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Case Report Plastic and Aesthetic Research

Lipoma causing Guyon’s canal syndrome:

a case report and review

Narayanathu Chellappantilla Sreekumar, Panambur Laxminarayan Bhandari,
Lalitha Sreedharan Sreelesh, Krishnankutty Rajamma Thushara

Department of Plastic Surgery, Govt. Medical College, Calicut 673017, Kerala, India.
Address for correspondence: Dr. Panambur Laxminarayan Bhandari, Mangala, Chilimbi Hilldale Road, P. O. Ashoknagar, Ladyhill,
Mangalore 575006, Karnataka, India. E-mail: lax321@gmail.com
ABSTRACT
Compression of the ulnar nerve in Guyon’s canal leads to Guyon’s canal syndrome. Lipoma is a
rare cause of such compressions with only 12 cases reported previously. We report a 55-year-old
man who presented with swelling in the left hand with decreased sensation in the ring and little
fi ngers. Magnetic resonance imaging revealed high signals in T1-weighted and T2-weighted images
with suppression of the short T1 inversion recovery signal, suggestive of lipoma. On exploration a
well-encapsulated, dumbbell-shaped, fatty tumor was seen in the hypothenar space and Guyon’s
canal. The tumor was enucleated in toto. At 6-month follow-up, the patient had fully regained
sensation. A review of the literature is presented for similar cases where a lipoma was the cause of
Guyon’s canal syndrome.

Key words:
Guyon’s canal, lipoma, ulnar neuropathy

INTRODUCTION CASE REPORT

Guyon’s canal, named after Felix Guyon, is a fibro-osseous A 55-year-old male presented with swelling in the left
tunnel within the ulnar side of the wrist. It is bound hand with a duration of 3.5 years. He complained of
[1]
radially by the hamate, volarly by the volar carpal numbness in the ring and little fingers. On examination,
ligament, dorsally by the transverse carpal ligament, a diffuse swelling was noted in the hypothenar area
and ulnarly by the pisiform and the flexor carpi ulnaris. extending from the distal palmar crease to the proximal
The ulnar neurovascular bundle enters the hand through wrist crease [Figure 1]. The swelling was soft but tense.
this tunnel. Ulnar nerve compression in this enclosed Sensory examination recorded diminished sensation over
space leads to Guyon’s canal syndrome, first described the little finger and the ulnar half of the ring finger on
by Hunt. The common causes are ganglion, repetitive their volar surfaces. The patient rated the sensation
[2]
trauma, vascular lesions, tumors, and anomalous muscles.
as three out of ten in the “ten test” (“ten test” is a
Lipoma, though termed universal tumor due to its semi-quantitative assessment in which the patient ranks
ubiquitous presence, is rare in Guyon’s canal. This is the quality of sensation in the affected digit compared
probably due to the paucity of adipose tissue in this with that in the normal contralateral digit on a score
fibro-osseous tunnel. There are only 12 previously of 1–10). Sensation on the dorsal aspect was normal.
reported cases. We report a case of lipoma in the Guyon’s There was no motor weakness, and the adductor pollicis,
canal causing ulnar neuropathy. lumbricals, and interossei had normal function.
Magnetic resonance imaging (MRI) revealed a
Access this article online
6.5 cm × 4 cm × 2.5 cm well-encapsulated swelling in
Quick Response Code: the hypothenar space extending into Guyon’s canal. The
Website:
www.parjournal.net lesion was hyper-intense on T1-weighted and T2-weighted
imaging with suppression of the short T1 inversion
recovery signal, suggestive of lipoma [Figure 2].
DOI:
10.4103/2347-9264.143559 Surgical exploration under axillary block with tourniquet
control revealed a well-encapsulated, dumbbell-shaped
118 Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014