How Guyon’s Canal Syndrome Is Diagnosed and Treated

Arthritis, carpal tunnel syndrome, tendinitis, and injuries are common causes of wrist and hand pain. However, when sharp tingling and burning sensations affect the ring and pinky fingers (and also cause weakened grip strength), the reason might be a relatively rare hand and wrist problem called Guyon’s canal syndrome.

Less than 4% of the population is born with anatomy that causes Guyon’s canal syndrome on its own. Instead, most of the time this condition occurs as a result of putting heavy stress on your wrists over an extended period or due to an underlying condition like ganglion cysts.

Keep reading to learn how to identify the symptoms of Guyon’s canal syndrome, the activities that cause it, and the most common treatment options.

What Is Guyon’s Canal Syndrome?a

Guyon canal syndrome (also known as Guyon’s tunnel syndrome, ulnar tunnel syndrome (UTS), and handlebar palsy) is an ulnar nerve compression in the wrist.

The ulnar nerve is a major arm nerve that extends from your shoulder to your hand, passing through a narrow channel in your wrist and palm called the Guyon canal, which is located on the underside (palm side) of the wrist, the same side as the pinky finger. Your ulnar nerve controls movement and feeling in the forearm, hand, and fingers.

Guyon’s canal syndrome occurs when the nerve becomes pinched inside the passageway. Usually, symptoms become progressively worse over time with use. They may be worse at night or in the morning after sleeping with your elbow bent.

Some common risk factors include:

• Repetitive hand and wrist movements
• Wrist injury
• Sports
• Construction work
• Arthritis
• Diabetes
• Anatomical variations

Guyon’s Canal Syndrome Causes

Guyon’s canal syndrome can be caused by an acute injury, repetitive trauma, or a condition that originates elsewhere in the arm or wrist and affects the ulnar nerve.

Compression of the ulnar nerve at the wrist by ganglion cysts accounts for 30 to 45% of cases of this condition. Ganglion cysts are sacs of fluid that develop near joints or tendons for unknown reasons. A large cyst in the hand or wrist can pinch the ulnar nerve and produce the symptoms of the syndrome. Ganglion cysts are most common in women ages 20 to 40, though they can develop at any age.

Some sports and different types of physical labor can also increase your risk of developing Guyon’s canal syndrome. The following are examples of activities linked with ulnar nerve entrapment in the Guyon canal:

• Cycling: Bracing or leaning on the handlebars puts pressure on the wrist in the area of the ulnar nerve.
• Baseball: A hook of hamate fracture in the wrist is a common baseball injury near the ulnar nerve. Guyon’s canal syndrome can develop as a complication of a hamate fracture.
• Heavy machinery use: Prolonged manual work that puts consistent pressure on the palm or wrist, or involves hard twisting, can damage the ulnar nerve and cause symptoms of Guyon’s canal syndrome. Tools that vibrate, like a jackhammer, add extra risk.
• Other manual labor: Besides tools, construction work poses a risk for Guyon’s canal syndrome in other ways. Bracing yourself with a palm on a hard surface or turning your hand or wrist in awkward positions can stress the ulnar nerve over time.

Learn the signs you have broken the side of your hand

Guyon’s Canal Syndrome Symptoms

The ulnar nerve splits into two branches in the palm. One branch controls movement, and the other regulates sensation. The compression can be on either branch, affecting either movement or sensation, or on the nerve trunk, affecting both.

• Sensation: The discomfort may include numbness, tingling, or burning. The sensation affects only the pinky finger and the side of the ring finger closest to the pinky.
• Movement: Muscle weakness makes it difficult to grip and perform fine motor skills. You may have trouble buttoning shirts or opening a jar. The impairment may also include difficulty spreading your fingers apart.
• Claw hand: In severe cases, the pointer and ring fingers may cramp and lock up.
• Radiating symptoms: If Guyon’s canal syndrome progresses, the sensations can radiate up the forearm to the elbow.

Zones of Compression

Guyon’s canal syndrome is categorized by the location of the compression, called zones: the nerve trunk, the motor branch, or the sensory branch.

• Zone 1 is located on the nerve trunk, at the top of your wrist, where it meets your palm. Symptoms may be mixed with both numbness and tingling and weakness, or just numbness and tingling without weakness.
• Zone 2 is located above Zone 1, near the bottom of your palm. Zone 2 affects the motor branch only. Weakness is the primary or only symptom.
• Zone 3 is found above Zone 2, near the middle of the palm, below the pinky finger. Zone 3 affects the sensory branch only. Tingling or numbness in the pinky and ring fingers is the primary symptom, and weakness is typically minimal.

Difference Between Guyon’s Canal, Carpal Tunnel, and Cubital Tunnel Syndromes

Capral tunnel and cubital tunnel syndromes are also nerve entrapments and are more common than Guyon’s canal syndrome. The early symptoms of all three are similar, but the location of symptoms sets them apart.

• Back of the hand: Cubital tunnel syndrome, which also affects the ulnar nerve, produces tingling, numbness, or burning on the back of the hand. Guyon’s canal syndrome doesn’t.
• Other fingers: Carpal tunnel syndrome, caused by compression of the median nerve, affects the fingers that Guyon’s canal doesn’t. This includes the thumb, the index finger, the middle finger, and the half of the ring finger next to the middle finger.

Find out how carpal tunnel syndrome is diagnosed using EMG tests

Diagnosing Ulnar Tunnel Syndrome

Physicians consider a patient’s history, a physical exam, and everyday activities or recent incidents that have affected the hand and wrist.

Simple clinical exams can help point to Guyon’s canal syndrome:

• Froment’s Sign: The physician will ask you to hold a piece of paper between your thumb and index fingers and try to pull the paper away. This is done to test the strength of the ulnar nerve, even though symptoms don’t occur in the thumb and index finger.
• Tinel’s Test: The physician will tap on the wrist around the Guyon’s canal to gauge the sensitivity of the ulnar nerve.
• Compression testing, or pushing on the nerve to see if symptoms develop in your fingers, is also used.

If further examination is needed, the physician may order a nerve conduction study to test the strength of electrical signals in the nerve, or an MRI to look for masses such as cysts or rule out other sources of the symptoms.

Guyon’s Canal Treatment Options

Noninvasive treatments may be enough to resolve symptoms of Guyon’s canal syndrome. Surgery, however, may be recommended if you have a large cyst or severe nerve or muscle damage.

Nonsurgical Treatment

The options for conservative treatment depend on the specific symptoms, the duration of the symptoms, and the presence of underlying conditions. Non-surgical care options include:

• Over-the-counter pain relievers and anti-inflammatories (NSAIDs)
• Sprint or brace, particularly while sleeping, working, or playing sports
• Ice to reduce swelling
• Therapy to alleviate the nerve compression
• Modifications to behavior that cause nerve compression
• Steroid injections to reduce extreme inflammation of the nerve

Surgery

Surgery may be recommended, especially if you have a cyst or severe nerve or muscle damage.

After a cyst removal, a patient can often resume normal activities within two to six weeks. Recovery from a Guyon tunnel release, which creates more room for the nerve, can last up to several months, depending on the extent of the nerve damage. Therapy is often recommended following surgery.

Get the Best Care for Guyon’s Canal Syndrome

For complex nerve entrapments, it’s critical to receive a correct diagnosis early so you can begin effective, targeted upper extremity treatment before the condition becomes more severe.

A board-certified hand and wrist care specialist has the expertise and experience to distinguish between similar nerve entrapments and identify any underlying conditions so that you can resume activities as safely and quickly as possible.

Choose the Specialists at IHTSC

Indiana Hand to Shoulder Center is home to the area’s most experienced and esteemed specialists for all upper extremity conditions and injuries.

Our care team has successfully treated many cases of Guyon’s canal syndrome and other nerve entrapment conditions, including patients with hand and wrist disorders that have failed to heal despite previous medical care. IHTSC’s comprehensive treatment and recovery services allow you to get the highest level of coordinated care.

To book a consultation, call IHSTC at (317) 743-3985 or schedule online.

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You Might Also Like:

• Hamate Fractures: The Broken Wrist With a Twist
• Poor Hand Circulation: Is It Normal or Something More?
• Cubital Tunnel Surgery: How One Mom with Pain Finally Found Relief—and Freedom

Reviewed by: Dr. Brandon Smetana