Ulnar Tunnel Syndrome (Guyon Canal)
Ulnar nerve entrapment at the wrist, commonly referred to as ulnar tunnel syndrome, has a variable presentation due to the intricate anatomy of the ulnar nerve as it courses through the distal ulnar tunnel, or Guyon’s canal. Having a fundamental understanding of the anatomy of the ulnar nerve at this level will allow the clinician to better diagnose the site of compression. Common etiologies include space-occupying lesions, acute and repetitive trauma, vascular, endocrine and anatomic anomalies. A detailed patient history can be very helpful in eliciting the proper diagnosis. Similarly, a thorough physical exam, including motor, sensory and vascular evaluations, assist in the diagnosis of ulnar tunnel syndrome. Electrodiagnostic and advanced imaging studies can also be helpful in confirming the diagnosis and defining the pathologic lesion responsible for compression. Treatment consists first of nonsurgical management; however surgical decompression may be warranted for failure of nonsurgical treatment or for persistent and/or worsening symptoms.
