Hypothenar hammer syndrome

Hypothenar hammer syndrome (HHS) is a vascular occlusion in humans in the region of the ulna. It is caused by repetitive trauma to the hand or wrist (such as that caused by the use of a hammer)[2] by the vulnerable portion of the ulnar artery as it passes over the hamate bone, which may result in thrombosis, irregularity or aneurysm formation. HHS is a potentially curable cause of Raynaud's syndrome, distinct from hand–arm vibration syndrome.[3]

Hypothenar hammer syndrome
SymptomsPain over the hypothenar eminence especially at the ring finger, though all fingers of the same hand may be affected (thumb is never affected); increased sensitivity to cold and reduced sense of touch in affected digits[1]
Risk factorsRegular use of vibrating tools (carpenters, mechanics, machinists) and a subset of athletics involving repeated high-impact on the hand (baseball catchers, golfers, karate, volleyball)[1]
TreatmentNonoperative: cessation of smoking, avoid recurrent trauma; operative: endovascular fibrinolysis, excision of involved segment and reconstruction with or without a vein graft, and arterial ligation[1]

Diagnosis

A physical examination of the hand may show discoloration (blanching, mottling, and/ or cyanosis; gangrene may be present in advanced cases), unusual tenderness/ a callous over the hypothenar eminence, and fingertip ulcerations and splinter hemorrhages over ulnar digits; if an aneurysm is present, there may also be a pulsatile mass. Allen's test will be positive if an occlusion is present and negative if an aneurysm is present. An angiogram may show a "corkscrew" ulnar artery or an occlusion or aneurysm at the hook of the hamate.

Treatment

Noninvasive treatments have an 80% success rate; surgical options exist for other instances.[1]

Epidemiology

HHS, though rare, occurs much more frequently in men than in women (9:1) and principally affects those in their 40s and 50s.

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References
  1. Colin Woon. "Hypothenar Hammer Syndrome". Orthobullets.com.
  2. "Hypothenar hammer syndrome".
  3. Cooke, R. A. (2003). "Hypothenar hammer syndrome: a discrete syndrome to be distinguished from hand-arm vibration syndrome". Occupational Medicine. 53 (5): 320–324. doi:10.1093/occmed/kqg071. ISSN 0962-7480. PMID 12890831.
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