Loge-de-Guyon syndrome is an extremely rare disorder that primarily affects the ulnar nerve. Due to a constriction, a reduction in sensation occurs in the area of the little as well as ring finger. In addition to surgical treatment, conservative therapy is also possible; the prognosis of the disease is good.
What is Loge-de Guyon syndrome?
Loge-de Guyon syndrome is a very rare condition that falls into the category of compression syndromes. It involves compression of the ulnar nerve – the ulnar nerve. The so-called Loge de Guyon is located next to the carpal tunnel; the motor branch of the ulnar nerve is located in this tunnel. This branch connects not only the muscles of the metacarpus, but also the little and ring fingers, respectively. If a constriction occurs, which is primarily caused by ganglions – cysts at the carpus – the typical complaints of Loge de Guyon syndrome subsequently occur.
Causes
The cause of why Loge-de-Guyon syndrome can develop in the first place is a narrowing that directly affects the nerve in what is known as Guyon’s canal. This constriction is triggered due to a ganglion (cyst or supra-leg). The ganglion is considered a benign tumor (from a medical point of view). Sometimes, however, long-term or often repeated compression or overextension of the nerve can be the reason why Loge de Guyon syndrome develops. These factors are favored by motorcycling, cycling or the use of tools. Likewise, “crutch paralysis” can trigger Loge-de-Guyon syndrome. Other causes include fractures that have damaged or constricted the structures of Guyon’s canal.
Symptoms, complaints, and signs
The first symptoms of Loge-de-Guyon syndrome are sensory disturbances in the area of the hand. Affected individuals usually experience mild tingling or numbness in the little finger and ring finger. The complaints occur in connection with overloading of the wrist, as is possible, for example, during prolonged cycling or push-ups. However, other triggers may also be present, and the symptoms vary accordingly. In the course of the disease, chronic pain and muscle weakness of the hand muscles can occur. The affected hand can then no longer be moved as before, resulting in restrictions in everyday life and, in the long term, secondary hand complaints. For example, a permanent posture of rest can lead to joint wear, muscle pain and cramps. Circulatory disorders are also conceivable. If the compression of the nerve persists over a long period of time, the muscles may atrophy and subsequently lead to deformities in the tissue of the little finger. Pronounced forms are manifested by temporary signs of paralysis in the entire hand and especially in the fingers. The symptoms of Loge de Guyon syndrome usually develop gradually and are often only noticed when they are already pronounced. The final consequence is permanent stiffening or functional incapacity of the affected hand.
Diagnosis and course of the disease
As part of the diagnostic process, the physician takes a medical history and performs a clinical examination of the patient. If damage to the nerve is suspected, an electrophysiological examination is usually performed. During this examination, the patient’s nerve conduction velocity is measured. This test provides confirmation and certainty as to whether the patient actually has Loge de Guyon syndrome. Magnetic resonance imaging, on the other hand, provides insight into whether and, if so, what structural causes have occurred that have triggered Loge de Guyon syndrome (for example, whether a cyst or ganglion is present). However, magnetic resonance imaging is only ordered in a very small number of cases and is therefore not one of the classic examination methods for determining Loge-de-Guyon syndrome. In the further course, the physician decides whether conservative or surgical treatment is necessary. However, when undergoing treatment, the patient must be patient. Only after a few weeks do the first signs of improvement appear; final healing can sometimes take several months.However, if the disease is severe or the ulnar nerve is damaged to such an extent, even surgical treatment may not bring the desired success. Thus, sensation reductions remain, which predominantly affect the hand muscles.
Complications
In general, Loge-de-Guyon syndrome results in various paralyses or sensory disturbances that occur mainly in the little finger and ring finger. Furthermore, there is no discomfort, although the paralysis and disturbances of sensibility may spread to the hand and the back of the hand. Further complaints or complications do not occur in most cases. Due to Loge de Guyon syndrome, the daily life of the affected person is limited and there are discomforts and difficulties in various activities or in the performance of various professions. The quality of life is also reduced by Loge-de-Guyon syndrome. If the symptoms occur suddenly or spontaneously, many patients may also suffer from anxiety or sweating. Not infrequently, paralysis also leads to psychological discomfort or further to depression. As a rule, treatment is carried out by immobilizing the affected regions. No complications occur during this process. In some cases, various therapies are necessary afterwards to restore the mobility of the fingers and the joints. Life expectancy is not affected by Loge de Guyon syndrome. Usually, the hand can be habitually used again after successful treatment.
When should you see a doctor?
If there is any discomfort in the fingers or hands, a visit to the doctor should be made. Tingling or numbness in the extremities are indications of existing irregularities that should be investigated and treated. If the disturbances in perception persist for several days or weeks, a visit to the doctor is recommended to clarify the cause. In the initial stage, the complaints occur when the hands or fingers are overloaded. Even if the symptoms disappear after a short time, a check-up with a doctor is recommended. If there are abnormalities in the blood circulation, cold fingers or a loss of the usual muscle strength in the hands, a doctor should be consulted. If cramps develop or the affected person suffers from pain in the hands, a visit to the doctor is necessary. Deformities in the fingers are a special warning sign of the organism. In addition, the optical change is a characteristic of Loge de Guyon syndrome and should be examined more closely by a physician. If the affected person suffers from symptoms of paralysis or restrictions of the usual movement possibilities in the fingers, hands or wrist, medical care is required. As the disease progresses, stiffening of the fingers will occur without therapy. If everyday activities can no longer be performed as usual, the affected person should consult a physician.
Treatment and therapy
Conservative therapy is used when Loge de Guyon syndrome is diagnosed relatively early or when the disease is still in its early stages. It is important that the patient refrains from any kind of activity that predominantly stresses the nerve. This includes cycling or any kind of martial arts. If there is an improvement after a few weeks, or if the nerve has been able to recover, the physician will not perform surgery. Nevertheless, the patient must avoid any factors that have led to Loge-de-Guyon syndrome or take preventive measures so that the nerve does not become constricted again. If the disease is already advanced or conservative therapy has not brought any noticeable success, the physician performs the surgical intervention. This is an open surgical technique. The physician makes a semi-shaped incision in the wrist (in the area of the little finger) so that he can expose the ulnar nerve and also its arteries. The nerve and its arteries are exposed and treated using magnifying glass. The sutures are removed after about 14 days. Even if immobilization by means of a plaster cast is not necessary, the wrist or arm is plastered in the majority of patients. However, the plaster cast is worn for only three to a maximum of five days. Subsequently, the patient must avoid any physical exertion for about three weeks.After the physician has removed the sutures, a scar mass is subsequently necessary, which can be done independently or as part of physiotherapeutic therapy. However, it takes several weeks before the patient notices the first improvements. After the cast is removed, postoperative exercises are recommended. These should be performed in physiotherapy. The treating therapist adapts the exercises to the severity of the Loge de Guyon syndrome. For this reason, physiotherapy is guided individually. After three and six months, respectively, renewed neurological as well as electrophysiological examinations are performed.
Outlook and prognosis
Overall, the prognosis of Loge de Guyon syndrome is favorable. There are several treatment options to achieve relief of symptoms or recovery. The course of the disease depends on individual circumstances, the time of diagnosis, and the patient’s cooperation in the healing process. The earlier a doctor is consulted in the event of complaints, the better the further course of the disease. It is particularly important that the joint is adequately rested. The patient should avoid any strain or overexertion until the end of the treatment period. Medical immobilization is usually not necessary, but the affected person should nevertheless maintain sufficient rest of the joint in everyday life. In addition, physiotherapeutic measures are applied. These can also be carried out on the patient’s own responsibility outside of the therapy sessions for faster healing success. In particularly severe cases, surgical intervention is performed. This is associated with risks. Normally, the operation proceeds without further complications or incidents, as it is a routine procedure. Under optimal conditions, the patient is completely free of symptoms within a few months, regardless of the treatment method. If complications occur, permanent restrictions on joint activity may result. Sensitivity disorders of the skin and a reduction in physical resilience are also possible. In these cases, everyday life must be restructured and adapted to the physical possibilities.
Prevention
Loge de Guyon syndrome can be prevented. First and foremost, cyclists should use road bike handlebars, which allow for reaching around in different positions. Likewise, the use of padded gloves can prevent the syndrome in the further course, because here the mechanical pressure effect is significantly reduced. However, no other preventive measures are known.
Aftercare
Loge de Guyon syndrome leads to various complaints and complications in the affected person, which result in restrictions in the movement of the affected person in everyday life. In some cases, this also results in muscle weakness and further disturbances in blood circulation. Paralysis or severe pain in the muscles can also occur and make the affected person’s everyday life more difficult. Sometimes affected persons are dependent on the help of their relatives or friends to cope with everyday life. Aftercare focuses on monitoring the recovery process by the accompanying physician. In addition, a gentle lifestyle is recommended to avoid a renewed flare-up of the disease. Regular use of exercises learned during physical therapy can significantly help strengthen the wrist.
Here’s what you can do yourself
Loge de Guyon syndrome can be treated by some self-help remedies. However, these remedies do not replace full treatment by a doctor. Therefore, if there is no improvement, a doctor must be consulted in any case. The affected person should refrain from sports that put a strain on the nerve. These include, above all, martial arts or cycling. This allows the ulnar nerve to recover in many cases, so that surgical intervention is not necessary. Furthermore, immobilization of the wrist can alleviate the symptoms. Here, the affected person should also not put unnecessary strain on the arm so that it can recover. Even after successful treatment, many patients with Loge de Guyon syndrome are dependent on physiotherapy. The exercises from this therapy can often be performed in the patient’s own home, which accelerates the healing process. As a rule, this completely alleviates the symptoms.During immobilization, those affected are often dependent on the help of other people in their everyday lives. In this context, the help of friends or relatives in particular proves to be ideal and can also promote healing.
