Ulnar Tunnel Syndrome AKA Guyon's Canal Syndrome and Handlebar Palsy

Dr Ozello's Sports Medicine Report: Ulnar Tunnel Syndrome AKA Guyon's Canal Syndrome, Handlebar Palsy and Cyclist’s Palsy

**Correction: Cubital Tunnel Syndrome is also known as Ulnar Neuropathy in the Elbow.

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Ulnar Tunnel Syndrome (AKA Guyon's Canal Syndrome, Handlebar Palsy and Cyclist’s Palsy)
Common in cyclists, especially long-distance cyclists due to compression and gripping of handlebars.
Study of one hundred and sixty professional cyclists demonstrated a thirty percent incidence of ulnar neuropathy.
Also seen in wheelchair sports, cross-country skiing, weightlifting (heavy bench press) and racquet sports.
Tennis, baseball and golf from fractures to hamate.

Anatomy
Guyon Canal AKA Ulnar Canal or Ulnar Tunnel
Space at ulnar border of anterior wrist.
Anatomical fibro-osseous structure.
Houses ulnar nerve and ulnar artery as they pass from distal forearm into hand.
Begins at proximal border of pisiform and ends distally at hook of hamate.
Bordered by volar carpal ligament, transverse retinacular ligament, pisiform and laterally by hook of hamate.

Common Causes ganglion cyst, trauma (hook of hamate fracture and pisiform fracture), ulnar artery aneurysms or external pressure.

Entrapment can occur prior to its bifurcation to superficial (sensory) and deep (motor) branches or to one branch.
Isolated compression of deep branch is more common.
Symptoms vary depending on exact site of lesion.
Proximal compression before nerve bifurcation causes motor weakness of ulnar innervated intrinsic muscles and sensory deficits over hypothenar eminence and small and ring finger.
Compression in Guyon canal causes pure muscle weakness, since superficial sensory branch is spared.
Pure sensory symptoms occur from compression of superficial branch of ulnar nerve.
Compression of ulnar nerve in Guyon canal can often be confused with compression of ulnar nerve at cubital tunnel.
A major distinguishing factor between the two compression sites is sensation over dorsal ulnar aspect of hand.
Dorsal ulnar cutaneous nerve provides sensation to this region.
This branch of ulnar nerve does not pass through Guyon canal and will be preserved if ulnar nerve is being compressed in Guyon canal.

Caused by continuous pressure, tension and vibration of Ulnar Nerve in Guyon’s canal.
Usually manifested by paresthesia and pain in fourth and fifth fingers and hand intrinsic muscle weakness.

Improper reach, narrow handlebars, gloves with poor padding, poor postural habits, long rides and increased weight are contributing factors.

Diagnosis of ulnar neuropathy in a cyclist increases likelihood of coexisting thoracic outlet syndrome (double-crush syndrome).

Atrophy of first dorsal interosseous muscle, without accompanying sensory deficit.
Pressure lesions usually improves spontaneously.

Instruct patient to constantly shift hand positioning while cycling, especially on long distance rides.

Carpal and Cubital Tunnel and Other, Rarer Nerve Compression Syndromes
https://www.ncbi.nlm.nih.gov/pmc/arti...

Upper Extremity Nerve Entrapment Syndromes in Sports: an Update http://journals.lww.com/acsm-csmr/Ful...

Guyon Canal Syndrome: lack of management in a case of unresolved handlebar palsy
https://www.ncbi.nlm.nih.gov/pmc/arti...

Mountain Biking Injuries https://journals.lww.com/acsm-csmr/Fu...

Anatomy, Shoulder and Upper Limb, Hand Guyon Canal
https://www.ncbi.nlm.nih.gov/books/NB...

Dr Donald A Ozello DC of Championship Chiropractic in Las Vegas, NV
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