Mateusz Gładysz FESSH prep

FESSH prep Microsurgery

Hypothenar hammer syndrome and ulnar artery thrombosis

Last reviewed v1.0

FESSH-104Microsurgery●●○ intermediate

Regarding hypothenar hammer syndrome:

  1. 1.The superficial palmar branch of the ulnar artery is injured against the hook of the hamate in Guyon's canal, causing occlusion or aneurysm.

  2. 2.In a multicentre case–control study, daily exposure to vibrating tools was not a significant risk factor for hypothenar hammer syndrome.

  3. 3.The clinical manifestations of hypothenar hammer syndrome are usually unilateral and involve the dominant hand.

  4. 4.Ulnar artery occlusion and embolic occlusion of the digital arteries are both common angiographic findings in hypothenar hammer syndrome.

  5. 5.On angiography, a 'string-of-beads' appearance of the palmar ulnar artery is diagnostic of fibromuscular dysplasia.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-104
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. The superficial palmar branch of the ulnar artery is injured against the hook of the hamate in Guyon's canal, causing occlusion or aneurysm.

    True

    Marie and colleagues describe the mechanism: in people who use the hypothenar part of the hand as a hammer, the hook of the hamate strikes the superficial palmar branch of the ulnar artery in Guyon's space, causing occlusion or aneurysm and, in turn, digital artery occlusion. In their series of 47 patients, 91.5% had occupational exposure to repetitive palmar trauma.

    • Marie I, Hervé F, Primard E, Cailleux N, Levesque H. Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients. Medicine (Baltimore). 2007;86(6):334-343. PMID 18004178

  2. 2. In a multicentre case–control study, daily exposure to vibrating tools was not a significant risk factor for hypothenar hammer syndrome.

    False

    Scharnbacher and colleagues compared 71 patients with 105 matched controls. In multivariable analysis, daily exposure to vibrating tools was a significant risk factor (adjusted odds ratio 3.41, 95% confidence interval 1.03–11.31), as were daily pressure on the palm (4.96) and, most strongly, daily use of the hand as a hammer (17.04).

    • Scharnbacher J, Claus M, Reichert J, Röhrl T, Hoffmann U, Ulm K, et al.. Hypothenar hammer syndrome: a multicenter case-control study. Am J Ind Med. 2013;56(11):1352-8. PMID 24038322

  3. 3. The clinical manifestations of hypothenar hammer syndrome are usually unilateral and involve the dominant hand.

    True

    In Marie and colleagues' series of 47 patients, manifestations were unilateral in 87.2% and involved the dominant hand in 93%. Ferris and colleagues nevertheless found similar arteriographic changes in the asymptomatic contralateral hand in 12 of the 13 patients who had bilateral studies.

    • Marie I, Hervé F, Primard E, Cailleux N, Levesque H. Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients. Medicine (Baltimore). 2007;86(6):334-343. PMID 18004178
    • Ferris BL, Taylor LM, Oyama K, McLafferty RB, Edwards JM, Moneta GL, et al.. Hypothenar hammer syndrome: proposed etiology. J Vasc Surg. 2000;31(1 Pt 1):104-13. PMID 10642713

  4. 4. Ulnar artery occlusion and embolic occlusion of the digital arteries are both common angiographic findings in hypothenar hammer syndrome.

    True

    In Larsen and colleagues' 67 surgically treated patients, angiography showed ulnar artery occlusion and digital emboli in 89% each, with irregularity or tortuosity in about half. In Marie and colleagues' series, angiography showed ulnar artery occlusion in the region of Guyon's space in 59.6%, aneurysm in 40.4% and multiple embolic digital artery occlusions in 57.4%.

    • Larsen BT, Edwards WD, Jensen MH, Johnson CH, McBane RD, Harmsen WS, et al.. Surgical pathology of hypothenar hammer syndrome with new pathogenetic insights: A 25-year institutional experience with clinical and pathologic review of 67 cases. Am J Surg Pathol. 2013;37(11):1700-8. PMID 23887165
    • Marie I, Hervé F, Primard E, Cailleux N, Levesque H. Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients. Medicine (Baltimore). 2007;86(6):334-343. PMID 18004178

  5. 5. On angiography, a 'string-of-beads' appearance of the palmar ulnar artery is diagnostic of fibromuscular dysplasia.

    False

    Ferris and colleagues proposed that hypothenar hammer syndrome arises when repetitive trauma affects an ulnar artery with pre-existing fibrodysplasia. In Larsen and colleagues' pathology review of 67 patients, however, specific dysplastic features were present in only 15% of cases and typical fibromuscular dysplasia was not found; the authors caution that in this superficial site a string-of-beads appearance may simply reflect a post-traumatic corkscrew deformity.

    • Larsen BT, Edwards WD, Jensen MH, Johnson CH, McBane RD, Harmsen WS, et al.. Surgical pathology of hypothenar hammer syndrome with new pathogenetic insights: A 25-year institutional experience with clinical and pathologic review of 67 cases. Am J Surg Pathol. 2013;37(11):1700-8. PMID 23887165
    • Ferris BL, Taylor LM, Oyama K, McLafferty RB, Edwards JM, Moneta GL, et al.. Hypothenar hammer syndrome: proposed etiology. J Vasc Surg. 2000;31(1 Pt 1):104-13. PMID 10642713