Digital Hypothenar Hammer Syndrome.
Daniel J. Bodmer , Michael L. Steigner
A 59-year-old man presented to the emergency department with 2 weeks of pain and numbness in the left fourth and fifth fingers. The distal fourth finger was cold and cyanotic at physical examination. Notably, the patient worked as a mechanic and smoked tobacco. CT angiography with three-dimensional reconstruction of the left hand (Figure, A) showed occlusion of the fourth and fifth proper palmar digital arteries (arrowheads) and a corkscrew configuration of the ulnar artery (arrow), characteristics of hypothenar hammer syndrome (1,2). Hypothenar hammer syndrome is an uncommon cause of digital ischemia due to repeated compression of the ulnar artery against the hook of the hamate. It usually occurs in middle-aged men in occupations that involve repeated impaction of the hypothenar eminence (eg, jackhammer operators, saddle makers). Imaging findings include digital thromboembolism and ulnar artery occlusion, corkscrew, and aneurysm. Treatment involves surgical resection of the corkscrew segment of the ulnar artery, which helps restore flow to the fourth and fifth digits.