Tunnel of Guyon Treatments with Cold laser & Physical Therapy
Pain, numbness, tingling or weakness in the little and ring fingers may be caused by compression of the ulnar nerve at the tunnel of Guyon. This nerve runs through a small tunnel at the wrist. Formed by the pisiform and hook of the hamate bones on the sides, the top and bottom borders by the insertion of the flexor carpi ulnaris tendon and transverse carpal ligament. The nerve runs through this tunnel and is responsible for sensation and muscle strength of the 4th and 5th digits.
Any activity that involves prolonged compression of the hand may cause this condition. Cyclists also call this handlebar or cyclist's palsy, occurring after long rides. Other causes include vascular disturbances, Dupuytren's contracture, joint arthritis, fractures, bursitis, edema, or inflammatory diseases.
At home, avoiding aggravating activities is the first line of treatment. Icing is a great treatment for decreasing pain and inflammation around the tunnel of guyon. Removing the fluid around the nerve decreases the compression and allows for nerve repair to occur.
Decreasing the direct compression and resting will help. Cyclists should change their handlebar or bicycle position. Gloves are available with padding to decrease the compression on the nerve for work-related causes. The goal of gloves is to reduce the direct compression and irritation of the ulnar nerve in the hand.
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.
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.
Class IV cold lasers are an excellent treatment modality for decreasing pain and inflammation around the 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.
Nerves are notorious for slow healing after entrapment syndromes. The extra blood flow provided by the class IV cold K laser increases the nutrients that the cell can use for repair and regeneration. In addition, specific wavelengths of low-level lasers increase the cellular production of ATP. ATP is the energy source within the cells that it uses during repair and healing processes. By increasing the amount of available energy, the cellular system is able to regenerate and repair faster and in a shorter period of time.
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.