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A 45-year-old man was frequently bothered by a weakness of the right hand, and it was difficult for him to do adduction of the thumb for half a year. According to his presentation, the patient held his child by the right upper limb with wrist flexion habitually for a year. Besides, there was an obvious atrophy of the hypothenar eminence. In MRI image, there were two lobulated cyst lesions in the Guyon’s canal between the right hook of the hamate bone and the abductor digiti minimi muscle. During the surgery, the two lobulated cysts were in the Guyon’s canal, and the ulnar nerve was compressed. Three weeks after the tumor excision, the weakness of the right hand improved dramatically, and the patient could perform adduction of the right thumb to pinch paper easily without flexion of the interphalangeal joint.

Aims Nurses' hand temperature may affect patient comfort but has not been investigated. This study aimed to determine female hospital nurses' hand skin temperature and clarify the effects of measurement site, time, nursing procedures, and environment. Design An observational study. Methods The middle finger, thenar eminence, hypothenar eminence, and medial forearm skin temperature of 29 female hospital nurses was measured at four time points during a day shift and before and after nursing procedures (hand disinfection, hand washing, taking vital signs, hygiene care, and positioning). Results Mean hand skin temperature was in the range of 29-32°C with interpersonal variations. Mean skin temperature at the medial forearm was 31.94-32.35°C (SD 0.87-1.52°C) and at the middle finger, 29.73-31.07°C (SD > 3°C). Time-dependent skin temperature fluctuations were confirmed on the middle finger (p = .022), and thenar (p = .005) and hypothenar eminence (p = .001). There were weak correlations between skin temperature and environmental factors, including ambient temperature (ρ = .194-.266), humidity (ρ = -.309 to -.319), and hospital room wind speed (ρ = .253-.314). The skin temperature dropped significantly after hand disinfection and handwashing at all measurement sites (middle finger: -1.30 and -3.56°C, respectively; thenar eminence: -1.19 and -3.32°C; hypothenar eminence: -0.80 and -3.39°C; medial forearm: -0.21 and -1.60°C). Conclusion These findings may raise nurses' awareness of their skin temperature. Moreover, our study highlights the need to develop countermeasures to ensure optimal nurses' skin temperature and patient comfort.

Ulnar artery aneurysm is very rare in infancy. Only a few reports have been done. We report an 8-month-old baby with true ulnar artery aneurysm on her hypothenar eminence. She had no specific past medical history, but an episode of falling. We resected the pulsating mass compressing the ulnar nerve, utilizing a surgical microscope. Reconstruction of the vascular deficit was not performed. She presented no functional deficit of the hand and no evidence of growth disturbance so far. As hypothenar eminence is a susceptible part for repetitive strikes, and as vein is fragile to the pressure, bypassing arterial route with vein graft is not recommended unless there is no other option.

The abductor digiti quinti flap for thumb hypoplasia has been used in its muscular variant as musculocutaneous flap. Several authors have reported myocutaneous branches in the proximal hypothenar region which would vascularize the skin segment covering the hypothenar muscles. Nevertheless, the presence of a cutaneous branch deep palmar artery (CBDPA) vascularizing the proximal hypothenar territory and possibly responsible for the proximal hypothenar cutaneous vascularization was reported. In this paper, a fasciocutaneous hypothenar flap was designed, based on the CBDPA, transposed to the wrist anterior region for the treatment of a post burn contracture which was limiting the wrist extension. Its viability was assessed. The flap had a lozenge-shaped design from the cutaneous fold of the wrist to the fifth metacarpophalangeal joint over the abductor digiti quinti muscle. It was dissected in the fasciocutaneous plane to a width of 20 mm. The adipose tissue zone 10 mm distal to the pisiform was preserved, as well as the ulnar nerve sensory branch crossing the flap longitudinally. The flap was transposed to the anterior fold of the wrist. Neither the flap nor the donor site underwent complications. The patient improved wrist extension without referring any discomfort. Sensitivity was 8 mm 2 months after surgery compared to 6 mm within the preoperative period. In conclusion, it is possible to develop a proximal fasciocutaneous hypothenar flap based on CBDPA involving the proximal and distal hypothenar territory.

Background: Fingertip is the most commonly injured area of the hand. The two most commonly advocated flaps for fingertip reconstructions are cross finger flap and thenar flap. There is another flap, raised from the middle of the palm, midway between thenar and hypothenar eminence, called the mid palmar flap which never became popular because of inherent drawback of causing extensive joint contractures. To overcome the problem of joint contractures we added extra 5 mm to the length of flap and separated it by 14 days. Aims and Objectives: This study was conducted to review the outcome, in terms of joint contracture and scar aesthetics in middle finger tip injuries covered with modified Mid palmar flap. Material and Methods: The present study was done in the Department of Plastic Surgery, at Dayanand Medical College & Hospital, Ludhiana, Punjab. Various variables analysed were age, sex, mode of injury, hand dominance, associated fractures and exposed bone. All cases were done under local anaesthesia. Time to division ranged from 12- 14 days. Results: A total of 12 patients were included in this study. The mean age of patients was 35 years. The most common mode was accidental machine injury. The dominant hand (right) was injured in 5 patients. There was associated distal phalanx fracture in 5 patients. There was exposed bone in 7 patients. There was no reported case of hypertrophic scarring at donor site. Scar tenderness was there in 3 of the 12 patients and it persisted for maximum of 6 weeks. PIP and DIP joint stiffness was there for initial 10 days. Conclusion: For middle finger tip injuries, mid palmar flap, with modifications as described, could be better than thenar flap.

A healthy 17-year-old baseball player presented with a 2-year history of right elbow pain and hand weakness. He first noticed pain on the lateral aspect of his right elbow exacerbated by movement and heavy lifting. Following a 4-month period of rest and physical therapy, he resumed playing baseball. Shortly thereafter, he developed the same right elbow pain, but also felt that his right grip was getting progressively weaker. With repetitive flexion at the elbow, he would feel a “snap” that caused tingling down his forearm. His right hand felt cooler than his left and his grip strength seemed weaker when in cold weather. He otherwise denied neck pain, bowel/bladder dysfunction, fasciculations, and cramps. He did not notice any weakness or sensory change in his other extremities. There was no antecedent trauma, infection, or vaccination. He did not take medications or use illegal substances. Family history was unremarkable. His neurologic examination revealed intact cranial nerves. His tone and bulk were normal except for mild atrophy of his right hypothenar eminence and the ulnar side of his distal forearm (figure 1), which is known as the reverse split hand sign.1 Passive flexion of the right elbow caused tingling down his forearm. Finger adduction in addition to fifth digit flexion and abduction were 4/5. There were no fasciculations. His reflexes were 2+ throughout. There was no sensory disturbance in either hand. The remainder of his examination including gait and coordination were normal.

A 26-year-old, right-handed male professional hockey player presented for a second opinion with dysesthesia of the tips of his right third, fourth, and fifth fingers after 2 previous incidents of hyperextension injuries to his right wrist while holding his hockey stick. Radiographs and computed tomography scans were negative for fracture. After magnetic resonance angiography and Doppler ultrasound imaging, the athlete was diagnosed with hypothenar hammer syndrome (HHS) with ulnar artery aneurysm and thrombosis. He underwent successful surgery with ligation and excision of the aneurysmal, thrombosed ulnar artery and was able to return to hockey 4 weeks after surgery. HHS is thought to be a rare posttraumatic digital ischemia from thrombosis and/or aneurysm of the ulnar artery and was traditionally considered an occupational injury but has been reported more frequently among athletes. There have only been 2 previous case reports of hockey players diagnosed with HHS, and in the previous 2 case reports, both involved repetitive trauma from the hockey stick, which resulted in thrombotic HHS. We present a case of a professional hockey player diagnosed with HHS also due to repetitive trauma from the hockey stick, but this time resulting in aneurysmal HHS with thromboembolism. This case report highlights the importance of keeping HHS in the differential diagnosis in athletes with pain, cold sensitivity, and paresthesia in their fingers with or without a clear history of repetitive trauma to the hypothenar eminence, as HHS is a condition with good outcomes after proper treatment.

INTRODUCTION: Published normal transcutaneous oxygen partial pressures (P(tc)O(2)) for the chest and lower limb have defined tissue hypoxia as a value of < 40 mmHg (< 30 mmHg in some patients, < 50 mmHg in others). AIM: To determine 'normal' P(tc)O(2) for the upper and lower limb in healthy, non-smoking adults using the Radiometer® TCM400 with tc Sensor E5250. METHODS: Thirty-two volunteers had transcutaneous oxygen measurements (TCOM) performed on the chest, upper and lower limbs breathing air, with leg then arm elevated and whilst breathing 100% oxygen. RESULTS: Room-air P(tc)O(2) (mmHg, mean (95% confidence interval)) were: chest: 53.6 (48.7–58.5); upper arm: 60.0 (56.1−64.0); forearm: 52.3 (44.8–55.8); dorsum of hand: 50.2 (46.1–54.3); thenar eminence: 70.8 (67.7–73.8); hypothenar eminence: 77.9 (75.1–80.7); lateral leg: 50.2 (46.2–54.2); lateral malleolus: 50.5 (46.6–54.3); medial malleolus: 48.9 (45.6–52.1); dorsum, between first and second toe: 53.1 (49.2–57.0); dorsum, proximal to fifth toe: 58.5 (55.0–62.0); plantar, 1st MTP: 73.7 (70.3–77.1). Nineteen subjects had at least one room-air P(tc)O(2) below 40 mmHg (nine upper limb, 13 lower limb, four chest). Approximately 10% lower limb P(tc)O(2) were < 100 mmHg on normobaric oxygen. Only one subject at one site had an upper limb P(tc)O(2) < 100 mmHg breathing oxygen. CONCLUSION: The broad dispersion in P(tc)O(2) in our healthy cohort reflects the inherent biologic variability in dermal perfusion and oxygen delivery, making it difficult to define narrow, rigid 'normal' values. Thus, we cannot recommend a single P(tc)O(2) value as 'normal' for the upper or lower limb. A thorough patient assessment is essential to establish appropriateness for hyperbaric oxygen therapy, with TCOM used as an aid to guide this decision and not as an absolute.

Hypothenar hammer syndrome is an uncommon injury of the ulnar artery in its passage through Guyon's canal, and has been associated with repetitive trauma. Its diagnosis requires of a high level of suspicion and a careful clinical interview. The appropriate treatment is not well defined in the literature, ranging widely from medical treatment to reconstructive surgery. A clinical case is presented of a 52 year-old healthy male, who presented with numbness of his fourth and fifth fingers after a trauma at the hypothenar eminence. The Allen test highlighted an absence of vascularisation from the ulnar artery, thus suspecting an ulnar artery thrombosis, which was later confirmed by angio-MRI. The thrombosed segment was resected and a by-pass with a forearm vein was performed to reconstruct the distal arterial flow, presenting with a good functional outcome at 6months follow-up.

This is a case study of a patient who was presented to the emergency room with ischemia of the left third, fourth and fifth fingers and a pulsatile mass in the hypothenar eminence. Non-invasive arterial exam of the upper extremities was performed bilaterally which resulted in normal pressures and normal blood flow velocities. The arterial duplex imaging was also normal in the subclavian, axillary, brachial, radial and ulnar arteries and also demonstrated triphasic Doppler flow velocities. The technologist scanned distal to the wrist where a branch of the ulnar artery along with the aspect of the palmer arch surface revealed a true aneuryms with both antegrade and retrograde flow. The patient was infused tissue plasminogen activator (TPA) for a total of 72 hours with eventual recanalization of the thrombosed aneurysm. Due to the high risk of limb threat the patient underwent a successful resection of the left ulnar artery aneurysm with vein patch.

A man in his late 40s presented to his general practitioner with a history of skin changes and two lumps in his left hand, which had been present for several years. He thought the symptoms were from repeated trauma after carrying heavy buckets as part of his job. The nodular lumps had recently increased in size. In the months before referral, the patient began to experience a severe burning sensation in the nodules in his hand, which interrupted his sleep. Examination of the hand revealed an area of skin tethering with a palpable thickening deep to it in the palm over the hypothenar eminence (fig 1, fig 2). Two small erythematous lumps were found, one proximal to the main lesion at the wrist crease and another on the ulnar border of the hypothenar eminence. In addition, the patient had numbness over the ulnar border of the hand, little finger, and half of the ring finger, and weakness in the intrinsic muscles of the hand (palmar and dorsal interossei). He …

Pisotriquetral (PT) osteoarthritis (OA) and enthesopathy of the flexor carpi ulnaris (FCU) are pathologies of the hypothenar eminence which both often remain undiagnosed, but can cause ulnar wrist pain. This study determined the prevalence of these pathologies in an older donor population. Twenty wrists were obtained from 10 cadavers with an age ranging from 65 to 94 years. Radiographs were taken of all wrists with the hand in pisotriquetral view and were assessed for osteoarthritic changes of the PT joint and signs of enthesopathy of the FCU. Ten wrists were grossly dissected and the other ten wrists were sagitally sectioned at a thickness of 10 μm. The wrists were analyzed for type and grade of osteoarthritis and signs of enthesopathy. On radiology, 2 out of 20 wrists showed no signs of osteoarthritis, 5 wrists showed severe changes. One wrist showed signs of enthesopathy. On macroscopy, 9 out of 10 wrists showed osteoartritic changes; 5 of these were severely osteoarthritic. On microscopy, all wrists showed some degree of osteoarthritis of which five showed severe changes. Signs of enthesopathy were seen in seven wrists. Pisotriquetral osteoarthritis has a high prevalence in the older donor population and may therefore be a cause of ulnar sided wrist pain. It should therefore always be considered in the differential diagnosis of ulnar sided wrist pain. By performing clinical examination with these pathologies in mind, diagnosis could be a lot faster. Furthermore, based on our results, radiographs seem to be not accurate in diagnosing osteoarthritis of the PT joint and enthesopathy of the FCU.

Intramuscular hemangiomas are benign vascular tumors. They develop in striated muscles. Various sites have been reported in the literature but only rarely in the hand. We report on a case of an intramuscular hemangioma located within the hypothenar eminence, diagnosed by a biopsy. Treatment options are limited in the hand as embolization may lead to a risk of digital ischemia and sclerotherapy may lead to recurrence. This type of infiltrating tumor is poorly structured within the muscle, thus simple removal is not an option. Surgical excision of the entire affected muscle, in our case the abductor digiti minimi, was performed without any consequences on the hand's function and no signs of recurrence at the latest follow-up of 6months.

Hypothenar hammer syndrome (HHS) is an uncommon cause of unilateral Raynaud's phenomenon, splinter haemorrhages and hypothenar weakness. The typical patient is a male blue-collar worker who uses their hypothenar eminence to hammer objects as part of their work. The distal ulnar artery beyond Guyon's canal is superficial and vulnerable to blunt trauma. CTA and MRA are common initial investigations and can suggest the diagnosis. DSA is the gold standard imaging modality and offers therapeutic opportunities. Management is controversial, but unless there is critical digital ischaemia, conservative treatment is first line.

Most of the accessory muscles of the forearm described in the radiology literature are located either in the radial aspect of the forearm or towards the hypothenar eminence. We present an unusual case of an ulnar-sided distal forearm accessory flexor carpi ulnaris muscle presenting as a “pseudotumour“ demonstrated with both ultrasound and MRI, rarely reported in the current surgical and anatomical literature. Given the location and relation to the ulnar nerve towards Guyon’s canal, the accessory muscle may also predispose to distal ulnar nerve entrapment.

BACKGROUND Hypothenar hammer syndrome is a rare vascular lesion of the distal ulnar artery in Guyon tunnel caused by acute or repetitive blunt trauma to the hypothenar eminence. Described treatment options vary greatly, from nonoperative management treatments to surgical interventions. The aim of this study was to evaluate the long-term outcomes of patients after surgical reconstruction of the ulnar artery. METHODS In this retrospective study, the results of 12 patients treated for hypothenar hammer syndrome were evaluated. Preoperative and postoperative examinations of the hand were recorded. Function impairment was assessed with the "Disabilites of the Arm, Shoulder and Hand" questionnaire. Comparisons were also made based on ulnar artery patency versus occlusion. All patients were evaluated for ulnar artery patency as determined by Allen's test and magnetic resonance angiography. RESULTS All patients were men with an average age of 42.8 years. In 3 patients, a direct end-to-end anastomosis of the ulnar artery was performed, and 9 patients received a reconstruction with a reverse interpositional vein graft. Nine vascular reconstructions remained patent after a mean follow-up period of 56.9 months. These patients had a complete or at least partial relief of their pain, dysesthesia, and cold intolerance compared with preoperatively. Patients with reoccluded ulnar arteries were statistically significant younger (P = 0.036) than patients with patent ulnar artery. They also had a higher pain level (P = 0.009) and a longer follow-up period (P = 0.036) than those with patent reconstruction. There was a trend for higher functional impairment in patients with reoccluded ulnar artery (P = 0.100). Smoking habits showed no influence on ulnar artery patency. CONCLUSIONS For patients with symptomatic hypothenar hammer syndrome and failed nonoperative treatment, surgical intervention is a good option. After more than 4.5 years after surgery 9 of 12 vascular reconstructions remained patent (75% patency rate), ensuring an immediate and long-term improvement of symptoms.

Background Hook of the hamate fractures are particularly rare carpal fractures with significant morbidity if not diagnosed early. Classically, these fractures occur from localized blunt trauma to the hook of the hamate in racket sports. Common complaints include pain localized in the hypothenar eminence and reduced grip strength. Hook of the hamate fractures have the potential to cause significant injury to the ulnar nerve and artery. Case Report We present the case of a 43-year-old man with hypothenar pain, paresthesias of the fifth finger and ulnar aspect of the fourth finger, and pallor of the fourth and fifth fingers. Using bedside ultrasonography, the patient was found to have a fracture of the hook of the hamate that was causing compression of the ulnar artery. Why Should an Emergency Physician Be Aware of This? Fracture of the hook of the hamate is often not seen on x-ray studies, and fracture fragments can cause compression of adjacent structures, including the ulnar and median nerves and ulnar artery. Bedside ultrasound may be a useful adjunct in the diagnosis of this carpal fracture when standard x-ray studies do not show a fracture and clinical presentation is concerning for the diagnosis.

Patient: Male, 33 Final Diagnosis: Hypothenar hammer syndrome Symptoms: Right hand pain • parethesias • weakness • mottling Medication: — Clinical Procedure: — Specialty: General and Internal Medicine Objective: Rare disease Background: Hypothenar hammer syndrome is a relatively rare disease process caused by repetitive stress or injury to the hypothenar eminence leading to chronic injury to the ulnar artery. This chronic stress (usually as a result of occupational or sport activities) may result in arterial constriction or thickening, which may lead to thrombosis or aneurysm formation. A review of current literature revealed that reports related to management of hypothenar hammer syndrome are limited. Case Report: A 33-year-old male without significant past medical history presented with left hand/digit pain, skin discoloration, and coolness of the hand/digits after a mechanical accident experienced 12 hours prior to presentation. Angiography confirmed reduced flow in the ulnar and radial artery with significant spasm of the ulnar artery. Treatment consisted of heparin, nitroglycerin, and papaverine with rapid resolution of symptoms. The patient was discharged on anticoagulation and a calcium channel blocker, with scheduled follow-up. Conclusions: Hypothenar hammer syndrome is a rare disease process which manifests in certain occupations and activities that put undue stress on the hypothenar area. The use of angiography for definitive diagnosis and the use of anticoagulation and calcium channel blockers for treatment should continue to be studied to determine a standard treatment regimen.

The palmaris brevis (PB) is a small muscle of variant morphology located on the ulnar aspect of the palm, superficial to the hypothenar eminence. Functionally, the PB has been proposed to protect the neurovasculature of the ulnar canal from compressive forces during repetitive or intermittent trauma associated with grasping. Although PB function has been inferred from cadaveric observations, it is unknown whether it has the contractile capacity and fatigue-resistance necessary to withstand these functional demands. Insight into the functional specialization of the PB can be provided through investigating the proportions of type I and type II muscle fibers by staining for myosin heavy chain (MHC) isoforms using immunohistochemical methods. Therefore, the purpose of this study was to quantify the proportion of type I and type II muscle fibers to provide insight into the role of the PB in palmar function based on its gross histological structure. Sixteen PB specimens were harvested from the hands (eight right, eight left) of eight formalin-embalmed cadavers (mean age: 75 ± 14 years; three males, five females). PB muscle composition was determined by labeling serial cross-sections with MHC type I and type II monoclonal antibodies. The results indicate that the PB is primarily composed of type I muscle fibers (72.2 ± 13.7%), with no significant differences between left and right hands. Given the predominance of type I muscle fibers, our findings indicate the PB may be fatigue-resistant and thus, capable of contracting for prolonged durations. This supports cadaveric observations indicating that the PB functions to protect the ulnar neurovasculature of the palm by providing a muscular barrier in addition to serving as a functional anchor to the hypothenar fat pad when objects are firmly compressed into the palm.

The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain’s disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.

Abstract Myopericytomas belong to a benign group of tumors consisting of perivascular myopericytes or pericytes with a characteristic myoid differentiation pattern. The tumor is histologically and radiographically heterogenous, similar to superficial myofibromas. We report on a case of a myopericytoma arising in the hypothenar eminence of a 58-year-old man with a history of over 15 years of ulnar-sided and midcarpal wrist pain. Decision was made to excise the mass after it had increased in size by over 50 % over a 10-year period. Excision of the mass led to remarkable relief of his symptoms in the hypothenar as well as midcarpal regions. Consideration of this rare perivascular tumor should be included in patients with slow-growing benign appearing masses within the subcutaneous tissues of the hand.

Background Hypothenar hammer syndrome (HHS) is an uncommon vascular syndrome of upper extremity. HHS should be considered in patients who are presented with digital ischemia. Distal ulnar artery compression at the level of Guyon's canal with trauma results in thrombus or aneurysm. It may be observed after repetitive chronic trauma or acute blunt trauma to hypothenar eminence. Middle-aged male laborers, smokers, and dominant hands are affected frequently. Hand pain, discoloration or ulceration of digits, cold intolerance, hypothenar pulsatile mass, hypothenar weakness, and numbness are significant clinical findings. Case characteristics In this report, we presented a 37-year-old woman complaining with intermittent hand pain, paleness, and cyanosis at third, fourth, and fifth fingers of the right hand. She had no blunt trauma to her hand but intense amount of needle lace with her hands. Doppler ultrasonography revealed ulnar arterial thrombus at right Guyon's canal level. Conclusions She was diagnosed as HHS secondary to intense needlework. A calcium channel blocker and low-dose aspirin were prescribed to her, and avoidance of hand traumas was suggested. These interventions relieved digital ischemia symptoms on her hand.

Ulnar nerve compression has been reported in association with variations in the contents of Guyon's canal, such as the presence of accessory muscles. In the current case study we report on two variations found concurrently in the same hand. Firstly, the presence of an accessory head of the abductor digiti minimi that originated principally from the tendon of palmaris longus in the lower third of the forearm, descended superficial to the ulnar nerve and artery in Guyon's canal, and joined three other heads of the same muscle in the hypothenar eminence. Secondly, the ulnar nerve within the canal showed trifurcation into superficial, deep and muscular branches. A study of 120 hands from cadavers of South Australian population revealed the presence of an accessory head of the abductor digiti minimi that occupied Guyon's canal in 2.5% of the cases, a much lower incidence than previously reported in other populations. Trifurcation of the ulnar nerve seen here was also noted in the left hand of the same cadaver, but without any accessory muscles in Guyon's canal. Knowledge of such variations is relevant to hand surgery.

There are three different neuropathies defined by where the ulnar nerve is compressed that are much less common than cubital tunnel. Nerve conduction is used to confirm diagnosis of cubital tunnel, defined as symptomatic ulnar nerve dysfunction at the level of the elbow; this is treated either nonoperatively or operatively depending on severity. Guyon’s canal syndrome, another nerve compression syndrome, occurs when the ulnar nerve is compressed in the space at the base of the hypothenar eminence where it bifurcates. It can be caused by lesion, and Phalen’s sign is a positive presentative symptom.

This study used electromyographic analysis to investigate specific upper limb and hand muscle activation during 15 common horticultural activities. A total of 30 Korean adults between the ages of 20 and 30 years, with an average age of 24.8 years, were recruited from Konkuk University, Seoul, South Korea. Electromyographic measurements were made using a portable four-channel electromyograph. Bipolar surface electromyography (EMG) electrodes were attached to six upper limb muscles (i.e., upper trapezius, triceps—long head, biceps brachialis, flexor carpi ulnaris, flexor carpi radialis, and brachioradialis) and two hand muscles (i.e., thenar eminence and hypothenar eminence) on the dominant hand. These eight muscles that were selected play a major role in the operation of upper limbs and hand muscles for upper body low-impact activities. Each participant did the 15 horticultural activities on one occasion with two separate sessions. Each activity was performed for 60 seconds followed by a 15-second rest period sitting at a table on a height-adjusted chair between each activity. All eight muscles measured were used together during most of 15 horticultural activities. Upper trapezius, thenar eminence, and hypothenar eminence had higher muscle activity than the other muscles. Triceps—long head displayed very low EMG values compared with the other muscles. The EMG data will facilitate developing scientific and research-based gardening intervention and/or horticultural therapy programs for improving physical health and physical rehabilitation.

Thenar and hypothenar hammer syndromes are uncommon conditions characterised by digital ischemia of the hand as a result of repetitive trauma at level of the thenar and/or hypothenar eminence and damage to the radial and/or ulnar arteries, respectively. The symptoms are related to the mechanism of the trauma and a Raynaud’s phenomenon can be predominant for a long time. The angiography is the “gold standard” imaging technique which allows to confirm the diagnosis. Therapeutic strategy depends on the type of the lesion and severity of symptoms and includes pharmacological (antithrombotic and thrombolytic drugs) and surgical treatments. The authors present a case of a 53-year-old man, carpenter by profession, with combined thenar and hypothenar hammer syndromes and Raynaud’s phenomenon, successfully treated with a short course of intravenous infusion of iloprost.

Macaques have been used as an important paradigm for understanding the neural control mechanisms of human precision grip capabilities. Therefore, we dissected the forearms and hands of two male Japanese macaques to systematically record the muscle mass, fascicle length and physiological cross-sectional area (PCSA). Comparisons of the mass fractions and PCSA fractions of the hand musculature among the Japanese macaque, chimpanzee, and human demonstrated that the sizes of the thenar and hypothenar eminence muscle groups are more balanced in the macaque and chimpanzee, but those of the thenar eminence group are much larger in the human, indicating that the capacity to generate force at the tip of the thumb is more restricted in macaques, despite their high manual dexterity. In the macaque, however, the extrinsic flexor muscles are much larger, possibly to facilitate weight bearing by the forelimbs in pronograde quadrupedal locomotion and forceful grasping of arboreal supports in gap-crossing movements such as leaping. Taking such anatomical differences imposed on the hand musculoskeletal system into consideration seems to be an important method of clarifying the mechanisms of precision grip in macaques.

The hypothenar eminence is the thick soft tissue mass located on the ulnar side of the palm. Understanding its location and contents is important for understanding certain aspects of hand function. Variation in motor nerve distribution of the hypothenar muscles makes surgery of the ulnar side of the palm more challenging. To avoid injury to nerve branches, knowledge of these differences is imperative. This article discusses the muscular anatomy and function, vascular anatomy, and nerve anatomy and innervation of the hypothenar muscles.

We repor there on a 16-year-old patient who presented with pain and swelling in the hypothenar eminence as well as loss of sensibility in the fingers of the region innervated by the ulnar nerve; this happened 2-3 weeks after an injury by a glass splinter in his proximal palm. A pseudoaneurysm could be verified by duplex sonography. The patient wished to avoid any graft for arterial bridging for religious reasons. On the basis of an the Allen test preoperatively and the intraoperative findings, an adequate blood supply of the finger by the radial artery was expected. Thus, in respect to the patients wish, the aneurysm was resected without bridging. The patient recovered perfectly. 4 years later, an MR-angiography showed the deep and superficial transverse palmar arc to be supplied by a voluminous radial artery. The ulnar finger arteries originated from the deep arc, the radial finger arteries from the superficial arc. In this paper, the criteria pro and contra grafting the ulnar atery at Guyons's canal will be discussed.

A 37-year-old right-handed man presents with a three-month history of worsening tingling, numbness and weakness of the left hand that is beginning to affect his occupation as a manual worker. Examination reveals wasting of the hypothenar eminence and reduced sensation in the little and ring fingers

BACKGROUND Hand-arm vibration syndrome (HAVS) includes a spectrum of vascular, neurological and musculoskeletal symptoms resulting from exposure to vibrating tools. Hypothenar hammer syndrome (HHS) is a lesion of the ulnar artery as it courses adjacent to the hamate bone and results from either single or repeated episodes of trauma to the hypothenar eminence. There is a need to distinguish symptoms of HHS from those of classical HAVS since precise diagnosis may alter both the clinical and occupational management of the affected employee. AIMS To highlight the value of simple Doppler assessments of the palmar blood flow to distinguish the condition of HHS from 'classical' HAVS. METHOD Among patients assessed for HAVS by the authors during 2006, three were identified as potentially having HHS. Doppler ultrasound of the palmar arches with and without ulnar arterial occlusion was used. RESULT We report three cases in which Doppler ultrasound assessment supports a diagnosis of HHS. CONCLUSIONS It is our recommendation that such Doppler assessments should form part of the clinical assessment of workers being assessed in connection with exposure to hand-transmitted vibration and in whom symptoms are present that are not typical of 'classical HAVS', particularly where there is a history of possible hypothenar trauma.

Recurrent Dupuytren contracture can be aggressive and prone to further recurrence even with surgical treatment. Recurrence risk is increased further by the presence of Dupuytren diathesis. Surgical fasciectomy allows for subtotal or total excision of the pathological Dupuytren cords and resultant contracture correction in recurrent contracture. Extra care must be taken in revision fasciectomy cases to carefully identify and protect the neurovascular bundles as their anatomy will be distorted by both Dupuytren tissue and scarring from prior surgery. Tension on the neurovascular bundles of the digit may compromise the neurovascular status of the digit in cases of severe contracture and full correction may not be possible. When closure of surgical wounds with Z-plasties alone is not possible, full-thickness skin grafting from the hypothenar eminence provides glabrous, non-hair bearing, durable donor skin that is a good texture match for the volar surfaces of the digits. Though further study on skin grafting following fasciectomy for Dupuytren contracture is needed, skin grafting may provide advantages in decreasing disease recurrence through allowing for resection of skin overlying Dupuytren tissue, which may be involved in the disease process, providing a “firebreak” between proximal and distal disease in a digit, and decreasing tension at the wound site.

In isolated true aneurysm of the upper extremity especially of the palmer arch, have been well described as a clinical finding as a part of the Hypothenar Hammer Syndrome. Presented is a case of true ulnar artery aneurysm in a 14 year old patient in with there was a history of repeated trauma probably caused by playing soccer goalie. The aneurysm was successfully resected and reconstructed by end to end anastomosis. Introduction: Aneurysms should be suspected in patients with a mass in the hand following either open or closed trauma. Posttraumatic aneurysms are classified as true or false [1]. False aneurysms usually result from penetrating trauma and can occur in any disrupted vessel. In contrast, true aneurysms usually occur in either the thenar or hypothenar eminence a few weeks following closed hand injuries. In this work, we report the case of a 14-year patient who presented with an isolated palmar arch aneurysm due to repetitious blunt trauma, probably caused by playing soccer goalie. The case is discussed in the context of other reported cases of ulnar artery aneurysms in children. Case Presentation: A 14-year-old-male patient was admitted to our hospital with a gradually enlarging pulsatile mass in his left palm in the hypothenar eminence. Our patient is a goal keeper without medical history who consulted for a swelling on the ulnar side of the left hand that has developed over 3 months and gradually increasing in volume with tingling of the 4th and 5th fingers (Figure 1). Physical examination revealed a pulsatile mass of the hypothenar eminence. Motor and sensory functions were normal, and there were no vascular changes distal to the site of swelling. Additional examinations showed that the inflammatory balance was normal. X-ray films of the hand did not present any abnormalities (Figure 2). The echography showed the presence of a cyst in the path of the ulnar artery, in addition the Doppler image and digitalized angiography showed the presence of arterial flow at this training, this image was in favor for an arterial aneurysm (Figure 3). During surgical exploration, a longitudinal skin incision was made directly over the aneurysm. Sharp dissection through the fascia revealed a 1.5 cm ulnar artery aneurysm. Dissection was done and vessel loops were used to control the aneurysm (Figure 4). All vessels that communicated with the aneurysm were therefore ligated and the aneurysm sac was resected. Reconstruction was made by end-to-end anastomosis. Histology demonstrated a true aneurysm, the patient’s postoperative course was uneventful, and he was discharged home on the second postoperative day. At follow-up 7 months later, the patient had normal left hand function and good perfusion. Discussion: Although injuries to the hand are very common in the athletic or occupational setting artery aneurysm of the hand has rarely been reported [2]. The first reported case of an arterial aneurysm involving the hand occurred in a coachman in Rome and was described by Guattani. The superficial ulnar artery distal to the hamet bone just as it leaves Guyon’s canal is most susceptible to trauma, leading to arterial wall injury and possible aneurysm formation. If the anatomy of the ulnar artery in the palm is reviewed, it can be seen why traumatic true aneurysms are the most frequent sub-type. The artery lies against the hook of the hamate and is relatively unprotected in the region between Guyon’s canal and the palmar fascia. It is within this region that trauma to the artery tends to occur and aneurysms form. True aneurysms were considered by Middleton to be occupational in origin and to be caused by blunt trauma, occurring in single or multiple episodes. Trauma causes contusion of the artery, with disruption of the tunica media due to hemorrhage and consequently the vessel dilates to form an aneurysm. This diagnosis can be revealed by a swelling of the hypothenar eminence that can be pulsatile. The lesion’s auscultation can objective a thrill witch confirms the vascular origin of the aneurysm. Sometimes, the aneurysm is associated with pain when placing hands on surfaces or gripped objects. We can also see a sensitive trouble in distality such as abnormal sensation or hypoesthesia of the fingers. Generally in front such lesion, we should make the difference between traumatic or occasional origin. Some aneurysms are revealed after blunt or penetrating trauma. Otherwise, some other lesions are perfectly asymptomatic. confirmation by surgical exploration, angiography, and other noninvasive tests have been described[3,4]. Although the use of doppler has revolutionized the evaluation of vascular patency the relative quantification of hemodynamics by doppler mapping has not been described of Hypothenar Hammer Syndrome. Doppler mapping, a proven, noninvasive technique of visualizing vascular anatomy [5,6] has applicability in the preoperative assessment of ulnar artery aneurysm. Surgery is the choice of treatment after intensive and careful investigation for other distal artery lesions. Intra-operatively the need for arterial reconstruction should be carefully considered. True posttraumatic aneurysms of the hand are usually due to closed hand trauma while false aneurysms usually occur after open trauma [7]. False aneurysms can occur in any artery in the path of the penetrating object that produced the injury. In Middleton’s series [5], the false aneurysms resulted from open trauma, with the exception of one case that followed closed reduction of a metacarpal-phalangeal dislocation of the thumb. True aneurysms are most common at two specific sites [8]. The first site is in the hypothenar eminence where the ulnar artery is very superficial and unprotected distal to Guyon’s canal and proximal to the palmar aponeurosis. In this location the ulnar artery is close to the hamate, which functions as an anvil. The second site is in the thenar eminence where the superficial branch of the radial artery overlies the greater multangular bone, again in a superficial and unprotected portion of its course. In this paper, we present an isolated palmar arch aneurysm following repetitious blunt trauma, responding well to surgery.

We examined 30 upper limbs in order to study the tendinous muscular insertions into the deep fascia and to verify whether they have a specific anatomical arrangement and to measure their resilience to traction. We have found that the fascia receives many tendinous muscular insertions, which are always present and exhibit a constant anatomical structure. In particular, the pectoralis major fascia always continues with the brachial fascia in two distinct ways: the fascia overlying the clavicular part of pectoralis major had an expansion towards the anterior brachial fascia, whereas the fascia covering its costal part extended into the medial brachial fascia and the medial intermuscular septum. The lacertus fibrosus was also composed by two groups of fibres: the main group was oriented downwards and medially, the second group longitudinally. The palmaris longus opened out into a fan-shape in the palm of the hand and sent some tendinous expansions to the flexor retinaculum and fascia overlying the thenar eminence muscles. In the posterior region of the arm, the fascia of the latissimus dorsi sent a fibrous lamina to the triceps brachial fascia. The triceps tendon inserted partially into the antebrachial fascia, while the extensor carpi ulnaris sent a tendinous expansion to the fascia of the hypothenar eminence. It is hypothesized that the tendinous muscular insertions maintain the fascia at a basal tension and create myofascial continuity between the different muscles actuating flexion and extension of the upper limb, stretching the fascia in different ways according to the different motor directions.

Three years following a blunt injury to his hand, a 44-year-old man presented with a persistently painful focal area of his left palm at the base of his thumb. Physical examination revealed a small painful pulsatile mass at the base of his left hypothenar eminence. His radial pulse was normal and he had a normal capillary refill of his ulnar and radial-sided digits. There was no evidence of digital ischaemia. MRI demonstrated a saccular outpouching at his distal ulnar artery (figure 1A, arrow), which on Doppler ultrasound demonstrated the so-called ‘yin-yang’ sign (figure …

Hypothenar hammer syndrome is a rare cause of ischemic fingers observed mainly in young men smoking cigarettes and it is associated with repeated trauma of the ulnar artery in the area of the hypothenar eminence of the dominant-hand arm, resulting in a deficit of blood supply with the occurrence of hand symptoms typical for chronic and sometimes critical ischemia. Artery injury in this location is most often the result of multiple repetitions of the same activity being mostly the result of occupational exposure. We present a case of a 27-year-old car mechanic admitted to the hospital with symptoms of critical ischemia of the fingers III, IV, and V of the right hand, which resolved after conservative treatment.

A 32-year-old man presented to our clinic complaining of numbness of the little finger and the ulnar aspect of the ring finger of his right hand. He complained about the weakness of grip strength and ulnar-sided pain. At the first glance, wasting of the first interossei muscle could be recognized. In his detailed examination, the medial half of the palmar aspect of the hand, including the hypothenar eminence, along with the palmar side of the fourth and fifth digits showed decreased sensation to light touch. Severe weakness of the abductor digiti minimi (ADM) was noted. No sensory loss was found in the dorsum of the hand, excluding the diagnosis of ulnar neuropathy at the elbow.

Hypothenar hammer Syndrome (HHS) is a condition characterised by digital ischaemia as a result of repetitive trauma to the hypothenar eminence of the hand. It occurs in people who repeatedly use the palm of the hand as a hammer to push, grind or twist objects. It is a curable and a preventable cause of upper digital ischemia. In this report we present a case of HHS and discuss the causes and pathogenesis of this syndrome. We review the incidence, clinical characteristics, differential diagnosis, investigation and treatment.

Pain, weakness, and sensory loss occur frequently in the hypothenar eminence. However, clinical examination is difficult and nonspecific, and the prescribed imaging technique may be inadequate, or images may be misinterpreted. Different imaging modalities have various degrees of usefulness for the diagnosis of painful pathologic conditions of the hypothenar eminence. Radiography, multidetector computed tomography (CT), multidetector CT arthrography, and magnetic resonance (MR) imaging of the wrist are useful for surveying the anatomy of the hypothenar eminence, the Guyon canal, and the ulnar nerve and artery and for determining the cause of pain or other symptoms. A fracture of the pisiform bone or the hook of the hamate bone, osteoarthritis or osteochondromatosis of the pisotriquetral joint, Guyon canal syndrome, hypothenar hammer syndrome, tendinopathy of the flexor carpi ulnaris, an anomalous muscle, a ganglion cyst, or a tumor may be responsible for ulnar neuropathy. Specific radiographic views, such as the semisupinated oblique view and the lateral view with the hand radially deviated and the thumb abducted, often provide a sufficient basis for the diagnosis of acute fracture of the hook of the hamate or the pisiform bone. Multidetector CT angiography is an efficient method for diagnosing hypothenar hammer syndrome, and multidetector CT arthrography is well suited for evaluation of the pisotriquetral joint. MR imaging is the modality of choice for depiction of the ulnar nerve.

Objective To investigate the source of an unusual and previously unreported volume conducted potential on motor nerve conduction studies. In a case of subacute ulnar neuropathy at wrist (UNW) selectively involving the deep motor branch, we recorded from the hypothenar eminence a large positive wave (2.5 ms–2 mV) preceding the negative takeoff of the delayed distal ulnar motor response. Methods We performed multiple channels motor and sensory ulnar nerve (UN) conduction studies; these included selective electrical stimulation and anaesthetic block of UN branches and also selective recording of motor responses by single fibre needles; data were confirmed by an intraoperative neurophysiological study and correlated with MRI and surgical findings. Results Detailed neurophysiological investigation demonstrated the generation of this waveform from the palmaris brevis (PB) muscle. MRI and surgical exploration documented a hypertrophy of this muscle. Conclusions In type II° UNW, depolarization of a spared palmaris brevis muscle may be recorded as a positive wave preceding the delayed abductor digiti minimi motor response. Significance We underline the peculiar localizing value of this volume conducted ‘meaningful artefact’ in that particular setting. It actually represented an early neurographic analogue of what is known as the clinical ‘Palmaris Brevis Sign’ in long standing type II° UNW.

We report on six patients of intramuscular lipoma of the hand. Four of them occurred in the thenar muscles and two in the hypothenar muscles. The mean age was 49 years (7–68 years). The duration of the lesions prior to excision was averaged as 35 months (12–60 months). Preoperative MRI was taken in all patients, and it was very useful for the diagnosis and differentiation between four well-circumscribed types and two infiltrative types. All operations were performed under loupe magnification. Preoperatively four patients with thenar lipoma had difficulty in moving their thumbs. Two out of four patients with lipomas in the thenar muscles had preoperative intermittent paresthesia and hyperesthesia caused by compression of the radial digital nerve of the thumb. Two patients with lipoma in the hypothenar eminence complained of difficulty with strong grip. The average diameter of the thenar group in its longest dimension was 5.2 cm (3–7 cm), and those of the hypothenar group was 5.5 cm (4–7 cm). At a mean follow-up of 55 months (21–91 months), no tumour had recurred.

In an adult male cadaver, the flexor digiti minimi brevis, a muscle of the hypothenar eminence, was found to arise from the superficial transverse septum (between the superficially placed flexor carpi ulnaris, palmaris longus, and flexor carpi radialis muscles, and the deeply placed flexor digitorum superficialis muscle) in the distal fourth of the flexor aspect of the left forearm. The muscle exhibited two strata of muscle fibers at its origin. The superficial stratum was a thin layer of transversely running fibers confined to the forearm, which has not been previously reported. The deep stratum, a thick layer of longitudinally running fibers, formed the bulk of the muscle. It traversed Guyon's canal superficial to the ulnar nerve and vessels to reach the hypothenar eminence. Its course through Guyon's canal could be a cause for ulnar tunnel syndrome. The ulnar nerve trunk innervated not only the anomalous flexor digiti minimi brevis muscle, but also abductor digiti minimi and palmaris brevis. This may be due to the common phylogeny of these three muscles from the same muscle mass. Clin. Anat. 16:340–343, 2003. © 2003 Wiley-Liss, Inc.

The ulnar tunnel syndrome occurs usually from ganglions, lipoma, cysts, chronic repetitive trauma, bicycling, and the activities that require either prolonged wrist hyper extension or continued pressure on the hypothenar eminence. The ulnar tunnel syndrome after flexor tendon repair is a rare complication. We report on a 24-year-old man with ulnar tunnel syndrome after a flexor tendon repair secondary to girder cut injury. The patient was managed conservatively for his hypertrophic scar for 9 weeks. After 9 weeks, the patient presented with no clawing and complete closure of the hand.

Leprosy is an uncommon disease in England and Wales, yet it remains an important disease globally with 2 50 000 cases diagnosed annually. Underreporting is likely in developed countries, where awareness of the clinical phenotypes and presentations of the disease may be lower than in higher prevalence countries. A 44 year old gentleman of Indian origin presented with swollen left forearm and erythematous plaque on the left hand. Clinical assessment revealed wasting of intrinsic muscles in the hypothenar eminence, profound motor and sensory deficit in the ulnar nerve distribution, with clawing of 4th and 5th digits of the left hand. EMG showed complete denervation of the left ulnar nerve. A modified Ziehl-Neelsen stain of the left arm skin biopsy demonstrated numerous, small aggregate bacilli, frequently co-localised within the areas of granulomatous inflammation. The skin biopsy sample identified the presence of bacterial 16 s DNA. Further analysis with 16S DNA sequencing was specific for Mycobacterium Leprae, thereby confirming the diagnosis of leprosy neuropathy.

To the Editor: Management of monomelic amyotrophy (Hirayama disease) is controversial and includes clinical observation, use of a cervical collar, and cervical decompression and fusion.1 Cessation of symptom progression with persistent arm weakness is the most common outcome.1,2 Some have documented regression of symptoms with cervical collar use or after cervical spine surgery.2 We describe clinical improvement in a young man with monomelic amyo-trophy who was asked to avoid prolonged neck flexion without using a cervical collar. A 19-year old man presented with 8 months of progressive asymmetric arm weakness and atrophy. There was no preceding trauma. He denied pain or sensory loss. When flexing his cervical spine, he described a “pulling” sensation originating in his lower cervical/upper thoracic region and radiating into his right fifth digit. He was starting college and when studying in bed with his head propped in flexion the hypothenar eminence and fifth digit would twitch or cramp. His medical history was unremarkable. His examination revealed atrophy in the right thenar and hypothenar eminences, fasciculations in the right first dorsal interosseous (FDI), and asymmetric weakness in muscles of the C7/C8/T1 myotomes [right elbow extensors, wrist extensors, finger flexors, finger abductors, and thumb abductors all medical research council (MRC) grade 4] but was particularly prominent in the right finger extensors, most dramatically in digits 3 and 4 (MRC grade 0 in digits 3 and 4; grade 3 in digit 5; and grade 4 in digit 2). The rest of the neurologic examination was normal. Nerve conduction studies were unremarkable. Electromyography demonstrated abnormalities in muscles innervated by C7/C8/T1 anterior horn cells, worse on the right. Fibrillation potentials and positive sharp waves were seen in the right FDI, extensor digitorum communis (EDC), and flexor carpi radialis. In these muscles, there were either no voluntary motor unit potentials (EDC) or reduced recruitment of chronically remodeled units (FDI, flexor carpi radialis). Similar changes were also seen in the right abductor pollicis brevis and triceps, and in the left FDI, abductor pollicis brevis and EDC. Needle examination of the legs and thoracic paraspinals was normal. Cervical spine magnetic resonance imaging revealed the loss of normal cervical lordosis but no disc herniation or cord signal change. Computed tomography myelogram demonstrated indentation on the right anterior cervical cord at the C5-6 vertebral level in flexion views (Fig. 1). The patient was advised to avoid all activities involving substantial neck flexion and to sleep with his neck in a neutral position. A year later, the patient reported improved strength in the right finger extensors, finger flexors, and wrist extensors (MRC grades 4, 5, and 5, respectively). These changes in strength resulted in significant improvement of his ability to type and perform manual tasks. After 3 years of follow-up, he has remained stable and continues to avoid neck flexion. FIGURE 1 Computed tomography myelogram. A, Axial image at C5-6 with neck neutrally aligned. B, Axial image at C5-6 with neck in flexion. Note the flattening and indentation (arrow) on the right anterior cervical cord. The radiographic findings and clinical course argue in favor of a compressive etiology of monomelic amyotrophy in this patient. Conservative management was a moderately successful strategy even with radiologic signs of cervical cord compression.

Purpose To determine the accuracy of digital palpation for clinical assessment of elevated intracompartmental pressure compared with needle manometry in a simulated compartment syndrome of the hand. Methods Three cadaveric hands were configured with interstitial fluid infusion and an arterial line pressure monitor to create and continuously measure intracompartmental pressure in the thenar and hypothenar compartments. Seventeen assessors clinically judged the presence or absence of compartment syndrome based on digital palpation for firmness and then measured pressures with a handheld manometer. An intracompartmental pressure threshold of 30 mm Hg or greater was used to diagnose compartment syndrome. Results The sensitivity and specificity of digital palpation of the thenar eminence were 49% and 79%, respectively, with a positive predictive value (PPV) of 86% and negative predictive value (NPV) of 37%. Using the handheld manometer, the sensitivity and specificity increased to 97% and 86% with a PPV of 95% and NPV of 92%. The sensitivity and specificity of digital palpation of the hypothenar eminence were 62% and 83%, respectively, with improvement of 100% and 100%, respectively, with a handheld manometer. For the hypothenar compartment, use of a handheld manometer improved the PPV from 92% to 100% and the NPV from 40% to 100% compared with digital palpation. Conclusions Digital palpation alone was insufficient to detect elevated compartment pressures in hands at risk for compartment syndrome. Handheld invasive pressure measurement was a useful adjunct for detecting elevated interstitial tissue pressures and may aid in diagnosing compartment syndrome. Type of study/level of evidence Diagnostic II.

Purpose: To investigate the reasons and disease course of Hypothenar Hammer Syndrom. Introduction: Occlusion of the ulnar artery at the level of the hamate bone due to repetitive trauma to the hypothenar eminence is implicated as the cause of the rarely diagnosed hypothenar hammer syndrome (HHS). The thrombotic occlusion and the formation of an aneurysm of the ulnar artery and the superificial palmar arch with possible peripheral embolism of the digital arteries are a direct cause of the chronic damage to the vessel wall. Generally, HHS is diagnosed too late for recanalisation to be a viable therapeutic option. Methods: From 1996 to 1998 the diagnosis of an HHS was made in 8 patients at our hospital. Etiology, clinical settings and disease course were assessed. Results: Our analysis suggests that HHS may be caused by a single severe trauma in addition to repetitive injuries. The pathogenesis of the syndrome is dependent on the vascular anatomy of the individual hand. Interindividual variations in the arterial supply of the affected hand influences the clinical symptomatology with possible masking of arterial occlusions. Conclusion: An exact investigation concerning the pathogenesis of HHS is a precondition for treating the disease and may help to establish HHS as an occupational disease. MR-angiography may be a new approach for assessing HHS.

The hypothenar hammer syndrome describes a constellation of symptoms resulting from repetitive trauma to the hypothenar eminence, often due to the use of the hand as a hammer. Sequelae of this syndrome include both true and false aneurysms, as well as thrombosis of the ulnar artery due to its vulnerability to blunt trauma as it exits Guyon's canal. Although this is a relatively well-documented phenomenon, an extensive review of the literature revealed that no cases have been described involving a patient with hemophilia. The present case describes a 46-year-old farmer with factor IX deficiency (hemophilia B) presenting with a 5 cm × 7 cm pseudoaneurysm of the ulnar artery of the right hand.

Flexor digiti minimi is a muscle of hypothenar eminence. It flexes the little finger at metacarpo­ phalangeal joint. During routine Anatomical dissection, an extra muscle was noticed in the flexor compartment of right forearm of a male cadaver. The identified muscle took origin from medial aspect of the Palmaris longus tendon just proximal to the wrist joint. When traced distally this muscle joined the fibers of the Flexor digiti minimi, and finally got inserted to palmar aspect of base of proximal phalanx of 5th digit. In its course, the muscle crossed median nerve and Ulnar artery. Because of this reason, this variation has the potential to cause compression of the structures mentioned above and is of interest to clinicians.

s s m T 53-year-old woman presented to the office with a complaint of severe bilateral thumb nail pain and deformity (Fig. 1). She deied previous trauma to the thumb nails and had o history of previous bacterial or fungal infecions of the nails. Based on the curvature of the ails, which increased from proximal to distal, a iagnosis of bilateral thumb pincer-nail deformity as made. The patient was scheduled for surgical correction y modification of previously described techniques. eginning with the left thumb a digital block was erformed and the affected digit was exsanguinated. he nail plate was sharply removed without damagng the underlying sterile and germinal matrix. The urved nail bed then was elevated off of the underying distal phalanx (Fig. 2). On the left side a dermal raft was obtained from the hypothenar eminence hat was closed primarily. This was harvested as a ull-thickness graft that then was de-epithelialized Figs. 3, 4). The dermal graft was divided into 2 qual pieces and placed in the area of the lateral nail olds, filling in the defects that had been present. The ail bed was sutured back over the graft to the lateral ail folds with 5-0 chromic suture. The nail bed now ad a less curved and more natural flattened appear