Therapeutic management of hypothenar hammer syndrome causing. In arterial thoracic outlet syndrome and vascular quadrilateral space syndrome, surgery is advocated in symptomatic individuals, with. The term hypothenar hammer syndrome hhs refers to the spectrum of abnormalities resulting in damage to the superficial palmar arch of the ulnar artery. Brown at, flores r, hamilton e, roberson pk, borrelli mj, culp wc. Understand the principles of prospective and retrospective cardiac gating. Ulnar artery thrombosis uat, or hypothenar hammer syndrome, occurs most commonly in manual laborers and highperformance athletes. Understand abdominal angiographic anatomy, as well as the pathophysiology and imaging manifestations of ischemia. Hypothenar hammer syndrome results from repetative trauma to the hand or wrist such as from using a hammer. Our radiology teaching file system tfs is free software developed under the rsna mirc project that gives users the ability to author, manage, store and share radiology teaching files locally or across institutions. We report 17 documented cases with longterm followup after diagnosis made on the basis of arte riography. This study was designed to assess the complications of angiography, including transfemoral, transaxillary, and translumbar approaches. In five patients with hypothenar hammer syndrome gdboptaenhanced elliptically reordered 3d pulse sequence mr was compared with oscillography findings and clinical symptoms focusing on angiographic appearance of. Feasibility of imaging superficial palmar arch using micro.
Image courtesy of the radiological society of north america rsna march 31, 2020 a brief article from henry ford health system in detroit, published today in radiology, reports on the first presumptive case of covid19 associated acute necrotizing hemorrhagic encephalopathy. Surgical management of hypothenar and thenar hammer. Hypothenar hammer syndrome is an uncommon cause of digital ischemia due to repeated compression of the ulnar artery against the hook of the hamate. We present a case of hhs for which pointofcare ultrasound pocus was used as the initial means of imaging, prompting management and disposition without further imaging studies ordered. Magnetic resonance imaging of breast vascularity in medial versus lateral breast cancer. Perfusion assessment with the spy system after arterial. Software based quantification of contrastenhanced ultrasound in focal liver lesionsa feasibility study. The parts of a system can be referred to as its elements or. Hypothenar hammer syndrome is a rare and often incorrectly diagnosed form of secondary raynauds phenomenon in workers who use their hand as a hammer. Issuu is a digital publishing platform that makes it simple to publish magazines, catalogs, newspapers, books, and more online. Hypothenar hammer syndrome is one such example, contributing to a high burden of morbidity in this population. Presented here is a case of a manual laborer who had symptoms of digital ischemia after acute hyperextension injury to the ring finger. Prevalence, risk factors, and clinical correlates of ulnar. Intimal injury, thrombosis, andor aneurysmal dilation occur when the artery is repeatedly crushed against the underlying bone.
Rutgers gelre ziekenhuizen, locatie lukas, department of surgery, postbus 9014, nl7300 ds. Ultrasound of peripheral nerves ultrasound video lecture. Our objective was to describe the imaging features of hypothenar hammer syndrome using minimally invasive contrastenhanced mr angiography in comparison with oscillography study. The palm of the hand is repeatedly used as a substitute for a. The condition is related to repeated impact at the hypothenar eminence as. Patients may be advised to wear a temporary splint or cast to immobilize the wrist and forearm for four to. Pointofcare ultrasound to identify distal ulnar artery. Hypothenar hammer syndrome hhs is a rare condition of distal ulnar artery injury and thrombosis secondary to repetitive blunt trauma to the hypothenar area. Hypothenar hammer syndrome definition of hypothenar hammer.
On the other hand, upper extremity imaging often entails venous imaging as well, especially in patients undergoing a preoperative imaging workup prior to creation of dialysis access. Alex chao, a vascular surgeon who died suddenly in 2003 at the age of 37 of severe acute respiratory syndrome sars acquired from a patient he had treated in singapore. Journals of harmonized research are devoted to the publication of original research papers in all areas of science and technology. Hypothenar hammer syndrome is an uncommon cause of upperextremity ischemia that is often overlooked in the absence of a thorough occupational and recreational history. Threedimensional electrocardiographically gated variable. Radiology teaching files university of rochester medical. Hypothenar or thenar hammer syndrome hhs and handarm vibration syndrome havs are diseases caused by acute or chronic trauma to the upper extremities. It usually occurs in middleaged men in occupations that involve repeated impaction of the hypothenar eminence eg, jackhammer operators, saddle makers.
This retrospective study assessed the results of treatment of 29 cases of hypothenar hammer syndrome and two cases of thenar hammer syndrome. Hypothenar hammer syndrome is an uncommon cause of symptomatic ischemia of the hand secondary to the formation of aneurysm or thrombosis of the ulnar artery as a result of repetitive trauma to the hypothenar region. Hypothenar hammer syndrome radiology reference article. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity.
Dependent on the mechanism of the trauma the clinical symptoms may appear late. Muscles stefano bianchi jeanlouis brasseur gerard morvan lionel pesquer dien hung luong introduction the elementary structure shared by every skeletal muscle is the myofiber, which is enveloped by a thin layer of connective tissue called the endomysium. First presented in 2004, this svu award is named in honor of dr. Apr 27, 2020 hypothenar hammer syndrome hhs is a rare occupationrelated condition describing either an aneurysm or thrombosis of the ulnar artery leading to upper arm ischemia.
Volume 16 issue 4 by western journal of emergency medicine. Genetically reengineered k562 cells significantly expand. The ulnar artery showed mural thrombi in its tortuous segment. Understand the pathophysiology and imaging findings of aortic dissection, traumatic aortic injury, intramural hematoma, and penetrating ulcer. Table of contents british journal of sports medicine. Hypothenar hammer syndrome interventional radiology. Hypothenar hammer syndrome hhs is a rare but treatable disease characterized by an aneurysm or occlusion of the arteries of the hand, typically the ulnar artery. Hypothenar hammer syndrome orthopaedicsone articles. By contrast, the raynaud phenomenon of the hypothenar hammer syndrome most often has a sudden onset, predominates on the dominant hand, and can be associated with ischemic skin lesions.
Journals of harmonized research provide researchers with continuing education in basic, advanced and innovative scientific research. Looking for online definition of hypothenar hammer syndrome in the medical dictionary. Though hypothenar hammer syndrome was suspected, there was no relevant occupational history. Anatomic findings and outcomes associated with upper. For faculty or fellow appointment updates and changes, please ask your appointing department to contact hms.
Dualenergy ct material density iodine quantification for distinguishing vascular from nonvascular renal lesions. There is no cotribution to the palmar arches by the ulnar artery. The clinical syndrome is hallmarked by unilateral finger ischemia caused by digital artery occlusions from ulnar artery emboli, and is associated with repetitive striking of the palm. There is a need to distinguish symptoms of hhs from those of classical havs since precise diagnosis may alter both the clinical and occupational. Hypothenar hammer syndrome disorder icd10cm alphabetical index references for i73. For imaging of both the upper and the lower arm, the relevant part was positioned between the two anterior and two posterior flexible arrays of the coil, while the hand was fixed in a sagittal position. Some of these muscles make up the fleshy edge of the palm hypothenar eminence. Sophia lin noninvasive vascular testing for diagnosis and management of hypothenar hammer syndrome 2014. Resources on hypothenar hammer syndrome and related topics in orthopaedicsone spaces. Originally described in patients using hammers and screwdrivers, it is also seen in various athletes such as basketball, handball, tennis and golf players. He was seen for 4 visits postoperatively which focused on splinting, scar mobilization, tendon gliding exercises, and wrist range of motion. Thrombosis of the ulnar artery at the carpal level with hypointense thrombus and perivascular inflammation.
Jan 08, 2016 figure 221 hypothenar hammer syndrome. Interleukin15 il15 and 41bbl are important modulators of nk expansion and functional activation. He was diagnosed with hypothenar hammer syndrome after ultrasound imaging showed significant vascular compromise of the fourth digit. Microbubbles improve sonothrombolysis in vitro and decrease hemorrhage in vivo in a rabbit stroke model. The radiologists reported on the complications of 118,591 examinations. Surgical management of hypothenar and thenar hammer syndromes. The parameters of the mixedeffects model were estimated with the use of sas proc mixed software. Visualizing atherosclerotic changes in small arteries such as the superficial palmar arch may provide valuable clinical. Specialties dental implantation imaging joint injections sports medicine trauma radiology locations loyola hospital loyola outpatient center loyola gottlieb memorial.
Diagnosis of the hypothenar hammer syndrome by high. Since both diseases are generally related to occupation and are recognised as occupational diseases in most countries, vascular physicians need to be able to distinguish between the two entities and differentiate them from other diagnoses. Perfusion assessment with the spy system after arterial veno. Computed tomography angiography of the extremities in.
This syndrome presents with distal upper extremity pain, hypothenar mass, and digital ischemia of the third through fifth digits. Use of doppler in the diagnosis of hypothenar hammer syndrome. A fracture of the pisiform bone or the hook of the hamate bone, osteoarthritis or osteochondromatosis of the pisotriquetral joint, guyon canal syndrome, hypothenar hammer syndrome, tendinopathy of the flexor carpi ulnaris, an anomalous muscle, a ganglion cyst, or a tumor may be responsible for ulnar neuropathy. Monteggia fracturecolorado radiology, denver radiologist. Grayscale and color doppler sonographic appearances we report a case of hypothenar hammer syndrome following a single severe blunt trauma in a 24year. Hypothenar hammer syndrome caused by recreational sports. The thrombosis secondary to to and hypothenar hammer syndrome may be relatively localized, whereas diffuse arterial thrombosis of the hand may occur secondary to intraarterial injection of medications or illegal substances. Utility of a computed tomography oral imaging software program for preoperative evaluation of head and neck. Hypothenar hammer syndrome occurs from trauma to the distal ulnar artery or proximal portion of superficial palmar arch as a result of repetitive trauma to the hypothenar eminence. Hypothalamohypophysial portal system definition of. We report the case of a 43yearsold man with a painful tumefaction of the left hypothenar region.
Hypothenar hammer syndrome hhs is an uncommon form of secondary raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a hammer. The hypothenar hammer syndrome is a traumatic occlusion of the distal arteria ulnaris. Overview of arterial pathology related to repetitive. Jaff, do is associate professor of medicine at harvard medical school and director of the vascular center at the massachusetts general hospital. Mar 22, 2010 hypothenar hammer syndrome hhs is caused by repetitive use of the hand as a hammer so that there is thrombosis of the superficial palmar arch of the ulnar artery. The system is intended to provide practice to physicians, fellows and residents in the interpreptation of radiological images from a variety of different cases. The series comprised 6 male patients mean age, 46 years who presented with upper extremity ischemia related to hypothenar hammer syndrome n 2, embolism with patent foramen ovale n 2, atherosclerosis n 1, and avulsion amputation of the thumb n 1. The initial treatment for both traumatic and degenerative tfcc lesions, with a stable druj, is conservative nonsurgical therapy. Magnetic resonance imaging and magnetic resonance angiography demonstrated an anomalous muscular sling around the ulnar artery immediately adjacent to the hook of the hamate. Color and power doppler allow accurate evaluation of the ulnar artery and its internal flow, thus differentiating nerve compression by the muscle from hypothenar hammer syndrome. Three hands were symptom free, 15 were improved, 11 were unchanged and two were worse at a mean followup of 43 range 460 months.
European journal of radiology vol 75, issue 2, pages e1. Svu scientific award winners society for vascular ultrasound. Interesting cases and teaching files from radiology cases used for educating faculty, fellows and residents. An update with algorithms for diagnosis and treatment. Normalization reduces intermanufacturer threshold variability. Hypothenar refers to the group of muscles that control the movement of the little finger. A specific angiographic or duplex sonographic diagnostic investigation is necessary to show the arterial occlusion. A digital subtraction arteriogram of the affected right hand shows occlusion of the ulnar artery at the wrist with emboli to the distal digital arteries of the fourth and fifth digits. Prevalence of ulnar artery thrombosis in orthopedic surgeons. Local representatives can answer questions about the profiles website or help with editing a profile or issues with profile data. Hypothenar hammer syndrome, a posttraumatic pathology arising from repetitive hitting of the hypothenar region of the hand, can cause ulnar artery occlusive disease with thromboembolism and resulting ischemia to the digits12. Hhs describes patients who experience signs and symptoms concerning for digital ischemia. Hypothenar hammer syndrome is a rare but serious cause of digital ischemia and morbidity.
Thomas walker harvard catalyst profiles harvard catalyst. Perfusion assessment with the spy system after arterial venous reversal for upper extremity ischemia. Hypothenar hammer syndrome how is hypothenar hammer. Venous enhancement may contaminate high spatial resolution arterial imaging when acquisition speeds that are too long or too slow are prescribed. Radiology publishes first case of covid19 encephalopathy.
There is trauma over the hook of hamate, where the superficial branch of the palmar artery lies. Presented at the 20 vascular annual meeting of the society for vascular surgery, san francisco, calif, may 30june 1, 20. Surgically, he underwent reconstruction of the ulnar artery. Scientific research organization irsst has released a pamphlet intended to help workers recognize hypothenar hammer syndrome. Three hands were symptom free, 15 were improved, 11 wer. Hypothenar hammer syndrome is most commonly observed in people exposed to acute blunt, vibratory, or repetitive chronic trauma to the hypothenar muscles like in carpal tunnel. Meaning of hypothenar hammer syndrome medical term. Ultrasound of peripheral nerves ultrasound video lecture by. Anatomic findings and outcomes associated with upper extremity arteriography and selective thrombolysis for acute finger ischemia. Detailed questionnaires were completed by radiologists at 514 of the 2,066 hospitals surveyed. The ulnar artery appeared thrombosed clinically and radiologically. Thenar hammer syndrome ths is a very rare condition in which the radial artery is injured by using the palm of the hand as a hammer.
Cts, cubital tunnel syndrome, cv, digital nerve, entrapment neuropathy, guyon canal, hypothenarhammer syndrome, median nerve, mortons neuroma, nerve compression. View the physician profile for laurie lomasney, md, who has clinical expertise in radiology at loyola medicine. Steigners phone number, address, insurance information, hospital affiliations and more. Us has become the imaging procedure of choice to evaluate pn pathology, pain in the ulnar nerve distribution right.
Normal anatomy of nerves, normal pn, us has become the imaging procedure of choice to evaluate pn pathology, pain in the ulnar nerve distribution right hand, etiology of peripheral nerve disorders, bifid median nerve, large median and ulnar nerves, traumatic nerve injuries, wrist pain 3 months after tfc repair, brachial plexus, brachial plexus injury, radial nerve. The hypothenar hammer syndrome is a rare traumatic vascular disease of the hand. Hypothenar hammer syndrome ulnar artery thrombosis treatment. Journal club educational tools ct scanning ct imaging. Typically, patients have a history of blunt trauma to the palmar hypothenar eminence of the hand. A fracture of the pisiform bone or the hook of the hamate bone, osteoarthritis or osteochondromatosis of the pisotriquetral joint, guyon canal syndrome, hypothenar hammer syndrome, tendinopathy of the. Hypothenar hammer syndrome is a traumatic injury diffuse or localized caused by compression of the ulnar artery hammered against the hook of hamate arterial insufficiency in hypothenar hammer syndrome is an urgent condition requiring urgent treatment, but usually the issue is an isolated thrombus, which may be managed conservatively. Risperidone in children with autism and serious behavioral.
Hypothenar hammer syndrome is a condition of the hand in which the blood flow to the fingers is reduced. Hypothenar hammer syndrome hhs is a lesion of the ulnar artery as it courses adjacent to the hamate bone and results from either single or repeated episodes of trauma to the hypothenar eminence. Hypothenar hammer syndrome raynauds syndrome thromboangiitis obliterans buergers disease digital artery aneurysm nail bed. Natural killer nk cells play a significant role in reducing relapse in patients with hematological malignancies after allogeneic stem cell transplantation, but nk cell number and naturally occurring inhibitory signals limit their capability. Dose optimization in computed tomography of brain using care kv and care dose 4d. Importantly, it is a reversible cause of hand ischemia that, if missed, can lead to significant morbidity and even amputation. He is an active clinical consultant in all aspects of vascular medicine, including peripheral arterial disease, venous thromboembolic disease, aneurysmal diseases, and all diagnostic strategies in vascular medicine. Peripheral vascular diseases harvard catalyst profiles.
249 131 1648 414 1254 876 1195 440 810 1572 382 1333 255 1201 606 923 441 1443 164 143 568 308 1309 1113 791 117 31 1691 192 1468 724 1195 237 1273 1262 1174 1383 863 984 1122 438