Hypothenar hammer syndrome: a case series and literature review
Mehmet Şükrü Şahin1, Tuna Özyürekoğlu1, Gökhan Çakmak2
1Christine M. Kleinert Institute For Hand and Microsurgery, Louisville, USA
2Department of Orthopedics and Traumatology, Medical Faculty of Başkent University, Alanya Training and Medical Research Center, Antalya, Turkey
Keywords: Arterial reconstruction; digital ischemia; hypothenar hammer syndrome; ulnar artery; vein graft.
Objectives: This study aims to report our experience regarding patients who were surgically treated due to hypothenar hammer syndrome and review the related literature.
Patients and methods: The study included 11 hands of eight patients (5 males, 3 females; mean age 48 years; range 29 to 60 years) who underwent surgery due to hypothenar hammer syndrome between September 2004 and March 2013. Mean follow-up period was 50 months (range 3-103 months). The time of symptom onset, occupational history, and detailed physical examination findings were recorded. Surgery was performed under sedation and axillary anesthesia. Distal segment of the forearm, all thrombosed segments of the Guyon and superficial arch were removed. Reconstruction of the ulnar artery and the superficial arch was performed using vein grafts obtained from the forearm.
Results: While all patients’ dominant hand was affected, both hands were affected in three patients. All patients complained of pain and color change in one finger or multiple fingers. While minimal amputation and debridement of fingertip pulp was performed in two patients, all other patients recovered uneventfully. Patency of the ulnar artery was uneventful at follow-up in five of the eight patients, whereas three patients were performed revision surgery for a new vein graft. Most patient complaints resolved during the follow-up period.
Conclusion: Hypothenar hammer syndrome is a disease of the upper extremities that should be considered in patients with digital ischemia, and a history of manual labor and smoking. Although this disease can be treated with conservative therapy, advance-stage patients who fail to respond to conservative treatment can be treated surgically with vein grafts.