Hypothenar hammer syndrome and repair of ulnar artery aneurysm in a patient without history of trauma

Abstract

The patient is a 50-year-old male with a history of tobacco use presented for evaluation of pulsatile right-hand mass. The patient was employed as a barber but had no known history of trauma or injury. He was diagnosed with hypothenar hammer syndrome and underwent excision of ulnar artery aneurysm with reconstruction of ulnar artery with interposition saphenous vein graft. The presented case describes an uncommon presentation of hypothenar hammer syndrome in a patient without history of repetitive blunt trauma or injury and discusses the diagnosis, pathophysiology and treatment options for symptomatic ulnar artery aneurysm.

A ‘thrill’ in the palm: surgical management of a symptomatic ulnar artery aneurysm

“…Other causes include vasculitis, infections or congenital abnormalities 2 . The ulnar artery is the most common site of aneurysm formation in the upper extremity as it has little protection in Guyon's canal, making the vessel wall prone to trauma when compressed against the hook of hamate 3 …”

“…Treatment of ulnar artery aneurysms is not well established due to the rarity of the condition, though surgery may be considered, particularly where there is nerve compression or risk of digital ischaemia 1 . Non‐operative management can include smoking cessation and limiting trauma to the affected hand though this presents practical difficulties for manual workers 3 . The goal of surgical resection is to restore blood flow and remove a possible source of emboli to distal arteries 3 .…”

“…Non‐operative management can include smoking cessation and limiting trauma to the affected hand though this presents practical difficulties for manual workers 3 . The goal of surgical resection is to restore blood flow and remove a possible source of emboli to distal arteries 3 . This usually necessitates arterial reconstruction with a interposition graft due to distance between proximal and distal ends of the ulnar artery preventing primary anastamosis 3 .…”

“…2 The ulnar artery is the most common site of aneurysm formation in the upper extremity as it has little protection in Guyon's canal, making the vessel wall prone to trauma when compressed against the hook of hamate. 3 Repetitive hand pounding with manual labour or sport is the most common cause, predominantly affecting right hand dominant men. 4 This may manifest as hypothenar hammer syndrome, whereby patients experience pain and digital ischaemia when striking the ulnar palm.…”

“…3 This usually necessitates arterial reconstruction with a interposition graft due to distance between proximal and distal ends of the ulnar artery preventing primary anastamosis. 3 Regular post-operative follow-up is essential to detect potential graft dysfunction. 1 True aneurysms of the ulnar artery are rare but an important cause of hand and wrist pain to consider in manual workers and smokers who experience repetitive minor trauma to the hand.…”