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Median nerve compression in the carpal tunnel
5%
9/187
Median nerve compression in the cubital tunnel
1%
2/187
Ulnar nerve compression in Guyon's canal
83%
155/187
Ulnar nerve compression by the ligament of Struthers
10/187
Radial nerve compression at the arcade of Frohse
2%
3/187
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The clinical presentation is consistent with an ulnar neuropathy. This is most commonly caused by compression of the ulnar nerve either in the cubital tunnel at the level of the elbow (cubital tunnel syndrome) or in Guyon's canal at the level of the wrist (ulnar tunnel syndrome). Ulnar tunnel syndrome is caused by compression of the ulnar nerve in Guyon's canal at the level of the wrist. It usually presents with pain and paresthesias in 4th and 5th digits, and weakness of the ulnar-innervated intrinsic muscles. This leads to weakness of pinch and grip, and eventual clawing of the 4th and 5th digits. Jones et al. report the most common cause of ulnar tunnel syndrome to be chronic occupational trauma, either from pressure exerted over the hypothenar eminence by a tool or from the use of the heel of the hand as a hammer. Nonoccupational etiologies include congenital, inflammatory, neoplastic, vascular, metabolic, degenerative and traumatic disorders. Elhassan et al. review entrapment neuropathies of the ulnar nerve. They describe the anatomy of Guyon's canal. They report the canal is approximately 4 cm long. The roof of the canal is formed by the volar carpal ligament, the floor by the pisohamate ligament and the transverse carpal ligament, the radial wall by the abductor digiti minimi and the hook of hamate, and the ulnar wall by the pisiform. Illustration A shows the distribution of paresthesias with ulnar tunnel syndrome, and the clinical appearance of intrinsic wasting. Incorrect Answers: Answer 1: Median nerve compression in the carpal tunnel leads to carpal tunnel syndrome. Note that the median nerve is the ONLY nerve that passes through the carpal tunnel. Answer 2: The median nerve does not travel through the cubital tunnel. Answer 4: The ligament of Struthers is a site of compression of the median nerve leading to Pronator Syndrome. Answer 5: Compression of the radial nerve at the arcade of Frohse leads to radial tunnel syndrome, which is characterized by pain in the proximal lateral forearm.
3.1
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