Hypothenar Hammer Syndrome: A Rare Presentation. (2015) - Warnock, M.
Abstract : Hypothenar Hammer syndrome (HHS) is a rare vascular complication of repeated trauma to the palm of the hand. It is traditionally thought to be prevalent amongst labourers and craftsmen. In this case we report HHS as a result of long-term use of a walking aid in an 82 year-old female with a complex orthopaedic history, having had a left-sided hip replacement and revision surgery. She required long-term use of a right-sided walking stick and presented with pain and swelling in her right hypothenar eminence. An ultrasound scan suggested an aneurysm of the ulnar artery, in keeping with Hypothenar Hammer Syndrome. She proceeded to exploration of the hypothenar eminence, under general anaesthetic, where the aneurysm was ligated and excised. This is a rare condition, with most cases involving young males who suffer trauma to their palm in the course of their employment or by playing sports. Very few cases have been reported of a patient with a similar history, or causation linked to the use of a walking aid. Highlights: Hypothenar Hammer syndrome (HHS) is a rare vascular complication of repeated trauma to the palm of the hand. This is a case of HHS in an elderly female, related to repetitive palmar trauma due to long-term waking stick use. The pathophysiology of HHS is based upon the vascular anatomy of the ulnar artery as it enters the palm. Investigation includes Doppler assessment and angiography. Most studies advocate reconstructive surgery for the treatment of aneurysmal HHS and cases with evidence of ischaemia.