J Reconstr Microsurg 2011; 27(6): 373-376
DOI: 10.1055/s-0031-1281517
© Thieme Medical Publishers

Case of Combined Thenar and Hypothenar Hammer Syndrome: Case Report and Brief Review of the Literature

Georgios Koulaxouzidis1 , Ziad Kalash1 , Horst Zajonc1 , Björn Stark1 , Holger Bannasch1
  • 1Department of Plastic and Hand Surgery, University Medical Center Freiburg (UMCF), Freiburg, Germany
Further Information

Publication History

Publication Date:
29 June 2011 (online)


Acute or chronic arterial thrombose due to repetitive blunt trauma to the palm of the hand is a rare occupational vascular disease. In most of the cases it affects the ulnar artery and its superficial palmar branch. Repetitive crush is pathogenic and the unique anatomy of the superficial branch of the ulnar artery lying next to the hook of hamate is causative. In rare cases it may affect the superficial palmar branch of the radial artery, called thenar hammer syndrome. The combination of both is an absolute rarity. Both syndromes are occupational diseases in workers using the hand as a hammer. Patients typically present with Raynaud phenomenon or complain about ischemic pain, cold intolerance, or cyanosis. The gold standard in diagnosis is the angiography. Surgical or conservative treatment can be performed successfully. We present a case of combined thenar and hypothenar hammer and a brief review of the literature.


  • 1 Ablett C T, Hackett L A. Hypothenar hammer syndrome: case reports and brief review.  Clin Med Res. 2008;  6 (1) 3-8
  • 2 Abudakka M, Pillai A, Al-Khaffaf H. Hypothenar Hammer Syndrome: rare or underdiagnosed?.  Eur J Vasc Endovasc Surg. 2006;  32 (3) 257-260
  • 3 Guttani C. De externis aneurysmatibus manu chirurgica methodice pertractandis. 1772. In: Erichsen J E, ed. trans. Observations on Aneurysm. London: Sydenham Society; 1884: 316-318
  • 4 Von Rosen S. Ein Fall Von Thrombose in der Arteria Ulnaris nach Einwirkung von stumpfer Gewalt.  Acta Chir Scand. 1934;  73 500-506
  • 5 Conn Jr J, Bergan J J, Bell J L. Hand ischemia: hypothenar hammer syndrome.  Proc Inst Med Chic. 1970;  28 (2) 83
  • 6 Aleksic M, Heckenkamp J, Gawenda M, Brunkwall J. Occupation-related vascular disorders of the upper extremity—two case reports.  Angiology. 2006;  57 (1) 107-114
  • 7 Hohendorff B, Treumann T, von Wartburg U. Thenar hammer syndrome.  Handchir Mikrochir Plast Chir. 2009;  41 (1) 38-43
  • 8 Marie I, Hervé F, Primard E, Cailleux N, Levesque H. Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients.  Medicine (Baltimore). 2007;  86 (6) 334-343
  • 9 Kaji H, Honma H, Usui M, Yasuno Y, Saito K. Hypothenar hammer syndrome in workers occupationally exposed to vibrating tools.  J Hand Surg [Br]. 1993;  18 (6) 761-766
  • 10 Winterer J T, Ghanem N, Roth M et al.. Diagnosis of the hypothenar hammer syndrome by high-resolution contrast-enhanced MR angiography.  Eur Radiol. 2002;  12 (10) 2457-2462
  • 11 Abdel-Gawad E A, Bonatti H, Housseini A M, Maged I M, Morgan R F, Hagspiel K D. Hypothenar hammer syndrome in a computer programmer: CTA diagnosis and surgical and endovascular treatment.  Vasc Endovascular Surg. 2009;  43 (5) 509-512
  • 12 Hammond D C, Matloub H S, Yousif N J, Sanger J R. The corkscrew sign in hypothenar hammer syndrome.  J Hand Surg [Br]. 1993;  18 (6) 767-769
  • 13 Pouliadis G P, Bollinger A, Brunner U. Das arteriographische bild des hypothenar-hammer-syndroms.  Fortschr Röntgestr. 1977;  127 (4) 345-349
  • 14 Ferris B L, Taylor Jr L M, Oyama K et al.. Hypothenar hammer syndrome: proposed etiology.  J Vasc Surg. 2000;  31 (1 Pt 1) 104-113
  • 15 Khatri V P, Gaulin J C, Amin A K. Fibromuscular dysplasia of distal radial and ulnar arteries: uncommon cause of digital ischemia.  Ann Plast Surg. 1994;  33 (6) 652-655
  • 16 Wylie E J, Binkley F M, Palubinskas A J. Extrarenal fibromuscular hyperplasia.  Am J Surg. 1966;  112 (2) 149-155
  • 17 Jagenburg A, Goyen M, Hirschelmann R, Carstens I M, Kröger K. Hypothenar hammer syndrome: causes, sequelae and diagnostic aspects.  Rofo. 2000;  172 (3) 295-300
  • 18 Foster D R, Cameron D C. Hypothenar hammer syndrome.  Br J Radiol. 1981;  54 (647) 995-996
  • 19 Yakubov S J, Nappi J F, Candela R J, George B S. Successful prolonged local infusion of urokinase for the hypothenar hammer syndrome.  Cathet Cardiovasc Diagn. 1993;  29 (4) 301-303
  • 20 Smith H E, Dirks M, Patterson R B. Hypothenar hammer syndrome: Distal ulnar artery reconstruction with autologous inferior epigastric artery.  J Vasc Surg. 2004;  40 (6) 1238-1242
  • 21 Cooke R A. Hypothenar hammer syndrome: a discrete syndrome to be distinguished from hand-arm vibration syndrome.  Occup Med (Lond). 2003;  53 (5) 320-324

Georgios Koulaxouzidis M.D. 

Department of Plastic and Hand Surgery, University Medical Centre Freiburg (UMCF)

Hugstetter Straße 55, Freiburg 79106, Germany

Email: georgios.koulaxouzidis@uniklinik-freiburg.de