A Rare Case of Hypothenar Hammer Syndrome Triggering Guyon’s Canal Syndrome

In certain occupations, injuries and microtrauma are commonly encountered by the soft tissues of the hand in the adult population, which may, however, less frequently lead to arterial occlusion. One such example is that of the Hypothenar Hammer Syndrome (HHS). It is a rare traumatic disease of the hand, caused by blunt traumas to the heel of the hand that may damage the ulnar artery at the level of hypothenar eminence. This results in occlusion or aneurysm of the vessel. It is of clinical importance due to the risk of loss of limb function following digital ischemia. The ulnar nerve barely gets compressed in the Guyon’s canal, which may in turn cause Guyon’s canal syndrome. This is a case of a 43-year-old male patient who presented with painful swelling of the right hand, which was diagnosed as a bizarre presentation of a bilobed and partially thrombosed pseudoaneurysm of the ulnar artery producing Guyon’s canal syndrome that had to be surgically excised. The objective of this case is to highlight the clinical presentation of HHS for early diagnosis and treatment.

Síndrome do canal de Guyon por aneurisma da artéria ulnar: relato de caso

Dentre os fatores que podem desencadear a compressão do canal de Guyon inclui-se o aneurisma da artéria ulnar. Uma das abordagens cirúrgicas é a reconstrução microcirúrgica através da ressecção e arteriorrafia término-terminal ou enxerto venoso de interposição. O objetivo deste trabalho é relatar o caso de paciente que desenvolveu neuropatia do nervo ulnar secundária à presença de aneurisma da artéria ulnar no canal de Guyon. Foi realizada a descompressão cirúrgica através de uma abertura do canal e a ressecção do segmento lesionado. A artéria ulnar foi reconstruída através da anastomose término-terminal microcirúrgica. O resultado foi o alívio completo dos sintomas no pós-operatório com manutenção do fluxo vascular. Descritores: Nervo Ulnar; Neuropatia Radial; Ferimentos e Lesões; Aneurisma. Referências Guyon F. Note sur une disposition anatomique proper à la face antérieure de la région du poignet et non encour décrite. Bulletins de la Societé anatomique de Paris, Second Series, 1861;6:184-86. Caetano EB, Brandi S, Oliveira Junior WM. Compressão do nervo ulnar no canal de Guyon por aneurisma verdadeiro: relato de um caso. Rev Bras Ortop. 2004;39(7):398-400. Shea JD, McClain EJ. Ulnar-nerve compression syndromes at and below the wrist. J Bone Joint Surg Am. 1969;51(6):1095-103. Rothkopf DM, Bryan DJ, Cuadros CL, May JW Jr. Surgical management of ulnar artery aneurysms. J Hand Surg Am. 1990;15(6):891-97. Harris EJ Jr, Taylor LM Jr, Edwards JM, Mills JL, Porter JM. Surgical treatment of distal ulnar artery aneurysm. Am J Surg. 1990;159(5):527-30. Dethmers RS, Houpt P. Surgical management of hypothenar and thenar hammer syndromes: a retrospective study of 31 instances in 28 patients. J Hand Surg Br. 2005;30(4):419-23. Aguiar PH, Bor-Seng-Shu E, Gomes-Pinto F, Almeida- Leme RJ, Freitas ABR, Martins RS et al. Surgical management of Guyon's canal syndrome, an ulnar nerve entrapment at the wrist: report of two cases. Arq Neuro-Psiquiatr. 2001;59(1):106-11. Jose RM, Bragg T, Srivastava S. Ulnar nerve compression in Guyon's canal in the presence of a tortuous ulnar artery. J Hand Surg Br. 2006;31(2):200-2. Galati G, Cosenza UM, Sammartino F, Benvenuto E, Caporale A. True aneurysm of the ulnar artery in a soccer goalkeeper: a case report and surgical considerations. Am J Sports Med. 2003;31(3):457-58. Rothkopf DM, Bryan DJ, Cuadros CL, May JW Jr. Surgical management of ulnar artery aneurysms. J Hand Surg Am. 1990;15(6):891-97.

Effects of Osteopathic Care on patients suffering with pudendal neuralgia: a prospective monocentric study

Introduction. Pudendal neuralgia is a canal syndrome. Patients present, among other symptoms, with chronic neuropathic pain, allodynia and dyspareunia; the chronicity of which impact their everyday life.The goal of research — is to measure the impact of osteopathic care on pudendal neuralgia′s pain.Materials and methods. Four females and eight males suffering from pudendal neuralgia received two osteopathic treatments within 15 days. Pain was the main outcome measure. We assessed pain through a simple verbal pain rating scale. The scale was used on three occasions: before the first session, before the second one and 15 days later.Results. 10 out of 12 patients find their pain decreased by 40 % or more. On inclusion, the main pain level is 6,3, before the second session it goes down to 4,5, then to 2,5 after 15 days. This decrease is very highly significant (p<0,0001). Every patient from this study would recommended this approach to a friend suffering from this neuralgia.Conclusion. Osteopathy seems to be interesting to consider in the global management of pudendal neuralgia. A comparative randomized trial would be necessary to confirm these first results. It would be interesting to compare results obtained with the osteopathic protocol with results from transcutaneous neuroelectric stimulation in order to assess if the action of osteopathy is linked with pain perception only.