Case of Combined Thenar and Hypothenar Hammer Syndrome: Case Report and Brief Review of the Literature

Abstract

Acute or chronic arterial thrombose due to repetitive blunt trauma to the palm of the hand is a rare occupational vascular disease. In most of the cases it affects the ulnar artery and its superficial palmar branch. Repetitive crush is pathogenic and the unique anatomy of the superficial branch of the ulnar artery lying next to the hook of hamate is causative. In rare cases it may affect the superficial palmar branch of the radial artery, called thenar hammer syndrome. The combination of both is an absolute rarity. Both syndromes are occupational diseases in workers using the hand as a hammer. Patients typically present with Raynaud phenomenon or complain about ischemic pain, cold intolerance, or cyanosis. The gold standard in diagnosis is the angiography. Surgical or conservative treatment can be performed successfully. We present a case of combined thenar and hypothenar hammer and a brief review of the literature.

Combined Thenar and Hypothenar Hammer Syndromes and Raynaud’s Phenomenon Successfully Treated with Iloprost

“…In the first report by Kostianen and Orava [ 14 ] the cases of three, well conservatively treated, volleyball players have been described. In the other reports by Neill-Cage et al [ 1 ], McCready et al [ 7 ], and Koulaxouzidis et al [ 16 ] patients underwent a successful surgical management.…”

“…Concomitant involvement of the radial and ulnar arteries, as described in our patient, is uncommon. Up to today, only four other reports, involving a total of six patients, described the simultaneous presence of HHS and thenar hammer syndrome [ 1 , 7 , 14 , 16 ]. In the first report by Kostianen and Orava [ 14 ] the cases of three, well conservatively treated, volleyball players have been described.…”

Adductor Pollicis Longus Strain in a Professional Baseball Player

“…11,14,22 For those baseball players with diagnosed digital ischemia due to repetitive trauma, nonoperative management including cold avoidance, increased padding, and if applicable, smoking cessation can be effective in limiting symptoms. 7,11,15 …”

“…While the repetitive vascular injuries tend to involve the hypothenar region, thenar hammer syndrome has been described 11 and is attributed to injury to the superficial palmar branch of the radial artery. 7 Catchers who are subjected to repetitive palmar trauma are particularly susceptible to "hammer" injuries. 20 In a study of 8 catchers, the index finger of the catcher's "mitt" hand is the most likely digit to experience ischemia due to repetitive trauma.…”

“…11,14,22 For those baseball players with diagnosed digital ischemia due to repetitive trauma, nonoperative management including cold avoidance, increased padding, and if applicable, smoking cessation can be effective in limiting symptoms. 7,11,15 Musculotendinous injuries to the thenar region are not commonly recognized as a source of injury for a baseball player. While flexor carpi radialis tendinitis caused by a malunited trapezial ridge has been reported in a baseball player, 19 no athletic injury to the adductor pollicis has been described.…”