Back to 2012 Annual Meeting Program
Concomitant Release of Guyon’s Canal with Ulnar Nerve Transposition
Kirsty Usher Boyd, MD; Andrew Yee; Hank Haw Sun, BA; Susan E. Mackinnon, MD
Washington University, St. Louis, MO, USA
Background: Ulnar compressive neuropathy at the elbow, or cubital tunnel syndrome, is one of the most common compressive neuropathies in the upper extremity. After failed conservative management, surgical intervention is often required, and a variety of methods ranging from simple decompression to ulnar nerve transposition have been described. These procedures are associated with varying degrees of success. Ulnar nerve compression at the level of Guyon’s canal may also occur, and surgical decompression of the deep motor branch has been described. The prevalence of compressive ulnar neuropathy at both the elbow and the wrist remains unknown, and there is very little in the literature to address simultaneous, compared to staged, decompression at both sites
Purpose: The purpose of this study was to review our practice patterns for the treatment of compressive ulnar neuropathies, and to determine how frequently concomitant release at both the elbow and the wrist is performed.
Method: A retrospective review of all patients undergoing ulnar nerve transposition at the elbow between 2005 and 2010 was performed. Information regarding age, gender, presenting symptoms, clinical signs, electrodiagnostic studies and surgical site of decompression was obtained.
Results: During the study period, 263 patients with 322 affected extremities underwent ulnar nerve transposition. The average age was 47 years (range 13-83). Average follow up was 6 months. Concomitant ulnar nerve transposition and Guyon’s canal decompression was performed in 57% of patients. Patient’s presenting with a positive Froment’s sign, intrinsic atrophy, and the inability to perform an index cross over test were statistically more likely to undergo concomitant release (p<0.05). A positive scratch collapse test and electrodiagnostic studies did not appear to impact surgical decision-making.
Conclusions: Ulnar nerve compression at both wrist and elbow is common, with 57% of patients requiring decompression at both sites. This phenomenon is under-reported in the current literature. With experience, the authors’ have adjusted their practice to perform concomitant Guyon’s canal release at the time of ulnar nerve decompression in selected patients, largely based more on clinical examination than on electrodiagnostic studies. Specifically, Froment’s sign, intrinsic wasting, and inability to perform index cross over predicted concomitant release. Further evaluation of the prevalence of ulnar compression at both sites, and of the clinical outcomes following decompression, is warranted.
Back to 2012 Annual Meeting Program