Age / Sex : 68 / F

Chief complaint : Left wrist pain

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)

Courtesy : 김상윤, Sang Yoon Kim, 단국대학교병원, Dankook UNIV Hospital

Hypothenar hammer syndrome

Discussion

Findings

1. Thrombosed pseudoaneurysm arising from ulnar artery


2. Ulnar nerve compression


3. Angiography: Focal increased vascularity in hamate shadow, supplied by a few tiny branches arising from ulnar artery

At Guyon’s canal, vascular segment of ulnar artery and superficial palmar arch can be compressed against the adjacent bony hook of the hamate and is very susceptible to injury.

With repetitive blunt trauma, ulnar artery can develop intimal damage producing vasospasm and thrombus formation. If the damage spreads through the media into the arterial wall, aneurysm formation can occur as well.

Neurologic symptoms such as paresthesia and pain may also result from compression of the sensory branches of the ulnar nerve.