The hypothenar hammer syndrome

Abstract

A 54-year-old truck driver presented with a tender swelling in the palmar aspect of his right hand. He regularly used the right palm as a "hammer" to secure loads onto his truck. Examination showed a 2-cm pulsatile swelling at the hypothenar eminence. The clinical diagnosis of a distal ulnar artery aneurysm was confirmed with duplex ultrasound imaging. Contrast-enhanced computed tomography with three-dimensional reconstruction (A, Cover) was used for further anatomic assessment.The aneurysm (B) was surgically excised under general anesthesia with end-to-end anastomosis of the healthy artery (C) using 6-0 Prolene (Ethicon, Somerville, NJ). Postoperatively the hand was well perfused, with intact neurologic and motor function. The patient made an uneventful recovery, and histologic analysis of the specimen confirmed a true aneurysm. COMMENTRepetitive blunt trauma to the palm of the hand may result in obstruction or aneurysm formation in the distal ulnar artery where it lies against the hamate bone. 1 The latter pathology occurs much less frequently. The "hypothenar hammer syndrome" has been described as an occupational hazard in carpenters, butchers, mechanics, and others who use their hand as a hammer. Operative intervention is associated with low morbidity and can prevent sequelae such as Raynaud phenomenon, digital gangrene, or ulnar nerve compression that eventually occur in most aneurysms treated conservatively. 2 Opinion is divided about whether the artery should simply be ligated after excision of the aneurysm or whether revascularization should be done by end-to-end anastomosis or interposition vein graft. 3 Ligation without reconstruction is possible when there is an adequate collateral circulation. Most would advocate selective revascularization based on an Allen test, back bleeding, and perfusion of the hand observed after the ulnar artery is occluded at surgery. REFERENCES 1. Smith JW. True aneurysms of traumatic origin in the palm. Am J Surg 1962;104:7-13.

Acute digital ischemia: A neglected microsurgical emergency. Report of 17 patients and literature review

“…Hypothenar hammer syndrome has been seen in patients whose occupation leads them to use the palms of their hands as hammers 22 : Wine growers, 23 Construction workers, 24 or Truck drivers. 25 Hendrickson, 26 Nakamura,27 and Neill-cage 28 have also described this pathology in athletes and we earlier underlined the great incidence of HHS in skaters. 9 Recently, Sadat 29 pointed out the role of physiotherapy as a cause of hypothenar hammer syndrome.…”

Combined Thenar and Hypothenar Hammer Syndromes and Raynaud’s Phenomenon Successfully Treated with Iloprost

“…The “gold standard” imaging techniques to confirm a suspected HHS and/or thenar hammer syndrome are multidetector CT angiography, magnetic resonance imaging angiography, or direct angiography [ 2 , 7 – 9 ].…”

“…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 and/or hypothenar eminence and damage to the radial and/or ulnar arteries, respectively [ 1 – 5 ]. The symptoms are related to the mechanism of the trauma and Raynaud's phenomenon can be predominant for a long time [ 1 , 2 , 5 , 6 ]. 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: A case and brief review

“…Pulsatile mass over the hypothenar eminence has been reported in cases of ulnar artery aneurysm. 20,21 In addition to digital ischemia, another key physical exam finding may be a positive Allen's sign. In order to avoid a false-positive result, avoidance of finger and wrist hyperextension should be emphasized.…”