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Hypothenar hammer syndrome (HHS) is a vascular occlusion in humans in the region of the ulna. It is caused by repetitive trauma to the hand or wrist (such as that caused by the use of a hammer) [ 2 ] by the vulnerable portion of the ulnar artery as it passes over the hamate bone , which may result in thrombosis , irregularity or aneurysm formation.
In medicine, split hand syndrome is a neurological syndrome in which the hand muscles on the side of the thumb (lateral, thenar eminence) appear wasted, whereas the muscles on the side of the little finger (medial, hypothenar eminence) are spared.
The muscles of hypothenar eminence are from medial to lateral: Opponens digiti minimi; Flexor digiti minimi brevis; Abductor digiti minimi; The intrinsic muscles of hand can be remembered using the mnemonic, "A OF A OF A" for, Abductor pollicis brevis, Opponens pollicis, Flexor pollicis brevis (the three thenar muscles), Adductor pollicis, and the three hypothenar muscles, Opponens digiti ...
The abductor digiti minimi is the most variable hypothenar muscle, [4] and might be joined by accessory slips from the tendon of the flexor carpi ulnaris, the flexor retinaculum, the fascia of the distal forearm, or the tendon of the palmaris longus. Occasionally, the muscle is partially inserted onto the fifth metacarpal bone. [5]
Palmar branch of ulnar nerve - arises from the middle part of the forearm and supplies the skin over the hypothenar eminence. [7] Dorsal branch of ulnar nerve - arises from 7.5 cm above the wrist, winds backwards to supply the skin of the proximal part of the ulnar one and half fingers and the adjoining area between the fingers. [6] [7]
Pregnancy may bring out symptoms in genetically predisposed individuals, which may be caused by the temporary changes in hormones and fluid increase pressure in the carpal tunnel. [46] High progesterone levels and water retention may increase the size of the synovium. Bleeding and swelling from a fracture or dislocation.
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If patients mention reproduction of symptoms to the forearm during elbow flexion of 120–130 degrees with the forearm in maximal supination, then the lesion may be localized to the area underneath the lacertus fibrosus (also known as bicipital aponeurosis). [8] This is sometimes misdiagnosed as elbow strain and medial or lateral epicondylitis. [9]