Site Search:

Question for Physiotherapists


ANSWER |  Guyon’s canal is immediately adjacent to the carpal tunnel on the volar part of the wrist and contains the ulnar nerve and ulnar artery. Compression of the ulnar nerve within Guyon’s canal is much less common than compression within the cubital tunnel, and both of these conditions are even much less common than compression of the median nerve within the carpal tunnel. Compression of the ulnar nerve within Guyon’s canal and within the cubital tunnel can lead to similar symptoms, but there are clinical signs that can be used to differentiate between the two.

Compression of the ulnar nerve within Guyon’s canal leads to sensory changes in the distribution of the ulnar nerve on the volar aspects of the ulnar 1.5 digits of the hand. Because the ulnar nerve divides into volar and dorsal branches prior to entering Guyon’s canal, compression of the nerve within the canal will spare sensation on the dorsal aspect of these ulnar 1.5 digits.

On the other hand, compression of the ulnar nerve in the cubital tunnel at the elbow occurs at a site proximal to the division of the ulnar nerve into its volar and dorsal branches, and therefore will cause sensory changes on both the volar and dorsal aspects of the ulnar 1.5 digits of the hand.    

Tapping along the ulnar nerve via Tinels testing may also show irritation to the ulnar nerve at the level of the wrist in the case of compression within Guyon’s canal, as opposed to irritation at the level of the elbow in the case of cubital tunnel syndrome.   

Severe compression at both levels would lead to weakness and wasting of the intrinsic muscles of the hand innervated by the ulnar nerve, whereas compression at the elbow will also involve the ulnar nerve-innervated muscles in the forearm (FCU; FDP to the ring and little fingers).

Therefore, by paying attention to the above differences during a careful examination, it is possible to determine the level of the compression of the ulnar nerve.    

If compression of the ulnar nerve at the level of Guyon’s canal is clinically suspected, then imaging studies to look for the cause should be performed. It is important to exclude a space occupying lesion – such as a ganglion from one of the nearby intercarpal joints – with an MRI scan. A basic x-ray will also give information about potential osteoarthritis in the area, which leads to surrounding soft tissue oedema which may compress the ulnar nerve. A nerve conduction study may be used to confirm the diagnosis.

The treatment is then directed based on the severity and cause of the nerve compression.   

If the cause is not reversible, then nonoperative management with splints and injections are unlikely to give long lasting results. However, if the cause is reversible (eg. short-term oedema due to recent trauma; direct trauma due to a fall onto this area) then splints and injections are useful to treat the symptoms until the cause has resolved.   

Sometimes, a steroid injection into Guyon’s canal, to the adjacent ganglion and to the cause of the nearby ganglion may help resolve symptoms, since resolving the ganglion may remove the cause of compression of the ulnar nerve.    

Ultimately, surgery may be indicated if the patient fails nonoperative management, or if the cause is one which is likely to be irreversible without surgery. Likewise, surgery is also indicated in the situation of motor weakness or wasting due to ulnar nerve compression because this indicates a more severe compression. Weakness and wasting can be irreversible even after decompression of the nerve, with more severe weakness and wasting leading to a worse long-term outcome. Therefore, if motor problems are detected during clinical examination, my recommendation is to proceed to surgery earlier rather than later so as not to leave the nerve compressed for a prolonged period of time in case nonoperative management fails to work.    

It is important to note that compression of the ulnar nerve within Guyon’s canal is fairly uncommon. It can be easy to overlook this and it is therefore important to take a careful history as to the symptoms and to make a careful examination to determine the involved nerve so that appropriate treatment can be initiated.

Dr Kwan Yeoh

If you are a physiotherapist and wish to be sent the Question for Physiotherapists or you would like to submit a Question please email including your name and practice. 

Previous Question for Physiotherapists:

Jun-2019  Whats new in ACL reconstruction 2019 Dr Doron Sher 
May-2019  Cuneiform Fracture Dr Todd Gothelf 
Apr-2019 Flexor Tendon Injuries  Dr Kwan Yeoh 
Mar-2019  Chronic Exertional Compartment Synd Dr Paul Annett 
Feb-2019  Achilles Tendon Rupture Dr John Negrine 
Nov-2018 Low Back Pain  Dr Paul Mason 
Sep-2018 Concussion part 2  Dr John Best 
Jul-2018 Concussion part1  Dr Paul Annett 
Jun-2018 Thessaly & McMurray Test  Dr Doron Sher 
May-2018  AC Joint Dr Doron Sher 
Apr-2018 Arthritis of the fingers  Dr Kwan Yeoh 
Feb-2018 CLAVICLE fractures Dr Doron Sher 
Oct-2017 ACL Grafts  Dr Doron Sher 
Sep-2017  Forefoot pain Dr John Negrine 
Aug-2017 Wrist Ganglion
Dr Kwan Yeoh 
Jul-2017 Anterolateral Ligament Reconstruction  Dr Doron Sher 
Jun-2017  Scapholunate ligament Dr Kwan Yeoh 
Apr-2017  Knee Brace - ACL Reconstruction Dr Doron Sher 
Mar-2017 Sesamoid fractures  Dr Kwan Yeoh 
Feb-2017  Plantar Fasciitis
Dr Todd Gothelf
Nov-2016  Sternoclavicular Joint Dr Doron Sher 
Oct-2016  Proximal Humerus Fractures Dr David Lieu 
Sep-2016 Wrist Fractures  Dr Kwan Yeoh 
Aug-2016  Patella Instability Dr Doron Sher 
Jul-2016 Snowboarders ankle
Dr Todd Gothelf
May-2016  Cortisone Injections Dr Paul Annett 
Apr-2016 Shoulder Instability_1  Dr Ivan Popoff 
Mar-2016 Exercise after TKR  Dr Doron Sher 
Dec-2015 Scaphoid OA Dr Kwan Yeoh 
Nov-2015  Greater Tuberosity Fractures Dr Doron Sher
Oct-2015 Stress Fractures  Dr Paul Annett
Boxers Fractures
Dr Kwan Yeoh
Aug 2015
Resistance Training  Dr John Best
July 2015 LARS Ligament
Dr Ivan Popoff
Distal Biceps  Dr Doron Sher
May-2015 Latarjet procedure
Dr Jerome Goldberg
Apr-2015 TFCC Questions  Dr Kwan Yeoh 
Mar-2015  Acute Ankle Sprains
Dr Todd Gothelf
Nov-2014  PRPP Dr Paul Annett
Oct-2014 Driving After Surgery
Dr Doron Sher
Sep-2014  Distal Biceps Rupture Dr Doron Sher
Aug-2014 Ankle Sprain
Dr Todd Gothelf
Jun-2014  Patella Dislocation Dr Doron Sher
May-2014  Shoulder Instability Dr Todd Gothelf
Apr-2014  De Quervains Dr Kwan Yeoh
Acromio-clavicular joint injuries
Dr Todd Gothelf
Feb-2014 Chronic Knee Pain
Dr Paul Annett
Dec-2013 Foot and Ankle Questions  Dr John Negrine
Oct-2013 Rotator Cuff Repair  Dr Todd Gothelf
Sep-2013  ACL Reconstruction
Dr Doron Sher
Jul-2013 Slipped Upper femoral epiphysis  Dr Rod Pattinson
May-2013 Skiers thumb Dr Kwan Yeoh
Apr-2013  Bakers_Cyst
Dr Ivan Popoff


 Tibial Osteotomy vs UKR

Dr Doron Sher 

 ALIF success rate

Dr Andreas Loefler


 Lisfranc Injuries

Dr Todd Gothelf 

 Anterior Spinal Fusions

Dr Andreas Loefler 

 MCL Injuries

Dr Doron Sher 

Compartment Syndrome

Dr Paul Annett 

 Carpal tunnel

Dr Kwan Yeoh 

 Anterior Process Calcaneus Fx

Dr Todd Gothelf 

 Tenodesis vs Tenotomy

Dr Jerome Goldberg 


 Osteoarthritis in the young active patient Dr Doron Sher 

 Syndesmosis Sprain

Dr Todd Gothelf 


 Triangular Fibrocartilage Injuries

Dr Kwan Yeoh 

 Shoulder Replacement Older Population

Dr Jerome Goldberg



 Wrist Fracture

Dr Kwan Yeoh 



 Adductor Tendon Tear

Dr Paul Annett 

 Navicular Pain 

Dr Todd Gothelf 

 OCD Lesion

Dr Doron Sher 

 Metal on Metal Hip Replacements

Dr Andreas Loefler 

 Femoral Neck Stress Fract (Pt 2)

Dr John Best 


 Femoral Neck Stress Fractures

Dr John Best 

 PCL Injury Part 2

Dr Doron Sher 

 PCL Injury Part 1

Dr Doron Sher 

 Prolotherapy Autologous Blood Injections

Dr Paul Annett 

 Shoulder Impingement

Dr Todd Gothelf 

 Does Chondral Grafting Work

Dr Doron Sher 

 Shoulder Immobilisation-Dislocation

Dr Jerome Goldberg

SLAP Lesions Stable Shoulder

Dr Todd Gothelf 

 Ankle Sprains

 Dr Todd Gothelf


 Dislocation After THR

 Dr Peter Walker


 Acupuncture Muscle Strength Programmes

 Dr Paul Annett


 Full Thickness Rotator Cuff Tears

Dr Jerome Goldberg


 Skiing after TKR

 Prof Warwick Bruce


 Fractures of the Clavicle

 Dr John Trantalis


 Osteoarthritis of the Knee

 Dr Doron Sher


 Fifrth Metatarsal Fractures

 Dr Todd Gothelf


Partial Rotator Cuff Tears

Dr Todd Gothelf

Copyright © 2009 Orthosports
Heel Pain - Colles Fracture - Shoulder Rehabilitation

Orthopaedic Surgeon - Knee Reconstruction - ACL tear - Osteotomy
Orthopaedic Surgeon

Enter your email address:
CONCORD 02 9744 2666 | HURSTVILLE 02 9580 6066 | PENRITH 02 4721 7799 | RANDWICK 02 9399 5333 | BELLA VISTA 02 9744 2666
Copyright © 2009 Orthosports