Painful Hand Swelling after a Roller Coaster Ride

Abstract

We present a case report on the Achenbach's syndrome, a condition characterized by a painful hematoma and swelling of the palmar side of the hand and/or fingers with a sudden onset. Symptoms are typically triggered by everyday activities like carrying a bag or pressing down a door handle. Achenbach's syndrome being rather unknown, its impressive clinical presentation might unsettle both patients and physicians and entail elaborate diagnostic measures despite its in fact benign and self-limiting character.ter performing manual labour about ten months ago; thereafter, the patient preferably used the left hand, where the same symptoms occurred. Another time, the symptoms had once been provoked by a roller-coaster ride. The symptoms were self-limiting after two weeks at the most. When the patient presented himself to our department, there was no discoloration visible, however he described residual tightness in the fingers of both hands, which was improvable by cooling. The patient reported to avoid manual labour and exposure to heat in fear of provoking the symptoms again. Smoking was stopped more than ten years ago, and there were no comorbidities obviously related to the symptoms. The patient did not take any medication and had not received any treatment for his symptoms.Before the presentation to our department, a series of MR-angiography scans had already been performed. These had shown circular angiomatous alterations along the phalanges, less along the metacarpalia of D II -IV on both hands (Figure 1). The patient was then referred to our department for further evaluation of the suspected angiomatous malformation. On physical examination, the veins in the palms of both hands appeared to prominently shine through the skin; there was no swelling or neurological dysfunction. Duplex ultrasound of the arm arteries revealed a normal triphasic pattern with rather slow flows in the lower arm of 39 cm/sec in the ulnar artery and of 32 cm/sec in the radial artery; ultrasound of the carotid arteries and the aorta did not show any abnormalities. On the oscillography of the finger arteries, the amplitudes were slightly re-