Guyon’s Canal Syndrome Caused by Dislocated Flexor Digitorum Superficialis Tendon after Mini-open Carpal Tunnel Release in Carpal Tunnel Syndrome - A Case Report -

Journal of the Korean Society for Surgery of the Hand 2007;12(2):81-83.
Published online June 1, 2007.

Kyung-Chil Chung, Heui-Chul Gwak, Dong-Jun Kim

수근관 증후군에서 감압술 후 천수지 굴건의 이탈에 의해 속발된 원위 척골관 증후군 - 증례 보고 -

정경칠, 곽희철, 김동준

Abstract

36 year-old woman with rheumatoid arthritis and carpal tunnel syndrome who experienced secondary Guyon’s canal syndrome by dislocated flexor digitorum superficialis tendon after mini-open carpal tunnel release will be introduced with review of pertinent articles. She showed improvement of median nerve symptoms after surgery but she complained progressive ulnar nerve symptoms including ulnar-sided paresthesia, atrophy of small intrinsic muscles and finger clawing. Electrophysiologic test (EMG/NCT) was competent with ulnar nerve neuropathy just proximal to Guyon’s canal. On exploration surgery, 4th flexor digitorum superficialis dislocated beyond the released transverse carpal ligament was compressing the Guyon’s canal on the medial side of hook of hamate. Clinical symptoms were resolved after reduction of dislocated tendon and release of the Guyon’s canal. Dislocation of flexor tendon as a part of bowstring phenomenon resulted from loss of pulley after carpal tunnel release demonstrate necessity of preservation of interthenar fascia and ulnar stump of transverse carpal ligament intraoperatively and extension splinting postoperatively.