Occupational Medicine Advance Access originally published online on March 17, 2009
Occupational Medicine 2009 59(3):185-190; doi:10.1093/occmed/kqp040
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Use of Doppler in the diagnosis of hypothenar hammer syndrome
1 Medical Department, Summers Place, Whitbourne, Worcester WR6 5ST, UK
2 Rolls-Royce—Occupational Health, PO Box 31, Derby, Derbyshire DE24 8BJ, UK
Background Hand–arm vibration syndrome (HAVS) includes a spectrum of vascular, neurological and musculoskeletal symptoms resulting from exposure to vibrating tools. Hypothenar hammer syndrome (HHS) is a lesion of the ulnar artery as it courses adjacent to the hamate bone and results from either single or repeated episodes of trauma to the hypothenar eminence. There is a need to distinguish symptoms of HHS from those of classical HAVS since precise diagnosis may alter both the clinical and occupational management of the affected employee.
Aims To highlight the value of simple Doppler assessments of the palmar blood flow to distinguish the condition of HHS from ‘classical’ HAVS.
Method Among patients assessed for HAVS by the authors during 2006, three were identified as potentially having HHS. Doppler ultrasound of the palmar arches with and without ulnar arterial occlusion was used.
Result We report three cases in which Doppler ultrasound assessment supports a diagnosis of HHS.
Conclusions It is our recommendation that such Doppler assessments should form part of the clinical assessment of workers being assessed in connection with exposure to hand-transmitted vibration and in whom symptoms are present that are not typical of ‘classical HAVS’, particularly where there is a history of possible hypothenar trauma.
Keywords Allen's test; Doppler; hand–arm vibration syndrome; hypothenar hammer syndrome; Raynaud's phenomenon
Correspondence to: Ian Lawson, Rolls-Royce—Occupational Health, PO Box 31, Derby, Derbyshire DE24 8BJ, UK. Tel: +44 (0)1332 244298; e-mail: ian.lawson{at}rolls-royce.com