SHM Converge Scientific Abstract ePoster Gallery-An Uncommon Cause of Secondary Raynaud's

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This case report describes a 61-year-old Caucasian man with tobacco use disorder who developed two weeks of pain, numbness, and coolness in the ulnar side of his right hand, especially the fourth and fifth fingers. He had no symptoms related to cold exposure or arm position. On exam, the affected hand was pale and cool with a diminished ulnar pulse, and Allen’s test suggested impaired palmar circulation.  <br /><br />Initial laboratory studies were normal. Because of concern for hand ischemia, CT angiography of the right upper extremity was performed and showed marked attenuation of the distal ulnar artery and digital arteries, suggesting hypothenar hammer syndrome (HHS). He was discharged on aspirin, a high-dose statin, and smoking cessation counseling, with vascular surgery follow-up. Outpatient catheter angiography confirmed occlusion of the right ulnar artery beginning in the mid-forearm, with occlusion of the distal ulnar artery and superficial palmar arch and attenuation of the digital branches to the fourth and fifth digits. He was managed conservatively with aspirin, clopidogrel, nifedipine, and smoking cessation advice.  <br /><br />HHS is a rare, underdiagnosed cause of secondary Raynaud’s phenomenon and hand ischemia caused by repetitive trauma or compression over the hypothenar eminence, often seen in blue-collar workers who use the heel of the hand as a hammer. Allen’s test may help assess palmar arch insufficiency but is not specific. Diagnosis can be made with angiography, CTA, MRA, or ultrasound. Initial treatment is conservative, while surgery is reserved for severe ischemia or aneurysm formation. The case emphasizes the importance of recognizing HHS and distinguishing it from other causes of hand ischemia.

Asset Subtitle

Tissa Bijoy George

Meta Tag

Author List Anjana Chandrasekhara Pillai, Khushboo Singh, Tissa Bijoy George

Category Clinical Vignettes

Concept Hypothenar Hammer Syndrome

Concept Raynaud Disease

Concept Hand Ischemia

Concept Ulnar-Sided Hand Pain

Concept Digital Pallor

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Tissa Bijoy George

Track Adult

Keywords

hypothenar hammer syndrome

ulnar artery occlusion

hand ischemia

secondary Raynaud phenomenon

Allen test

digital artery attenuation

catheter angiography

computed tomography angiography

smoking cessation

conservative management

Hypothenar Hammer Syndrome

Raynaud Disease

Hand Ischemia

Ulnar-Sided Hand Pain

Digital Pallor