ULNAR TUNNEL SYNDROME - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE - Orthodnb.com

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE - Orthodnb.com

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Thursday 17 May 2018



  • compression of motor or and sensory portions of ulnar nerve in canal of Guyon
  • Guyon's canal
    • fibro osseous triangular space on the ulnar aspect of volar wrist
    • roof - volar carpal ligament proximally – (unites with the tendinous portion of insertion of FCU to pissiform) – distally pisohamate ligament – (extension of FCU from pissiform on to the hook of hamate
    • lateral wall – TCL proximally and hook of hamate distally
    • medial wall – pissiform and its associated fibrous structures, abd. Digi minimi
    • contents – ulnar art and nerve – enter canal at wrist deep and radial to FCU – artery lying radial to nerve
    • proximal part of canal – motor and sensory bundles of nerve lie side by side as one nerve
    • distal margin of pissiform – divides to deep ( motor) and sup (sensory) br
    • Deep br supplies intrinsics of hand
    • superficial – ulnar and radial of little finger, ulnar of ring finger
  • Zones of Ulnar tunnel
    • Zone I
      • from proximal margin of the volar carpal ligament to distal margin of pissiform- where the nerve bifurcates
      • both motor and sensory divisions present
    • Zone II
      • zone of motor branch
    • Zone III
      • zone of sensory branch
      • Causes
  • space occupying lesion
    • ganglion form triquitrohammate ligament (MC)
    • aneurysm, lipoma, acc. Or aberrant muscles
    • # of bony wall (hook of hamate)
  • repeated blunt trauma to hypothenar region ( second common)
    • exposure of vibrating tools
    • repeated percussion to ulnar side of wrist
  • Zone I , II – by ganglion, hook of hamate #
  • Zone III - vascular lesion of ulnar art
  • Clinical features
  • insidious or a/c post traumatic onset
  • symptoms
    • numbness and tingling in ring and little finger
    • weakness of intrinsic muscles of hand
    • pain on ulnar aspect of hand
  • sensory examination
    • decreased sensation in ring and little finger
    • sensation spared on dorsal ulnar hand ( cubital canal)
    • threshold testing most sensitive
  • motor examination
    • decreases strength in ulnar innervated intrinsic muscle of hand
    • spare long flexors of ring and little (claw deformity – paradox)
  • provocative test
    • compression of the ulna just proximal to wrist
    • Tinel's sign
    • Phalen's sign
  • Diagnostic studies
    • Allen's test for vascular sufficiency of ulnar art
    • NCV slowing across the wrist
    • X ray to r/o #
    • MRI for soft tissue swellings
    • USG for evaluation of vascular lesion
    • Differential diagnosis
  • cubital tunnel syndrome
  • thoracic outlet syndrome
  • cervical radiculopathy
  • Treatment
    • decompression
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