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Surgical Management of Hypothenar Hammer Syndrome

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ABSTRACT

Hypothenar hammer syndrome results from thrombosis of the ulnar artery at the wrist due to repetitive trauma to the ulnar aspect of the hand. It typically occurs in laborers and results in symptoms of pain, cold, cyanosis, and possibly digital ischemia due to the showering of emboli. A retrospective chart review and phone survey was conducted of all patients at our institution diagnosed with hypothenar hammer syndrome to determine the long-term outcome of surgical intervention in the treatment of hypothenar hammer syndrome. Patients with systemic vasculitis or Raynaud’s syndrome were excluded.

From 1976-2003, 66 patients (65 men and 1 woman) underwent a surgical procedure to improve the symptoms of hypothenar hammer syndrome. Age at diagnosis ranged from 21-68 years. Thirty-six patients underwent excision of the thrombus with ulnar artery reconstruction using saphenous vein graft, 13 patients had reconstruction with cephalic vein grafts, 6 patients had primary anastomosis after excision of the thrombus, 9 patients had ulnar artery ligation, and 1 patient had a thoracic sympathectomy. Follow-up ranged from 1 month to 26 years.

Thirty-four patients (95%) patients who underwent excision with saphenous vein graft reconstruction reported complete resolution of symptoms or improvement in symptoms. All patients with primary anastomosis also reported complete resolution or improvement in their symptoms. Only 46% (6/13) of patients undergoing ulnar artery reconstruction with cephalic vein graft had symptom improvement or resolution postoperatively and a 41% (4/13) known occlusion rate was noted. In patients who had ulnar artery ligation, 67% (6/9) had no change in preoperative symptoms or experienced symptom worsening. The single patient treated by thoracic sympathectomy had a phrenic nerve injury and no change in preoperative symptoms.

Although these surgical results need to be compared to conservative or medical treatment of hypothenar hammer syndrome, based on this review, we recommend surgical excision of the ulnar artery thrombosis with reconstruction using saphenous vein graft for hypothenar hammer syndrome treatment.