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Piessat C, De Almeida YK, Athlani L. Hypothenar hammer syndrome: outcomes after ulnar artery reconstruction with autologous vein graft. HAND SURGERY & REHABILITATION 2023; 42:203-207. [PMID: 36893887 DOI: 10.1016/j.hansur.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/09/2023]
Abstract
The most common surgical procedure for the treatment of hypothenar hammer syndrome (HHS) is resection of the pathological segment followed by arterial reconstruction using a venous bypass. Bypass thrombosis occurs in 30% of cases, with various clinical consequences, ranging from no symptoms to reappearance of the preoperative clinical symptoms. We reviewed 19 patients with HHS who underwent bypass graft, to assess clinical outcomes and graft patency, with a minimum follow-up of 12 months. Objective and subjective clinical evaluation and ultrasound exploration of the bypass were carried out. Clinical results were compared according to bypass patency. At a mean follow-up of 7 years, 47% of patients had complete resolution of symptoms; symptoms were improved in 42% of cases, and unchanged in 11%. Mean QuickDASH and CISS scores were 20.45/100 and 28/100, respectively. Bypass patency rate was 63%. Patients with patent bypass had shorter follow-up (5.7 vs 10.4 years; p = 0.037) and a better CISS score (20.3 vs 40.6; p = 0.038). There were no significant differences between groups for age (48.6 and 46.7 years; p = 0.899), bypass length (6.1 and 9.9 cm; p = 0.081) or QuickDASH score (12.1 and 34.7; p = 0.084). Arterial reconstruction gave good clinical results, with the best results in case of patent bypass. Level of evidence: IV.
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Affiliation(s)
- Colin Piessat
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France.
| | - Yoan-Kim De Almeida
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France
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Elhadhri S, Chaouch N, Boughanmi K, Zlitni M, Hentgen B, Fallouh A. Hypothenar hammer syndrome associated with rapidly evolving ulnar false aneurysm. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:153-156. [PMID: 36055686 DOI: 10.1016/j.jdmv.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Affiliation(s)
- S Elhadhri
- Department of vascular and thoracic surgery, René-Dubos Hospital, Pontoise, France.
| | - N Chaouch
- Department of vascular and thoracic surgery, René-Dubos Hospital, Pontoise, France
| | - K Boughanmi
- Department of vascular and thoracic surgery, René-Dubos Hospital, Pontoise, France
| | - M Zlitni
- Department of vascular and thoracic surgery, René-Dubos Hospital, Pontoise, France
| | - B Hentgen
- Department of vascular and thoracic surgery, René-Dubos Hospital, Pontoise, France
| | - A Fallouh
- Department of vascular and thoracic surgery, René-Dubos Hospital, Pontoise, France
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Panchal G, Hari JP, Roy N, Rao PP, Deki S. A case of acute limb ischemia due to ulnar artery thrombosis: a rare surgical challenge. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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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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Lescoat A, Yelnik CM, Coiffier G, Wargny M, Lamotte C, Cazalets C, Belhomme N, Ballerie A, Hatron P, Launay D, Perdriger A, Sobanski V, Hachulla E, Jégo P. Ulnar Artery Occlusion and Severity Markers of Vasculopathy in Systemic Sclerosis: A Multicenter Cross‐Sectional Study. Arthritis Rheumatol 2019; 71:983-990. [DOI: 10.1002/art.40799] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Alain Lescoat
- CHU Rennes, University of Rennes, INSERM, EHESP, Institut de Recherche en Santé, Environnement et Travail (IRSET) Rennes France
| | - Cécile Marie Yelnik
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | | | - Christophe Lamotte
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | | | | | - Pierre‐Yves Hatron
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - David Launay
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | - Vincent Sobanski
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - Eric Hachulla
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - Patrick Jégo
- CHU Rennes, University of Rennes, INSERM, EHESP, Institut de Recherche en Santé, Environnement et Travail (IRSET) Rennes France
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Severe Preeclampsia, Antiphospholipid Syndrome, and Ulnar Artery Thrombosis in a Teenage Pregnancy: A Rare Association. Case Rep Obstet Gynecol 2018; 2018:1794723. [PMID: 30319825 PMCID: PMC6167596 DOI: 10.1155/2018/1794723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/19/2018] [Indexed: 12/03/2022] Open
Abstract
Antiphospholipid syndrome (APS) is associated with vascular thrombosis and pregnancy complications. It causes recurrent miscarriage and it is associated with other adverse pregnancy outcomes such as preterm delivery, intrauterine growth restriction, preeclampsia, and HELLP syndrome. Obstetric morbidity is one of the major manifestations of APS with a wide variety of clinical manifestations. This case describes a case of a severe preeclampsia in a 16-year-old primigravida at 29 weeks resulting in a caesarean delivery and subsequent finding of an ulnar artery thrombosis in postpartum period. APS was diagnosed on further investigations of her symptoms and signs.
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Lescoat A, Coiffier G, Rouil A, Droitcourt C, Cazalets C, de Carlan M, Perdriger A, Jégo P. Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study. Arthritis Care Res (Hoboken) 2017; 69:543-551. [PMID: 27390194 DOI: 10.1002/acr.22965] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the relevance of power Doppler ultrasonography (PDUS) as a predictive tool of 1-year digital ulcer (DU) occurrence in systemic sclerosis (SSc). METHODS A total of 55 SSc patients and 19 controls underwent PDUS of both hands to evaluate the prevalence of ulnar artery occlusion (UAO) at baseline. Finger pulp blood flow (FPBF) of the third and fourth fingers was also assessed and considered as pathologic if a defect of the Doppler signal on a finger pulp was observed. All patients were clinically re-evaluated 6 and 12 months later and new ischemic DU occurrences in the meantime were retrospectively recorded. Patients were also asked to call if new DUs occurred between consultations. RESULTS PDUS parameters were normal in all controls. The prevalence of UAO was 36.4% and was bilateral in 70% of the SSc cases. A total of 56.4% of SSc patients had a pathologic FPBF. UAO and pathologic FPBF were associated with a history of multiple DU episodes (odds ratio [OR] 8.98 [95% confidence interval (95% CI) 2.52-32.01], P < 0.001, and OR 4.69 [95% CI 1.30-16.93], P = 0.014, respectively) and the occurrence of new DUs during the followup in the univariable model (OR 8.73 [95% CI 2.00-38.16], P = 0.005, and OR 12.65 [95% CI 1.50-106.77], P = 0.005, respectively). The association of UAO and pathologic FPBF in the same patient was a predictive factor of new DUs in the multivariable analysis (P = 0.015). CONCLUSION This study suggests that UAO and pathologic FPBF are associated with a history of multiple DUs and are predictors of new ischemic DUs. These parameters could be used as prognostic factors and considered in further studies evaluating DU treatment strategies.
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Affiliation(s)
| | | | - Alban Rouil
- CHU Rennes, University of Rennes, Rennes, France
| | | | | | | | | | - Patrick Jégo
- CHU Rennes, University of Rennes, Rennes, France
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Pruzan AN, Kaufman AE, Calcagno C, Zhou Y, Fayad ZA, Mani V. Feasibility of imaging superficial palmar arch using micro-ultrasound, 7T and 3T magnetic resonance imaging. World J Radiol 2017; 9:79-84. [PMID: 28298968 PMCID: PMC5334505 DOI: 10.4329/wjr.v9.i2.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/17/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To demonstrate feasibility of vessel wall imaging of the superficial palmar arch using high frequency micro-ultrasound, 7T and 3T magnetic resonance imaging (MRI).
METHODS Four subjects (ages 22-50 years) were scanned on a micro-ultrasound system with a 45-MHz transducer (Vevo 2100, VisualSonics). Subjects’ hands were then imaged on a 3T clinical MR scanner (Siemens Biograph MMR) using an 8-channel special purpose phased array carotid coil. Lastly, subjects’ hands were imaged on a 7T clinical MR scanner (Siemens Magnetom 7T Whole Body Scanner) using a custom built 8-channel transmit receive carotid coil. All three imaging modalities were subjectively analyzed for image quality and visualization of the vessel wall.
RESULTS Results of this very preliminary study indicated that vessel wall imaging of the superficial palmar arch was feasible with a whole body 7T and 3T MRI in comparison with micro-ultrasound. Subjective analysis of image quality (1-5 scale, 1: poorest, 5: best) from B mode, ultrasound, 3T SPACE MRI and 7T SPACE MRI indicated that the image quality obtained at 7T was superior to both 3T MRI and micro-ultrasound. The 3D SPACE sequence at both 7T and 3T MRI with isotropic voxels allowed for multi-planar reformatting of images and allowed for less operator dependent results as compared to high frequency micro-ultrasound imaging. Although quantitative analysis revealed that there was no significant difference between the three methods, the 7T Tesla trended to have better visibility of the vessel and its wall.
CONCLUSION Imaging of smaller arteries at the 7T is feasible for evaluating atherosclerosis burden and may be of clinical relevance in multiple diseases.
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Evaluation of anatomy and variations of superficial palmar arch and upper extremity arteries with CT angiography. Surg Radiol Anat 2016; 39:419-426. [DOI: 10.1007/s00276-016-1750-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/12/2016] [Indexed: 12/22/2022]
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Boulon C, Chauvel R, Maillet A, Skopinski S, Constans J. [Ischemia of the hand in a lumberjack who underwent surgery for wrist fracture]. ACTA ACUST UNITED AC 2016; 41:298-9. [PMID: 27297641 DOI: 10.1016/j.jmv.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- C Boulon
- Service de médecine vasculaire, hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux, France.
| | - R Chauvel
- Service de médecine vasculaire, hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux, France
| | - A Maillet
- Service de médecine vasculaire, hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux, France
| | - S Skopinski
- Service de médecine vasculaire, hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux, France
| | - J Constans
- Service de médecine vasculaire, hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux, France
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Abstract
Hypothenar hammer syndrome is a rare vascular condition resulting from injury to the ulnar artery at the level of Guyon canal. The ulnar artery at the wrist is the most common site of arterial aneurysms of the upper extremity and is particularly prone to injury. Signs and symptoms include a palpable mass, distal digital embolization to long, ring, or small fingers, pain, cyanosis, pallor, coolness, and recurrent episodes of vasospasm. Modalities for diagnosis, evaluation, and surgical planning include duplex study, contrast arteriography, and computerized tomographic angiography (CTA). Management includes medical, nonoperative, or operative treatments. Appropriate treatment options are reviewed.
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12
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Wong VW, Katz RD, Higgins JP. Interpretation of upper extremity arteriography: vascular anatomy and pathology [corrected]. Hand Clin 2015; 31:121-34. [PMID: 25455362 DOI: 10.1016/j.hcl.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding the utility and interpretation of upper extremity angiography is critical for the hand surgeon treating vaso-occlusive diseases of the hand. Although invasive and requiring the use of contrast dye, it remains the gold standard for imaging of the vascular system of the upper extremity. Angiography may detect numerous variants of the upper limb arterial system which may contribute to surgical pathology. Extensive vascular collateralization helps to maintain perfusion to the hand and facilitates reconstruction of the upper extremity. It is paramount to remember that angiography is a dynamic study and should represent a "flexible roadmap" for surgical reconstruction.
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Affiliation(s)
- Victor W Wong
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - Ryan D Katz
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - James P Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA.
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