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Hypothenar Hammer Syndrome


Presentation

  • […] fingertip ulcerations over ulnar digits splinter hemorrhages over ulnar digits provocative tests Allen's test positive if occlusion is present negative if aneurysm is present Imaging Doppler ultrasound indications first line test measure digital brachial[orthobullets.com]
  • Less commonly, aneurysm formation of the ulnar artery is present.[radsource.us]
  • Presentation Arterial damage may present dramatically or with subtle, intermittent signs and symptoms that may be temporally remote from the episode of injury. 18 Typically, a male patient will present with ischemia of the second, third, fourth or fifth[ncbi.nlm.nih.gov]
  • Sign in Published on Mar 6, 2017 Alice Turcot, MD with the INSPQ is presenting a prevention pamphlet about how to recognize the hypothenar hammer syndrome (HHS).[youtube.com]
  • Pulsatile hypothenar mass (if aneurysm present). Discolouration of fingers - white or purplish, usually lacking the 'blush' (red) phase of Raynaud's phenomenon. Cool fingertips. Positive Allen's test (see below).[patient.info]
Gangrene
  • Hyothenar Hammer Syndrome Clinical Evaluation Ulnar nerve symptoms: numbness, tingling, pain, weakness Ischemic symptoms: cold intolerance, pain, occasionally ulceration of the small and/or ring finger or even gangrene. Allen's test is positive.[eorif.com]
  • […] golf, volleyball, karate Pathophysiology mechanism single or repetitive blunt impact on hypothenar eminence leads to ulnar artery thrombosis or aneurysm hook of hamate functions as an anvil, causing thrombosis distal embolisation leads to ulceration, gangrene[orthobullets.com]
  • In severe cases, other signs of digital ischaemia, eg finger pulp wasting, ulcers, eschar or gangrene. Allen's test [ 2 ] The Allen's test assesses the patency of the superficial palmar arch.[patient.info]
  • Because of the variable anatomy of the palmar circulation as described above, the effects of these processes can be highly variable from no symptoms to digital gangrene in injured workers and recreationists.[ncbi.nlm.nih.gov]
  • In severe cases, gangrene, ulceration or eschar formation of the involved fingertips may occur. 3,5,7 In one large series, 45% of patients with HHS presented with digital ischemia and necrosis and 23% presented with symptoms referable to the sensory branch[radsource.us]
Metal Worker
  • Workers at risk include auto mechanics, metal workers, lathe operators, miners, machinists, butchers, bakers, carpenters, and bricklayers. Workers who use vibrating tools are also at risk.[ccohs.ca]
  • Typically, it occurs in men around age 40 years, in occupations and sports where the heel of the hand is used as a hammer or is subject to repeated force; for example: Occupations such as metal workers, machinists, mechanics, miners, sawmill workers,[patient.info]
  • Workers most at risk include metal workers, auto mechanics, lathe operators, machinists, miners, sawmill workers, butchers, bakers, brick layers and carpenters.[ncbi.nlm.nih.gov]
  • Workers at risk include metal workers, auto mechanics, lathe operators, machinists, miners, sawmill workers, butchers, bakers, brick layers and carpenters. 1,3,4,6,7 HHS has been associated with numerous sports including handball, baseball, tennis, squash[radsource.us]
Finger Pain
  • Abstract Patients with hand and finger pain regularly present to primary care practices.[ncbi.nlm.nih.gov]
  • Presentation [ 2 ] Symptoms Digital symptoms (in the index, middle, ring or little fingers) - pain, paraesthesia, cold sensitivity, blanching or claudication. Hypothenar pain. Signs [ 1, 6 ] Possible signs are: A hypothenar callus or tenderness.[patient.info]
Lower Extremity Pain
  • At time of follow-up the patient presented instead to Urgent Care for left lower extremity pain and swelling.[ncbi.nlm.nih.gov]
Noncompliance
  • Early referral to a hand specialist should be considered as persistent signs and symptoms leading to significant disability are not uncommon with a delayed diagnosis of hypothenar hammer syndrome, noncompliance or insufficient treatment.[ncbi.nlm.nih.gov]
Cyanosis
  • […] tissue and skin Presentation History occupational or sporting risks (see above) Symptoms pain over hypothenar eminence and ring finger may involve small, middle and index fingers cold sensitivity paresthesia Physical exam inspection blanching, mottling, cyanosis[orthobullets.com]
Splinter Hemorrhage
  • hemorrhages over ulnar digits provocative tests Allen's test positive if occlusion is present negative if aneurysm is present Imaging Doppler ultrasound indications first line test measure digital brachial index Angiogram, CT angiogram or MR angiogram[orthobullets.com]
  • In addition, these findings are usually unilateral in contrast to the bilateral findings in connective tissues disorders, Raynaud’s disease and thromboangiitis obliterans. 10 Pulp wasting, splinter hemorrhages and coldness may be present in the affected[ncbi.nlm.nih.gov]
Flushing
  • Features which differ between hypothenar hammer syndrome (HHS) and classical Raynaud's are: Male preponderance and occupational history Allen's test Lack of the normal hyperaemic flush phase of Raynaud's phenomenon Digital ulcers in area the supplied[patient.info]
Papule
  • On examination, the patient’s left hand showed two small papules at the base of the small fingernail but no other skin changes.[ncbi.nlm.nih.gov]
Fingertip Ulceration
  • ulcerations over ulnar digits splinter hemorrhages over ulnar digits provocative tests Allen's test positive if occlusion is present negative if aneurysm is present Imaging Doppler ultrasound indications first line test measure digital brachial index[orthobullets.com]
Erythema
  • On examination, there was erythema of the skin over the distal phalanx of the third, fourth and fifth fingers of the left hand. No edema or other skin changes were noted. The fourth finger was cool to the touch as compared to the other fingers.[ncbi.nlm.nih.gov]
Tinel's Sign
  • sign (due to ulnar nerve compression) positive Allen test 2 It may be caused by any repetitive compression or blunt trauma to this region.[radiopaedia.org]
Acroparesthesia
  • […] acroparaesthesia Simple acroparesthesia Simple acroparesthesia (finding) Simple acroparesthesia Vasomotor dysfunction Vasomotor reaction ICD 10 CM 2017, (Clinical Modification) for coding of death certificates and mortality data.[averbis.com]
Muscle Strain
  • The patient reported that about 3 weeks earlier he had developed pain in the thigh while playing softball and suspected that he had a muscle strain.[ncbi.nlm.nih.gov]
Irritability
  • The clinical ndings included (alone or in combination) irritation of the sensory branch of the ulnar nerve in ve patients, ischaemic symptoms in ve patients and local tenderness as a presenting feature in only two patients.[kundoc.com]

Workup

  • […] with vascular injuries Jos C. van den Berg (Vasa 1/2019) Computed tomography angiography evaluation of acute limb ischemia Alex Wallace, Yash Pershad, Aman Saini, Sadeer Alzubaidi, Sailendra Naidu, Grace Knuttinen, Rahmi Oklu (Vasa 1/2019) Diagnostic workup[dga-gefaessmedizin.de]

Treatment

  • Two patients refused operative treatment and received oral platelet aggregation inhibitors and were told to avoid local trauma.[kundoc.com]
  • Non-surgical treatment is considered sufficient, particularly in the setting of vasospasm with adequate collateral circulation.[radiopaedia.org]
  • Therefore, conservative treatment or bypass of the thrombosed vessels is possible in hypothenar hammer syndrome .[handsurgeryresource.com]
  • Prognosis [ 7, 9 ] Many patients improve with nonsurgical treatments (above). Results of reconstructive surgery have been shown to be variable, with fairly common recurrence.[patient.info]

Prognosis

  • Angiography “corkscrew” or beaded irregular appearance distal ulnar artery aneurysm formation occlusion of the ulnar artery segment overlying the hook of the hamate occluded or under-filled distal digital arteries in an ulnar artery distribution Treatment and prognosis[radiopaedia.org]
  • Prognosis [ 7, 9 ] Many patients improve with nonsurgical treatments (above). Results of reconstructive surgery have been shown to be variable, with fairly common recurrence.[patient.info]
  • Wilkinson (VASA 6/16) Vascular puncture site complications - diagnosis, therapy and prognosis Wolfgang Mlekusch, Irene Mlekusch, Schila Sabeti-Sandor (VASA 6/16) Nailfold capillaroscopy microscopy – an interdisciplinary appraisal Peter Frank Klein-Weigel[dga-gefaessmedizin.de]

Etiology

  • Arteriography showing complete occlusion of ulnar artery DDx Other etiology of ischemia of the hand (thoracic outlet syndrome, arteriosclerosis or thromboangiitis obliterans) References Anderson SE et al.[imaios.com]
  • J Ultrasound Med 20(8):921-924 (PMID: 11503929 ) [8] Ferris BL, Taylor LM Jr, Oyama K, et al (2000) Hypothenar hand syndrome: proposed etiology.[eurorad.org]
  • […] synonyms: Hyothenar Hammer Syndrome ICD-10 I74.2: Embolism and thrombosis of arteries of the upper extremities Hyothenar Hammer Syndrome ICD-9 444.21 Arterial embolism and thrombosis; upper extremity Hyothenar Hammer Syndrome Etiology / Epidemiology [eorif.com]
  • Hypothenar hammer syndrome: proposed etiology. J Vasc Surg. 2000 ;31: 104 - 113. Google Scholar Crossref Medline ISI 2. Marie, I, Herve, F, Primard, E. Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients.[journals.sagepub.com]
  • Hypothenar hammer syndrome: proposed etiology. J Vasc Surg 2000; 31 :104–113. [ PubMed ] [ Google Scholar ] 17. Stone JR. Intimal hyperplasia in the distal ulnar artery; influence of gender and implications for the hypothenar hammer syndrome.[ncbi.nlm.nih.gov]

Epidemiology

  • […] synonyms: Hyothenar Hammer Syndrome ICD-10 I74.2: Embolism and thrombosis of arteries of the upper extremities Hyothenar Hammer Syndrome ICD-9 444.21 Arterial embolism and thrombosis; upper extremity Hyothenar Hammer Syndrome Etiology / Epidemiology [eorif.com]
  • Epidemiology incidence rare demographics male : female ratio is 9:1 age bracket is 40s-50s location unilateral, dominant ring finger /- small finger less commonly, index and middle fingers thumb is spared risk factors occupations using vibrating tools[orthobullets.com]
  • This leads to vascular insufficiency of the ulnar side of the hand. [ 1 ] Epidemiology [ 1, 2, 3 ] Hypothenar hammer syndrome (HHS) is probably rare, but may be underdiagnosed.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Hypothenar hammer syndrome is caused by trauma to the ulnar artery: the intravascular injury may be diffuse (eg, resulting from intra-arterial injection) or localized (eg, repetitive compression or blunt force).[handsurgeryresource.com]
  • […] ring finger /- small finger less commonly, index and middle fingers thumb is spared risk factors occupations using vibrating tools such as carpenters, machinists, mechanics sports such as baseball catchers, mountain biking, golf, volleyball, karate Pathophysiology[orthobullets.com]
  • […] of the hand Pre-existing abnormalities of the arteries or variations in arterial anatomy (eg incomplete superficial palmar arch) Underlying prothrombotic factors [ 4 ] Other anatomical variations, eg an anomalous hypothenar muscle. [ 5 ] Anatomy and pathophysiology[patient.info]
  • Gary (VASA 4/14) Venous thromboembolism and cancer pathophysiology and incidence H. Striker (VASA 4/14) MiRNAs in peripheral artery disease - something gripping this way comes W. Kloss, B. Vogel, E.[dga-gefaessmedizin.de]

Prevention

  • Sign in Published on Mar 6, 2017 Alice Turcot, MD with the INSPQ is presenting a prevention pamphlet about how to recognize the hypothenar hammer syndrome (HHS).[youtube.com]
  • Prevention Improve work practices so as to avoid using the palm of the hand as a hammer. Occupational screening (where relevant) has been advocated, since some degree of ulnar arterial damage may occur preclinically. [ 2 ][patient.info]
  • Conclusions As described above, hypothenar hammer syndrome may not be as rare as once thought. 27 It is a curable and preventable cause of upper extremity digital ischemia.[ncbi.nlm.nih.gov]

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