[Hypothenar hammer syndrome as a cause of severe digital ischemia].
METHODS
A 69-year-old amateur carpenter complained of a sudden stabbing pain and a white discoloration of D4 and D5 of the right hand while shoveling snow. On admission in our clinic twelve days later, clinical inspection showed a gangrene of the distal bone of D5 and proximal garland-shaped radial and ulnar subcutaneous haemorrhage and already ischemic contracture. D4 showed pale livid colour.


METHODS
According to the results of an arteriography acral pulse oscillography revealed a occlusion of the digital arteries. Duplex sonography showed a thrombotic occluded aneurysm of the right ulnar artery over the hypothenar area.


METHODS
Hypothenar hammer syndrome with a thrombotic occlusion of an aneurysm of the distal ulnar artery and multiple thromboembolic occlusions of the digital arteries of D4 and D5 of the right hand.


METHODS
After initial therapy with Iloprost, treatment of pain and local treatment, an intraarterial locoregional lysis therapy with urokinase was performed. Acral blood circulation improved significantly and the patient was completely painless after treatment.


CONCLUSIONS
In case of an acute onset of unilateral digital ischemia hypothenar hammer syndrome should be considered. Regional thrombolysis can be performed in case of severe digital ischemia.
Wörnle
M
M
Gefässzentrum-Innenstadt, Angiologie, Medizinische Poliklinik, Klinikum der Ludwig-Maximilians-Universität München. Markus.Woernle@medpoli.med.uni-muenchen.de
Tatò
F
F
Hoffmann
U
U
D000208:Acute Disease; D000368:Aged; D000783:Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D015901:Angiography, Digital Subtraction; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use; D007511:Ischemia / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013577:Syndrome; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D017535:Ulnar Artery; D018616:Ultrasonography, Doppler, Duplex; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator; D016285:Iloprost