Hypothenar Hammer Syndrome

Hypothenar hammer syndrome abbreviated as (HHS). It is a condition of the hand in which the blood flow to the fingers is reduced.

Hypothenar hammer syndrome occurs when workers repeatedly use the palm of the hand (especially the hypothenar eminence) as a hammer to grind, push, and twist hard objects. These activities can damage certain blood vessels of the hand especially the ulnar artery resulting in reduction of blood flow to the fingers..

Signs and symptoms

  • Hand may show discoloration (blanching, mottling, and/ or cyanosis; Gangrene may be present in advanced cases);
  • Unusual tenderness/ a callous over the hypothenar eminence;
  • Fingertip ulcerations;
  • Splinter hemorrhages over ulnar digits;
  • Pulsatile mass.
  • Pain over hypothenar eminence and ring finger, may involve small, middle and index fingers.
  • Cold sensitivity
  • Paresthesia

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Allen’s test is mostly use to identify this syndrome. It will be positive if an occlusion is present and negative if an aneurysm is present. Also, an angiogram may show a “corkscrew” ulnar artery or an occlusion or aneurysm at the hook of the hamate.


There are two main treatment plan for this syndrome –

  • Non-operative procedure: This involve lifestyle modifications, symptomatic treatment, and vascular consult
  • Operative procedure: This could involve endovascular fibrinolysis; excision of involved segment and reconstruction with or without a vein graft; arterial ligation (Leriche procedure).

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