Presentation
[…] fingertip ulcerations over ulnar digits splinter hemorrhages over ulnar digits provocative tests Allen's test positive if occlusion is present negative if aneurysm is present Imaging Doppler ultrasound indications first line test measure digital brachial [orthobullets.com]
Less commonly, aneurysm formation of the ulnar artery is present. [radsource.us]
Presentation Arterial damage may present dramatically or with subtle, intermittent signs and symptoms that may be temporally remote from the episode of injury. 18 Typically, a male patient will present with ischemia of the second, third, fourth or fifth [ncbi.nlm.nih.gov]
Sign in Published on Mar 6, 2017 Alice Turcot, MD with the INSPQ is presenting a prevention pamphlet about how to recognize the hypothenar hammer syndrome (HHS). [youtube.com]
Pulsatile hypothenar mass (if aneurysm present). Discolouration of fingers - white or purplish, usually lacking the 'blush' (red) phase of Raynaud's phenomenon. Cool fingertips. Positive Allen's test (see below). [patient.info]
Entire Body System
- Asymptomatic
Incidence and Related Conditions Considered rare; precise incidence unknown because either ulnar artery occlusion is asymptomatic or individuals do not present for evaluation Possibly more common than believed, hypothenar hammer syndrome has been reported [handsurgeryresource.com]
[…] hook of the hamate Differential Raynaud's disease involves the thumb but hypothenar hammer syndrome does not Treatment Nonoperative lifestyle modifications, symptomatic treatment, and vascular consult indications thrombosis without aneurysm > 2 weeks asymptomatic [orthobullets.com]
[…] involvement of the adventitia may affect periarterial sympathetic fibers, resulting in reflex vasospasm and thus further decreasing the surrounding collateral circulation. 6 Abnormalities of the at risk segment of the distal ulnar artery are present in asymptomatic [radsource.us]
Restini (VASA 6/14) Asymptomatic peripheral artery disease and antiplatelet management V. Raparelli, M. Proietti, L. Napoleone, T. Bucci, G. Talerico, F.S. [dga-gefaessmedizin.de]
The patient was noted as “asymptomatic on hydroxychloroquine” in a follow-up visit 4 years after his initial presentation. [ncbi.nlm.nih.gov]
- Metal Worker
Workers at risk include auto mechanics, metal workers, lathe operators, miners, machinists, butchers, bakers, carpenters, and bricklayers. Workers who use vibrating tools are also at risk. [ccohs.ca]
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; for example: Occupations such as metal workers, machinists, mechanics, miners, sawmill workers, [patient.info]
Workers most at risk include metal workers, auto mechanics, lathe operators, machinists, miners, sawmill workers, butchers, bakers, brick layers and carpenters. [ncbi.nlm.nih.gov]
Workers at risk include metal workers, auto mechanics, lathe operators, machinists, miners, sawmill workers, butchers, bakers, brick layers and carpenters. 1,3,4,6,7 HHS has been associated with numerous sports including handball, baseball, tennis, squash [radsource.us]
- Falling
Références Van Rosen S (1934) Ein Fall von thrombose in der Arteria ulnaris nach Einwirkung von stumpfer Gewalt. [link.springer.com]
Ein Fall von Thrombose in der Arteria ulnaris nach Einwirkung von stumpfer Gewalt. Acta Chirurgica Scandinavica, 73: 500±506. References Received: 17 March 1999 Accepted after revision: 18 May 1999 D. [kundoc.com]
Ein Fall Von Thrombose in der Arteria Ulnaris nach Einwirkung von Stumper Gewalt. ACTA Chir Scand 1934; 73 :500–506. [ Google Scholar ] 5. Conn J Jr, Bergan JJ, Bell JL. Hand ischemia: hypothenar hammer syndrome. [ncbi.nlm.nih.gov]
Cardiovascular
- Thrombosis
Most common lesions = Ulnar artery thrombosis. [eorif.com]
Introduction Post-traumatic digital ischemia from thrombosis of ulnar artery at Guyon's canal. [orthobullets.com]
When the trauma is repetitive, aneurysm with or without thrombosis and occlusion of the ulnar artery may result. [handsurgeryresource.com]
There were ®ve thrombosed aneurysms, one patent aneurysm and one isolated thrombosis. [kundoc.com]
Repetitive blunt trauma to it may lead to spasm, thrombosis, or aneurysm formation; or cause a palpable hypothenar mass, digital ischemia, or unilateral Raynaud's phenomenon—the “hypothenar hammer syndrome.” [pubs.rsna.org]
Musculoskeletal
- Fracture
Most common lesions = ganglions and hook of hamate fracture. Ulnar tunnel zone 2=hook of hamate, deep motor branch only. Most common lesions = ganglions and hook of hamate fracture. ulnar tunnel zone 3=superficial sensory branch only. [eorif.com]
Other views that may be helpful include semisupinated oblique view and a lateral view with the hand radially deviated and the thumb abducted. 8 Routine radiography can diagnose osseous abnormalities such as hamulus fractures and arthropathies. [radsource.us]
In two cases the onset of symptoms could clearly be related to a single direct injury to the hypothenar area: one occurred in an 82-year-old woman after a distal fracture of the radius and one in a 29-yearold professional hockey-player after a violent [kundoc.com]
Mouawad (Vasa 1/2019) Imaging and endovascular management of traumatic pelvic fractures with vascular injuries Jos C. van den Berg (Vasa 1/2019) Computed tomography angiography evaluation of acute limb ischemia Alex Wallace, Yash Pershad, Aman Saini, [dga-gefaessmedizin.de]
The authors point out that this technique not only displays pertinent vascular anatomy but can rule out bone abnormalities such as hamate fracture, and can show the relationship of the ulnar artery to the hamulus. [ncbi.nlm.nih.gov]
Neurologic
- Vertigo
Translation of "hypothenar hammer syndrome " (English → French) : Pneumatic hammer syndrome Traumatic vasospastic syndrome Vertigo from infrasound Syndrome de:marteau-piqueur | vasospasme traumatique | Vertige dû aux infra-sons WORLD HEALTH ORGANIZATION [wordscope.com]
Workup
[…] with vascular injuries Jos C. van den Berg (Vasa 1/2019) Computed tomography angiography evaluation of acute limb ischemia Alex Wallace, Yash Pershad, Aman Saini, Sadeer Alzubaidi, Sailendra Naidu, Grace Knuttinen, Rahmi Oklu (Vasa 1/2019) Diagnostic workup [dga-gefaessmedizin.de]
Treatment
Two patients refused operative treatment and received oral platelet aggregation inhibitors and were told to avoid local trauma. [kundoc.com]
Prognosis [ 7, 9 ] Many patients improve with nonsurgical treatments (above). Results of reconstructive surgery have been shown to be variable, with fairly common recurrence. [patient.info]
Non-surgical treatment is considered sufficient, particularly in the setting of vasospasm with adequate collateral circulation. [radiopaedia.org]
Therefore, conservative treatment or bypass of the thrombosed vessels is possible in hypothenar hammer syndrome. [handsurgeryresource.com]
Prognosis
Angiography “corkscrew” or beaded irregular appearance distal ulnar artery aneurysm formation occlusion of the ulnar artery segment overlying the hook of the hamate occluded or under-filled distal digital arteries in an ulnar artery distribution Treatment and prognosis [radiopaedia.org]
Prognosis [ 7, 9 ] Many patients improve with nonsurgical treatments (above). Results of reconstructive surgery have been shown to be variable, with fairly common recurrence. [patient.info]
Wilkinson (VASA 6/16) Vascular puncture site complications - diagnosis, therapy and prognosis Wolfgang Mlekusch, Irene Mlekusch, Schila Sabeti-Sandor (VASA 6/16) Nailfold capillaroscopy microscopy – an interdisciplinary appraisal Peter Frank Klein-Weigel [dga-gefaessmedizin.de]
Etiology
Arteriography showing complete occlusion of ulnar artery DDx Other etiology of ischemia of the hand (thoracic outlet syndrome, arteriosclerosis or thromboangiitis obliterans) References Anderson SE et al. [imaios.com]
J Ultrasound Med 20(8):921-924 (PMID: 11503929 ) [8] Ferris BL, Taylor LM Jr, Oyama K, et al (2000) Hypothenar hand syndrome: proposed etiology. [eurorad.org]
[…] synonyms: Hyothenar Hammer Syndrome ICD-10 I74.2: Embolism and thrombosis of arteries of the upper extremities Hyothenar Hammer Syndrome ICD-9 444.21 Arterial embolism and thrombosis; upper extremity Hyothenar Hammer Syndrome Etiology / Epidemiology / [eorif.com]
Hypothenar hammer syndrome: proposed etiology. J Vasc Surg. 2000 ;31: 104 - 113. Google Scholar | Crossref | Medline | ISI 2. Marie, I, Herve, F, Primard, E. Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients. [journals.sagepub.com]
Hypothenar hammer syndrome: proposed etiology. J Vasc Surg 2000; 31 :104–113. [ PubMed ] [ Google Scholar ] 17. Stone JR. Intimal hyperplasia in the distal ulnar artery; influence of gender and implications for the hypothenar hammer syndrome. [ncbi.nlm.nih.gov]
Epidemiology
[…] synonyms: Hyothenar Hammer Syndrome ICD-10 I74.2: Embolism and thrombosis of arteries of the upper extremities Hyothenar Hammer Syndrome ICD-9 444.21 Arterial embolism and thrombosis; upper extremity Hyothenar Hammer Syndrome Etiology / Epidemiology / [eorif.com]
Epidemiology incidence rare demographics male : female ratio is 9:1 age bracket is 40s-50s location unilateral, dominant ring finger +/- small finger less commonly, index and middle fingers thumb is spared risk factors occupations using vibrating tools [orthobullets.com]
This leads to vascular insufficiency of the ulnar side of the hand. [ 1 ] Epidemiology [ 1, 2, 3 ] Hypothenar hammer syndrome (HHS) is probably rare, but may be underdiagnosed. [patient.info]
Pathophysiology
Pathophysiology Hypothenar hammer syndrome is caused by trauma to the ulnar artery: the intravascular injury may be diffuse (eg, resulting from intra-arterial injection) or localized (eg, repetitive compression or blunt force). [handsurgeryresource.com]
[…] ring finger +/- small finger less commonly, index and middle fingers thumb is spared risk factors occupations using vibrating tools such as carpenters, machinists, mechanics sports such as baseball catchers, mountain biking, golf, volleyball, karate Pathophysiology [orthobullets.com]
[…] of the hand Pre-existing abnormalities of the arteries or variations in arterial anatomy (eg incomplete superficial palmar arch) Underlying prothrombotic factors [ 4 ] Other anatomical variations, eg an anomalous hypothenar muscle. [ 5 ] Anatomy and pathophysiology [patient.info]
Gary (VASA 4/14) Venous thromboembolism and cancer pathophysiology and incidence H. Striker (VASA 4/14) MiRNAs in peripheral artery disease - something gripping this way comes W. Kloss, B. Vogel, E. [dga-gefaessmedizin.de]
Prevention
Sign in Published on Mar 6, 2017 Alice Turcot, MD with the INSPQ is presenting a prevention pamphlet about how to recognize the hypothenar hammer syndrome (HHS). [youtube.com]
Prevention Improve work practices so as to avoid using the palm of the hand as a hammer. Occupational screening (where relevant) has been advocated, since some degree of ulnar arterial damage may occur preclinically. [ 2 ] [patient.info]
Conclusions As described above, hypothenar hammer syndrome may not be as rare as once thought. 27 It is a curable and preventable cause of upper extremity digital ischemia. [ncbi.nlm.nih.gov]