The arteries found within the finger have blood clots that cause blockages in the digital arteries. Surgical treatment can be performed, consisting of resection and vein grafting. The injury to the blood vessels of the hand causes pain. Ulnar artery aneurysm and hypothenar hammer syndrome. Ulcerative changes and blanching at the tips of right fourthfifth digits were observed. Management of hypothenar hammer syndrome a case report. This condition is often caused due to repetitive injury to the palmer ulna. Hypothenar hammer syndrome hhs is an uncommon form of secondary raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a hammer. Hypothenar hammer syndrome is an uncommon cause of upperextremity ischemia that is often overlooked in the absence of a thorough occupational and recreational history. This leads to vascular insufficiency of the ulnar side of the hand. The hypothenar hammer syndrome connecting repositories. Hypothenar hammer syndrome hhs is the name used to describe the signs and symptoms associated with hand and finger ischemia resulting from trauma and thrombosis of the ulnar artery.
Hypothenar refers to the group of muscles that control the movement of the little finger. Abstract hypothenar hammer syndrome affects less than 1% of the population, but if the diagnosis is delayed, digital gangrene and critical ischemia can ensue. Repetitive blunt trauma to it may lead to spasm, thrombosis, or aneurysm formation. Presented here is a case of a manual laborer who had symptoms of digital ischemia after acute hyperextension injury to the ring finger.
The symptoms are related to the mechanism of the trauma and raynauds phenomenon. Hypothenar hammer syndrome hhs is a vascular disorder characterized by ulnar artery thrombosis or aneurysmal formation. Hypothenar hammer syndrome is an infrequent disorder of the arteries found within the hand. An isolated hypothenar hammer syndrome hhs with involvement of the ulnar artery occurs more frequently than thenar hammer syndrome which is related to the radial artery damage 1, 4, 7. Hypothenar hammer syndrome hhs is a rare diagnosis characterized by ulnar insufficiency, often accompanied by ulnar nerve neurologic deficit. The syndrome is related to repeated microtrauma to the heel of the hand resulting from its use as a hammer, which is likely to cause endothelial lesions and false aneurysms with occlusion due to arterial. Importantly, it is a reversible cause of hand ischemia that, if missed, can lead to significant morbidity and even amputation.
Its diagnosis requires a high level of suspicion and a careful clinical interview. This chronic stress usually as a result of occupational or sport activities may result in arterial constriction or thickening, which may lead to thrombosis or aneurysm formation. Hypothenar hammer syndrome hhs is a lesion of the ulnar artery as it courses adjacent to the hamate bone and results from either single or repeated episodes of trauma to the hypothenar eminence. Nevertheless, a combination of the two syndromes has been reported 7. Alice turcot, md with the inspq is presenting a prevention pamphlet about how to recognize the hypothenar hammer syndrome hhs. Significant tenderness to palpation over the right distal palm was observed. Hypothenar atrophy is associated with the lesion of the ulnar nerve, which supplies the three hypothenar muscles. There is a need to distinguish symptoms of hhs from those of classical havs since precise diagnosis may alter both the clinical and occupational. Hypothenar hammer syndrome definition of hypothenar.
The clinical diagnosis of a distal ulnar artery aneurysm was confirmed with duplex ultrasound imaging. Doppler mapping, a proven, noninvasive technique of visualizing vascular anatomy5,6 has applicability in the preoperative assessment of ulnar artery aneurysm. Hypothenar hammer syndrome is a rare but serious cause of digital ischemia and morbidity. Hypothenar hammer syndrome in a middle blocker case. Surgery is the choice of treatment after intensive and careful investigation for other distal artery lesions. Originally described in patients using hammers and screwdrivers, it is also seen in various athletes such as basketball, handball, tennis and golf players. Mar 22, 2010 hypothenar hammer syndrome hhs is probably rare, but may be underdiagnosed. Hhs describes patients who experience signs and symptoms concerning for digital ischemia. A righthand dominant patient presented with pain and a tender mass in the hypothenar eminence, and with paraesthesia of the fourth and fifth fingers.
Combined thenar and hypothenar hammer syndromes and. It is believed that the ulnar artery is repetitively damaged by blunt compression against the hamate. It is traditionally thought to be prevalent amongst labourers and craftsmen. The superficial palmar branch of the ulnar artery is the major source of blood to the fingers. Importantly, it is a reversible cause of hand ischemia. That is why this condition is called hammer syndrome from.
Magnetic resonance imaging revealed thrombosed ulnar artery aneurysm. Presented here is a case of a manual laborer who had symptoms of digital. The patient was referred for mri of the hand, which showed thrombosed ulnar artery aneurysm and an irregularity of the superficial ulnar artery, suggesting a diagnosis of hypothenar hammer syndrome hhs. Examination showed a 2cm pulsatile swelling at the hypothenar eminence. In a common law claim submitted in the uk, the original diagnosis of handarm vibration syndrome havs was called into question on the basis of the findings of. Hypothenar hammer syndrome radiology reference article. The condition is caused by injury to the ulnar artery at the level of the hook of hamate when the palm of the hand is repetitively used as a hammer. It most often develops after repeated trauma to the hypothecan j plast surg vol 9 no 5 septemberoctober 2001 201 recurrent hypothenar hammer syndrome figure 4. Treatment is largely dependent on the extent of arterial damage.
This syndrome is caused by repetitive trauma to the ulnar artery in the guyons or ulnar canal, causing arterial intimal dissociation with possible aneurysmal formation, vasospasm, or even thrombosis. In the latter case, it is named hypothenar hammer syndrome,1,2 and it results in. It is most commonly reported in middleaged males who suffer from repetitive trauma to the palm secondary to occupational or recreational activities. The symptoms are related to the mechanism of the trauma and a raynauds phenomenon can be predominant for a long. Hypothenar hammer syndrome hhs is a rare occupationrelated condition describing either an aneurysm or thrombosis of the ulnar artery leading to upper arm ischemia. Hypothenar hammer syndrome is caused by chronic repetitive trauma to the ulnar artery and superficial palmar arch.
We report the case of a 43yearsold man with a painful tumefaction of the left hypothenar region. A 54yearold truck driver presented with a tender swelling in the palmar aspect of his right hand. Robotic assisted microsurgery in hypothenar hammer. Background hypothenar hammer syndrome is a rare vascular lesion of the distal ulnar artery in guyon tunnel caused by acute or repetitive blunt trauma to the hypothenar eminence. The hypothenar hammer syndrome ejves vascular forum. Hypothenar hammer syndrome is an uncommon cause of digital ischemia due to repeated compression of the ulnar artery against the hook of the hamate. The aim of this study was to evaluate the longterm outcomes of patients after. There is trauma over the hook of hamate, where the superficial branch of the palmar artery lies. Hypothenar hammer syndrome hhs is caused by repetitive use of the hand as a hammer so that there is thrombosis of the superficial palmar arch of the ulnar artery. Ulnar artery aneurysms are a vascular anomaly related to vascular overuse syndrome, a condition known as hypothenar hammer syndrome hhs. Hypothenar hammer syndrome hhs is a vascular occlusion in humans in the region of the ulna. Typically, it occurs in men around age 40 years, in occupations and sports where the heel of the hand is used as a hammer or is subject to repeated force. Resultant intimal hyperplasia occurs along with duplication and fragmentation of the internal elastic lamina 4.
Often related to occupational practices, thrombosis and embolization can occur. It is caused by repetitive trauma to the hand or wrist such as that caused by the use of a hammer by the vulnerable portion of the ulnar artery as it passes over the hamate bone, which may result in thrombosis, irregularity or aneurysm formation. The patient was referred for mri of the hand, which showed thrombosed ulnar artery aneurysm and an irregularity of the superficial ulnar artery, suggesting a diagnosis of hypothenar hammer syndrome hhs figures 1 and 2. Hypothenar hammer syndrome occurs from trauma to the distal ulnar artery or proximal portion of superficial palmar arch as a result of repetitive trauma to the hypothenar eminence. It is seen in posstraumatic digital ischaemia caused by irregularity or occlusion of the distal ulnar artery at the level of the. This motion is usually associated with sports or occupations that require the constant striking of the heel of the hand. Hypothenar hammer syndrome journal of hand surgery.
He regularly used the right palm as a hammer to secure loads onto his truck. Hypothenar hammer syndrome is a vascular occlusion of this region. Allens test was negative delayed colour return only after 30 s on the right, normal on the left. Hypothenar hammer syndrome is a relatively rare disease process caused by repetitive stress or injury to the hypothenar eminence leading to chronic injury to the ulnar artery.
The factory worker experienced repetitive ischemia and pain attacks in all his digits. Ulnar artery aneurysm and hypothenar hammer syndrome bmj. The syndrome is seen in the dominant hand of males who, during occupational or recreational activities, use their hand as a hammer. It is predominantly found in men with a mean age of 40 years 1, involving the dominant hand and in occupational setting where the hypothenar portion of the hands are. Background hypothenar hammer syndrome hhs is a cause of vascular insufficiency to the hand and. Hypothenar hammer syndrome hhs is a rare cause of digital ischemia and pain caused from repetitive trauma to the palm. Hypothenar hammer syndrome hhs is a rare posttraumatic occlusive disease of the terminal portion of the ulnar artery which results in digital ischemia and raynauds symptoms. Hypothenar hammer syndrome is caused by trauma to the hand or caused by reoccurring compression, squeezing, or hammering of the hand.
Pdf hypothenar hammer syndrome richard abben academia. Hypothenar hammer syndrome is a condition of the hand in which the blood flow to the fingers is reduced. Checking for direct pdf access through ovid abstract hypothenar hammer syndrome is an uncommon cause of symptomatic ischemia of the hand secondary to the formation of aneurysm or thrombosis of the ulnar artery as a result of repetitive trauma to the hypothenar region. The hypothenar hammer syndrome is a rather rare vascular injury. This insidious disease that can be easily confused with other. A 32yearold man, a mason, presented with right hand pain of 2week duration, but reported no acute injury. Nonsurgical treatment includes avoidance of further trauma, calcium channel. Thenar and hypothenar hammer syndromes are uncommon conditions characterised by digital ischemia of the hand as a result of repetitive trauma at level of the thenar andor hypothenar eminence and damage to the radial andor ulnar arteries, respectively 15. Da vinci, microsurgery, robotics, hammer syndrome introduction the hypothenar hammer syndrome was first described in 1772 1. It occasionally causes raynaud phenomenon or other forms of digital ischemia. Background hypothenar hammer syndrome hhs is an uncommon vascular overuse syndrome caused by trauma to the palmar portion of the ulnar artery. In this article, we report a case of the thenar hammer syndrome, a less common counterpart to the hypothenar hammer syndrome, involving damage to the distal radial artery.
Often related to occupational practices, thrombosis and embolization can occ. The hypothenar hammer syndrome journal of vascular surgery. Pdf on oct 27, 2017, meng geng and others published hypothenar hammer syndrome. The hypothenar hammer syndrome is a more familiar manifestation of this type of injury involving the distal ulnar artery and its extension the superficial palmar arch. The ulnar artery appeared thrombosed clinically and radiologically.
Thenar and hypothenar hammer syndromes are uncommon conditions characterised by digital ischemia of the hand as a result of repetitive trauma at level of the thenar andor hypothenar eminence and damage to the radial andor ulnar arteries, respectively. Hypothenar hammer syndrome is a rare condition consisting of finger ischemia due either to embolization from an aneurysm or thrombosis of the distal ulnar artery. Are your fingers white, painful, numb, sensitive to touch and to. Use of doppler in the diagnosis of hypothenar hammer syndrome. Hypothenar hammer syndrome is an uncommon injury of the ulnar artery in its passage through guyons canal, and has been associated with repetitive trauma. Repetitive striking of the palmar portion of the ulnar artery has been known to cause hhs. The hypothenar hammer syndrome is a rare traumatic vascular disease of the hand. Damage to the ulnar artery from sports or occupations in which a person uses the side of the hand as a pounding tool, resulting in recurrent blunt trauma to the hand. Mar 06, 2017 alice turcot, md with the inspq is presenting a prevention pamphlet about how to recognize the hypothenar hammer syndrome hhs. Described treatment options vary greatly, from nonoperative management treatments to surgical interventions. It usually occurs in middleaged men in occupations that involve repeated impaction of the hypothenar eminence eg, jackhammer operators, saddle makers. May 10, 2019 hypothenar hammer syndrome is a rare but serious cause of digital ischemia and morbidity. Some of these muscles make up the fleshy edge of the palm hypothenar eminence.
Typically, patients have a history of blunt trauma to the palmar hypothenar eminence of the hand. The patient underwent surgery to resolve the ulnar nerve compression and revascularise the artery. Hypothenar hammer syndrome defined hypothenar hammer syndrome is a health condition resulting from a deficiency of the blood flow within the hand. Objective in this report, we describe a representative case in the volleyball player as well as a brief approach to clinical features, pathogenesis, diagnosis, imaging and management. Hypothenar hammer syndrome hhs is an uncommon form of secondary raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a. Management of hypothenar hammer syndrome a case report ncbi. Combined thenar and hypothenar hammer syndromes and raynauds. Therapeutic management of hypothenar hammer syndrome causing. Robotic assisted microsurgery in hypothenar hammer syndrome. Therapeutic management of hypothenar hammer syndrome. Hypothenar hammer syndrome hhs is a rare vascular complication of repeated trauma to the palm of the hand.
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