year-old man, manual worker, who sustained a right hand injury, after a fall on his outstretched hand. Initial diagnosis was isolated pisiform fracture, documented with the conventional carpal views and a conservative treatment was applied by using a cast. Three months after the trauma episode, the patient presented at hospital outpatient’s clinic with symptoms of ulnar neuropathy. The fracture had been already united, according to the signs of callus formation in plane radiographs. Nerve conduction studies confirmed the ulnar nerve’s neuropathy and a decision of surgical exploration of Guyon’s canal was made. Intraoperatively, we found that pisohamate ligament was ruptured and an acquired aberrant fibrous band was the main cause of ulnar nerve compression. The patients’ symptoms were promptly receded after the resection of the pisohamate ligament band. At one-year follow-up, no recurrence of symptoms was reported and the patient was successfully returned to his priory to injury occupation.