Symptoms of Loge-de-Guyon syndrome

The Guyon Lodge is one of the three most typical sites of damage to the ulnar nerve and is located furthest distal (away from the center of the body). Because the nerve at the site of its constriction has usually already delivered the ramus superficialis for the sensitive (transmission of sensation) care of the hand, a purely motoric restriction results in the majority of cases. On the one hand, this manifests itself through atrophy of the affected muscles.

This is particularly evident in the area of the back of the hand between the thumb and the index finger (spatium interosseum I), where the skin appears sunken. However, the muscles between the other fingers on the back of the hand are also affected, so that the same kind of skin depressions can be observed here. The ball of the little finger (on the inside of the hand) can also be atrophic.

In addition to these visible muscle affections, patients often report a loss of strength in the hand, which becomes noticeable when spreading and joining the fingers. If – in rare cases – the sensitive ramus superficialis is also affected by the constriction, this can lead to a loss of strength in the hand. In the much more common case of damage to the nerve located further proximal (in the area of the elbow) (sulcus-ulnaris syndrome), there are two very typical signs, which are not always found in Guyon-Logen syndrome: (Fingers cannot be fully stretched due to a failure of the lumbrical and interosseous muscles) (the patient is asked to hold a piece of paper between thumb and index finger, but can only do so by bending the thumb and thus holding it with the tip of the thumb, which indicates an impairment of the M. adductor pollicis innervated by the ulnar nerve, which is responsible for bringing the thumb closer to the other fingers)

Tingling,
Numbness and
Sensitivity disorders in the supply area of the ulnar nerve, i.e. the little and ring finger as well as the edge of the hand on the little finger side.
Claw Hand
From-character

The Loge de Guyon is located between the carpal bones on the ulnar side (thus also on the side of the little finger) of the wrist.Here the ulnar nerve (a nerve that supplies both motor and sensory functions) runs around one of the bones at the base of the hand, the pea bone.

If there are spatial demands here, for example due to tumors, ganglions or simple, long-lasting pressure loads, the ulnar nerve can be constricted or irritated. This is usually first noticed by tingling and slight numbness. Later, if left untreated, pain may also occur.

This pain can be improved either conservatively or surgically. Here it is important to weigh up which course of the disease has preceded. The pain in the hand can speak for many things and should not be limited to the Logen-de-Guyon syndrome.

To find out what could be behind the pain, please also see our articles on the following topics:

Pain in the hand – Why?
Diseases of the hand

A conservative (non-operative) treatment is usually at the beginning. Among other things, painkillers and, if necessary, a splint for immobilization relief are used. In most cases, however, surgical exposure of the Guyon Lodge with decompression (neurolysis) of the ulnar nerve is indicated.

If the Loge de Guyon syndrome is caused by the nerve having been subjected to long-term and heavy strain, as may be the case, for example, when cycling, immobilization with a splint can help. This is often worn at night, but can also be worn during the day. In addition, it serves to prevent the nerve from being irritated by the movements that directly affect it.

A special wrist splint is suitable for this purpose and is best selected by an orthopedist or medical supply store. An operation is absolutely necessary if the Loge de Guyon syndrome is caused by an unphysiological, i.e. unnatural constriction. This can be caused, for example, by an overgrowth of a bone or by a new formation of tissue, i.e. a tumor, a new formation of vessels and scar tissue in the area there.

In these cases, surgery is necessary because the structures there must be removed in order to improve the symptoms. Especially in the case of a tumor, it must be clarified whether it is a metastasis of an already existing tumor. In almost every operation, intolerance to the anaesthetic can occur.

Recurrences may occur (i.e. the symptoms return) and there may be impaired wound healing, increased scarring and postoperative bleeding or haematoma. In addition, there is always the risk during surgery on nerves that the nerves are also irritated by the surgeon and that postoperatively numbness in the treated area occurs. In addition to numbness, muscle loss or restriction can also occur.

Furthermore, there is no guarantee that the operation will help to cure Loge de Guyon syndrome. These articles may also be of interest to you:

Complications after surgery
Swelling after surgery – tips for treatment

The treatment of Loge de Guyon syndrome is very much dependent on the underlying cause. If the nerve compression is present because the nerve is pinched by a tumor or an overbone, no physiotherapy will help and the syndrome must be treated surgically.

If overstrain and compression is the cause of the symptoms, a splint may be helpful. Physiotherapy or “occupational therapy”, as the physiotherapeutic treatment of the hand is called, can also bring relief. Strengthening surrounding muscles can, but does not have to, reduce the pressure on the ulnar nerve and thus ease the symptoms.