CLINICAL VIGNETTE |
Hypothenar hammer syndrome in a patient with rheumatoid arthritis: a mimic of vasculitis
Correspondence to: E. Rankin. E-mail: elizabeth.rankin{at}uhb.nhs.uk
A 50-yr-old right-handed man with RA suddenly developed painful discoloration of the middle, ring and little fingers of the left hand. He smoked 20 cigarettes per day. There was minimal synovitis but the affected fingers were blue and mottled. He was well and afebrile. ESR was 25 mm/h and RF was positive. ANA, ANCA and cryoglobulins were negative. Doppler studies of the proximal vessels and echocardiography were normal and blood cultures were negative.
Angiography (Fig. 1) showed occlusion of the palmar branch of the ulnar artery as it passed over the hamate and lack of filling of the digital arteries of the affected fingers, findings consistent with hypothenar hammer syndrome. This syndrome is usually seen in men who use the heel of the hand as a hammer: our patient was a builder. The ulnar three fingers are usually affected and the thumb spared. Intimal hyperplasia is common at this injury-prone site and, in a post-mortem study, was more severe in the right hands of men than in either their corresponding left hands or in either hand in women [1].
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We treated him conservatively with aspirin and nifedipine. He has had no further acute episodes. Other treatments described include intra-arterial fibrinolysis or interposition vein graft.
We are grateful to the patient for permission to describe his case.
The authors have declared no conflicts of interest.
References
- Stone JR. Intimal hyperplasia in the distal ulnar artery: influence of gender and implications for the hypothenar hammer syndrome. Cardiovasc Pathol 2004;13:20–5.[Medline]
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