1
|
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 Surg Rehabil 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Beyaz MO, Kaya S, Demir İ. Fistulized Pseudoaneurysm Associated with Hypothenar Hammer Syndrome to the Skin in a 12-Year-Old Patient: A Case Report. Vasc Specialist Int 2023; 39:37. [PMID: 37981728 PMCID: PMC10658078 DOI: 10.5758/vsi.230070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
In this case, we present a condition where the extension of the hamate hook in the Guyon canal can damage the ulnar artery or its branches, leading to the development of an aneurysm or pseudoaneurysm. The patient, a 12-year-old female, presented to our clinic with a complaint of an uncontrolled palm lump that has been growing for several months and began to bleed in a pulsatile manner after trauma. She was an amateur volleyball player who trained twice weekly for two hours. Color Doppler ultrasound examination revealed a 1.1×0.8 cm pseudoaneurysm in a branch of the ulnar artery. Aneurysmectomy and primary repair were performed. Timely diagnosis and treatment planning are crucial for ulnar artery pseudoaneurysms or aneurysms to prevent ischemic events in a later period.
Collapse
Affiliation(s)
- Metin Onur Beyaz
- Department of Cardiovascular Surgery, Tayfur Ata Sökmen Medical Faculty, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Sefer Kaya
- Department of Cardiovascular Surgery, Tayfur Ata Sökmen Medical Faculty, Hatay Mustafa Kemal University, Hatay, Turkey
| | - İbrahim Demir
- Department of Cardiovascular Surgery, Kirsehir Education and Research Hospital, Kirsehir, Turkey
| |
Collapse
|
3
|
Piessat C, De Almeida YK, Athlani L. Hypothenar hammer syndrome: outcomes after ulnar artery reconstruction with autologous vein graft. Hand Surg Rehabil 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
4
|
Pulos N, Michalik AJ Jr. Common Hand Injuries in the Baseball Player. Curr Rev Musculoskelet Med 2023; 16:19-23. [PMID: 36508080 DOI: 10.1007/s12178-022-09812-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE OF THE REVIEW The list of potential hand and wrist injuries among baseball players is numerous and includes fractures, dislocations, strains, and sprains. The purpose of this review, however, is to highlight injuries to the hand and wrist which are either particularly common or unique to professional baseball players with an emphasis on diagnostic pearls and treatment principles. RECENT FINDINGS For many baseball-related hand and wrist injuries, descriptions of the pathophysiology, diagnosis, and treatment options are based on single institution case series. With the implementation of Major League Baseball's Health and Injury Tracking System, our understanding of the epidemiology of these injuries in professional baseball players has greatly improved. The most common injury requiring operative treatment is a hook of hamate fracture, and recent evidence increasingly supports fracture fragment excision for early pain-free return to sport. Fractures of the proximal phalanges of fingers, thumb phalangeal fractures, and UCL injuries are the most common indication for surgery of the digits. A4 pulley ruptures in pitchers and repetitive trauma to the vasculature of the palm and digits are relatively unique to professional baseball players and are frequently able to be managed non-operatively. While injuries to the hand and wrist are common, the median number of days missed due to such an injury was only 4 days among professional baseball players. Statements and Declarations" for inclusion in the published paper. Please note that submissions that do not include relevant declarations will be returned as incomplete.
Collapse
|
5
|
Wahl U, Ochsmann E, Siemers F, Corterier CC, Hirsch T. [Accident-related and workplace-related vascular disorders of the hand]. Unfallchirurg 2022. [PMID: 34989852 DOI: 10.1007/s00113-021-01127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Limited hand function as the result of occupational exposure or accidental injury could primarily be of vascular origin. Since it is quite rarely seen in the course of routine traumatology, special awareness of this is needed. AIM OF THE PAPER The occupational diseases hypothenar/thenar hammer syndrome (occupational disease 2114) and vibration-induced vasospastic syndrome (occupational disease 2104) are presented on the basis of their etiological and pathogenetic characteristics, taking aspects of occupational medicine and expert opinion into consideration. DISCUSSION Blunt force trauma to vascular structures of the hand can damage the tunica intima of the affected thenar or hypothenar arteries. Chronic exposure of the arms, hands and fingers to vibration can lead to the injury of nerve and vascular structures. Thermometry and pallesthesiometry are used in the diagnostics alongside methods of vascular medicine. CONCLUSION Vascular entities can also play a role in the surgical assessment of the impact of an accident or of an occupational disease after exposure to vibration. Awareness of them can shorten the latency between the onset of symptoms and a definitive diagnosis.
Collapse
|
6
|
Morel L, Goy JJ. [Finger paresthesia]. Rev Med Interne 2020; 42:365-366. [PMID: 33190971 DOI: 10.1016/j.revmed.2020.10.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Affiliation(s)
- L Morel
- Service de cardiologie, clinique Cecil, avenue Ruchonnet 57, 1003 Lausanne, Suisse
| | - J-J Goy
- Service de cardiologie, clinique Cecil, avenue Ruchonnet 57, 1003 Lausanne, Suisse.
| |
Collapse
|
7
|
Malsagova AT, van Burink MV, Smits ES, Zöphel OT, Stassen CM, Botman JMJ, Rakhorst HA. Prospective assessment of function and cold-intolerance following revascularization for hypothenar hammer syndrome. J Plast Reconstr Aesthet Surg 2020; 73:2164-2170. [PMID: 32565138 DOI: 10.1016/j.bjps.2020.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/31/2020] [Accepted: 05/15/2020] [Indexed: 01/24/2023]
Abstract
Ulnar artery revascularization in hypothenar hammer syndrome has repeatedly been shown to reduce ischaemic symptoms, however with varying graft patency percentages. This study prospectively assesses the effect of revascularization surgery with a vein graft using validated questionnaires in seven patients. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Cold Intolerance Symptom Severity (CISS) questionnaires have been used to compare the preoperative and postoperative functionality and cold intolerance. All patients showed improvement in either functionality, or cold intolerance, or both from disabled to nearly normalized levels and resumed their occupation at final follow-up (mean of 28 months). Strikingly this was also the case in a patient with graft stenosis. Patients with the highest preoperative questionnaire scores showed most postoperative improvement. In conclusion, revascularization surgery seems to improve the symptomatology irrespective of graft patency. Questionnaires can be a valuable contribution to quantify and to follow the symptomatology in hypothenar hammer syndrome.
Collapse
Affiliation(s)
- A T Malsagova
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
| | - M V van Burink
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands.
| | - E S Smits
- Department of Plastic Surgery, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 Rotterdam, CE, the Netherlands
| | - O T Zöphel
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
| | - C M Stassen
- Department of Radiology, Ziekenhuisgroep Twente in Almelo and Hengelo/Medisch Spectrum Twente, the Netherlands
| | - J M J Botman
- Department of General Surgery, Ziekenhuisgroep Twente Almelo and Hengelo, the Netherlands
| | - H A Rakhorst
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
| |
Collapse
|
8
|
Carr MP, Becker GW, Taljanovic MS, McCurdy WE. Hypothenar hammer syndrome: Case report and literature review. Radiol Case Rep 2019; 14:868-871. [PMID: 31193096 PMCID: PMC6517613 DOI: 10.1016/j.radcr.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 12/02/2022] Open
Abstract
Hypothenar hammer syndrome is a rare but serious cause of digital ischemia and morbidity. Presented here is a case of a manual laborer who had symptoms of digital ischemia after acute hyperextension injury to the ring finger. Magnetic resonance imaging revealed thrombosed ulnar artery aneurysm. Etiology, presentation, and current treatments are reviewed.
Collapse
Affiliation(s)
- Marcus P Carr
- Department of Medical Imaging, University of Arizona College of Medicine, Banner - University Medical Center, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ 85724, USA
| | - Giles W Becker
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Banner - University Medical Center, 1501 N. Campbell Ave., PO Box 245064, Tucson, AZ 85724, USA
| | - Mihra S Taljanovic
- Department of Medical Imaging, University of Arizona College of Medicine, Banner - University Medical Center, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ 85724, USA
| | - Wendy E McCurdy
- Department of Medical Imaging, University of Arizona College of Medicine, Banner - University Medical Center, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ 85724, USA
| |
Collapse
|
9
|
Athlani L, De Almeida YK, Maschino H, Dap F, Dautel G. [ Hypothenar hammer syndrome: A recurrent case report after surgery]. J Med Vasc 2018; 43:320-324. [PMID: 30217347 DOI: 10.1016/j.jdmv.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 05/25/2018] [Indexed: 11/19/2022]
Abstract
Hypothenar hammer syndrome is a rare entity secondary to ulnar artery damage in the wrist, affecting mainly those exposed to repeated hand-palm trauma. Surgery is discussed in case of severe symptoms, resistant to medical treatment, and/or when anatomical lesions with emboligenic potential are demonstrated in the radiological exams. In this case, resection of the pathological zone with revascularization by autologous vein graft is the best option. We report the case of a 60-year-old patient who had a recurrence of symptoms more than 10 years after the completion of a surgical treatment. There was an aneurysmal thrombosed vein graft with extensive thrombus extending from the ulnar artery upstream of the Guyon's canal to the superficial palmar arch. The digital revascularization was provided by the radial superficial palmar arch and the presence of a collateral vascular supply. This late complication was responsible for compression of the ulnar nerve in Guyon's canal. A new surgery was performed consisting of the resection of the thrombosed zone, including the vein graft, without vascular reconstruction given the good vascularization of all the fingers, and release of the ulnar nerve to the wrist. The operative follow-up was uneventful with the disappearance of pain and sensory-motor deficits. Good digital vascularization was confirmed by imaging at 3 months postoperatively; nerve recovery by electromyogram at 6 months with normal conduction.
Collapse
Affiliation(s)
- L Athlani
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - Y K De Almeida
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - H Maschino
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - F Dap
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - G Dautel
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Ewelina Biskup
- 1 Shanghai University of Medicine and Health Sciences, Shanghai, P.R. China
| |
Collapse
|
11
|
Athlani L, De Almeida YK, Maschino H, Dap F, Dautel G. Hypothenar hammer syndrome: A case of a late complication after surgery. Hand Surg Rehabil 2018; 37:316-319. [PMID: 30037779 DOI: 10.1016/j.hansur.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/17/2018] [Accepted: 07/05/2018] [Indexed: 11/15/2022]
Abstract
Hypothenar hammer syndrome is a rare condition secondary to ulnar artery damage in Guyon's canal, affecting mainly those exposed to repeated palm trauma. Surgery is discussed in cases of severe symptoms that are resistant to conservative treatment, and/or when anatomical lesions with high embolism potential are discovered during imaging exams. Resection of the pathological zone with revascularization by autologous vein graft is the best option. We report the case of a 60-year-old patient who had a recurrence of symptoms more than 10 years after this type of surgical treatment was performed. There was an aneurysmal thrombosed vein graft with extensive thrombus from the ulnar artery upstream to Guyon's canal to the superficial palmar arch. Finger revascularization was provided by the superficial branch of the radial artery and the presence of a collateral vascular supply. This late complication was responsible for compression of the ulnar nerve in Guyon's canal. A new surgery was performed to resect the thrombosed zone, including the vein graft, without vascular reconstruction due to the good vascularization of all the fingers, and to release the ulnar nerve at the wrist. The postoperative course was uneventful with the disappearance of pain and sensory-motor deficits. Good finger vascularization was confirmed by imaging at 3 months postoperative; nerve conduction was normal at 6 months on electroneuromyography.
Collapse
Affiliation(s)
- L Athlani
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - Y-K De Almeida
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - H Maschino
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - F Dap
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - G Dautel
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| |
Collapse
|
12
|
Estermann L, Ducommun P, Steurer-Dober I, Hug U. Hypothenar hammer syndrome: caused by a muscle anomaly? A case report with review of the literature. Arch Orthop Trauma Surg 2018; 138:739-42. [PMID: 29511800 DOI: 10.1007/s00402-018-2913-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 10/17/2022]
Abstract
The hypothenar hammer syndrome (HHS) is a rare entity of secondary Raynaud's phenomenon. The blunt hypothenar trauma causes a lesion of the vessel wall with a consecutive thrombosis or aneurysm of the ulnar artery at the Guyon's canal. Different risk factors are discussed such as nicotine abuse, or a muscle anomaly in the Guyon's canal. To date, there are five case reports published about muscle anomalies and HHS. We present a case of a 51-year-old shipbuilder with a unilateral HHS on his right dominant hand with a bilateral muscle anomaly. We successfully treated the patient by resection of the aneurysm without a resection of the atypical muscle.
Collapse
|
13
|
Abstract
INTRODUCTION/PURPOSE Arterial injury in the hand is most often due to repetitive blunt trauma. Although not always associated with significant impairment, it may cause serious ischemic damage or considerable disability. As a cause of digital ischemia, the frequency of this disorder is widely under appreciated. This study reviews the clinical and angiographic features of this condition. MATERIALS/METHODS An extensive literature review combined with the authors experience with arterial injury in the hand due to repetitive blunt hand trauma is summarized with emphasis on mechanisms of injury and pathologic changes to explain the angiographic findings and clinical presentations. RESULTS Angiographic findings are related to severity of injury and underlying changes in the arterial wall. The clinical presentation varies from asymptomatic to digital necrosis and gangrene, related to severity of arterial injury, collateral circulation, and the highly variable arterial anatomy in the hand. CONCLUSION Early recognition is important because compared to many other causes of digital ischemia in the upper extremities, traumatic arterial injury is frequently readily treatable. Angiographic findings and clinical presentation are often characteristic. The diagnosis should not be based on a clear history of repetitive hand trauma since the patient may be unaware of this occurrence.
Collapse
|
14
|
Adams NS, Ford RD. Recurrent Hypothenar Hammer Syndrome: A Case Report. J Hand Surg Asian Pac Vol 2016; 21:414-6. [PMID: 27595964 DOI: 10.1142/s2424835516720188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hypothenar hammer syndrome (HHS) is a rare cause of digital ischemia and pain caused from repetitive trauma to the palm. Often related to occupational practices, thrombosis and embolization can occur. Treatment is often surgical and involves excision with or without reconstruction. We describe a 55 year-old, male pipe fitter previously diagnosed and treated for HHS with excision and repair using a reversed interpositional vein graft in the mid-1980's. He continued to work in the profession, which he regularly used his palm as a hammer and returned approximately 30 years later with recurrent symptoms of cold intolerance and pain. Angiography confirmed occlusion of the ulnar artery with emboli present distally. The patient was again treated with excision and reconstruction. HHS is an uncommon cause of digital ischemia. Its recurrence is even more rare. To our knowledge, this is the first described case of diagnosed and treated recurrent HHS.
Collapse
Affiliation(s)
- Nicholas S Adams
- * Grand Rapids Medical Education Partners/Michigan Stage University Plastic Surgery Residency, Grand Rapids, USA
| | - Ronald D Ford
- * Grand Rapids Medical Education Partners/Michigan Stage University Plastic Surgery Residency, Grand Rapids, USA.,† Elite Plastic Surgery, Grand Rapids, USA
| |
Collapse
|
15
|
Abstract
The diagnosis of hypothenar hammer syndrome (HHS) should be considered in the case of hand ischemia in people who occupationally or recreationally use the hypothenar region literally as a hammer. Routine diagnostics should consist of physical examination including Allens test, acral plethysmography and duplex sonography. According to the prevailing opinion angiography remains the «gold standard test» for establishing the diagnosis of HHS. Early diagnosis allows more effective therapeutic strategies and is important to prevent long-term negative medical sequelae. Several basic principles apply to all patients, for example hand protection and smoking cessation. The optimal treatment options, particularly the indication for surgery, remain controversial due to a lack of sound data from case series or prospective randomized trials.
Collapse
Affiliation(s)
- Angelika Schröttle
- 1 Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilian-University Hospital, München, Germany
| | | | | | | | | | | |
Collapse
|
16
|
Endress RD, Johnson CH, Bishop AT, Shin AY. Hypothenar hammer syndrome: long-term results of vascular reconstruction. J Hand Surg Am 2015; 40:660-5.e2. [PMID: 25746144 DOI: 10.1016/j.jhsa.2015.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate long-term patency rates and related outcomes after vascular reconstruction of hypothenar hammer syndrome and identify patient- or treatment-related factors that may contribute to differences in outcome. METHODS We used color flow ultrasound to determine the patency of 18 vein graft reconstructions of the ulnar artery at the wrist in 16 patients. Validated questionnaires evaluated patients' functional disability with the Disabilities of the Arm, Shoulder, and Hand score, pain with the visual analog scale, and cold intolerance with the Cold Intolerance Symptom Severity survey. Patient demographics, clinical data, and surgical factors were analyzed for association with graft failure. Patients were asked to grade the result of treatment on a scale of 0 to 10. RESULTS Of 18 grafts, 14 (78%) were occluded at a mean of 118 months postoperatively. Patients with patent grafts had significantly less disability related to cold intolerance according to the Cold Intolerance Symptom Severity survey in addition to significantly less pain on the visual analog scale. There was no statistical difference in Disabilities of the Arm, Shoulder, and Hand scores between patients with patent or occluded grafts. Patients graded the result significantly higher in patent reconstructions. CONCLUSIONS We noted a higher incidence of graft occlusion than previously reported at a mean follow-up of 9.8 years, which represents a long-duration follow-up study of surgical treatment of hypothenar hammer syndrome. Despite a high percentage of occlusion, overall, patients remained satisfied with low functional disability and all would recommend surgical reconstruction. This study suggests that improved outcomes may result from patent grafts in the long term. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Ryan D Endress
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Craig H Johnson
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Allen T Bishop
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
17
|
Abstract
Repetitive, high-stress, or high-impact arm motions can cause upper extremity arterial injuries. The increased functional range of the upper extremity causes increased stresses on the vascular structures. Muscle hypertrophy and fatigue-induced joint translation may incite impingement on critical neurovasculature and can cause vascular damage. A thorough evaluation is essential to establish the diagnosis in a timely fashion as presentation mimics more common musculoskeletal injuries. Conservative treatment includes equipment modification, motion analysis and adjustment, as well as equipment enhancement to limit exposure to blunt trauma or impingement. Surgical options include ligation, primary end-to-end anastomosis for small defects, and grafting.
Collapse
Affiliation(s)
- Tristan de Mooij
- Mayo Clinic, 200 1st Street South West, Rochester, MN 55905, USA
| | - Audra A Duncan
- Mayo Clinic, 200 1st Street South West, Rochester, MN 55905, USA
| | - Sanjeev Kakar
- Mayo Clinic, 200 1st Street South West, Rochester, MN 55905, USA.
| |
Collapse
|
18
|
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.
Collapse
|