Chiropractor Chandler AZ

hand muscles anterior carpal tunnel

Tunnel of Guyon

Feelings of numbness, tingling, and weakness in the little and ring fingers are the characteristics of ulnar nerve entrapment. Most of the time, people who are suffering from ulnar nerve entrapment will feel as if these two fingers are not functioning as they should be and are lacking coordination. This feeling is due to the compression of the ulnar nerve at the tunnel of Guyon. The tunnel of Guyon is a small tunnel at the wrist formed by the pisiform and hook of the hamate bones on the sides while the top and bottom borders are formed by the insertion of the flexor carpi ulnaris tendon and transverse carpal ligament. The ulnar nerve runs through this tunnel and is responsible for sensation and muscle strength of the 4th and 5th digits.

These uncomfortable feelings can worsen with repetitive activities and motions which require coordination such as playing the piano, typing, knitting, and other activities which require a lot of use from the hands. The level and amount of discomfort felt varies from person to person. While some people may only feel a slight discomfort like if they had hit their "funny bone," others may feel it a lot more. The ulnar nerve extends down the arm and past the elbow as it makes its way to the hands. Bumping your elbow will cause pain, numbness, and tingling in the fourth and fifth digits because the ulnar nerve is being compressed and the pain receptors travel to those fingers.


Sometimes, ulnar nerve entrapment can be misdiagnosed. Often, it is diagnosed as carpal tunnel syndrome or thoracic outlet syndrome because these conditions share the same symptoms: numbness, tingling, pain, weakness, and lack of coordination in the fingers. However, unlike ulnar nerve entrapment, carpal tunnel syndrome doesn't affect the little and ring fingers; it affects the thumb, pointer, and middle digits. Thoracic outlet syndrome affects the whole hand, including all the digits. Since the ulnar nerve specifically controls the little and ring finger, compression or damage to the nerve will only affect these two fingers. When consulting a doctor, it is important to let them know which fingers are being affected to a proper diagnosis can be made.

Causes of Tunnel of Guyon Syndrome

Tunnel of Guyon syndrome is the entrapment of the ulnar nerve specifically at the site of the wrist and the palm of the hand. The tunnel of Guyon runs between the two wrist bones and ligaments and the condition is common in people who lean on their hand or elbow while resting on a hard surface for long periods of time. It can also occur in people who work with heavy machinery or power tools. Using tools that vibrate or have a pulling/pushing movement increases the likelihood of damaging the ulnar nerve or the area surrounding the ulnar nerve. Compressing the ulnar nerve for a prolonged period of time can damage the muscles, tendons, and ligaments. Other causes of tunnel of Guyon syndrome include vascular disturbances, Dupuytren's contracture, joint arthritis, fractures, bursitis, edema, or inflammatory diseases.

Tunnel of Guyon Treatment

Any nerve entrapment treatment works at reducing pain, inflammation, and irritation that is compressing the nerve. Specifically to treat the tunnel of Guyon at the wrist, we use treatments that include heat, ice, electric therapy, or cold laser therapy to decrease the inflammation and increase the blood flow. Decreased inflammation and increased blood flow will speed the healing process.

Home Treatments

Before contacting your doctor, there are at home treatments you can try to decrease your pain. The first step is always PRICE: protect, rest, ice, compress, and elevate. Reduce the stress and strain to the wrist. Ice helps block the wrist pain and reduce inflammation. Over the counter nonsteroidal anti inflammatory drugs (NSAIDs) as recommended by your doctor can help reduce pain and inflammation. Wearing wrist and hand braces can decrease strain and stress on the ulnar nerve and hand by restricting hand movement and allowing the area to rest and recover. If your pain still persists after trying home treatments, contact your Phoenix, Scottsdale, or Mesa chiropractor for in-office treatments.

Office Treatments

Therapy treatments in the office will have similar goals for decreasing pain and inflammation in the hand and tunnel of Guyon. Therapeutic modalities will be utilized to stop the inflammatory process and help remove the swelling and irritation around the ulnar nerve. Traditional treatments such as ice, heat, electric, and ultrasound therapy can be utilized throughout the forearm, wrist, tunnel of Guyon, and fingers. Massage therapy and manual therapy can be used on the hand and wrist flexor muscles to enhance flexibility and decrease the muscle contraction that is complicating recovery. Decreasing muscle spasms will help with the overall recovery time and reduce the likelihood of future occurrences.

hand and tunnel of guyon

Additional treatments include Graston Technique and active release technique on the hand, wrist, and forearm muscles that are contributing to the tunnel syndrome with repetitive activity. Most cases of chronic repetitive stress syndromes affect multiple areas in that extremity, and this is especially the case in carpal tunnel and ulnar nerve entrapment syndromes. The arm and forearm muscles have been compensating and slowly tightening over time. This reduces the normal joint flexibility and movements, and also increases the likelihood of a nerve entrapment. Graston technique and active release technique help remove scar tissue and fashion adhesions from the muscle, which allows for greater flexibility and function. Combining these treatments will reduce the likelihood of future occurrences of tunnel of Guyon syndrome.

Graston Technique for Tunnel of Guyon

Graston Technique is utilized in many professional, Olympic, and collegiate sports therapy programs. Specifically-designed stainless steel instruments have rounded, concave and convex edges. The edges are not sharp. Graston tools are classified under Instrument Assisted Soft Tissue Mobilization (IASTM) and are used to detect and effectively treat soft tissue fibrosis or chronic inflammation. With these instruments the practitioner can scan over and detect areas of fibrotic tissue.

There are six different Graston tools to help break up fascial restrictions or scar tissue that develops after trauma to muscles, ligaments, tendons, or fascia, which is commonly referred to as soft tissue. Scar tissue forms when tissue does not heal correctly, or is under chronic, repetitive stress. Scar tissue is weaker than normal muscle and connective tissue, which is why it becomes chronically sore with activity.

cold laser wrist hand treatment
Cold Laser for Tunnel of Guyon

Class IV cold lasers are an excellent treatment modality for decreasing pain and inflammation around the ulnar nerve. We commonly utilize these for nerve entrapment syndromes because of the direct compression around the nerve and how lasers enhance nerve healing. Nerve entrapment syndromes are often the result of direct compression and entrapment of the nerve. This also creates excessive inflammation and fluid that accumulates around the nerve. The extra fluid further compresses the nerve and slows the healing. Class IV cold lasers help decrease inflammatory products that account for the swelling and fluid. The lasers also help increase blood flow by causing dilation of the arteries. Bigger and wider arteries bring more blood flow to the tissues, which provides more nutrients needed in the repair and regeneration process.

Class IV cold lasers are in excellent treatment modality in nerve compression and entrapment syndromes. They complement traditional therapies to decrease pain and inflammation associated with the nerve entrapment. In addition, the lasers provide unique therapeutic benefits for increasing nerve cellular repair and regeneration. Class IV cold lasers combined with traditional therapeutic treatments will produce faster and better healing, and further reduce the likelihood of future tunnel of Guyon ulnar nerve entrapments.

Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler, AZ.