Identification of Double Compression Lesion of Ulnar Nerve after Cubital Tunnel Release

Joon Yub Kim; Ho Il Kwak; Jeong Hyun Yoo; Joo Hak Kim; Dong Wook Sohn; Jae Ho Cho

doi:10.12790/jkssh.2015.20.3.148

Journal List > J Korean Soc Surg Hand > v.20(3) > 1106494

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Kim, Kwak, Yoo, Kim, Sohn, and Cho: Identification of Double Compression Lesion of Ulnar Nerve after Cubital Tunnel Release

Case Report

J Korean Soc Surg Hand 2015;20(3):148-152.

Published online: 11 September 2015

DOI: https://doi.org/10.12790/jkssh.2015.20.3.148

Identification of Double Compression Lesion of Ulnar Nerve after Cubital Tunnel Release

Joon Yub Kim, Ho Il Kwak, Jeong Hyun Yoo, Joo Hak Kim, Dong Wook Sohn, Jae Ho Cho

Deaprtment of Orthopedic Surgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea

Correspondence to: Ho Il Kwak Department of Orthopedic Surgery, Myongji Hospital, Seonam University College of Medicine, 55 Hwasu-ro 14 beon-gil, Deokyang-gu, Goyang 10475, Korea TEL: +82-31-810-5114 FAX: +82-31-969-0500 E-mail: khinael@naver.com

Received 27 May 201513 August 201528 August 2015 Accepted 31 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The double compression syndrome of the ulnar nerve is a rare condition. Herin, we experienced double compression of ulnar nerve at cubital tunnel and Guyon’s canal by re-evaluation after surgical decompression of cubital tunnel. We might suspect the double compression lesion in cases of worsening of symptom or nerve conduction velocity findings in a relative short duration of symptom as in our case. Meticulous physical examination might be needed to detect the Guyon’s canal syndrome as a comorbidity in the treatment of cubital tunnel syndrome and re-evaluation for dual compression might be recommended if the resolution of symptom was not achieved after surgical decompression of single nerve lesion.

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Keywords: Cubital tunnel syndrome, Guyon’s canal syndrome, Double crushing syndrome, Double compression syndrome, Surgical decompression

References

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3. Monacelli G, Spagnoli AM, Pardi M, Valesini L, Rizzo MI, Irace S. Double compression of the ulnar nerve at the elbow and at the wrist (double-crush syndrome): case report and review of the literature. G Chir. 2006; 27:101–4.

4. Guidicelli T, Londner J, Gonnelli D, Magalon G. Two anomalous muscles of a forearm revealed by ulnar nerve compressions, a Double Crush syndrome. Ann Chir Plast Esthet. 2014; 59:208–11.

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Fig. 1.

Surgical decompression of cubital tunnel and subcutaneous ulnar nerve anterior transposition were performed. Focal mild swelling of the ulnar nerve was observed (white arrow).

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Fig. 2.

Magnetic resonance imaging of Guyon’s canal. A dumbbell-shaped ganglion at the pisotriquetral joint volarly abutting the ulnar nerve at Guyon’s canal was observed. (A) T2 fat suppression coronal image. (B) T2 fat suppression axial image.

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Fig. 3.

Guyon’s canal decompression with excision of the ganglion and carpal tunnel release. (A) Ganglion was observed on the pisotriquetral ligament. (B) After excision of the ganglion, the capsule was opened. (C) Carpal tunnel release was also performed with Guyon’s canal release.

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