Hypothenar hammer syndrome

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Hypothenar hammer syndrome
Symptoms Pain over the hypothenar eminence especially at the ring finger, though all fingers of the same hand may be affected (thumb is never affected); increased sensitivity to cold and reduced sense of touch in affected digits [1]
Causesmultiple trauma of the fingers leading to Ischemia., Smoking, type of occupation: example carpenters, polishers, builders.
Risk factors Regular use of vibrating tools (carpenters, mechanics, machinists) and a subset of athletics involving repeated high-impact on the hand (baseball catchers, golfers, karate, volleyball) [1]
TreatmentNonoperative: cessation of smoking, avoid recurrent trauma; operative: endovascular fibrinolysis, excision of involved segment and reconstruction with or without a vein graft, and arterial ligation [1]

Hypothenar hammer syndrome (HHS) is a vascular occlusion in humans in the region of the ulna. It is caused by repetitive trauma to the hand or wrist (such as that caused by the use of a hammer) [2] by the vulnerable portion of the ulnar artery as it passes over the hamate bone, which may result in thrombosis, irregularity or aneurysm formation. HHS is a potentially curable cause of Raynaud's syndrome, distinct from hand–arm vibration syndrome. [3]

Contents

Cause

Diagnosis

A physical examination of the hand may show discoloration (blanching, mottling, and/ or cyanosis; gangrene may be present in advanced cases), unusual tenderness/ a callous over the hypothenar eminence, and fingertip ulcerations and splinter hemorrhages over ulnar digits; if an aneurysm is present, there may also be a pulsatile mass. Allen's test will be positive if an occlusion is present and negative if an aneurysm is present. An angiogram may show a "corkscrew" ulnar artery or an occlusion or aneurysm at the hook of the hamate.[ citation needed ]

Treatment

Noninvasive treatments have an 80% success rate; Example: switch jobs, stop smoking, regular finger exercise, surgical options exist for other instances. [1]

Epidemiology

HHS, though rare, occurs much more frequently in men than in women (9:1) and principally affects those in their 40s and 50s.[ citation needed ]

Related Research Articles

Ulnar nerve Nerve which runs near the ulna bone

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

Hamate bone

The hamate bone, or unciform bone, Latin os hamatum and occasionally abbreviated as just hamatum, is a bone in the human wrist readily distinguishable by its wedge shape and a hook-like process ("hamulus") projecting from its palmar surface.

Allens test

In medicine, Allen's test or the Allen test is a medical sign used in physical examination of arterial blood flow to the hands. It was named for Edgar Van Nuys Allen, who described the original version of the test in 1942. An altered test, first suggested by Irving S Wright in 1952, has almost universally replaced the original method in contemporary medical practice. The alternative method is often referred to as the modified Allen's test or modified Allen test.

Moyamoya disease Disease characterized by constriction of brain arteries

Moyamoya disease is a disease in which certain arteries in the brain are constricted. Blood flow is blocked by constriction and blood clots (thrombosis). A collateral circulation develops around the blocked vessels to compensate for the blockage, but the collateral vessels are small, weak, and prone to bleeding, aneurysm and thrombosis. On conventional angiography, these collateral vessels have the appearance of a "puff of smoke".

Klumpke paralysis Medical condition

Klumpke's paralysis is a variety of partial palsy of the lower roots of the brachial plexus. The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla (armpit), and gives rise to nerves to the upper limb. The paralytic condition is named after Augusta Déjerine-Klumpke.

Vibration white finger (VWF), also known as hand-arm vibration syndrome (HAVS) or dead finger, is a secondary form of Raynaud's syndrome, an industrial injury triggered by continuous use of vibrating hand-held machinery. Use of the term vibration white finger has generally been superseded in professional usage by broader concept of HAVS, although it is still used by the general public. The symptoms of vibration white finger are the vascular component of HAVS.

Flexor carpi ulnaris muscle

The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint.

Opponens digiti minimi muscle of hand

The opponens digiti minimi is a muscle in the hand. It is of a triangular form, and placed immediately beneath the palmaris brevis, abductor digiti minimi and flexor digiti minimi brevis. It is one of the three hypothenar muscles that control the little finger.

Hypothenar eminence Group of three muscles of the palm

The hypothenar muscles are a group of three muscles of the palm that control the motion of the little finger.

Flexor retinaculum of the hand A thickened fascia over the carpal tunnel

The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.

Fibromuscular dysplasia Human arterial disease

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery. FMD has been found in nearly every arterial bed in the body although the most common arteries affected are the renal and carotid arteries.

Flexor digiti minimi brevis muscle of hand

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Ulnar canal

The ulnar canal or ulnar tunnel (also known as Guyon's canal or tunnel) is a semi-rigid longitudinal canal in the wrist that allows passage of the ulnar artery and ulnar nerve into the hand. The roof of the canal is made up of the superficial palmar carpal ligament, while the deeper flexor retinaculum and hypothenar muscles comprise the floor. The space is medially bounded by the pisiform and pisohamate ligament more proximally, and laterally bounded by the hook of the hamate more distally. It is approximately 4 cm long, beginning proximally at the transverse carpal ligament and ending at the aponeurotic arch of the hypothenar muscles.

Triangular fibrocartilage Anatomical feature in the wrist

The Triangular fibrocartilage complex (TFCC) is formed by the triangular fibrocartilage discus (TFC), the radioulnar ligaments (RULs) and the ulnocarpal ligaments (UCLs).

Ocular ischemic syndrome is the constellation of ocular signs and symptoms secondary to severe, chronic arterial hypoperfusion to the eye. Amaurosis fugax is a form of acute vision loss caused by reduced blood flow to the eye; it may be a warning sign of an impending stroke, as both stroke and retinal artery occlusion can be caused by thromboembolism due to atherosclerosis elsewhere in the body. Consequently, those with transient blurring of vision are advised to urgently seek medical attention for a thorough evaluation of the carotid artery. Anterior segment ischemic syndrome is a similar ischemic condition of anterior segment usually seen in post-surgical cases. Retinal artery occlusion leads to rapid death of retinal cells, thereby resulting in severe loss of vision.

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Anterior spinal artery syndrome is syndrome caused by ischemia of the anterior spinal artery, resulting in loss of function of the anterior two-thirds of the spinal cord. The region affected includes the descending corticospinal tract, ascending spinothalamic tract, and autonomic fibers. It is characterized by a corresponding loss of motor function, loss of pain and temperature sensation, and hypotension.

Ulnar tunnel syndrome Medical condition

Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is caused by entrapment of the ulnar nerve in the Guyon canal as it passes through the wrist. Symptoms usually begin with a feeling of pins and needles in the ring and little fingers before progressing to a loss of sensation and/or impaired motor function of the intrinsic muscles of the hand which are innervated by the ulnar nerve. Ulnar tunnel syndrome is commonly seen in regular cyclists due to prolonged pressure of the Guyon's canal against bicycle handlebars. Another very common cause of sensory loss in the ring and pink finger is due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome.

Carpal tunnel

In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the hand.

Ulnar nerve entrapment Medical condition

Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or pinched, resulting in pain, numbness, or weakness, primarily affecting the little finger and ring finger of the hand. Entrapment may occur at any point from the spine at cervical vertebra C7 to the wrist; the most common point of entrapment is in the elbow. Prevention is mostly through correct posture and avoiding repetitive or constant strain. Treatment is usually conservative, including medication, activity modification and exercise, but may sometimes include surgery. Prognosis is generally good, with mild to moderate symptoms often resolving spontaneously.

Ulnar neuropathy Medical condition

Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. Motor function can be assessed by testing for a positive Froment's sign, or making an OK sign, little finger abduction can be tested as well.

References

  1. 1 2 3 4 Colin Woon. "Hypothenar Hammer Syndrome". Orthobullets.com.
  2. "Hypothenar hammer syndrome".
  3. Cooke, R. A. (2003). "Hypothenar hammer syndrome: a discrete syndrome to be distinguished from hand-arm vibration syndrome". Occupational Medicine. 53 (5): 320–324. doi: 10.1093/occmed/kqg071 . ISSN   0962-7480. PMID   12890831.