Disclosures: Samantha Mastanduno, DO: Nothing to disclose

Case Description: A 42-year-old female secretary presented with acute painful swelling of her wrist and hand numbness. She complained of stabbing pain in her hand for 2 weeks without an inciting event and a painful, palpable cyst on her left forearm for 1 week, associated with numbness/tingling on the dorsum of her left hand and forearm. Pain was worse after prolonged computer use and with twisting motions. On examination, there was a fluid-filled cyst proximal to left ulnar wrist crease. Left digits 3-4 were tender to palpation and digits 3-5 were cool to touch. Allen’s test was positive for ulnar artery occlusion. Ultrasound revealed occlusion of the ulnar artery from the distal forearm to Guyon’s canal. Magnetic resonance angiography revealed occlusion of the distal ulnar artery with aneurysmal expansion indicating hypothenar hammer syndrome. The patient was referred for surgery and underwent ulnar artery excision of aneurysm with vein graft.

Setting: Outpatient clinic

Patient: 42-year-old female secretary

Assessment/Results: Hypothenar hammer syndrome after computer use.

Discussion: Hypothenar hammer syndrome is a rare, limb threatening diagnosis caused by repetitive trauma to the hypothenar eminence resulting in injury to the ulnar artery at the level of Guyon’s canal. This has been described in middle-aged men with occupations such as manual laborers or mechanics and athletes who experience repetitive trauma to the palm such as in mountain biking or baseball. To our knowledge, this syndrome has rarely been seen in a younger female as a result of prolonged computer use. It is important to identify this condition in order to get appropriate treatment in a timely matter. The use of Doppler ultrasound is beneficial to hasten referral to the appropriate specialist.

Conclusion: It is important to consider the diagnosis of hypothenar hammer syndrome when evaluating a patient for wrist pain and numbness in order to prevent serious complications including limb ischemia.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/hypothenar-hammer-syndrome-after-prolonged-computer-use-a-case-report/