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]
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]
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]
Skin
- 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]
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]
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]
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
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]
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]
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]
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]
[…] 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]
[…] 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]
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]