Working Diagnosis:
Right distal ulnar artery thrombosis
Treatment:
Given her gradual symptom onset and lack of critical digital limb ischemia, a trial of low-dose calcium channel blocker was recommended.
Outcome:
The patient chose to defer pharmacologic intervention and instead modified her activities and training regimen to avoid exacerbating movements.
Author's Comments:
Hypothenar hammer syndrome is an uncommon cause of vascular insufficiency of the hand due to ulnar artery trauma leading to thrombosis of aneurysm. As Raynaud's syndrome typically affects the digital arterioles but not the medium-sized vessels of the hand or wrist, the ulnar artery thrombosis was likely a separate entity.
Editor's Comments:
Hypothenar hammer syndrome is indeed a rare diagnosis. When initial imaging and examination findings do not warrant an answer advanced imaging is a consideration. Digital substraction angiography is the standard for diagnosis of hypothenar hammer syndrome. Treatment is mainly conservative.
References:
1. Zhang F, Weerakkody Y, Tosenovsky P. Hypothenar hammer syndrome in an office worker. J Med Imaging Radiat Oncol. 2017;61(6):774-776. doi:10.1111/1754-9485.12651
Return To The Case Studies List.