Abstract No. 500 Patterns of clinical history and angiography in hypothenar hammer syndrome: a case series

Abstract

Hypothenar Hammer Syndrome (HHS) is a rare syndrome that may be defined as damage to the palmar ulnar artery typically due to chronic, repetitive trauma. Clinical and imaging manifestations may include: aneurysm, pseudoaneurysm, thrombosis, microemboli, vasospasm, “corkscrew” vessels, stenosis, ectasia, pulsatile mass, and digital ischemia. While HHS is thought to be due to chronic, repetitive palmar trauma related to occupations such as mechanic, machinist, carpenter, and other workers who use vibrating tools, case reports of HHS stemming from acute isolated incidents have been described. This case series presents five patients who were diagnosed with HHS in order to examine trends in risk factors and clinical history leading to similar presentations. A chart review of all upper extremity angiograms from October 2003 to April 2018 was performed (n = 400). Angiography reports were reviewed if present in the electronic medical record to determine indications and findings of the studies. In cases where HHS could not be ruled out from the reports, follow-up clinic visits were reviewed to provide corroborative information. In total, 5 patients were found to have HHS. All five patients were middle-aged males with a history of repetitive occupational hand trauma, often from machinery-type jobs. Clinical presentations were similar among patients, involving some combination of digital numbness, pain, and discoloration. Two patients presented with an acute-on-chronic history, two patients had a distant acute trauma in addition to chronic occupational history, and one patient had only chronic, repetitive trauma with no acute inciting event. HHS can occur in the setting of isolated chronic trauma alone. However, this series shows the most common presentation of HHS to be associated with an acute event in the setting of chronic repetitive trauma.