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Diagnosis of the hypothenar hammer syndrome by high-resolution contrast-enhanced MR angiography
J T Winterer1, N Ghanem, M Roth
1Department of Diagnostic Radiology, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. winterja@ruf.uni-freiburg.de
Abstract:
Our objective was to describe the imaging features of hypothenar hammer syndrome using minimally invasive contrast-enhanced MR angiography in comparison with oscillography study. In five patients with hypothenar hammer syndrome Gd-BOPTA-enhanced elliptically reordered 3D pulse sequence MR was compared with oscillography findings and clinical symptoms focusing on angiographic appearance of vessel injury, distribution pattern of hand vasculature and joining branches between the radial and ulnar artery supply. All patients showed segmental occlusion at the site of trauma impact with varying involvement of the superficial palmar arch, common volar digital arteries. Embolic disease was present in 50% of patients and could be clearly identified with MRA. Good correspondence was found between angiographic appearance including the presence of collaterals, clinical symptoms and oscillography. Bilateral comparison was helpful in distinguishing between vessel variants and pathology. Bilateral Gd-BOPTA-enhanced MR angiography is a minimally invasive method to depict clearly the localization and extent of vessel injury in hypothenar hammer syndrome providing valuable information about distribution pattern of hand vasculature and presence of collaterals; however, no flow data can be obtained.
Insights
Hypothenar hammer syndrome imaging is best visualized with contrast-enhanced MR angiography, which clearly shows vessel injury and hand vasculature patterns. This method aids in distinguishing pathology from normal variations, offering valuable diagnostic insights.
Area of Science:
- Radiology
- Vascular Imaging
- Musculoskeletal Imaging
Background:
- Hypothenar hammer syndrome (HHS) is a condition affecting the blood vessels in the hand.
- Accurate imaging is crucial for diagnosis and management.
Purpose of the Study:
- To describe the imaging features of HHS using contrast-enhanced MR angiography.
- To compare MR angiography findings with oscillography and clinical symptoms.
Main Methods:
- Five patients with HHS underwent Gd-BOPTA-enhanced MR angiography.
- MR angiography was compared with oscillography findings and clinical presentation.
- Focus on angiographic appearance, vessel injury, and hand vasculature patterns.
Main Results:
- MR angiography clearly identified segmental occlusion at trauma sites, affecting the superficial palmar arch and digital arteries.
- Embolic disease was present in 50% of patients and visualized with MRA.
- Good correlation found between MRA, clinical symptoms, and oscillography.
Conclusions:
- Bilateral Gd-BOPTA-enhanced MR angiography is a minimally invasive method for depicting vessel injury in HHS.
- It provides valuable information on hand vasculature distribution and collateral presence.
- MRA is effective for differentiating pathology from vessel variants but does not provide flow data.
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