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Case report
Diagnosis of hypothenar hammer syndrome in a patient with acute ulnar artery occlusion
  1. Frederique St-Pierre1,
  2. Roger F Shepherd2 and
  3. Matthew Asher Bartlett1
  1. 1 Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
  2. 2 Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
  1. Correspondence to Dr Matthew Asher Bartlett, bartlett.matthew{at}


A 56-year-old truck driver with a history of tobacco use presented with acute onset digital ischaemia in the ulnar distribution of his dominant hand, associated with severe pain. Occupational exposures included extensive manual labour and prolonged vibratory stimuli. Workup with Doppler and angiography confirmed the diagnosis of hypothenar hammer syndrome (HHS). After the failure of medical management, he underwent ulnar artery thrombectomy with reconstruction and arterial bypass grafting. His pain improved significantly postsurgically, and he was able to return to a normal routine. This case illustrates the classic presentation, examination, imaging findings and management options of HHS. HHS should be considered in patients with digital ischaemia and associated occupational exposures. Diagnosing the condition appropriately allows for optimal management, aiming at minimising symptoms and maximising quality of life.

  • haematology (incl blood transfusion)
  • general practice/family medicine
  • occupational and environmental medicine

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  • Contributors FS-P: review of the literature, information gathering, primary writer of the manuscript. MAB and RFS: significant participation to the intellectual content of the manuscript and review of the text.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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