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American Association of Plastic Surgeons
31. The Management and Treatment of Hypothenar Hammer Syndrome
Craig Johnson, MD.
Mayo Clinic, Rochester, MN, USA.

PURPOSE: Hypothenar Hammer Syndrome, or traumatic occlusion of the Ulnar Artery at the leve of the wrist, is a rare condition. A paucity of information exists, ussually in very small series to guide treatment. The purpose of this study was to gather and report on a large institutional and large single surgeon series, with emphasis on treatment options and outcomes.
METHODS: 115 hands in 101 patients were evaluated at the Mayo Clinic in Rochester MN. This included 38 hands in 30 patients by a single surgeon. Medical and surgical treatment options were evaluated by chart review, post operative phone calls, and in surgical bypass patients, duplex scans.
RESULTS: There were 98 males and 3 females. Most patients were laborers, but this was not universally true. Follow up ranged from 6 months to 14 years, with the average follow up time being 3 and one half years. Graft patentcy was 84% at two years for those patints treated with vein bypass grafting. 41 patients and 46 hands were treated medically. 5 of 41 were improved on conservative treatment. 4 patients were treated with sympathectomy, only one of which was improved. Conservative treatment ultimately showed 29 of 41 patients showed no change, and 7 of 41 were clearly worse. In contrast, 60 patients were treated surgically. 4 of these were treated with excision and ligation, while the rest of the group had excision and vein bypass grafting. In the ligation group, 3 of 4 were unchanged. The bypass grafting group showed 78% of patients improved, with loss of cold intolerance and pain, as well as back to work. 22% showed no change or worse, but of these, 86% had occluded their graft when studied.
CONCLUSION:Hypothenar Hammer syndrome is clearly a surgical disease. Patients do better with bypass grafting than medical management or other forms of surgical treatment. The etiology of the disease remains to be fully understood.

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