Vascular trauma of the hand – a systematic review

Abstract

Abstract. Hypothenar or thenar hammer syndrome (HHS) and hand-arm vibration syndrome (HAVS) are diseases caused by acute or chronic trauma to the upper extremities. Since both diseases are generally related to occupation and are recognised as occupational diseases in most countries, vascular physicians need to be able to distinguish between the two entities and differentiate them from other diagnoses. A total of 867 articles were identified as part of an Internet search on PubMed and in non-listed occupational journals. For the analysis we included 119 entries on HHS as well as 101 papers on HAVS. A professional history and a job analysis were key components when surveying the patient’s medical history. The Doppler-Allen test, duplex sonography and optical acral pulse oscillometry were suitable for finding an objective basis for the clinical tests. In the case of HHS, digital subtraction angiography was used to confirm the diagnosis and plan treatment. Radiological tomographic techniques provided very limited information distal to the wrist. The vascular component of HAVS proved to be strongly dependent on temperature and had to be differentiated from the various other causes of secondary Raynaud’s phenomenon. The disease was medicated with anticoagulants and vasoactive substances. If these were not effective, a bypass was performed in addition to various endovascular interventions, especially in the case of HHS. Despite the relatively large number of people exposed, trauma-induced circulatory disorders of the hands can be observed in a comparatively small number of cases. For the diagnosis of HHS, the morphological detection of vascular lesions through imaging is essential since the disorder can be accompanied by critical limb ischaemia, which may require bypass surgery. In the case of HAVS, vascular and sensoneurological pathologies must be objectified through provocation tests. The main therapeutic approach to HAVS is preventing exposure.

Endovascular Thrombolysis in Hypothenar Hammer Syndrome: A Systematic Review

“…Nevertheless, large prospective or comparative studies investigating endovascular, surgical and conservative treatment options in HHS are yet missing. Wahl et al ( 34 ) investigated in a systematic review of vascular traumatic disorders different therapeutic approaches and reported a pronounced inconsistency of data regarding those treatment options. However, those data included cases of HHS, thenar hammer syndrome and of hand-arm vibration syndrome while this systematic review included only patients with HHS.…”

CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings

“…Peripheral emboli affect the upper extremities in up to 20% of cases, 70% of which are cardioembolic while 30% are caused by vascular lesions (proximal aneurysm, traumatic lesion, etc.) [28]. Therefore, imaging of the arteries of the entire upper limb is necessary in the event of suspected embolism due to lesions of the large vessels.…”

Nailfold capillaroscopic findings in a semi-professional volleyball player

“…Elite athletes are exposed to the possibility of a variety of injuries and although musculoskeletal lesions are the most common cause of complain [1], some of the most devious and disabling could be vascular injuries [2,3]. The causes of venous or arterial injuries in athletes could be high-speed collisions and repetitive motions.…”