Hypothenar hammer syndrome: long-term results of vascular reconstruction.
OBJECTIVE
To evaluate long-term patency rates and related outcomes after vascular reconstruction of hypothenar hammer syndrome and identify patient- or treatment-related factors that may contribute to differences in outcome.


METHODS
We used color flow ultrasound to determine the patency of 18 vein graft reconstructions of the ulnar artery at the wrist in 16 patients. Validated questionnaires evaluated patients' functional disability with the Disabilities of the Arm, Shoulder, and Hand score, pain with the visual analog scale, and cold intolerance with the Cold Intolerance Symptom Severity survey. Patient demographics, clinical data, and surgical factors were analyzed for association with graft failure. Patients were asked to grade the result of treatment on a scale of 0 to 10.


RESULTS
Of 18 grafts, 14 (78%) were occluded at a mean of 118 months postoperatively. Patients with patent grafts had significantly less disability related to cold intolerance according to the Cold Intolerance Symptom Severity survey in addition to significantly less pain on the visual analog scale. There was no statistical difference in Disabilities of the Arm, Shoulder, and Hand scores between patients with patent or occluded grafts. Patients graded the result significantly higher in patent reconstructions.


CONCLUSIONS
We noted a higher incidence of graft occlusion than previously reported at a mean follow-up of 9.8 years, which represents a long-duration follow-up study of surgical treatment of hypothenar hammer syndrome. Despite a high percentage of occlusion, overall, patients remained satisfied with low functional disability and all would recommend surgical reconstruction. This study suggests that improved outcomes may result from patent grafts in the long term.


METHODS
Prognostic IV.
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Ryan D
RD
Endress
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Craig H
CH
Johnson
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Allen T
AT
Bishop
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN. Electronic address: shin.alexander@mayo.edu.
Alexander Y
AY
Shin
D000328:Adult; D005260:Female; D005385:Fingers / Q000098:blood supply; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D007511:Ischemia / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013577:Syndrome; D013927:Thrombosis / Q000601:surgery*; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*
Hypothenar hammer syndrome; digital ischemia; ulnar artery thrombosis