Search

We report a case of 32-year-old female with a 6 months history of excruciating pain in hypothenar region of the left hand. Pain was aggravated by pressure, touch, and cold temperature. Musculoskeletal ultrasonography revealed – a well-defined, hypoechoic lesion in deep dermis, and subcutaneous fat in the left hypothenar eminence with mixed arterial and venous signals within on Doppler study, suggestive of – subcutaneous vascular lesion and diagnosis of glomus tumor was suggested. The patient underwent excision of the lesion. Pathological examination of the specimen showed a glomus tumor and excluded malignant transformation to glomangiosarcoma. Extradigital glomus tumor can be diagnosed on ultrasound with high confidence in appropriate clinical setting.

Background: Palmaris brevis syndrome, a pseudodystonia characterized by abnormal involuntary contractions of the palmaris brevis muscle which resides in the hypothenar eminence, is believed to be due to compressive irritation of motor fibers which arise from the superficial branch of the ulnar nerve. Case report: Herein, we review the origins, differential diagnosis and pathophysiology of the palmaris brevis syndrome, and effective treatment of a patient with workplace modifications and injections of botulinum toxin type A. Discussion: Prompt diagnosis of the palmaris brevis syndrome facilitates effective treatment and resolution. Highlights Like the task-specific hand dystonias seen in writers and musicians, palmaris brevis syndrome, a pseudodystonia, may be caused and aggravated by extreme repetitive use. Here, we report a case of palmaris brevis syndrome apparently triggered by high-volume use of a pipette and computer mouse and review relevant clinical facets from previously published cases. Treatment must include workplace modifications and may include injections of botulinum toxin.

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.

Histiocytic sarcoma (HS) is a rare hematopoietic tumor that mainly involves extranodal sites, including the intestinal tract, skin, soft tissues and other organs. It is well known as an aggressive neoplasm that shows a poor response to therapy. However, a subset of patients with resectable disease has shown a favorable outcome with surgical treatment. Primary cutaneous HS is exceedingly rare and, to date, its long-term prognosis has thus not been well described. Here, we highlight two cases of primary cutaneous HS that showed long-term survival. Case 1 was a healthy 47-year-old woman who found a 12-mm tumor on her forehead. Case 2 was a 66-year-old woman, under follow up of a myxoid liposarcoma in her leg, who presented with a 25-mm tumor in her hypothenar eminence. Histologically, the tumors in both cases had a smooth outline with proliferating atypical tumor cells that showed histiocytic differentiation as revealed by immunohistochemistry with antibodies to CD68 (KP-1) and lysozyme in case 1; and CD68, lysozyme and CD163 in case 2. Tumor cells in case 1 had a monotonous appearance. After complete resection, cases 1 and 2 have survived for 10 and 4 years, respectively, without recurrence. To date, such patients are relatively long follow-up cases of survival from HS and highlight how a clear outline of the primary cutaneous HS tumor may be associated with its resectability and be an important factor in the assessment of its curability.

Background: The distal half of the hypothenar eminence (HE) skin vascularization has been extensively investigated. Different flaps have been described based on these arteries. Similarly, the vascularization of the proximal half of HE has also been investigated, although to a lesser extent. The aim of this paper is to determine, in a cadaver sample, the anatomy of the hypothenar cutaneous branches in their proximal half. Methods: In all, 20 adult, red-colored-latex-injected hands were studied. Dissections were performed with a 4X to 10X magnification. Cutaneous branches in the proximal half of the HE were found. Their variants were studied, and they were classified into different types according to their relationships. Results: A cutaneous branch of the deep palmar artery (CBDPA) was identified. It was located in the subcutaneous cellular tissue thickness in the proximal half of the HE. Moreover, it presented 3 anatomical variants, classified according to its relationships with the superficial ulnar nerve branch (SUN). Type 1 variant: the CBDPA and the PDA ran in front of the SUN (60% of cases). Type 2: the CBDPA and the DPA ran behind the SUN (30% of cases). Type 3: the CBDPA ran in front of the SUN while the DPA ran behind it (10% of cases). Conclusion: There is a CBDPA which is the HE proximal half main cutaneous branch. Although it presented several variants, its existence is constant, making it possible to use it as pedicle for proximal hypothenar flaps.

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.

Our aim was to analyse body core temperature and peripheral vascular microcirculation at skin hypothenar eminence of the hands and its relationship to symptoms in fibromyalgia syndrome (FMS). A total of 80 FMS women and 80 healthy women, matched on weight, were enrolled in this case–control study. Thermography and infrared thermometer were used for evaluating the hypothenar regions and core body temperature, respectively. The main outcome measures were pain pressure thresholds (PPTs) and clinical questionnaires. Significant associations were observed between overall impact [β = 0.033; 95% confidence interval (95%CI) = 0.003, 0.062; p = 0.030], daytime dysfunction (β = 0.203; 95%CI = 0.011, 0.395; p = 0.039) and reduced activity (β = 0.045; 95%CI = 0.005, 0.085; p = 0.029) and core body temperature in FMS women. PPTs including greater trochanter dominant (β = 0.254; 95%CI = 0.003, 0.504; p = 0.047), greater trochanter non-dominant (β = 0.650; 95%CI = 0.141, 1.159; p = 0.013), as well as sleeping medication (β = −0.242; 95%CI = −0.471, −0.013; p = 0.039) were also associated with hypothenar eminence temperature. Data highlighted that FMS women showed correlations among body core temperature and hand temperature with the clinical symptoms.

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.

Intoduction: Eccrine angiomatous hamartoma (EAH) is an extremely rare and benign malformation in adults which presents with single or multiple nodules or single large plaque over the extremities at birth with pain and marked sweating. On histopathological examination,there is increased proliferation of eccrine sweat glands and capillary vessels in the dermis. Herein we report a 43 year-old male who presented with a single hyperpigmented plaque over the hypothenar eminence of right palm associated with excessive sweating for 3 months duration.Biopsy from the lesion was suggestive of eccrine angiomatous hamartoma.This case has been reported due to it’s unusual adult onset. Keywords: Eccrine angiomatous hamartoma, EAH, Benign tumor, Adult onset. Introduction Eccrine angiomatous hamartoma (EAH) is a rare and benign tumor, histologically characterized by increased number of dilated eccrine glands and capillary vessels. It was first described in 1859 by Lotzbeck as an angiomatous lesion on the cheek of a child and later EAH was coined in 1968 by Hyman and coworkers.[1] [2]EAH may appear as flesh colored, blue brown, yellow or reddish macule, plaque or nodule associated with exquisite pain on palpation and hyperhidrosis. Asymptomatic lesions do not require any treatment. It is important to recognize this benign clinical entity, for which aggressive treatment is not necessary.?1; Case Report A 43 year old male, working as a supervisor in a hotel came with complaints of hyperpigmented plaque over right palm for 3 months duration which started as a small red itchy plaque. It was associated with excessive sweating over the plaque and pain following local pressure and physical exertion. No history of trauma or similar lesions in other parts of the body. No history of atopy. No history of hypopigmented patches or altered sensations over the extremities. Clinical Examination A solitary, well defined, hyperpigmented plaque of 5x3cm

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.

Hypothenar hammer syndrome (HHS) is a vascular disorder characterized by ulnar artery thrombosis or aneurysmal formation. It is most commonly reported in middle-aged males who suffer from repetitive trauma to the palm secondary to occupational or recreational activities. Most cases of HHS can be managed conservatively; however, surgical management is typically indicated for persistent symptoms following conservative measures, imminent vascular compromise, those who fail conservative treatment, or those in imminent danger of rupture. Here we present the case of a right-handed 74-year-old female with HHS who presented with a three-week history of a mass in the hypothenar eminence of the left hand. Reportedly, the mass had appeared slowly and had no associated pain, ischemia of the distal hand, numbness, paresthesia, or changes in the overlying skin. She denied any history of a blunt or penetrating hand injury. The patient was treated surgically by removing a 2.0-cm thrombosed pseudoaneurysm of a collateral branch of the ulnar artery within the left hypothenar eminence. On follow-ups at 1, 2, and 12 weeks postoperatively, the patient's pain was found to be well-controlled. Her normal range of motion was restored, and her digits remained neurovascularly intact. This was an atypical presentation of HHS, and our review of the disorder emphasizes the importance of diagnostic reasoning in rare conditions with unusual presentations of HHS.

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.

We report a case of a 32-year-old female with a 6-month history of excruciating pain in hypothenar region of the left hand. Pain was aggravated by pressure, touch, and cold temperature. Musculoskeletal ultrasonography revealed a well-defined, hypoechoic lesion in the deep dermis and subcutaneous fat in the left hypothenar eminence with mixed arterial and venous signals within on Doppler study, suggestive of subcutaneous vascular lesion, and a diagnosis of glomus tumor was suggested. The patient underwent excision of the lesion. Pathological examination of the specimen showed a glomus tumor and excluded malignant transformation to glomangiosarcoma. Extra digital glomus tumor can be diagnosed on ultrasound with high confidence in appropriate clinical setting.

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.

Acellular nerve allografts can help preserve normal nerve structure and extracellular matrix composition. These allografts have low immunogenicity and are more readily available than autologous nerves for the repair of long-segment peripheral nerve defects. In this study, we repaired a 40-mm ulnar nerve defect in rhesus monkeys with tissue-engineered peripheral nerve, and compared the outcome with that of autograft. The graft was prepared using a chemical extract from adult rhesus monkeys and seeded with allogeneic Schwann cells. Pathomorphology, electromyogram and immunohistochemistry findings revealed the absence of palmar erosion or ulcers, and that the morphology and elasticity of the hypothenar eminence were normal 5 months postoperatively. There were no significant differences in the mean peak compound muscle action potential, the mean nerve conduction velocity, or the number of neurofilaments between the experimental and control groups. However, outcome was significantly better in the experimental group than in the blank group. These findings suggest that chemically extracted allogeneic nerve seeded with autologous Schwann cells can repair 40-mm ulnar nerve defects in the rhesus monkey. The outcomes are similar to those obtained with autologous nerve graft.

Although the musculoskeletal injuries associated with break-dancing which is gaining more popularity among adolescent and young people has been reported, the report regarding a peripheral nerve injury associated with breakdance is scarce. We report a rare case of a young amateur break-dancer, 'b-boy' who suffered from a painful paresthesia in his left hand, later diagnosed as type III Guyon's canal syndrome. A 23-year-old, right handed college man presented with a tenderness over the left hypothenar eminence and painful paresthesia over the ring and little fingers of 3 months duration. He trained himself as an amateur 'b boy' break-dancer for the last 10 months. Conservative management under the diagnosis of wrist sprain before presentation did not improve his hand pain. An magnetic resonance imaging and electrodiagnostic study revealed that painful paresthesia was caused by type III Guyon's canal syndrome, and 4 weeks of corticosteroid treatment was given with resolution of pain and paresthesia.

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.

Background: The carpal tunnel syndrome (CTS) is the most common cause of severe hand pain. In this study we treated acute pain in CTS patients by means of local intradermal injections of anti-inflammatory drugs (mesotherapy). Methods: In twenty-five patients (forty-five hands), CTS diagnosis was confirmed by clinical and neurophysiological examination prior to mesotherapy. A mixture containing lidocaine 10 mg, ketoprophen lysine-acetylsalycilate 80 mg, xantinol nicotinate 100 mg, cyanocobalamine 1,000 mcg plus injectable water was used. Sites of injection were three parallel lines above the transverse carpal ligament and two v-shaped lines, one at the base of the thenar eminence, and the other at the base of the hypothenar eminence. Results: The day after the treatment, all but four patients reported a significant reduction in pain and paresthesias. After 12 months, 17 patients had a complete pain relief, eight patients reported recurrence of pain and sensory symptoms and four out of them underwent surgical treatment. Conclusions: With the obvious limits of a small-size open-label study, our results suggest that mesotherapy can temporary relieve pain and paresthesias in most CTS patients and in some cases its effect seems to be long-lasting. Further controlled studies are needed to confirm our preliminary findings and to compare mesotherapy to conventional approaches for the treatment of CTS. (Korean J Pain 2014; 27: 49-53)

Two delayed unions and one nonunion of hook of the hamate fractures in adults aged 31-, 40-, and 41-years-old were treated with low-intensity pulsed ultrasound (LIPUS). Ultrasound treatment was started at three, four, and six months after injury and ultrasound exposure at the hook of the hamate in the hypothenar eminence was carried out for four to five months. During the management period, there was no immobilisation with a cast or brace and limited strain with only routine daily activities allowed. In all cases, bony union was confirmed on carpal tunnel radiographs or computed tomography at the final follow-up time of eight and 36 months after injuries.

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.

Infections of prosthetic aortic grafts status post-acute aortic dissection with Candida albicans (C. albicans) are rare. The gold standard of treatment for aortic graft infection is a combination of surgical resection and lifelong antimicrobial drug therapy, however postoperative mortality rates remain high. Here we present a 44-year-old man who presented with 2 months of fever, painful microembolic lesions localized to his right hypothenar eminence, right conjunctival hyperemia, right neural hearing loss, and a systolic murmur radiating from the aorta towards the neck. C. albicans was isolated from 3 separate blood cultures. Computed tomography (CT) displayed distinct thrombotic material affixed to the aortic prosthetic graft in the brachiocephalic artery. The patient was then treated with intravenous (IV) fluconazole for 8 weeks. During the treatment period, the patient suffered from brain hemorrhage in the right temporal lobe, presenting with hemiparalysis. After 8 weeks on IV fluconazole, oral fluconazole was then administered. Through 12 months of follow up, he remained asymptomatic, lab values only notable for slightly elevated inflammatory markers. This case suggests that for some patients, either unwilling or unable to endure surgery, candidemia associated with a prosthetic graft can be managed conservatively, with antifungal therapy alone.

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.