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Ulnar nerve compression isolated to the motor branch: a case series of three unique etiologies
John D. Jennings, MD1; John F. Jennings, MD2
1Temple University, Philadelphia, PA; 2Grandview Hospital, Sellersville, PA

Introduction: Compression along the motor branch of the ulnar nerve distal to Guyon’s canal is both a rare and difficult clinical diagnosis with very few cases described in the literature. Here we describe a case series of four patients with compression of the ulnar nerve isolated to the motor branch, each with a unique etiology.
Materials & Methods: A chart review was performed of four cases where isolated compression of the ulnar motor branch was identified. All patients had a minimum follow up of one year. The preoperative and postoperative exam, nerve conduction studies and imaging studies were reviewed along with the operative note.
Results: Four patients were identified with ulnar nerve compression symptoms isolated to the motor branch distal to Guyon’s canal. Three patients were treated surgically and each had a different cause of compression; an intraneural ganglion cyst, a constricting leash of vessels, and several soft tissue bands around the nerve. All three surgical patients had full resolution of pain and motor symptoms postoperatively. A fourth patient had full resolution of symptoms without surgical intervention.
Discussion: Intraneural ganglion cysts confined to the motor branch of the ulnar nerve are extremely rare and optimal treatment has not been established. This patient was one of four we describe with a unique etiology of compression distal to Guyon’s canal. While this may present both a diagnostic and surgical dilemma, this case series demonstrates several types of unique pathology as well as successful treatment with and without surgery.

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