Hypothenar hammer syndrome is a rare but serious cause of digital ischemia and morbidity. Hypothenar hammer syndrome hhs is a rare cause of digital ischemia and pain caused from repetitive trauma to the palm. Pdf hypothenar hammer syndrome richard abben academia. 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. Therapeutic management of hypothenar hammer syndrome. Nevertheless, a combination of the two syndromes has been reported 7. 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. 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. It is most commonly reported in middleaged males who suffer from repetitive trauma to the palm secondary to occupational or recreational activities. Therapeutic management of hypothenar hammer syndrome causing. Hypothenar hammer syndrome is a vascular occlusion of this region. Hypothenar hammer syndrome is an infrequent disorder of the arteries found within the hand. Robotic assisted microsurgery in hypothenar hammer syndrome.
Allens test was negative delayed colour return only after 30 s on the right, normal on the left. A 32yearold man, a mason, presented with right hand pain of 2week duration, but reported no acute injury. Ulnar artery aneurysms are a vascular anomaly related to vascular overuse syndrome, a condition known as hypothenar hammer syndrome hhs. Doppler mapping, a proven, noninvasive technique of visualizing vascular anatomy5,6 has applicability in the preoperative assessment of ulnar artery aneurysm. Described treatment options vary greatly, from nonoperative management treatments to surgical interventions. Hypothenar hammer syndrome in a middle blocker case. Background hypothenar hammer syndrome hhs is an uncommon vascular overuse syndrome caused by trauma to the palmar portion of the ulnar artery. Resultant intimal hyperplasia occurs along with duplication and fragmentation of the internal elastic lamina 4. 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. The ulnar artery appeared thrombosed clinically and radiologically. Hypothenar hammer syndrome hhs is a vascular disorder characterized by ulnar artery thrombosis or aneurysmal formation. It is traditionally thought to be prevalent amongst labourers and craftsmen. 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. 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.
Ulnar artery aneurysm and hypothenar hammer syndrome. There is a need to distinguish symptoms of hhs from those of classical havs since precise diagnosis may alter both the clinical and occupational. Often related to occupational practices, thrombosis and embolization can occur. It is believed that the ulnar artery is repetitively damaged by blunt compression against the hamate. 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. The symptoms are related to the mechanism of the trauma and a raynauds phenomenon can be predominant for a long. Hhs describes patients who experience signs and symptoms concerning for digital ischemia. May 10, 2019 hypothenar hammer syndrome is a rare but serious cause of digital ischemia and morbidity.
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 defined hypothenar hammer syndrome is a health condition resulting from a deficiency of the blood flow within the hand. 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. Presented here is a case of a manual laborer who had symptoms of digital. It occasionally causes raynaud phenomenon or other forms of digital ischemia. 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. Repetitive striking of the palmar portion of the ulnar artery has been known to cause hhs. Some of these muscles make up the fleshy edge of the palm hypothenar eminence. 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. This insidious disease that can be easily confused with other. Surgical treatment can be performed, consisting of resection and vein grafting. Repetitive blunt trauma to it may lead to spasm, thrombosis, or aneurysm formation. Hypothenar hammer syndrome is a condition of the hand in which the blood flow to the fingers is reduced. Examination showed a 2cm pulsatile swelling at the hypothenar eminence.
The syndrome is seen in the dominant hand of males who, during occupational or recreational activities, use their hand 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. The clinical diagnosis of a distal ulnar artery aneurysm was confirmed with duplex ultrasound imaging. In the latter case, it is named hypothenar hammer syndrome,1,2 and it results in. The factory worker experienced repetitive ischemia and pain attacks in all his digits. 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. There is trauma over the hook of hamate, where the superficial branch of the palmar artery lies. The hypothenar hammer syndrome is a rare traumatic vascular disease of the hand. Robotic assisted microsurgery in hypothenar hammer. Hypothenar hammer syndrome is an uncommon injury of the ulnar artery in its passage through guyons canal, and has been associated with repetitive trauma.
Presented here is a case of a manual laborer who had symptoms of digital ischemia after acute hyperextension injury to the ring finger. Use of doppler in the diagnosis of hypothenar hammer syndrome. This leads to vascular insufficiency of the ulnar side of the hand. A 54yearold truck driver presented with a tender swelling in the palmar aspect of his right hand. We report the case of a 43yearsold man with a painful tumefaction of the left hypothenar region. Management of hypothenar hammer syndrome a case report.
The injury to the blood vessels of the hand causes pain. Hypothenar hammer syndrome hhs is a vascular occlusion in humans in the region of the ulna. The symptoms are related to the mechanism of the trauma and raynauds phenomenon. Ulnar artery aneurysm and hypothenar hammer syndrome bmj. Combined thenar and hypothenar hammer syndromes and. 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 usually occurs in middleaged men in occupations that involve repeated impaction of the hypothenar eminence eg, jackhammer operators, saddle makers. 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. Mar 06, 2017 alice turcot, md with the inspq is presenting a prevention pamphlet about how to recognize the hypothenar hammer syndrome hhs. Hypothenar hammer syndrome hhs is a rare vascular complication of repeated trauma to the palm of the hand. Abstract hypothenar hammer syndrome affects less than 1% of the population, but if the diagnosis is delayed, digital gangrene and critical ischemia can ensue.
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. Importantly, it is a reversible cause of hand ischemia that, if missed, can lead to significant morbidity and even amputation. Significant tenderness to palpation over the right distal palm was observed. The hypothenar hammer syndrome is a rather rare vascular injury. Importantly, it is a reversible cause of hand ischemia. Hypothenar hammer syndrome radiology reference article. Are your fingers white, painful, numb, sensitive to touch and to. 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. The hypothenar hammer syndrome journal of vascular surgery. The superficial palmar branch of the ulnar artery is the major source of blood to the fingers.
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. This condition is often caused due to repetitive injury to the palmer ulna. Management of hypothenar hammer syndrome a case report ncbi. 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. Hypothenar hammer syndrome hhs is a rare occupationrelated condition describing either an aneurysm or thrombosis of the ulnar artery leading to upper arm ischemia. 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. 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. Hypothenar hammer syndrome hhs is a rare diagnosis characterized by ulnar insufficiency, often accompanied by ulnar nerve neurologic deficit.
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. Hypothenar atrophy is associated with the lesion of the ulnar nerve, which supplies the three hypothenar muscles. That is why this condition is called hammer syndrome from. Originally described in patients using hammers and screwdrivers, it is also seen in various athletes such as basketball, handball, tennis and golf players. Background hypothenar hammer syndrome hhs is a cause of vascular insufficiency to the hand and. 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. The patient underwent surgery to resolve the ulnar nerve compression and revascularise the artery. Surgery is the choice of treatment after intensive and careful investigation for other distal artery lesions. 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. Pdf on oct 27, 2017, meng geng and others published hypothenar hammer syndrome. Hypothenar hammer syndrome definition of hypothenar.
Treatment is largely dependent on the extent of arterial damage. Mar 22, 2010 hypothenar hammer syndrome hhs is probably rare, but may be underdiagnosed. This motion is usually associated with sports or occupations that require the constant striking of the heel of the hand. Hypothenar hammer syndrome is caused by chronic repetitive trauma to the ulnar artery and superficial palmar arch. Often related to occupational practices, thrombosis and embolization can occ.
Hypothenar hammer syndrome is an uncommon cause of upperextremity ischemia that is often overlooked in the absence of a thorough occupational and recreational history. 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. Ulcerative changes and blanching at the tips of right fourthfifth digits were observed. Hypothenar hammer syndrome is an uncommon cause of digital ischemia due to repeated compression of the ulnar artery against the hook of the hamate. He regularly used the right palm as a hammer to secure loads onto his truck.
A righthand dominant patient presented with pain and a tender mass in the hypothenar eminence, and with paraesthesia of the fourth and fifth fingers. The aim of this study was to evaluate the longterm outcomes of patients after. Alice turcot, md with the inspq is presenting a prevention pamphlet about how to recognize the hypothenar hammer syndrome hhs. Hypothenar hammer syndrome is caused by trauma to the hand or caused by reoccurring compression, squeezing, or hammering of the hand. Magnetic resonance imaging revealed thrombosed ulnar artery aneurysm. The hypothenar hammer syndrome ejves vascular forum. 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. 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.
Combined thenar and hypothenar hammer syndromes and raynauds. Hypothenar hammer syndrome journal of hand surgery. 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. 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. The arteries found within the finger have blood clots that cause blockages in the digital arteries. It is seen in posstraumatic digital ischaemia caused by irregularity or occlusion of the distal ulnar artery at the level of the.