Common Impairments of Tunnel of Guyon

By Carolyn Kisner PT, MS and Lynn Allen Colby PT, MS on February 24th 2009

• Pain and paresthesia along the ulnar side of the palm of the hand and digits in the distribution of the ulnar nerve
• Progressive weakness or atrophy in the intrinsic muscles innervated by the ulnar nerve
• Restricted mobility in the extrinsic finger flexor and extensor muscles
• Possible restricted mobility of the pisiform
Common Functional Limitations/Disabilities
• Decreased grip strength
• Unable to use fourth and fifth digits for spherical or cylindrical power grips
• Decreased ability to perform provoking activity

Nonoperative Management

• Follow the same guidelines as for CTS. Modify the provoking activity, avoid pressure to the base of the palm of the hand, and provide rest with a cock-up splint.
• Ulnar nerve mobilization: Move the wrist into extension and radial deviation, then apply overpressure stretch into extension against the ring and little finger. Include forearm pronation and elbow flexion to move the nerve in a proximal direction.

Surgical Release and Postoperative Management

After release of the ulnar tunnel, the wrist is immobilized 3 to 5 days; then treatment begins with gentle ROM. Follow the same guidelines as with carpal tunnel surgery but with ulnar nerve mobilization techniques.
Complex Regional Pain Syndrome: Reflex Sympathetic Dystrophy and Causalgia

Reflex sympathetic dystrophy (RDS) and causalgia are former diagnoses that are now classified as complex regional pain syndromes I and II, respectively (CPRS type I and CPRS type II). This revised taxonomic system was developed by a consensus conference in 1993 to clarify confusion about the meaning and interpretation of the previous diagnoses. Basically, this is a grouping of complex painful disorders that develop as a consequence of trauma affecting the extremities with or without an obvious nerve lesion.

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Tags: Guyon, impairments, Limitations

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