hypothenar hammer syndrome

Hypothenar
Hammer Syndrome. Longitudinal Doppler ultrasound demonstrate thrombus of ulnar artery distal to the Guyon"s canal. The thrombosed wall appears thickened.
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Hypothenar
Hammer Syndrome. Transverse Doppler ultrasound demonstrates non compressible ulnar artery distal to Guyon"s canal and its 4th digit branch, consistent with thrombus formation.
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Hypothenar
Hammer Syndrome. Transverse Doppler ultrasound demonstrates non compressible ulnar artery distal to Guyon"s canal and its 4th digit branch, consistent with thrombus formation.
www.eurorad.org • CC by-nc-sa-4.0
Pseudotumoural
soft tissue lesions of the hand and wrist: a pictorial review. Hypothenar hammer syndrome. a Sagittal SE T1-WI shows a hypointense lesion superficial to the flexor tendons (arrowhead) and immediately distal to the hamulus of the hamate (asterisk). b Axial FS SE T1-WI after intravenous administration of gadolinium contrast medium shows focal aneurysmal dilatation of the ulnar artery with central thrombosis (arrow). Note only faint peripheral enhancement. c Doppler ultrasound shows intraluminal thrombosis of the aneurysm of the ulnar artery. d MR angiography shows multiple stenoses at the distal ulnar artery with aneurysmal dilatation with internal clot formation (arrow)
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Radiopaedia • CC-by-nc-sa 3.0 • de

Hypothenar hammer syndrome occurs from trauma to the distal ulnar artery or proximal portion of superficial palmar arch as a result of repetitive trauma to the hypothenar eminence. Originally described in patients using hammers and screwdrivers, it is also seen in various athletes such as basketball, handball, tennis and golf players.

Clinical presentation

  • cold senstation and pain in the palm
  • Raynaud syndrome
  • tender hypothenar eminence 
  • ischemia of (usually) fourth and fifth fingers
  • positive Tinel sign (due to ulnar nerve compression)
  • positive Allen test 

Pathology

It may be caused by any repetitive compression or blunt trauma to this region. The ulnar artery is particularly vulnerable as it passes over the hook of hamate. Trauma to the artery may result in dissection, stenosis, occlusion or false aneurysm formation. This may be complicated by distal thromboembolism.

Radiographic features

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

Overall management strategy is controversial. Non-surgical treatment is considered sufficient, particularly in the setting of vasospasm with adequate collateral circulation.

Conservative options include;

  • smoking cessation
  • avoidance of further trauma
  • padded protective gloves
  • cold avoidance
  • calcium channel blockers (e.g. nifedipine, diltiazem)
  • antiplatelet agents or anticoagulation
  • local care of fingers with necrosis
  • pentoxifylline: for viscosity reduction

See also 

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Hypothenar-Hammer-Syndrom:
Arcus
palmaris superficialis
Wikipedia • Public domain
pseudotumoröse
Weichteilläsionen von Hand und Handgelenk
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