Hypothenar hammer syndrome (HHS) is a rare condition of distal ulnar artery injury and thrombosis secondary to repetitive blunt trauma to the hypothenar area. We present a case of HHS for which point-of-care ultrasound (POCUS) was used as the initial means of imaging, prompting management and disposition without further imaging studies ordered in the emergency department (ED). This case demonstrates the utility of POCUS to aid the Emergency Physician in the diagnosis and management of patients with extremity vascular issues in the ED, and details a rarely seen clinical entity in the ED.

The presence of hypertension in individuals with type 2 diabetes augments the risk for cardiovascular morbidity and mortality. In this regard, data support that management of hypertension in this high-risk population is a critical risk reduction strategy. In recent years, a number of work groups have redefined hypertension, management strategies, and targets. In this context, there is still considerable discussion on an appropriate target for blood pressure in the diabetic population. However, despite this discussion on target blood pressure, it is widely recognized that there is considerable residual risk for heightened cardiovascular events in the hypertensive, diabetic population despite widespread awareness and treatment. There has been increasing interest in management strategies for blood pressure reduction in this high-risk population that complement traditional antihypertensive agents. Large-scale clinical trials have shown that hypoglycemic agents can complement blood pressure reduction and have a favorable effect on cardiovascular outcomes such as the sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. In the diabetic population, consideration should be given to the blood pressure lowering effects of the newer hypoglycemic agents when working toward additional glycemic control in patients with hypertension.

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Diabetes mellitus and hypertension are interrelated conditions that predispose patients to cardiovascular disease. The 2015 American Diabetes Association guidelines recommend a blood pressure goal of <140/90 but indicates that a lower goal can be set for some individuals if this can be achieved without undue burden. Renin angiotensin system blockers remain the main stay of treatment in hypertensive diabetics together with lifestyle interventions. Guidelines indicate that combination therapy may be initiated in patients who have a blood pressure 20/10 over the target BP. As discussed in this review, there are several diabetic medications that have antihypertensive effects. Management of hypertension in diabetes mellitus is an important factor in reducing cardiovascular disease in conjunction with other cardiovascular disease prevention strategies such as use of stains and aspirin. Patients will benefit from multidisciplinary team expertise including a primary care provider, endocrinologist, hypertension specialist, diabetic educator and dietician.