Tunnel of Guyon

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Pain, numbness, tingling or weakness in the little and ring fingers may be caused by compression of the ulnar nerve at the tunnel of Guyon. This nerve runs through a small tunnel at the wrist. Formed by the pisiform and hook of the hamate bones on the sides; the top and bottom borders by the insertion of the flexor carpi ulnaris tendon and transverse carpal ligament. The nerve runs through this tunnel and is responsible for sensation and muscle strength of the 4th and 5th digits.

Any activity that involves prolonged compression of the hand may cause this condition. Cyclists also call this handlebar or cyclist's palsy, occurring after long rides. Other causes include vascular disturbances, Dupuytren's contracture, joint arthritis, fractures, bursitis, edema, or inflammatory diseases.

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Treatment of Ulnar Nerve compression at the wrist

At home, avoiding aggravating activities is the first line of treatment. Decreasing the direct compression, icing, and resting will help mild cases. Cyclists should change their handlebar or bicycle position. Gloves are available with padding to decrease the compression on the nerve for work related causes.

Office treatment will consist of modalities and techniques to decrease the inflammation in the tunnel of Guyon. Manual therapies are very effective; however, treatment can last many months in severe conditions. Local corticosteroid injections and anti-inflammatory medication are also very helpful in reducing inflammation.

With persistent symptoms beyond 6 months, muscle atrophy, or failure of conservative therapy may require surgical decompression with release.

Any nerve entrapment syndrome can often be treated with conservative treatment by a professional experience with entrapments. It is easier to treat mid nerve entrapments instead of severe ones. Seek help sooner than later.

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