Ulnar Artery Thrombosis: A 6-Year Experience

Stephen J. Troum, MD, Waldo E. Floyd III, MD and John Sapp, MD

Disclosures

J South Orthop Assoc. 2001;10(3) 

In This Article

Abstract and Introduction

Abstract

Thrombosis of the ulnar artery can be a cause of significant morbidity. Most often a consequence of blunt trauma to the hypothenar eminence of the hand, it may be attributable to one traumatic event or to repetitive insults. Surgery is often required. We reviewed the presentation and diagnosis of ulnar artery thrombosis and evaluated the effectiveness of treatment by ulnar artery excision with interposition vein grafting. Retrospective chart analysis from 1989 to 1995 at the Medical Center of Central Georgia showed that nine patients (eight male, one female) were treated for ulnar artery thrombosis. Three had associated ulnar artery aneurysms. Eight of the nine were treated with artery excision and interposition vein grafting. Four also received stellate ganglion blocks before surgery. One was treated with stellate ganglion blocks alone. All patients had symptomatic relief and resolution of physical findings. We conclude that ulnar artery thrombosis can be managed with ulnar artery excision and interposition vein grafting when conservative measures fail.

Introduction

Thrombosis of the distal ulnar artery is an uncommon, often unrecognized complication of trauma to the hand. The diagnosis is often missed or delayed. Other names for this disease include hypothenar hammer syndrome, posttraumatic digital ischemia, and pneumatic tool disease. The history usually involves blunt trauma to the hypothenar eminence. Repetitive trauma, such as the use of vibrating power tools or use of the heel of the hand as a hammer, may be the etiology in many cases. The differential diagnosis includes embolic phenomenon, Raynaud's disease, ulnar tunnel syndrome, peripheral vascular disease, hook of the hamate fracture, and myriad connective tissue and autoimmune diseases, including Buerger's disease and scleroderma.

Symptoms of ulnar artery thrombosis range from none at all to debilitating pain and ischemic changes of the fingers. It is this latter group of patients that requires prompt diagnosis and treatment. The lack of awareness of this condition among many physicians and the likelihood that this problem may be underdiagnosed prompted our study.

The purpose and goal of our study was to review the presentation, diagnosis, and treatment of this condition in a hand surgery practice (two surgeons) that provides primary, secondary, and tertiary care of all disorders of the upper extremity. We hypothesized that ulnar artery excision with interposition vein grafting would yield favorable outcomes in cases of ulnar artery thrombosis in which conservative management had failed.

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