Case report

A Guyon's canal ganglion presenting as occupational overuse syndrome: A case report

Jeffrey CY Chan¹ , William H Tiong¹ , Michael J Hennessy² and John L Kelly¹

¹  Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Galway, Ireland

²  Department of Neurology, University Hospital Galway, Galway, Ireland

author email corresponding author email

Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:4doi:10.1186/1749-7221-3-4

Published:	12 February 2008

Abstract

Background

Occupational overuse syndrome (OOS) can present as Guyon's canal syndrome in computer keyboard users. We report a case of Guyon's canal syndrome caused by a ganglion in a computer user that was misdiagnosed as OOS.

Case presentation

A 54-year-old female secretary was referred with a six-month history of right little finger weakness and difficulty with adduction. Prior to her referral, she was diagnosed by her general practitioner and physiotherapist with a right ulnar nerve neuropraxia at the level of the Guyon's canal. This was thought to be secondary to computer keyboard use and direct pressure exerted on a wrist support. There was obvious atrophy of the hypothenar eminence and the first dorsal interosseous muscle. Both Froment's and Wartenberg's signs were positive. A nerve conduction study revealed that both the abductor digiti minimi and the first dorsal interosseus muscles showed prolonged motor latency. Ulnar conduction across the right elbow was normal. Ulnar sensory amplitude across the right wrist to the fifth digit was reduced while the dorsal cutaneous nerve response was normal. Magnetic resonance imaging of the right wrist showed a ganglion in Guyon's canal. Decompression of the Guyon's canal was performed and histological examination confirmed a ganglion. The patient's symptoms and signs resolved completely at four-month follow-up.

Conclusion

Clinical history, occupational history and examination alone could potentially lead to misdiagnosis of OOS when a computer user presents with these symptoms and we recommend that nerve conduction or imaging studies be performed.