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Hypothenar hammer syndrome, known for affecting laborers, gets relief from
bypass grafting.
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ROCHESTER, Minn. -- The hand pain, tingling, numbness and
cold sensitivity of hypothenar hammer syndrome, also known
as hammer hand, are best alleviated by bypass grafting
surgery, according to a new study by Mayo Clinic plastic
surgeons.
"In the past, treatment of hypothenar hammer syndrome has been
controversial, and physicians have been searching for some way to
treat it," says Craig Johnson, M.D., chair of Mayo Clinic's Division
of Plastic Surgery and lead study investigator. "From our study,
it's clear that people with this syndrome shouldn't be treated with
medication or other treatments, but with surgery."
Dr. Johnson explains that symptoms improved in 78 percent of the
patients in his study who underwent a bypass grafting operation and
that he witnesses an almost immediate relief in his patients with
this surgery.
"Post-surgery, patients feel their hands are warmer right away,
though ulcers take a little longer to heal," he says. "Most people
do quite well and get back to work quickly."
Patients with this condition have a damaged ulnar artery, a key
means of blood flow to the hand. In addition to the sensory damage,
they also can develop small ulcers in their fingertips resulting in
blackened fingers or even gangrene, due to lack of oxygenation.
"Many times they can't do their jobs due to pain," says Dr.
Johnson. "They have cold intolerance, so often they can't go outside
when it's cold or handle anything chilled, like cold meat. They also
can't hold heavy objects."
The treatment found to improve these symptoms, bypass grafting
surgery, involves removing the damaged portion of the artery, which
Dr. Johnson describes as clotted much like a clogged lead pipe. The
artery's blood flow is then restored by replacing the section of
blocked artery with a vein graft.
In this study, Dr. Johnson studied 115 hands in 101 patients
evaluated at Mayo Clinic. Medical and surgical treatment options
pursued were evaluated by chart review and postoperative phone calls
for all patients, and by duplex scan, an ultrasound of the arteries
that measures blood flow, for those who underwent bypass surgery.
The patients studied included 98 males and three females; most were
laborers.
An average of 3.5 years post-treatment, 29 of the 41 patients
treated with medication or sympathectomy -- surgery to interrupt the
nerve pathway -- showed no change in symptoms, seven were worse and
five showed symptom improvement.
Two types of excision operations were used for the remaining 60
patients studied. Four received excision of the damaged portion of
the ulnar artery or surrounding vessels followed by ligation, or
binding; symptoms in three out of four of these patients were
unchanged post-surgery. The other 56 patients were treated with
surgical excision of the damaged ulnar artery or surrounding vessels
followed by bypass grafting; 78 percent of these patients improved,
losing their pain and cold intolerance and returning to work. Of the
22 percent who showed no change or worsening of symptoms following
bypass grafting surgery, 86 percent of the patients had continued
smoking.
Dr. Johnson explains that quitting smoking is key to a lasting
effect of the bypass grafting surgery, thus he tries not to operate
on patients who continue to smoke. "Smokers do well for awhile, but
over time their bypass graft gets clotted," he explains.
The cause of hypothenar hammer syndrome is unknown. Previously
the condition has been thought to be task or work related due to use
of the palm as a hammer, but this is yet unsettled, says Dr.
Johnson. "It's not entirely certain whether you have to be running a
jackhammer for 20 years or laying concrete to develop this
syndrome." There could also be a genetic predisposition to the
syndrome, he indicates. Dr. Johnson points to a need for further
research into the origins of this syndrome.
###
These findings will be presented in an abstract at the American
Association of Plastic Surgeons 84th Annual Meeting at the Hyatt
Regency at Gainey Ranch in Scottsdale, Ariz.
Sources
Mayo Clinic.
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