A 43-year-old man presented with no relevant past medical, family or social history except for 1 pack-a-day tobacco use.
Several-week history of right fourth- or fifth-digit coolness, pain, and ulceration of fourth digit.
Patient's occupation was manual labor.
His physical examination showed the following:
There were 2+ carotid, brachial, radial, femoral, popliteal, and pedal pulses. He did not have an ulnar pulse on the right side.
He had ischemia of his right fourth and fifth fingers, with decreased capillary refill, and there was a dry, and ischemic ulceration over the nail bed laterally on the fourth finger. No signs of infection were present.
A Doppler signal was present over the palmar arch until the radial artery was manually compressed.
Repetitive use of the palm of the hand in activities that include pounding and pushing.
Anatomic site of injury to the ulnar artery is in the hypothenar eminence (Figure 19-1). The terminal branches of the ulnar artery arise in a groove that is bounded medially by the hamate bone.
As the distal ulnar artery lies superficially in the palm, it is covered for approximately 2 cm by only the skin, subcutaneous tissue, and the palmaris brevis muscle. Therefore, pounding and pushing of the hand causes the ulnar artery to hit the hamate bone repeatedly.
When this area is repeatedly traumatized, ulnar or digital spasm, aneurysms, occlusion, or a combination of these can result.
Schematic showing the mechanism of ulnar artery injury (upper inset) in a patient with hypothenar hammer syndrome. The lower inset shows that the terminus of the ulnar artery is susceptible to injury because of its proximity to the hamate bone. (Modified from Eskandari MK. Occupational vascular problems. In: Cronenwett JL, Johnston KW, eds. Rutherford's Vascular Surgery. 7th ed. Philadelphia, PA: Saunders-Elsevier; 2010.)
Intimal damage results in thrombotic occlusion. Damage to the media results in palmar aneurysms.
Fourth digit is most often involved.
Differentiated from Raynaud phenomenon by the lack of tricolor changes and sometimes absence of thumb involvement.
Suggested by history and physical examination.
Arteriography defines lesion, rules out other causes, and possibly can be therapeutic (Figures 19-2,19-3,19-4,19-5, and 19-6).
Contrast injection into brachiocephalic artery revealing no stenosis in main brachiocephalic artery or proximal right common carotid or proximal right subclavian arteries.
Normal right subclavian-axillary artery angiogram.
Normal right brachial artery bifurcating into normal proximal radial and ulnar arteries.
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessCardiology Full Site: One-Year Subscription
Connect to the full suite of AccessCardiology content and resources including textbooks such as Hurst's the Heart and Cardiology Clinical Questions, a unique library of multimedia, including heart imaging, an integrated drug database, and more.
Pay Per View: Timed Access to all of AccessCardiology
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.