Loge de Guyon syndrome is an extremely rare disease that primarily affects the ulnar nerve. Due to a narrowing, there is a loss of sensation in the area of the little and 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?
According to Fun-Wiki, Loge de Guyon syndrome is a very rare condition that falls under the compression syndrome category. It is a compression of the ulnar nerve – the ulnar nerve. The so-called Loge de Guyon is located next to the carpal tunnel; in this is the motor branch of the ulnar nerve.
This branch not only connects the muscles of the metacarpus, but also the little and ring fingers. If a constriction occurs, which is primarily caused by ganglia – i.e. cysts on the wrist -, the typical symptoms of Loge-de-Guyon syndrome subsequently appear.
Causes
The reason why Loge-de-Guyon syndrome can develop at all is a narrowing that directly affects the nerve in the so-called Guyon canal. This narrowing is caused by a ganglion (cyst or ganglion). The ganglion is considered (medically) to be a benign tumor.
Sometimes, however, long-term or often repeated compressions or hyperextension of the nerve can be the reason why Loge-de-Guyon syndrome develops. Those factors are promoted, for example, by motorcycling, cycling or the use of tools. A “crutch paralysis” can also trigger the Loge de Guyon syndrome. Other causes are sometimes fractures that have damaged or narrowed the structures of the Guyon canal.
Symptoms, Ailments & Signs
The first symptoms of Loge de Guyon syndrome are abnormal sensations in the hand. Those affected usually feel a slight tingling or numbness in the little finger and ring finger. The complaints occur in connection with overloading the wrist, as is possible, for example, with prolonged cycling or with push-ups.
However, other triggers may be present, and symptoms vary accordingly. Chronic pain and muscle weakness of the hand muscles can also occur as the disease progresses. The affected hand can then no longer be moved as before, which results in limitations in everyday life and, in the long term, in subsequent hand problems.
A permanent protective posture can lead to joint wear, muscle pain and cramps. Circulatory disorders are also conceivable. If the nerve is compressed for a long time, it can lead to atrophy of the muscles and, as a result, to deformation of the tissue of the little finger.
Pronounced forms are expressed by temporary signs of paralysis in the entire hand and especially in the fingers. The symptoms of Loge de Guyon syndrome usually appear gradually and are often only noticed when they are already severe. Ultimately, the affected hand becomes permanently stiff or unable to function.
Diagnosis & disease progression
As part of the diagnosis, the physician carries out an anamnesis and a clinical examination of the patient. If there is a suspicion of damage to the nerve, an electrophysiological examination is usually carried out. During this examination, the nerve conduction velocity of the patient 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 an insight into whether and, if so, which structural causes have occurred that triggered the Loge de Guyon syndrome (e.g. whether a cyst or ganglion is present). However, magnetic resonance imaging is only ordered in very few cases and is therefore not one of the classic examination methods to diagnose Loge-de-Guyon syndrome.
In the further course, the doctor decides whether conservative or surgical treatment is necessary. However, when undergoing treatment, the patient must have patience. Only after a few weeks do the first signs of improvement appear; the final healing can sometimes take several months. However, if the disease is severe or if the ulnar nerve is damaged to such an extent, even surgical treatment cannot bring the desired success. This leaves a reduction in feeling, which mainly affects the hand muscles.
Complications
As a rule, the Loge-de-Guyon syndrome leads to various paralysis or sensory disturbances, which mainly occur in the little finger and ring finger. Furthermore, there are no complaints, although the paralysis and the disturbances in sensitivity can also spread to the hand and the back of the hand. In most cases, there are no other symptoms or complications.
The everyday life of those affected is restricted by the Loge-de-Guyon syndrome and complaints and difficulties arise in various activities or when exercising various professions. The quality of life is also reduced by Loge de Guyon syndrome. If the symptoms occur suddenly or spontaneously, many patients can also suffer from anxiety or sweating. It is not uncommon for paralysis to lead to psychological problems or even depression.
As a rule, the treatment is carried out by immobilising the affected regions. There are no complications. In some cases, various therapies are also necessary afterwards so that the mobility of the fingers and joints can be restored. Life expectancy is not affected by Loge de Guyon syndrome. Usually, after a successful treatment, the hand can be used normally again.
When should you go to the doctor?
If you experience discomfort in your fingers or hands, you should consult a doctor. Tingling or numbness in the extremities are indications of existing irregularities that should be investigated and treated. If the disturbances of perception last for several days or weeks, a doctor’s visit is recommended to clarify the cause. In the early stages, the symptoms appear when the hands or fingers are overloaded.
Even if the symptoms subside after a short time, it is advisable to see a doctor for a check-up. If there are abnormalities in blood circulation, cold fingers or a loss of the usual muscle strength in the hands, a doctor should be consulted. If cramps appear or if the person concerned suffers from pain in the hands, a doctor’s visit is necessary. Deformities on the fingers are a special warning of the organism.
In addition, the optical change is a feature of Loge-de-Guyon syndrome and should be examined more closely by a doctor. Medical care is required if the person concerned suffers from signs of paralysis or restrictions in the usual range of motion in the fingers, hands or wrist. In the further course of the disease, if there is no therapy, the fingers will become stiff. If everyday activities can no longer be carried out as usual, the person concerned should consult a doctor.
Treatment & Therapy
Conservative therapy is used when the diagnosis of Loge-de-Guyon syndrome was made relatively early or when the disease is still in an early stage. It is important that the patient refrains from any kind of activity that primarily stresses the nerve. These include 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 doctor refrains from surgical intervention. Nevertheless, the patient must avoid any factors that led to Loge de Guyon syndrome or take preventive measures so that the nerve does not become narrowed again.
If the disease is already advanced or if conservative therapy has not brought any noticeable success, the doctor carries out the surgical procedure. This is an open surgical technique. The doctor makes a half-cut in the wrist (around the little finger) so that the ulnar nerve and its arteries can be exposed. The exposure and treatment of the nerve and its arteries is carried out using a magnifying glass. The sutures are removed after about 14 days.
Even if immobilization with a plaster cast is not necessary, the wrist or arm is put in plaster for the majority of patients. The wearing time of the plaster cast is only three to a maximum of five days. Subsequently, the patient must avoid any physical exertion for about three weeks. After the doctor has removed the sutures, a scar mass is then necessary, which can be done independently or as part of a physiotherapeutic therapy.
However, it takes several weeks for the patient to notice the first improvements. After the cast is removed, postoperative exercises are recommended. Those should be done in physical therapy. The treating therapist adapts the exercises to the severity of the Loge de Guyon syndrome. For this reason, physiotherapy is conducted individually. After three or six months, new neurological and electrophysiological examinations are carried out.
Outlook & Forecast
The overall prognosis of Loge de Guyon syndrome is favorable. There are various treatment options to achieve relief from symptoms or recovery. The course of the disease depends on the 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 symptoms, the more optimal the further course will be.
Sufficient protection of the joint is particularly important. The patient should avoid any strain or exertion until the end of the treatment period. Medical immobilization is usually not necessary, but the affected person should keep the joint sufficiently rested in everyday life. In addition, physiotherapeutic measures are used. These can also be carried out independently outside of the therapy sessions to ensure faster healing.
In particularly severe cases, an operation 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 symptom-free within a few months, regardless of the treatment method. If complications arise, there may be permanent restrictions on joint activity. Sensitivity disorders of the skin and a limitation of physical resilience are also possible. In these cases, everyday life has to be restructured and adapted to the physical possibilities.
Prevention
Loge de Guyon syndrome can be prevented. Above all, cyclists should use racing bike handlebars that allow them to change their grip in different positions. The use of padded gloves can also prevent the syndrome as it progresses, since the mechanical pressure effect is significantly reduced here. However, further preventive measures are not known.
Aftercare
The Loge-de-Guyon syndrome leads to various symptoms and complications in the affected person, which lead to restrictions in the movement of the affected person in everyday life. In some cases, this also leads to muscle weakness and further to disturbances in blood circulation. Paralysis or severe pain in the muscles can also occur and make everyday life difficult for those affected.
Sometimes those affected are dependent on the help of their relatives or friends in order to master everyday life. Follow-up care focuses on the monitoring of the recovery process by the attending physician. A gentle lifestyle is recommended to prevent the disease from flaring up again. Regular use of the exercises learned during physical therapy can make a significant contribution to strengthening the wrist.
You can do that yourself
Loge de Guyon syndrome can be treated through some self-help means. However, these remedies do not replace full treatment by a doctor. If there is no improvement, a doctor must be consulted in any case.
The affected person should refrain from sports in which the nerve is stressed. These include martial arts and cycling. This allows the ulnar nerve to recover in many cases, so that surgery is not necessary. Immobilizing the wrist can also relieve the discomfort. The person concerned 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 carried out at home, which speeds up healing. This usually relieves the symptoms completely. During the immobilization, those affected are often dependent on the help of other people in their everyday life. Above all, the help of friends or relatives proves to be ideal and can also promote healing.
