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Ulnar neuropathy caused by a thrombosed ulnar vein. Case report and literature review
244 © Socidt# d~Edition de l'Association d'Enseignement M#dical des Hdpitaux de Paris, 1996
Ulnar neuropathy caused by a thrombosed ulnar vein Case report and literature review
J.A.I. GROSSMAN, G.A. BECKER
SUMMARY: A previously unreported finding of ulnar nerve compression at the wrist caused by a thrombosed ulnar artery vena comitans is described. The value of magnetic resonance imaging (MRI) in evaluating wrist masses is reviewed. A n n C h i r M a i n ( A n n H a n d Surg), 1996, 15, n ° 4, 244-247.
K E Y - W O R D S : Ulnar neuropathy.
T h r o m b o s e d ulnar vein.
INTRODUCTION
CASE REPORT
A variety of lesions in or near Guyon's canal have been reported to cause an ulnar neuropathy (table I). Although vascular lesions have been well described, especially ulnar artery thromboses and aneurysms, there are no previous reports in the English literature o f ulnar nerve compression secondary to a thrombosed ulnar vein.
A 35 year old right handed nurse was seen in consultation because of a three months history of an enlarging mass on the volar ulnar aspect of the right wrist, just proximal to the distal wrist crease. It was moderately painful and caused occasional paresthesias in the small and ring fingers. Her past medical history was unremarkable with no history o f
TABLE TABLEAU TABLA
I. -
Previously
Reported
Causes
of
Ulna
Nerve
Entrapment.
I. - Causes p r 6 c e d e m m e n t decrites de la c o m p r e s s i o n du nerf cubital. I. - Causas p r e c e d e n t e m e n t e descritas en la c o m p r e s i 6 n del nervio cubital.
Ulnar artery disease (arteritis, thromboangiitis) [18, 19, 22] Ulnar artery false aneurysm [1, 17] Ulna artery aneurysm [2] Ulna artery thrombosis [2, 16, 20, 21,23] Lipoma [3, 24] Ganglion [4, 5, 6, 7, 8, 9, 10, 11] Anomalous muscle [12, 13] - aberrent flexor carpi ulnaris insertion [14] -acessory palmaris muscle [15] - thickened palmaris brevis [16] Rheumatoid synovial wrist [25] Calcinosis in scleroderma [26] Intraneural cyst [27] Neurolemmoma of the deep branch [28] Giant cell tumor [29]
Manuscrit rec2u ~ la R~daction le 21 aofit 1996.
Wrist fractures [30, 31] Hook of hamate fractures [32] Repetitive trauma related to occupation, sports [17] - cyclists [33] - crutch walking [34] - gold polishes [35] - oyster openers [36] - cutlery workers [18] - motorcycling [37] Acute thromboangiitis of ulna artery and veins following release of Dupuytren's - Osteoarthritis of the piso-triquetral joint [32] - Hemophiliac pseudocyst [32] - Thickened volar carpal ligament [16] - Palmar fasciitis [16] - Perineura[ scarring [16]
Upper Extremity Program Miami Children's Hospital Suite 302, 3200 S W 60 th Court Miami, FL 33155.
ANNALES DE CH1RURGIE DE LA MAIN
ETDU~,E~8,ESurtR,EUR ANNALS OF HAND ANDUPPERLIMB SURGERY
1996, 15, n ° 4
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ULNAR NE UROPA THY
la Fig. 1. - a) Pre-operative MRI showing lesion between arrows lying volar to ulna. b) Sagittal view of mass (arrow) ulna (u). Note the suggestion of a lumen within the mass on this view and cut. Fig. 1. - a) IRM pr6op6ratoire montrant la lesion entre les fl~ches, en position palmaire par rapport au cubitus, b) Vue sagittale de la masse (fl~che), du cubitus (u). R e m a r q u e r I'existence possible d'une lumi~re dans la masse sur cette vue et sur la coupe. Fig. 1. - a) RMN pre operatoria que muestra la lesi6n entre las flechas, en posicidn palmar con referencia al cubito, b) Im&gen sagital de la masa (flecha), del cubito (u). N6tese la posible existencia de una luz en la masa imfigen y e n este corte.
lb
of the right hand was within normal limits, except for minimal alterations in pressure threshhold as recorded by Semmes-Weinstein monofilament testing. Radial and ulnar pulses were strong and the Allen's test was negative. Plain radiographs were unremarkable. An MRI was suggestive of an intraneural tumor (fig. la et lb). At operation, a cystic mass adjacent to the ulnar artery and adherent to the ulnar nerve was found (fig. 2). It appeared to be in continuity with one of the vena comitantes. The mass was removed and a local area of epineural thickening of the ulnar nerve was incised. The post-operative course was uneventful with c o m p l e t e r e s o l u t i o n o f all s y m p t o m s . H i s t o pathologic diagnosis demonstrated a thrombosed vein. Fig. 2. - Intraoperative view of the mass prior to resection. Fig. 2. - Vue p e r o p & a t o i r e de la masse avant r6section. Fig. 2. - I m a g e n p e r i o p e r a t o r i a de la m a s a antes de la reseocion.
trauma. On physical examination, a 3 cm mobile mass overlying the flexor carpi ulnaris tendon, along its more radial aspect, was seen. A positive Tinel's sign was elicited over the mass. Sensibility
DISCUSSION Lesions causing ulnar nerve compression at the wrist can arise from any of the soft tissue elements found in or near to Guyon's canal. This <> was first d e s c r i b e d in 1861 by Felix Guyon, a French urologist: In 1908, J.R. Hunt [36]
1996,
246
ULNAR NEUROPA THY
described compression of the ulnar nerve at the level of Guyon's canal. Anatomically, Guyon's canal has a flattened triangular shape [16]. The floor is formed primarily by the transverse carpal ligament with some contribution from the musculature origins of both the opponens digiti quinti and flexor digiti quinti. The roof of Guyon's canal is formed not only by the volar carpal ligament but also by the hypothenar fascia and the palmar aponeurosis as well as the palmaris brevis muscle. The ulnar wall of the region is formed by the pisiform, the tendon of the flexor carpi ulnaris and the origin of the abductor digiti quinti. Kuschner et al. have described three anatomic zones of Guyon's canal [8]. The clinical findings in cases of ulnar nerve compression caused by pathology within Guyon's canal is generally related to the zone in which the pathology is located. Zone I is just proximal to the entrance to Guyon's canal and is the location of the pathology in the case reported. Although Zone I masses are reported to produce mixed motor and sensory findings, in Kuschner's series, 41% of the patients presented with pure sensory findings, as in this case. Lesions in Zone II generally involve only the deep motor branch of the
15, n ° 4
ANNALES DE C H I R U R G I E DE L A MAIN
~TDUmEmBRES~PEr~Eu'~ ANNALS OF HAND ANDUPPERLIMB SURGERY
ulnar nerve and Zone III lesions generally involve only the distal sensory branches to the fourth web space and ulnar aspect of the small finger. Because physical examination and plain radiographs were of little value pre-operatively in determining the pathology of the lesion in this case, an MRI was performed, as this type of imaging is felt to give the best anatomic definition of the soft tissues of the hand and wrist [39]. The increased cost of the test was felt to be outweighed by the information potentially available to both the surgeon and the patient prior to undertaking operation. Indeed, the pre-operative interpretation of the magnetic resonance image suggested the possibility of an intraneural lesion and the surgical consequences were reviewed with the patient. The decision to proceed with surgery was based in large part on the combination of symptomatology as well as the presence of a clearly defined mass impinging upon the ulnar nerve. Correlation of the operative pathology with specific images in the pre-operative study reviewed retrospectively do suggest minute findings compatible with a vascular lesion. The evaluation of masses within Guyon's canal should take into account the presence of a venous lesion.
REFERENCES 1. K A L I S M A N M., L A B O R D E K., W O L F F T.W. - Ulna Nerve
Compression Secondary to Ulnar Artery False Aneurysm at the Guyon's Canal. J. HandSurg., 1982, 7, 137-139. 2. M I L L E N D E R L . H . , N A L E B U F F E . A . , K A S D O N E. A n e u r y s m s and Thrombosis of the Ulnar Artery of the Hand. Arch. Surg., 1972, 105, 686.
3. McFARLAND G.B., HOFFER M.M. - Paralysis of the Intrinsic Muscles of the Hand Secondary to Lipoma in Guyon's Tunnel.
J. Bone Joint Surg. (Am.), 1971, 53, 375. K . P . , H A G S T R O M P. - Distal Ulnar Nerve Compression caused by Ganglion Formation in the loge de Guyon.
4. F O R S H E L L
Scand. J. Plast. Reconstr. Surg., 1975, 9, 77. 5. B R O O K S D.M. - Nerve Compression by Simple Ganglion. A Review of Thirteen Collected Cases. J. Bone Joint Surg. (Br.), 1952, 34, 391. 6. S E D D O N H.J. - Carpal Ganglion as a Cause of Paralysis of the Deep Branch of the Ulnar Nerve. J. Bone Joint Surg. (Br.), 1952, 34, 386.
7. RICHMOND D.A. - Carpal Ganglion with Ulnar Nerve Compression. J. Bone Joint Surg. (Br.), 1953, 45, 513. 8. K U S C H N E R S.H., G E L B E R M A N R . H . , J E N N I N G S C. Ulnar Nerve Compression at the Wrist. J. HandSurg., 1988, 13A, 577-580. 9. O L N E Y R.F., H A N S O N M. - Ulnar Neuropathy at or Distal to the Wrist. Muscle & Nerve, 1988, 11, 828-832. 10. A Z O U Z E.M., KOZLOWSKI, M A S E L J. - Soft Tissue Tumors of the Hand and Wrist in Children. J. Can. Assoc. RadioL, 1989, 40, 251-255. 11. T O S H I M A Y., K I M A T A Y. - A Case of Ganglion Causing Paralysis of Intrinsic Muscles Innervated by the Ulnar Nerve. J. BoneJoint Surg., 1961, 43A, 153. 12. DUNEDIN J.A.K. - Compression of the Deep Palmar Branch of the Ulnar Nerve by an Anomalous Muscle. J. Bone Joint Surg. (Br.), 1971, 53, 718.
13. S W A N S O N A . B . , B I D D U L P H S.L., B A U G H M A N F . A . , DeGROOT G. - Ulnar Nerve Compression Due to an Anomalous Muscle in the Canal of Guyon. Clin. Orthop., 1972, 83, 64. 14. O ' H A R A J.J., S T O N E J.H. - Ulnar Neuropathy at the Wrist Associated with Aberrant Flexor Carpi Ulnaris Insertion. a~ Hand Surg., 1988, 13A, 370-371. 15. R O B I N S O N D., A G H A S I M.K., HALPER1N N. - Ulnar Tunnel
Syndrome Caused by an Accessory Palmaris Muscle. Orthop.
Rev., 1989, 18, 345-347. 16. K L E I N E R T H.E., H A Y E S J.E. - The Ulnar Tunnel Syndrome. Plast. Reeonstr. Surg., 1971, 47, 21-24. 17. G R U N D B E R G A.B. - Ulnar Tunnel Syndrome. J. Hand Surg., 1984, 98, 72-74. 18. S H E A J.D., M c C L A I N E.J. - Ulnar Nerve Compression Syndromes at and Below the Wrist. J. Bone Joint Surg., 1969, 51A, 1095-1103. 19. B U G G Jr. E.L., C O O N R A D R.W., G R I M K.B. - Giant Cell Arteritis. An Acute Hand Syndrome. J. Bone Joint Surg., 1963, 45A, 12, 69-72. 20. CAMERON B'M" - Occlusi°n °f the Ulnar Artery with Impending Gangrene of the Fingers Relieved by Section of the Volar Carpal Ligament. J. Bone Joint Surg., 1954, 36A, 406-408. 21. JACKSON J.P. - Traumatic Thrombosis of the Ulnar Artery in the Palm. J. Bone Joint Surg., 1954, 36B, 438-439. 22. K A P L A N E.B. - Arteritis Involving the Arteries of the Hand. Bull. Hosp. Joint Dis., 1965, 26, 20-25. 23. TEECE L.G. - Thrombosis of the Ulnar Artery. Austr. NZJ. Surg., 1949, 19, 156-157. 24. P H A L E N G.S., K E N D R I C K J.I., R O D R I G U E Z J.M. - Lipomas of the Upper Extremity; A Series of Fifteen Tumors in the Hand
and Wrist and Six Tumors Causing Nerve Compression. Am. J.
Surg., 1971, 121, 298-306.
ANNALES DE CHIRURGIE DE LA MAIN ETDU MEMBRESUPERIEUR ANNALS OF HAND ANDUPPERLIMB SURGERY
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15, n ° 4 ULNAR NE UR OPA THY
247
25. DELL P.C. - C o m p r e s s i o n o f the Ulnar Nerve at the Wrist Secondary to Rheumatoid Synovial Cyst: Case Report and Review of the Literature. J. Hand Surg., 1979, 4, 468. 26. T H U R M A N R.T., JINDAL P., W O L F F T.W. - Ulnar Nerve C o m p r e s s i o n in G u y o n ' s C a n a l C a u s e d by C a l c i n o s i s in Scleroderma. J. Hand Surg., 1991, 16A, 739-741. 27. BOWERS W.H., POPPELT S.H. - Compression of the Deep Branch of the Ulnar Nerve by an Intraneural Cyst. J. Bone Joint Surg., 1979, 61A, 612-613. 28. SARANGAPANI K., MORE A.R. - N e u r o l e m m o m a of the Deep Branch of the Ulnar Nerve Presenting as Ulnar Tunnel Syndrome. Hand., 1983, 15, 2167. 29. RAFECAS J.C., D A U B E J.R., E H M A N R.C. - Deep Branch Ulnar Neuropathy Due to Giant Cell Tumor : Report of a Case. Neurology, 1988, 38, 327-329. 30. HOWARD F.M. - Ulnar Nerve Palsy in Wrist Fractures. J. Bone JointSurg., 1961, 43A, 1197-1201. 31. ZOEGN H. - Fracture of the Lower End of the Radius with Ulnar Nerve Palsy. J. Bone Joint Surg., 1966, 48B, 514-516. 32. SABIN G.D., M A L L O N W.J., U R B A N I A K J.R. - Diagnosis of Ganglion in Guyon's Canal by Magnetic Resonance Imaging. Hand Surg., 1989, 14A, 640-643.
33. HANKEY G.J., GUBBAY S. - Compressive Mononeuropathy of the Deep Branch of the Ulnar Nerve in Cyclists. J. Neurol. Psychiatry, 1988, 51, 1588-1590. 34. DUPONT C., CLOUTLER G.E., PREVOST Y., DION M.A. Ulnar Tunnel Syndrome at the Wrist. A Report of Four Cases of Ulnar Nerve Compression at the Wrist. J. Bone Joint Surg., 1965, 47A, 757-761. 35. G E S S L E R H. - Eine E g e n a r t i g e F o r m v o n P r o g r e s s i v e Muskelatrophie ber-Goldpolirinner. Med. Cor-bl. d. Wurtlem. Arstl., 1929, 36, 281. 36. H U N T J.R. - The T h e n a r and H y p o t h e n a r Types o f Neural Atrophy of the Hand. Am. J. Med. Sci., 1911,141, 224-241. 37. HARRIS W. - Occupational Pressure Neuritis of the Deep Palmar Branch of the Ulnar Nerve. Br. Med. J., 1929, 1, 98. 38. BUTLER E.D., HAMILL J.P., SEIPEL R.S., DeLORIMIER A.A. - T u m o r s o f the Hand. A T e n Year S u r v e y a n d Report o f 437 Cases. Am. 3:. Surg., 1960, 100, 293-302. 39. WEISS K.L., B E L T R A N J., S H A M A M O.M., STILLA R.F., LEVEY M. - High-field MR Surface-coil Imaging of the Hand and Wrist. Part I : Normal Anatomy. Radiology, 1986, 160, 143-146. 40. GROSS M.S. GELBERMAN R.H. The Anatomy of the Distal Ulnar Tunnel. Clin. Orthop., 1984, 196, 238-247.
G R O S S M A N J.A.I., B E C K E R G.A. - N e u r o p a t h i e c u b i t a l e p r o v o q u r e par u n e t h r o m b o s e de la veine cubitale. (En Anglais). A n n C h i r M a i n ( A n n H a n d S u r g ) , 1996, 15, n ° 4, 244-247.
GROSSMAN J.A.I., BECKER G.A. - Neuropatia cubital secundaria a u n a t r o m b o s i s de la v e n a cubital. A n n C h i r M a i n ( A n n H a n d S u r g ) , 1996, 15, n ° 4, 244-247.
RI~SUMI~ : Uauteur drcrit une compression du neff cubital au niveau du poignet provoqure par une thrombose veineuse satellite de l'artrre cubitale (vena comitans ?), non drcrite jusqu'~t maintenant. Uintdrrt de FIRM pour l'rvaluation des masses du poignet est 6tudire.
R E S O M E N : E1 autor describe una compresidn del nervio cubital a nivel de la mufieca provocada por una trombosis de la vena comitans arteria cubital ? no descrita hasta la actualidad. E1 interrs de la R M N para la evaluacidn de las masas de la mufieca se estudia.
MOTS-CLI~S : N e u r o p a t h i e cubitale. - T h r o m b o s e de la veine cubitale.
P A L A B R A S - C L A V E : N e u r o p a t i a c u b i t a l . - T r o m b o s i s de la v e n a cubital.
G R O S S M A N J.A.I., B E C K E R G.A. - A n n C h i r M a i n ( A n n H a n d S u r g ) , 1996, 15, n ° 4, 244-247.
Ulnar neuropathy caused by a thrombosed ulnar vein Case report and literature review
J.A.I. GROSSMAN, G.A. BECKER
SUMMARY: A previously unreported finding of ulnar nerve compression at the wrist caused by a thrombosed ulnar artery vena comitans is described. The value of magnetic resonance imaging (MRI) in evaluating wrist masses is reviewed. A n n C h i r M a i n ( A n n H a n d Surg), 1996, 15, n ° 4, 244-247.
K E Y - W O R D S : Ulnar neuropathy.
T h r o m b o s e d ulnar vein.
INTRODUCTION
CASE REPORT
A variety of lesions in or near Guyon's canal have been reported to cause an ulnar neuropathy (table I). Although vascular lesions have been well described, especially ulnar artery thromboses and aneurysms, there are no previous reports in the English literature o f ulnar nerve compression secondary to a thrombosed ulnar vein.
A 35 year old right handed nurse was seen in consultation because of a three months history of an enlarging mass on the volar ulnar aspect of the right wrist, just proximal to the distal wrist crease. It was moderately painful and caused occasional paresthesias in the small and ring fingers. Her past medical history was unremarkable with no history o f
TABLE TABLEAU TABLA
I. -
Previously
Reported
Causes
of
Ulna
Nerve
Entrapment.
I. - Causes p r 6 c e d e m m e n t decrites de la c o m p r e s s i o n du nerf cubital. I. - Causas p r e c e d e n t e m e n t e descritas en la c o m p r e s i 6 n del nervio cubital.
Ulnar artery disease (arteritis, thromboangiitis) [18, 19, 22] Ulnar artery false aneurysm [1, 17] Ulna artery aneurysm [2] Ulna artery thrombosis [2, 16, 20, 21,23] Lipoma [3, 24] Ganglion [4, 5, 6, 7, 8, 9, 10, 11] Anomalous muscle [12, 13] - aberrent flexor carpi ulnaris insertion [14] -acessory palmaris muscle [15] - thickened palmaris brevis [16] Rheumatoid synovial wrist [25] Calcinosis in scleroderma [26] Intraneural cyst [27] Neurolemmoma of the deep branch [28] Giant cell tumor [29]
Manuscrit rec2u ~ la R~daction le 21 aofit 1996.
Wrist fractures [30, 31] Hook of hamate fractures [32] Repetitive trauma related to occupation, sports [17] - cyclists [33] - crutch walking [34] - gold polishes [35] - oyster openers [36] - cutlery workers [18] - motorcycling [37] Acute thromboangiitis of ulna artery and veins following release of Dupuytren's - Osteoarthritis of the piso-triquetral joint [32] - Hemophiliac pseudocyst [32] - Thickened volar carpal ligament [16] - Palmar fasciitis [16] - Perineura[ scarring [16]
Upper Extremity Program Miami Children's Hospital Suite 302, 3200 S W 60 th Court Miami, FL 33155.
ANNALES DE CH1RURGIE DE LA MAIN
ETDU~,E~8,ESurtR,EUR ANNALS OF HAND ANDUPPERLIMB SURGERY
1996, 15, n ° 4
245
ULNAR NE UROPA THY
la Fig. 1. - a) Pre-operative MRI showing lesion between arrows lying volar to ulna. b) Sagittal view of mass (arrow) ulna (u). Note the suggestion of a lumen within the mass on this view and cut. Fig. 1. - a) IRM pr6op6ratoire montrant la lesion entre les fl~ches, en position palmaire par rapport au cubitus, b) Vue sagittale de la masse (fl~che), du cubitus (u). R e m a r q u e r I'existence possible d'une lumi~re dans la masse sur cette vue et sur la coupe. Fig. 1. - a) RMN pre operatoria que muestra la lesi6n entre las flechas, en posicidn palmar con referencia al cubito, b) Im&gen sagital de la masa (flecha), del cubito (u). N6tese la posible existencia de una luz en la masa imfigen y e n este corte.
lb
of the right hand was within normal limits, except for minimal alterations in pressure threshhold as recorded by Semmes-Weinstein monofilament testing. Radial and ulnar pulses were strong and the Allen's test was negative. Plain radiographs were unremarkable. An MRI was suggestive of an intraneural tumor (fig. la et lb). At operation, a cystic mass adjacent to the ulnar artery and adherent to the ulnar nerve was found (fig. 2). It appeared to be in continuity with one of the vena comitantes. The mass was removed and a local area of epineural thickening of the ulnar nerve was incised. The post-operative course was uneventful with c o m p l e t e r e s o l u t i o n o f all s y m p t o m s . H i s t o pathologic diagnosis demonstrated a thrombosed vein. Fig. 2. - Intraoperative view of the mass prior to resection. Fig. 2. - Vue p e r o p & a t o i r e de la masse avant r6section. Fig. 2. - I m a g e n p e r i o p e r a t o r i a de la m a s a antes de la reseocion.
trauma. On physical examination, a 3 cm mobile mass overlying the flexor carpi ulnaris tendon, along its more radial aspect, was seen. A positive Tinel's sign was elicited over the mass. Sensibility
DISCUSSION Lesions causing ulnar nerve compression at the wrist can arise from any of the soft tissue elements found in or near to Guyon's canal. This <
1996,
246
ULNAR NEUROPA THY
described compression of the ulnar nerve at the level of Guyon's canal. Anatomically, Guyon's canal has a flattened triangular shape [16]. The floor is formed primarily by the transverse carpal ligament with some contribution from the musculature origins of both the opponens digiti quinti and flexor digiti quinti. The roof of Guyon's canal is formed not only by the volar carpal ligament but also by the hypothenar fascia and the palmar aponeurosis as well as the palmaris brevis muscle. The ulnar wall of the region is formed by the pisiform, the tendon of the flexor carpi ulnaris and the origin of the abductor digiti quinti. Kuschner et al. have described three anatomic zones of Guyon's canal [8]. The clinical findings in cases of ulnar nerve compression caused by pathology within Guyon's canal is generally related to the zone in which the pathology is located. Zone I is just proximal to the entrance to Guyon's canal and is the location of the pathology in the case reported. Although Zone I masses are reported to produce mixed motor and sensory findings, in Kuschner's series, 41% of the patients presented with pure sensory findings, as in this case. Lesions in Zone II generally involve only the deep motor branch of the
15, n ° 4
ANNALES DE C H I R U R G I E DE L A MAIN
~TDUmEmBRES~PEr~Eu'~ ANNALS OF HAND ANDUPPERLIMB SURGERY
ulnar nerve and Zone III lesions generally involve only the distal sensory branches to the fourth web space and ulnar aspect of the small finger. Because physical examination and plain radiographs were of little value pre-operatively in determining the pathology of the lesion in this case, an MRI was performed, as this type of imaging is felt to give the best anatomic definition of the soft tissues of the hand and wrist [39]. The increased cost of the test was felt to be outweighed by the information potentially available to both the surgeon and the patient prior to undertaking operation. Indeed, the pre-operative interpretation of the magnetic resonance image suggested the possibility of an intraneural lesion and the surgical consequences were reviewed with the patient. The decision to proceed with surgery was based in large part on the combination of symptomatology as well as the presence of a clearly defined mass impinging upon the ulnar nerve. Correlation of the operative pathology with specific images in the pre-operative study reviewed retrospectively do suggest minute findings compatible with a vascular lesion. The evaluation of masses within Guyon's canal should take into account the presence of a venous lesion.
REFERENCES 1. K A L I S M A N M., L A B O R D E K., W O L F F T.W. - Ulna Nerve
Compression Secondary to Ulnar Artery False Aneurysm at the Guyon's Canal. J. HandSurg., 1982, 7, 137-139. 2. M I L L E N D E R L . H . , N A L E B U F F E . A . , K A S D O N E. A n e u r y s m s and Thrombosis of the Ulnar Artery of the Hand. Arch. Surg., 1972, 105, 686.
3. McFARLAND G.B., HOFFER M.M. - Paralysis of the Intrinsic Muscles of the Hand Secondary to Lipoma in Guyon's Tunnel.
J. Bone Joint Surg. (Am.), 1971, 53, 375. K . P . , H A G S T R O M P. - Distal Ulnar Nerve Compression caused by Ganglion Formation in the loge de Guyon.
4. F O R S H E L L
Scand. J. Plast. Reconstr. Surg., 1975, 9, 77. 5. B R O O K S D.M. - Nerve Compression by Simple Ganglion. A Review of Thirteen Collected Cases. J. Bone Joint Surg. (Br.), 1952, 34, 391. 6. S E D D O N H.J. - Carpal Ganglion as a Cause of Paralysis of the Deep Branch of the Ulnar Nerve. J. Bone Joint Surg. (Br.), 1952, 34, 386.
7. RICHMOND D.A. - Carpal Ganglion with Ulnar Nerve Compression. J. Bone Joint Surg. (Br.), 1953, 45, 513. 8. K U S C H N E R S.H., G E L B E R M A N R . H . , J E N N I N G S C. Ulnar Nerve Compression at the Wrist. J. HandSurg., 1988, 13A, 577-580. 9. O L N E Y R.F., H A N S O N M. - Ulnar Neuropathy at or Distal to the Wrist. Muscle & Nerve, 1988, 11, 828-832. 10. A Z O U Z E.M., KOZLOWSKI, M A S E L J. - Soft Tissue Tumors of the Hand and Wrist in Children. J. Can. Assoc. RadioL, 1989, 40, 251-255. 11. T O S H I M A Y., K I M A T A Y. - A Case of Ganglion Causing Paralysis of Intrinsic Muscles Innervated by the Ulnar Nerve. J. BoneJoint Surg., 1961, 43A, 153. 12. DUNEDIN J.A.K. - Compression of the Deep Palmar Branch of the Ulnar Nerve by an Anomalous Muscle. J. Bone Joint Surg. (Br.), 1971, 53, 718.
13. S W A N S O N A . B . , B I D D U L P H S.L., B A U G H M A N F . A . , DeGROOT G. - Ulnar Nerve Compression Due to an Anomalous Muscle in the Canal of Guyon. Clin. Orthop., 1972, 83, 64. 14. O ' H A R A J.J., S T O N E J.H. - Ulnar Neuropathy at the Wrist Associated with Aberrant Flexor Carpi Ulnaris Insertion. a~ Hand Surg., 1988, 13A, 370-371. 15. R O B I N S O N D., A G H A S I M.K., HALPER1N N. - Ulnar Tunnel
Syndrome Caused by an Accessory Palmaris Muscle. Orthop.
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G R O S S M A N J.A.I., B E C K E R G.A. - N e u r o p a t h i e c u b i t a l e p r o v o q u r e par u n e t h r o m b o s e de la veine cubitale. (En Anglais). A n n C h i r M a i n ( A n n H a n d S u r g ) , 1996, 15, n ° 4, 244-247.
GROSSMAN J.A.I., BECKER G.A. - Neuropatia cubital secundaria a u n a t r o m b o s i s de la v e n a cubital. A n n C h i r M a i n ( A n n H a n d S u r g ) , 1996, 15, n ° 4, 244-247.
RI~SUMI~ : Uauteur drcrit une compression du neff cubital au niveau du poignet provoqure par une thrombose veineuse satellite de l'artrre cubitale (vena comitans ?), non drcrite jusqu'~t maintenant. Uintdrrt de FIRM pour l'rvaluation des masses du poignet est 6tudire.
R E S O M E N : E1 autor describe una compresidn del nervio cubital a nivel de la mufieca provocada por una trombosis de la vena comitans arteria cubital ? no descrita hasta la actualidad. E1 interrs de la R M N para la evaluacidn de las masas de la mufieca se estudia.
MOTS-CLI~S : N e u r o p a t h i e cubitale. - T h r o m b o s e de la veine cubitale.
P A L A B R A S - C L A V E : N e u r o p a t i a c u b i t a l . - T r o m b o s i s de la v e n a cubital.
G R O S S M A N J.A.I., B E C K E R G.A. - A n n C h i r M a i n ( A n n H a n d S u r g ) , 1996, 15, n ° 4, 244-247.