Guyon's canal syndrome due to tortuous ulnar artery with DeQuervain stenosing tenosynovitis, ligamentous injuries and dorsal intercalated segmental instability syndrome, a rare presentation: a case report

Abstract

The Guyon's canal syndrome is a well known clinical entity and may have significant impact on patient's quality of life. We report a case of 43-year-old male who presented with complaints of pain and numbness in right hand and difficulty in writing for past one month. On imaging diagnosis of Guyon's canal syndrome because of tortuous ulnar artery was made with additional findings of DeQuervain's stenosing tenosynovitis and dorsal intercalated segmental instability syndrome with ligamentous injury and subsequently these were confirmed on surgery.Although it is a rare syndrome, early diagnosis and treatment prevents permanent neurological deficits and improve patient's quality of life.

Tortuous ulnar artery presenting as left distal forearm mass

“…15 Symptoms arose after a traumatic event in three of the four cases, and surgical decompression of the ulnar nerve was required in all cases to ensure symptom resolution. [12][13][14][15] In contrast to the cases described in the literature, our patients had focal tortuosity in ulnar arteries located proximal to Guyon canal and did not have any ulnar nerve compression symptoms. The cause of their tortuous ulnar arteries cannot be determined with certainty.…”

“…Three cases tie their presence to Guyon canal syndrome or ulnar tunnel syndrome. [12][13][14][15] In these cases, the tortuous vessel contorted and compressed the adjacent ulnar nerve in Guyon canal, a fibro-osseous tunnel in the wrist. 2 This caused patients to experience classic ulnar nerve compression symptoms like hand pain, tingling, and numbness in the fourth and fifth digits.…”

“…2 This caused patients to experience classic ulnar nerve compression symptoms like hand pain, tingling, and numbness in the fourth and fifth digits. [12][13][14][15] In the fourth case, the patient experienced focal neuropathy after a tortuous ulnar artery impinged on the ulnar nerve proximal to Guyon canal in the distal forearm. 15 Symptoms arose after a traumatic event in three of the four cases, and surgical decompression of the ulnar nerve was required in all cases to ensure symptom resolution.…”

A case of distal limb arterial tortuosity and dilation: observations and potential clinical significance

“…Numerous distal limb arterial variations have been reported in the literature [11,14,[23][24][25][26]. The present case reports a cadaveric dissection revealing a distally tortuous ulnar and posterior tibial arteries, without any other vascular abnormalities.…”

“…Clinically, both arterial and venous abnormal tortuosity has been associated with compression of nerves [10][11][12][13]. A tortuous ulnar artery may also present difficulties to neuroradiologists, radiologists and surgeons during relevant procedures [14,15].…”