title: Hypothenar hammer syndrome from ice hockey stick-handling.
abstract: Ulnar artery thrombosis and hypothenar hammer syndrome are rare vascular complications that could potentially occur with repeated blows or trauma to the hand. Although initially reported as an occupational hazard among laborers and craftsmen, it has been observed more recently among recreationalists and athletes. Until now, it has never been reported as a complication in ice hockey players. In this case report, a 26-year-old Canadian professional ice hockey player presented with acute dominant right hand paleness, coolness, and pain with hand use. The patient used a wooden hockey stick with a large knob of tape at the end of the handle, which he regularly gripped in the palm of his right hand to help with face-offs and general stick-handling. Sonographic evaluation demonstrated no arterial flow in the distal right ulnar artery distribution, and ulnar artery occlusion with no aneurysmal degeneration was confirmed by magnetic resonance angiogram. Intraarterial thrombolytic therapy was initiated, and subsequent serial angiograms demonstrated significant improvement in distal ulnar artery flow as well as recanalization of right hand deep palmar arch and digital arteries. The patient's symptoms resolved, and he was maintained on therapeutic anticoagulation for 3 months prior to returning to playing ice hockey professionally, but with a padded glove and no tape knob at the handle tip. This case highlights a unique presentation of hockey stick-handling causing ulnar artery thrombosis that was likely from repeated palmar hypothenar trauma. Appropriate diagnostic imaging, early intraarterial thrombolysis, and postoperative surveillance and follow-up were crucial for the successful outcome in this patient.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Zayed
authors.forename: Joey
authors.initials: J
authors.lastname: McDonald
authors.forename: Jacques G
authors.initials: JG
authors.lastname: Tittley
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D003251:Constriction, Pathologic; D012090:Cumulative Trauma Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006225:Hand / Q000098:blood supply*; D006230:Hand Injuries / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006688:Hockey / Q000293:injuries*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D011859:Radiography; D020127:Recovery of Function; D012039:Regional Blood Flow; D019876:Sports Equipment / Q000009:adverse effects*; D013577:Syndrome; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants