hypothenar hammar syndrome

Etiology

• trauma to the palmar portion of the ulnar artery
  • occupational or sports activities which involve repetitively striking objects with the heel of the hand
  • prolonged use of air hammers, chain saws, impact wrenches & other power tools that generate vibration
  • baseball, karate, badminton, mountain biking, golf, tennis, handball, volleyball, softball, weight lifting, break-dancing, hockey

Epidemiology

• uncommon
• men, mean age of 40 years
• occupational settings
  • metal workers, auto mechanics, lathe operators, machinists, miners, sawmill workers, butchers, bakers, brick layers, carpenters

Pathology

• vascular overuse syndrome
• generally involves dominant hand
• digital ischemia

Clinical manifestations

• digital pain with paresthesias
• cold sensitivity
• phasic blanching or discoloration of the fingertips
• finger claudication or hypothenar pain
• positive Allen test

Radiology

• arteriography showing occlusion of ulnar artery

Differential diagnosis

• Raynaud's syndrome

Management

• conservative management
  • smoking cessation
  • avoidance of further trauma (may require change of occupation)
  • padded protective gloves
  • cold avoidance
  • calcium channel blocker (nifedipine, diltiazem)
  • antiplatelet agents or anticoagulation
  • local care of fingers with necrosis
  • pentoxifylline to reduce blood viscosity
• vascular surgery
  • arterial ligation (intact radial/palmar arch)
  • resection of thrombosed arterial segment or aneurysm with end-to-end anastomosis
  • resection & vascular reconstruction with vein or artery graft

More general terms

• arterial disease
• syndrome