ULNAR TUNNEL SYNDROME

• 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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