Hypothenar hammer syndrome: Gray‐scale and color Doppler sonographic appearances

Gençhellaç, Hakan; Demir, Mustafa Kemal; Ünlü, Ercüment; Temízöz, Osman; Özdemir, Hüseyin

doi:10.1002/jcu.20364

Cited by 11 publications

(13 citation statements)

References 6 publications

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“…4,11,12 With advanced thrombosis, involvement of the adventitia may affect periarterial sympathetic fibers, resulting in reflex vasospasm, which further diminishes the adjacent collateral flow. 13 Ischemia can appear as unilateral cold sensation, paresthesia, blanching, cyanosis, and even mottling of the digits and atrophic ulceration.…”

Section: Incidence and Presentationmentioning

confidence: 99%

Hypothenar Hammer Syndrome

Yuen¹,

Wright²,

Johnson³

et al. 2011

Annals of Plastic Surgery

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Hypothenar hammer syndrome is an uncommon cause of symptomatic ischemia of the hand secondary to the formation of aneurysm or thrombosis of the ulnar artery as a result of repetitive trauma to the hypothenar region. The injury to the palmar ulnar artery occurs in subjects who use the hypothenar part of the hand as a hammer; the hook of the hamate strikes the superficial palmar branch of the ulnar artery in the Guyon space. Such injuries of the ulnar artery may lead to severe vascular insufficiency in the hand with thrombosis and distal embolization of the digital arteries. Imaging of vascular lesions of the hand has greatly improved in recent years with the use of Doppler, multislice computed tomographic angiography, magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography. The aim of this article is to describe a case report using current-day imaging and to present a review of literature. Algorithms for the diagnosis and treatment of hypothenar hammer syndrome will be proposed.

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Section: Incidence and Presentationmentioning

confidence: 99%

Hypothenar Hammer Syndrome

Yuen¹,

Wright²,

Johnson³

et al. 2011

Annals of Plastic Surgery

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“…4 HHS pathophysiology has been theorized to begin with initial vasospasm, eventually leading to intimal hyperplasia and disruption of the internal elastic lamina. 5 The damage can initiate platelet aggregation and encourage thrombus formation at the site of injury. 6 Further, depending on the extent of arterial wall damage, it may lead to aneurysm (true or false), though this occurs much less frequently.…”

Section: Introduction and Underlying Pathophysiologymentioning

confidence: 99%

“…6 Further, depending on the extent of arterial wall damage, it may lead to aneurysm (true or false), though this occurs much less frequently. 5,6 Intra-aneurysmal thrombus formation with subsequent distal embolization often develops in the setting of ulnar artery aneurysm. 6 Additionally, thrombus at the original site of injury, if extensive, may cause reflex vasospasm of surrounding vasculature, further limiting digital perfusion.…”

Section: Introduction and Underlying Pathophysiologymentioning

confidence: 99%

“…6 Additionally, thrombus at the original site of injury, if extensive, may cause reflex vasospasm of surrounding vasculature, further limiting digital perfusion. 5 Finally, vascular trauma to the adventitial layer can cause thickening and fibrosis, ultimately leading to extrinsic scarring and subsequent arterial occlusion. 1 Incidence HHS incidence is difficult to characterize because of frequent under-recognition but is generally thought to be quite rare.…”

Section: Introduction and Underlying Pathophysiologymentioning

confidence: 99%

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Hypothenar hammer syndrome: A case and brief review

2011

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A 51-year-old, right-handed, Caucasian, male factory mechanic with an underlying history of active tobacco abuse, hypertension and hyperlipidemia, awoke with severe, throbbing, left hand pain. His hand felt 'ice-cold'; 'like someone pulled my fingernails out'. He denied previous trauma of the involved upper limb or hand. He denied similar past symptomatology. Home medications included zolpidem, simvastatin, losartan, celecoxib, amitriptyline and diltiazem. His work activities were physically demanding, involving heavy use of his hands. He described a history of frequently using his left hand for pounding during previous employment as a farmer. For the previous 6 years, he had been employed as a factory mechanic, requiring less overall use of the left hand as a hammer, though he did still use this technique. Pounding activities using the right hand were much less frequent.He sought initial evaluation in the emergency department where Raynaud's phenomenon was suspected and a trial of cilostazol started. Symptoms, however, progressed to dusky, cyanotic-appearing 2nd, 3rd, 4th, and, to a lesser extent, 5th digits ( Figure 1) with worsening pain and hypersensitivity. Early signs of tissue loss were noted at the tip of the long finger (Figure 2 AbstractHypothenar hammer syndrome is an uncommon cause of upper-extremity ischemia that is often overlooked in the absence of a thorough occupational and recreational history. Importantly, it is a reversible cause of hand ischemia that, if missed, can lead to significant morbidity and even amputation. The occupational ramifications and quality of life of those affected can be significant. Its relative rarity, set against the ubiquitous use of the hand as a 'hammer' is noteworthy. Several other causes of hand ischemia can present similarly; therefore, consideration of other etiologies must be thoroughly investigated. Key distinguishing clinical features, in addition to a detailed occupational and recreational history, may include characteristic sparing of the thumb, the absence of a hyperemic phase in 'Raynaud's phenomenon', and a positive Allen's sign. Both non-invasive and invasive diagnostic studies, including bilateral upper-limb segmental pulse volume recordings (PVR), arterial duplex examination, and upper-extremity angiography, are complementary to a thorough history and physical examination. Optimal management strategies are not well defined because of its rarity and resultant lack of quality, evidence-based data. Though most cases can be successfully managed non-operatively, micrographic arterial reconstruction may be limb saving in severe or recalcitrant cases. Newer, experimental strategies including selective sympathetic blockage using botulinum toxin A have been reported in a few recalcitrant cases. The brief case description illustrates the typical presentation and potential treatment strategies employed in a difficult case. A review of relevant literature is also presented.

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“…37 US, electroneuromyography, computerized tomography, and magnetic resonance contribute to diagnosis. US presents advantages regarding vascular diagnostic, 25,38 particularly in cases of ulnar artery occlusion. 39,40 Thermography has been used to evaluate carpal tunnel syndrome, 41 Raynaud's phenomenon 42 and armforearm-hand vibration syndrome.…”

Section: Introductionmentioning

confidence: 99%

Digital Traumatic Fistula and Arteriovenous Malformation in a Patient with Ulnar Nerve Compression Syndrome

Oliveira¹,

Salles-Cunha²

2017

Journal for Vascular Ultrasound

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Objective.-Ulnar nerve compression, the Guyon's canal syndrome, is more unusual than carpal tunnel disorders. An exceptional case of a patient with vascular and neurogenic signs and symptoms is described.Patient Presentation.-A 26-year-old female physiotherapist presented with neurogenic and arteriovenous signs and symptoms involving the right hand. The patient described fourth fi nger and wrist pain with fl exion, and pain and itching extending to arm and forearm. Sensations worsened when exposed to air conditioning. Enlarged vessels were noted in the medial aspect of the fourth digit; trauma occurred 8 years earlier during attempts to open a nail polish container.Methods.-Color fl ow, duplex-Doppler ultrasonography (US) of the subclavian to digital vessels was performed using 3-to 13-MHz transducers. Interpretation focused on fl ow waveforms obtained with the hand open and closed, having the left extremity as reference. Thermography was performed with camera Flir 15, room temperature at 21°C (70°F) and relative humidity at 48%.Results.-Right subclavian to digital arteries had high diastolic fl ow with opened hand. Hand closure interrupted diastolic fl ow except in the ulnar circulation to the fourth digit. Common digital arteries feeding digits 3-4 and 4-5 had signifi cantly more diastolic fl ow than the artery feeding digits 2-3. Diastolic fl ow through a dilated ulnar artery despite hand closure was associated to a millimetric arteriovenous fi stula in the fourth fi nger. Hyperthermia saturating at 35°C (95°F) showed channel-like images over the ulnar nerve and artery and fourth digit, compared with 20°C (68°F) for digit 2.Conclusions.-US and thermography demonstrated high fl ow and hyperthermia associated with a fourth digit fi stula and abnormal vessels, and ulnar artery dilatation likely associated with ulnar nerve injury. A coadjuvant diagnosis of Guyon's canal syndrome at the wrist was raised.

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Hypothenar hammer syndrome: Gray‐scale and color Doppler sonographic appearances

Cited by 11 publications

References 6 publications

Hypothenar Hammer Syndrome

Hypothenar Hammer Syndrome

Hypothenar hammer syndrome: A case and brief review

Digital Traumatic Fistula and Arteriovenous Malformation in a Patient with Ulnar Nerve Compression Syndrome

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