Jnl Wrist Surg 2018; 07(02): 182
DOI: 10.1055/s-0037-1608683
Letter to the Editor
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

An Aberrant Abductor Digiti Minimi Muscle Crossing Guyon's Canal with Intermittent Compression of Nerve: Crucial Diagnostic Role of Nerve and Muscle Ultrasound

Riccardo Luchetti
Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy
,
Luca Padua
Don Carlo Gnocchi Onlus Foundation, Milan, Italy
Institute of Neurology, Universita Cattolica del Sacro Cuore, Rome, Italy
,
Daniele Coraci
Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, “Sapienza” University, Rome, Italy
,
Ilaria Paolasso
Don Carlo Gnocchi Onlus Foundation, Milan, Italy
,
Valter Santilli
Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, “Sapienza” University, Rome, Italy
Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
› Author Affiliations
Further Information

Publication History

05 September 2017

28 September 2017

Publication Date:
05 January 2018 (eFirst)

Response to: An Aberrant Abductor Digiti Minimi Muscle Crossing the Guyon's Canal with Intermittent Compression of Nerve: Crucial Diagnostic Role of Nerve and Muscle Ultrasound

We read with interest your anatomical study “An aberrant abductor digiti minimi muscle crossing Guyon's canal” published in the Journal of Wrist Surgery 2017,[1] in which you demonstrated the presence of the aberrant abductor digiti minimi (AADM) muscle as a cause of compression of the ulnar nerve at Guyon's canal. In 2015, we published an article on muscle and nerve[2] in which an AADM was demonstrated bilaterally by using the ultrasonography (US) followed by a magnetic resonance imaging which confirmed the US diagnosis. The history of the patient was suggestive: he complains pain, grip weakness, and intermittent paresthesia on the three medial digits related to repetitive and heavy activity and the neurophysiological study fails to demonstrate ulnar nerve sensory and motor conduction velocity and amplitude deficits. The patient was operated on the symptomatic right side, and the AADM muscle was showed confirming the previously performed US. Surgery consisted of the simply AADM muscle resection and ulnar nerve decompression from the wrist to the palm ([Figs. 1] and [2]).

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Fig. 1 Accessory abductor digity minimi (white asterisk) crossed obliquely the ulnar nerve showed by dissector.
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Fig. 2 The ulnar nerve is decompressed by proximally detaching the accessory abductor digity minimi (white asterisk).

By this experience, we strongly suggest performing US (static and dynamic) in a patient with paresthesia and pain in which the neurophysiological study is negative.