Extradigital Glomus Tumor on Hypothenar Region Diagnosed on Ultrasound – A Case Report

We report a case of 32-year-old female with a 6 months history of excruciating pain in hypothenar region of the left hand. Pain was aggravated by pressure, touch, and cold temperature. Musculoskeletal ultrasonography revealed – a well-defined, hypoechoic lesion in deep dermis, and subcutaneous fat in the left hypothenar eminence with mixed arterial and venous signals within on Doppler study, suggestive of – subcutaneous vascular lesion and diagnosis of glomus tumor was suggested. The patient underwent excision of the lesion. Pathological examination of the specimen showed a glomus tumor and excluded malignant transformation to glomangiosarcoma. Extradigital glomus tumor can be diagnosed on ultrasound with high confidence in appropriate clinical setting.

Association of core body temperature and peripheral blood flow of the hands with pain intensity, pressure pain hypersensitivity, central sensitization, and fibromyalgia symptoms

Our aim was to analyse body core temperature and peripheral vascular microcirculation at skin hypothenar eminence of the hands and its relationship to symptoms in fibromyalgia syndrome (FMS). A total of 80 FMS women and 80 healthy women, matched on weight, were enrolled in this case–control study. Thermography and infrared thermometer were used for evaluating the hypothenar regions and core body temperature, respectively. The main outcome measures were pain pressure thresholds (PPTs) and clinical questionnaires. Significant associations were observed between overall impact [ β = 0.033; 95% confidence interval (95%CI) = 0.003, 0.062; p = 0.030], daytime dysfunction ( β = 0.203; 95%CI = 0.011, 0.395; p = 0.039) and reduced activity ( β = 0.045; 95%CI = 0.005, 0.085; p = 0.029) and core body temperature in FMS women. PPTs including greater trochanter dominant ( β = 0.254; 95%CI = 0.003, 0.504; p = 0.047), greater trochanter non-dominant ( β = 0.650; 95%CI = 0.141, 1.159; p = 0.013), as well as sleeping medication ( β = −0.242; 95%CI = −0.471, −0.013; p = 0.039) were also associated with hypothenar eminence temperature. Data highlighted that FMS women showed correlations among body core temperature and hand temperature with the clinical symptoms.

Severe hand trauma with damage to the myotendinous structure in the hypothenar eminence and the neurovascular bundle

The human hand is a unique tool, without which daily life is impossible. Violation of internal structures integrity leads to disturbance of connections and to functional impairments. Injuries, genetic diseases, infections – all these are but a few among many causes of pathology development. Mechanical damage occupies a separate place in this classification since damage is suffered by several structures. Statistically, the damage to internal components of the hand ranges from 1.9% to 18.8%. A clinical case describing observation of a patient with severe hand injury with damage to flexor tendons of the fingers, muscles of the hypothenar and violation of neurovascular bundle integrity obtained by the profiled sheeting is presented. The tactics of surgical treatment is subdivided into the general and the special ones. The general tactics consists in primary surgical treatment of the wound, the special one is decided upon drawing on the intraoperative data. Unfortunately, it was not possible to obtain data of long-term outcomes since the communication with the patient was lost. The case described below demonstrates the need to perform these surgical interventions on an emergency basis and improve knowledge in the field of hand surgery.

Accessory flexor carpi ulnaris: case report and review of the literature

Most of the accessory muscles of the forearm described in the radiology literature are located either in the radial aspect of the forearm or towards the hypothenar eminence. We present an unusual case of an ulnar-sided distal forearm accessory flexor carpi ulnaris muscle presenting as a “pseudotumour“ demonstrated with both ultrasound and MRI, rarely reported in the current surgical and anatomical literature. Given the location and relation to the ulnar nerve towards Guyon’s canal, the accessory muscle may also predispose to distal ulnar nerve entrapment.

The Cutaneous Branch of the Deep Palmar Artery and Blood Supply to the Proximal Hypothenar Skin: An Anatomic Research Oriented to Flap Design

Background: The distal half of the hypothenar eminence (HE) skin vascularization has been extensively investigated. Different flaps have been described based on these arteries. Similarly, the vascularization of the proximal half of HE has also been investigated, although to a lesser extent. The aim of this paper is to determine, in a cadaver sample, the anatomy of the hypothenar cutaneous branches in their proximal half. Methods: In all, 20 adult, red-colored-latex-injected hands were studied. Dissections were performed with a 4X to 10X magnification. Cutaneous branches in the proximal half of the HE were found. Their variants were studied, and they were classified into different types according to their relationships. Results: A cutaneous branch of the deep palmar artery (CBDPA) was identified. It was located in the subcutaneous cellular tissue thickness in the proximal half of the HE. Moreover, it presented 3 anatomical variants, classified according to its relationships with the superficial ulnar nerve branch (SUN). Type 1 variant: the CBDPA and the PDA ran in front of the SUN (60% of cases). Type 2: the CBDPA and the DPA ran behind the SUN (30% of cases). Type 3: the CBDPA ran in front of the SUN while the DPA ran behind it (10% of cases). Conclusion: There is a CBDPA which is the HE proximal half main cutaneous branch. Although it presented several variants, its existence is constant, making it possible to use it as pedicle for proximal hypothenar flaps.

Perforator Flap Based Technique for the Treatment of Dupuytren's Contracture

Background: Perforator flap based technique was used in treating Dupuytren’s Contracture in a cohort of 48 patients. This perforator based on the ulnar palmar digital artery originates from the superficial palmar arch and supplies the hypothenar area. Methods: A curved incision that exposes the diseased palmar fascia was made in middle to distal palm lateral to the hypothenar eminence beginning 20mm distal to the distal wrist crease up to the heel of the palm. An additional incision from the arch of the curved incision extends into the middle phalanx for exposure of the digital cord. The perforator flap was raised along the hypothenar region in 53 hands of 48 patients, nine females and 39 males and their ages at the time of surgery averaged 56 years. The Tubiana classification illustrates the extent of the disease in our patients’ population with no distal interphalangeal joint involvement. Results: Of the 48 patients, five patients had bilateral hands involvement. Two patients complained of paresthesia in the ring and little fingers after surgery, the symptom had disappeared without further intervention before the latest follow-up. There was no incidence of skin necrosis and delayed healing. Up to date, there has been no reported recurrence. Conclusion: This perforator flap based technique is technically simple and reliable with better exposure and easier removal of all the diseased fascia, making it possible for primary healing without skin necrosis and acceptable for treatment of patients at all stages of the disease.

Ulnar Artery Aneurysm and Repair

This is a case study of a patient who was presented to the emergency room with ischemia of the left third, fourth and fifth fingers and a pulsatile mass in the hypothenar eminence. Non-invasive arterial exam of the upper extremities was performed bilaterally which resulted in normal pressures and normal blood flow velocities. The arterial duplex imaging was also normal in the subclavian, axillary, brachial, radial and ulnar arteries and also demonstrated triphasic Doppler flow velocities. The technologist scanned distal to the wrist where a branch of the ulnar artery along with the aspect of the palmer arch surface revealed a true aneuryms with both antegrade and retrograde flow. The patient was infused tissue plasminogen activator (TPA) for a total of 72 hours with eventual recanalization of the thrombosed aneurysm. Due to the high risk of limb threat the patient underwent a successful resection of the left ulnar artery aneurysm with vein patch.

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

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.