Isolated compression of the ulnar motor branch due to carpal joint ganglia: clinical series, surgical technique and post
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ORIGINAL ARTICLE
Isolated compression of the ulnar motor branch due to carpal joint ganglia: clinical series, surgical technique and postoperative outcomes Michela Saracco1 · Rocco Maria Panzera1 · Barbara Merico2 · Francesca Madia2 · Antonio Pagliei1 · Lorenzo Rocchi1 Received: 23 June 2020 / Accepted: 3 October 2020 © The Author(s) 2020
Abstract The entrapment of the ulnar nerve in Guyon’s canal (GC) is a well-known wrist canalicular syndrome which is usually followed by a gradual combination of both sensitive and motor symptomatology. However, GC nerve compression could also cause a pure hand motor dysfunction. This condition, less frequent than the classic Guyon’s syndrome, can be difficult to diagnose. Authors report a case series of eight patients affected by isolated compression of the ulnar nerve motor branch, due to piso-triquetrum or triquetro-hamate joint ganglia. Surgical technique and postoperative outcomes are discussed in this paper. The isolated compression of the ulnar nerve motor branch is a very rare clinical condition which is often linked to several causes. The rarity of the pathology is probably due to lack of knowledge and therefore to the difficulty in formulating a correct diagnosis. Surgical treatment appears to be decisive in most cases, although late diagnosis often leads to incomplete functional recovery. Keywords Ulnar nerve · Entrapment · Motor branch · Motor dysfunction · Joint ganglia
Introduction Entrapment syndromes of the ulnar nerve are quite widespread in the population, second only to carpal tunnel syndrome. The ulnar nerve may be compressed at different points along its course into the forearm and hand. The most frequent site of compression is at the elbow, followed by Guyon’s canal (GC) [1]. The space in which the ulnar nerve runs into the wrist was first described by Felix Guyon in 1861, but it was only in 1908 that a compression syndrome of the ulnar nerve at this level was identified [2, 3]. The etiology of the ulnar nerve compression at the wrist includes soft-tissue tumors, repetitive or acute trauma, the presence
* Michela Saracco [email protected] 1
Department of Orthopaedics ‑ Hand Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
Department of Neurophysiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
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of anomalous muscles and fibrous bands, arthritic, synovial, endocrine, and metabolic conditions, iatrogenic injury and soft tissue edema following previous trauma or burns [4]. Depending on whether the compression is at the GC level or further downstream, the symptomatology can be sensitive, functional or a combination of both. The GC is a 4 cm fibrous-bone tunnel. It extends radiallyto-ulnary from the transverse carpal ligament, proximally to the pisiform, to the enthesis of the hypothenar muscles at the hook of the hamate. The ulnar nerve passes thr
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