Long-term results of surgical treatment for hypothenar hammer syndrome

Ulnar artery occlusion at the wrist and proximal palm can cause debilitating pain and tissue loss. There is disagreement in the literature as to whether the diseased ulnar artery needs to be reconstructed or merely resected. The authors report the long-term outcomes of patients treated surgically with reconstruction of the ulnar artery.

The long-term outcomes of 14 patients treated for this condition were evaluated. Comparisons of late postoperative to preoperative and early postoperative measurements were performed for digital brachial index. Subjective symptoms and function impairment were compared for preoperative and postoperative states using validated questionnaires. Comparisons were also made based on ulnar artery patency versus occlusion at late postoperative measurement.

Two patients underwent excision of the thrombosed segment and direct ulnar artery repair. All reconstructions were performed using vein grafts. Eight reconstructions remained patent at a mean 52 months postoperatively. All patients had a mean improvement in digital brachial index (0.82 versus 0.70), decrease in pain and dysesthesia symptoms, and decrease in cold intolerance compared with preoperatively. Patients with ulnar artery occlusion at final measurement had more improvement in digital brachial index (0.19 versus 0.03) and tended to have better subjective improvement in symptoms and function than those whose ulnar artery remained patent.

Ulnar artery reconstruction in the setting of hypothenar hammer syndrome results in immediate and long-term improvement of commonly used objective and subjective measurements of digital blood flow. Interestingly, long-term follow-up demonstrates superior endpoints in those reconstructions that occluded. A proposed mechanism to explain this phenomenon is presented.