Loge de Guyon syndrome
Definition - Loge de Guyon Syndrome
The Loge de Guyon syndrome is one of the
Nerve congestion / nerve compression syndromes.
Here, the ulnar nerve is narrowed in the narrow point on the wrist named after a Parisian doctor.
The ulnar nerve emerges as one of three main branches from the brachial plexus, a plexus of nerves supplying the upper extremity. It pulls behind the elbow (the pain when thrusting the "musician's bone" is caused by irritation of the ulnar nerve in its course). Then it pulls on the elbow side (side of the little finger) along the forearm and reaches the palm of the hand in the area of the wrist through the loge de Guyon, where it is divided into its two terminal branches, a superficial branch (ramus superficialis) and a deep branch (ramus profundus ) divides.
To learn more about the anatomy of the ulnar nerve, also read: Ulnar nerve
In motor terms, the nerve is involved in:
- of diffraction and
- Sideways tilt of the wrist towards the little finger (Ulnar deviation) and also provides a
- Flexion of the little and ring fingers, one
- Flexion of the fingers in the metatarsophalangeal joint with extension in the terminal joints and a
- Spreading movement of the fingers.
He takes care of:
- the edge of the hand facing the little finger including the
- Little finger,
- Ring finger and - in the area of the back of the hand - half
- Middle finger.
The Loge de Guyon is a niche that is essentially formed by two of the carpal bones (Hamulus ossis hamati and Os pisiforme) and parts of the muscle-ligament apparatus (Retinaculum musculi flexorum, M. palmaris brevis) is limited. It is traversed by the ulnar nerve and the ulnar artery.
Cause of Loge de Guyon syndrome
The cause of a constriction of the nerve in the Guyon canal can be a ganglion ("overbone"), i.e. a benign tumor. Repeated long-term compression of the nerve by hyperextension (Hyperextension) of the wrist in its canal can be a cause. This can occur, for example, with:
- Cycle,
- Motorcycling, at
- Use of tools or as part of a
- "Crutch Paralysis".
Furthermore, previous fractures (breaks) in the area of the structures of the Guyon Canal can lead to a narrowing.
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Symptoms of Loge de Guyon Syndrome
The Guyon lodge is one of the three most typical sites of damage to the ulnar nerve and is most distal (away from the center of the body). Because the nerve is mostly already the Ramus superficialis for the sensitive (conveying of the feeling) supply of the hand, in the majority of cases a purely motor impairment results.
This manifests itself on the one hand by an atrophy (thinning) of the affected muscles. This is usually particularly evident in the area of the back of the hand between the thumb and forefinger (Interosseous space I.), the skin looks sunken here. But the muscles between the other fingers on the back of the hand are also affected, so that skin hollows can be observed here. The ball of the little finger (on the palm of the hand) can also be atrophic.
In addition to these visible muscle affections, patients often also report a loss of strength in the hand, which is noticeable when the fingers are spread and brought together.
Is - in rare cases - also the sensitive one Ramus superficialis affected by the narrowing, so it comes to
- Tingle,
- Numbness and
- Sensitivity disorders in the supply area of the ulnar nerve, i.e. the little finger, ring finger and the edge of the hand on the side of the little finger.
In the case of the more proximal (in the area of the elbow) damage to the nerves (Sulcus ulnaris syndrome) there are two very typical signs that are not always found in Guyon Lodge syndrome:
- Claw hand
(Fingers cannot be fully extended due to failure of the Lumbrical muscles and Interossei muscles)
- Froment sign
(The patient is asked to hold a piece of paper between thumb and forefinger, but can only do so by flexing the thumb and holding it with the tip of the thumb, which impairs the innervation of the ulnar nerve M. adductor pollicis who is responsible for bringing the thumb to the other fingers).
Pain in Loge de Guyon syndrome
The Loge de Guyon lies between the carpal bones on the elbow side (thus also on the side of the little finger) on the wrist.
Here, the ulnar nerve (a nerve that supplies both motor and sensitivity) runs around one of the bones at the base of the hand, the pea bone. If there are masses here, for example from tumors, over-legs or simple, long-lasting pressure loads, the ulnar nerve can be narrowed or irritated.
This usually first becomes noticeable as tingling and mild numbness. Then later, if left untreated, pain also occurs. This pain can be improved either conservatively or surgically. Here it is important to consider which course of the disease has preceded it.
The pain in the hand can speak for many things and should not be limited to just Logen-de-Guyon syndrome. To find out what could be behind the pain, also read the following articles:
- Hand Pain - Why?
- Hand diseases
Therapy for Loge de Guyon syndrome
A conservative (non-operative) treatment is usually the beginning. Here, among other things, painkillers and, if necessary, a splint to immobilize / relieve the strain are used.
In most cases, however, the operative exposure of the Guyon Lodge with decompression (Neurolysis) of the ulnar nerve.
Which splints can help with Loge de Guyon syndrome?
If the Loge de Guyon syndrome is caused by long-term and severe stress on the nerve, as can be the case, for example, when cycling, immobilization using a splint can help. This is often worn at night, but can also be worn during the day. It also serves to refrain from directly stressful movements and to ensure that the nerve is not irritated.
A special wrist splint is suitable for this, which is best chosen by an orthopedic surgeon or medical supply store.
When do I need surgery for Loge de Guyon syndrome?
An operation is absolutely necessary if the Loge de Guyon syndrome was caused by an unphysiological, i.e. unnatural, narrowing. This can be triggered, for example, by an overbone, i.e. an outgrowth of a bone, or a new formation of tissue, i.e. a tumor, a new formation of vessels and scar tissue in the area there.
In these cases, surgery is necessary because the structures there have to be removed so that the symptoms improve.
In the case of a tumor in particular, it must be clarified whether it is a metastasis of an existing tumor.
What are the risks of an operation in Loge de Guyon syndrome?
In almost every operation, intolerance to the anesthetic can occur.
It can relapse (that means the symptoms return) and it can lead to wound healing disorders, increased scarring and secondary bleeding or bruising.
In addition, during operations on nerves there is always the risk that the nerves will also be irritated by the surgeon and that postoperative numbness will occur in the treated area.
In addition to numbness, muscle failures or limitations can also occur.
Furthermore, there is no guarantee that the operation will help cure Loge de Guyon syndrome.
You might also be interested in these articles:
- Complications after surgery
- Swelling after surgery - tips for treatment
Physiotherapy for Loge de Guyon syndrome
Treatment for Loge de Guyon Syndrome is very dependent on the underlying cause.
If the nerve is compressed because the nerve is pinched by a tumor or an excess leg, physiotherapy will not help and the syndrome must be treated surgically.
If overload and pressure are the trigger of the symptoms, protection with a splint may help.
Physiotherapy or "occupational therapy", as the physiotherapeutic treatment of the hand is called, can bring relief. Strengthening the surrounding muscles can, but does not have to, reduce the pressure on the ulnar nerve and thus reduce the symptoms.
At this point you can also read our main page on physiotherapy for general information: Physiotherapy / physiotherapy
Diagnosis of Loge de Guyon Syndrome
The anamnesis (questioning the patient about symptoms and history) and clinical examination (see symptoms) provide the indicative signs.
Carrying out an electrophysiological examination in the sense of measuring the nerve conduction velocity (NLG) ensures the diagnosis (slowed NLG over the affected area).
A magnetic resonance imaging (Magnetic resonance imaging) can be used to find a structural cause (e.g. a ganglion) for such damage, but is not part of routine diagnostics.
Measurement of the nerve conduction velocity in Loge de Guyon syndrome
The nerve conduction velocity is measured to measure the functionality of a nerve in the body.
Electrodes are attached to the skin over the corresponding nerve at two points or directly to the nerve through minimal punctures. These will then measure how quickly the nerve sends information from the central nervous system to the muscles, or how quickly it sends information about sensitivity and pain from the "periphery" back to the central nervous system.
If this conduction speed is below certain norms, one can assume that the corresponding nerve is damaged. Since the Loge de Guyon syndrome is also based on nerve compression, one can try to diagnose it with a reduced nerve conduction velocity.
However, the sole measurement of the nerve conduction velocity in this case is not the gold standard of diagnostics nowadays, but an MRI of the wrist should also be done in order to be able to exclude masses.
You can find important information about MRI in hand in the following article. Here's how to do this and what to do about it: MRI of the hand
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