Hypothenar Hammer Syndrome

Other Names

• Ulnar Hammer Syndrome

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Background

• Uncommon problem
• Most commonly seen with hypothenar eminence trauma by repetitively using the hands as a hammer

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Pathophysiology

• Symptom complex attributable to an ulnar artery aneurysm
• Athletes who use their hand for catching and striking objects
• Manual laborers whose hands are subjected to repetitive trauma
• The superficial palmar branch of the ulnar artery can develop intimal damage producing vasospasm and encouraging platelet aggregation and thrombus formation.
• If the damage spreads through the media into the arterial wall, aneurysm formation can occur as well. The periadventitial tissues can become involved, leading to extrinsic scarring, vascular narrowing and thrombosis.
• Microemboli can be generated that can occlude the digital arteries downstream, resulting in digital ischemia.

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Risk Factors

• Male
• Occupations
  • Metal workers
  • Auto mechanics
  • Lathe operators
  • Machinists
  • Miners
  • Sawmill workers
  • Butchers
  • Bakers
  • Brick layers
  • Carpenters
• Sports
  • Baseball
  • Karate
  • Golf
  • Softball
  • Hockey

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Differential Diagnosis

Potential vascular etiologies include

• Buerger's Disease
• Autoimmune Diseases
• Ulnar Artery Anomalies
• Vasculitis
• Raynaud's Phenomenon

Potential neurogenic causes include

• Ulnar Tunnel Syndrome
• Carpal Tunnel Syndrome
• Thoracic Outlet Syndrome
• Lower Trunk Brachial Plexopathy
• C8-T1 Radiculopathy

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Clinical Features

• Related to the degree of vascular insufficiency
  • Most common: Finger discoloration or pain
  • Ulceration
  • Cold intolerance
  • Numbness
  • Coolness
  • Cyanosis
  • Paresthesia
  • Hypothenar mass

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Evaluation

Radiographs

• Standard Radiographs Wrist
• Screening tool, typically normal

Angiography

• Gold standard
• Diagnosis and helps plan surgical management

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See Also

• External
  • Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/

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