Diagnosis of hypothenar hammer syndrome in a patient with acute ulnar artery occlusion

Abstract

A 56-year-old truck driver with a history of tobacco use presented with acute onset digital ischaemia in the ulnar distribution of his dominant hand, associated with severe pain. Occupational exposures included extensive manual labour and prolonged vibratory stimuli. Workup with Doppler and angiography confirmed the diagnosis of hypothenar hammer syndrome (HHS). After the failure of medical management, he underwent ulnar artery thrombectomy with reconstruction and arterial bypass grafting. His pain improved significantly postsurgically, and he was able to return to a normal routine. This case illustrates the classic presentation, examination, imaging findings and management options of HHS. HHS should be considered in patients with digital ischaemia and associated occupational exposures. Diagnosing the condition appropriately allows for optimal management, aiming at minimising symptoms and maximising quality of life.

Digital Arterial Occlusion at the Metacarpophalangeal Joint with Hypothenar Hammer Syndrome-like Symptoms: A Case Report

“…Causes of arterial occlusion, including HHS, can be trauma, embolism and thrombus, arterial malformation, thoracic outlet syndrome and quadrilateral space syndrome (i.e., constriction), medium and small-vessel vasculitis, Raynaud’s disease, antiphospholipid antibody syndrome, myeloproliferative disorders, sclerosis, hypercoagulable states, and immune-mediated/inflammatory disease [ 3 , 4 ]. Miyayama et al reported two patients with heart disease and thrombosis of the upper extremity, which accounted for 19% of the total thrombosis [ 5 ].…”

“…The treatment for hand ischemia, including HHS, remains unclear. St-Pierre et al summarized possible treatments of hand ischemia from the previous reports [ 3 ]. The first choice of treatment was thrombolytics and anti-platelet drugs within 2 weeks.…”

Hypothenar Hammer Syndrome in a Cyclist

“…Differential diagnosis includes embolic/proximal vascular disease as well as local disease with or without associated systemic disease. Proximal etiologies include cardioembolic causes and large vessel disease such as atherosclerotic plaque and arterial thoracic outlet syndrome [12] . Local etiologies with systemic manifestations include atherosclerotic disease, vasculitis, Raynaud's disease, connective tissue disease.…”