Hypothenar hammer syndrome occurs from trauma to the distal ulnar artery or proximal portion of superficial palmar arch as a result of repetitive trauma to the hypothenar eminence. Originally described in patients using hammers and screwdrivers, it is also seen in various athletes such as basketball, handball, tennis and golf players.
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Clinical presentation
cold sensation and pain in the palm
tender hypothenar eminence
ischemia of (usually) fourth and fifth fingers
positive Tinel sign (due to ulnar nerve compression)
positive Allen test 2
Pathology
It may be caused by any repetitive compression or blunt trauma to this region. The ulnar artery is particularly vulnerable as it passes over the hook of hamate. Trauma to the artery may result in dissection, stenosis, occlusion or false aneurysm formation. This may be complicated by distal thromboembolism.
Radiographic features
Angiography (DSA)
“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
Overall management strategy is controversial. Non-surgical treatment is considered sufficient, particularly in the setting of vasospasm with adequate collateral circulation.
Conservative options include 4:
smoking cessation
avoidance of further trauma
padded protective gloves
cold avoidance
calcium channel blockers (e.g. nifedipine, diltiazem)
antiplatelet agents or anticoagulation
local care of fingers with necrosis
pentoxifylline: for viscosity reduction