Abstract
Background Occupational overuse syndrome (OOS) can present as Guyon’s canal syndrome in computer
keyboard users. We report a case of Guyon’s canal syndrome caused by a ganglion in
a computer user that was misdiagnosed as OOS.
Case presentation A 54-year-old female secretary was referred with a six-month history of right little
finger weakness and difficulty with adduction. Prior to her referral, she was diagnosed
by her general practitioner and physiotherapist with a right ulnar nerve neuropraxia
at the level of the Guyon’s canal. This was thought to be secondary to computer keyboard
use and direct pressure exerted on a wrist support. There was obvious atrophy of the
hypothenar eminence and the first dorsal interosseous muscle. Both Froment’s and Wartenberg’s
signs were positive. A nerve conduction study revealed that both the abductor digiti
minimi and the first dorsal interosseus muscles showed prolonged motor latency. Ulnar
conduction across the right elbow was normal. Ulnar sensory amplitude across the right
wrist to the fifth digit was reduced while the dorsal cutaneous nerve response was
normal. Magnetic resonance imaging of the right wrist showed a ganglion in Guyon’s
canal. Decompression of the Guyon’s canal was performed and histological examination
confirmed a ganglion. The patient’s symptoms and signs resolved completely at four-month
follow-up.
Conclusion Clinical history, occupational history and examination alone could potentially lead
to misdiagnosis of OOS when a computer user presents with these symptoms and we recommend
that nerve conduction or imaging studies be performed.
