Ulnar Tunnel Syndrome Research Articles

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.

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.

Radiofrequency Ablation of Palmar Digital Branches of Ulnar Nerve in a Patient with Ulnar Neuropathy

Ulnar Tunnel Syndrome (UTS) is ulnar neuropathy at the wrist or hand typically caused by ganglion cysts, lipomas, wrist or hand compression, carpal bone fractures, carpal tunnel syndrome, or anything else that can impinge on the nerve. The symptoms of UTS can be uncomfortable and debilitating, with numbness and tingling of the 4th and 5th digits being the most common. Weakness of the ulnar portion of the hand can lead to decreased grip strength. UTS is typically managed with conservative treatment including anti-inflammatory oral medications, splinting, physical therapy, activity modification, acupuncture, and stretching. Second line treatment includes corticosteroid injections, although these have shown to have little efficacy. Surgery is also an option but may lead to iatrogenic ramifications. Radiofrequency ablation (RFA) is a treatment modality used for chronic pain, which utilizes heat to target nociceptive fibers. Traditionally, RFA is used in treating cervical and lumbar radiculopathy, but it is less studied in peripheral nerve areas. This case report examines a patient who had clinically significant pain relief after RFA to the palmar digital branches of the ulnar nerve. The patient was 63-year-old male who presented with left ulnar neuropathy that had been ongoing for 3 years. Despite conservative management, his symptoms of pain, paresthesia, and weakness persisted. The patient then elected to have a left cubital tunnel release at the elbow with anterior subcutaneous transposition. The surgery provided relief for three months but then led to worsening contractures and pain in the 4th and 5th digits of the left hand. Due to persistent symptoms after conservative management and surgical intervention, he was referred to interventional pain clinic. A decision was made to trial a digital nerve block of the left medial and lateral digital palmar nerves. Following the nerve block, the patient reported 100% improvement in pain and increased range of motion and function. Four weeks later, the patient returned for a radiofrequency ablation of the same nerves. In the week following the procedure, the patient reported that the pain in the little finger was entirely resolved. While radiofrequency ablation has become increasingly popular for the treatment of chronic back pain, its use in peripheral nerve pain has been limited to case reports and few randomized control trials. This case report highlights the successful use of radiofrequency ablation in the treatment of little finger pain and ulnar neuropathy by targeting the median and lateral branches of the palmar digital nerve.

Recurrence of ulnar tunnel syndrome: Long-term clinical and functional results of surgical management using revision neurolysis and subcutaneous anterior transposition

ObjectiveRecurrence after primary ulnar tunnel syndrome surgery is observed in 1.4%–25% of patients. However, the outcome of revision surgery is uncertain and limited. This study aimed to assess the clinical and functional outcomes of neurolysis combined with anterior subcutaneous transposition in cases of recurrence. Patients and methodsThis retrospective single-center study included patients who were operated on for iterative ulnar tunnel syndrome at the elbow between January 1996 and December 2020, with a minimum follow-up of 24 months. Demographic data, pre- and post-operative clinical evaluations, surgical details, and satisfaction levels were collected. ResultsTwenty-eight patients were reviewed. Mean follow-up was 11.7 years (range, 2.1–26.4 years). The secondary procedure led to significant improvement in mean Quick-DASH score, from 25.3 (range, 11–50) to 20.0 (range, 11–49) (p = 0.023), with a satisfaction rate of 78.5%. Symptoms of pain (p = 0.033), amyotrophy (p = 0.013), hypoesthesia (p < 0.01), and paresthesia (p < 0.001) also showed significant improvement. There were 7 cases of failure (25.0%). ConclusionThe combination of neurolysis and anterior subcutaneous transposition was a reliable technique, improving clinical outcome in recurrent ulnar tunnel syndrome after previous surgery. Level of evidenceIV — retrospective study.

SYNDROME DU TUNNEL CUBITAL DUE AU MUSCLE ANCONEUSEPITROCHLEARIS : A PROPOS DUN CAS

Ulnar tunnel syndrome in the elbow is a common ductal neuropathy of the upper limb. The discovery of the anconeusepitrochlearis muscle may be an etiology of this compressive neuropathy, whose management in the event of failure of medical treatment consists of resection of this muscle to relieve the ulnar nerve and avoid sometimes dramatic functional consequences.

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

Comparison of results of arthroscopic arthrolysis between traumatic and degenerative elbow stiffness

IntroductionElbow stiffness significantly affects the patient's quality of life. This joint must have at least 30°/130° extension/flexion and 50°/50° pronation/supination to function normally according to Morrey. HypothesisThe objective of this study was to evaluate functional outcome of arthroscopic arthrolysis by comparing stiffness of post-traumatic and degenerative origin. The hypothesis was that this surgical technique allows functional improvement in any indication but with a faster result in degenerative pathology. Material and methodsThis was a retrospective study including all patients who underwent elbow arthrolysis under arthroscopy, operated on by a single operator, between 2013 and 2020. Thirty-four patients were included, with a mean age of 45years (range, 18–78years). Patients were divided into two groups according to etiology. Group A (post-traumatic) consisted of 18 patients with a mean age of 33years (range, 18–64years) and group B (degenerative) of 16 patients with a mean age of 59years (range, 42–78years). All patients were clinically assessed at a mean 27months. Range of motion, level of satisfaction and Mayo Elbow Performance Score (MEPS) were collected. ResultsIn the overall series, preoperative range of motion was 81° and significantly improved postoperatively to 122° (p<0.001). The preoperative data of the 2 groups were comparable except for age (p<0.001) and MEPS (p=0.044). Postoperatively, range of motion improved significantly in both groups but with greater gain in group A (p=0.003). MEPS improved significantly in both groups, but the postoperative score was poorer in group B (p=0.001). Recovery of range of motion was faster in group B (2.4months) than in group A (3.7months) (p=0.021). There were 5 complications: 4 secondary decompensations of ulnar tunnel syndrome, and 1 postoperative radial nerve paresis. 94% of patients were satisfied or very satisfied with the result of surgery. ConclusionArthroscopic arthrolysis is an effective option for post-traumatic and non-traumatic elbow stiffness. Improvement was significant in terms of both function and range of motion, with, however, better results in the post-traumatic group but results achieved more rapidly in the degenerative pathology group. Level of evidenceIV, retrospective study.

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.

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.

Prospective outcome analysis of ulnar tunnel syndrome: Comparing traumatic versus non-traumatic etiologies

Ulnar tunnel syndrome (UTS) is relatively uncommon compared to the carpal tunnel or cubital tunnel syndromes. Few reports dedicated to the functional outcomes after surgical intervention of the UTS exist. Herein we compare the outcomes of patients with UTS of different etiologies. Patients diagnosed with UTS between 2016 and 2020 were recruited. Ulnar tunnel release was performed in all patients, along with other necessary osteosynthesis or reconstructive procedures in the traumatic group. Patients were followed-up every six months post-operatively. Outcomes measured include: objective evaluations, subjective questionnaires, records of clinical signs, and grading of the British Medical Research Council scale for intrinsic muscle strength. 21 patients were recruited, and favorable results were noted in all of them after surgery. Traumatic UTS patients had a worse initial presentation than the non-traumatic cases, but had a greater improvement after surgery and yielded outcomes comparable with those of the patients without trauma. Patients with aberrant muscles in their wrists had better outcomes in some objective measurements than those without aberrant muscles. Ulnar tunnel release improves the outcome of patients regardless of the etiology, especially in patients with trauma-induced UTS. Thus, a proper diagnosis of the UTS should be alerted in all patients encountering paresthesia in the ulnar digits, ulnar-sided pain, weakness of grip strength, or intrinsic weakness to ensure good outcomes.

New approaches to the diagnosis and surgical treatment of tunnel syndromes of the upper limb

The purpose of the work was to evaluate the modern methods of diagnosis that determined the state of vegetative fibers, tunnel morphology, and surgical treatment of tunnel syndrome. There were 30 healthy individuals (control group) and 45 patients (16 with compression of the ulnar nerve in the zone of cubital canal, 27 with carpal canal syndrome and median nerve compression and 2 patients with Guyon canal syndrome). Clinical-roentgenologic methods, electroneuromyography (ENMG), ultrasonography, computer tomography, Lazer Doppler flowmetry (LDF), ultrasound dopplergraphy of wrist were used. The diagnosis of tunnel syndromes is based on a through clinical-roentgenologic and instrumental evaluation of the nerve trunk fibers function. Not only ENMG with assessment of the sensor and motor innervation is expedient but the evaluation of the neurogenic LDF indices stipulated by sympathic fibers as well. Auxiliary diagnostic method is ultrasonography of tunnel zone which provides information on the morphology of the canal structures, topography and general sizes of the nerves in the compression zone. All patients underwent surgical intervention for the decompression of nerve trunks. It is for the first time that the method of endoscopic dissection of the carpal ligament has been used at our clinic in 7 patients with early stages (I-II) of the disease. Endoscopic method of carpal canal syndrome treatment is an effective and lower invasive intervention that allows to restore the working ability of patients with early stages of the process in a short time.

Guyon canal syndrome after endoscopic carpal tunnel release (ECTR): A case report

Guyon canal syndrome after endoscopic carpal tunnel release (ECTR): A case report

Possible points of compression of the ulnar nerve: Tricks and traps that await clinicians from an anatomical point of view.

The ulnar nerve can be subject to numerous types of compression. The most common are cubital tunnel and ulnar tunnel syndromes, but there are many others with more uncommon etiologies. The existence of additional communicating branches, median nerve involvement, various types of injuries, and unusual anatomical variations can be a challenge for both diagnosis and treatment. This review presents a comprehensive depiction of ulnar nerve entrapment syndromes with particular reference to their anatomical background, risk factors, and clinical evaluation. Even common disorders can result from atypical morphological changes. It is important to be familiar with them as it is a key ability in daily medical practice.

Compression Neuropathies of the Upper Extremity: A Review

Compressive neuropathies of the forearm are common and involve structures innervated by the median, ulnar, and radial nerves. A thorough patient history, occupational history, and physical examination can aid diagnosis. Electromyography, X-ray, and Magnetic Resonance Imaging may prove useful in select syndromes. Generally, first line therapy of all compressive neuropathies consists of activity modification, rest, splinting, and non-steroidal anti-inflammatory drugs. Many patients experience improvement with conservative measures. For those lacking adequate response, steroid injections may improve symptoms. Surgical release is the last line therapy and has varied outcomes depending on the compression. Carpal Tunnel syndrome (CTS) is the most common, followed by ulnar tunnel syndrome. Open and endoscopic CTS release appear to have similar outcomes. Endoscopic release appears to incur decreased cost baring a low rate of complications, although this is debated in the literature. Additional syndromes of median nerve compression include pronator syndrome (PS), anterior interosseous syndrome, and ligament of Struthers syndrome. Ulnar nerve compressive neuropathies include cubital tunnel syndrome and Guyon’s canal. Radial nerve compressive neuropathies include radial tunnel syndrome and Wartenberg’s syndrome. The goal of this review is to provide all clinicians with guidance on diagnosis and treatment of commonly encountered compressive neuropathies of the forearm.

In Situ Neurolysis of Ulnar Nerve for Patients With Failed Anterior Subcutaneous Transposition - A Case Series.

BACKGROUNDVarious surgical techniques have been attempted to treat patients with failed anterior subcutaneous transposition performed for cubital tunnel syndrome.OBJECTIVETo analyze intraoperative findings of failed anterior subcutaneous transposition and to report the outcome of in Situ neurolysis of ulnar nerve.METHODSPatients who, under diagnosis of failed anterior subcutaneous transposition of ulnar nerve, underwent in Situ neurolysis between 2001 and 2018 were included in this study. We excluded patients with follow-up of less than one year, records of traumatic ulnar nerve injury, and concomitant double crush syndrome such as cervical spondylosis causing radicular pain, ulnar tunnel syndrome, or thoracic outlet syndrome. Surgical outcomes were evaluated using visual analog scale (VAS) pain score and Disabilities of the Arm, Shoulder, and Hand (DASH) score, which were assessed before and after surgery. A total of 28 elbows in 27 patients whose average age was 58.5 (range, 31-76) yr were enrolled, and the duration of follow-up was 5.8 (range, 1.0-14.9) yr.RESULTSThe most common pathologic finding identified during operation was severe adhesion of the transposed nerve in all elbows, followed by incomplete decompression of deep flexor-pronator aponeurosis in 26 elbows (93%). The average VAS pain score improved from 4.9 (range, 2-7) to 1.3 (range, 0-5), and the average DASH score from 31.7 (range, 18.1-66.7) to 14.1 (range, 5.0-46.6). Of the 28 elbows, 27 (96.4%) showed improvement of preoperative symptoms.CONCLUSIONIn Situ neurolysis of ulnar nerve for patients with failed anterior subcutaneous transposition resulted in satisfactory outcome.

Influential factors of surgical decompression for ulnar nerve neuropathy in Guyon's canal.

Guyon's canal syndrome is nerve compressive pathology which can lead to sensory and/or motor function deficits. This problem is usually difficult to distinguish from cubital tunnel syndrome and relatively less common than cubital tunnel syndrome. This study evaluated the functional results and patient-reported outcomes following decompression of the ulnar nerve in Guyon's canal. Patients who were diagnosed with Guyon's canal syndrome confirmed by electrodiagnostic studies and underwent nerve decompression surgery were included in this study. The functional improvement by examining the Froment's sign, Wartenberg's sign, static two-point discrimination, and Semmes Weinstein monofilament examination as physical examination scores was evaluated. The visual analogue scale of satisfaction and the disabilities of the arm, shoulder, and hand questionnaire were used for the postoperative patient-reported outcome evaluation. From 2003 to 2019, 38 cases had been enrolled with a mean age of 53 years, ranging from 19 to 85 years. There were seven patients with comorbidity of diabetes mellitus and 28 patients who received additional neurolysis combined with the Guyon's release procedure. There were 19 patients with a good response to surgery and 10 patients with a poor surgical outcome due to persistent paresthesia or weakness. After statistical analysis, it was revealed that several influential factors could have been related to a compromised functional outcome, including a symptom duration of more than 3 months, combination with additional neurolysis of ipsilateral extremity, and/or comorbidity with diabetes mellitus. It was concluded that promising functional outcomes after surgical release of ulnar neuropathy in Guyon's canal could be achieved if the patients did not need additional neurolysis or the symptom duration was within 3 months.

A novel local adipofascial flap for the management of recalcitrant ulnar tunnel syndrome

Ulnar tunnel syndrome is the second most common upper-limb peripheral nerve compression syndrome. Recurrence or persistence of symptoms after primary surgery is found in 9.9%–21% of cases. The main cause of failure is peri- and endo-neural fibrosis, and management is difficult and controversial. Revision of nerve neurolysis combined with freestyle adipofascial flap provides nerve decompression and coverage with vascularized tissue, which prevents scar tissue formation around the nerve and restores glide. We performed a preliminary vessel-injected cadaver study. The perforating vessels from the posterior recurrent ulnar artery vascularize the medial adipose and fascial tissues of the elbow, allowing elevation of an adipofascial flap which is able to reach the ulnar nerve. Eight patients with neuropathic ulnar nerve pain in recalcitrant ulnar tunnel syndrome due to peri- and/or endo-neural fibrosis were treated by neurolysis, and the nerve was covered with an ulnar adipofascial flap. All patients were evaluated by percussion test, visual analog scale for pain, electromyography, electroneurography and ultrasound, and were classified according to the McGowan classification as modified by Goldberg. The study was approved by the review board. All patients had good 4-year outcome, with complete return to daily activity, work and sports 4 months after surgery. The results of this novel surgical technique were encouraging, without complications or donor site morbidity. Adipofascial flap combined with neurolysis could be a valid solution in the treatment of recalcitrant ulnar tunnel syndrome.