Double Trouble- Concomitant Carpal Tunnel Syndrome and Guyon’s Canal Syndrome: A Case Report

Case Diagnosis: Diagnosis of right carpal tunnel syndrome (CTS) and Guyon’s canal syndrome in a patient.

Case Description or Program Description: A 54-year-old female with a notable history of right wrist ganglion excision, left deQuervain’s surgery, and C5-7 ACDF and C6 corpectomy four months prior presented with numbness and tingling in both hands, worse on the right. Her symptoms worsened over a year, exacerbated by daily activities. Physical exam showed negative Spurling’s and Tinel's signs at bilateral wrists and elbows, intact sensation, full strength, and 1+ deep tendon reflexes throughout. Electrodiagnostic studies revealed mild right carpal tunnel syndrome (CTS), mild right ulnar nerve entrapment at Guyon’s canal, and chronic right C5 radiculopathy. Treatment for this patient included nighttime wrist splinting and follow up with an orthopedic hand specialist for management of her symptoms.

Setting: Outpatient Private Practice General PM&R Clinic

Assessment/Results: Due to prior cervical fusion complicating symptom interpretation, electrodiagnostic findings were required to confirm CTS and GCS. The right median sensory nerve showed prolonged latency across the wrist, while the right ulnar sensory amplitude was diminished across the wrist. Normal conduction of the dorsal ulnar cutaneous nerve (DUCN) helped confirm Guyon’s canal entrapment with normal ulnar motor studies across the elbow. Needle EMG showed polyphasic potentials in the right deltoid but no other abnormalities.

Discussion (relevance): This is a very rare case of simultaneous GCS and CTS with a cervical radiculopathy. Electrodiagnostic testing, including testing the integrity of the DUCN, was crucial in confirming the diagnosis and confirming localization of ulnar involvement which can often be overlooked.

Conclusions: Although median mononeuropathies across the wrist are well known, concomitant ulnar neuropathies across the wrist also may exist. Electrodiagnostics can help in determining simultaneous pathologies that may be missed by ultrasound. Further studies may be warranted to look at simultaneous nerve entrapments at the wrist.