Ulnar nerve entrapment in Guyon’s canal caused by a ganglion cyst: two case reports and review of the literature

Springer Science and Business Media LLC - Tập 29 - Trang 1565-1574 - 2019
Stylianos Tottas1, Ioannis Kougioumtzis1, Zafeiria Titsi1, Athanasios Ververidis1, Konstantinos Tilkeridis1, Georgios I. Drosos1
1Orthopaedic Department, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece

Tóm tắt

In this article, two cases of ulnar nerve neuropathy in Guyon’s canal caused by a ganglion cyst are reported. A review of the literature found 73 cases reported in 35 articles of ulnar neuropathy at the wrist secondary to a ganglion cyst. We investigated the pathogenesis of ganglion cysts, which are separated as extraneural and intraneural. At this anatomical area, there are a variety of clinical factors that can also lead to ulnar nerve compression such us trauma, fracture of the hamate’s hook, arterial thrombosis, tumors and other anatomical variations. The symptoms may include weakness, paresthesia, numbness and atrophy of hypothenar muscles. Except the careful clinical assessment, magnetic resonance imaging, ultrasound and electrophysiological control are useful tools regarding our differential diagnosis. The treatment of this clinical condition is surgical. We consider that instant surgical decompression is of the essence and enables postoperatively total recovery. Level III.

Tài liệu tham khảo

Latinovic R, Gulliford MC, Hughes RA (2006) Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry 77(2):263–265 Chen SH, Tsai TM (2014) Ulnar tunnel syndrome. J Hand Surg 39(3):571–579 Earp BE, Floyd WE, Louie D, Koris M, Protomastro P (2014) Ulnar nerve entrapment at the wrist. J Am Acad Orthop Surg 22(11):699–706 Murata K, Shih JT, Tsai TM (2003) Causes of ulnar tunnel syndrome: a retrospective study of 31 subjects. J Hand Surg 28(4):647–651 Depukat P, Mizia E, Kuniewicz M et al (2015) Syndrome of canal of Guyon—definition, diagnosis, treatment and complication. Folia Med Cracoviensia 55(1):17–23 Wang B, Zhao Y, Lu A, Chen C (2014) Ulnar nerve deep branch compression by a ganglion: a review of nine cases. Injury 45(7):1126–1130 Nahra ME, Bucchieri JS (2004) Ganglion cysts and other tumor related conditions of the hand and wrist. Hand Clin 20(3):249–260 Aleksenko D, Dulebohn SC (2017) Guyon canal syndrome. StatPearls, Treasure Island (FL) Pearce C, Feinberg J, Wolfe SW (2009) Ulnar neuropathy at the wrist. HSS J 5(2):180–183; quiz 184–185 Kobayashi N, Koshino T, Nakazawa A, Saito T (2001) Neuropathy of motor branch of median or ulnar nerve induced by midpalm ganglion. J Hand Surg 26(3):474–477 Bordalo-Rodrigues M, Amin P, Rosenberg ZS (2004) MR imaging of common entrapment neuropathies at the wrist. Magn Reson Imaging Clin N Am 12(2):265–279 Wang H, Terrill RQ, Tanaka S, Amrami KK, Spinner RJ (2009) Adherence of intraneural ganglia of the upper extremity to the principles of the unifying articular (synovial) theory. Neurosurg Focus 26(2):E10 Bowers WH, Doppelt SH (1979) Compression of the deep branch of the ulnar nerve by an intraneural cyst. Case report. J Bone Joint Surg 61(4):612–613 Zielinski CJ (2003) Intraneural ganglion of the ulnar nerve at the wrist. Orthopedics 26(4):429–430 Chen WA, Barnwell JC, Li Y, Smith BP, Li Z (2011) An ulnar intraneural ganglion arising from the pisotriquetral joint: case report. J Hand Surg 36(1):65–67 Naam NH, Carr SB, Massoud AH (2015) Intraneural Ganglions of the hand and wrist. J Hand Surg 40(8):1625–1630 Spinner RJ, Scheithauer BW, Amrami KK (2009) The unifying articular (synovial) origin of intraneural ganglia: evolution-revelation-revolution. Neurosurgery 65(4 Suppl):A115–A124 Brooks DM (1952) Nerve compression by simple ganglia. J Bone Joint Surg 34(3):391–400 Seddon HJ (1952) Carpal ganglion as a cause of paralysis of the deep branch of the ulnar nerve. J Bone Joint Surg 34(3):386–390 Jenkins SA (1952) Solitary tumours of peripheral nerve trunks. J Bone Joint Surg 34(3):401–411 Richmond DA (1963) Carpal Ganglion with Ulnar Nerve compression. J Bone Joint Surg 45:513–515 Vanderpool DW, Chalmers J, Lamb DW, Whiston TB (1968) Peripheral compression lesions of the ulnar nerve. J Bone Joint Surg 50(4):792–803 Hayes JR, Mulholland RC, O’Connor BT (1969) Compression of the deep palmar branch of the ulnar nerve. Case report and anatomical study. J Bone Joint Surg 51(3):469–472 Forshell KP, Hagstrom P (1975) Distal ulnar nerve compression caused by ganglion formation in the loge de Guyon. Case report. Scand J Plast Reconstr Surg 9(1):77–79 McDowell CL, Henceroth WD (1977) Compression of the ulnar nerve in the hand by a ganglion. Report of a case. J Bone Joint Surg 59(7):980 Kuschner SH, Gelberman RH, Jennings C (1988) Ulnar nerve compression at the wrist. J Hand Surg 13(4):577–580 Feldman MD, Rotman MB, Manske PR (1995) Compression of the deep motor branch of the ulnar nerve by a midpalmar ganglion. Orthopedics 18(1):65–67 Shu N, Uchio Y, Ryoke K, Yamamoto S, Oae K, Ochi M (2000) Atypical compression of the deep branch of the ulnar nerve in Guyon’s canal by a ganglion. Case report. Scand J Plast Reconstr Surg Hand Surg 34(2):181–183 Kitamura T, Oda Y, Matsuda S, Kubota H, Iwamoto Y (2000) Nerve sheath ganglion of the ulnar nerve. Arch Orthop Trauma Surg 120(1–2):108–109 Elias DA, Lax MJ, Anastakis DJ (2001) Musculoskeletal images. Ganglion cyst of Guyon’s canal causing ulnar nerve compression. Can J Surg 44(5):331–332 Nakamichi K, Tachibana S (2003) Ganglion-associated ulnar tunnel syndrome treated by ultrasonographically assisted aspiration and splinting. J Hand Surg 28(2):177–178 Papathanasiou ES, Loizides A, Panayiotou P, Papacostas SS, Kleopa KA (2005) Ulnar neuropathy at Guyon’s canal: electrophysiological and surgical findings. Electromyogr Clin Neurophysiol 45(2):87–92 Jacob A, Moorthy TK, Thomas SV, Sarada C (2005) Compression of the deep motor branch of the ulnar nerve: an unusual cause of pure motor neuropathy and hand wasting. Arch Neurol 62(5):826–827 Duggal A, Anastakis DJ, Salonen D, Becker E (2006) Compression of the deep palmar branch of the ulnar nerve by a ganglion: a case report. Hand 1(2):98–101 Erkin G, Uysal H, Keles I, Aybay C, Ozel S (2006) Acute ulnar neuropathy at the wrist: a case report and review of the literature. Rheumatol Int 27(2):191–196 Inaparthy PK, Anwar F, Botchu R, Jahnich H, Katchburian MV (2008) Compression of the deep branch of the ulnar nerve in Guyon’s canal by a ganglion: two cases. Arch Orthop Trauma Surg 128(7):641–643 Chan JC, Tiong WH, Hennessy MJ, Kelly JL (2008) A Guyon’s canal ganglion presenting as occupational overuse syndrome: a case report. J Brachial Plex Peripher Nerve Inj 3:4 Chalidis BE, Sachinis NC, Dimitriou CG (2009) Ulnar nerve penetration by a volar ganglion in the Guyon canal. Plast Reconstruct Surg 124(5):264e–266e Almeida V, de Carvalho M (2010) Lesion of the deep palmar branch of the ulnar nerve: causes and clinical outcome. Neurophysiol Clin 40(3):159–164 Kwak KW, Kim MS, Chang CH, Kim SH (2011) Ulnar nerve compression in Guyon’s Canal by Ganglion Cyst. J Korean Neurosurg Soc 49(2):139–141 Okada M, Sakaguchi K, Oebisu N, Takamatsu K, Nakamura H (2011) A ganglion within the ulnar nerve and communication with the distal radioulnar joint via an articular branch: case report. J Hand Surg 36(12):2024–2026 Colbert SH, Le MH (2011) Case report: intraneural ganglion cyst of the ulnar nerve at the wrist. Hand 6(3):317–320 Jayakumar P, Jayaram V, Nairn DS (2014) Compressive neuropathies related to ganglions of the wrist and hand. Hand Surg 19(1):113–116 Bingol UA, Cinar C, Tasdelen N (2015) Ganglion cyst associated with triangular fibrocartilage complex tear that caused ulnar nerve compression. Plast Reconstruct Surg 3(3):e318 Gan LP, Tan JS (2016) Concomitant lipoma and ganglion causing ulnar nerve compression at the wrist: a case report and review of literature. Ann Plastic Surg 76(4):472–473 Meena S, Gupta A (2014) Dorsal wrist ganglion: current review of literature. J Clin Orthopaed Trauma 5(2):59–64 Thommasen HV, Johnston S, Thommasen A (2006) Management of the occasional wrist ganglion. Can J Rural Med 11(1):51–52 Depukat P, Mizia E, Klosinski M et al (2014) Anatomy of Guyon’s canal: a systematic review. Folia Med Cracoviensia 54(2):81–86 Maroukis BL, Ogawa T, Rehim SA, Chung KC (2015) Guyon canal: the evolution of clinical anatomy. J Hand Surg 40(3):560–565 Shea JD, McCLAIN EJ (1969) Ulnar-nerve compression syndromes at and below the wrist. JBJS 51(6):1095–1103 Gross MS, Gelberman RH (1985) The anatomy of the distal ulnar tunnel. Clin Orthop Relat Res 196:238–247 Rohilla S, Yadav RK, Dhaulakhandi DB (2009) Lipoma of Guyon’s canal causing ulnar neuropathy. J Orthopaed Traumatol 10(2):101–103 Francisco BS, Agarwal JP (2009) Giant cell tumor of tendon sheath in Guyon’s canal causing ulnar tunnel syndrome: a case report and review of the literature. Eplasty 9:e8 Aguiar PH, Bor-Seng-Shu E, Gomes-Pinto F, Almeida-Leme RJD, Freitas ABR, Martins RS, Nakagawa ES, Tedesco-Marchese AJ (2001) Surgical management of Guyon’s canal syndrome, an ulnar nerve entrapment at the wrist: report of two cases. Arquivos de Neuro-Psiquiatria 59(1):106–111 Blum AG, Zabel JP, Kohlmann R, Batch T, Barbara K, Zhu X, Gilles D, Dap F (2006) Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics 26(4):1021–1044 Kowalska B, Sudoł-Szopińska I (2012) Ultrasound assessment on selected peripheral nerve pathologies. Part I: entrapment neuropathies of the upper limb–excluding carpal tunnel syndrome. J Ultrasonogr 12(50):307 Shen L, Masih S, Patel DB, Matcuk GR Jr (2016) MR anatomy and pathology of the ulnar nerve involving the cubital tunnel and Guyon’s canal. Clin Imaging 40(2):263–274 Shehab R, Mirabelli MH (2013) Evaluation and diagnosis of wrist pain: a case-based approach. Am Family Phys 87(8):568 Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D (2006) Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics 26(5):1267–1287 Stephen AB, Lyons AR, Davis TRC (1999) A prospective study of two conservative treatments for ganglia of the wrist. J Hand Surg 24(1):104–105 Richman JA, Gelberman RH, Engber WD, Salamon PB, Bean DJ (1987) Ganglions of the wrist and digits: results of treatment by aspiration and cyst wall puncture. J Hand Surg 12(6):1041–1043 Hoogvliet P, Coert JH, Fridén J, Huisstede BMA (2013) How to treat Guyon’s canal syndrome? Results from the European HANDGUIDE study: a multidisciplinary treatment guideline. Br J Sports Med 47(17):1063–1070