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[Hypothenar hammer syndrome: A recurrent case report after surgery]
L Athlani1, Y K De Almeida1, H Maschino1
1Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHU de Nancy, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
Journal De Medecine Vasculaire
|September 16, 2018
Summary
Recurrent hypothenar hammer syndrome can occur years after initial surgery. Aneurysmal vein graft thrombosis led to ulnar nerve compression, requiring surgical resection and nerve decompression for symptom resolution.
Area of Science:
- Vascular Surgery
- Hand Surgery
- Neurology
Background:
- Hypothenar hammer syndrome (HHS) is a rare condition caused by ulnar artery damage, often due to repetitive hand-palm trauma.
- Surgical intervention for HHS is indicated for severe, medically resistant symptoms or when emboligenic lesions are identified.
Observation:
- A 60-year-old patient presented with recurrent HHS symptoms over 10 years post-surgery.
- Imaging revealed an aneurysmal, thrombosed vein graft occluding the ulnar artery and extending to the superficial palmar arch, causing ulnar nerve compression in Guyon's canal.
Findings:
- The patient's digital revascularization was maintained by the radial superficial palmar arch and collateral circulation.
- Surgical management involved resection of the thrombosed vein graft and decompression of the ulnar nerve without vascular reconstruction.
Implications:
- This case highlights a rare late complication of vein graft reconstruction for HHS.
- Successful surgical management achieved symptom resolution and nerve recovery, underscoring the importance of addressing both vascular and neurological components in recurrent cases.
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