CASE 22 A 34-year-old carpenter presented to his family physician with complaints of right hand pain and numbness. On physical exam, the fourth and fifth digits were cold and pale. An Allen’s test was performed with the wrist and fingers in mild flexion and revealed no apparent flow through the ulnar artery. Figure 22-1 Hypothenar hammer syndrome. (A) Digital subtraction arteriogram of the affected right hand shows occlusion of the ulnar artery at the wrist with emboli to the distal digital arteries of the fourth and fifth digits. (B) Digital subtraction angiogram of the unaffected left hand shows typical “corkscrew” configuration of the ulnar artery at the wrist, suggesting fibrous dysplasia. The patient was referred to interventional radiology for arteriography. The right common femoral artery was punctured using the Seldinger technique and a 5-French (F) sheath was inserted. A pigtail catheter was advanced into the aortic arch and an aortogram was performed (not shown) which was normal. The right axillary artery was selectively catheterized using an H1H catheter (Boston Scientific, Natick, Massachusetts) and arteriography of the arm and hand was performed. Views of the upper arm and forearm were normal. At the level of the wrist, there was an abrupt termination of the ulnar artery and of the distal digital arteries in the fourth and fifth fingers (Fig. 22-1A). These findings persisted after administration of 25 mg of papaverine. Arteriography of the left arm was normal with the exception of a “corkscrew” configuration of the distal ulnar artery at the level of the wrist (Fig. 22-1B). Hypothenar hammer syndrome. The patient was taken to the operating room, and the affected segment of ulnar vein was resected. Vein bypass was performed.
Clinical Presentation
Radiologic Studies
Diagnosis
Treatment
Equipment
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
