Surgical outcome for type I Guyon's canal syndrome with claw hand deformity: a review of 11 patients

BACKGROUND: Guyon's canal syndrome (GCS) is an uncommon compressive ulnar neuropathy at the wrist, and claw hand deformity could be seen in severe Tpye I cases. Data on whether claw hand deformity could be reversed by surgical treatment is lacking, and we aimed to evaluate the prognosis of these patients. METHODS: 11 patients with claw hand deformity were enrolled in this retrospective study, and the minimum follow-up was set at 1 year. All patients underwent exploration of the ulnar nerve, decompression of Guyon's canal, and removal of potentially concomitant space-occupying lesions. Clinical symptoms, physical examination findings, and the Disabilities of the Shoulder, Arm, and Hand Questionnaire were evaluated preoperatively and at final follow-up. Motor strength of intrinsic muscles was rated using the British Medical Research Council (MRC) scale. RESULTS: VAS pain and weakness, 2-PD, and key-pinch strength all improved significantly. Improvement of intrinsic muscle strength was achieved in all 11 hands, and 8 hands (72.7%) regained MRC grade 5 muscle strength. Claw hand deformity was completely corrected in 10 patients (90.9%) at final follow-up. DASH scores improved from an average of 30.1 points preoperatively to 3.7 points postoperatively. CONCLUSION: Surgical outcome for Tpye I GCS with claw hand deformity is satisfactory, and claw hand deformity could be reversed with promising functional recovery of intrinsic muscles.