Review Question - QID 217889

Hypothenar hammer syndrome is a result of repetitive blunt trauma resulting in a true aneurysm or gradual dilation of all arterial layers.

Hypothenar hammer syndrome is most common in men and in those with occupations with repetitive trauma to the hypothenar area such as manual laborers, baseball catchers, and mountain bikers. It may result in either aneurysm or thrombosis of the ulnar artery. Patients typically have pain and cold sensitivity in their ulnar digits. Doppler ultrasound is the first diagnostic step, with angiography typically following a positive ultrasound. Conservative management is indicated in asymptomatic lesions without the threat of digit loss. Surgical options include ligation, endovascular fibrinolysis, direct repair, or vein grafting.

Ho et al. retrospectively reviewed their series of 30 aneurysms of the upper extremity. They found that false aneurysms develop from penetrating trauma, while true aneurysms develop after blunt trauma. They recommend early treatment, but the form of treatment should be individualized.

Demetri et al. retrospectively reviewed their outcomes following surgical treatment of hypothenar hammer syndrome. They identified 27 patients who underwent either ligation, direct repair, or vein grafting. There were no differences in outcomes between these three techniques. The most common complaint following surgery was persistent cold intolerance.

Incorrect Answers:

Answer 1: A digital brachial index of <0.7 traditionally necessitates reconstruction.
Answer 3: Outcomes following ligation, direct repair, and vein grafting have not been shown to be different.
Answer 4: Doppler ultrasound and digital brachial index measurements are the first steps in diagnosis.
Answer 5: The most common complication following surgery is persistent cold intolerance, regardless of the technique.