Hypothenar Hammer Syndrome in Workers Occupationally Exposed to Vibrating Tools

1993 ◽  
Vol 18 (6) ◽  
pp. 761-766 ◽  
Author(s):  
H. KAJI ◽  
H. HONMA ◽  
M. USUI ◽  
Y. YASUNO ◽  
K. SAITO
Keyword(s):  
Ulnar Artery ◽  
Proximal Part ◽  
Vascular Lesions ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Left Hand ◽  
Hypothenar Hammer Syndrome ◽  
Occupationally Exposed ◽  
The Right

Among 330 vibration-exposed workers, 24 cases of hypothenar hammer syndrome in 29 hands were diagnosed by arteriography. The right hand was involved in 13, the left hand in six, and both hands in five cases. The mean age was 55 years, mean duration of vibration exposure 19.4 years, and mean duration of episodic Raynaud’s phenomenon 6.4 years. The vascular lesions of the ulnar arteries were classified into three major types with subtypes. Type 1: stenosis of the superficial palmar arch around the hook of the hamate. Type 2a: occlusion of the superficial palmar arch around the hook of the hamate. Type 2b: occlusion of both superficial and deep palmar arches around the hook of the hamate. Type 3a: occlusion of the ulnar artery at the proximal part of the wrist. Type 3b: occlusion of the ulnar artery near the wrist with the occlusion of the dorsal carpal branch of the ulnar artery.

scholarly journals A Rare Finding In The Hand Irrigation

2018 ◽  
Vol 17 (3) ◽  
pp. 496-500
Author(s):  
Humberto Ferreira Arquez
Keyword(s):  
Blood Supply ◽  
Anatomical Variation ◽  
Medical Science ◽  
Ulnar Artery ◽  
Palmar Arch ◽  
Left Hand ◽  
Composite Tissue ◽  
Critical Knowledge ◽  
The Right ◽  
The University

Background: The blood supply of the hand is complex and challenging. Awareness of the anatomical variationis necessary not only for the anatomist but also for surgeons.The ulnar artery provides a major blood supply to the hand with the assistance of the radial artery in the form of the superficial palmar arch.The objective of this study was reported a rareanatomical variation of the superficial palmar arch.Materials and Methods: The anatomical variation described was found during routine dissection performed by medical students of second semester in a 75-year-old male embalbed adult cadaver in the laboratory of Morphology of the University of Pamplona.Results and Discussion: In the right hand, the superficial palmar arch only gave rise to two common palmar digital arteries. In the left hand, the arch provided common palmar digital arteries which ran into the first, third and the fourth spaces and one proper palmar digital for the little finger. The arch does not supply the second intermetacarpal space.Conclusions: Less critical knowledge of vasculature of the hand might lead iatrogenic injury during surgery, microvascular surgery for revascularization, replantation and composite tissue transfers.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.496-500

scholarly journals Traumatic injury of radial and ulnar artery with perfusion of the hand through the median artery: a case report

2021 ◽  
Vol 52 (2) ◽  
pp. e5024521
Author(s):  
Daniela Calderón Ardila ◽  
Daniel Raúl Ballesteros Larrota ◽  
María Andrea Calderón Ardila ◽  
Luis Ernesto Ballesteros Acuña
Keyword(s):  
Young Male ◽  
Ulnar Artery ◽  
Vascular Lesions ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Anatomical Variant ◽  
Anterior Interosseous Artery ◽  
Left Limb ◽  
Interosseous Artery ◽  
Median Artery

Case description: A young male patient with a complete section of the ulnar and radial arteries preserved the perfusion of the hand through an anatomical variant, the median artery, identified by angiotomography. Clinical Findings: A wound in the distal third of the left forearm with present pulses and adequate hand coloration. An angiotomography of the upper left limb showed a median artery originating as a continuation of the anterior interosseous artery and ending in the palm of the hand with an incomplete superficial palmar arch. Treatment and Outcomes: Ligation of both radial and ulnar arteries was performed. It was not possible to follow up with the patient. Clinical Relevance: Forming the superficial and deep palmar arches, the irrigation of the hand comes from the ulnar and radial arteries, which can compromise the viability of the limb when injured. The median artery is present in 0.6-21.1% of the population, originates from the anterior interosseous artery (branch of the ulnar), accompanies the median nerve in its path and ends in the palm joining the superficial palmar arch. Diagnostic imaging is a key tool for assessing arterial circulation and characterizing upper limb vascular lesions. Knowledge of the anatomical variations of the arterial supply of the hand, including variability of the superficial palmar arch, is crucial for the safety and success of hand surgeries.

scholarly journals Double superficial palmar arch - a case report

2012 ◽  
Vol 01 (03) ◽  
pp. 148-150
Author(s):  
Gurbachan Singh Gindha ◽  
Bindu Aggarwal ◽  
Sukhinder Baidwan
Keyword(s):  
Case Report ◽  
Distal Part ◽  
Ulnar Artery ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Secondary Hemorrhage ◽  
Male Cadaver ◽  
The Common ◽  
The Right ◽  
The Relationship

AbstractThe superficial palmar arch is formed predominantly by the ulnar artery with a contribution from the superficial palmar branch of the radial artery. However, the arch formation is highly variable. The knowledge of the relationship, course and variations of the arch are important in various surgical procedures. Incomplete ligation of vessels in cases of variable arterial arch can lead to serious secondary hemorrhage in the depth of the wounds of hand. In the present study, a case of double superficial palmar arch is reported in the right hand of a male cadaver. The radio-ulnar type of arch had a proximal and a distal part from where the common palmar digital arteries arose.

scholarly journals A case of intra-arterial thrombolysis with alteplase in a patient with hypothenar hammer syndrome but without underlying aneurysm

2018 ◽  
Vol 6 ◽  
pp. 2050313X1774886
Author(s):  
Harshal Shukla ◽  
Vicken Yaghdjian ◽  
Issam Koleilat
Keyword(s):  
Thrombolytic Therapy ◽  
Therapeutic Option ◽  
Subsequent Development ◽  
Ulnar Artery ◽  
Bleeding Risk ◽  
Palmar Arch ◽  
Left Hand ◽  
Hypothenar Hammer Syndrome ◽  
Catheter Directed Thrombolysis ◽  
Hypothenar Eminence

Hypothenar hammer syndrome is a cause of symptomatic ischemia of the hand secondary to the formation of aneurysm or thrombosis of the ulnar artery in the setting of a complete or incomplete palmar arch. Acute occlusive thrombus or embolus of the hand represents a complex problem that often may require immediate surgical intervention. We report a case of acute unilateral arterial hand ischemia requiring catheter-directed thrombolysis with Alteplase therapy in a patient with acute occlusive arterial thrombosis of the left ulnar artery. A catheter-directed thrombolytic regimen consisted of Alteplase 1 mg/h for 24 h, and heparin was infused through the sheath side arm at a rate of 500 units per hour for resolution of the thrombus and improvement in symptoms. A former truck driver presented with worsening pain and subsequent development of significant cyanosis with early gangrenous changes of the left second and third fingertips. He had significant callous of the hypothenar eminence and reported that his left hand was not only his “driving” hand but also a cane has been used in his left hand to ambulate. Initial angiogram revealed only ulnar artery occlusion at the wrist with reconstitution just distal to the hypothenar eminence. After 24 h of the initiation of thrombolysis, repeat angiography revealed resolution with a widely patent ulnar artery. His symptoms and the color of his digits immediately improved, and within a few months, his hand had normalized. The patient had no clinical sequelae of thrombolytic therapy. Catheter-directed thrombolytic therapy in situations of acute occlusive thrombus of the hand may provide a therapeutic option for patients with suspected hypothenar hammer syndrome. However, thrombolytic therapy carries risk of significant hemorrhagic complications. Before initiating therapy, careful judgment about the possibility for bleeding risk is required. This provides for a minimally invasive alternative to open surgical revascularization especially in the absence of underlying correctable anatomic defect such as aneurysm.

Congenital Bilateral Absence of the Radial Artery: A Very Rare Variation in Humans - Phylogenetic and Ontogenetic Aspects

2016 ◽  
Vol 203 (3) ◽  
pp. 194-202 ◽  
Author(s):  
Bettina Pretterklieber ◽  
Gerda Martschini ◽  
Michael L. Pretterklieber
Keyword(s):  
Radial Artery ◽  
Wrist Joint ◽  
Anatomic Variation ◽  
Ulnar Artery ◽  
Caucasian Woman ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Arterial Blood ◽  
Bilateral Absence ◽  
The Right

In an 80-year-old Caucasian woman, both radial arteries were found to be replaced by an enlarged anterior interosseous artery. Additionally, the right forearm revealed a persistent median artery which formed the superficial palmar arch together with the ulnar artery. In both hands, the replaced radial artery was connected only to the deep but not the superficial palmar arch. In clinical practice, lack of an arterial pulse on the radial aspect of the wrist joint may indicate the presence of this anatomic variation. In this case, arterial blood sample collections, application of contrast media, invasive measurements of blood pressure, and several angiographic interventions cannot be performed via the radial artery. As this is the fourth reported case since 1830, bilateral aplasia of the radial artery appears to be an exceptional variation in humans. Thus, the phylo- and ontogenetic aspects of this anomaly are discussed.

scholarly journals ABSENCE OF SUPERFICIAL PALMAR ARCH WITH PERSISTENT MEDIAN ARTERY - A CASE REPORT

2014 ◽  
Vol 04 (03) ◽  
pp. 109-111
Author(s):  
Kavitha K. ◽  
Prima D'Souza ◽  
Vishal Kumar ◽  
Keyword(s):  
Case Report ◽  
Ulnar Artery ◽  
Anatomical Variations ◽  
Arterial Supply ◽  
Vascular Pattern ◽  
Superficial Palmar Arch ◽  
Undergraduate Medical Students ◽  
Palmar Arch ◽  
Surgical Emergencies ◽  
Median Artery

AbstractThe anatomical variations in the arterial supply of the palm are frequently reported. One such variation reported during routine dissection for undergraduate medical students in our college is the absence of superficial palmar arch and presence of persistent median artery. The arterial supply to the palm is in the form of superficial and deep palmar arches. In the present case the median artery and ulnar artery supplies the palm without forming an arch on the left extremity. Awareness of variations in the vascular pattern of the palm is clinically important in case of angiographic procedures and surgical emergencies.

scholarly journals Bilateral superficial median arteries

1999 ◽  
Vol 194 (3) ◽  
pp. 475-477
Author(s):  
TOSHIO NAKATANI ◽  
ATSUSHI IZUMI ◽  
SHIGENORI TANAKA
Keyword(s):  
Clinical Importance ◽  
Ulnar Artery ◽  
Crossing Over ◽  
Upper Limbs ◽  
Superficial Palmar Arch ◽  
Arterial Variation ◽  
Palmar Arch ◽  
Flexor Muscles ◽  
Median Artery ◽  
Superficial Ulnar Artery

A superficial artery may be present in the forearm, arising from the axillary, brachial or superficial brachial arteries and crossing over the origin of the flexor muscles of the forearm to reach the palm (Adachi, 1928; Bergman et al. 1988). When this superficial artery continues as the normal ulnar artery accompanying the ulnar nerve at the wrist, it is referred to as the superficial ulnar artery, with an incidence of ∼4%. When the artery passes below or superficial to the flexor retinaculum in the middle of the forearm, sometimes continuing to join the superficial palmar arch, it is called the superficial median artery, with an incidence of ∼1%. We have observed a relatively rare variation involving the presence of a superficial median artery in both upper limbs. We discuss the clinical importance and the developmental aspects of this arterial variation.

Patterns of Arterial Arcades of the Superficial Palmar Arch: A Study In Embalmed Cadaver Palms

2021 ◽  
Vol 9 (3.3) ◽  
pp. 8097-8102
Author(s):  
Suman Udupi ◽  
◽  
Pushpa Gowda ◽  
Keyword(s):  
Radial Artery ◽  
Index Finger ◽  
Ulnar Artery ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Artery Cannulation ◽  
Complete Type ◽  
Cardio Vascular ◽  
Interesting Area

Background: The complex and variable pattern of the arterial arcades of the palm form an interesting area of study anatomically and surgically. In the present study arches were classified into complete and incomplete types, the complete type being the most prominent in 88.6% of the palms. Among the complete type, arch formed by ulnar artery alone supplying the thumb and index finger was found in majority of the specimens (50%). The classical or standard superficial palmar arch formed by the superficial palmar branch of radial and ulnar arteries was found in only 28.5%. Different patterns of the arterial arcades of the superficial palmar arch are normally encountered during routine anatomical dissections of the palm which needs to be emphasized and highlighted for a desired surgical out come during microvascular reconstructive surgeries of the palm and during radial artery cannulation. Context: With technological advancements in microsurgical procedures of the hand, fields of anatomical interest like the classification of arterial arcades of the palm, now becomes essential for operating vascular surgeons for a desired surgical outcome Purpose of the study: The present study was taken up to analyze and document varying patterns of the arterial arcades of the superficial palmar arch. Methods and Material: the study was conducted by dissecting 70 randomly obtained formalin fixed cadaver palms. Results: In the present study arches were classified into complete and incomplete types, the complete type being the most prominent in 88.6% of the palms. Among the complete type, arch formed by ulnar artery alone supplying the thumb and index finger was found in majority of the specimens (50%). The classical or standard superficial palmar arch formed by the superficial palmar branch of radial and ulnar arteries was found in only 28.5%. Out of the 70 hands, incomplete arches were found only in 8 hands with an incidence of 11.4%. Conclusion: Knowledge of arterial pattern of the hand is very important to vascular and reconstructive surgeons for effective treatment of injuries of the hand. Such a knowledge of the disposition of the arterial arcades of the palm also enables cardio-vascular surgeons to plan and modify surgical procedures such as radial artery harvesting, cannulation and in preventing the ischemia of hands in such procedures. KEY WORDS: Superficial palmar arch, Arterial arcades, Complete arch, Incomplete arch.

scholarly journals VARIATIONS OF THE SUPERFICIAL PALMAR ARCH: A CLINICO-ANATOMICAL CONSIDERATION

2020 ◽  
Vol 8 (4.2) ◽  
pp. 7817-7822
Author(s):  
Pooja Dawani ◽  
◽  
Anita Mahajan ◽  
Sabita Mishra ◽  
Neelam Vasudeva ◽  
...  
Keyword(s):  
Radial Artery ◽  
Blood Supply ◽  
Myocardial Revascularization ◽  
Ulnar Artery ◽  
Vital Role ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Human Cadavers ◽  
Median Artery ◽  
Digital Caliper

Introduction: The superficial palmar arch plays a vital role in the blood supply to the hand. The knowledge of variations in the pattern of superficial palmar arch and its branches, and caliber of these arteries, has become more important for surgeons in reconstructive hand surgeries and radial artery harvesting for myocardial revascularization. The aim of this study was to observe the variations and measure the diameter of contributing arteries of the arches. Materials and methods: In the present study, thirty hands from formalin fixed adult human cadavers were dissected. Normal pattern as well as variations in the arteries contributing to the arch, completeness of arch, and the branching pattern were observed and noted. With the help of a digital caliper, the diameters of ulnar and radial arteries and median artery were taken at the level of the wrist and statistical analysis of the results was done. Results: It was observed that in 96.7 % cases, the superficial palmar arch was complete where there was anastomosis between the arteries forming the arch. In 3.3% cases, the arch was incomplete. The complete arch was divided into radioulnar (36.7%), ulnar (56.7%) and medianoulnar (3.3%) types. The diameter of superficial palmar branch of radial artery was found to be significantly less than the diameter of ulnar artery. (p=0.003). Conclusion: The data obtained on variations and morphometry of superficial palmar arches will certainly be useful in planning and choosing appropriate and safe surgical procedures to prevent inadvertent outcome. KEY WORDS: Palmar arch, blood supply, Hand, radial artery, myocardial revascularization.

scholarly journals Anatomical variations of the superficial palmar arch and its clinical relevance

2021 ◽  
pp. 14-14
Author(s):  
Milos Malis ◽  
Slobodan Kapor ◽  
Laslo Puskas ◽  
Milan Aksic ◽  
Valentina Blagojevic ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Circulatory System ◽  
Ulnar Artery ◽  
Anatomical Variations ◽  
Terminal Branch ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Area Of Interest ◽  
Complete Type ◽  
Significant Difference

Backgorund / Aim. In-depth knowledge of the vascular network of hand is of great importance in modern medicine. The main vessel of hand is the superficial palmar arch. As typically described in anatomical textbooks, it arises as terminal branch of the ulnar artery which then anastomoses with the superficial palmar branch of the radial artery. However, the superficial palmar arch is characterized by remarkable variability, which was the area of interest of many researchers so far. Comprehensive examination of the anatomy of the superficial palmar arch which included two parameters - the formation of the superficial palmar arch and its localization in relation to the topographic landmarks of the hand. Methods. Research was conducted on a total number of 14 cadavers. After careful dissection, variations and distance of the superficial palmar arch from Kaplan?s cardinal line were observed on the right hands. Collected data were then analyzed statistically in SPSS 11.0 using the Mann-Whitney U test, with the accepted level of statistical significance of p < 0.05. Results. According to Coleman and Anson classification, the higher incidence of incomplete type (57.14%) of the superficial palmar arch should be in comparison to complete type (42.86%). In addition to this, a statistically significant difference discovered in distance of the superficial palmar arch from Kaplan?s cardinal line between two groups with complete and incomplete types, respectively. The parameter examined in the group with complete type took the value of 2.13 ? 0.32 cm, while in the group with incomplete type measured 3.33 ? 0.87 cm. Conclusion. The present study showed a very important complexity in the domain of anatomy of the superficial palmar arch with numerous clinical implications. For that reason, a thorough evaluation of the hand circulatory system should be considered while planning surgical procedures in order to avoid operative and postoperative complications.

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