Canal Syndrome Research Articles

Spontaneous Postoperative Reduction of Ulnar Aneurism by Simple Decompression of Guyon’s Canal in a Patient with Hypothenar Hammer Syndrome: A Case Report

Background: Guyon’s canal syndrome is a pathological condition caused by compression of the ulnar nerve at the level of the wrist. It is less frequent than other compression syndromes of the upper limb (cubital and carpal tunnel), and different causative agents, including vascular lesions, are described. Among these, aneurysm of the ulnar artery is described in the literature as an infrequent aetiology. Case Presentation: We report the case of a 25-year-old young man with Guyon’s canal syndrome caused by an aneurysm of the ulnar artery, who underwent surgical decompression of the Guyon’s canal without intervening on the aneurysm. The postoperative course was free of complications, and the patient reported satisfaction, with reduced symptoms. Clinical examination and ultrasound imaging showed mass reduction of the aneurysm in the postoperative period, which appears to be an evolution hitherto undocumented in the literature. Conclusions: Many treatments are available for Guyon’s canal syndrome. Past medical and surgical treatments, duration and severity of symptoms, causes, and pathogenesis are important for therapeutic choice. Surgical treatment based on ligament section and lysis of the Guyon’s canal downstream, without any action on the aneurysm and with ulnar artery preservation, determined a reduction in terms of volume, relief of the symptoms, and patient satisfaction. With this case we describe a surgical therapeutic option for the treatment of Guyon’s canal syndrome caused by an aneurysm of the ulnar artery, in which surgery is limited to canal decompression and consequential aneurism mass reduction with concomitant relief of symptoms.

Anatomy and pathology of adductor canal (Hunter's canal).

Adductor canal (Hunter's canal) pathologies are often underdiagnosed, with the saphenous nerve being the most commonly affected. While uncommon, involvement of the femoral artery and vein can cause severe and irreversible complications if not detected early. Significant attention must be given to adductor canal pathologies because the musculoaponeurotic tunnel is predominantly fibrotic with minimal adipose tissue. As a result, any edema or space-occupying lesion can lead to early compression of the structures within the adductor canal. Incorporating adductor canal syndrome into the imagingdifferential diagnosisis essential. For diagnosing and sometimes managing these conditions. In this article, we describe theanatomy and spectrum of pathologies involving the Hunter's canal.

Guyon’s Canal Syndrome and its’ impact on everyday life and sport - literature review

Guyon’s Canal Syndrome and its’ impact on everyday life and sport - literature review

Trends and impact of comorbidities on Guyon's Canal release for the treatment of Guyon's Canal syndrome: A decade long nationwide analysis

BackgroundGuyon's Canal Syndrome (GCS) is a rare nerve entrapment condition with limited studies exploring the trends of GCS patients undergoing Guyon's Canal release. The aim of this study is to examine the trends associated with GCS: (1) Guyon's Canal release procedures performed; (2) surgically relevant comorbidities; (3) 90-day readmissions; and (4) same-day and 90-day reimbursement. MethodsA retrospective query was performed on the PearlDiver Mariner Database from 2010 to 2020 by CPT code 64719 to identify patients who underwent Guyon's Canal release. A total of 33,3764 patients were identified. Linear regression models were used to analyze trends in procedures performed, comorbidities, readmission, and reimbursement over this period. A P-value less than 0.05 was considered statistically significant. ResultsBetween 2010 and 2020, there was an overall significant decreasing trend in the number of Guyon's Canal release procedures performed (RC, −127.50; p < 0.001). There was an increase in number of GCS patients that had undergone Guyon's Canal release who drink alcohol (RC, 0.33; p < 0.001), are obese (RC, 0.81; p < 0.001), and use tobacco (RC, 0.56; p < 0.004), and decrease number of GCS patients with a history of diabetes (RC, −0.82; p < 0.001), hypothyroidism (RC, −0.56; p < 0.001), PVD (RC, −0.71; p < 0.001), and RA (RC, −0.33; p < 0.001). We also found an overall increasing trend in 90-day readmissions (RC, 0.09; p = 0.019) and increased same-day (RC, 68.09; p < 0.001) and 90-day average reimbursement (RC, 257.15; p < 0.001) from 2010 to 2020. ConclusionThe study demonstrated a decreasing trend in Guyon's Canal release performed in GCS patients but increasing cost of care implicated by the increased 90-day readmissions and same day and 90-day reimbursement. This may be attributed to the comorbidities present in GCS patients undergoing Guyon's Canal release. Therefore, it is imperative when consulting GCS patients with surgically relevant comorbidities to weigh the risk and benefits of the procedure.

Ultrasound-guided minimally invasive thread release of Guyon’s canal: initial experience in cadaveric specimens

ObjectiveGuyon’s canal syndrome is caused by compression of the ulnar nerve at the wrist, occasionally requiring decompression surgery. In recent times, minimally invasive approaches have gained popularity. The aim of this study was to assess the efficacy and safety of ultrasound-guided thread release for transecting the palmar ligament in Guyon’s canal without harming surrounding structures, in a cadaveric specimen model.MethodsAfter ethical approval, thirteen ultrasound-guided thread releases of Guyon’s canal were performed on the wrists of softly embalmed anatomic specimens. Cadavers showing injuries or prior operations at the hand were excluded. Subsequently, the specimens were dissected, and the outcome of the interventions and potential damage to adjacent anatomical structures as well as ultrasound visibility were evaluated with a score from one to three.ResultsOut of 13 interventions, a complete transection was achieved in ten cases (76.9%), and a partial transection was documented in three cases (23.1%). Irrelevant lesions on the flexor tendons were observed in two cases (15.4%), and an arterial branch was damaged in one (7.7%). Ultrasound visibility varied among specimens, but essential structures were delineated in all cases.ConclusionUltrasound-guided thread release of Guyon’s canal has shown promising first results in anatomic specimens. However, further studies are required to ensure the safety of the procedure.Relevance statementOur study showed that minimally invasive ultrasound-guided thread release of Guyon’s canal is a feasible approach in the anatomical model. The results may provide a basis for further research and refinement of this technique.Key points• In Guyon’s canal syndrome, the ulnar nerve is compressed at the wrist, often requiring surgical release.• We adapted and tested a minimally invasive ultrasound-guided thread release technique in anatomic specimens.• The technique was effective; however, in one specimen, a small anatomic branch was damaged.Graphical

Simultaneous Versus Staged Surgery for Double Crush Syndrome of Cervical Radiculopathy and Peripheral Nerve Compression at the Wrist: A Retrospective Single-Center Study.

Retrospective single-center study. To evaluate the results of surgical treatment in patients with double crush syndrome associated with cervical radiculopathy and upper limb peripheral nerve compression after staged and simultaneous operations. Currently, choosing the optimal diagnostic and therapeutic modalities for treating patients with double crush syndrome remains unresolved. The study included 79 patients with double crush syndrome (cervical radiculopathy and syndrome of Guyon's canal or Carpal tunnel syndrome). Two independent groups were studied: In the Staged Group (n=35), we performed a cervical decompression with stabilization and peripheral nerve decompression at separate days due to ongoing clinical symptoms (average interval between interventions being 22 (18;26) days). In the simultaneous group (n=33), we performed both the cervical spine surgery as well as the peripheral nerve procedures in one surgical session. Total operative time, estimated blood loss, length of hospitalization, complications, and clinical data (NDI score, SF-36, VAS neck pain score, VAS arm pain score, Disabilities of Arm, Shoulder, and Hand (DASH) score, and Macnab scale) were compared. We used the Mann-Whitney (MW) test for intergroup comparisons, the Wilcoxon criterion for dependent samples, and the Fisher exact test for binomial parameters. There was a significantly lower operative time, duration of inpatient treatment, and temporary disability in the simultaneous group (P=0.01, P=0.04, and P=0.006, respectively). Comparative analysis did not reveal significant intergroup differences using NDI, VAS, and DASH ( P >0.05), whereas, at discharge, significantly better clinical parameters were appreciated for the simultaneous group using SF-36 and Macnab scores ( P =0.04 and P =0.03, respectively). At the last follow-up, an intra-group analysis revealed comparable clinical effectiveness between the two approaches ( P >0.05). Comparison of the effectiveness of simultaneous and staged surgery revealed comparable long-term clinical outcomes. However, simultaneous surgery conveys clinically important advantages in terms of surgical time, anesthesia duration, length of hospitalization, and patient disability. 3.

Rare nerve compression neuropathies

In regard to the complex anatomical relationship of peripheral nerves and muscles, tendons, fasciae as well as their long course within those anatomical structures and additional close contact to bony structures, they are prone to suffer from local compression syndromes. Hence creating a vast majority of entrapment syndromes - well described in literature for almost every single nerve. The purpose of this article is to give an overview of symptoms, signs, diagnostic studies and treatment options, addressing especially the less known syndromes. Compression syndromes of the upper arm and shoulder region include the suprascapular nerve syndrome the compression of the axillary nerve within the spatium quadrilaterale and the compression of the long thoracic nerve at the chest wall. The upper extremity offers a variety of infrequent entrapment syndromes, as the pronator teres syndrome and anterior interosseus syndrome, both resulting from pressure to the median nerve in the forearm. Compression neuropathy in the course of the radial nerve in the distal upper extremity is also known as supinator syndrome. Guyon's canal syndrome is the ulnar side equivalent to the well-known carpal tunnel syndrome. In the case of a Cheiralgia paresthetica, a compression of a sensory branch of the superficial radial nerve can be seen. In the lower extremities, a variety of nerves especially in the groin and thigh area can be compressed as they pass through the narrow spaces between the abdominal muscles or underneath the inguinal ligament. Compression of the lateral femoral cutaneous nerve is the most common syndrome. Compression syndromes of the femoral and obturator nerves are most often iatrogenic. Pain around the knee, especially the lateral part and following orthopedic procedures of the knee, can arise from a compression or a lesion of a small infrapatellar branch of the saphenous nerve. Another probably underdiagnosed syndrome is piriformis syndrome, resulting from an entrapment of the sciatic nerve as it passes through certain muscular structures. In the distal lower extremity, the peroneal and tibial nerves can be compressed at multple sites, clinically known as peroneal nerve paralysis resulting from nerve compression around the fibular head, the anterior and posterior tarsal tunnel syndrome, and Morton's metatarsalgia.

On the Issue of Diagnosis and Treatment of Tunnel Neuropathy of the Ulnar Nerve in the Cubital Canal

The article presents current data on the problem of the renal canal syndrome, which is observed in people of working age in certain professions. Anatomical features of the canal and biomechanics of the elbow joint create prerequisites for compression of the ulnar nerve. The issues of distribution, classification, clinic, and effectiveness of various diagnostic methods are considered in detail. The treatment methods are analyzed in detail: conservative and surgical. If conservative treatment is ineffective, various options for surgical decompression are used. Special attention is paid to postoperative complications. Provocative tests, ultrasound, electro-neuromyography, and magnetic resonance imaging are used to diagnose the disease.

The "Near"-Narrowed Internal Auditory Canal Syndrome in Adults: Clinical Aspects, Audio-Vestibular Findings, and Radiological Criteria for Diagnosis.

Vestibular Paroxysmia (VP) refers to short attacks of vertigo, spontaneous or triggered by head movements, and implies the presence of a compressive vascular loop in contact with the cochleovestibular nerve (CVN). Classically, a narrowed internal auditory canal (IAC) corresponds to a diameter of less than 2 mm on CT, usually associated with a hypoplastic CVN on MRI. The aim of this study was to discuss a distinct clinical entity mimicking VP in relation to a "near"-narrowed IAC (NNIAC) and to propose radiological criteria for its diagnosis. Radiological measurements of the IAC were compared between three groups: the study group (SG, subjects with a clinical presentation suggestive of VP, but whose MRI of the inner ear and pontocerebellar angle excluded a compressive vascular loop) and two control groups (adult and children) with normal vestibular evaluations and no history of vertigo. 59 subjects (18 M and 41 F) were included in the SG. The main symptoms of NNIAC were positional vertigo, exercise- or rapid head movements-induced vertigo, and dizziness. The statistical analysis in the study group showed that the threshold values for diagnosis were 3.3 mm (in tomodensitometry) and 2.9 mm (in MRI) in coronal sections of IAC. Although a significantly lower mean value for axial IAC diameter was found in SG compared with controls, the statistics did not reveal a threshold due to the large inter-individual variations in IAC measurements in normal subjects. There was no significant difference in IAC diameter between the adult and pediatric controls. In the present study, we report a new anatomopathological condition that appears to be responsible for a clinical picture very similar-but not identical-to VP in association with the presence of an NNIAC. The diagnosis requires a careful analysis of the IAC's shape and diameters in both axial and coronal planes.

Fibular canal syndrome: modern principles of diagnosis and treatment

Fibular tunnel syndrome is the most common tunnel syndrome of the lower extremity. Compression of the fibular nerve most often occurs at the level of the fibular head. The article describes in detail the etiology and pathogenesis of this tunnel neuropathy. Clinical manifestations of fibular tunnel syndrome are considered, methods of diagnosis and treatment are described. The prognosis of peroneal nerve neuropathy is favorable, and in most patients there is a complete or almost complete restoration of nerve function. If conservative treatment is ineffective, surgical techniques are recommended.

Persistent Mullerian canal syndrome in a 68-year-old patient

Persistent Müllerian duct syndrome is a rare disease, genotypically affects only males (46, XY); Difficult to diagnose, in adulthood patients are normally virilized, the discovery is often fortuitous during surgery to treat intra-abdominal testicular ectopia or during the management of infertility as a couple. Infertility is a common manifestation of the disease. In general, the serum testosterone concentration is normal. In children, surgical treatment is aimed at preserving testicular function, in adulthood the risk of cancerization on the intra abdominal testes is real, the excision of the testes and the müllerien remains is frequently proposed.

Literature study: Superior semicircular canal syndrome (SSCS)

Superior Semicircular Canal Syndrome (SSCS) or Superior Canal Dehiscence Syndrome is a rare abnormality in the medical field in the form of balance disturbance or vertigo caused by loud noises or changes in pressure causing rupture of the roof of the superior semicircular canal. SSCS was first described by Lloyd Minor in 1998 after more than 70 years since Tullio and Hennebert discovered the Tullio phenomenon, a condition in which vertigo or nystagmus is triggered by loud noises, and the Hennebert phenomenon, a condition in which vertigo or nystagmus, is triggered by changes in pressure. The exact prevalence of superior semicircular canal syndrome is not known until now. Estimates of prevalence varied from 0.5–2% of cases in temporal bone studies, to 3–9% of cases in studies performed with CT scans. Cases of SSCS are more common in males than females. Clinical symptoms that appear in SSCS are caused by dehiscence so that patients will complain of autophonia, which the sound produced by their body sounds louder, hyperacusis, tinnitus, vertigo which is triggered by loud noises, and nystagmus. A Careful history, an examination of hearing and balance function, also high-resolution CT scan are needed to establish the diagnose of SSCS. Management can be done conservatively. If the complaints are severe, then operative options can be considered.

Ultrasound Imaging and Guidance for Distal Peripheral Nerve Pathologies at the Wrist/Hand.

Ultrasound has emerged as a highly valuable tool in imaging peripheral nerve lesions in the wrist region, particularly for common pathologies such as carpal tunnel and Guyon's canal syndromes. Extensive research has demonstrated nerve swelling proximal to the entrapment site, an unclear border, and flattening as features of nerve entrapments. However, there is a dearth of information regarding small or terminal nerves in the wrist and hand. This article aims to bridge this knowledge gap by providing a comprehensive overview concerning scanning techniques, pathology, and guided-injection methods for those nerve entrapments. The median nerve (main trunk, palmar cutaneous branch, and recurrent motor branch), ulnar nerve (main trunk, superficial branch, deep branch, palmar ulnar cutaneous branch, and dorsal ulnar cutaneous branch), superficial radial nerve, posterior interosseous nerve, palmar common/proper digital nerves, and dorsal common/proper digital nerves are elaborated in this review. A series of ultrasound images are used to illustrate these techniques in detail. Finally, sonographic findings complement electrodiagnostic studies, providing better insight into understanding the whole clinical scenario, while ultrasound-guided interventions are safe and effective for treating relevant nerve pathologies.

Guyon canal syndrome and handlebar palsy – summary of available knowledge

1. Aleksenko D, Varacallo M. Guyon Canal Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Google Scholar

Non-surgical management of Trapezium canal syndrome an uncommon presentation of Flexor carpi radialis tenosynovitis

Flexor carpi radialis (FCR) tendonitis is described as an uncommon condition that is causing pain at the palmar aspect of the radial wrist. FCR tendonitis is a middle-aged condition which tends to affect the dominant hand. Patients with FCR tendonitis usually presents with pain and swelling over the palmar side of the radial wrist. Resistance against radial deviation of the wrist may illicit tenderness. FCR tendinitis can be diagnose clinically, however, radiographs MRI can help confirm the diagnosis. Management of FCR tendinitis includes physiotherapy, oral anti-inflammatory medication, steroid injection and surgical decompression. Surgical release showed a high rate of symptomatic satisfaction, and a reduced rate of recurrence.

Correlation between the Guyon Canal Syndrome and the Forward Head Posture in Prolonged Smartphone Users

Introduction: From youth to the eldest, smartphones have become an essential gadget of life. Neutral head posture plays an important role in our day-to-day activities as it is responsible for stability. Although smartphones have made our lives easier, they tend to increase the number of complaints related to the cervical spine, hand complex, wrist, and elbow pain as a result of their excessive use. This might result in various faulty postural adaptations, which can greatly contribute to the increased risk of musculoskeletal disorders. Also, its prolonged use can lead to forwarding head posture (FHP), which can be accompanied by Guyon Canal Syndrome (GCS). This study aimed to find and determine the correlation between Guyon canal syndrome and forward head posture in prolonged smartphone users. Methods: This was a cross-sectional study that consisted of 80 college subjects who were selected based on the criterion for selection. The data that was collected included, demographic details, smartphone usage characteristics, the severity of pain, presence of FHP, and mechanosensitivity of the ulnar nerve. Statistical analysis was done using a non-parametric test. Spearman’s correlation coefficient test was used. Results: The results of this study among the 80 prolonged smartphone users showed that 42 users (52.5%) were in the age group of 18–21, and 38 users (47.5%) were found to be in the age group of 22–25. Most of them were right-handed i.e., 61 (76%), while 19 (24%) were left-handed. In BMI, normal-weighing subjects (18.5-24.9) were 48 (60%) and overweight subjects were 32 (40%). Mean + SD of Smartphone Addiction Scale, Visual Analogue Scale, Upper Limb Tension Test and Occiput to Wall Distance was 29.99 + 6.50, 1.48 + 0.86, 0.73 + 0.45, and 2.78 + 0.96, respectively. Spearman’s correlation coefficient was shown to have a moderately positive correlation between both SAS and VAS (r = 0.36, p = 0.0010), SAS and ULTT (r = 0.14, p = 0.022), and SAS and OWD (r = 0.17, p = 0.013). Linear regression was used to check the correlation and significance between FHP and GCS, where the r value was (0.27) and the p-value was 0.0177, which was found to be statistically significant. Conclusion: Based on the findings of this study, we found that there was a positive correlation between forwarding head posture and Guyon canal syndrome in prolonged smartphone users. FHP can give rise to moderate pressure on the ulnar nerve, which mainly supplies the fifth finger of the hand, causing Guyon Canal Syndrome. Hence, we can conclude that in subjects with prolonged usage of smartphones, FHP can further progress and these subjects may have the tendency to develop GCS.

Autoimmune hepatitis complicated with entrapment neuropathy &amp; fibromyalgia: A case report

46. y-old right-handed female with history of controlled autoimmune hepatitis since 2001 with negative liver biopsy on 2017 presented with chronic generalized pain affecting neck, upper back, buttocks, knee and chest associated with paresthesia and tingling of left hand with nocturnal exacerbation. Clinical exam revealed; Neurologically Positive Tinel sign over median nerve at wrist bilaterally, Positive Phalen test bilaterally, Musculoskeletal exam revealed multiple tender points bilaterally with limited neck Rom due to pain. Electrophysiological testing of both upper extremities documented bilateral median sensory neuropathy at wrist, demyelinating pathology and bilateral ulnar nerve entrapment at wrist: Guyon canal syndrome; sensory-motor axonal demyelinating. Normal liver and kidney function tests and glycosylated hemoglobin 5.

Bilateral Martin-Gruber and Marinacci Anastomosis Associated with Carpal Tunnel and Guyon’s Canal Syndrome: Case Report

ABSTRACT Anastomoses between the median and ulnar nerves are commonly found on electrodiagnostic studies. These anastomoses are usually asymptomatic and are not discovered until nerve injuries occur that lead to unusual motor or sensory deficits. Their presence can cause difficulties in the interpretation of electrophysiological findings for the diagnosis of neuropathies and suppose a risk of iatrogenic damage during surgical procedures. We describe a rare case of bilateral Martin Gruber and Marinacci anastomosis, associated with median and ulnar nerve injuries in the carpal tunnel and Guyon’s canal, respectively. The detailed anatomical knowledge of these anastomosis allows the electromyographist to identify them correctly, facilitating the interpretation of the findings and, incidentally, preventing iatrogenic injuries.

Guyon's canal resulting from lipoma: A case report and review of the literature.

IntroductionCompression of the ulnar nerve at the wrist is a rare condition. Clinical presentations of ulnar nerve compression at the wrist and hand can vary widely due to the complex anatomic course of ulnar nerve at the wrist. Lipoma is a common benign soft tissue tumor and rarely causes neuropathy. We present a rare case of Guyon's canal syndrome caused by lipoma.Case reportsWe describe a case with acute ulnar nerve deficit. Clinical examination, EMG and MRI suggested Guyon's canal syndrome. Surgical exploration revealed a well-encapsulated fatty tumor within Guyon's canal. Histopathology demonstrated mature adipose tissue consistent with lipoma. Post-operative course was uneventful and the sensory symptom had subsided at the three month follow up.Discussion and conclusionThere are many etiologies of Guyon's canal syndrome which can be classified into groups. Symptoms of ulnar nerve compression at the wrist can vary depend on the location of the lesion. Treatment options depend on severity and duration of symptoms, previous treatment attempts, and underlying etiology. Lipoma is not a common cause of Guyon's canal with few case reports in the literature. Surgery to open and release the roof of Guyon's canal and excision of the lipoma can yield good outcome in most reports.

Characteristics of surgically treated Guyon canal syndrome: A multicenter retrospective study

Guyon canal (GC) syndrome is a rare peripheral neuropathy involving the distal part of the ulnar nerve. Several causes are associated with GC syndrome, including anatomic variations, space-occupying tumors, and trauma. Because of disease rarity, the only reported studies of GC syndrome are case series with small sample size. We conducted a multicenter study to identify the basic characteristics of patients with surgically treated GC syndrome and the risk factors for the disease. This retrospective multicenter study was conducted between January 2001 and December 2020. We screened 70 patients who underwent GC release surgery by seven hand surgeons at six institutes. A total of 56 patients were included in this study, including 38 patients (67.9%) who underwent isolated GC decompression and 18 (32.1%) who underwent combined peripheral nerve decompression. The mean patient age was 48.4 years (range: 20-89 years), and 40 patients (71.4%) were male. The average preoperative symptom duration was 18.5 months, and most patients were office workers. Ultrasound was positive for GC syndrome in 7/10 patients evaluated, CT in 2/5, MRI in 17/23, and electrodiagnostic studies in 35/44. The most common cause of GC syndrome was tumor (n=23), followed by idiopathic (n=17), trauma (n=12), anatomic variants (n=3), and inflammation (n=3). In conclusion, most patients with GC syndrome in this study were male and had symptoms in one wrist. The most common cause of GC syndrome in this study was a tumor, including a ganglion cyst. Level of Evidence: Level IV case series.