General Guideline Principles for Ulnar Nerve Entrapment at the

Wrist (Including Guyon’s Canal Syndrome and Hypothenar

Hammer Syndrome) for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome).

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome) of Hand, Wrist and Forearm Injuries

Ulnar nerve entrapment involves delayed ulnar nerve conduction and the corresponding symptoms. Clinical symptoms can be predicted based on where the ulnar nerve lesion is located as it passes through Guyon’s canal and the wrist.

The tendons and their tenosynovium do not accompany the nerve in this canal, which makes most of the commonly postulated causal mechanisms for carpal tunnel syndrome impossible. However, one postulated occupational mechanism involves using the hypothenar region of the hand as a hammer.

Diagnostic Studies of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

  1. Diagnostic Electrodiagnostic Studies

    Diagnostic Electrodiagnostic Studies is recommended to confirm a clinical suspicion of wrist-based ulnar nerve entrapment.Rationale for Recommendation – Studies must be carried out by qualified electrodiagnosticians, ideally those who have earned certification from the American Board of Electrodiagnostic Medicine.

     

  2. MRI or Ultrasound

    MRI or Ultrasound are not recommended to identify wrist ulnar nerve entrapment.MRI or Ultrasound are recommended regarding a possible soft tissue mass. In general, soft tissue masses like ganglion cysts are better treated with an MRI. Ulnar Nerve Entrapment at the Wrist: MRI and Ultrasound Data to Support Use

     

  3. CT

    CT is recommended if a hook of the hamate fracture is suspected based on the history, a potential fracture mechanism, focal pain at the hamate, and where there are ulnar nerve symptoms, to diagnose ulnar nerve entrapment at the wrist. For the evaluation of fractures, CT is preferred.

Medications of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even though the majority of research indicates it is only marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective at treating pain as opioids, such as tramadol.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Ulnar Nerve Compression at the Wrist

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Ulnar Nerve Compression at the Wrist are recommended for the treatment of wrist ulnar nerve compression that is either acute, subacute, or chronic.

    Indications – NSAIDs are advised as a treatment for acute, subacute, or chronic ulnar nerve compression at the wrist. First, try over-the-counter (OTC) medications to see if they work. As needed use may be appropriate for many patients in terms of frequency and duration

    Indications for Discontinuation: Symptoms go away, the medication is ineffective, or negative side effects arise that require stopping the medication.

     

  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended for patients at high risk of gastrointestinal bleeding to take misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors concurrently.

    Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a longer course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

    Frequency/Dose/Duration: H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

    Discontinuation: Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

     

  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    Patients with known cardiovascular disease or multiple risk factors for cardiovascular disease should have the risks and benefits of NSAID therapy for pain discussed.

     

    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended As far as adverse cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.

       

    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended As far as adverse cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.

      The NSAID should be taken at least 30 minutes after or 8 hours before the daily aspirin to reduce the chance that it will negate the protective effects of aspirin, whether for primary or secondary cardiovascular disease prevention.

       

  4. Acetaminophen for Treatment of Ulnar Nerve Compression at the Wrist Pain

    Acetaminophen for Treatment of Ulnar Nerve Compression at the Wrist Pain is recommended for the treatment of ulnar nerve compression at the wrist pain, especially in patients who have medical conditions that make NSAIDs contraindicated.

    Indications: All patients, including those with acute, subacute, chronic, and post-operative ulnar nerve compression at the wrist pain.

    Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of hepatic toxicity.

    Indications for Discontinuation: pain, side effects, or intolerance are gone.

     

  5. Opioids of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

    Opioids of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome) is not recommended for ulnar nerve entrapment at the wrist that is either acute, subacute, or chronic.

    Opioids of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome) is recommended for brief (no longer than seven days) use as an adjunctive therapy to more potent treatments for postoperative pain management.

    Indications: A brief prescription of opioids is frequently needed for post-operative pain management, especially at night, as an adjunct to more effective treatments (especially NSAIDs, acetaminophen).

    Frequency/Duration: As needed during the day, only at night later, and finally completely discontinued.

    Rationale for Recommendation: When NSAIDs are ineffective in relieving a patient’s pain, opioids should be used sparingly, especially at night. Opioids are advised for brief, selective use in postoperative patients, with nighttime use being the main recommendation for achieving postoperative sleep.

     

  6. Glucocorticosteroids – Oral and/or Injected

    Glucocorticosteroids – Oral and/or Injected is not recommended for the treatment of wrist ulnar nerve compression that is either acute, subacute, or chronic.

Treatments Opioids of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

Neutral Wrist Splinting

Neutral Wrist Splinting is recommended as a first-line therapy for ulnar nerve compression at the wrist that is acute, subacute, or persistent
Rehabilitation of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put forth an internal effort to finish a particular exercise or task. The interventions known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their part.

Passive interventions are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active interventions should be prioritised.

To maintain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

To facilitate functional gains, assistive devices may be used as an adjunctive measure in the rehabilitation plan.

Therapy – Active of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

Therapeutic Exercise

Therapeutic Exercise is not recommended for severe wrist ulnar nerve compression

Therapeutic Exercise is recommended for use after surgery to treat wrist ulnar nerve compression

Therapeutic Exercise is recommended if functional deficits are present, for subacute and chronic ulnar nerve compression at the wrist.

Rationale for Recommendation – In general, acute exercise is not recommended; however, recovery or postoperative phases may require exercise. Increased grip strength, key pinch strength, range of motion, and the development of work skills should all be considered functional goals.

Frequency/Dose/Duration –With documentation of ongoing objective functional improvement, the total number of visits may be as low as two to three for patients with mild functional deficits or as high as 12 to 15 for those with more severe deficits.

If there is evidence of functional improvement toward specific objective functional goals, more than 12 to 15 visits may be necessary when there are persistent functional deficits (e.g., increased grip strength, key pinch strength, range of motion, advancing ability to perform work activities).

A home exercise programme should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Therapy – Passive of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

  1. Ice – Self-application

    Ice – Self-application is recommended for the treatment of radial nerve entrapment that is either acute, subacute, or chronic.

     

  2. Heat – Self-appliation

    Heat – Self-appliation is recommended for the treatment of radial nerve entrapment that is either acute, subacute, or chronic.

     

  3. Manipulation/Mobilization

    Manipulation/Mobilization is not recommended for the treatment of radial nerve entrapment that is acute, subacute, or chronic.

    Iontophoresis

    Iontophoresis is not recommended for the treatment of radial nerve entrapment that is either acute, subacute, or chronic.

     

  4. Massage, Friction Massage

    Massage, Friction Massage is not recommended for the treatment of acute, subacute, or chronic radial nerve entrapment.

     

  5. Acupuncture

    Acupuncture is not recommended for the treatment of acute, subacute, or chronic radial nerve entrapment. Evidence for Ulnar Neuropathy at the Wrist: Physical Methods and Rehabilitation

     

  6. Activity Modification

    Activity Modification is recommended For the treatment of ulnar nerve compression at the wrist, it is advised to avoid significant localised mechanical compression of the nerve or using the hand as a hammer.

Surgery of Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

Surgical Decompression

Surgical Decompression is recommended if non-operative treatment for subacute or chronic ulnar nerve compression at the wrist fails or if space-occupying lesions are present

Rationale for Recommendation – It is advised for certain patients who have tried and failed other non-operative treatments or if there are lesions that take up a lot of space. Additionally, those with diabetes mellitus may benefit more from it.

What our office can do if you have Ulnar Nerve Entrapment at the Wrist (Including Guyon’s Canal Syndrome and Hypothenar Hammer Syndrome)

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

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15:02 02 Mar 23
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21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
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20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
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16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
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21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
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19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
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23:31 19 May 22
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Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
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Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.