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.
Level of evidence: V |
- Chen SH, Tsai TM. Ulnar Tunnel Syndrome. J Hand Surg. 2014; 39(3):571-579. doi:10.1016/j.jhsa.2013.08.102.
- Omejec G, Podnar S. Differentiation of ulnar neuropathy at the wrist due to ganglion cyst from ulnar neuropathy at the elbow. Neurophysiol Clin. 2020; 50(5):345-351. doi:10.1016/j.neucli.2020.08.004.
- Murata K, Shih JT, Tsai TM. Causes of ulnar tunnel syndrome: a retrospective study of 31 subjects 1 1No benefits in any form have been received or will be received by a commercial party related directly or indirectly to the subject of this article. J Hand Surg. 2003; 28(4):647-651. doi:10.1016/s0363-5023(03)00147-3.
- Shea JD, McClain EJ. Ulnar-nerve compression syndromes at and below the wrist. J bone Jt Surg Am Vol. 1969; 51(6):1095-1103.
- Khajeh R, Farzan M, Jamshidi SMMM, Moharrami A. Guyon Canal Syndrome Due to Schwannomas of Zone 3 Ulnar Nerve without Neurologic Symptoms: A Case Report. Arch Bone Jt Surg. 2021; 9(5):598-600. doi:10.22038/abjs.2020.50869.2520.
- Yavari M, Afshar A, Shahraki SS, Tabrizi A, Doorandish N. Management of Symptomatic Lipoma of the Hand: A Case Series and Review of Literature. Arch bone Jt Surg. 2021; 10(6):530-535. doi:10.22038/abjs.2021.57846.2864.
- McGurk K, Tracey JA, Daley DN, Daly CA. Diagnostic Considerations in Compressive Neuropathies. J Hand Surg Glob Online. 2023; 5(4):525-535. doi:10.1016/j.jhsg.2022.10.010.
- Wu JS, Morris JD, Hogan GR. Ulnar neuropathy at the wrist: case report and review of literature. Arch Phys Med rehabilitation. 1985; 66(11):785-788.
- Nico B, Waclawik AJ. Ganglion Cysts as a Cause of Ulnar Neuropathy at the Wrist. WMJ. 2021; 120(4):325-329.
- Saracco M, Panzera RM, Merico B, Madia F, Pagliei A, Rocchi L. Isolated compression of the ulnar motor branch due to carpal joint ganglia: clinical series, surgical technique and postoperative outcomes. Eur J Orthop Surg Traumatol. 2021; 31(3):579-585. doi:10.1007/s00590-020-02807-y.
- Asprec LM, Freedman MK, Beredjiklian PK, Young GW. Isolated Neuropathy of the Motor Branch of the Ulnar Nerve Sparing the Hypothenar Muscle and Ulnar Intrinsic Groups due to Compressive Lesion: A Case Report. Int J Physiatry. 2019; 5(1). doi:10.23937/2572-4215.1510017.
- Duggal A, Anastakis DJ, Salonen D, Becker E. Compression of the Deep Palmar Branch of the Ulnar Nerve by a Ganglion. HAND. 2006; 1(2):98-101. doi:10.1007/s11552-006-9008-0.
- Hammarstedt JE, Duethman NC, Dennison DG. Pigmented Villonodular Synovitis as an Atypical Cause of Deep Motor Branch Neuropathy. J Orthop Case Rep. 2021; 11(4):80-84. doi:10.13107/jocr.2021.v11.i04.2162.
- Jennings JD, Jennings JF. Isolated Compression of the Ulnar Nerve Motor Branch. Ann Plast Surg. 2018; 80(5):529-532. doi:10.1097/sap.0000000000001406.
- Kobayashi N, Koshino T, Nakazawa A, Saito T. Neuropathy of motor branch of median or ulnar nerve induced by midpalm ganglion. J Hand Surg. 2001; 26(3):474-477. doi:10.1053/jhsu.2001.24146.
- Maio FD, Bisicchia S, Farsetti P, Ippolito E. Isolated Paralysis of the Adductor Pollicis: A Case Report. Adv Orthop. 2011; 2011:321020. doi:10.4061/2011/321020.
- Steppe C, Seradge H, Parker W, Seradge C. Subperiosteal Ulnar Nerve Entrapment at the Wrist. J Hand Surg Glob Online. 2022; 4(1):45-48. doi:10.1016/j.jhsg.2021.09.004.
|
