Ulnar Tunnel Syndrome Research Articles

Pressure changes in Guyon's canal after carpal tunnel release

We measured pressure changes in Guyon's canal and the carpal tunnel before and after endoscopic (11 cases) and open (10) carpal tunnel release. We found that release of the flexor retinaculum by endoscopic and open techniques measurably decreased pressure in both the carpal tunnel and Guyon's canal. This study provides an explanation for relief of ulnar tunnel syndrome symptoms following carpal tunnel release and may indicate that carpal tunnel release alone may be sufficient to provide symptomatic relief for most patients with carpal and ulnar tunnel syndromes.

Delayed ulnar tunnel syndrome following a minor closed wrist injury

A 3%year-old lady fell on her outstretched right hand. There was mild pain, but no swelling. A radiograph revealed no fracture of the carpus, and the pain settled in a day with normal function. Five weeks later she noticed progressive weakness of her dominant right hand while doing routine housework. This also affected her professional work on the computer keyboard, due to weakness and palmar flexion of the ulnar fingers of this hand. There was no associated sensory loss. Clinical examination revealed clawing of the ring and little fingers with normal abduction of the latter. There was a positive Froment’s sign with wasting of the interrossei, adductor pollicis, and hypothenar muscles, and no sensory deficit. Radiographs and CT scan of the wrist were normal. Electromyography (EMG)

MR demonstration of an anomalous muscle in a patient with coexistent carpal and ulnar tunnel syndrome case report and literature summary

An aberrant muscle is demonstrated by magnetic resonance (MR) imaging in a patient presenting with focal wrist swelling and compression neuropathy of median and ulnar nerves following 4 months of carpentry work. The muscle originated from the palmaris longus tendon and ulnar antebrachial fascia at the lower half of the forearm as a single belly, then diverged medially from palmaris longus tendon and bifurcated. Both portions of the split muscle extended into the distal ulnar tunnel or Guyon's canal. One segment joined with the abductor digiti minimi muscle and the other with the flexor retinaculum. MR was able to clearly delineate this hypertrophied, symptomatic muscle anomaly. It may be helpful when mass effect is suspected in either tunnel, or in patients with atypical work-related carpal tunnel syndrome with evidence of significant ulnar neuropathy for evaluation of underlying anomalous musculature. Normal MR images of the wrist are included for comparison and the literature is reviewed.

尺骨神経刺激による小指球からのＭ波

In general, configuration of M-wave shows a simple dome-shape by belly-tendon montage. The M-wave recorded over the hypothenar eminence elicited by ulnar naerve stimulation often has double peaks in the negative phase. The origin of this double-peaked response has not been clarified. To investigate the origin of these double peaks, we recorded ulnar M-waves from abductor digiti minimi, 1st dorsal interossei, and adductor pollicis simultaneously in 11 hands of six normal volunteers, in two cases of Guyon's canal syndrome and in two cases of ulnar nerve injury at the wrist. In the seven hands of normal volunteers, we recorded double-peaked M-waves from abductor digiti minimi. The latency of the second peak corresponded to the peak latency of the 1st dorsal interossei and adductor pollicis. In the two cases of Guyon's canal syndrome and in the two cases of ulnar nerve injury at the wrist, M-waves from abductor digiti minimi were a simple domeshape. In those cases M-waves from the 1st dorsal interossei and adductor pollicis were almost absent. We concluded that M-waves from the 1st dorsal interossei and adductor pollicis influenced the second peak of the M-wave recorded over the hypothenar eminence.

Nerve Entrapment Syndromes in the Wrist.

The patient with compression neuropathies of the median and ulnar nerves at the wrist commonly presents with pain, paresthesias, and weakness in the hand and digits. Diagnosis of these conditions is becoming more widespread with the increased attention given to "cumulative trauma disorders" during the past decade. Successful management requires a thorough understanding of the pathophysiology of compression neuropathy and how it relates to the various diagnostic tests available today. The authors review the epidemiology, etiology, and evaluation of compression neuropathy and discuss common clinical presentations, treatment recommendations, and controversies surrounding carpal and ulnar tunnel syndromes.

Double syndrome canalaire au membre supérieur par tophi goutteux: A propos d'un cas

Association of two tunnel syndromes secondary to tophaceous gout is uncommon. This article presents a case of ulnar and carpal tunnel compression. It concerns a 71 year old man with gout and treated for that condition. He presented with paraesthesiae in the fingers and loss of muscular strength in right hand. Physical examination discovered two masses, one in the epitrochlear groove, the other in the olecranon bursa; a severe ulnar palsy and a carpal tunnel syndrome. Neurolysis of both ulnar and median nerves was performed. After 2 years follow-up, paraesthesiae disappeared but atrophy of ulnar intrinsic muscles remained unchanged. The literature is reviewed. Carpal tunnel syndrome is well known in gout (28 reported cases), and is secondary to gouty tenosynovitis. Ulnar tunnel syndrome has been described once by Akizuki in 1984. The combination of the two conditions has not been previously been reported. In our case, median nerve compression was secondary to gouty synovitis but also to a bulky tophus from the floor of the carpal tunnel.

神経鞘腫によるＧｕｙｏｎ管症候群の３例

We experienced 3 cases with ulnar nerve palsy at Guyon's canal caused by a schwannoma.On preoperative examination, all cases had a tender mass at Guyon's camal. There was also loss of sensation in the volar side of the ring and little finger, and a positive Tinnel's sign. Atrophy of the first dorsal interosseus muscle was present in two cases.On electromyographical examination, termnal latency time of the abductor digiti minimi was delayed in all cases.Surgical exploration was performed in all cases and the tumour excised easily.When only using clinical examination, it was very difficult to distinguish between schwannoma with other causes of Guyon's canal syndrome.

Localized nodular synovitis: A rare cause of ulnar nerve compression in Guyon's canal

A rare case of ulnar nerve entrapment at the wrist by a nodule of localized nodular synovitis is presented. The literature is reviewed with particular reference to the causes of ulnar tunnel syndrome, the uncertainty over the origin of this type of tumor, and its tendency to recur after incomplete excision.

ULNAR NERVE COMPRESSION AT THE WRIST

Compression neuropathy of the ulnar nerve at the wrist can be caused by several lesions. The most common cause is a carpal ganglion followed by occupational repeated trauma to the hypothenar area. This process is in contrast to carpal tunnel syndrome in which the majority of the cases are idiopathic in nature with no local cause found except for synovitis of the flexor tendons. The site of the lesion will determine the clinical picture whether it is both motor and sensory abnormalities, only motor paralysis or only sensory abnormality. The latter is rare. If the abnormality is purely motor, then the compression is distal in the ulnar tunnel and the hypothenar muscles are usually spared. Carpal ganglia must be sought and removed. After an extensive search through the literature, I found only one report in which thickening of the volar carpal ligament was found to be the cause of ulnar nerve compression. I encourage the use of the term "ulnar tunnel syndrome" to discuss these lesions and the classification outlined by Shea to determine the site of the lesion. Patients with type 2 syndrome usually present late because of the lack of sensory changes. Average delay in obtaining a diagnosis of 5 months was found in my patients. The condition should be suspected if spontaneous clumsiness or awkwardness of the use of the hand occurs in a middle-aged patient.

PROXIMAL ULNAR NERVE COMPRESSION

Ulnar nerve compression about the elbow is common. If diagnosed and treated early, satisfactory results can be expected. Severe chronic nerve compression may lead to permanent nerve damage. The diagnosis can be made by careful history, physical examination, knowledge of the nerve anatomy, and sometimes electrodiagnosis. Cubital tunnel syndrome must be differentiated from TOS and ulnar tunnel syndrome. Double-crush syndrome should be ruled out. Nonoperative treatment must be attempted first, whereas surgical treatment is indicated in severe and chronic cases. Satisfactory results can be achieved after surgery if nerve damage is absent and careful attention to technical details and gentle handling of the nerve are exercised.

Compression syndromes in reflex sympathetic dystrophy

Over an 8-year period we treated 93 cases of reflex sympathetic dystrophy. The initial treatment consisted of long-acting intramuscular corticosteroids and active exercises. Twenty-two patients who did not respond significantly to this treatment had carpal tunnel syndrome. In addition, five had cubital tunnel syndrome, one had ulnar tunnel syndrome, and one had a herniated disk of the cervical spine. All nerves were decompressed with significant improvement in the patient's condition. Pain was relieved in all except three who had mild pain. Motion of the proximal interphalangeal joint improved from an average of 35 degrees before operation to 76 degrees after operation. Grip strength improved from an average of 4 pounds to 27 pounds.

豆状骨単独骨折の２症例

Isolated fractures of the pisiform bone are uncommon. We reported two cases of isolated fracture of the pisiform bone. The first case was a 40-year-old male, and the second case was a 24-year-old female. The second case showed the Guyon canal syndrome. Both cases were treated by open reduction and fixation with microscrew. Bony unions were otained in both cases. A few months after the operation both patients were asymptomatic.

ガングリオンによるｕｌｎａｒ ｔｕｎｎｅｌ ｓｙｎｄｒｏｍｅの一例

Ulnar tunnel syndrome in the entrapment neuropathy is rare. We reported a case of this syndrome caused by ganglion. A 30-year-old woman complained of paresthesia at the left little finger and a mass in the left palm. The extirpation of the tumor was performed. Both the superficial and deep branches of the ulnar nerve were found to be entrapped by the ganglion. Ulnar nerve palsy was improved remarkably at months after operation.

Ulnar Tunnel Syndrome Caused by Schwannoma-A Case Report-

Ulnar Tunnel Syndrome Caused by Schwannoma-A Case Report-

Thermography in the detection of carpal tunnel syndrome and other compressive neuropathies

Studies were conducted using liquid crystal thermography (FlexiTherm) and electronic thermography for the diagnosis of carpal tunnel syndrome. Studies were also conducted to differentiate carpal tunnel syndrome from peripheral neurovascular injuries. Ninety patients were included in the study, with an average follow-up time of 24 months. Fifty patients also had electric studies for comparison and contrast. Thermal patterns of carpal tunnel syndrome showed a decreased vascular heat emission pattern over the median nerve distribution. The procedures using thermography consisted of imaging of the cervical spine, shoulders, forearms, and hands by Wexlerian guidelines to obtain diagnostic thermograms and a stress series. Results of the studies showed that thermographic studies were efficacious and sensitive for the differential diagnosis of carpal tunnel syndrome from other peripheral compressive neuropathies, including cervical radiculitis, thoracic outlet syndrome, cubital tunnel syndrome, and Guyon's canal syndrome. Biomechanic and etiologic factors indict carpal tunnel syndrome to be an occupational disease. Thermographic technique use may lead to the early diagnosis, treatment, and preventative measures that could eliminate the high cost of manpower loss and of medical care often concomitant with carpal tunnel syndrome.

Atrophy of the thumb web space in rheumatoid arthritis: clinical and electrodiagnostic studies.

One hundred and twenty definite or classical rheumatoid arthritis (RA) patients with an average duration of the disease of 12.1 years were studied. Sixty-two patients had distinct atrophy of the first dorsal interosseous of the hand without definite signs of carpal, cubital, or ulnar tunnel syndrome (group A); 43 patients showed neither distinct atrophy nor sensory disturbance of either hand (group B). Other patients had sensory and/or motor disturbances due to carpal, cubital, or ulnar tunnel syndrome and other neuropathies. Electrodiagnostic examinations revealed that there were differences in the distal latency to the first dorsal interosseous muscle from the wrist between 24 group-A patients and 14 normal controls (P less than 0.05), and between the group-A patients and 12 group-B patients (P less than 0.1). The results of this study indicate that some RA patients with atrophy of the thumb web space may have compression neuropathy of the most distal branches of the ulnar nerve.

Dupuytren's disease as a cause of ulnar tunnel syndrome

Two clinical cases of documented ulnar nerve compression in Guyon's canal caused by Dupuytren's disease are described. Surgical decompression of the canal promptly relieved the symptoms, and histologic studies confirmed the presence of Dupuytren's disease.

Ulnar tunnel syndrome due to an anomalous muscle. (Japanese)

Ulnar tunnel syndrome due to an anomalous muscle. (Japanese)

Neurilemmoma of deep branch of ulnar nerve presenting as ulnar tunnel syndrome

A rare case of neurilemmoma of the deep branch of the ulnar nerve presented as ulnar nerve compression syndrome. This tumour was arising from the deep branch at the wrist just distal to the ulnar tunnel. By its proximity to the sensory division, it led to sensory symptoms in the ulnar two digits. Certain features of this case, which are uncommon are discussed.

Ulnar tunnel syndrome

Ulnar tunnel syndrome or compression of the ulnar nerve at the wrist is of two distinct types. In the first type compression is at the level of the pisiform with involvement of both sensory and motor fibres. In the second type compression is distal to the pisiform with involvement of the motor fibres only.