Guyon’s canal syndrome is caused by blockage or compression of the ulnar nerve in the wrist, leading to numbness and pain in the ring and little fingers. It can be caused by injuries, tumors, pressure, or arthritis. Early symptoms include “pins and needles” sensations, which can progress to burning pain and difficulty controlling hand muscles. Diagnosis is made through a thorough history and tests such as X-rays and nerve conduction velocity. Treatment includes stopping the activities that caused the syndrome, wearing a brace or cast, physical therapy, and surgery if necessary.
Two small bones in the wrist along the bottom edge of the palm, called the pisiform and hamate, form a sort of canal through which the ulnar nerve passes. This is called Guyon’s canal and any blockage or narrowing of this space can lead to tenderness and numbness or pain in the ring finger, little finger and wrist. When something blocks or compresses the ulnar nerve in this location, it is referred to as Guyon’s canal syndrome.
The causes of Guyon’s canal syndrome vary. They may include injuries or fractures of the pisiform or hamate bones. Small tumors can also form near the blocking nerve. Constant pressure on the site, such as when someone holds on to the handlebars of a bicycle can also be a cause and as a result, is sometimes called handlebar palsy. Arthritis in the wrist bones can also create problems in the Guyon’s canal.
Early symptoms include “pins and needles” sensations in the ring and little fingers of the affected hand. When this is ignored, Guyon’s canal syndrome can progress to a very painful, ‘burning’ sensation in the wrist. The condition can also cause ongoing numbness in the little and ring fingers.
The condition often worsens without medical intervention and will eventually result in difficulty controlling the muscles in the hands. Spreading the fingers can be difficult, and thumb movements can be difficult as well. Wrist pain often increases.
Pain and numbness usually signal a problem. Most people with this condition are assumed to have carpal tunnel syndrome. It’s actually easy to distinguish between the two syndromes, because carpal tunnel initially causes numbness in the thumb, index and middle fingers, while Guyon’s canal syndrome affects the little and ring fingers first.
Diagnosis of the condition is made by taking a thorough history and determining the activities in which the patient engages. X-rays may be done if your doctor suspects a broken or fractured bone. Another common test is called a nerve conduction velocity (NCV), which measures the speed of nerve impulses and allows the healthcare provider to definitively diagnose where the nerve is working the slowest.
If Guyon’s canal syndrome is diagnosed in its early stages, stopping the activities that created the situation can sometimes treat it. Patients can wear a brace at night and during the day to keep the wrist in a stable position. If the cause is a fracture, patients can wear a cast. Some medical professionals also prescribe physical therapy to help patients practice better body alignment and positioning of the arms and hands to release pressure on the nerve.
When early intervention doesn’t solve the problem, surgery may be done to remove any obstruction to the ulnar nerve and rebuild a stable passageway for it. This is often an outpatient surgery and patients can usually go home the same day. The hand must remain heavily bandaged for several weeks, and a patient can work with physical therapists after surgery. The outcome of this surgery is usually good, especially when following a regimen of physical therapy.
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