Hypothenar hammer syndrome

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.

  • cold senstation and pain in the palm
  • Raynaud syndrome
  • tender hypothenar eminence 
  • ischaemia of (usually) fourth and fifth fingers
  • positive Tinel sign (due to ulnar nerve compression)
  • positive Allen test 2

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.

Angiography
  • may show a beaded irregular appearance to the distal ulnar artery +/- associated aneurysm formation
  • occlusion or underfill of distal ulnar arterioles

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 (nifedipine, diltiazem
  • antiplatelet agents or anticoagulation
  • local care of fingers with necrosis
  • pentoxifylline: for viscosity reduction
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Article Information

rID: 1486
System: Vascular
Synonyms or Alternate Spellings:
  • Hypo-thenar hammer syndrome

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