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Bordas C, Piessat C, Perez M, Gondim Teixeira PA, Dap F, Athlani L. Reconstruction of the ulnar artery in Guyon's canal with an arterial graft: Anatomical study. HAND SURGERY & REHABILITATION 2024; 43:101617. [PMID: 37951495 DOI: 10.1016/j.hansur.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
Ulnar artery thrombosis in Guyon's canal can lead to vascular insufficiency in the fingers. The recommended treatment is resection and reconstruction of the pathological area. A bypass may be necessary, which may be venous or arterial. Arterial bypasses have better long-term patency; however, they are a source of donor-site complications. We carried out an anatomical study on 11 upper limbs and 7 lower limbs from cadavers to identify a technically accessible arterial graft, of a diameter suitable for bypassing the ulnar artery in Guyon's canal and with acceptable scar sequelae (few predicted postoperative complications, discreet size and/or location of scar). Three grafts were considered: anterior interosseous artery, radial recurrent artery and descending genicular artery. The various grafts were dissected and harvested from cadaver specimens, then their lengths and diameters were measured. The diameter of the candidate grafts was compared to the diameter of the distal ulnar artery. The diameter of the descending genicular artery matched the ulnar artery better than the radial recurrent artery or the anterior interosseous artery (103% vs 44% and 67%, respectively). Mean graft length was 6.6 cm. The anatomical configuration of the descending genicular artery allowed Y-shaped bypasses to be performed. Harvesting this artery appears to cause little damage and allows bypasses up to 6 cm to be performed. Despite its smaller diameter making it necessary to perform a microvascular size adjustment, the anterior interosseous artery is a candidate graft because it is long enough (119 mm) and located near the surgical site. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Coralie Bordas
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France.
| | - Colin Piessat
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France
| | - Manuela Perez
- Faculty of Medicine and University Hospital, Department of Anatomy, University of Lorraine, Nancy, France
| | | | - François Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France
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2
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Nikizad H, Tsai D, Lookstein R, Hausman M. Catheter-Directed Thrombolysis for Acute Digit Ischemia in the Setting of Heterozygous Factor V Leiden Mutation: A Case Report and Review of Literature. JBJS Case Connect 2022; 12:01709767-202212000-00034. [PMID: 36417546 DOI: 10.2106/jbjs.cc.22.00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/01/2022] [Indexed: 11/24/2022]
Abstract
CASE We are reporting the successful treatment of a patient with a heterozygous factor V Leiden mutation who presented with spontaneous thrombotic ischemia of ring and small fingers. Microcatheter-directed administration of thrombolytics at the level of common and proper digital arteries resulted in the salvage of the ring finger to the level of the distal tuft and the entirety of the small finger. CONCLUSION Heterozygous factor V Leiden mutation is an extremely unusual etiology for thrombotic digital ischemia. This case report emphasizes the importance of correct diagnosis, timely intervention, and thrombolytic therapy using microcatheters to optimize digital rescue.
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Affiliation(s)
- Hooman Nikizad
- Department of Orthopedic Surgery at Mount Sinai Health System, New York, New York
| | - David Tsai
- Department of Orthopedic Surgery at Mount Sinai Health System, New York, New York
| | - Robert Lookstein
- Department of Diagnostic, Molecular, and Interventional Radiology at Mount Sinai Health System, New York, New York
| | - Michael Hausman
- Department of Orthopedic Surgery at Mount Sinai Health System, New York, New York
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Patil AR, Narasimhan S. Dual Aneurysm Formation in an Occupationally Predisposed Male: Atypical Hypothenar Hammer Syndrome. Indian J Radiol Imaging 2021; 31:1027-1030. [PMID: 35136522 PMCID: PMC8817795 DOI: 10.1055/s-0041-1740163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hypothenar hammer syndrome is typically described as a chronic repetitive injury to the ulnar artery at the level of hamulus of hamate and shows certain occupational predilection. Our case is an occupationally predisposed patient who had two aneurysm formations from the superficial palmar branch of ulnar artery and the digital branch, respectively, diagnosed and treated surgically. We call it an atypical hypothenar hammer syndrome as the arterial involvement was not typically at the level of hamate bone and only corresponded to the site of recurrent friction. This article also discusses the role of imaging and treatment options.
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Cerezal L, Llopis E, Canga A, Piñal FD. Postoperative Imaging of Ulnar Wrist Pain. Semin Musculoskelet Radiol 2021; 25:329-345. [PMID: 34374067 DOI: 10.1055/s-0041-1731331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ulnar wrist pain, caused by a broad spectrum of bone and soft tissue injuries, is the most common clinical condition of the wrist. Multiple surgical techniques and their variants in the treatment of these injuries are constantly evolving. Postoperative evaluation of the wrist for many surgeons is limited to serial clinical and radiographic monitoring. However, imaging methods such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and arthrographic techniques (arthrographic CT and arthrographic MRI) play a fundamental role in diagnosing and managing postsurgical complications.The several critical aspects in evaluating the postsurgical wrist imaging spectrum are familiarity with the surgical techniques, knowledge of the original clinical problem, understanding the strength and limitations of the different radiologic modalities, and effective communication between surgeon and radiologist.
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Affiliation(s)
- Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Santander, Spain
| | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
| | - Ana Canga
- Department of Radiology, Marqués de Valdecilla University Hospital, Santander, Spain
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Abstract
Injuries of the hand and wrist are common in baseball. Because of the unique motions and loads encountered in this sport, physicians treating baseball players may encounter hand and wrist injuries ranging from common to rare. An understanding of these baseball-related injuries must include their pathoanatomy, diagnosis, and treatment options. This knowledge is critical for the general orthopaedic surgeon treating baseball players to allow for timely and appropriate treatment. This article reviews the pathophysiology, diagnosis, and treatment of baseball-related hand and wrist injuries, with a target audience of general orthopeadic surgeons.
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Hart J, Hajjar R, Laveroni E. Hypothenar hammer syndrome and repair of ulnar artery aneurysm in a patient without history of trauma. BMJ Case Rep 2021; 14:14/5/e240729. [PMID: 34016629 DOI: 10.1136/bcr-2020-240729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The patient is a 50-year-old male with a history of tobacco use presented for evaluation of pulsatile right-hand mass. The patient was employed as a barber but had no known history of trauma or injury. He was diagnosed with hypothenar hammer syndrome and underwent excision of ulnar artery aneurysm with reconstruction of ulnar artery with interposition saphenous vein graft. The presented case describes an uncommon presentation of hypothenar hammer syndrome in a patient without history of repetitive blunt trauma or injury and discusses the diagnosis, pathophysiology and treatment options for symptomatic ulnar artery aneurysm.
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Affiliation(s)
- Justin Hart
- Plastic and Reconstructive Surgery, Beaumont Hospital - Farmington Hills, Farmington Hills, Michigan, USA
| | - Raymond Hajjar
- Plastic and Reconstructive Surgery, Beaumont Hospital - Farmington Hills, Farmington Hills, Michigan, USA
| | - Eugene Laveroni
- Vascular Surgery, Beaumont Hospital - Farmington Hills, Farmington Hills, Michigan, USA
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Chun-Yu Tu J, Lin YC, Hu CH. Hypothenar Hammer Syndrome with Ulnar Nerve Neuropathy. Ann Vasc Surg 2020; 69:450.e7-450.e11. [PMID: 32512113 DOI: 10.1016/j.avsg.2020.05.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 11/18/2022]
Abstract
Hypothenar hammer syndrome is a rare medical condition that is usually associated with repetitive hand trauma. In this article, we delineate the importance of the nerve conduction velocity study to help determine objectively whether neuropathy is significant to the point that surgical means should be considered in absence of obvious ischemic change.
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Affiliation(s)
- Junior Chun-Yu Tu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, Institute for Radiological Research, and Chang Gung Medical University, Taoyuan, Taiwan
| | - Ching-Hsuan Hu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan.
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St-Pierre F, Shepherd RF, Bartlett MA. Diagnosis of hypothenar hammer syndrome in a patient with acute ulnar artery occlusion. BMJ Case Rep 2019; 12:12/9/e230963. [PMID: 31519720 DOI: 10.1136/bcr-2019-230963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old truck driver with a history of tobacco use presented with acute onset digital ischaemia in the ulnar distribution of his dominant hand, associated with severe pain. Occupational exposures included extensive manual labour and prolonged vibratory stimuli. Workup with Doppler and angiography confirmed the diagnosis of hypothenar hammer syndrome (HHS). After the failure of medical management, he underwent ulnar artery thrombectomy with reconstruction and arterial bypass grafting. His pain improved significantly postsurgically, and he was able to return to a normal routine. This case illustrates the classic presentation, examination, imaging findings and management options of HHS. HHS should be considered in patients with digital ischaemia and associated occupational exposures. Diagnosing the condition appropriately allows for optimal management, aiming at minimising symptoms and maximising quality of life.
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Affiliation(s)
| | - Roger F Shepherd
- Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Menon D, Onida S, Davies AH. Overview of arterial pathology related to repetitive trauma in athletes. J Vasc Surg 2019; 70:641-650. [PMID: 31113722 DOI: 10.1016/j.jvs.2019.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 02/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Sport-related vascular trauma is an important consequence of increased physical activity. Repetitive, high-intensity movements predispose athletes to vascular disease, including arterial pathology, by exerting increased pressure on neurovascular structures. This is an important source of morbidity in an otherwise young and healthy population. Arterial pathology associated with repetitive trauma is often misdiagnosed as musculoskeletal injury. This article increases awareness of sport-related arterial disease by reviewing the symptomatology, investigation, and treatment modalities of this pathology. In addition, prognostic outcomes specific to the athlete are discussed. RESULTS Arterial thoracic outlet syndrome and vascular quadrilateral space syndrome are associated with athletes involved in overhead throwing exercises. Sport-related arterial pathology of the lower limb include external iliac artery endofibrosis (EIAE), popliteal artery entrapment syndrome (PAES), and adductor canal syndrome. Vascular stress and kinking secondary to vessel tethering are important contributors to pathology in EIAE. Chronic exertional compartment syndrome must also be considered, presenting with clinical features similar to PAES. In addition, athletes are predisposed to blunt mechanical trauma. Hypothenar hammer syndrome is one such example, contributing to a high burden of morbidity in this population. CONCLUSIONS In arterial thoracic outlet syndrome and vascular quadrilateral space syndrome, surgery is advocated in symptomatic individuals, with postoperative outcomes favorable for the athlete. Acute limb ischemia may occur as a result of secondary thrombosis or embolization, often without preceding claudication. PAES and adductor canal syndrome are associated with functional entrapment in the athlete, secondary to muscular hypertrophy. Surgical exploration may be indicated. Poorer outcomes are noted when this process is associated with vascular reconstruction. Surgical treatment of EIAE follows failure of conservative management, with limited data available on postoperative prognosis. Investigations for all these conditions should be targeted based on clinical suspicion. A delay in diagnosis can have severe consequences on return to competition in these high-functioning individuals.
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Affiliation(s)
- Deepak Menon
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
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Abstract
Cold and White - Hypothenar Hammer Syndrome Abstract. Hypothenar hammer syndrome (HHS) is a condition caused by digital ischemia as a result of repeated trauma to the little finger. Routine diagnosis should include a detailed medical history and a physical examination including Allen's test. Imaging of vascular lesions can be done initially by acral plethysmography and duplex sonography, or directly in the context of angiography (gold standard). Early diagnosis enables effective therapeutic strategies and preventing permanent sequelae. The optimal treatment options are selected depending on the intensity of symptoms, ranging from conservative methods, secondary prevention, through a local thrombolysis up to operational measures.
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Affiliation(s)
- Ewelina Biskup
- 1 Shanghai University of Medicine and Health Sciences, Shanghai, P.R. China
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11
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Huxley VH, Kemp SS, Schramm C, Sieveking S, Bingaman S, Yu Y, Zaniletti I, Stockard K, Wang J. Sex differences influencing micro- and macrovascular endothelial phenotype in vitro. J Physiol 2018; 596:3929-3949. [PMID: 29885204 DOI: 10.1113/jp276048] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022] Open
Abstract
KEY POINTS Endothelial dysfunction is an early hallmark of multiple disease states that also display sex differences with respect to age of onset, frequency and severity. Results of in vivo studies of basal and stimulated microvascular barrier function revealed sex differences that are difficult to ascribe to specific cells or environmental factors. The present study evaluated endothelial cells (EC) isolated from macro- and/or microvessels of reproductively mature rats under the controlled conditions of low-passage culture aiming to test the assumption that EC phenotype would be sex independent. The primary finding was that EC, regardless of where they are derived, retain a sex-bias in low-passage culture, independent of varying levels of reproductive hormones. The implications of the present study include the fallacy of expecting a universal set of mechanisms derived from study of EC from one sex and/or one vascular origin to apply uniformly to all EC under unstimulated conditions, and no less in disease. ABSTRACT Vascular endothelial cells (EC) are heterogeneous with respect to phenotype, reflecting at least the organ of origin, location within the vascular network and physical forces. As an independent influence on EC functions in health or aetiology, susceptibility, and progression of dysfunction in numerous disease states, sex has been largely ignored. The present study focussed on EC isolated from aorta (macrovascular) and skeletal muscle vessels (microvascular) of age-matched male and female rats under identical conditions of short-term (passage 4) culture. We tested the hypothesis that genomic sex would not influence endothelial growth, wound healing, morphology, lactate production, or messenger RNA and protein expression of key proteins (sex hormone receptors for androgen and oestrogens α and β; platelet endothelial cell adhesion molecule-1 and vascular endothelial cadherin mediating barrier function; αv β3 and N-cadherin influencing matrix interactions; intracellular adhesion molecule-1 and vascular cell adhesion molecule-1 mediating EC/white cell adhesion). The hypothesis was rejected because the EC origin (macro- vs. microvessel) and sex influenced multiple phenotypic characteristics. Statistical model analysis of EC growth demonstrated an hierarchy of variable importance, recapitulated for other phenotypic characteristics, with predictions assuming EC homogeneity < sex < vessel origin < sex and vessel origin. Furthermore, patterns of EC mRNA expression by vessel origin and by sex did not predict protein expression. Overall, the present study demonstrated that accurate assessment of sex-linked EC dysfunction first requires an understanding of EC function by position in the vascular tree and by sex. The results from a single EC tissue source/species/sex cannot provide universal insight into the mechanisms regulating in vivo endothelial function in health, and no less in disease.
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Affiliation(s)
- Virginia H Huxley
- National Center for Gender Physiology, University of Missouri-Columbia, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO, USA.,Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO, USA
| | - Scott S Kemp
- National Center for Gender Physiology, University of Missouri-Columbia, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Christine Schramm
- National Center for Gender Physiology, University of Missouri-Columbia, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Steve Sieveking
- National Center for Gender Physiology, University of Missouri-Columbia, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Susan Bingaman
- National Center for Gender Physiology, University of Missouri-Columbia, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Yang Yu
- National Center for Gender Physiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Isabella Zaniletti
- Department of Statistics, University of Missouri-Columbia, Columbia, MO, USA
| | - Kevin Stockard
- National Center for Gender Physiology, University of Missouri-Columbia, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Jianjie Wang
- National Center for Gender Physiology, University of Missouri-Columbia, Columbia, MO, USA.,Department of Biomedical Sciences, Missouri State University, Springfield, MO, USA
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Swofford BP, Swofford DP. Management of Hypothenar Hammer Syndrome A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:150-152. [PMID: 29422482 PMCID: PMC5813519 DOI: 10.12659/ajcr.906849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypothenar hammer syndrome is a relatively rare disease process caused by repetitive stress or injury to the hypothenar eminence leading to chronic injury to the ulnar artery. This chronic stress (usually as a result of occupational or sport activities) may result in arterial constriction or thickening, which may lead to thrombosis or aneurysm formation. A review of current literature revealed that reports related to management of hypothenar hammer syndrome are limited. CASE REPORT A 33-year-old male without significant past medical history presented with left hand/digit pain, skin discoloration, and coolness of the hand/digits after a mechanical accident experienced 12 hours prior to presentation. Angiography confirmed reduced flow in the ulnar and radial artery with significant spasm of the ulnar artery. Treatment consisted of heparin, nitroglycerin, and papaverine with rapid resolution of symptoms. The patient was discharged on anticoagulation and a calcium channel blocker, with scheduled follow-up. CONCLUSIONS Hypothenar hammer syndrome is a rare disease process which manifests in certain occupations and activities that put undue stress on the hypothenar area. The use of angiography for definitive diagnosis and the use of anticoagulation and calcium channel blockers for treatment should continue to be studied to determine a standard treatment regimen.
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Affiliation(s)
- Brenen P Swofford
- Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA.,University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Devon P Swofford
- A.T. Still University - Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
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Abstract
BACKGROUND Pediatric ulnar aneurysms are rare and, unlike their adult counterparts, cannot be explained by repetitive trauma to the palm. A small number of case reports describe diagnostic difficulty with these lesions and different treatments. METHODS We present the case of a 6-month-old with an ulnar artery aneurysm of unknown cause. The diagnosis was supported with magnetic resonance imaging, and the lesion was resected. RESULTS Because the hand remained well perfused, the ulnar artery was not reconstructed. CONCLUSIONS Although the early result was good, the long-term outcome of this approach is unknown.
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Affiliation(s)
| | - George B. Carey
- The Perelman School Medicine, University of Pennsylvania, Philadelphia, USA
| | - James P. Higgins
- The Curtis National Hand Center, Baltimore, MD, USA,James P. Higgins, Care of Anne Mattson, The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, #200, Baltimore, MD 21218, USA.
| | - Benjamin Chang
- The Perelman School Medicine, University of Pennsylvania, Philadelphia, USA
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14
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Abstract
Ischemia of the upper extremity is uncommon but can be seen with open or closed trauma. Those dealing with traumatic injury of the upper extremity should be conversant with techniques of vascular surgery and microsurgery to address these injuries when they occur. Closed injury can occur as well, and at times these are best managed nonoperatively. This article discusses the management of both in the acute setting.
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Affiliation(s)
- William C Pederson
- Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin, Suite 610, Houston, TX 77030, USA.
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Combined Thenar and Hypothenar Hammer Syndromes and Raynaud's Phenomenon Successfully Treated with Iloprost. Case Rep Rheumatol 2016; 2016:4824929. [PMID: 27092287 PMCID: PMC4820597 DOI: 10.1155/2016/4824929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/07/2016] [Indexed: 11/18/2022] Open
Abstract
Thenar and hypothenar hammer syndromes are uncommon conditions characterised by digital ischemia of the hand as a result of repetitive trauma at level of the thenar and/or hypothenar eminence and damage to the radial and/or ulnar arteries, respectively. The symptoms are related to the mechanism of the trauma and a Raynaud's phenomenon can be predominant for a long time. The angiography is the “gold standard” imaging technique which allows to confirm the diagnosis. Therapeutic strategy depends on the type of the lesion and severity of symptoms and includes pharmacological (antithrombotic and thrombolytic drugs) and surgical treatments. The authors present a case of a 53-year-old man, carpenter by profession, with combined thenar and hypothenar hammer syndromes and Raynaud's phenomenon, successfully treated with a short course of intravenous infusion of iloprost.
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Ken J, Khangura D, Stickles SP. Point-of-care Ultrasound to Identify Distal Ulnar Artery Thrombosis: Case of Hypothenar Hammer Syndrome. West J Emerg Med 2015; 16:565-7. [PMID: 26265969 PMCID: PMC4530915 DOI: 10.5811/westjem.2015.4.25888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022] Open
Abstract
Hypothenar hammer syndrome (HHS) is a rare condition of distal ulnar artery injury and thrombosis secondary to repetitive blunt trauma to the hypothenar area. We present a case of HHS for which point-of-care ultrasound (POCUS) was used as the initial means of imaging, prompting management and disposition without further imaging studies ordered in the emergency department (ED). This case demonstrates the utility of POCUS to aid the Emergency Physician in the diagnosis and management of patients with extremity vascular issues in the ED, and details a rarely seen clinical entity in the ED.
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Affiliation(s)
- Jonathan Ken
- University of Missouri, Department of Emergency Medicine, Columbia, Missouri
| | - Darshan Khangura
- University of Missouri, Department of Internal Medicine, Columbia, Missouri
| | - Sean P Stickles
- University of Missouri, Department of Emergency Medicine, Columbia, Missouri
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