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| Volume 347:339 |
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August 1, 2002 |
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Number 5 |
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Work-Related
Vascular Injuries of the Hand � Hypothenar Hammer Syndrome
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A 47-year-old construction worker
reported a two-month history of blanching of the second to fifth
fingers and a recent ulcer on the tip of the third finger of his
right hand. One week before the onset of symptoms, he had
straightened a slab of iron with a hammer. Angiography (Panel A)
revealed an aneurysm of the distal ulnar artery measuring 5 mm
in diameter (large arrowhead) and occlusions of digital branches
presumed to be secondary to thromboembolism (small arrowheads).
Surgery revealed a partially thrombosed false aneurysm of the
ulnar artery, which was resected. The postoperative course was
uneventful, and the ulnar artery was shown to be patent.
A 42-year-old car mechanic noted blanching of the fourth and
fifth fingers on exposure to cold and an ulcer on the tip of the
fourth finger of his right hand. Symptoms developed after he
jacked up a car with his right hand. Angiography (Panel B)
revealed a stenosis of the distal ulnar artery (large arrowhead)
and occlusions of digital branches in the fourth and fifth
fingers presumed to be secondary to thromboembolism (small
arrowheads). An aneurysm of the distal ulnar artery was ruled
out by color-coded duplex sonography. The patient was treated
successfully with a daily dose of aspirin. The ulcer healed, but
the fingers continued to blanch on exposure to cold.
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Manuela Birrer, M.D.
Iris Baumgartner, M.D.
Universit�tsspital Bern
3010 Bern, Switzerland
Another Image in Clinical Medicine (Leu KM, Kalemkerian GP. Osteoporosis
Circumscripta. N Engl J Med 2002;347:e2) has also been published in
this issue and can be seen at http://www.nejm.org.
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