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hypothenar hammar syndrome
Etiology:
- trauma to the palmar portion of the ulnar artery
- occupational or sports activities which involve repetitively striking objects with the heel of the hand
- prolonged use of air hammers, chain saws, impact wrenches & other power tools that generate vibration
- baseball, karate, badminton, mountain biking, golf, tennis, handball, volleyball, softball, weight lifting, break-dancing, hockey
Epidemiology:
- uncommon
- men, mean age of 40 years
- occupational settings
- metal workers, auto mechanics, lathe operators, machinists, miners, sawmill workers, butchers, bakers, brick layers, carpenters
Pathology:
- vascular overuse syndrome
- generally involves dominant hand
- digital ischemia
Clinical manifestations:
- digital pain with paresthesias
- cold sensitivity
- phasic blanching or discoloration of the fingertips
- finger claudication or hypothenar pain
- positive Allen test
Radiology:
- arteriography showing occlusion of ulnar artery
Differential diagnosis:
- Raynaud's syndrome
Management:
- conservative management
- smoking cessation
- avoidance of further trauma (may require change of occupation)
- padded protective gloves
- cold avoidance
- calcium channel blocker (nifedipine, diltiazem)
- antiplatelet agents or anticoagulation
- local care of fingers with necrosis
- pentoxifylline to reduce blood viscosity
- vascular surgery
- arterial ligation (intact radial/palmar arch)
- resection of thrombosed arterial segment or aneurysm with end-to-end anastomosis
- resection & vascular reconstruction with vein or artery graft
General
arterial disease
syndrome
References
- Ablett AT and Hackett LA
Hypothenar Hammer Syndrome: Case Reports and Brief Review.
Clin Med Res. May 2008; 6(1): 3-8
PMID: 18591371
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442026/