Hypothenar Hammer Syndrome: An Update With Algorithms for Diagnosis and Treatment

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.

[1]  R. F. Morgan,et al.  Hypothenar Hammer Syndrome in a Computer Programmer: CTA Diagnosis and Surgical and Endovascular Treatment , 2009, Vascular and endovascular surgery.

[2]  A. Bass,et al.  Hypothenar Hammer Syndrome: Apropos of Six Cases and Review of the Literature , 2008, Vascular.

[3]  B. Taute,et al.  Das sonographische Bild des Hypothenar-Hammer-Syndroms , 2008 .

[4]  Laurel A Hackett,et al.  Hypothenar Hammer Syndrome: Case Reports and Brief Review , 2008, Clinical Medicine & Research.

[5]  A. Ct,et al.  Hypothenar hammer syndrome: case reports and brief review. , 2008 .

[6]  Hüseyin Özdemir,et al.  Hypothenar hammer syndrome: Gray‐scale and color Doppler sonographic appearances , 2008, Journal of clinical ultrasound : JCU.

[7]  E. Ghersin,et al.  Sonographic Evaluation of Vascular Injuries , 2008, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[8]  I. Marie,et al.  Long-Term Follow-Up of Hypothenar Hammer Syndrome: A Series of 47 Patients , 2007, Medicine.

[9]  H. Al-khaffaf,et al.  Hypothenar Hammer Syndrome: rare or underdiagnosed? , 2006, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[10]  G. Dautel,et al.  Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. , 2006, Radiographics : a review publication of the Radiological Society of North America, Inc.

[11]  M. Aleksić,et al.  Occupation-Related Vascular Disorders of the Upper Extremity , 2006, Angiology.

[12]  Kamran M H Karimi,et al.  Overuse-related vascular injury of the hand--hypothenar hammer syndrome: a case report. , 2005, The West Virginia medical journal.

[13]  P. Houpt,et al.  Surgical Management of Hypothenar and Thenar Hammer Syndromes: A Retrospective Study of 31 Instances in 28 Patients , 2005, Journal of hand surgery.

[14]  K. Michael,et al.  Pseudoaneurysm of the Uterine Arteries , 2005 .

[15]  M. Graif,et al.  Gray Scale and Color Doppler Sonographic Appearance , 2005 .

[16]  F. Ingegnoli,et al.  [Raynaud's phenomenon]. , 2011, Reumatismo.

[17]  R. Cooke.  Hypothenar hammer syndrome: a discrete syndrome to be distinguished from hand-arm vibration syndrome. , 2003, Occupational medicine.

[18]  B. Coulier,et al.  Colour duplex sonographic and multislice spiral CT angiographic diagnosis of ulnar artery aneurysm in hypothenar hammer syndrome. , 2003, JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie.

[19]  P. Araoz,et al.  Imaging features of pseudoaneurysms of the hand in children and adults. , 2003, AJR. American journal of roentgenology.

[20]  L. Taylor.  Hypothenar hammer syndrome. , 2003, Journal of vascular surgery.

[21]  R. Horch,et al.  Diagnosis of the hypothenar hammer syndrome by high-resolution contrast-enhanced MR angiography , 2002, European Radiology.

[22]  Ravindra Sharma,et al.  Hypothenar Hammer Syndrome , 2002 .

[23]  A. Shepard,et al.  Hypothenar hammer syndrome: an uncommon and correctable cause of digital ischemia. , 2002, The Journal of cardiovascular surgery.

[24]  Ravindra Sharma,et al.  Images in cardiovascular medicine: Hypothenar hammer syndrome. , 2002, Circulation.

[25]  G. Tsavellas,et al.  Soft-tissue case 42. Hypothenar hammer syndrome. , 2001, Canadian journal of surgery. Journal canadien de chirurgie.

[26]  M. Puckett,et al.  Sonographic diagnosis of ulnar artery aneurysm in hypothenar hammer syndrome: report of 2 cases. , 2001, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[27]  G. Moneta,et al.  Hypothenar hammer syndrome: proposed etiology. , 2000, Journal of vascular surgery.

[28]  D. De Monaco,et al.  Hypothenar Hammer Syndrome , 1999, Journal of Hand Surgery-American Volume.

[29]  S. Knight,et al.  Hypothenar hammer syndrome diagnosed by ultrasound. , 1999, Injury.

[30]  F. Moll,et al.  The hypothenar hammer syndrome: update and literature review. , 1998, Acta chirurgica Belgica.

[31]  J. Bakhach,et al.  Hypothenar hammer syndrome: management of distal embolization by intra-arterial fibrinolytics. , 1998, Chirurgie de la main.

[32]  B. Taute,et al.  [Ultrasound image of the hypothenar hammer syndrome]. , 1998, Ultraschall in der Medizin.

[33]  M. Wheatley,et al.  The Use of Intra‐Arterial Urokinase in the Management of Hand Ischemia Secondary to Palmar and Digital Arterial Occlusion , 1996, Annals of plastic surgery.

[34]  W. C. Duncan.  Hypothenar hammer syndrome: an uncommon cause of digital ischemia. , 1996, Journal of American Academy of Dermatology.

[35]  J. Sanger,et al.  The Corkscrew Sign in Hypothenar Hammer Syndrome , 1993, Journal of Hand Surgery-American Volume.

[36]  H. Honma,et al.  Hypothenar Hammer Syndrome in Workers Occupationally Exposed to Vibrating Tools , 1993, Journal of hand surgery.

[37]  B. George,et al.  Successful prolonged local infusion of urokinase for the hypothenar hammer syndrome. , 1993, Catheterization and cardiovascular diagnosis.

[38]  J. A. Spittell,et al.  Occlusive arterial disease of the hand due to repetitive blunt trauma: a review with illustrative cases. , 1993, International journal of cardiology.

[39]  W. Idema,et al.  [Hypothenar hammer syndrome]. , 1991, VASA. Zeitschrift fur Gefasskrankheiten.

[40]  M. Ruff,et al.  Doppler mapping in hypothenar syndrome: an alternative to angiography. , 1989, The Journal of hand surgery.

[41]  S. Savader,et al.  Hypothenar hammer syndrome with embolic occlusion of digital arteries. , 1988, Clinical radiology.

[42]  G. Spencer-Green,et al.  Hypothenar hammer syndrome: an occupational cause of Raynaud's phenomenon. , 1987, The Journal of rheumatology.

[43]  J. Cantero.  Le syndrome hypothénarien du marteau: A propos de deux cas , 1987 .

[44]  J. Cantero.  [Hypothenar hammer syndrome. Apropos of 2 cases]. , 1987, Annales de chirurgie de la main : organe officiel des societes de chirurgie de la main.

[45]  R. Sanders,et al.  Ulnar artery aneurysm complicated by distal embolization: management with regional thrombolysis and resection. , 1986, Journal of vascular surgery.

[46]  S. Saltzstein,et al.  Hypothenar hammer syndrome. Form of reversible Raynaud's phenomenon. , 1985, The American journal of medicine.

[47]  R. Dilley,et al.  Selective streptokinase infusion: clinical and laboratory correlates. , 1983, Radiology.

[48]  K. Benedict,et al.  The hypothenar hammer syndrome. , 1974, Radiology.

[49]  J M Little,et al.  The incidence of the hypothenar hammer syndrome. , 1972, Archives of surgery.

[50]  W. K. Lindsay.  Hypothenar hammer syndrome: post-traumatic digital ischemia , 1971 .

[51]  J. L. Bell,et al.  Hypothenar hammer syndrome: posttraumatic digital ischemia. , 1970, Surgery.

[52]  J. Zweig,et al.  Thrombosis of the ulnar artery following blunt trauma to the hand. , 1969, The Journal of bone and joint surgery. American volume.