How is ulnar artery thrombosis diagnosed and treated?

Updated: Apr 26, 2021
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Thrombosis of the ulnar artery in the Guyon canal can occur as a consequence of direct trauma. Patients with ulnar artery thrombosis at the wrist may present with pain at night or with repetitive activity and cold intolerance. Exquisite tenderness is present at the site of pathology. Eventually, patients may have dependent rubor or ulceration of the ring finger and the tips of the little fingers. Excitation of the sympathetic fibers of the ulnar proper digital nerves frequently is noted. The diagnosis can be confirmed with the Allen test.

In the Allen test, the patient's affected wrist is elevated, and the patient makes a fist for about 30 seconds. The examiner applies pressure over the radial and ulnar arteries; then the patient opens the fist. The hand should appear blanched. The examiner then releases the ulnar artery pressure. The test is positive when blood does not return to the hand or the time to return of blood flow is prolonged.

Arteriography is often helpful before the definitive treatment is decided. The standard treatment for ulnar artery thrombosis is ligation and resection of the thrombosed segment. Reconstruction of the artery with a vein graft is necessary only when backflow from the radial side of the arch is insufficient.

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