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Moradi A, Hajian A. Presentation of the hypothenar hammer syndrome as a low incidence aneurysmal disorder of the ulnar artery. Int J Surg Case Rep 2021; 85:106200. [PMID: 34314975 PMCID: PMC8326418 DOI: 10.1016/j.ijscr.2021.106200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE The hypothenar hammer syndrome (HHS) is either rare or underdiagnosed condition that arises from vascular insufficiency of the ulnar artery in the hand. The most common accused mechanism is repetitive blunt trauma to hypothenar region while activating the latter as a hammer to do the job. CASE PRESENTATION A 48 year old woman worked as a master of university claimed from pain and numbness in her left hand concurrent with a pulsatile mass. The second case was a 48 year old man who was a mechanic engineer in automotive industry that claimed of a pain and pulsatile mass in his non-dominant left hand. CLINICAL DISCUSSION Ulnar artery enters the hand from Guyon's canal where fixes to adjacent structure and is susceptible for injury. Aneurysmal formation is an outcome of arterial trauma which could result in distal necrosis if remains untreated. CONCLUSION This study has revealed that even whether a single blunt trauma or writing with pen could lead to aneurysmal formation. It has also showed primary aneurysmal resection with no further surgical procedure is both safe and reliable if digital ischemia is not concurrently present.
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Affiliation(s)
- Arash Moradi
- Ebnesina Applied Science and Technology Educational Center, Tehran, Iran.
| | - Abbas Hajian
- Kashan University of Medical Sciences, Kashan, Iran.
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2
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Deeg J, Loizides A, Löscher W, Zangerle A, Gruber H. Cycling-Related Compressive Neuropathy of the Deep Ulnar Motor Branch in the Hand: Is Sonography a Valid Tool? ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1970-1975. [PMID: 33810886 DOI: 10.1016/j.ultrasmedbio.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/26/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
Repetitive vibratory trauma in cyclists is one of the most common causes of ulnar nerve compression at the wrist. This study describes five cases of clinically suspected compression syndrome of the deep terminal branch of the ulnar nerve (DBUN) defined by high-resolution ultrasound (HRUS) with a 18-MHz linear transducer. Reliable HRUS visualization of the DBUN was feasible in all patients. The affected nerves had focally swollen and hypo-echoic changed segments. HRUS is a good imaging tool for the evaluation of a suspicious DBUN neuropathy if no electrodiagnostic testing is available or in patients with mild to moderate clinical symptoms with inconclusive electrodiagnostic results.
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Affiliation(s)
- Johannes Deeg
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
| | - Alexander Loizides
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Wolfgang Löscher
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Hannes Gruber
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
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3
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Affiliation(s)
- Daniel J Bodmer
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Michael L Steigner
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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Repetitive Blunt Trauma and Arterial Injury in the Hand. Cardiovasc Intervent Radiol 2017; 40:1659-1668. [PMID: 28560551 DOI: 10.1007/s00270-017-1702-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION/PURPOSE Arterial injury in the hand is most often due to repetitive blunt trauma. Although not always associated with significant impairment, it may cause serious ischemic damage or considerable disability. As a cause of digital ischemia, the frequency of this disorder is widely under appreciated. This study reviews the clinical and angiographic features of this condition. MATERIALS/METHODS An extensive literature review combined with the authors experience with arterial injury in the hand due to repetitive blunt hand trauma is summarized with emphasis on mechanisms of injury and pathologic changes to explain the angiographic findings and clinical presentations. RESULTS Angiographic findings are related to severity of injury and underlying changes in the arterial wall. The clinical presentation varies from asymptomatic to digital necrosis and gangrene, related to severity of arterial injury, collateral circulation, and the highly variable arterial anatomy in the hand. CONCLUSION Early recognition is important because compared to many other causes of digital ischemia in the upper extremities, traumatic arterial injury is frequently readily treatable. Angiographic findings and clinical presentation are often characteristic. The diagnosis should not be based on a clear history of repetitive hand trauma since the patient may be unaware of this occurrence.
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Riegler G, Lieba-Samal D, Brugger PC, Pivec C, Platzgummer H, Vierhapper M, Muschitz G, Jengojan S, Bodner G. High-resolution ultrasound visualization of the deep branch of the ulnar nerve. Muscle Nerve 2017; 56:1101-1107. [DOI: 10.1002/mus.25614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 02/03/2017] [Accepted: 02/14/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Georg Riegler
- Department of Biomedical Imaging and Image-Guided Therapy; Medical University of Vienna; Währingergürtel 18-20, 1090 Vienna Austria
| | - Doris Lieba-Samal
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - Peter C. Brugger
- Department of Anatomy, Center for Anatomy and Cell Biology; Medical University of Vienna; Vienna Austria
| | - Christopher Pivec
- Department of Biomedical Imaging and Image-Guided Therapy; Medical University of Vienna; Währingergürtel 18-20, 1090 Vienna Austria
| | - Hannes Platzgummer
- Department of Biomedical Imaging and Image-Guided Therapy; Medical University of Vienna; Währingergürtel 18-20, 1090 Vienna Austria
| | | | | | - Suren Jengojan
- Department of Biomedical Imaging and Image-Guided Therapy; Medical University of Vienna; Währingergürtel 18-20, 1090 Vienna Austria
| | - Gerd Bodner
- Department of Biomedical Imaging and Image-Guided Therapy; Medical University of Vienna; Währingergürtel 18-20, 1090 Vienna Austria
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Aleksic M, Heckenkamp J, Gawenda M, Brunkwall J. Occupation-Related Vascular Disorders of the Upper Extremity. Angiology 2016; 57:107-14. [PMID: 16444465 DOI: 10.1177/000331970605700116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypothenar hammer (HH) syndrome and vibration-induced white finger (VWF) syndrome are the main occupation-related vascular diseases of the upper extremity. The clinical presentation is similar to that of Raynaud’s phenomenon. The characteristic history will lead to the appropriate diagnosis being confirmed by angiographic features in HH and by functional tests in VWF. While in HH the underlying cause, which is mostly thought to be an aneurysm of the ulnar artery, might be cured surgically, in VWF only medical treatment offers relief from the symptoms. The knowledge of these entities is necessary to suspect such disorders so that further exposure to risk factors like repetitive hypothenar trauma or work with vibrating hand-held tools can be avoided, which is of great importance for the overall prognosis of these patients.
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Affiliation(s)
- Marko Aleksic
- Division of Vascular Surgery, Department of Visceral and Vascular Surgery, University of Cologne, Germany.
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Swanson KE, Bartholomew JR, Paulson R. Hypothenar hammer syndrome: A case and brief review. Vasc Med 2011; 17:108-15. [DOI: 10.1177/1358863x11425878] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypothenar hammer syndrome is an uncommon cause of upper-extremity ischemia that is often overlooked in the absence of a thorough occupational and recreational history. Importantly, it is a reversible cause of hand ischemia that, if missed, can lead to significant morbidity and even amputation. The occupational ramifications and quality of life of those affected can be significant. Its relative rarity, set against the ubiquitous use of the hand as a ‘hammer’ is noteworthy. Several other causes of hand ischemia can present similarly; therefore, consideration of other etiologies must be thoroughly investigated. Key distinguishing clinical features, in addition to a detailed occupational and recreational history, may include characteristic sparing of the thumb, the absence of a hyperemic phase in ‘Raynaud’s phenomenon’, and a positive Allen’s sign. Both non-invasive and invasive diagnostic studies, including bilateral upper-limb segmental pulse volume recordings (PVR), arterial duplex examination, and upper-extremity angiography, are complementary to a thorough history and physical examination. Optimal management strategies are not well defined because of its rarity and resultant lack of quality, evidence-based data. Though most cases can be successfully managed non-operatively, micrographic arterial reconstruction may be limb saving in severe or recalcitrant cases. Newer, experimental strategies including selective sympathetic blockage using botulinum toxin A have been reported in a few recalcitrant cases. The brief case description illustrates the typical presentation and potential treatment strategies employed in a difficult case. A review of relevant literature is also presented.
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Affiliation(s)
- Keith E Swanson
- Section of Vascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Internal Medicine and Vascular Diseases, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - John R Bartholomew
- Cleveland Clinic Lerner College of Medicine, Section of Vascular Medicine, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rolf Paulson
- Internal Medicine and Vascular Diseases, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
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Dumas P, Chignon-Sicard B, Médard de Chardon V, Balaguer T, Lebreton E. Le syndrome du marteau hypothénarien : analyse de la littérature et cas clinique. ACTA ACUST UNITED AC 2010; 29:289-93. [DOI: 10.1016/j.main.2010.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 04/05/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
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9
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Friedrich KM, Frühwald-Pallamar J, Stadlbauer A, Salem G, Salomonowitz E. Hypothenar hammer syndrome: Long-term follow-up of selective thrombolysis by 3.0-T MR angiography. Eur J Radiol 2010; 75:e27-31. [DOI: 10.1016/j.ejrad.2009.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 11/04/2009] [Indexed: 11/28/2022]
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Kapoor JR, Kapoor R, Assimes TL. Digital ischemia. J Cardiovasc Med (Hagerstown) 2008; 9:1285-6. [PMID: 19001942 DOI: 10.2459/jcm.0b013e3283168d50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this report, we describe the case of a 43-year-old mechanic who presented with very painful, numb, and cold left middle and fourth fingers. The diagnosis of the hypothenar hammer syndrome was made by history, physical examination, and characteristic findings on diagnostic imaging. This syndrome often goes unrecognized by physicians yet rapid recognition and treatment are crucial to avoid permanent injury. As the differential diagnosis for isolated digital ischemia is broad, physicians need to remain aware of this rare acquired vascular disorder, especially in susceptible patients.
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Affiliation(s)
- John R Kapoor
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Abstract
Patients with hand and finger pain regularly present to primary care practices. Although a well-known clinical entity to specialists, hypothenar hammer syndrome is an uncommon vascular overuse syndrome that may not be familiar to primary care practices. It is caused by trauma to the palmar portion of the ulnar artery, usually as a result of occupational or sports activities which involve repetitively striking objects with the heel of the hand. In this report we describe two representative cases as well as discuss clinical features, pathogenesis, diagnosis, imaging and management.
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Affiliation(s)
- C Timothy Ablett
- Occupational Health, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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Abudakka M, Pillai A, Al-Khaffaf H. Hypothenar Hammer Syndrome: Rare or Underdiagnosed? Eur J Vasc Endovasc Surg 2006; 32:257-60. [PMID: 16697225 DOI: 10.1016/j.ejvs.2006.02.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 02/14/2006] [Indexed: 11/28/2022]
Abstract
Hypothenar hammer Syndrome (HHS) is a condition characterised by digital ischaemia as a result of repetitive trauma to the hypothenar eminence of the hand. It occurs in people who repeatedly use the palm of the hand as a hammer to push, grind or twist objects. It is a curable and a preventable cause of upper digital ischemia. In this report we present a case of HHS and discuss the causes and pathogenesis of this syndrome. We review the incidence, clinical characteristics, differential diagnosis, investigation and treatment.
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Affiliation(s)
- M Abudakka
- Department of Surgery, Burnley General Hospital, Casterton Avenue BB10 2PQ, East Lancashire Hospitals NHS Trust, UK
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Kim S, Choi JY, Huh YM, Song HT, Lee SA, Kim SM, Suh JS. Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol 2006; 17:509-22. [PMID: 16572333 DOI: 10.1007/s00330-006-0180-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 01/10/2006] [Accepted: 01/26/2006] [Indexed: 10/24/2022]
Abstract
The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging.
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Affiliation(s)
- Sungjun Kim
- Department of Diagnostic Radiology, College of Medicine, Yonsei University, 134, Shinchondong, Seodaemun-ku, 120-752 Seoul, South Korea
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Drapé JL, Feydy A, Guerini H, Desmarais E, Godefroy D, Le Viet D, Chevrot A. Vascular lesions of the hand. Eur J Radiol 2005; 56:331-43. [PMID: 16298677 DOI: 10.1016/j.ejrad.2005.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/10/2005] [Accepted: 03/15/2005] [Indexed: 11/23/2022]
Abstract
The vascular malformations are not uncommon on the hand and offer diagnostic and therapeutic challenges. Enjolras and Mulliken's classification is exposed. Their depiction and pretreatment assessment may benefit from non-invasive imaging as color-Doppler ultrasound and MRI combined with magnetic resonance angiography (MRA). Some chronic traumatic vascular injuries as the hypothenar hammer syndrome may also take advantage of these imaging modalities.
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Affiliation(s)
- Jean-Luc Drapé
- Service de Radiologie B, Hôpital Cochin, APHP, Université Paris, 27 rue du Fbg Saint-Jacques, 75014 Paris, France.
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