Figure 4 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
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Surgical view. Retraction of tissue to reveal the ulnar nerve distal to the Guyon canal. Abnormal penetration of the TCL is shown clearly. DUN, deep motor branch of ulnar nerve; SUN, superficial sensory branch of ulnar nerve.
Source publication
Ulnar nerve entrapment at the wrist can cause debilitating sensory, motor, or sensory and motor deficits in the hand. The sources of compression have been well documented, with ganglions, lipomas, and trauma being common etiological factors. We treated a professional sculptor with intrinsic pain and weakness in her dominant hand because of compress...
Context in source publication
Context 1
... exploration of the ulnar nerve at the wrist revealed a typical Guyon canal and bifurcation of the ulnar nerve (Fig. 3). However, the radial branch took an abnormal course, penetrating the TCL radial to the tip of the hook of the hamate (Fig. 4). We exposed the radial branch of the ulnar nerve by meticulous dissection and transection of the TCL (Fig. 5). The nerve traversed subperiosteally and radial to the base of the hook of the hamate and emerged at the distal end of the carpal tunnel on the floor of the hand (Fig. 6). The nerve was unroofed from the radial side of the hook ...
Citations
Ulnar nerve compression is commonly seen at the elbow at the cubital tunnel and the wrist at the Guyon canal but is rarely seen in the hand. This case report describes an 18-year-old male presenting with seven months of atraumatic hand weakness and atrophy associated with heavy weightlifting. Exam demonstrated isolated interosseous muscle atrophy mostly sparing the abductor digiti minimi with intact sensation and negative nerve compression tests including Tinel at carpal and ulnar tunnels, Froment sign, Wartenberg test, cross finger test, and Spurling test. Electromyography and nerve conduction studies demonstrated prolonged distal latency, low amplitude potential, and large amplitude fibrillations with severely reduced motor unit firing in the first dorsal interosseous muscle consistent with ulnar nerve deep motor branch compromise. Magnetic resonance imaging revealed a ganglion cyst between the third metacarpal shaft and the flexor profundus tendon. Given the progressive symptoms, ganglion cyst excision and ulnar motor nerve branch neurolysis were performed.
