Hypothenar hammer syndrome complicated by critical finger ischaemia in a fight sports instructor

Abstract

Hypothenar hammer syndrome (HHS) is a rare entity of arterial insufficiency to the hand and is seen in patients, especially men, with a history of repetitive blunt trauma to the hypothenar eminence. It is characterized by unilateral digital ischaemia of the dominating hand, which spares the thumb, with the most often manifestations being pain, paresthesias and cold intolerance. In advanced cases trophic skin changes and necrosis of the fingertips may develop. The diagnosis is verified by angiography, showing thrombosis or aneurysm of the distal ulnar artery. Treatment and prevention of HHS consists mainly of hand protection against mechanical injury and cessation of smoking. Anticoagulants, antiplatelet drugs, surgical revascularization and cervical sympathectomy may be useful in its management. Here we present the case of a fight sports instructor with critical right hand ischaemia in the course of HHS, in whom early diagnosis and treatment enabled almost complete remission of changes.