J Korean Rheum Assoc.  2007 Dec;14(4):417-421.

A Case of Hypothenar Hammer Syndrome Presented as Digital Ulcerations

• Kim KH
• Kim JM
• Song EJ
• Han SW
• Nam EJ
• Kang YM

Abstract

Hypothenar hammer syndrome (HHS) is a non-atherosclerotic, non-inflammatory vascular disease that causes a digital ischemia as a result of the occlusion of distal ulnar artery adjacent to the hook of hamate. This syndrome is usually observed in men who use the hypothenar eminence of the hand to grip devices such as a hammer. As a consequence of repeated blunt trauma, the ulnar artery beneath hypothenar eminence may lead to pathologic changes, such as intima-medial hyperplasia and reactive inflammatory infiltrates, which lead to the digital ischemia. We experienced a case of HHS with digital ulcerations which occurred after intensive work with nail remover for 10 days. Selective angiography of right forearm showed complete occlusion of the ulnar artery at the level of hook of hamate with deficient superficial palmar arch. After treatment with intravenous prostaglandin E1 and heparin, the ulcerative lesions of fingers improved without surgical intervention, which implicates that medical management of HHS should be considered prior to the surgical treatment.

Keyword

Hypothenar hammer syndrome; Finger ulceration

MeSH Terms

Alprostadil
Angiography
Fingers
Forearm
Hand
Hand Strength
Heparin
Humans
Hyperplasia
Ischemia
Male
Ulcer*
Ulnar Artery
Vascular Diseases
Alprostadil
Heparin

Figure

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  Fig. 1. The right hand of the patient shows ulcerations of the third to fifth fingers.

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  Fig. 2. Angiography of the right hand shows total occlusion of the ulnar artery at the level of hook of hamate (arrow-heads) and poor filling of superficial palmar arch (A), while that of the unaffected left hand shows normal filling of the ulnar artery, radial artery, superficial and deep palmar arch (B).

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